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Y4 medicine > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

what is malignant cord compression?

A

radiological evidence of indentation of the thecal sac secondary to cancer

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2
Q

which cancers are associated most bone mets leading to malignant cord compression?

A

lung
breast
kidney
prostate
thyroid

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3
Q

where in the spine do majority of malignant cord compression occur?

A

60% thoracic
30% lumbar
10% cervical

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4
Q

clinical features of cord compression?

A
  • pain (severe, progressive)
  • weakness (typically symmetrical)
  • UMN lesions (increased tone, hyperreflexia, upgoing plantars)
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5
Q

difference in features between cord compression and cauda equina?

A

cord compression: back pain, paralysis, hyperreflexia, +ve babinskis

cauda equina: back pain radiculopathy, reduced anal tone, saddle anaesthesia, paralysis hyporeflexia, hypotonia

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6
Q

Ix to diagnose cord compression

A

MRI = gold standard

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7
Q

Mx of cord compression?

A
  • analgesia
  • VTE prophylaxis
  • high dose dexamethasone
  • radiotherapy as adjuvant to surgery (or stand alone if unable to undergo surgery)
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8
Q

what is malignant hypercalcaemia?

A

serum calcium >2.6mmol/L, secondary to malignant process

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9
Q

what are the most common malignancies associated with hyperparathyroidism?

A

breast cancer
multiple myelom a
lymphoma
lung cancer

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10
Q

what are the 3 main mechanisms that cause malignant hypercalcaemia?

A

osteolytic mets
PTH - related protein (PTHrP) secretion
increased 1,25-dihydroxyvitamin D production

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11
Q

clinical features of malignant hypercalcaemia?

A

‘stones, bones, thrones, abdo groans, psychiatric mones’

renal stones
bone pain
polyuria
abdo pain
psychiatric features

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12
Q

Ix to diagnose malignant hypercalcaemia?

A
  • serum calcium level calcium level >2.6
  • identification of underlying cancer

(measure PTH as in malignant hypercalcaemia the PTH should be suppressed compared to primary hyperparathyroidism)

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13
Q

Mx of malignant hypercalcaemia?

A

IV rehydration, calcitonin and bisphosphonate therapy

admit to hosp if serum calcium >3mmol/L

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14
Q

what is neutropenic sepsis ?

A

fever >38 degrees OR features of sepsis in a pt with pt w/ neutrophil count of <0.5

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15
Q

causes of neutropenia?

A

genetic: congenital neutropenia, chediak-higashi syndrome
acquired: malignancy, infections, drugs, autoimmune

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16
Q

clincial features of neutropenic sepsis?

A

signs of infection: (e.g. pneumonia or UTI)

  • temperature
  • acute confusion
  • tachypnoea
  • low BP
  • tachycardia
  • low urine output
17
Q

Ix to diagnose neutropenic sepsis?

A

Ix to identify source of infection + evidence of organ dysfunction and complications

  • bedside
  • bloods
  • cultures
  • imagine e.g. CXR, LP, ECHO
18
Q

Mx of neutropenic sepsis?

A

SEPSIS 6:
1. give 02
2. IV access, take bloods
3. give IV abx
4. give IV fluids
5. measure urine output
6. measure lactate

19
Q

what is malignant SVCO?

A

obstruction to the flow of blood through the superior vena cava secondary to cancer (from direct tumour growth or lymphadenopathy)

20
Q

most common cancers to cause SVCO?

A

lung carcinoma (70-80%)
non hodgkins lymphoma (10%)

less common:
- thymic
- breast
- mediastinal germ cell tumours

21
Q

clinical features of SVCO?

A

dyspnoea, facial swelling, head fullness, cough, dysphagia, worsening on bending forward, facial plethora, upper limb oedema , distended neck and chest well veins
+ve pembertons sign

22
Q

Ix to diagnose SVCO?

A

CXR - showing abnormality e.g. mediastinal widening or malignant pleural effusion

CT = diagnostic

then diagnose malignancy: tissue biopsy + staging CT

23
Q

Mx of SVCO?

A

conservative: elevation of head and neck, o2 titrated to sats

stenting, radiotherapy and chemo = main tx but dexamethasone can be to reduce swelling

24
Q

what is tumour lysis syndrome?

A

metabolic disturbances arising from breakdown of malignant cells following initiation of treatment for malignancy

25
Q

what electrolyte abnormalities do you get in tumour lysis syndrome?

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia

26
Q

consequences of electrolyte disturbance in tumour lysis syndrome?

A

AKI, arrythmias, sudden death

27
Q

what type of malignancy is tumour lysis syndrome common in?

A

haematological malignancy

28
Q

what factors are associated with developing tumour lysis syndrome?

A
  • high proliferation rate
  • chemosensitivity
  • large tumour burden
  • pre existing metabolic disturbances
  • renal impairment
29
Q

clinical features of tumour lysis syndrome?

A

(tend to occur within first 72 hours following initiation of treatment)

lethargy
n+v
diarrhoea
anorexia
muscle cramps
syncope
pruritus
arthritis
fluid overload
heamaturia
tetany + parasthesia
bronchospasm (wheezing)

30
Q

what Ix are done to diagnose tumour lysis syndrome?

A

renal function, electrolytes, serum urate

+/-
urine dip
urine microscopy
serum lactate
lactate dehydrogenase
ECG
cardiac monitoring

31
Q

what monitoring needs to be done if a pt is at high risk of tumour lysis syndrome

A

renal function, electrolytes and serum urate regularly

32
Q

how is the diagnosis of tumour lysis syndrome made?

A

based on the cairo-bishop definition

lab diagnosis: 2 or more needed
- uric acid >476micromol/L
- K+ > 6mmol/L
- phosphate >1.45mmol/L
- calcium <1.75mmol/L

AND

clin diagnosis: 1 or more needed
- serum creatinine >1.5 upper limit normal
- cardiac arrythmia / sudden death
- seizure

33
Q

what prophylaxis can be given to patient who are at high risk of developing tumour lysis syndrome?

A

oral or IV hydration
allopurinol
rasburicase

34
Q

how is tumour lysis syndrome managed?

A

hyperphosphataemia -> hydration + diet restriction

hyperkalaemia -> IV calcium gluconate, insulin/dextrose infusion and neb salbutamol

hypocalcaemia -> dont treat unless symptomatic in which give IV replacement

renal impairement -> fluids rehydration, adjustment of drug doses, possibly haemofiltration

Y4 medicine (18 decks)

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