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Oncology APP > oncologic emergencies > Flashcards

oncologic emergencies Flashcards

1
Q

what presentation of hyponatremia constitutes an oncologic emergency?

A

severe hyponatremia with neurologic changes

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2
Q

how to treat euvolemic, severe hyponatremia from SIADH with no neurologic changes

A

free water restriction and treatment of underlying cause

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3
Q

what is the max rate of sodium correction to avoid central pontine myelinolysis?

A

less than 0.5 mEg/L/h

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4
Q

hypertonic saline should be reserved for what patients?

A

those with severe hyponatremia with neurologic symptoms

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5
Q

what drug class bind to the v2 receptor of the collecting ducts where ADH exerts its effects, in order to cause aquaresis?

A

vaptans

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6
Q

for asymptomatic and euvolemic hyponatremia, what is the recommended water restriction?

A

restrict to less than 0.5 to 1 liter per day

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7
Q

to diagnose the cause of hyponatremia, what conditions must be excluded to rule out SIADH

A

hypothyroidism and adrenal insufficiency

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8
Q

what urine osmolality is supportive of the diagnosis of SIADH

A

> 40 mOsm/kg

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9
Q

what is the most common cause of euvolemic hyponatremia?

A

SIADH

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10
Q

what is the differential for hyponatremia in the oncologic setting?

A

SIADH from tumors, brain mets, N/V, several chemotherapy drugs, imatinib, and unrelieved pain

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11
Q

cisplatin, cyclophosphamide, ifosphamide, vinca alkaloids, and imatinib can all cause what condition that can affect nervous system function?

A

hyponatremia

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12
Q

what is the gold standard for evaluating spinal cord compression?

A

MRI

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13
Q

cancer and back pain should be considered what until proven otherwise

A

spinal cord compression

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14
Q

what are the most common causes of spinal cord compression?

A

breast, lung, and prostate cancer (15-20% of cases)

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15
Q

what are the less common causes of spinal cord compression?

A

renal cancer, myeloma, and hodgkin lymphoma (5-10% of cases)

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16
Q

what masses can compress the spinal cord yet present with normal plain spine films and normal bone scans?

A

paraspinous masses. They invade through the intervertebral foramen, most commonly lymphomas, sarcomas, and lung cancer.

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17
Q

cancer patients with back pain with a normal neurologic exam should be evaluated for spinal cord compression within what time frame?

A

24-48 hours

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18
Q

cancer patients with back pain and an abnormal neurologic exam should be evaluated for spinal cord compression within what time frame?

A

immediately

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19
Q

what is a key pharmacologic treatment in spinal cord compression?

A

standard dose of dexamethasone 16 mg bolus IV followed by 4-6 mg q 4-6 hours, followed by rapid taper after resection or radiation therapy

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20
Q

surgical decompression and radiation therapy should be used when?

A

highly selected cases not involving radiosensitive tumors, multiple discrete lesions, only cauda equina or spinal root compression.

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21
Q

what are the life-threatening symptoms of SVC syndrome?

A

central airway obstruction
laryngeal edema
coma from cerebral edema

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22
Q

what imaging is indicated for suspicion of SVC syndrome when there are mild symptoms?

A

CT or MRI

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23
Q

what imaging is indicated for suspicion of SVC syndrome when there are severe symptoms?

A

CT venogram

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24
Q

what is the NCCN recommended approach for life threatening SVC syndrome, non-radiation/non-chemotherapy sensitive malignancies, and non-iatrogenic related SVC syndromes?

A

endovascular stent

25
Q

new onset dyspnea/orthopnea, cough, hoarse voice, stridor, syncope, and/or headaches/mental status changes are all symptoms of what serious condition?

A

SVC syndrome

26
Q

what ecg findings are strongly suggestive of pericardial effusion, and not necessarily cardiac tamponade?

A

electrical alternans

27
Q

what is the name of the classic xray finding for pericardial effusion?

A

water bottle pattern of cardiomegaly

28
Q

what echocardiogram finding is diagnostic for cardiac tamponade?

A

pericardial effusion andright ventricular collapse during diastole

29
Q

hypotension, muffled precordium, and elevated JVP are known as what finding suggestive of tamponade?

A

Beck’s triad

30
Q

what test is the definitive diagnostic test for tamponade?

A

echocardiogram

31
Q

if a bowel obstruction is suspected, what findings are suggestive of a perforation?

A

fever, tachycardia, hypotension, peritoneal signs, ascites

32
Q

what physical exam finding should not be relied on to rule out bowel obstruction?

A

bowel sounds, as they can continue early in the obstruction

33
Q

what is the imaging/lab test workup for a suspected bowel obstruction?

A

CT AP with contrast, CBC, CMP, lactate

34
Q

type of obstruction which is due to insufficient or absent peristalsis

A

functional bowel obstruction

35
Q

what descriptors signify whether the obstruction is inside or outside the bowel?

A

intraluminal or extraluminal.

36
Q

what descriptor signifies that the obstruction is located within the bowel wall?

A

intramural

37
Q

tumor involvement of the enteric nervous system or the celiac plexus, paraneoplastic syndrome, or drug induced ileus can result in what type of bowel obstruction?

A

functional bowel obstruction

38
Q

what are the most common causes of bowel obstruction in patients with cancer?

A

adhesions and tumors

39
Q

what is the term for a bowel obstruction caused by two distinct points of obstruction?

A

closed-loop obstruction

40
Q

what is the term for a bowel obstruction with compromised blood flow to the bowel causing ischemic necrosis?

A

strangulated obstruction

41
Q

when is a strangulated obstruction most likely to occur?

A

in setting of complete bowel obstruction, and more common in closed-loop obstructions.

42
Q

in adults, an intussusception is usually due to what conditions?

A

instrinsic bowl tumor/metastases

43
Q

what is the most common cause of large bowel obstruction?

A

colorectal cancers. 60% are due to this.

44
Q

what is the usual treatment for large bowel obstruction?

A

stent and/or resection

45
Q

how is bowel perforation diagnosed

A

free air seen on imaging studies

46
Q

what is the treatment priority in bowel obstruction and peritonitis?

A

sepsis management. Can include microbiologic evaluation, fluid resuscitation, broad spectrum antibiotics to cover enteric pathogens, and source control (drainage of infected fluid collections and colonic resection)

47
Q

in the initial management of malignant bowel obstruction, what lab finding should raise the suspicion for bowel necrosis?

A

persistent acidosis

48
Q

what common complication of bowel obstruction makes it important to monitor urine output?

A

dehydration

49
Q

what intervention can be considered for nausea and vomiting to decrease the risk of aspiration?

A

nasogastric tube placement

50
Q

for malignant small bowel obstruction with concern for perforation, necrosis, or ischemia, what other features should prompt surgical consideration?

A

closed-loop obstruction, volvulus, intussusception, or small bowel tumor

51
Q

in medical management of malignant bowel obstruction, why is IV hydration important?

A

prevent dehydration and correct electrolyte abnormalities

52
Q

T or F: opioids may be used for pain control with bowel obstructions

A

True, a meta-analysis showed there is no difference in the rate of spontaneous resolution between patients who are treated with opioids and those who are not.

53
Q

in medical management of malignant bowel obstruction, what is recommended in addition to antiemetics to help control nausea?

A

dexamethasone to reduce bowel edema, inflammation, and distension

54
Q

in medical management of malignant bowel obstruction, what agents can be considered to reduce secretions?

A

scopolamine, h2 blockers, glycopyrrolate ( muscarinic receptor antagonist), octreotide ( mimics natural somatostatin pharmacologically, though it is a more potent inhibitor of growth hormone, glucagon, and insulin than the natural hormone)

55
Q

what is the role of the NG tube in medical management of malignant bowel obstruction?

A

decompress the stomach which may facilitate resolution of the obstruction, and may prevent aspiration from gastric contents

56
Q

why monitor NG tube output?

A

to replace fluid losses, and low output (<100 mL in 4 hours) may suggest obstruction has resolved

57
Q

what are the signs and symptoms of a bowel obstruction?

A

nausea, vomiting, abdominal pain, obstipation, abdominal tenderness

58
Q

small bowel malignant bowel obstructions including closed loop, intussuception, volvulus, and small bowel tumors should all be considered for what treatment?

A

surgical resection

59
Q

malignant bowel obstruction is often a harbinger of what?

A

the transition into the terminal phase of the illness and rapid deterioration of clinical status

Oncology APP (9 decks)

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