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Oncology > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Neurological Emergencies

A

Cord Compression
CNS metastases
Vascular events: Hyperviscosity/ leukostasis

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2
Q

Cardiopulmonary Emergencies

A

Cardiac tamponade

SVC syndrome

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3
Q

Metabolic Emergencies

A

Tumor lysis
Hypercalcemia
SIADH

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4
Q

Hematological Emergencies

A

Neutropenic fever
Severe thrombocytopenia
Overanticoagulation

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5
Q

Emergencies That Need to be Approached Immediately

A

Neutropenic fever
Tamponade
Cord compression
CNS metastases with symptoms

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6
Q

Emergencies That Need to be Approached Today

A 
Coagulopathies
Tumor lysis
Leukostasis
Hyperviscosity
Severe thrombocytopenia (
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7
Q

Emergencies That Need to be Approached Today or Tomorrow

A

SVC Syndrome
Most hypercalcemia
Most CNS mets without edema
INR 5-9

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8
Q

Neurological: Cord Compression

A 
Inflammation
Paresthesia
Autonomic dysfunction
Usually with vertebral mets
Rapid deterioration = worse outcome
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9
Q

How does cord compression occur?

A

Thecal sac becomes compressed

Spread through venous plexus & blood stream

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10
Q

Examination of Cord Compression

A

MRI/CT of whole spine
Decadron
Neurosurgery
XRT: radiation if multiple levels

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11
Q

How do steroids help with cord compression?

A

Decreased risk of paralysis due to reduction in inflammation

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12
Q

What is the most common brain tumor?

A

Brain mets

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13
Q

CNS Metastases with Symptoms

A 
Headaches
Altered mental status
Vision changes
Ataxia
CN problems
Seizures
Personality changes
Confusion
Sensory changes
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14
Q

Which cancers like to go to the brain?

A 
Lung
Breast
Colorectal
Melanoma
Kidney
Germ cell
Neuroblastoma
Sarcoma
Prostate
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15
Q

Presentation of Brain Metastases

A

Headache
Seizures
Altered mental status
Focal deficits

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16
Q

What improves survival of isolated brain mets?

A

Surgery + radiation

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17
Q

Necessary Steps to Treat Brain Metastases with Symptoms

A

Decadron: edema, focal symptoms
Dilantin: seizures
MRI imaging
Neurosurgery

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18
Q

Symptoms of Leukostasis

A 
Altered mental status
Coma
Other organs involved: brain, respiratory
Hypoxia
Renal insufficiency
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19
Q

Leukostasis Mostly In

A

AML: WBC > 100,00

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20
Q

Relatively Nonspecific Symptoms Hyperviscosity

A

Somnolence
Headache
Blurry vision
Dizziness

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21
Q

What condition is hyperviscosity most common with?

A

Waldenstrom’s

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22
Q

Less Common Conditions with Hyperviscosity

A

Multiple myeloma
Polycythemia vera
Essential thrombocytosis

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23
Q

Polycythemia Vera Hemoglobin Levels

A

> 19 or 20

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24
Q

Essential Thrombocytosis Platelet Level

A

> 10^6

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25
Q

Necessary Steps to Treat Hyperviscosity

A

Hydrated
Apheresis for IgM + chemotherapy
Phlebotomy for polycythemia vera
Hydroxyurea & aspirin for essential thrombocytosis

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26
Q

Necessary Steps to Treat Leukostasis

A 
Hydrated
Quentin access (renal)
Chemotherapy
LP for cytology rule in/out CNS leukemia
Steroids
27
Q

Most Common Primaries with Cardiac Tamponade

A

Lung

Breast

28
Q

What does an EKG show with cardiac tamponade

A

Electrical alternans
Low voltage
ST elevation in all leads

29
Q

Presentation of Cardiac Tamponade

A

Left or right sided failure
Pulsus paradoxus
Big heart on CXR

30
Q

3 Main Reasons for Tamponade

A

Malignancy
Idiopathic
Autoimmune

31
Q

Beck’s Triad

A

Low arterial blood pressure
Distended neck veins
Distant, muffled heart sound

32
Q

Necessary Steps to Treat Cardiac Tamponade

A

Echo & cytology from pericardiocentesis
Catheter drainage of pericardial space
Medical management
Chemotherapy
Subxiphoid pericardial window or balloon percardiotomy

33
Q

Define Pulsus Paradoxis

A

Drop of 10 mmHg in arterial blood pressure on inspiration

34
Q

Cancers with SVC Syndrome

A 
Lung cancer
Bronchogenic carcinomas
Lymphoma
Breast cancer
Mediastinal tumors
35
Q

Presentation of SVC Syndrome

A

Facial edema
Symmetric or asymmetric upper extremity edema common
SOB but not hypoxic

36
Q

Necessary Steps to Treat SVC Syndrome

A 
Pulse Ox/CSR
Chest CT to outline mass
Chemo for small cell, lymphoma, germ cell
Radiation for almost all else
Heparin or corticosteroids
IR: stenting
37
Q

Tumor Lysis Syndrome

A

Occurs in tumors with high body burden & high chemrsensitivity
Usually due to therapy
Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure

38
Q

Cancers Associated with Tumor Lysis Syndrome

A

High-grade lymphomas
High-grade leukemias
Small cell
Germ cell

39
Q

Tumor Lysis Syndrome Lab Abnormalities

A

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

40
Q

Necessary Steps for Pre-Treatment of Tumor Lysis Syndrome

A

Fix conditions that will make effects worse: dehydration, renal obstruction, IV contrast
Baseline labs: K, Ca, Phos, Uric acid, LDH, Cr
Alkaline diuresis: D5 1/2 with 2-3 amps NaHCO3/1 at 200+ cc/hr
Allopurinol 600 mg, then 300/day to keep uric acid production down
Rasburicase

41
Q

Necessary Steps During Treatment for Tumor Lysis Syndrome

A

High K+, low Ca++
Keep alkaline urine output high
Check BID electrolytes, phos, UA, Ca, LDH, Cr
Keep phosphate 6, K

42
Q

Cancers Associated with Hypercalcemia

A

Breast
Lung
Multiple myeloma
SCC make PTH-rP

43
Q

Presentation of Hypercalcemia

A 
Gradual in onset
Fatigue
N/V
Constipation
Anorexia
Apathy
Decreased consciousness
44
Q

Pathologic Role of PTH-rP

A

Does everything PTH does but without negative feedback system

45
Q

Necessary Steps to Treat to Hypercalcemia

A

Volume replete patient
Furosemide
IV Pamidronate (Aredia) or IV Zoledronic (Zometa)
Adjunct: dialysis, calcitonin (Miacalcin), steroids

46
Q

Symptoms of SIADH with Serum Sodium

A 
Anorexia
Irritability
N/V
Constipation
Muscle weakness
Myalgia
47
Q

Symptoms of SIADH with Serum Sodium

A

Seizure
Coma/Death
Abnormal reflexes
Papilledema

48
Q

SIADH Most Common in What Cancer

A

Small cell lung cancer

49
Q

Lab Results of SIADH

A

Decreased BUN & serum osmolarity

Increased urine osmolarity & sodium levels

50
Q

Necessary Steps to Treat SIADH

A

Treat tumor
Limit fluid intake to 500-1000 mL/day
Furosemide
Parenteral sodium replacement with severe neurological symptoms
Monitor electrolytes: Magnesium, K+, Ca++

51
Q

Presentation of Neutropenic Fever

A

Initially subtle

Rapid development of hypotension, dyspnea, sepsis

52
Q

Short-term Neutropenia Predicts What Type of Organisms

A

Gram-negative&raquo_space; gram-positive

53
Q

Long-term Neutropenia Predicts What Type of Organisms

A

Fungal
Viral
Opportunistic

54
Q

Necessary Steps to Treat Neutropenic Fever

A

Evaluate patient for a source: blood, CXR, sputum, urine, skin, LP
Suspected source: treat it
Not a suspected source: treat empirically

55
Q

Empiric Antibiotics to Treat Gut Flora

A 
Cefipime
Moxifloxacin
Pip/Gent
Aztreonam
Add coverage for lack of response
56
Q

Symptoms of Severe Thrombocytopenia

A 
Asymptomatic
Epistaxis
Gingival bleeding
Bullous hemorrhages
Petechiae
Eccymosis
Menorrhagia
CNS bleeding least common
57
Q

Platelet Defect Bleeding

A 
Site: skin, mucous membranes
Minor cut bleeding: yes
Petechiae: present
Ecchymoses: small, superficial
Hemarthrosis: rare
Bleeding after surgery: immediate, mild
58
Q

Clotting Factor Defect Bleeding

A 
Site: deep in soft tissue
Minor cut bleeding: not usually
Petechiae: absent
Ecchymoses: large, palpable
Hemarthrosis: common
Bleeding with surgery: delayed, severe
59
Q

Necessary Steps to Treat Thrombocytopenia

A

Be sure it’s not TTP, DIC, HIT, HELLP
Assess for active bleeding
Transfuse if patient is actively bleeding
Prednisone 1mg/kg/day if patient well
IVIG x 2 days if patient ill
Kids: remit
Adults: relapse & require splenectomy

60
Q

What does HELLP stand for?

A

Hemolysis
Elevated Liver enzymes
Low Platelet count

61
Q

Overanticoagulation

A

Agents being used more & more
INR’s up to 5
INR’s >9

62
Q

Necessary Steps to Treat Overanticoagulation for Patients on Warfarin

A

Assess whether there is significant bleeding
Assess for head trauma
Assess whether the patient should be anti coagulated again in the future
Give FFP & Vitamin K for significant bleeding
Give PO Vitamin K for INR >9 without bleeding
Avoid SQ Vitamin K

63
Q

Necessary Steps to Treat Overanticoagulation for Patients on Non-Warfarin Agents

A

Assess for bleeding & head trauma
Identify the specific agent & call pharmacy/hematology
For significant bleeding, consider protamine sulfate for heparin or LMWF
Significant bleeding, consider recombinant activate Factor VII

Oncology (11 decks)

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