Question 1

tumour lysis syndrome

Accepted Answer

rapid lysis of tumour cells releases intracellular components ``` results in  Hyperuricemia  Hyperkalemia  Hyperphosphatemia  AKI (uric acid and/or calcium phosphate crystals in the renal tubules)  Hypocalcemia ```

Question 2

RFs tumor types patient specific RFs for tumor lysis syndrome

Accepted Answer

``` o Large tumour burden o Extensive marrow involvement o ALL o Burkitt lymphoma o High chemosensitivity o High proliferation rate ``` ``` pt specific RFS o Renal impairment  Pretreatment hyperuricaemia  Hypovolemia/ Pretreatment diuretic use  Pretreatment LDH high  Urinary tract obstruction from tumor o Pre-existing metabolic abnormalities are associated with TLS ```

Question 3

Sx and signs of tumour lysis

Accepted Answer

``` present 3-7 days post chemo Symptoms o Nausea o Diarrhoea o Anorexia o Lethargy o Seizures o Altered mental status o Muscle cramps ``` ``` Signs o Fluid overload o Haematuria o Tetany & paraesthesia o Weakness o Bronchospasm o Arrhythmias  Peaked T waves, QTc derangement  Primary presentation of malignancy  ‘Spontaneous tumor lysis’ o AKI ```

Question 4

Ix for TLS

Accepted Answer

``` Urea and electrolytes  Metabolic abnormalities: Hyperkalaemia, Hyperphosphatemia, Hyperuricaemia, Hypocalcaemia o Urine dip followed by MC&S o Full blood count o Serum lactate o Basic metabolic panel o Phosphorus o High Lactate dehydrogenase o ECG ```

Question 5

define neutropenic sepsis responsible pathogens

Accepted Answer

 Patient undergoing systemic anticancer treatment (SACT)
 Temp >38
 Neutrophil count < 0.5 x 10 9 per litre or lower
- reaches its lowest level 5 to 10 days after the last dose of chemotherapy

gram +ve cocci; indwelling plastic catheters promote colonisation
- staph aureus, staph epidermidis, enterococcus and streptococcus

fungal candida

Question 6

Sx of neutropenic sepsis signs

Accepted Answer

``` Fever  Symptoms related to a specific system  cough, shortness of breath  Drowsy  Confused ``` ``` signs - Febrile  Tachycardic and hypotensive  Drowsy  Impaired MMSE  Signs of infection? Don’t forget:  Hickmann/Picc Line  Skin wounds/ soft tissue  Mouth ```

Question 7

Ix of neutropenic sepsis

Accepted Answer

``` Blood tests:  FBC (with differential)  U&Es/Renal profile  LFTs (including albumin)  Lactate  CRP ``` Cultures: - Blood – central and peripheral - Urine Swabs:  Lines  Wounds ABG imaging CXR AXR CT/MRI DDx malig related fever chemo related fever PE

Question 8

Mx of neutropenic sepsis

Accepted Answer

- empirical IV ABx within one hour - > TAZOCIN - fluid resuscitation - consider catheterisation - if risk is low switch to oral ABx - GCSF on profoundly septic/neutropenic

Question 9

pathophysiology of malignant spinal cord compression

Accepted Answer

 Usually caused by the collapse or compression of a vertebral
body that contains metastatic disease (arterial seeding)
 10% by direct tumour (paraspinal mass) extension into the
vertebral column
 Compression of cord initially causes oedema, venous congestion
and demyelination which are reversible
 Prolonged compression  vascular injury, cord necrosis and
permanent damage

BLT and kosher pickle

Ix
MRI whole spine

Question 10

signs and Sx of malignant spinal cord compression

Accepted Answer

``` back pain first and prolonged spinal or radicular pain - exarcerbated by straight leg raising, coughing, sneezing or straining - limb weakness - sensory level - bladder and anal sphincter dysfunction diminishing performance status ```

Question 11

examination of MSCC

Accepted Answer

- Acute onset; flaccid paralysis  Progressing over time - Spasticity (increased tone, clonus and hyperreflexia in limbs below level of MSCC  Plantar reflexes up going (not cauda equina)  Sensory loss with well defined dermatonal level  Palpable bladder (urinary retention) Ix full spinal MRI

Question 12

if a pt comes with MSCC

Accepted Answer

Local pathway for rapid diagnosis, treatment,
rehabilitation and on-going care
 Educate high risk patients
 Pain suggestive of spinal mets; MRI within 1 week
 Signs MSCC; MRI within 24 hours
 Admit
 Bed rest with log-rolling
 Dexamethasone 16mg + PPI (unless ?lymphoma)
 Adequate analgesia
 Treatment within 24 hours of diagnosis

Question 13

Mx of MSCC

Accepted Answer

Steroids improve functional outcome stat dex 16mg then 8mg BD til the imaging
 > 48hr no motor function; best supportive care, 1# RT for pain
 SURGERY - relieves compression, removes tumour, stabilises spine
- Continence preserved
- Reduced pain
- Greater degree of mobility
preserved
 Treatment of choice if fit and good prognosis (>3/12)

balloon kyphoplasty

 Good nursing care; care re pressure areas
 Analgesia
 Laxatives
 Bladder care
 Monitor BMs
 VTE prophylaxis
 Physiotherapy
 Occupational therapy

Question 14

prognostic indicators of MSCC

Accepted Answer

``` Multiple myeloma, lymphoma, or breast, prostate or renal cancers  Good motor function at presentation  Good performance status  Limited comorbidity  Single-level spinal disease  Absence of visceral metastasis  Long interval from primary diagnosis  Also for biopsy or stabilisation ```

Question 15

Radiotherapy for MSCC

Accepted Answer

- Majority (extensive disease and poor physiological reserve)  Delivered within 24 hour of confirmation  Relieves compression of the spine and nerve roots by causing cell death in the rapidly dividing tumour tissue  Relieves pain  Stabilises neurological deficit  Life expectancy often measured in months

onco emergencies Flashcards