Oncologic Emergencies

Question 1

The oncologic Emergencies include?

Answer 1

SVC syndrome
Pericardial effusion/ tamponade
Intestinal obstruction
Malignant biliary obstruction
Malignant spinal cord compression
Increased Intracranial Pressure
Neoplastic Meningitis
Metabolic Emergencies
Treatment related emergencies (TLS)
Human antibody infusion reactions
HUS
Typhitis
Hemorrhagic cystitis
Hypersensitivity reactions

Question 2

Which is the most common cause of SVC?
A. Mediastinal germ cell tumor
B. Lung carcinoma
C. Hodgkin lymphoma
D. Metastatic Ca

Answer 2

Lung CA

Question 3

Patients with SVC if obstruction is above which structure?

Answer 3

Azygous vein

Question 4

Most common sx of intestinal obstruction secondary to CA

Answer 4

Colicky pain

Question 5

Most common sx of urinary obstruction

Answer 5

Flank pain

Question 6

Earliest radiologic finding of vertebral tumor:

Answer 6

Winking owl sign

Erosion of pedicles

Question 7

Most common CA that metastasize to the brain

Answer 7

Lung CA

Question 8

Most common cause of neoplastic meningitis

Answer 8

Melanoma

Question 9

The following are features of Tumor Lysis syndrome except?
A. Hyperphosphatemia
B. Hypercalcemia
C. Hyperuricemia
D. Hyperkalemia

Answer 9

B- Should be Hypocalcemia

Question 10

Consequence of Hyperphosphatemia in Tumor lysis syndrome
A. Lactic acidosis
B. Ventricular arrhythmias
C. Sudden death
D. Tetany

Answer 10

Tetany and Neuromuscular irritability

Question 11

You are consulted by a patient 6 weeks post chemotherapy with Gemcitabine for lung cancer. He is complaining of dyspnea with associated weakness and fatigue. PE reveals an elevated BP with BP of 200/100. On PE there are crackles. There is also a pericardial friction rub. There is purpura in the extremities. Labs show reticulocytosis, increased LDH. Bilirubin is slightly elevated, Coomb’s test is negative. There is thrombocytopenia with platelet of <100,000. Coagulation profile is normal. There is also azotemia. Urinalysis shows hematuria, proteinuria and granular casts.
What is the tx?

Answer 11

A/I: Hemolytic Uremic Syndrome

P: No optimal tx
Rituximab (?)

Question 12

You are presented with a patient complaining of right lower quadrant pain. He also has associated fever and watery diarrhea. History reveals this patient was previously undergoing treatment for acute leukemia. PE reveals rebound tenderness and a tense distended abdomen. CBC shows neutropenia. CT scan showed marked bowel wall thickening particularly in the cecum with bowel wall edema. What is the tx?

Answer 12

A/I: Typhilitis (Neutropenic enterocolitis)

P: Broad spectrum antibiotic coverage
Nasogastric suction
Surgery if no improvement within 24 hours

Question 13

Due to metabolism of ifosfomide or cyclophosphomide to acrolein

Answer 13

Hemorrhagic cystitis