oncologic emergencies

Question 1

right now this minute

Answer 1

neutropenic fever, cns mets w/ sxs, tampanode, cord compression

Question 2

today

Answer 2

coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9

Question 3

if not today, tomorrow

Answer 3

SVC Syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9

Question 4

cord compression

Answer 4

MRI / CT [+/- myelogram] of the WHOLE spine

Decadron

Question 5

neurological sxs

Answer 5

ha, seizure, focal neurological deficits, altered mental status

Question 6

neurological metastasis

Answer 6

decadron if edema or focal sx

dilantin if having seizure

Question 7

hyperviscosity

Answer 7

using from waldenstroms
somnolence, dizziness, ha, blurriness
get pt hydrated and apherisis for igm

Question 8

leukostatis

Answer 8

usually in aml

get pt hydrated, quinten access for renal, and chemo

Question 9

tamponade

Answer 9

lung and breast most likely primary

get echo and cytology

Question 10

svc syndrome

Answer 10

most common cause is bronchogenic carcinoma
usually from lung cancer
SOB most common sx

Question 11

tumor lysis syndrome

Answer 11

common w/ all and bur kits lymphoma (high grade lymphoma and leukemia)
can cause renal failure

Question 12

hypercalcemia

Answer 12

breast, lung, multiple myeloma most common cause
Fatigue, N/V, constipation, anorexia, apathy, decreased consciousness most common
tx IV Pamidronate (Aredia)90 mg over 3-4 hrs,
Or if renal function okay, IV Zoledronic (Zometa) acid 4 mg over 15 minutes
know that dialysis, calcitonin (Miacalcin), & steroids are not as effective, but can be used as adjunctive treatment.

Question 13

tx for neutropenic fever

Answer 13

Cefipime, Moxifloxacin, Pip/Gent, Aztreonam

Question 14

how to reverse heparin

Answer 14

ffp or protamine sulfate

Question 15

how to reverse warfarin

Answer 15

FFP or vitamin k