Exam 2 - Oncologic Emergencies Weddle

Question 1

which is NOT part of the pathophysiology of tumor lysis syndrome (TLS)?

a. hyperkalemia
b. hyperuricemia
c. hyperphosphatemia
d. hypercalcemia

Answer 1

d. hypercalcemia (hypo)

Question 2

4 principles of management for TLS

Answer 2

1. identify high risk pts
2. monitor electrolytes
3. aggressive hydration
4. control of hyperuricemia

Question 3

TLS aggressive hydration: what IV do we use and what urine output should we maintain?

Answer 3

-5% dextrose/0.45% NS or 0.9% NS
-urine output = 80-100 mL/m^2/hr

Question 4

hyperuricemia: humans lack functional gene for ______ ______ (enzyme) -> further metabolizes uric acid to excretable _______ (molecule)

Answer 4

urate oxidase; allantoin

Question 5

T or F: allopurinol requires renal adjustment for CrCl < 30

Answer 5

F (< 20)

Question 6

drug for tx of hyperuricemia in TLS (2 of them)

Answer 6

allopurinol, rasburicase

Question 7

T or F: rasburicase can be used in pregnancy

Answer 7

F

Question 8

tx of MILD hyperkalemia from TLS

a. IV fluids and loop PRN or sodium polystyrene sulfonate
b. IV calcium gluconate or dextrose and regular insulin or sodium bicarb or IV fluids and loop
c. sevelamer with meals
d. small amounts and slow admin of IV calcium gluconate

Answer 8

a. IV fluids and loop PRN or sodium polystyrene sulfonate

Question 9

tx of SEVERE hyperkalemia from TLS

a. IV fluids and loop PRN or sodium polystyrene sulfonate
b. IV calcium gluconate or dextrose and regular insulin or sodium bicarb or IV fluids and loop
c. sevelamer with meals
d. small amounts and slow admin of IV calcium gluconate

Answer 9

b. IV calcium gluconate or dextrose and regular insulin or sodium bicarb or IV fluids and loop

Question 10

T or F: we should still treat hypocalcemia even if it is asymptomatic

Answer 10

F

Question 11

T or F: Early diagnosis and treatment of MSCC are
ESSENTIAL to prevent permanent neurologic damage and possible paralysis

Answer 11

T

Question 12

which cancer is most likely to cause MSCC?

a. breast
b. lung
c. prostate

Answer 12

c. prostate

Question 13

MSCC diagnosis method of choice

Answer 13

MRI of whole spine

Question 14

if strong suspicion of MSCC, start _______ immediately

Answer 14

steroids

Question 15

T or F: radiotherapy and surgery are NOT treatment options for MSCC

Answer 15

F

Question 16

laminectomy/anterior decompression for MSCC

a. Some or all surgical removal of pathological vertebral body & tumor mass
b. Bone cement injected into fractured bone
c. Balloon inserted & inflated to expand the compressed vertebra to its normal height before filling the space with bone cement

Answer 16

a. Some or all surgical removal of pathological vertebral body & tumor mass

Question 17

vertebroplasty for MSCC

a. Some or all surgical removal of
pathological vertebral body & tumor mass
b. Bone cement injected into fractured bone
c. Balloon inserted & inflated to expand the compressed vertebra to its normal height before filling the space with bone cement

Answer 17

b. Bone cement injected into fractured bone

(trying to raise height of the vertebrates)

Question 18

kyphoplasty for MSCC

a. Some or all surgical removal of
pathological vertebral body & tumor mass
b. Bone cement injected into fractured bone
c. Balloon inserted & inflated to expand the compressed vertebra to its normal height before filling the space with bone cement

Answer 18

c. Balloon inserted & inflated to expand the compressed vertebra to its normal height before filling the space with bone cement

Question 19

what drug class should be offered in MSCC pts with vertebral involvement to reduce risk of fracture/collapse?

Answer 19

bisphosphonates

Question 20

what does MSCC stand for?

Answer 20

malignant spinal cord compression

Question 21

primary goal in superior vena cava (SVC) syndrome

a. cure
b. alleviate sx and tx of underlying disease

Answer 21

b. alleviate sx and tx of underlying disease

Question 22

3 adjunctive therapies for SVC syndrome

Answer 22

-elevation of head
-steroids
-diuretics

Question 23

T or F: most cases of SVC syndrome are considered an oncologic emergency

Answer 23

F

Question 24

first test done for diagnosis of MPE (malignant pleural effusion)

a. chest X-ray
b. MRI
c. CT scan

Answer 24

a. chest X-ray (ultrasound used immed pre-procedure)

Question 25

everything important about MPE management and tx (5 things)

Answer 25

-thoracentesis -> drains fluid
-pleural fluid analysis -> to distinguish type
-pleurodesis -> obliteration of pleural space
-pleural catheters
-pleurectomy -> removal of pleura

Question 26

T or F: we don’t want to drain a huge amount of fluid during thoracentesis

Answer 26

T (otherwise body will react and try to replace quickly -> flash pulmonary edema)