Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Therapeutics II (Spring 2018) > Exam 1: Malignant emergencies > Flashcards

Exam 1: Malignant emergencies Flashcards

1
Q

SVC Syndrome can be caused by what type of catheter?

A

Thrombosis from indwelling catheter (IV cath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common sx of SVC Syndrome?

A

Dyspnea

Followed by cough and orthopnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two most frequent signs of SVC syndrome?

A

Neck vein distension (JVD) AND facial swelling/fullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do the arm veins, neck veins, and face look like in SVC Syndrome?

A

Distended arm and neck veins. Facial swelling/fullness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an ominous sign of SVC syndrome that represents a true emergency?

A

Papilledema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is compressed or occluded in SVC Syndrome?

A

Superior Vena Cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dx to confirm SVC Syndrome?

A

CXR first, confirm with Chest CT with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx of SVC Syndrome? (Hint: position? meds? remove?)

A
  • keep in head-up position (to make fluid go down)
  • IV steroids (shrinks tumor swelling)
  • IV diuretics (Torsemide)
  • Anticoagulants or thrombolytics (if clot in SVC)
  • Emergent mediastinal radiation
  • remove central IV catheter if present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute Spinal Cord Compression usually results from extension of what?

A

Extension of spinal bony metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do mets most commonly occur in Acute Spinal Cord Compression?

A

Thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 4 most common tumors causing spinal cord compression

A 
Breast
Lung
Prostate
Renal cell
All 4 hide in bone

Other tumors include lymphomas, MM and sarcomas which destroy bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sx in Acute Spinal Cord Compression?

A

Localized back pain (most common) +/- tenderness (may be absent with lymphomas)

  • paraparesis/paraplegia
  • distal sensory deficits
  • gait disturbance
  • urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dx of choice for Acute Spinal Cord Compression? What other studies can you do ?

A

MRI STUDY OF CHOICE

cervical, thoracic, or lumbar spine films (but neg films don’t rule out SCC)

radionuclide bone scan (>90% sensitivity, except for multiple myeloma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx for Acute Spinal Cord Compression? What is key tx?

A

Spine immobilization. Emergent decompressive Laminectomy.
Key tx=radiation!

+/- IV steroids / diuretic / mannitol for swelling
Foley cath for incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the most common tumors causing hypercalcemia

A

Metastatic breast, lung or prostate ca

Multiple myeloma

NHL

Head+neck scc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2 most common types of Hypercalcemia of Malignancy?

A
  1. Humoral hypercalcemi of malignancy via PTHrP
  2. Local bone destruction

Less commonly Tumor production of Vit D analogues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sx of Hypercalcemia of Malignancy?

A

Moans, bones, stones, groans, psych undertones.

Vague malaise/weakness, polydipsia, anoexia, nausea, confusion

Can lead to seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lower the albumin what happens to calcium levels?

A

Lower albumin, higher calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Formula for Corrected Calcium? What is dangerous?

A

Corrected Ca2+ = Total Ca + {0.8 X (4.0-albumin)}

>12 is dangerous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Low Serum ___ can indicate Hypercalcemia of Malignancy?

A

Low Serum Cl-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

QT in Hypercalcemia of Malignancy?

A

Short QT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PR in Hypercalcemia of Malignancy??

A

Long PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Voltage in Hypercalcemia of Malignancy?

A

Low voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

IV hydration until when in Hypercalcemia of Malignancy?

A

Voiding 150-200 mL/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Once euvolemic what to give in Hypercalcemia of Malignancy?
Loop diuretics
26
Which diuretic to avoid in Hypercalcemia of Malignancy?
Thiazide!
27
What to avoid in Hypercalcemia of Malignancy?
PO Phosphate
28
What to discontinue in Hypercalcemia of Malignancy? (hint: 4)
1. Calcium 2. VitD 3. Thiazides 4. NSAIDs
29
Meds to control high Ca2+ in Hypercalcemia of Malignancy?
SC/IM Calcitonin, Bisphosphonates, corticosteroids, dialysis, AVOID ORAL PHOSPHATE Calcitonin quickly lowers serum calc levels Bisphosphonattes block osteoclasts bone resorption Corticosteroids most effective (elevated Vit D) HD for renal/heart failure
30
Which bisphosphonates to avoid in renal failure?
Zoledronic acid
31
Which two bisphosphonates are IV. Which one is SQ
Pamindronate 60-90mg IV over 60 minutes Zolendronic Acid 4mg IV over 15 minutes - don’t use in renal failure Denosumab 120 mg sc
32
Normal ANC?
>1000
33
Neutropenic ANC?
500-1000
34
Severe neutropenia?
<500
35
How to calculate ANC?
ANC=(WBC)(% neutrophils + % bands)
36
What is ANC if WBC=6000; Seg=30%; Band=3%
ANC=(6000)(0.30+0.03) | ANC=2000
37
When does Febrile Neuropenia most commonly occur?
During nadir after chemo
38
When is nadir in Febrile Neuropenia?
5-10 days after chemo. Lasts 5 days.
39
Which gram bacteria from central lines in Febrile Neuropenia?
Gram positive
40
Which gram are enteric bacteria in Febrile Neuropenia?
Gram negative
41
Sx of Febrile Neuropenia?
ASx to severe sepsis UTI without pyuria (no WBCs in urine)
42
What exam should you try to avoid in febrile neutropenia
Internal rectal exam Don’t want to compromise mucosa
43
Single PO temp above what in Febrile Neuropenia?
>101.3F
44
Sustained temp above ___ for how long in Febrile Neuropenia?
>100.4 for 1 hour
45
How many blood cultures in Febrile Neuropenia? Where?
2x peripheral | 1x from catheter
46
What is involved in febrile neutropenia work up
Blood Cx (2 sets one from Peripheral vein and one from catheter) Urine Cx Sputum Cx and gram stain Stool, CSF Cx if inficated CXR –may be nl, consider a CT if respiratory complaints
47
Which 2 abx for Febrile Neuropenia?
Vanco=staph and strep | Cefepime=gram + and pseudomonas
48
What time frame to give abx in Febrile Neuropenia?
Within 1 hour of presentation
49
Tx if afebrile Neuropenia? (Hint: based on ANC)
IV Abx for 5-7 days then PO Abx when ANC >1000 - continue initial abx until blood cx available, then adjust abx based on culture/sensitivities - treat for 5-7 days of IV and consider PO if ANC >1000
50
Tx for febrile Febrile Neuropenia?
IV Abx for 5-7 days.
50
When to add antifungal in Febrile Neuropenia?
After 4 days (>72h) Fluconazole and ketoconazole
51
What medication makes neutrophils? What dose?
G-CSF. | 5mcg/kg/day SC . (300-480mcg/day)
52
When to D/C (discharge) tx in Febrile Neuropenia? (3 criteria)
1. ANC normal >1000 2. Afebrile for 24h 3. Cx negative
53
Most common tumors causes of tumor lysis syndrome
Leukemia’s with high WBCs Lymphomas Small cell ca Metastatic adenoca
55
What is tumor lysis syndrome? What happens to cancer cells in Tumor Lysis Syndrome?
Rapid destruction of CA cells after chemo or radiation metabolic complications which occur after tx of bulky chemo-responsive malignancies
55
When does Tumor Lysis Syndrome happen?
6-72 hours after chemo or radiation
57
What sort of complications occur with Tumor Lysis Syndrome?
Metabolic complications from release of cell contents into serum
58
metabolic complications that occur in tumor lysis syndrome? | What 3 things are elevated? what is low?
HyperK, Hyperuricemia, Hyperphophatemia Hypocalcemia. (D/t precip of calc phosphate) Can lead to Acute renal failure and arrhythmias
59
Etiologic factors of TLS. What two elevated labs are attributed with acute tumor lysis
High preRx serum LDH or uric acid large tumor burden, high growth fraction, high preRx serum LDH or uric acid, pre-existing renal insufficiency
60
What to do with chemo and radiation in Tumor Lysis Syndrome?
STOP THEM!
61
How hydrate in Tumor Lysis Syndrome?
Aggressively with diuresis
62
How to treat elevated uric acid in Tumor Lysis Syndrome?
Alkalize urine to pH 7 with NaHCO3 (bicarb)
63
How to treat HyperK in Tumor Lysis Syndrome?
CaCl2, NaHCO3, Glucose/Insulin, Kayexalate
64
When to do emergent hemodialysis in Tumor Lysis Syndrome? (hint: K, uric acid, Cr, peeing)
1. K>6 2. Uric Acid >10 3. Cr >10 4. or can’t tolerate diuretics
65
Which med to prevent uric acid build up in Tumor Lysis Syndrome?
Allopurinol
66
Which med to rapidly decrease uric acid in Tumor Lysis Syndrome?
Rasburicase Rasburicase is a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin so it can be secreted.
67
All treatments for tumor lysis
Stop the chemoRx, hold any further lysis Aggressive IV hydration NS/ diuresis +/- alkalinize urine to pH 7 (NaHco3) –Decreases uric acid but may worsen hypocalcemic tetany CaCl2, NaHCO3, glucose / insulin, kayexalate for hyperkalemia Emergency hemodialysis –If K > 6, uric acid > 10, creat. > 10, or unable to tolerate diuresis Can use allopurinol for prevention pre & Post Chemo Rasburicase – rapid degredation of uric Acid
67
What happens to the kidneys with tumor lysis
Proteins and nuclei acids broken down by xanthine oxidase to uric acid Excess uric acid accumulated in kidney and results in uric acid Nephropathy and AKI elevates phosphate causes dec urine output. Binds to serum calc which also precip in kidney
68
How often is Malignant Pericardial Temponade an early sign of malignancy?
Rarely!
70
Heart tones in Malignant Pericardial Temponade?
Muffled/decreased
70
JVD in Malignant Pericardial Temponade?
Yes they will have JVD
72
Pulsus paradoxis in Malignant Pericardial Temponade?
>10mmHg
73
QRS complex in Malignant Pericardial Temponade?
Low voltage
74
Most common causative tumors in pericardial tamponade
``` Melanoma HL acute leukemia Lung ca Breast ca Ovarian ca ``` Radiation pericarditis
75
Friction rub in Malignant Pericardial Temponade?
Rarely
76
what is the EKG like for malignant pericardial tamponade?
low QRS voltage +/- pulses alternans
77
Dx of choice for Malignant Pericardial Temponade? What will it show?
Echo! Will show equalization of heart chamber pressures.
78
Tx for Malignant Pericardial Temponade?
MC Needle catheter pericardiocentesis. | Others=pericardial window, pericardiectomy, radiation, intrapericardial chemoRx or sclerosis
80
Si/sx of malignant pericardial tamponade
–Dyspnea / weakness +/- chest pain -Hypotension / narrow pulse pressure -Friction rub rare –Jugular venous distention -Muffled (decreased) heart tones -Pulsus paradoxicus > 10 mm Hg -Low EKG QRS voltage +/- pulsus alternans +/- cardiomegaly on CXR
81
causative tumors of SVC syndrome
- small cell (oat cell) lung cancer - squamous cell lung cancer - lymphoma - anaplastic mediastinal cancer
82
what can form in spinal column and cause acute spinal cord compression?
epidural abscess/hematoma
83
what IV steroid is given for tx of acute spinal cord compression?
Decadron aka dexamethasone -decreases swelling of tumor
84
what is key in tx of acute spinal cord compression? what does it do?
radiation - shrinks the tumor pressing on the cord
85
When and why do you do a corrected calcium
Done in setting of hypO albuminemia. Low albumin = less ionized Ca bound to albumin = pseudohypOcalcemia. The labs for calcium drawn measure the ionized calcium, and thus will report a false low. Your patient may have hypercalcemia but without a corrected value may appear normocalcemic.
86
What IV fluid is tx of choice for hypercalcemia?
Normal saline
87
what needs to be given immediately to pts with hypercalcemia?
HYDRATION - IV FLUIDS -> TO PEE OUT THE CA -Normal Saline is of choice
88
How do bisphosphonates work?
block osteoclastic bone resorption
89
when would hypercalcemic pt go on dialysis?
pt with renal or heart failure not life-long, just for acute episode used b/c fluid will start to back up -> CHF
90
what is febrile neutropenia defined as?
single oral temp >101.3 F sustained temp >100.4 for 1 hr ANC <1000
91
risk of infection if neutropenic increases with what?
- duration of neutropenia - severity of ANC <100 - comorbidities - central lines - hepatic or renal insufficiency
92
when to use G-CSF for febrile neutropenia?
- profound neutropenia, shock, co-morbidities - worsening clinical course and expected prolonged neutropenia - pt not responding to abx
93
what is G-CSF? what does it do?
Granulocyte Colony Stimulating Factor speeds up resolution of neutropenia (stimulates production or neutrophils)
93
how long does it take G-CSF to work? how long do you have to wait to give it again?
- profound neutropenia, shock, co-morbidities - worsening clinical course and expected prolonged neutropenia - pt not responding to abx

Clin Therapeutics II (Spring 2018) (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions