Oncologic Emergencies Flashcards Preview

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Flashcards in Oncologic Emergencies Deck (45):
1

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

need to be treated immediately

2

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

need to be treated same day

3

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

need to be treated same day or the next day

4

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

spinal cord compression

5

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

motor/sensory dysfxn

6

Imaging needed for cord compression

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

7

Medication that can be helpful for cord compression, brain metastases

Decadron

8

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

brain metastases

9

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

brain metastases

10

Pharmacological therapy for brain metastases

decadron to reduce edema and dilantin if seizure suspected

11

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

hyperviscosity/leukostasis

12

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

hyperviscosity

13

Tx for hyperviscosity

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

14

Most commonly in AML

leukostasis (blast crisis)

15

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

leukostasis (blast crisis)

16

Cancers that commonly cause cardiac tamponade

lung and breast cancers

17

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

cardiac tamponade

18

Surgical therapy for cardiac tamponade

subxiphoid pericardial window or balloon pericardiotomy

19

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

Beck's triad

20

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

pulsus paradoxus

21

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

SVC syndrome

22

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

Pancoast tumor

23

Tx for SVC

radiatin of tumor, heparin or corticosteroids.

24

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

tumor lysis syndrome

25

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

tumor lysis syndrome

26

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

hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

27

Metabolic levels that kill

high K+ and low Ca++

28

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

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

29

Cancers most commonly associated with hypercalcemia

breast, lung, multiple myeloma

30

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

hypercalcemia

31

Why are patients volume depleted with hypercalcemia?

due to calcium-induced renal tubular defects

32

Tx of hypercalcemia

volume repletion, furosemide, IV pamidronate (Aredia)

33

Predicts short survival

hypercalcemia

34

Cancer that commonly causes SIADH

small cell lung cancer

35

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

SIADH

36

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

SIADH

37

Tx for SIADH

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

38

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

neutropenic fever

39

When does most neutorpenia occur?

10-15 days after chemotherapy is given

40

Antibiotic tx for neutropenic fever without a suspected source

Cefipime, Moxifloxacin, Pip/Gent, Aztreonam

41

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

thrombocytopenia

42

Tx for thrombocytopenia

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

43

Tx for overanticoagulation due to warfarin

2 units FFP and 5 mg IV vitamin K

44

Tx for overanticoagulation due to heparin or LMWH

protamine sulfate

45

Tx for overanticoagulation due to fondaparinux (Arixtra)

Factor VII