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Heme > Lec 21 > Flashcards

Lec 21 Flashcards

1
Q

What are the 3 types of oncologic emergencies?

A
  • structural/obstructive
  • metabolic or hormonal
  • secondary to treatment from chemo or surgery
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2
Q

What is neutropenic fever?

A

fever in setting of neutropenia with temp > 101 and absolute neutrophil count < 500

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3
Q

What types of bugs are most often cause of neutropenic fever?

A

75% gram positive [staph epi, staph aurea, strep]

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4
Q

How do you diagnose neutropenic fever?

A

blood culture of ports; urine culture

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5
Q

What exam should you not perform on a neutropenic patient?

A

do not perform rectal exam

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6
Q

What is treatment for neutropenic fever?

A

broad spectrum coverage w/in 60 min of presentation = usually cefepime

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7
Q

When should you include gram + coverage for neutropenic fever?

A

if hypotesion, mucositis, skin or catheter infection, hemodynamic instability

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8
Q

What gram + coverage would you add to cefepime for neutropenic fever?

A

vancomycin

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9
Q

What are most common cancers associated with hypercalcemia?

A

breast and lung cancer and multiple myeloma followed by lymphoma

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10
Q

What is definition of hypercalcemia of malignancy?

A

calcium > 12 [need to correct for low albumin]

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11
Q

What is corrected equation for Ca?

A

[0.8 x (normal albumin - pts albumin)] + serum Ca

normal albumin = 4

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12
Q

What can you measure instead of normal serum Ca?

A

measure ionized Ca

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13
Q

What is prognosis of hypercalcemia of malignancy?

A

50% die within 30 days

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14
Q

What is the etiology of hypercalcemia of malignancy in breast cancer, multiple myeloma, lymphoma?

A

due osteolytic metastases

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15
Q

What is etiology of hypercaclemia of malignancy in squamous cell carcinoma and breast cancer with no bone mets ?

A

humoral hypercalcemia of malignancy = due to expression of parathyroid related rpotein in bone

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16
Q

What is etiology of hypercalcemia of malignancy in lymphoma?

A

calcitrol secreting lymphoma

17
Q

What are 5 symptoms of hypercalcemia of malignancy?

A
  • stones [renal or biliary]
  • bones [bone pain]
  • groans [ab pain, N/V]
  • thrones [polyuria]
  • psychiatric overtones
18
Q

What is treatment for acute hypercalcemia of malignancy?

A

Ca > 14 give

  • hydration
  • bisphophonates = toxic to osteoclasts
  • calcitonin = inhibit osteoclast maturation
  • corticosteroids = decrease calcitrol production
  • hemodialisis for pts at risk for CHF renal failure

TREAT UNDERLYING MALIGNANCY

19
Q

What is adverse effect of bisphosphonates?

A

osteonecrossi of the jaw

20
Q

What is definition of superior vena cava syndrome?

A

obstruction of blood flow in superior vena cava to RA causing severe reduction in blood flow from head/neck/upper extremiites

can be due to compression, invasion, thrombosis, or fibrosis

21
Q

What are symptoms of superior vena cava syndrome?

A
  • dyspnea
  • facial swelling exacerbated by bending forward or lying down
  • cough
  • arm edema
  • cyanosis
  • venous distension
  • facial edema
22
Q

What is pemberton’s sign?

A

when arms raised above head; patient develops facial plethora, distended veins in head + neck, inspiratory stridor, elevation of JVP

23
Q

What are two most common etiologies of superior vena cava syndrome?

A
  • lung cancer [small or squamous]

- lymphoma

24
Q

What are 3 less common causes of superior vena cava?

A
  • thymoma
  • mediastinal germ cell neoplasm
  • solid tumor with mediastinal nodal met
25
Q

What are radiographic findings with SVC syndrome?

A
  • mediastinal widening

- pleural effusion

26
Q

What is initial treatment for SVC syndrome?

A
  • elevate head
  • steroids
  • oxygen
27
Q

What is exception to the rule that SVC syndrome is not an emergency?

A

if presence of stridor –> means there is airway obstruction need intubation + stent

28
Q

What is normal cause of malignant epidural spinal cord compression [SCC]?

A

usually from bone met

29
Q

What is presentation of epidural spinal cord compression? [3 symptoms]

A
  • back pain
  • weakness in extremities
  • bowel and bladder incontinence
30
Q

Where does spinal cord compression usually occur?

A
  • 60% thoracic spine
  • 30% lumbosacral spine
  • 10% cervical spine
31
Q

What is standard of care for diagnosing cord compression?

A

MRI

32
Q

WHat is prognosis of spinal cord compression?

A

median survival 6 months

Heme (20 decks)

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