Oncologic Emergencies

Question 1

State 4 causes of metabolic oncologic emergencies

Answer 1

Tumor lysis syndrome
Hypercalcemia
Hyponatremia
Hypoglycemia

Question 2

State the electrolyte imbalance in TLS x4

Answer 2

Hyperphosphatemia, hyperkalemia, hyperuricemia
Hypocalcemia

Question 3

Solid tumors that can cause TLS x4

Answer 3

Melanoma
Germ cell tumors
Small cell lung cancer
Inflammatory breast cancer

Question 4

Acute TLS treatment x5

Answer 4

1. Stop chemo
2. Aggressive IV fluids
3. Potassium shifting
4. Emergency hemodialysis
5. Allopurinol for prevention of hyper uricemia

Question 5

Malignant causes of hypercalcemia x5

Answer 5

Breast
Lung
Renal CC
Multiple myeloma
Adult T-cell lymphoma/leukemia

Question 6

Steps involved in potassium shifting x4

Answer 6

1. Calcium gluconate to stabilize the cardiac muscles
2. Give dextrose and insulin
3. Salbutamol promotes K uptake by cells
4. Kayexalate prevents K uptake in the GIT

Question 7

Describe 4 ways in which tumors can cause hypercalcemia

Answer 7

1. Systemic release of parathyroid hormone related peptide by the tumor
2. Systemic secretion of vitamin D analogues
3. Penetration into bone > bone resorption
4. Local stimulation of osteoclasts > osteolytic activity

Question 8

Presentation of hypercalcemia x4

Answer 8

Skeletal pain
Nephrolithiasis
Abdominal discomfort
Altered mental state, reduced LOC

Question 9

Differential diagnosis for SIADH x2

Answer 9

Adverse effects of cytotoxic chemotherapy agents
Ectopic production of atrial natriuretic factor

Question 10

Causes of hyponatremia

Answer 10

SIADH
Small cell lung cancer

Question 11

Clinical symptoms of mild hyponatremia x5

Answer 11

Fatigue
Headache
Memory loss
Impaired abstract thinking
Subtle mental status

Question 12

Clinical symptoms of severe hyponatremia x5

Answer 12

Confusion
Seizures
Coma
Asterixis
Altered mental status

Question 13

Treatment of hyponatremia x3

Answer 13

Fluid restriction or induced diuresis
Demeclocycline to prevent sensitivity to ADH
3% hypertonic saline to treat seizures or coma

Question 14

Treatment of cardiac tamponade x3

Answer 14

Pericardiocentesis
Drainage from sac through catheter
Pericardial stripping ie pericardiectomy

Question 15

Cancers associated with superior vena cava syndrome x5

Answer 15

Lung cancer - right
Breast cancer
Thymoma
Lymphoblastic lymphoma
Primary mediastinal lymphoma

Question 16

Causes of neutropenic sepsis x2

Answer 16

Cancers direct interference with hematopoiesis
Side effect of cytotoxic therapy about 10 days after last dose

Question 16

Areas where spinal cord compression can occur x3

Answer 16

Posterior extension of the vertebral body
Vertebral foramen

Question 17

Define fundus paraproteinaemicus

Answer 17

Dilated engorged veins that resemble sausage links on ophthalmologic exam in Hyperviscosity

Question 18

Clinical consequences of Hyperviscosity x3 per system

Answer 18

Congestive cardiac failure
Pulmonary edema
Ischemic acute tubular necrosis

Question 19

Define kussmauls signs

Answer 19

Paradoxical rise in JVP during inspiration

Question 20

Laboratory findings for Hyperviscosity x5

Answer 20

Thrombocytopenia
Rouleaux formation
Iron deficiency anemia
Renal dysfunction with azotemia
Elevated RBC mass in relation to the blood volume

Question 21

Diseases that predispose patients to leukostasis x2

Answer 21

AML
CML in blast crisis

Question 22

Causes of tissue damage in hyperleukocytosis syndrome x3

Answer 22

Local hypoxia caused by blast cell consumption of O2
Hyperpermeability - blast cell invasiveness
Release of lysosomes and procoagulants