Cancer/Endocrine Flashcards
What are some hematologic changes that occur with cancer?
- Anemia
- Thrombocytopenia
- Neutropenia
- Bone marrow suppression
- GI ulcers
- Reccurrent venous thrombus with pancreatic cancer
What are some musculoskeletal changes that occur with cancer?
- Myofacial pain
- Peripheral neuropathies
What are some musculoskeletal changes that occur with cancer?
- Myofacial pain
- Peripheral neuropathies
- Spinal cord compression
What are some pulmonary changes that can occur with cancer?
-Pulmonary edema, CHF, recurrent pleural effusions, pneumonitis
What changes can occur with squamous cell lung cancer?
-Hypercalcemia
What changes can occur with adenocarcinoma lung cancer?
-Hypercoagable state and osteoarthritis
What changes can occur with large cell carcinoma?
-Gynecomastia
What changes can occur with small cell carcinoma?
- Inappropriate ADH secretion
- Corticotropin secretion
- Eaten-Lambert syndrome (muscle weakness that resembles MG)
What changes can occur with small cell carcinoma?
- Inappropriate ADH secretion
- Corticotropin secretion
- Eaten-Lambert syndrome (muscle weakness that resembles MG)
What are some electrolyte/nutritional/hormone changes that can occur with cancer?
- Hypercalcemia due to bone marrow involvement
- Anorexia, may need hyperalimentation
- K and Na changes with n/v, diarrhea
- Adrenal insufficiency-may need corticosteroids
What are some electrolyte/nutritional/hormone changes that can occur with cancer?
- Hypercalcemia due to bone marrow involvement
- Anorexia, may need hyperalimentation
- K and Na changes with n/v, diarrhea
- Adrenal insufficiency-may need corticosteroids
What are some cardiac changes that can occur with cancer?
- Pericardial involvement can cause electric alternans, paroxysmal a fib or a flutter, pericardial tamponade
- Drug induced cardiomyopathies
- Compression of SVC- dyspnea, airway obstruction, enlarged veins of upper body
What are the cardiotoxic cancer medications and what are some effects they can cause?
- Doxorubicin and Daunorubicin
- ECG chances
- CHF
- Acute or severe and irreversible cardiomyopathies
- Can enhance the myocardial depressant effects of anesthesia and cause acute LV under sedation
What are the cardiotoxic cancer medications and what are some effects they can cause?
- Doxorubicin and Daunorubicin
- ECG chances
- CHF
- Acute or severe and irreversible cardiomyopathies
- Can enhance the myocardial depressant effects of anesthesia and cause acute LV under sedation
What are the pulmonary toxic cancer medications and what are their effects?
Methotrexate:
- Can cause fulminant non-cardiogenic pulmonary edema
- Progressive inflammation with infiltrates and effusions
Bleomycin:
- Can cause endothelial damage/pulmonary fibrosis
- Increased A-a gradient
- Induced hyperoxic pulmonary injury
- Want to avoid high FiO2 and use colloids rather than crystalloids
What are the pulmonary toxic cancer medications and what are their effects?
Methotrexate:
- Can cause fulminant non-cardiogenic pulmonary edema
- Progressive inflammation with infiltrates and effusions
Bleomycin:
- Can cause endothelial damage/pulmonary fibrosis
- Increased A-a gradient
- Induced hyperoxic pulmonary injury
- Want to avoid high FiO2 and use colloids rather than crystalloids
What cancer medication ca be heme toxic and what are its effects?
5-Fluorouacil:
- Immunosuppression
- Leukopenia
- Megoblastic anemia
What cancer medication can be renal toxic and what are its effects?
Cisplatin
- Decreased GFR
- Acute tubular necrosis can progress to acute renal failure and pt may need dialysis
- Treat with hydration and mannitol diuresis
- Can also cause dose dependent damage to dorsal root ganglion-large fiber nueropathies
What cancer drugs can cause encephalopathy?
- Cyclophosphomide (delerium)
- Methotrexate (dementia)
What cancer drugs can cause nueropathies?
Vincristine: peripheral and autonomic neuropathies
Cisplatin: large fiber neuropathies
What cancer drugs can cause nueropathies?
Vincristine: peripheral and autonomic neuropathies
Cisplatin: large fiber neuropathies
What effect can alkylating agents have?
- Inhibits cholinesterases
- Can prolong the effects of succ
What are some side effects of radiation?
- Cardiomyopathy
- Cystitis
- Limited range of motion
- Fibrosis
- Diarrhea
What lab tests would you want for a cancer patient?
- CBC
- PT
- Liver tests
- BUN/Cr
- Electrolytes- Na/K/Ca/Mg
- Blood glucose
- ABGs
- CXR
- ECG
What lab tests would you want for a cancer patient?
- CBC
- PT
- Liver tests
- BUN/Cr
- Electrolytes- Na/K/Ca/Mg
- Blood glucose
- ABGs
- CXR-masses, pulmonary edema, cardiomegaly, tracheal deviation or compression
- ECG
What are some common airway considerations for cancer patients?
- Tracheal deviation or cmpression
- Dysphagia or difficulty breathing (airway obstruction)
- Trach
- Colon obstruction
- One lung ventilation
What are some common airway considerations for cancer patients?
- Tracheal deviation or cmpression
- Dysphagia or difficulty breathing (airway obstruction)
- Trach
- Colon obstruction
- One lung ventilation
What are some clinical manifestations of diabetes?
- Polydypsia
- Polyuria
- Polyphagia
- Weight loss
- Recurrent infections
- Vision changes
- Parasthesias
- Lethargy and fatigue
What are some GU complications associated with diabetes?
- Nephropathy
- Chronic renal failure
What are some GI complications associated with diabetes?
- Gastroparesis
- Nocturnal diarrhea
What are some CNS complications associated with diabetes?
- Strokes
- Peripheral and autonomic neuropathies
What are some CV complications associated with diabetes?
- HTN
- CAD
- Retinopathy
- Cardiomyopathy
What are some miscellaneous complications associated with diabetes?
- Infections
- Stiff joint syndrome
What are some symptoms of autonomic neuropathies?
- Loss of heart rate variability
- Orthostatic hypotension
- Resting tachycardia
- Cardiac dysrhythmias
- Altered regulation of breathing
- Gastroparesis
- Impotence
- Sudden death syndrome
- Peripheral neuropathy
What are some miscellaneous complications associated with diabetes?
- Infections
- Stiff joint syndrome- temperomandibular, antlantooccipital, and other c spine joints may be affected
What are some symptoms of autonomic neuropathies?
- Loss of heart rate variability
- Orthostatic hypotension
- Resting tachycardia
- Cardiac dysrhythmias
- Altered regulation of breathing
- Gastroparesis
- Impotence
- Sudden death syndrome
- Peripheral neuropathy
How can diabetes affect the airway assessment?
- 30-40% of Type 1 diabetics can have stiff joint syndrome
- Can have difficult laryngoscopy due to limited atlanto-occipital and laryngeal mobility
- Prayer sign
- 15% association of Type 1 diabetes and autoimmune diseases such as hashimoto thyroiditis and graves disease-assess thyroid gland size
What are the signs of DKA?
- Nausea
- Vomiting
- Lethargy
- Signs of dehydration
- Abdominal pain
- Fruity breath
- Kussmaul’s respirations
- Coma
What are the s/s of a pheochromocytoma?
- Hypertension
- Epigastric pain
- Chest pain
- headache
- Pallor
- Sweating
- Palpitations
- Painless hematuria (rare)
- Flushing (rare)
- Tremor
What are the s/s of a pheochromocytoma?
- Hypertension
- Epigastric pain
- Chest pain
- headache
- Pallor
- Sweating
- Palpitations
- Painless hematuria (rare)
- Flushing (rare)
- Tremor
What are the s/s of Conn’s disease
- Hypertension that may be resistant to treatment
- Hypokalemia-can cause skeletal muscle cramps and weakness, polyuria
What is the hallmark of hyperparathyroidism?
- Hypercalcemia
- Serum calcium of higher than 5.5 mEq/L and ionized calcium greater than 2.5 mEq/L
- If calcium is greater than 7/5 most likely cancer
