Exam 2 - Oncologic Emergencies Weddle Flashcards
which is NOT part of the pathophysiology of tumor lysis syndrome (TLS)?
a. hyperkalemia
b. hyperuricemia
c. hyperphosphatemia
d. hypercalcemia
d. hypercalcemia (hypo)
4 principles of management for TLS
- identify high risk pts
- monitor electrolytes
- aggressive hydration
- control of hyperuricemia
TLS aggressive hydration: what IV do we use and what urine output should we maintain?
-5% dextrose/0.45% NS or 0.9% NS
-urine output = 80-100 mL/m^2/hr
hyperuricemia: humans lack functional gene for ______ ______ (enzyme) -> further metabolizes uric acid to excretable _______ (molecule)
urate oxidase; allantoin
T or F: allopurinol requires renal adjustment for CrCl < 30
F (< 20)
drug for tx of hyperuricemia in TLS (2 of them)
allopurinol, rasburicase
T or F: rasburicase can be used in pregnancy
F
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
a. IV fluids and loop PRN or sodium polystyrene sulfonate
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
b. IV calcium gluconate or dextrose and regular insulin or sodium bicarb or IV fluids and loop
T or F: we should still treat hypocalcemia even if it is asymptomatic
F
T or F: Early diagnosis and treatment of MSCC are
ESSENTIAL to prevent permanent neurologic damage and possible paralysis
T
which cancer is most likely to cause MSCC?
a. breast
b. lung
c. prostate
c. prostate
MSCC diagnosis method of choice
MRI of whole spine
if strong suspicion of MSCC, start _______ immediately
steroids
T or F: radiotherapy and surgery are NOT treatment options for MSCC
F
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
a. Some or all surgical removal of pathological vertebral body & tumor mass
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
b. Bone cement injected into fractured bone
(trying to raise height of the vertebrates)
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
c. Balloon inserted & inflated to expand the compressed vertebra to its normal height before filling the space with bone cement
what drug class should be offered in MSCC pts with vertebral involvement to reduce risk of fracture/collapse?
bisphosphonates
what does MSCC stand for?
malignant spinal cord compression
primary goal in superior vena cava (SVC) syndrome
a. cure
b. alleviate sx and tx of underlying disease
b. alleviate sx and tx of underlying disease
3 adjunctive therapies for SVC syndrome
-elevation of head
-steroids
-diuretics
T or F: most cases of SVC syndrome are considered an oncologic emergency
F
first test done for diagnosis of MPE (malignant pleural effusion)
a. chest X-ray
b. MRI
c. CT scan
a. chest X-ray (ultrasound used immed pre-procedure)
everything important about MPE management and tx (5 things)
-thoracentesis -> drains fluid
-pleural fluid analysis -> to distinguish type
-pleurodesis -> obliteration of pleural space
-pleural catheters
-pleurectomy -> removal of pleura
T or F: we don’t want to drain a huge amount of fluid during thoracentesis
T (otherwise body will react and try to replace quickly -> flash pulmonary edema)
