Malignancy

Question 1

When is neutropenia seen after starting chemo?

Answer 1

Day 8-16

Question 2

How does this relate to infections?

Answer 2

The patient is more susceptible

Question 3

What is the temp definition of fever?

Answer 3

Oral Temp >101 or 100.4 sustained for >1 hour

Question 4

What is always the right answer?

Answer 4

H&P

Question 5

Questions to ask patients presenting with fever

Answer 5

H&P, sources of infection, resp, GU, GI, CBC, LFTs, UA, CXR, draw cultures from 2 different sites (urine C/S)

Question 6

What ANC count do you want before administering chemo?

Answer 6

Ideally 1500 but at least 1000

Question 7

What defines high-risk fever and neutropenia?

Answer 7

ANC

Question 8

High-risk RX

Answer 8

Inpatient IV antibx

Question 9

Anemia

Answer 9

Blood transfusion and erythropoietin

Question 10

Wet purpura. What risk do they have?

Answer 10

Seen on mucus membranes. High risk of intracranial bleeds

Question 11

Dry purpura

Answer 11

Seen on skin

Question 12

Types of nausea

Answer 12

Acute- 24 hrs of chemo

Delayed

Question 13

Stimulation of nausea and vomiting

Answer 13

Stimulation of vomiting center in medulla by chemodrugs

Question 14

Nausea drugs?

Answer 14

Zofran, dexamethasone, apepritant and lorazepam

Question 15

General advise on nutrition?

Answer 15

Eat small meals, no alcohol, relaxation techniques and no spicy food

Question 16

Drugs which casue infusional reactions

Answer 16

MABs: Rituximab

Question 17

Rx for infusion reactions

Answer 17

Benadryl, steroids and Epi

Question 18

mucositis

Answer 18

dsgs

Question 19

Diarrhea

Answer 19

Usually self-limiting

Question 20

Diarrhea RFs

Answer 20

GI tumors, old age, hx of colitis

Question 21

Diarrhea Rx

Answer 21

Hydration, diet (BRAT), Loperamide and Octreotide

Question 22

BRAT

Answer 22

Bananas, apples, rice and toast

Question 23

Drugs which casue neuropathy

Answer 23

Vincristine, Vinblastine, Oxaliplatin and Taxanes

Question 24

Key Oxaliplatin toxiticity

Answer 24

Acute cold electric shock-like neuropathy

Question 25

What drugs are rashes common with?

Answer 25

MABs

Question 26

Fever+Nausea

Answer 26

Send patient to ED and possibly start Rx with broad-spec antibx

Question 27

Rx for hot flashes

Answer 27

Venlafaxine (Also an anti-depression)