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Flashcards in Oncology Emergencies Deck (16):
1

Three mechanisms for hypercalcemia in malignancy

Bone destruction (multiple myeloma, bony mets)
Paraneoplastic syndrome (pth like substance)
Osteoclast activation (lymphoma, leukaemia)

2

Blood work for hypercalcemia

Calcium, pth, get ECG (shortened QT)

3

4 ER treatments of hypercalcemia
Drugs to avoid

Aggressive iv fluid is mainstain
Bisphosphonates (pamidronate, zolendronate)
Calcitonin for first 48-72 hours until bisphophonates are therapeutic
Lasix as needed for volume overload from fluids
No thiazides, no lithium

4

Which conditions are associated with hyperviscosity syndrome

Waldnenstrom macroglobinemia
Multiple myeloma
Leukaemia with blasts
Polycythemia Vera

(Causes of thrombocytopenia, lymphocytosis, neutrophilia, polycythemia)

5

Clinical presentation hyperviscosity syndrome

Blurred vision
Mucosal bleeding
Neuro (AMS, Headache, dizziness)

6

Treatment of hyperviscosity syndrome

Phlebotomy as temporizing measure (or definitive for polycythemia
Plasmapheresis for dysproteinemias
Leukaphoresis for blast transformation
Chemo

7

Most common sources infection and bugs implicated in febrile neutropenia

Resp, GI, urinary, line infection
Bugs: GP (staph, strep)
GN(uti bugs, pseudomonas)
Consider CMV, herpes
Opportunistic (pjp, fungal)

8

What is typhlitis

Inflammation or necrosis of ileum and cecum in neutropenic patients
High mortality rate 40-50%

9

Management of febrile neutropenia

Hemodynamic support
Broad spectrum iv antibiotics eg piptaz vanco
Source control

10

Which malignancies tend to cause spinal cord compression

Multiple myeloma
Lymphoma
Metastatic cancer (breast, lung, prostate)

11

Presentation of superior vena cava syndrome

Periorbital edema
Conjunctival suffusion
Facial swelling (usually worst in morning)
Dyspnea from tracheal edema
Neuro symptoms (headache, AMS, coma)

12

Imaging modalities for SVC syndrome

Cxr
CT chest
MRI if thoracic or cervical pain to rule out spinal cord compression (Rubin syndrome)

13

Management of SVC syndrome

Oxygen
Elevate head of bed
Vascular stents for CNS involvement

14

What is the morbidity associated with tumor lysis syndrome

Metabolic derangements can lead to cardiac dysrrhythmias
Renal failure

15

What lab tests suggest tumor lysis syndrome

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

16

Treatment of tumor lysis syndrome

Hyperuric acid: iv hydration, allopurinol
Consider alkalizatiln of urine but controversial as can worsen other metabolic issues
Correct hypo cal and hyper k as usual
Consider hemodialysis for refractory lyte disturbances, volume overload, symptomatic hypocalcemia