Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 6 > ONC > Flashcards

ONC Flashcards

1
Q

list 5 key oncological emergencies

A
  1. neutropenic sepsis
  2. tumour lysis syndrome
  3. hypercalcaemia
  4. SVC obstruction
  5. metastatic spinal cord compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are oncological emergencies?

A
  • Complications of known cancer
  • Complications of treatment
  • Emergency presentations of new cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Commonest organisms in febrile neutropenia

A

Gram +ve organisms commonest today
- Staphylococcus: aureus, coagulase negative
- Enterococcus
- Streptococcus: pyogenes, viridans, pneumoniae
- Corynebacterium pp

Gram –ve organisms commonest in 70s
E.coli, Klebsiella, Pseudomonas, Enterobacter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1st line abx in neutropenic sepsis

A

IV piperacillin/tazobactam 4.5 g QDS

Plus Amikacin

(in penicillin allergy give Meropenem 1g IV TDS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2nd line abx in neutropenic sepsis

A

Meropenem 1g IV TDS

(if no response to 1st line in 48h or if the pt has a penicillin allergy )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prevention of febrile neutropenia

A
  • Dose reduction of chemotherapy
  • Prophylactic GCSF
    typically if risk with chemo regime is >20%
  • Prophylactic antibiotics
    -> Not used routinely
    -> Increased antibiotic resistance and C diff.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mx of metastatic spinal cord compression

A
  • Dexamethasone
  • Pain control
  • Bed rest/log role (spinal precautions).
  • Prophylactic anticoagulation
  • Contact the MSCC co-ordinator as soon as possible (but definitely within 24hrs).
  • Quick management is vital, once neurological function is lost is may not return.
  • neurosurg opinion
  • +/- radiotherapy, chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prognosis in metastatic spinal cord compression

A

Many patients have a poor overall prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is 18-FDG

A

18-fluoro-deoxyglucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T4 dermatome

A

at the level of nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S2 Dermatome

A

S2 dermatome is perineum and back of thigh/calf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1st line med for metastatic spinal cord compression

A

dexamethasone

(pred is not strong enough)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of SVCO

A

Cancer responsible for >90%
- NSCLC (50%), SCLC (20%)
- Lymphoma (10%), other 7%
- GCT 3%
- 2-4% patients with lung ca develop SVCO

Non malignant cause e.g. CV catheter thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

signs of SVCO

A

SOB, stridor
- upper limb and facial oedema
- facial swelling and erythema
neck vein engorgement
dilated superficial veins (e.g. on chest)
- distended neck and chest wall veins as a result of a collateral circulation developing
- arm swelling and distended arm veins
- papilloedema (a late sign)
- stridor (if severe)
- cyanosis (less common).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mx of SVCO

A
  • Dexamethasone
  • +/- anticoagulation (if clot)
  • Biopsy (if new presentation)

NB steroids may impact results so discuss with onc first if new presentation

  • Stenting
    If haemodynamically unstable and/or chemotherapy or radiotherapy not possible.
  • Chemotherapy
    For lymphoma, germ cell and SLCL, response rate up to 80%
  • Radiotherapy
  • Symptomatic improvement within 48hrs, effective in 50-95%, precludes subsequent biopsy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do pts with SVCO get cannon A waves?

A

No

Cannon ‘a’ waves in the JVP are associated with ventricular tachycardia and 3rd degree heart block; they are not seen in SVCO.

17
Q

What are the commonest causes of SVCO?

A
  1. lung cancer
  2. non-Hodgkin’s lymphoma
18
Q

Causes of hypercalcaemia of mlaignancy

A
  • 80% tumour production PTHrP
  • 20% Osteolytic bone mets
  • 1% ectopic PTH secretion, Vit D secreting lymphomas
19
Q

Mx of hypercalcaemia of malugnaancy

A
  • Rehydration
    Normal saline
    Sufficient in mild cases (ca <3.0)
  • Review medication
    Stop thiazides and Ca supplements
  • Bisphosphonates
    Response within 2-4 days, Nadir 7-10 days, effective 90%
  • Investigations
    PTH (?), PTHrP (?)
  • Refractory cases
    Repeat bisphosphonates, calcitonin, steroids
20
Q

With what elevated calcium level will you develop significant sx

A

> 3.0 mmol/L

21
Q

severity of hypercalcaemia levels

A

Mild hypercalcaemia: 2.65–3.00 mmol/L.

Moderate hypercalcaemia: 3.01–3.40 mmol/L.

Severe hypercalcaemia: > 3.40 mmol/L.

adjusted calcium concentration

22
Q

Abnormalities seen in TLS

A

↑ PO4
↑K
↓Ca2+
↑Urate
Acidosis
Resulting in AKI/potential for cardiac arrhythmias/seizures

23
Q

What is TLS?

A

Tumor lysis syndrome

= group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumour cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.

24
Q

Mx of TLS

A
  • FLUIDS!
  • ↑ PO4 - Phosphate binder, furosemide, mannitol
  • ↑K - Insulin/glucose, Ca gluconate

-↓Ca2+ - Correct phosphate

  • ↑Urate - Allopurinol or rasburicase
  • Early discussion regarding dialysis/renal replacement therapy
25
Q

Prevention of TLS

A
  • Important in all intermediate/ high risk patients (e.g. high tumour burden with rapid response to treatment)
  • Prophylactic treatment – e.g. allopurinol/rasburicase (test for 6GPD deficiency)
  • Hydration
  • Monitor electrolytes
26
Q

How does alluporinol prevent TLS?

A

xanthine oxidase inhibitor

less uric acid produced

27
Q

Which chemotherapy agent is associated with hypomagnesaemia?

A

cisplatin

28
Q

What cancer is CA 15-3 a marker for?

A

breast cancers

(cancer antigen 15-3)

29
Q

Which chemotherapy agent is associated with pulmonary fibrosis?

A

Bleomycin may cause pulmonary fibrosis

30
Q

Which chemotherapy agent is known for causing cardiomyopathy?

A

doxorubicin

31
Q

What is the commonest cause of SVCO?

A

small cell lung cancer

32
Q

Which chemotherapy drug causes peripheral neuropathy?

A

vincristine

33
Q

Which chemotherapy agent causes haemorrhagic cystitis?

A

Cyclophosphamide

34
Q

Which opioids in severe renal impairment?

A

fentanyl or buprenorphine

35
Q

What is the first line medication for confusion and agitation in palliative care?

A

oral haloperidol

Year 6 (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions