Febrile Neutropenia

Question 1

What is febrile neutropenia

Answer 1

1. Temperature recorded as above 38 degrees with absolute neutrophil count <1.0 x 10^9

Question 2

Why is not diagnosing febrile neutropenia on time a problem

Answer 2

Patients can easily die

Question 3

What patients are at risk

Answer 3

1. Chemotherapy less than a week ago
2. Those who had stem cell transplant or high dose chemotherapy within the last year
3. Any haematological conditions resulting in neutropenia

Question 4

What haematological conditions can cause neutropenia

Answer 4

1. Aplastic anaemia
2. Autoimmune
3. Leukaemia

Question 5

What drugs can cause neutropenia

Answer 5

METHOTREXATE
CARBIMAZOLE
CLOZAPINE

Question 6

Clinical presentation of neutropenia

Answer 6

1. Pyrexia > 38 degrees
2. Malaise
3. Swetas
4. Coughs/diarrhoae, abode pain
5. Tachycardia, hypotension + raised respiratory rate
6. May not always have temp/rigors due to inability to amount immune response

Question 7

How is neutropenia managed

Answer 7

1. Start broad spectrum IV anrtibiiotcis WITHOUT waiting for results (1 hour into admission)
2. DO NOT CATHETORISE

Question 8

Why do we not catheterise

Answer 8

Increased risk of infection

Question 9

What is Malignant spinal cord compression caused by

Answer 9

1. Bone metastasis, vertebral collapse
2. Local tumour extension
3. Deposition of malignant cells within cord

Question 10

What conditions are commonly seen with spinal cord compression

Answer 10

1. Myeloma

2. Lymphoma

Question 11

Clinical presentation of Malignant spinal cord compression

Answer 11

1. Back Pain
2. Weakness/numbness in legs
3. Inability to control bladder/bowel
4. Saddle paresthesia
5. Uni/bilateral leg weakness
6. Decreased anal tone
7. Decreased perineal sensation
8. In acute cord compression, tone, reflexes will be reduced

Question 12

How is Malignant spinal cord compression managed

Answer 12

BED REST

2. High dose steroid (DEXAMETHASONE)
3. ANALGESIA
4. MRI of whole spine

Question 13

What is tumour lysis syndrome

Answer 13

Life threatening metabolic derangement that occurs when malignant cells BREAKDOWN:

HIGH uric acid
HYPERkalaemia
HYPERphosphataemia
HYPOcalcaemia

Question 14

What patients are at risk of tumour lysis syndrome

Answer 14

1. High tumour burden
2. High grade disease
3. Pre-existing renal impairment
4. Increasing age

Question 15

How is Tumour lysis Syndrome treated

Answer 15

1. HYDRATION
2. ALLOPURIONOL (Xanthine oxidase inhibitor) or RASBURICASE (recombinant rate oxidase)

Monitor electrolytes

Refere for dialysis

Question 16

What is hyper viscosity syndrome

Answer 16

1. Increase in blood viscosity due to HIGH levels of igG

Question 17

How is hypercalcaemia treated

Answer 17

IV hydration - 3L a day

BISPHOSPHONATES (ZOLENDRONATE -r educed ca production)

Question 18

What is ONDANSETRON

Answer 18

1. Anti-emetic drug

2. 5HT3 antagonist

Question 19

How is heparin treated

Answer 19

APTT - Activated Partial Thromboplastin Time)

Question 20

How does clopidogrel reduce platelet aggregation

Answer 20

Inhibits ADP induced

Question 21

When dow e stop aspirin before a surgery

Answer 21

5 days before

Question 22

What do NOACs act on

Answer 22

Factor II or X