Oncological emergencies I

Question 1

what is the cause of superficial thoracic varicosities?

Answer 1

venous blockage

Question 2

what is SVC syndrome?

Answer 2

any condition benign or malignant that is caused by obstruction of blood flow through to the SVC

Question 3

the SVC accounts for what % of venous return to the heart?

Answer 3

33%

Question 4

when the SVC is obstructed, how does blood flow back to the heart?

Answer 4

venous collateral networks and via IVC or azygous system

Question 5

what are the signs and symptoms of SVC symptoms that represent true oncological emergencies?

Answer 5

1. edema of larynx and brain

2. confusion, coma

Question 6

what is the etiology of SVC syndrome?

Answer 6

1. malignancy - 70%
2. benign - SVC stenosis and/or thrombosis due to intravascular devices
3. fibrosing mediastinitis - histoplasma capsulatum

Question 7

what is the most common malignancy causing SVC syndrome?

Answer 7

lung cancer

Question 8

what is the diagnostic test of choice for SVC syndrome?

Answer 8

contrast enhanced CT with multiplanar reformation (to outline vasculature)

Question 9

what is the course of action if thrombosis from an indwelling central venous device is suspected in SVC syndrome?

Answer 9

catheter based venography

Question 10

what are the treatments for SVC

Answer 10

1. alleviate symptoms - early stenting

2. treat underlying disease (radiation, chemo)

Question 11

what is the treatment of choice for SVC syndrome?

Answer 11

endovascular stenting

Question 12

the success of endovascular stenting depends on what factors?

Answer 12

tumor type and anticipated response

severity of symptoms

Question 13

what is the temperature for a patient with neutropenic fever?

Answer 13

single - over 38.3 oral

sustained temp for over an hour over 38

Question 14

in which case will a patient with neutropenic fever not show a fever?

Answer 14

glucocorticoid

Question 15

what is the absolute neutrophil count in a patient with neutropenic fever?

Answer 15

less than 500 cells / microliter

Question 16

what are the neutropenic fever syndromes?

Answer 16

1. microbiologically documented infection
2. clinically documented infection
3. unexplained fever

Question 17

definition: microbiologically documented infection

Answer 17

neutropenic fever with a clinical focus of infection AND an associated pathogen

Question 18

definition: clinically documented infection

Answer 18

neutropenic fever with a clinical focus but without isolation of an associatedpathogen

Question 19

neutropenic fever is usually induced by what cause?

Answer 19

cytotoxic antineoplastic therapy sufficient to suppress myelopoiesis and affect integrity of GI mucosa allowing translocation of bacteria and fungi across intestinal mucosal surfaces

Question 20

what is the immediate treatment for neutropenic fever?

Answer 20

empiric antibiotics

Question 21

what lab studies should be performed for neutropenic fever?

Answer 21

CBC with differential
LFTs
CMP cultures

Question 22

what radiological test should be performed for neutropenic fever?

Answer 22

CXR

Question 23

what are the three main causes of neutropenic fever?

Answer 23

1. direct effect of chemo - majority
2. obstruction of lymph, bile, GI, urinary
3. breech in host defense

Question 24

an infection source is found in what % of patients with neutropenic fever?

Answer 24

20-30%

Question 25

80% of documented infections in neutropenic fever are believed to arise from what source?

Answer 25

endogenous gut flora

Question 26

endogenous gut flora are implicated in what % of neutropenic fever cases?

Answer 26

80%

Question 27

risk of infection in a neutropenic fever patient is usually related to what factors?

Answer 27

1. disruption of skin and mucosal membrane barriers 2. immunological impairment 3. virulence of pathogen 4. severity of neutropenia

Question 28

which types of microbes are implicated in neutropenic fever?

Answer 28

gram positive gram negative fungal viral

Question 29

which fungal species of account for most of the cases of neutropenic fever?

Answer 29

candida and aspergillus

Question 30

which fungal species is the most common cause of central venous catheter-associated infection?

Answer 30

candida

Question 31

what is the most common viral cause of neutropenic fever?

Answer 31

herpes viruses

Question 32

when should antibiotics be given to a patient with neutropenic fever?

Answer 32

immediately after blood cultures are drawn but before other investigations are completed WITHIN 60 MINUTES OF PRESENTATION

Question 33

what is variable pulse strength with respiration?

Answer 33

pulsus paradoxus

Question 34

malignant pericardial disease is most commonly associated with what causes?

Answer 34

``` lung cancer breast cancer leukemia lymphoma previous chemo or radiation ```

Question 35

what is the diagnostic test of choice for pericardial tamponade?

Answer 35

echocardiogram

Question 36

the severity of pericardial tamponade symptoms depend on what main factor?

Answer 36

how rapid the accumulation of fluid occurs

Question 37

what is the minimum amount of fluid that can cause tamponade?

Answer 37

200 mL

Question 38

what are the signs and symptoms of cardiac tamponade?

Answer 38

cough, chest pain, SOB, weakenss tachycardia, neck vein distension, peripheral edema, diminished heart sounds

Question 39

what is the treatment for cardiac tamponade?

Answer 39

drainage via ``` pericardiocentesis - treatment of choice pericardial window (surgery) - for recurrence ```