Flashcards in OSCE Prep Deck (14):
How do you recognise neutropenic sepsis?
Anyone with a neutrophil count of < 0.5x10^9 per litre.
Who also has a temperature of higher than 38*C, OR any signs/symptoms of sepsis.
Who has known immunodeficiency or has had chemo within 6 weeks.
Treatment for neutropenic sepsis:
ABX TREATMENT: TAZOCIN w/i 60 minutes
15 L/min of O2 via non-rebreathe
Contact acute oncology team!
Signs of (neutropenic) sepsis:
Fever / hypothermia
Poor perfusion (cyanosis, cold, clammy, mottled appearance)
Reduced urine output
What does a neutrophil count of less than 0.1 suggest?
Bacteraemia: bacterial infection of blood
How soon do you give antibiotics in suspected neutropenic sepsis?
Immediately AFTER blood cultures are taken
(Unless there is likely to be any delay in getting blood cultures)
Certainly no later than 1 hour after they present.
Further investigations after acute management of neutropenic sepsis
CT chest to check for fungal infection of lungs.
What is MSCC
Malignant spinal cord compression.
Spinal metastases pressing on the spinal cord.
What types of cancers are most likely to spread to bone?
Prostate, breast, lung.
Symptoms of MSCC
Bladder or bowel dysfunction
Numbness / parasthesia
Weakness or paralysis
Loss of tone
Cauda equina syndrome:
- saddle anaesthesia
- bladder retention
- leg weakness
Investigations for MSCC
CT-guided tumour biopsy and histopathology
What is the probability of cancer patients developing hypercalcaemia?
What does it mean for the patient if they develop hypercalcaemia?
40% of patients with myeloma.
Poor prognostic sign: 75% mortality within 3 months.
What causes raised calcium in cancer patients?
Parathyroid hormone-related protein produced by the tumour.
Local osteolysis (in myeloma)
Symptoms of malignancy-associated hypercalcaemia