complications

Question 1

test in SVCO

Answer 1

pembertons (lift arms up, facial congestion after one minute?)

Question 2

most common presentation of SVCO

Answer 2

acute onset dyspnoea
(other presentation - dizziness, headache, facial plethora and distended veins)

Question 3

Mx of SVCO

Answer 3

A-E
-keep head elevated 30 degrees, lose clothing
-dex 16mg
-endovascular stenting
-may give morphine to reduce respiratory distress

Question 4

complications of SVCO

Answer 4

upper airway obstruction and stent thrombosis

Question 5

most common lung cancer to cause SVCO

Answer 5

SCLC (as this is normally central and around the big vessels)

Question 6

what signs do you get on an ECG from hypercalcaemia

Answer 6

shortened QT, heart block

Question 7

three reasons you get hypercalcaemia of malignancy

Answer 7

PTHrP, mets, calcitriol (which causes more calcium absorption in the gut) from lymphomas

Question 8

Mx of hypercalcaemia of malignancy

Answer 8

rehydrate with 3L in 24 hours, IV zoledronic acid, renal dialysis in refractory cases

Question 9

Complications of hypercalcaemia of malignancy

Answer 9

pancreatitis, AKI, arrhythmias, seizures

Question 10

symptoms of hypercalcaemia

Answer 10

abdo pain, bone pain, polyuria, polydipsia, nausea, confusion

Question 11

two causes of raised ICP

Answer 11

SOL or obstructive hydrocephalus

Question 12

a seizure in someone with cancer should always prompt what

Answer 12

MRI to look for brain mets

Question 13

what chemo is known to cause seizures

Answer 13

cisplatin

Question 14

how do you treat seizures in cancer

Answer 14

Benzos PRN

Question 15

what Ix do you do if there is a pleural effusion

Answer 15

pleural fluid aspiration under US guidance and do MC+S

Question 16

what is a parapneumonic pleural effusion?

Answer 16

a pleural effusion where there is an adjacent pneumonia and pH is <7.2

Question 17

what is used to determine whether ascites is transudate or exudate

Answer 17

Serum-ascites albumin gradient

Question 18

what is SAAG in a exudate

Answer 18

<11g/L

Question 19

what is SAAG in a transudate

Answer 19

> 11g/L

Question 20

what investigations do you do for a ascites

Answer 20

an ascitic tap and then send it for MC+S and biochemistry

Question 21

Mx of ascites

Answer 21

low sodium diet, potassium sparing diuretics (spironolactone/amiloride), paracentesis, indwelling catheter, peritoneovenous shunt (where the peritoneum is made to drain into the IJV)

Question 22

what are the most common cancers to cause MSCC

Answer 22

breast, prostate, renal, myeloma, lung

Question 23

how can MSCC be caused

Answer 23

can be due to direct compression of cancer, can be due to collapse of the vertebral body, can be due to pressure from intrabdominal malignancy

Question 24

what reflexes are early signs of MSCC

Answer 24

hyperreflexia and positive babinski sign

Question 25

Ix for MSCC

Answer 25

T2 weighted whole spine MRI

Question 26

apart from whole spine MRI, what other investigations would you do for MSCC

Answer 26

bloods - bone profile, myeloma screen, tumour markers
May do a bladder skin to see if there is retention
Continence management
Pressure sore awareness

Question 27

apart from Dex and referral for decompressive surgery, give some other management points for MSCC

Answer 27

-LMWH
-immobilisation if spinal instability is suspected
-analgesia
-omeprazole

Question 28

what does pt need to be to be a candidate for decompressive spinal surgery

Answer 28

they need to have life expectancy above 6 months, they need to have good spinal structure above and below the met. Note –> if they are not a suitable candidate they may have radiotherapy instead.

Question 29

apart from direct compression by a SCLC, what else can cause SVCO

Answer 29

mets from breast, lymphoma

Question 30

what is post thrombotic syndrome

Answer 30

following DVT get painful calves, swelling, ulceration and pruritus