Oncologic Emergencies Flashcards Preview

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Flashcards in Oncologic Emergencies Deck (45)
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1
Q

What do the following have in common: Neutropenic fever, tamponade, cord compression, CNS metastases with symptoms?

A

need to be treated immediately

2
Q

What do the following have in common: coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9?

A

need to be treated same day

3
Q

What do the following have in common: SVC Syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9?

A

need to be treated same day or the next day

4
Q

Presents as back pain, inflammation, and paresthesias. Usually occurs in diseases with vertebral body mets, not hematogenous dural mets

A

spinal cord compression

5
Q

What comes first in cord compression, autonomic dysfxn or motor/sensory?

A

motor/sensory dysfxn

6
Q

Imaging needed for cord compression

A

MRI / CT [+/- myelogram] of the WHOLE spine

7
Q

Medication that can be helpful for cord compression, brain metastases

A

Decadron

8
Q

Presentation includes: headache, seizures, altered mental status, or focal deficits

A

brain metastases

9
Q

Most commonly from lung or breast cancer if no prior known primary

A

brain metastases

10
Q

Pharmacological therapy for brain metastases

A

decadron to reduce edema and dilantin if seizure suspected

11
Q

Presentation includes nonspecific sx’s: somnolence, headache, blurry vision, dizziness

A

hyperviscosity/leukostasis

12
Q

commonly occurs with Waldenstrom’s. less commonly with multiple myeloma or polycythemia Vera, essential thrombocytosis

A

hyperviscosity

13
Q

Tx for hyperviscosity

A

hydration, apheresis for IgM, plus chemotherapy. Hydroxyurea/aspirin for ET

14
Q

Most commonly in AML

A

leukostasis (blast crisis)

15
Q

Sx include altered mental status, coma common, but other organs also involved.
Hypoxia, renal insufficiency

A

leukostasis (blast crisis)

16
Q

Cancers that commonly cause cardiac tamponade

A

lung and breast cancers

17
Q

Presentation includes left or right sided failure, pulsus paradoxus, big heart on CXR

A

cardiac tamponade

18
Q

Surgical therapy for cardiac tamponade

A

subxiphoid pericardial window or balloon pericardiotomy

19
Q

collection of three medical signs associated with acute cardiac tamponade. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds

A

Beck’s triad

20
Q

abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

A

pulsus paradoxus

21
Q

Usually from bronchogenic carcinomas. Presents with facial edema, symmetric or asymmetric upper extremity edema, SOB common, but not hypoxic

A

SVC syndrome

22
Q

Tumor of pulmonary apex. Presents with progressively enlarging veins over the anterior chest wall

A

Pancoast tumor

23
Q

Tx for SVC

A

radiatin of tumor, heparin or corticosteroids.

24
Q

Occurs in tumors with high body burden and high chemosensitivity. Usually high-grade lymphomas or leukemias (Burkitt’s, ALL)

A

tumor lysis syndrome

25
Q

Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure

A

tumor lysis syndrome

26
Q

Metabolic abnormalities associated with tumor lysis syndrome due to rapid turnover of tumor cells

A

hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

27
Q

Metabolic levels that kill

A

high K+ and low Ca++

28
Q

What should you do if phosphate level is greater than 7?

A

switch NaHCO3 to NS to prevent Ca-PO4 deposits in kidney

29
Q

Cancers most commonly associated with hypercalcemia

A

breast, lung, multiple myeloma

30
Q

Presentation includes: Fatigue, N/V, constipation, anorexia, apathy, decreased consciousness most common

A

hypercalcemia

31
Q

Why are patients volume depleted with hypercalcemia?

A

due to calcium-induced renal tubular defects

32
Q

Tx of hypercalcemia

A

volume repletion, furosemide, IV pamidronate (Aredia)

33
Q

Predicts short survival

A

hypercalcemia

34
Q

Cancer that commonly causes SIADH

A

small cell lung cancer

35
Q

Labs include decreased BUN/serum osmolarity and increased urine osmolarity and sodium levels

A

SIADH

36
Q

Presentation includes: anorexia, irritability, N/V, constipation, muscle weakness, myalgia, abnormal reflexes, papilledema

A

SIADH

37
Q

Tx for SIADH

A

limit fluid intake to 500-1000ml/day, furosemide, Na+ replacement if neuro sx

38
Q

May initially be very subtle, then rapid development of hypotension, dyspnea, sepsis

A

neutropenic fever

39
Q

When does most neutorpenia occur?

A

10-15 days after chemotherapy is given

40
Q

Antibiotic tx for neutropenic fever without a suspected source

A

Cefipime, Moxifloxacin, Pip/Gent, Aztreonam

41
Q

Sx include: Mucosal bleeding most common epistaxis, gingival bleeding, bullous hemorrhages. Cutaneous bleeding, petechiae, ecchymoses, Menorrhagia

A

thrombocytopenia

42
Q

Tx for thrombocytopenia

A

Prednisone if patient is well. IV-IG if patient ill

43
Q

Tx for overanticoagulation due to warfarin

A

2 units FFP and 5 mg IV vitamin K

44
Q

Tx for overanticoagulation due to heparin or LMWH

A

protamine sulfate

45
Q

Tx for overanticoagulation due to fondaparinux (Arixtra)

A

Factor VII