Oncological Emergencies Flashcards

1
Q

when should you suspect neutropenic sepsis?

A

> 38 temp

<0.5 x10^9/L

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2
Q

when does neutropenic sepsis usually occur?

A

first 10-14 days

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3
Q

management of neutropenic sepsis

A

tazobactam
piperacillin

if penicillin allergic= gent + vanc + ciprofloxacin

IV fluids

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4
Q

what to use in neutropenic sepsis if penicillin allergy?

A

gentamicin
vancomycin
ciprofloxacin

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5
Q

causes of spinal cord compression

A

vertebral metastasis
retroperitoneal tumours growing through intervertebral foramina
compression of blood supply

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6
Q

which part of the spinal cord is most at risk of compression

A

thoracic spine

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7
Q

presentation of spinal cord compression

A

radicular pain
bowel/urinary changes
weakness/ sensation change

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8
Q

when can surgery be done in spinal cord compression?

A

no more than 1 level affected

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9
Q

management of spinal cord compression

A

dexamethasone + PPI + radiotherapy

bisphosphonates?

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10
Q

causes of superior vena cava syndrome (SVCO)

A
external
internal compression (thrombosis)
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11
Q

presentation of superior vena cava obstruction

A

rapid onset swelling of face, neck and arms
distended veins
SOB
headache

late= injected conjunctiva and sedation

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12
Q

diagnosis of superior vena cava obstruction

A

Pemberton’s test

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13
Q

initial management of superior vena cava obstruction

A

prop patient up

oxygen

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14
Q

internal cause of SVCO management

A

anticoagulation

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15
Q

external cause of SVCO management

A

dexamethasone

stent

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16
Q

when are clinical features more pronounced in SVCO?

A

when obstruction occurs below the azygous vein

17
Q

diagnosis of malignancy-associated hypercalcaemia

A

corrected calcium >2.6mmol/L

18
Q

what does calcium bind to?

A

albumin

19
Q

what causes malignancy associated hypercalcaemia?

A

PTH produced by tumour
tumour produces vit D analogues
local osteolysis

20
Q

what does PTHrP do?

A

stimulates osteoclasts to resorb bone
increases reabsorption of Ca in DCT
production of 1.25 dihydrovitamin D3

21
Q

management of malignancy associated hypercalcaemia

A

saline
bisphosphonates
calcitonin

22
Q

which bisphosphonate is used in malignancy associated hypercalcaemia?

A

pamidronate IV

23
Q

adverse of pamidronate?

A

renal failure if not properly hydrated first

24
Q

why is malignancy associated hypercalcaemia life-threatening?

A

acute pancreatitis
renal failure
coma

25
Q

what is tumour lysis syndrome?

A

chemotherapy leads to cell death with increased urate, K+, phosphate and reduced calcium

26
Q

what does tumour lysis syndrome risk?

A

arrhythmias

renal failure

27
Q

management of tumour lysis syndrome

A

hydration

uricolytics (allopurinol)