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Year 4 exams > OSCE emergencies (Cancer care) > Flashcards

OSCE emergencies (Cancer care) Flashcards

(42 cards)

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1
Q

Presentation of bowel obstruction

A
  • Stomach pain- colicky
  • Constipation
  • Vomiting Occurs early in upper GI obstruction and later in lower GI
  • Abdominal distension
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2
Q

investigations for bowel obstruction

A
  • Abdominal X ray
    o Central- upper
    o Peripheral- lower
  • CT scan (best)
  • Barium enema
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3
Q

management of BO

A

depends on stage and what is appropriate

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4
Q

management of BO

A

Supportive
- NG decompression/ venting gastrostomy (PEG)
- IV fluids to prevent rehydration
- Buscipan- stop muscle spasms and reduce pain
- Strong painkillers
- IV antibiotics
- Antiemetics
- Octreotide
o Reduces fluid that building up in GI tract
- Steroids to reduce inflammation in bowel

Surgery
Tends to be palliative to relieve pain
- Resection of damaged bowel-> stoma
- Stent insertion

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5
Q

superior vena cava obstruction presentation

A

can be due to a tumour pressing on SVC -> stops blood draining from bveins in the brain to the heart

  • Tachycardia, tachypnoea, hypotension
  • Swollen, red face
  • Neck and shoulder swollen
  • Jugular venous distension
  • Pemberton sign
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6
Q

Pemberton sign

A
  • Ask patient to raise both arms above head
  • Normal: nothing
  • SVC syndrome: facial and neck swelling, cough, SoB, cyanosis
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7
Q

investigation for SVCO

A

CT scan with contrast

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8
Q

Management of SVCO

A

Mild

  • Head elevation and diuretics
  • Endovenous stents

Palliative care

  • Cryotherapy
  • Diathermy
  • Bronchial stents for central airway
  • Endobronchial radiotherapy
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9
Q

hypercalcaemia causes in cancer

A

Humoral cause -80%

  • Chemical agents released by tumour disrupt normal calcium homeostasis e.g. PTH-related protein released by certain cancers
  • E.g. paraneoplastic feature of lung cancer – SCC
  • Causes increased release of calcium from bone and increase uptake from kidneys

Bone invasion

  • Osteolytic metastases with local release of cytokines -> increased bone reportion and therefore calcium release from bone into blood

Tumour calcitriol release- Hodgkins lymphoma

Immunotherapies and hormonal therapy

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10
Q

hypercalcaemia presentation

A

Bones, moans, groans, stones, psychiatric overtones
- Nausea
- Anorexia
- Thirst
- Constipation
- Kidney stones
- Confusion
- Polydipsia and polyuria
- Fatigue and weakness
- Bone bane

Neurological
- Seizures
- Poor coordination
- Change in personality

Cardiac
- Bradycardia
- HTN
- Shortened QT interval

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11
Q

investigations for hypercalcaemia

A

Bedside
- Neurological examination
- Urinalysis
- ECG

Laboratory
- Bloods: PTH, blood calcium, UEs

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12
Q

management of hypercalcaemia

A
  • Rehydration (24 hours of normal saline)
  • Steroids
  • Bisphosphonates (inhibit osteoclasts)
  • Systemic treatment of malignant
  • Dialysis if kidney failure

Refractory

  • Denosumab
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13
Q

VTE background and cancer

A
  • Hypercoagulable state is a hallmark of cancer
  • Increased risk 2-3X the normal population
  • Complicated managing risk of thrombocytopenic bleeding and risk of clots

Pathophysiology
- Hypercoagulable state induced by specific prothrombotic properties of cancer cells that activate blood clotting

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14
Q

DVT presentation

A
  • Redness
  • Tenderness
  • Swelling
  • Pitting oedema
  • Collateral superficial veins
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15
Q

PE presentation

A
  • SoB
  • Pleuritic chest pain
  • Cough
  • Tachycardia
  • Cyanosis
  • Dizziness and fainting
  • Sweating
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16
Q

investigations for DVT/ PE in cancer patients

A
  • D-dimer raised in cancer so not used as a predictor
  • DVT- US
  • PE- CTPA

(wells score??)

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17
Q

Management of DVT/PE

Study These Flashcards
A

DOACS

  • Apixaban
  • Dabigatran
  • Edoxaban
  • Rivaroxaban

LMWH

  • Dalteparin
  • Enoxaparin
18
Q

Reducing risk of blood clots whilst in hospital

Study These Flashcards
A
  • Anticoagulants
  • Antiembolic stockings
  • Compression devices
  • Keeping moving
  • Stopping COCB or HRT
  • Keeping hydrated
19
Q

status epilepticus definition

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A

It is defined as a seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness in the interim.

20
Q

management of status epilepticus

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A

1) Start timer
2) After 5 mins give
- Lorazepam IV or if in community midazolam buccally/rectally
3) After 10 mins
- Lorazepam IV
- Prepare second line medication
4) At 15 mins
- Phenytoin or Phenobarbital
5) At 20 mins
- Intubate or administer further alternatives to the second line drugs (Levetiracetam, phenytoin, phenobarbital)
6) If this doesnt work
- Rapid sequence induction of anaesthesia using thiopental sodium

21
Q

metastatic spinal cord compression presentation

Study These Flashcards
A

THINK: prostate, lung, breast cancers

A key feature is back pain that is worse on coughing or straining.

Back pain

  • Often for 2-3 months
  • Poorly responsive to analgesia
  • Radiation around chest- band like
  • Radicular
    o Exacerbated by neck flexion, SLR, coughing, sneezing, straining
  • Pain at night/ wakes up

Motor symptoms (upper motor neuronee signs)

  • Affects >75%,
  • Reduced power, difficulty standing, walking, climbing stairs, often symmetrical
  • increased tone, clonus, hyperreflexia

Sensory loss

  • Affects >50%, but may be unaware until examined

Sphincter dysfunction
- Urinary retention with overflow
- Diminishing performance status/generally unwell

22
Q

commonest site of metastatic spinal cord compression

Study These Flashcards
A

thoracic vertebrae

lumbar for spinal cord compression

23
Q

investigations for MSCC

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A

oncological emergency and requires rapid imaging and management.
- MRI of whole spine
- Blood tests: group and save, clotting (high risk of surgery being required)

24
Q

referral with signs of MSCC

Study These Flashcards
A
  • Pain suggestive of spinal mets – MRI within1 weeks
  • Signs MSCC, MRI within 24 hours
25
management of MSCC
Treatments will depend on individual factors. They may include: **Admit and treat within 24 hours** * High dose dexamethasone (to reduce swelling in the tumour and relieve compression) * Analgesia * Surgery * Radiotherapy * Chemotherapy
26
Radiotherapy and MSCC
- Majority receive this (due to extensive disease and poor performance status when MSCC occurs) - Delivered within 24 hours - MOA o Targets abnormal area plus 1-2 vertebra either side - Aim o Relieve compression of the spine and nerve roots by causing cell death in the rapidly dividing tumour tissue o Relives pain and stabilises neurological deficit - Life expectancy often measured in months
27
cauda equina
- Caused by compression of the spinal cord - Below L2 - Peripheral nerves (LMN), containing motor and sensory fibres - High level of suspicion and rapid intervention required
28
Presentation of cauda equina syndrome
Lower motor neurone signs - Reduced lower limb sensation (often bilateral) - Hyporeflexia - Bladder or bowel dysfunction o Perianal (saddle) numbness o Loss of anal tone o Urinary retention - Lower limb motor weakness - Severe back pain - Impotence
29
investigations for cauda quina syndrome
Investigations - PR examination - Post-void bladder scan - Lumbar-sacral spine MRI
30
cauda equina mangement
Management - Surgical decompression - Radiotherapy and/or chemotherapy
31
neutropenic sepsis definition
- Patient undergoing systemic anticancer treatment (SACT) - Temp >38 or over 37.5 degrees over 1 hour - Neutrophil count **< 0.5 x 10 9**per litre or <1.0 and falling - Patient can have infection and no fever
32
Presentation neutropenic sepsis
- Fever >38 or over 37.5 degrees over 1 hour - Tachycardia >90 - HYPOTENSION < 90 systolic= URGENT - RR > 20 - Symptoms related to a specific system e.g. cough, SOB, line, mucositis - Drowsy - Confused
33
investigations for neutropenic sepsis
**Bedside** - Basic observations **Laboratory** Blood tests - FBC (with differential) - U&Es - LFTs - ABG (lactate) - CRP Cultures/swabs - Blood – central and peripheral - Urine - Sputum - Wound swabs **Imaging** CXR
34
management of neutropenic sepsis
Call for senior help - Empiric IV broad spectrum antibiotics within the hour: **Piperacillin with tazobactam (tazocin)** - Fluid resuscitation - Oxygen - Consider catheterisation
35
Prophylaxis for neutropenic sepsis
- A neutrophil count of < 0.5 x 109 as a consequence of their treatment they should be offered a fluoroquinolone - All patients should be issued with an alert card with 24gr contact numbers
36
tumour lysis syndrome background
triggered by the initiation of cytotoxic therapy- metabolic emergency
37
key biochemical markers of tumour lysis syndrome
Massive tumour cell lysis -> release of large amounts of potassium, phosphate and uric acid into the systemic circulation - Hyperuricemia - Hyperkalaemia - Hyperphosphatemia - Hypocalcaemia AKI from uric acid and/or calcium phosphate crystals in renal tubules
38
highest risk cancers for tumour lysis syndrome
o High grade lymphoma o Leukaemia o Myeloma
39
TLS presentation
Presentation - Normally day 3-7 post chemotherapy - N and V - Diarrhoea - Anorexia - Lethargy - Haematuria-> oliguria -> anuric - Fluid overload - Cardiac arrhythmia/arrest (peaked T waves, QTc derangement) - Muscle cramps/ tetany/ seizures
40
management of tumour lysis syndrome
- Vigrourous rehydration (fluid resus: 500ml normal saline over 15 mins) - Rasburicase to lower uric acid levels - Calcium gluconate for hyperkalaemia Allopurinal to prevent i.e. give to patients at risk
41
investigations for tumour lysis syndrome
**Bedside** - Urine dip - ECG - Cardiac monitoring **Laboratory** Urine microscopy (e.g. uric acid crystals) Bloods - Serum lactate - Lactate dehydrogenase (LDH) Diagosis: diagnosis of TLS is based on the Cairo-Bishop definition.
42
complication of TLS
deposition of uric acid and calcium phosphate crystals in the **renal tubules may cause acute renal failure** which is often exacerbated by concomitant intravascular volume depletion. These products are normally renally excreted - therefore preexisting renal failure exacerbates the metabolic derangements of tumor lysis syndrome

Year 4 exams (21 decks)

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