Lecture 2020 - Onc Emergencies

Question 1

How to make lab diagnosis of TLS?

Answer 1

2 or more abnormal lab values (3 days before or 7 days after treatment starts)
-Uric acid > 8
K > 6
Phs > 4.5
Ca < 7

Question 2

Treatment for TLS?

Answer 2

Intense hydration, allopurinol 300mg BID

Rasburicase if very high uric acid (3mg initial dose)

Question 3

In patient with neutropenic fever, what are the indications to add Vancomycin/Linezolid?
Name at least 3

Answer 3

• Hypotension
• mental status changes
• suspected catheter-associated infection
• severe mucositis

Question 4

When to add antifungal coverage in patient with neutropenic fever?

Answer 4

• Pt continues spiking fevers for 4-7 days

- high risk neutropenic patients

Question 5

If no source of the neutropenic fever is identified, at what point can antimicrobials be discontinued?

Answer 5

• Afebrile 24-48 hours

- ANC > 500

Question 6

Recent data suggest SVC syndrome is not often an emergency. If it is an emergency, (stridor, severe larygneal edema present) what is your first step?

Answer 6

Get an immediate stent placed

Question 7

Threshold to classify severe hypercalcemia?

Answer 7

> 14

Or you could also argue >12 with symptoms.

Question 8

Tx for severe hypercalcemia:

Answer 8

• Isotonic saline 200-300cc/hr
• Calcitonin
• Bisphosphanate (or denusomab if can’t tolerate)

-Hemodialysis also warranted in some cases