EXAM #3: ONCOLOGIC EMERGENCIES II

Question 1

What is the definition of Malignant Spinal Cord Compression?

Answer 1

Compression of the spinal cord or cauda equina by an extra dural tumor

Question 2

Outline the pathophysiology of MSCC?

Answer 2

Cord compression leads to interrupted blood flow and cord infarction

Question 3

What is the most frequent site of MSCC?

Answer 3

T-spine

Question 4

What are the signs and symptoms of MSCC?

Answer 4

1) Localized pain
2) Radicular pain
3) Lhermitte’s Sign
4) Motor/Sensory signs
5) Bowel/bladder incontinence

Question 5

What is the test of choice to diagnose MSCC if a patient CANNOT have a MRI?

Answer 5

CT myelogram

Question 6

How is MSCC treated?

Answer 6

1) Glucocorticoids
2) Radiation
3) Surgery/ decompression

Surgery is the treatment of choice*

Question 7

What is Tumor Lysis Syndrome (TLS)?

Answer 7

Syndrome caused by rapid death of a rapidly proliferative volume of cells

Question 8

What are the characteristics of TLS?

Answer 8

1) Hyperkalemia
2) Hyperuricemia
3) Hyperphosphatemia
4) Hypocalcemia
5) Metabolic acidosis
6) Acute kidney injury

Question 9

What type of cancer is TLS common in?

Answer 9

Hematologic malignancies

Question 10

What is the timeline for the diagnosis of TLS?

Answer 10

3 days prior to 7 days after chemotherapy

Question 11

Outline the pathophysiology of TLS.

Answer 11

• Lysed tumor cells release K+ and nucleic acid that are metabolized to uric acid
• Hyperphosphatemia leads to hypocalcemia
• Cytokines are released that cause systemic inflammatory response

Question 12

What induces acute kidney injury in TLS?

Answer 12

Hyperuricemia

Question 13

What patients are at high risk for TLS?

Answer 13

1) Pre-existing chronic renal insufficiency
2) Oliguria
3) Volume depletion
4) Hypotension
5) Acidic urine

Question 14

How is TLS managed?

Answer 14

1) Hydration
2) Allopurinol
3) Rasburicase

Question 15

What is the mechanism of action of Allopurinol?

Answer 15

Blocks the conversion of xanthine and hypoxanthine to uric acid

Question 16

What is the mechanism of action of Rasburicase?

Answer 16

This is urate oxidase–catalyzes the oxidation or uric acid to water soluble allantoin

Question 17

Why does cancer predispose one to PE?

Answer 17

Hypercoaguability due to cancer

Question 18

What is the gold standard for diagnosing PE?

Answer 18

CT pulmonary angiography (CTPA)

Question 19

What is the treatment for a PE?

Answer 19

Anticoagulation

1) Heparin
2) Coumadin

Question 20

What are the most common symptoms of a PE?

Answer 20

Dyspnea
Pleuritic chest pain
Cough
Calf or thigh pain

Question 21

What are the most common signs of PE?

Answer 21

Tachypnea
Tachycardia
Rales
JVD

Question 22

What are the risk factors for a PE?

Answer 22

Malignancy
Immobility 
Trauma- ortho 
Surgery 
Central catheter 
Obesity