EXAM #3: ONCOLOGIC EMERGENCIES II Flashcards
What is the definition of Malignant Spinal Cord Compression?
Compression of the spinal cord or cauda equina by an extra dural tumor
Outline the pathophysiology of MSCC?
Cord compression leads to interrupted blood flow and cord infarction
What is the most frequent site of MSCC?
T-spine
What are the signs and symptoms of MSCC?
1) Localized pain
2) Radicular pain
3) Lhermitte’s Sign
4) Motor/Sensory signs
5) Bowel/bladder incontinence
What is the test of choice to diagnose MSCC if a patient CANNOT have a MRI?
CT myelogram
How is MSCC treated?
1) Glucocorticoids
2) Radiation
3) Surgery/ decompression
Surgery is the treatment of choice*
What is Tumor Lysis Syndrome (TLS)?
Syndrome caused by rapid death of a rapidly proliferative volume of cells
What are the characteristics of TLS?
1) Hyperkalemia
2) Hyperuricemia
3) Hyperphosphatemia
4) Hypocalcemia
5) Metabolic acidosis
6) Acute kidney injury
What type of cancer is TLS common in?
Hematologic malignancies
What is the timeline for the diagnosis of TLS?
3 days prior to 7 days after chemotherapy
Outline the pathophysiology of TLS.
- 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
What induces acute kidney injury in TLS?
Hyperuricemia
What patients are at high risk for TLS?
1) Pre-existing chronic renal insufficiency
2) Oliguria
3) Volume depletion
4) Hypotension
5) Acidic urine
How is TLS managed?
1) Hydration
2) Allopurinol
3) Rasburicase
What is the mechanism of action of Allopurinol?
Blocks the conversion of xanthine and hypoxanthine to uric acid
What is the mechanism of action of Rasburicase?
This is urate oxidase–catalyzes the oxidation or uric acid to water soluble allantoin
Why does cancer predispose one to PE?
Hypercoaguability due to cancer
What is the gold standard for diagnosing PE?
CT pulmonary angiography (CTPA)
What is the treatment for a PE?
Anticoagulation
1) Heparin
2) Coumadin
What are the most common symptoms of a PE?
Dyspnea
Pleuritic chest pain
Cough
Calf or thigh pain
What are the most common signs of PE?
Tachypnea
Tachycardia
Rales
JVD
What are the risk factors for a PE?
Malignancy Immobility Trauma- ortho Surgery Central catheter Obesity
