billies case scenario practice questions (no judging, be kind) Flashcards
a patient presents with low neutrophil counts as a result of bone marrow toxicity due to chemotherapeutic agents. what group of medications would you treat them with? What is the MOA of these medications? what are some medications in this group?
(Neutropenia = filgrastim, pegfilgrastim, sargramostim)
you would treat them with Colony stimulating factors.
MOA - increased production of functionally active neutrophils. Stimulates the production of monocytes, neutrophils and eosinophils.
CFS agents: filgrastim, pegfilgrastim, sargramostim
(and men Never fight penguin sargents )
a patient presents with low neutrophil counts as a result of bone marrow toxicity due to chemotherapeutic agents. What chemotherapeutic agents that you know of cause bone marrow suppression?
Antimetabolites - methotrexate and 5-FU
Mitotic spindle inhibitors - vincristine, vinblastine, paclitaxel.
A patient who is currently undergoing chemotherapy presents with a low RBC count. How would you treat this patient?
depending on how severe they are you could do infusions.
Could also give epogen
a patient presents who is currently undergoing chemotherapy. He states he is having sores in his mouth. What are the medications that he is likely being treated with? How would you treat this side effect?
meds: cytarabine, 5-FU, methotrexate
Treatment: diphenhydramine, lidocaine, Maalox =
“Magic mouthwash” - 1/3 lidocaine, maalox, benadryl
jacob, who is currently being treated with chemotherapy infusions, is now experiencing multiple diarrheal episodes daily. what is the medication most likely to cause his symptoms? how would you treat this side effect
med : 5-FU
Treatment: Loperamide
octreotide/opiate based preps
(flamingos (5-FU) have diarrhea but octopuses (octreotide/opioids) and leopards (loperamide) do not)
a patient who is currently undergoing chemotherapy presents with a history of recurring fevers of above 38’C. He denies any other symptoms. what diagnostic tests would you want to run on this patient? Discuss what these tests are looking for.
Cultures - should be taken from all lumens, skin and line sites, blood, urine, sputum and stool (to assess for site of infection)
CXR - may appear normal because it takes neutrophils to create infiltrates
Labs - CBC w diff, CMP, coagulation panel. (to confirm neutrocytosis and rule out any other differentials I assume)
a patient who is currently undergoing chemotherapy presents with a history of recurring fevers of above 38’C. He denies any other symptoms. You run the basic tests for the differential diagnosis and your assumption is confirmed. What would you treat this patient with?
IV empiric antibiotic therapy! AFTER CULTURE HAS BEEN OBTAINED
ceftazidime, cefepime, or imipenem for antipseudomonal
+
aminoglycoside (micin or mycin) to cover gram - bacteria
+
vancomycin to cover MRSA
a patient who has a history of prostate cancer presents with upper back pain that he rates an 8/10 that began 3 days ago. He reports that the pain radiates around to his chest “like a belt.” The pain is worse with sneezing and lying down and there are no alleviating factors. The pain has been progressively getting worse and he denies any history of trauma.
what is your #1 differential diagnosis and what is causing it.
How do you diagnose and treat this patient
spinal cord compression due to cancer metastasizing to the vertebral bodies resulting in physical damage to the spinal cord.
diagnostic studies - MRI
Treatment -
High dose IV corticosteroids
surgical decompression
radiation
A patient who is currently undergoing chemotherapy for breast carcinoma presents with AMS. Her husband says that for the past week she has had a lot of abdominal pain, nausea and constipation. What labs should you order on this patient to confirm a differential diagnosis? what treatment would you give if it was confirmed?
First of all we think this is hypercalcemia.
Total serum Ca+ (would be elevated)
EKG: short QT, ST depression, AV blocks.
Treatment: (in this order)
Hydration + forced Diuresis
Bisphosphonates
Calcitonin
Hemodialysis
A patient with a history of recently diagnosed Burkitt Lymphoma began radiochemotherapy 2 days ago. She now presents to the ED extremely lethargic with N/V. Her partner reports he believes she had a seizure which prompted him to bring her to the hospital. What tests would you run on this patient? what is the differential diagnosis and treatment plan for that diagnosis?
diff dx: tumor lysis syndrome
Diagnostic studies -
EKG - may show peaked T waves and arrhythmias.
the powerpoint only says EKG but you would probs also get a potassium level, UA, and phosphate level to assess for hyperuricemia, hyperkalemia and hyperphosphatemia.
Treatment - IV hydration and correction of electrolyte abnormalities. May require emergency hemodialysis.
A 7 year old caucasian female with no previous health problems presents with a three day history of a fever and complaints of a stomach ache. her mother reports that she is usually a very active child but for the past couple weeks has been inactive and has not wanted to participate in her favorite activities. upon exam you find petechiae on her lower legs and feet as well as hepatosplenomegaly. What is causing the symptoms that this patient presents with? (dont just give the disease, give what the disease is doing)
Acute Lymphoblastic leukemia (ALL)
This occurs due to chromosomal translocation in a single abnormal lymphoblast which results in increased resistance in cell apoptosis = too many lymphoblasts!!
the lymphoblasts suppress normal hematopoeisis which causes anemia, thrombocytopenia, and neutropenia.
The lymphoblasts also lead to accumulation of lymphoblasts in other organs leading to enlargement which can be seen upon exam as well as abnormal organ function and lab results.
A 7 year old caucasian female with no previous health problems presents with a three day history of a fever and complaints of a stomach ache. her mother reports that she is usually a very active child but for the past couple weeks has been inactive and has not wanted to participate in her favorite activities. upon exam you find petechiae on her lower legs and feet as well as hepatosplenomegaly. what INITIAL diagnostic studies would you order on this patient to confirm your differential diagnosis?
CBC (check for anemia, thrombocytopenia and neutrophilia)
ALL shows:
decreased RBC, platelets and neutrophils
WBC could be normal, high or low.
CMP (check kidney and liver function)
Blood cultures (check for infection)
CXR - r/o pnx as source of infection or mediastinal mass.
CT/MRI Brain w/o contrast - only if neurologic s/s present or leukostasis is suspected.
A 7 year old caucasian female with no previous health problems presents with a three day history of a fever and complaints of a stomach ache. her mother reports that she is usually a very active child but for the past couple weeks has been inactive and has not wanted to participate in her favorite activities. upon exam you find petechiae on her lower legs and feet as well as hepatosplenomegaly. You order initial diagnostic studies and they come back with findings indicative of your differential diagnosis. What additional work up might you order
peripheral smear to confirm CBC findings
LDH (increased indicated tissue destruction)
CT WITH CONTRAST - asses lymphadenopathy and further assess any mediastinal masses.
CSF analysis - to evaluate CNS involvement (if lymphoblasts are in CSF then disease has involved CNS)
Flow Cytometry - expression of CD19 antigens +/- CD10 antigens indicate presence of ALL cells
only definitive study is a bone marrow aspiration and biopsy
A 7 year old caucasian female with no previous health problems presents with a three day history of a fever and complaints of a stomach ache. her mother reports that she is usually a very active child but for the past couple weeks has been inactive and has not wanted to participate in her favorite activities. upon exam you find petechiae on her lower legs and feet as well as hepatosplenomegaly. How would you treat this patient if diagnostic studies confirmed diagnosis?
remeber, take care of “R SIC Patients”
1. Refer to hem/onc
2. screen and treat for active infections in febrile patients
3. Induction Chemotherapy (MD chemo over 4-6 weeks)
4. CNS prophylaxis (intrathecal therapy to prevent reoccurrence)
5. Post remission therapy w/wo stem cell transplantation
A 68 yo caucasian male presents with complaints of a swollen lymph node. On exam he is found to have HSM. CBC shows WBC of 22,000 and decreased RBC and Platelet levels.
