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Hematology > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are oncological emergencies?

A

Any clinical oncological situation that requires diagnostic attention and therapeutic intervention

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2
Q

Varices over the chest is likely due to what cause?

A

Increase pressure/blockage in the IVJ

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3
Q

What are the tumors that can cause Periorbital edema, and respiratory symptoms?

A

Mediastinal tumors

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4
Q

What is superior vena cava syndrome?

A

Ay condition, benign or malignant, that causes obstruction of blood flow through the SVC

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5
Q

What areas does the SVC drain?

A

Head
Arms
Upper torso

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6
Q

What are the ssx of SVC syndrome?

A

JVD
Edema of the head/neck/ upper chest
Larynx

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7
Q

What are the emergency parts of SVC syndrome?

A

Impairment of breathing/pharynx

Confusion/coma

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8
Q

What is the most common malignancy causing SVC syndrome?

A

Lung CA and NHL

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9
Q

What are the benign causes of SVC syndrome?

A

Thrombosis d/t intravascular devices

Fibrosing mediastinitis

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10
Q

What is the diagnostic study of choice for SVC syndrome?

A

CT w/ contrast

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11
Q

Why do you want contrast with imaging for SVC syndrome?

A

Outline venous

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12
Q

What is the treatment for SVC syndrome?

A

SVC stent

Treat underlying disease (xrt or chemo)

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13
Q

Are diuretics indicated for SVC syndrome?

A

No

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14
Q

Are steroids indicated for SVC syndrome?

A

No

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15
Q

The role of stenting in SVC syndrome?

A

Dependent on the tumor type, and the anticipated response to therapy and the severity of the symptoms

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16
Q

Why is it not a big deal about the thrombogenic nature of stents in SVC syndrome?

A

CA has poor prognosis, and they probably will die of CA sooner than the stent

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17
Q

Breast CA with fever, tachycardia, and hypotension is probably what?

A

Infections secondary to myelosuppression

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18
Q

What is neutropenic fever?

A

Neutropenia induced infection and fever

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19
Q

What is the absolute neutrophil count in neutropenic fever?

A
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20
Q

What are the three different syndromes that present in neutropenic fever?

A
  1. Microbiologically documented infection
  2. Clinically documented infection
  3. Unexplained fever
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21
Q

What is the sign of neutropenic fever?

A

Mucositis

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22
Q

What is the treatment for neutropenic fever?

A

Empiric abx/antifungals

Remove infected devices

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23
Q

What are the important bits of evaluating neutropenic fevers? (General, labs (4), imaging)

A 
Meticulous H&P
CBC w/ diff
LFTs
CMP
Cultures

CXR

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24
Q

What is the cause of neutropenic fever?

A

Effects of chemo on mucosal barriers and the immune system

Obstruction of lymphatics, biliary tract, or UG system

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25
Q

What is the cause of most infections in neutropenic fever?

A

Gut flora

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26
Q

What are the usual gram + agents that cause neutropenic fevers?

A

staph strep

27
Q

What are the usual gram -agents that cause neutropenic fevers?

A

e.coli

Pseudomonas

28
Q

What are the usual fungal agents that cause neutropenic fevers?

A

Candida

Aspergillus

29
Q

What are the usual viral agents that cause neutropenic fevers? (4)

A

Herpes simplex
Herpes zoster
CMV
EBV

30
Q

How fast must broad spectrum abx be administered for neutropenic fever?

A

60 minutes

31
Q

Is GSF usually indicated for neutropenic fever?

A

Not usually

32
Q

What is pulsus paradoxus?

A

Variable pulse strength with respiration

33
Q

What is the sensitivity of CXR with pericardial effusion?

A

Very low

34
Q

What is the cause of alternating electrical magnitude on an EKG?

A

Pericardial effusion

35
Q

What is the test of choice for diagnosing a pericardial effusion?

A

Echocardiogram

36
Q

What is pericardial tamponade?

A

Accumulation of fluid in the pericardial sac surrounding the heart

37
Q

Pericardial tamponade is usually caused by what?

A

Malignant disease most commonly Lung CA, beast CA, leukemia, lymphomas or previous chemo

38
Q

What are the ssx of pericardial tamponade?

A

Cough, CP, SOB, weakness

Tachycardia, JVD, peripheral edema

Pulsus paradoxus

39
Q

What is the treatment for pericardial effusion?

A

Pericardiocentesis

40
Q

What is malignant spinal cord compression?

A

Tumor that compresses the spinal cord, that may lead to paraplegia d/t spinal cord infarction

41
Q

What are the common etiologies of malignant spinal cord compression?

A

Lung
Breast
Prostate
Multiple Myeloma

42
Q

What is the most frequent site of spinal cord compression in malignant spinal cord compression?

A

Thoracic

43
Q

What are the SSx of malignant spinal cord compression?

A

Localized back pain worse with movement

Lhermitte’s sign

Bowel and bladder dysfunction

44
Q

What are the ssx of cauda equina?

A

Decreased patella and achilles reflex

LE weakness

Bowel/bladder dysfunction

45
Q

What is the diagnostic study of choice for malignant spinal cord compression?

A

MRIs

46
Q

What is the treatment for malignant spinal cord compression?

A

Steroids
XRT
Surgical intervention

47
Q

What is tumor lysis syndrome?

A

Syndrome caused by the rapid death or cell turnover of a large colume of rapidly proliferating cells

48
Q

What are the characteristics of tumor lysis syndrome (metabolic effects)?

A 
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
Metabolic acidosis
49
Q

What is the major organ damage with tumor lysis syndrome? How?

A

Acute kidney injury

Deposition of uric acid crystals in the renal tubule

50
Q

Why is uric acid increased in tumor lysis syndromes?

A

Metabolism of nucleic acids

51
Q

What causes the hypocalcemia in tumor lysis syndrome?

A

Hyperphosphatemia

52
Q

What is the major issue problem with hyperkalemia in tumor lysis syndrome?

A

Arrhythmias

53
Q

What is the major issues of CaPO3 release in tumor lysis syndrome?

A

Precipitate throughout the body, can cause serious dysrhythmias

54
Q

What causes the inflammatory response seen in tumor lysis syndrome?

A

Release of cytokines

55
Q

What is the primary means of excreting xanthine and phosphate?

A

Renal

56
Q

What are the CAs that are at high risk for tumor lysis syndrome?

A

High grade lymphomas
Acute leukemias
ANy rapidly proliferating tumors

57
Q

What is the prophylactic treatment for tumor lysis syndrome?

A

Hydration
Allopurinol
Rasburicase

58
Q

What is rasburicase?

A

Drug that catalyzes the oxidation of uric acid to the more water soluble allantoin

59
Q

What are the high risk group of tumor lysis syndrome?

A

Preexisting renal insufficiency

Hypotension
Acidic urine

60
Q

What is the acute treatment of tumor lysis syndrome?

A

Dialysis

61
Q

What is the MOA of allopurinol?

A

Blocks the conversion of xanthine and hypoxanthine to uric acid

62
Q

What is the therapy for PE?

A

tPA or heparin

63
Q

When are V/Q scan performed for PEs?

A

Absolute contraindications to contrast

Hematology (32 decks)

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