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Hematology and Oncology > EXAM #3: ONCOLOGIC EMERGENCIES > Flashcards

EXAM #3: ONCOLOGIC EMERGENCIES Flashcards

1
Q

What is the most common cause of cancer (lifestyle factor)? What is number two?

A

1) Smoking

2) Obesity

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2
Q

What causes SVC Syndrome?

A

Mediastinal mass

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3
Q

What is a common cause of a mediastinal mass in a smoker?

A

Lung cancer

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4
Q

What is the result of a mediastinal mass compressing the SVC?

A

Blood flows through venous collateral networks, returning blood to the heart via the IVC or azygous vein

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5
Q

What is the definition of SVC Syndrome?

A

Any condition, benign or malignant that causes obstruction of blood flow through the SVC

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6
Q

Where does the SVC drain blood from?

A

Head
Arms
Upper torso

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7
Q

What are the signs of SVC Syndrome?

A

1) Presence of venous collaterals
2) Edema of the head, neck, arms, upper chest, larynx, and brain
3) Dyspnea, headache, cyanosis, chest pain, confusion, coma

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8
Q

What are the two most common malignant causes of SVC syndrome?

A

1) Lung cancer

2) NHL

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9
Q

What are the benign causes of SVC Syndrome?

A

1) SVC stenosis/ thrombosis due to venous catheter/ pacemaker wire
2) Fibrosing mediastinitis

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10
Q

What is the gold standard for imaging/diagnostics for SVC Syndrome?

A

Chest CT with contrast

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11
Q

How is SVC Syndrome treated?

A

1) SVC endovascular stent

2) Treat underlying cause

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12
Q

What are the treatments that would be appropriate for treating malignancy causing SVC Syndrome?

A
  • Radiation
  • Chemotherapy

Steroids and diuretics don’t really help*

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13
Q

What is the treatment for LIFE-THREATENING SVC Syndrome?

A

SVC Endovascular Stent

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14
Q

A 50 year-old patient presents to the ED w/ a fever of 103. She is s/p chemo for metastatic breast cancer one week ago. What is this until proven otherwise?

A

Neutropenic fever

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15
Q

What is mucositis?

A

Inflammation of the mucous seen in neutropenic fever

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16
Q

What is the definition of neutropenic fever?

A
  • Single temp greater than 101 F or sustained temp greater than 100.4

AND

  • Absolute Neutrophil Count less than 500
17
Q

How do you calculate the ANC?

A

WBC x % neutrophils + %bands

18
Q

Outline how neutropenic fever commonly develops?

A
  • Cytotoxic antineoplastic therapy
  • Compromises the integrity of GI tract
  • Allows the translocation of bacteria/fungi
19
Q

What is an absolute MUST for the treatment for neutropenic fever?

A

Broad-spectrum empiric antibiotics within 60 minutes of arrival to the ED

20
Q

How do you evaluate patients with suspected neutropenic fever?

A

1) Detailed history and PE (naked)
2) Labs and culture
3) CXR

21
Q

What PE procedure should you NOT do in a patient with a suspected neutropenic fever?

A

Rectal exam (DRE)

22
Q

What is the most common cause of documented infections in neutropenic patients?

A

Infection from patients endogenous gut flora

23
Q

Though fungal infections are uncommon causes of infection in neutropenia, what is Candida infection commonly associated with?

A

Central venous catheter associated infections

24
Q

What increases the risk/ need for anti-fungal agents in neutropenia?

A

Prolonged neutropenia

25
Q

Is GM-CSF a part of the normal treatment for acute neutropenia?

A

No–it doesn’t work fast enough

26
Q

What is pulsus paradoxus?

A

Variable pulse with respiration

27
Q

What is a common cause of a very narrow pulse pressure?

A

Cardiac Tamponade/ pericardial effusion

28
Q

What is the EKG manifestation of cardiac tamponade?

A

Electrical alternans

29
Q

What is the CXR finding that is pathogonomic for pericardial effusion?

A

Water-bottle sign

30
Q

What is the gold standard for diagnosing pericardial effusion?

A

ECHOcardiogram

31
Q

What is malignant pericardial effusion associated with?

A

1) Lung cacner
2) Breast cancer
3) Leukemia
4) Lymphoma
5) Prior chemo or radiation

32
Q

What determines the severity of symptoms in pericardial tamponade?

A

How rapid the accumulation of fluid occurs

33
Q

What are the signs of Cardiac Tamponade?

A

1) Tachycardia
2) JVD
3) Diminished heart sounds
4) Pulsus paradoxus
5) Reduced pulse pressure
6) Electrical alternans

34
Q

What is the emergent treatment for Pericardial Tamponade?

A

Pericardiocentesis

35
Q

What is the procedure for recurrent pericardial effusion?

A

Pericardial window

Hematology and Oncology (38 decks)

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