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Cancer Care > Emergency Presentations > Flashcards

Emergency Presentations Flashcards

1
Q

What is Neutropenic Sepsis?

A

A patient on systemic anticancer therapy that presents with a temperature >38 degrees and a neutrophil count <0.5x10^9/L

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2
Q

What are some causative organisms for Neutropenic Sepsis?

A 
Staph. Aureus
Staph. Epidermis
Enterococcus
Streptococcus
MRSA
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3
Q

What are some symptoms of Neutropenic Sepsis?

A

Fever
System Specific
Drowsiness
Confusion

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4
Q

What are some signs of Neutropenic Sepsis?

A 
Febrile
Tachycardia
Hypotension
Impaired MMSE
Signs of Skin/Line infection
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5
Q

Which investigations are appropriate for suspected Neutropenic Sepsis?

A

Bloods - FBC, U+E, LFTs, Lactate, CRP, ABG, Cultures

CXR

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6
Q

How should suspected Neutropenic Sepsis be managed?

A

Prompt IV Tazocin - 4.5g QDS
Fluid Resuscitation
?Catheterisation
G-CSF if Profound Neutropenia

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7
Q

What are some preventative measures which can help to avoid Neutropenic Sepsis?

A

Patient Education including emergency information
Abx Prophylaxis
?Prophylactic G-CSF

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8
Q

What causes Malignant Spinal Cord Compression?

A

Either vertebral body collapse secondary to metastases or direct tumour spread within the cord

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9
Q

What can prolonged cord compression in Malignant Spinal Cord Compression lead to?

A

Vascular injury
Cord necrosis
Permanent damage

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10
Q

What are some symptoms of Malignant Spinal Cord Compression?

A

Prolonged back pain
Spinal/Radicular pain
Limb Weakness
Bladder/Anal Sphincter dysfunction

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11
Q

What may be demonstrated on examination of acute Malignant Spinal Cord Compression?

A

Flaccid Paralysis

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12
Q

What may be demonstrated on examination of chronic Malignant Spinal Cord Compression?

A

Hypertonia
Hypereflexia
Up-going Plantars
Palpable bladder

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13
Q

How should suspected Malignant Spinal Cord Compression be investigated?

A

Urgent MRI

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14
Q

How can Malignant Spinal Cord Compression be managed?

A

Steroids - 16mg Stat then BD. Remember PPI Cover
Surgery - Debulking of Tumour +/- Decompression
Radiotherapy within 24h
Urgent Chemotherapy if Chemosensitive
Supportive Care

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15
Q

What is Superior Vena Cava Obstruction?

A

Obstruction of blood through the SVC due to compression or occlusion

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16
Q

What are some causes of SVCO?

A

Lung Ca
Lymphoma
Thrombus occlusion

17
Q

What are some symptoms of SVCO?

A 
Breathlessness
Face + Neck swelling
Trunk + arm swelling
Choking
Headache
Lethargy 
Chest pain
Cough
Dysphagia
Hallucinations
Seizures
18
Q

What are some signs of SVCO?

A 
Neck vein distension
Facial oedema
Increased respiratory rate
Plethora
Cyanosis
19
Q

What is Pemberton’s Sign?

A

Arm raising leads to significant neck distension, suggestive of SVCO

20
Q

Which investigation is appropriate for suspected SVCO?

A

CT Thorax + Contrast

21
Q

How can confirmed SVCO be managed?

A

Steroids
Stent
Chemotherapy if sensitive - SCLC, Lymphoma, Teratoma
Radiotherapy

22
Q

Why does Hypercalcaemia occur in malignancy?

A

PTHrp release leads to osteolytic bone destruction

23
Q

Which cancer is commonly associated with Hypercalcaemia?

A

SCC

24
Q

What are some symptoms of Hypercalcaemia?

A 
Nausea
Anorexia
Thirst
Polyuria + Polydypsia
Fatigue and Weakness
Constipation
Confusion
Reduced concentration
Drowsiness
25
Q

How should Hypercalcaemia be managed?

A

Rehydration

Bisphosphonates - IV Zolendronic Acid 4mg

26
Q

What is Acute Tumour Lysis Syndrome?

A

Rapid malignant cell destruction releases cellular contents leading to systemic changes

27
Q

How does Acute Tumour Lysis syndrome present?

A 
Hyperuricaemia
Hyperkalaemia
Hyperphosphataemia
AKI
Hypocalcaemia
28
Q

What are risk factors for developing Acute Tumour Lysis Syndrome?

A

Pre-existing renal impairment
Hypovolaemia
Raised LDH
Urinary obstruction by a tumour

29
Q

What are some symptoms of Acute Tumour Lysis Syndrome?

A 
Nausea and Vomiting
Diarrhoea
Anorexia
Lethargy 
Haematuria then Oligouria then Anuria
HF
Cardiac arrhythmia/arrest
30
Q

How should Acute Tumour Lysis Syndrome be managed?

A

Allopurinol - Hyperuricaemia
IV Rasburicase if high risk of complications from Hyperuricaemia
Calcium replacement

Cancer Care (5 decks)

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