Oncology

Question 1

Which type of spine tumors are most common?

Answer 1

Metastatic (95%), 50% are from breast, lung, or prostate cancers.
Thoracic spine is MC affected (70%)

Question 2

While evaluating back pain, what would raise your concern of spinal cord compression due to tumors?

Answer 2

Pain worsens when the pt is lying down or w/ vertebral body percussion.
Incontinence and loss of sensory function with late neurologic deficits.
Positive Valsalva, Babinski
DTR’s increased

Question 3

What subset of cord compression cases has diminished DTR’s, retention, constipation, lower limb flaccidity, and sensory loss of leg and perianal region?

Answer 3

Cauda equina syndrome

Question 4

What type of imaging should be used for suspected spinal tumors?

Answer 4

MRI or CT
Lumbar puncture may be necessary
X-rays may reveal lytic changes, but may miss lesions.

Question 5

What is the treatment for spinal cord compression tumors?

Answer 5

IV steroids and possibly radiation or surgery

Question 6

For what condition might Gamma-knife radiosurgery be indicated?

Answer 6

Brain tumors

Question 7

What is Superior Vena Cava Syndrome (SVCS) [obstruction] usually caused by?

Answer 7

Malignancies

Question 8

What malignancy is the MC cause of SVCS?

Answer 8

Bronchogenic carcinoma

can also be caused by thrombosis around an indwelling catheter, or uncommonly a cerebral edema

Question 9

What are the MC symptoms of SVCS?

Answer 9

SOB
Facial or arm swelling
Headache
Edema of the face

Question 10

What is Trousseau’s sign of malignancy?

Answer 10

Episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time.

Question 11

What sign is specific for SVCS?

Answer 11

Pemberton’s sign
(Development of facial flushing, distended neck and head superficial veins, inspiratory stridor and elevation of the jugular venous pressure (JVP) upon raising both of the patient’s arms above his/her head simultaneously)

Question 12

What are the items of Beck’s triad and what condition does it indicate?

Answer 12

Hypotension
JVD
Muffled heart sounds;
Indicates cardiac tamponade

Question 13

What ECG finding is seen with cardiac tamponade?

Answer 13

Electrical alternans and low voltage of T waves

Question 14

What is one of the MC complications related to cancer treatment, particularly chemotherapy?

Answer 14

Febrile neutropenia

Question 15

What defines febrile neutropenia?

Answer 15

Temp 101F or higher

ANC less than 500 per mm3

Question 16

Hypercalcemia caused by bone lysis and resorption is MC due to what?

Answer 16

Metastatic breast or prostate cancer

Question 17

Hypercalcemia due to cytokine production is MC due to what?

Answer 17

Multiple Myeloma

Question 18

What is the normal range of serum calcium?

Answer 18

9-10.5 mg/dL

Question 19

What can be produced by a variety of different tumor cells and is MC associated with cancer of the lung, breast, and kidney?

Answer 19

Parathyroid hormone related protein (PTHrP)

Question 20

What is the prognosis for hypercalcemia of malignancy?

Answer 20

Grave (1 to 2 months)

Question 21

How do you treat hypercalcemia?

Answer 21

Saline for dehydration
IV Lasix for Ca excretion
Bisphosphonates

Question 22

What MC causes SIADH?

Answer 22

Small cell carcinoma of the lung

Question 23

What lab finding is a hallmark of SIADH?

Answer 23

Hyponatremia

Question 24

Tx for SIADH?

Answer 24

Fluid intake restriction
Demeclocycline (ADH antagonist)
Tx cancer

Question 25

What is a major risk factor for tumor lysis syndrome?

Answer 25

Pre-existing renal dysfunction

Question 26

Who might experience tumor lysis syndrome?

Answer 26

Cancer pts w/ large tumor burden that is very sensitive to chemotherapy

Question 27

What is Homan’s sign?

Answer 27

Discomfort in the calf or behind the knee on dorsiflexion of the foot

Question 28

What are the SSX of pulmonary embolism?

Answer 28

SOB
Chest pain - pleuritic
Apprehension
Tachypnea/tachycardia

Question 29

What are the SSX of hypercalcemia?

Answer 29

Stones (renal or biliary), bones (bone pain), groans
(abdominal pain, nausea and vomiting),
thrones (constipation and polyuria) and
psychiatric overtones (depression 30-40%,
anxiety, cognitive dysfunction, coma).