Oncologic emergencies

Question 1

define febrile neutropenia

Answer 1

fever >38 for >1h
Absolute neutrophil count <1500 cells/uL

Question 1

how to calculate absolute neutrophil count

Answer 1

WBC x (%neutrophils + %bands)

Question 2

how can chemo cause febrile neutropenia?

Answer 2

chemo ➔ decreases the immune system ➔ nadir ~1wk after chemo ➔ easier to be infected ➔ fever + low neutrophil counts

Question 3

ix for febrile neutropenia

Answer 3

CBC
find the source – blood cultures x2 + swab anything + urines + stool
imaging for pneumonia etc.

Question 4

tx febrile neutropenia

Answer 4

empiric abx - piptazo, vanco, metronidazole
admit
consult ID and onc
granulocyte colony stimulating factor

Question 5

key s/s of spinal cord compression

Answer 5

progressive back pain not alleviated by anything + bowel or urinary dysfunction

saddle anesthesia, paresthesias etc

Question 6

ix for spinal cord compression

Answer 6

MRI

Question 7

common cancers that cause spinal cord compression

Answer 7

lung
multiple myeloma
prostate

Question 8

tx for spinal cord compression

Answer 8

steroids - dexamethasone +/- PPI w/high dose
consult surgery and radiation – require decompression
pain management - opioids or NSAIDS

Question 9

define leukostasis

Answer 9

increase in immature leukocytes in the blood resulting in decrease blood flow because of aggregate formation and increase of blood viscosity

Question 10

cancer most common to have leukostasis

Answer 10

leukemias and lymphomas

Question 11

s/s of leukostasis

Answer 11

vision changes
ALoC and headaches
SOB

Question 12

tx leukostasis

Answer 12

leukopheresis
fluids
hydroxyurea
tx for potential tumour lysis syndrome: allopurinol

Question 13

define hyperviscosity syndrome

Answer 13

increase blood viscosity because of an increase in serum proteins

Question 14

which cancer most common to have hyperviscosity syndrome

Answer 14

MM - Waldenstrom’s

Question 15

s/s of hyperviscosity syndrome?

Answer 15

vision changes, headache, mucosal bleeding

Question 16

tx of hyperviscosity syndrome

Answer 16

phlebotomy
fluids
plasmapheresis

Question 17

difference between hyperviscosity syndrome and leukostasis

Answer 17

leukostasis results in wbc aggregates blocking the blood fluid whist also increasing blood viscosity

hypervisosity syndrome - blood cells and proteins reuslting int he thickening of the blood

Question 18

define tumour lysis syndrome

Answer 18

increase in phosphate, potassium, and uric acid and a decrease in Ca
when there is an overwhelming about of cellular contents released that the kidney is unable to clear it

Question 19

s/s of tumour lysis syndrome

Answer 19

arrythmias, palpitations
gout s/s - joint pain
N/V cramps, fatigue

Question 20

cancers most common to have tumour lysis syndrome as cx

Answer 20

leukemia bc of induction therapy

Question 21

ix for suspected tumour lysis syndrome

Answer 21

blood work
extended lytes
uric acid
lytes

Question 22

tx for tumour lysis syndrome

Answer 22

fluids
allopurinol
insulin and dex for potassium