oncologic emergencies

Question 1

febrile neutropenia

Answer 1

ANC less than 1000 + single oral temp greater than 38.3

Question 2

febrile neutropenia assessment

Answer 2

• very thorough exam, particular attention to skin, oral cavity, catheters, perianal area, often fungemias from nail bed infections (fungal sinus infection also common)

Question 3

febrile neutropenia labs

Answer 3

CMP, CBC with diff, UA
BCX x 2
CXR, sputum CX if respiratory symptoms
GI PCR if diarrhea

Question 4

next step after labs for febrile neutropenia

Answer 4

Risk stratify

Question 5

management of any sort of possible neurologic compromise in cancer patient (including back pain)

Answer 5

image entire spine! (could be metastatic mets)

Question 6

presentation of spinal cord compression

Answer 6

back pain, a dermatome of increased sensation, paralysis of limbs below the level of compression, decreased sensation below the level of compression, urinary and fecal incontinence and/or urinary retention.

Question 7

management of possible cord compression in cancer patient

Answer 7

10 mg IV dexamethasone, and then scan

Question 8

chemo and brain mets

Answer 8

• no role (chemo drugs can’t cross BBB)

Question 9

pericardial window

Answer 9

procedure in which part of pericardium is removed, in order to facilitate drainage (treatment for pericardial effusion)

Question 10

how to confirm SVC syndrome

Answer 10

CT chest with contrast

Question 11

management of hypercalcemia

Answer 11

• hydration with NS (heavy hydration)

- IV bisphosphonates once hydrated

Question 12

SIADH management

Answer 12

• fluid restriction
• Lasix if you have to
• for severe, hypertonic saline, get renal involved

Question 13

SIADH workup

Answer 13

rule out adrenal insufficiency, hypothyroidism