Oncology Emergencies Flashcards Preview

Y4 Oncology > Oncology Emergencies > Flashcards

Flashcards in Oncology Emergencies Deck (27)
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1
Q

What are the four main oncology emergencies?

A

superior vena cava obstruction
neutropenic sepsis
spinal cord compression
hypercalcaemia

2
Q

what is the difference between neutropenic sepsis and neutropenic fever?

A

there is no haemodynamic compromise in neutropenic fever

3
Q

what bacteria most commonly causes neutropenic sepsis?

A

endogenous flora

4
Q

is most of endogenous flora that causes neutropenic sepsis gram + or -?

A

gram - bacilli

5
Q

what three things are required to make a diagnosis of neutropenic sepsis ?

A

fever
neutrophils <1x10^9
haemodynamic compromise (hypotension, tachycardia)

6
Q

what investigations should be done for netropenic sepsis ?

A
FBC, blood cultures, coagulation screen
CRP, U&amp;Es 
MSSU, stool culture 
sputum culture, throat swab 
CXR
7
Q

what is the treatment for neutropenic sepsis?

A

IV fluids
O2
broad spectrum Abs (pipercilliin, tazobactam, gentamicin)

8
Q

what are some causes of superior vena cava obstruction ?

A
bronchogenic tumour 
lymphoma
metastatic tumours 
SVC thrombosis 
mediastinal fibrosis (from RT/chemo)
9
Q

what is the presentation of neutropenic sepsis ?

A

hypotension, tachycardia
asymptomatic
fever

10
Q

what is the presentation of SVC obstruction?

A
headache
dyspnoea
plethora 
swollen arms/face
engorged neck veins
11
Q

what investigations should be done for SVC obstuction?

A

CXR, CT
superior venocavogram
bronchoscopy

12
Q

what is pembertons sign?

A

arms raised above head for >1min

  • facial plethora
  • increased JVP
  • inspiratory stridor
13
Q

what causes pembertons sign?

A

narrowing of thoracic inlet

14
Q

what is the management of SVC obstruction ?

A
steroids 
RT/chemo 
stenting 
thrombolysis 
anticoagulation
15
Q

what two things need to be considered before giving steroids ?

A

monitor glucose

give gastric protection

16
Q

what locations of cancer commonly spread to bone?

A
breast 
lung 
prostate 
myeloma
renal
17
Q

what investigations should be done for spinal cord compression?

A

whole spine MRI

check Ca

18
Q

what symptoms does spinal cord compression have?

A
back pain/tenderness (usually the first sign - try and catch early) 
weakness 
UMN pattern (hyporeflexia/tonia, brisk reflexes) 
bladder and bowel dysfunction 
radicular pain along dermatome (worse when coughing and sneezing)
19
Q

what can occur if the spinal cord compression is above T6?

A

spinal shock can occur

- sympathetic response disruption causing vasodilation and hypotension

20
Q

what is the treatment for spinal cord compression?

A
lie flat 
steroids 
RT 
surgery (laminectomy)
chemo
21
Q

what are the main causes of hypercalaemia ?

A

bony mets

paraneoplastic syndrome

22
Q

what investigations should be done for hypercalaemia ?

A

Ca, PTH, CXR, isotope bone scan

23
Q

state some signs of hypercalcaemia ?

A

stones, bones, groans, moans

renal stones, polyuria, polydipsia
pathological fractures
fatigue, abdo pain, constipation
depression, confusion

24
Q

what is the treatment for hypercalcaemia ?

A

rehydrate (0.9% saline)
diuretics to increase fluid intake
bisphosphonates (give PPI)

25
Q

what prophylaxis is used for neutropenic sepsis ?

A

co-trimoxazole

26
Q

what is a complication of tumour lysis syndrome ?

A

renal failure

27
Q

what are the levels of K, urate, PO4 and Ca in tumour lysis syndrome ?

A

↑K, ↑urate, ↑PO4, ↓Ca

􏰀 → renal failure