Oncological emergencies

Question 1

What is SVCS?

Answer 1

Manifestation of blood flow- obstruction in SVC

Question 2

Symptoms of SVCS?

Answer 2

Facial and arm edema
Distended neck veins
Dyspnea
Hoarseness
Increased ICP

Question 3

How to diagnose SVCS?

Answer 3

CLINICAL! CT, MRI

Question 4

How can we divide SVCS ?

Answer 4

High dynamic and low dynamic

Question 5

Characteristics of high dynamic SVCS?

Answer 5

Life threatening
NO collaterals
Very cyanotic

Question 6

CHaracteristics of low dynamic SVCS?

Answer 6

NOT-life threatening
Collaterals
Less cyanotic

Question 7

Tx of SVCS?

Answer 7

1) VASCULAR INTERVENTION!!!

2) Radio- and chemotx

Question 8

When is SVCS usually seen?

Answer 8

LUNG cancer

Question 9

Which lung cancer is SVCS?

Answer 9

SCLC

Question 10

MC locaization of MSCC?

Answer 10

THoracic spine

Question 11

MC causes of MSCC?

Answer 11

Breast ca
Lung ca
Prostate cs

Question 12

Diagnostic tool for MSCC?

Answer 12

MRI

Question 13

Symptoms of MSCC?

Answer 13

Pain (back pain
Motor dysfunction (weakness, hyperreflexia)
Sensory dysfunction

Question 14

Management of MSCC?

Answer 14

DETECT ANT TREAT ASAP!

• decrompression of spine
• steroids
• opioids
• radio, chemotx

Question 15

Why is it so important to prevent permanent neurological damage in MSCC?

Answer 15

Loss of possibility to give chemo and radiotx

Question 16

Which drug to treat neuropathic pain?

Answer 16

Neurontin (gabapentin)

Question 17

Median survival if MSCC pt?

Answer 17

6 months :(

Question 18

At which day will you see refeeding syndrome?

Answer 18

4TH DAY after refeeding

Question 19

What is seen in labs in refeeding syndrome?

Answer 19

Hypophosphatemia

Question 20

Most important tx of refeeding syndrome?

Answer 20

PREVENTION!

• low calory nutrition dose
• monitor electrolytes, creatinine
• cooperate with other teams

Question 21

What does SIADH cause?

Answer 21

Hyponatremia

Question 22

What is SIADH caused by?

Answer 22

Paraneoplastic s from SCLC (ectopic production)

Question 23

Symptoms of SIADH?

Answer 23

Confusion, lethargy
Weakness
Decreased relfex
Seixures, coma

Question 24

Tx of SIADH?

Answer 24

Fluid restriction
Demeclocycline/Vaptans
Treat cause

Question 25

What should you think about if hypophosphatemia?

Answer 25

refeeding syndrome

Question 26

What should you think about if hyponatremia? Which ca?

Answer 26

SIADH, SCLC

Question 27

What should you think about if hypercalcemia? Which ca?

Answer 27

Paraneoplastic syndrome produces PTH, MYELOMA

Question 28

MC cause of ICP?

Answer 28

MEtastasis: LUNG CA, Renal ca

Question 29

Diagnostic in ICP?

Answer 29

MRI! Most sensitive

Question 30

Symptoms of ICP?

Answer 30

Morning headache Blurry vision Altered consciousness CUSHINGS TRIAD

Question 31

What is Cushing's triad?

Answer 31

Hypertension Irregular RR Bradycardia

Question 32

Tx of ICP?

Answer 32

Elevate head IV mannitol Hyperventilation Dexamethasone

Question 33

In which disease is Beck's triad seen?

Answer 33

Pericardial tamponade

Question 34

In which disease is Cushing's triad seen?

Answer 34

Increased ICP

Question 35

In which disease is Virchow's triad seen?

Answer 35

VTE

Question 36

Symptoms in Virchow's triad?

Answer 36

Endothelial injury, Abnormal blood flow, hypercoagulability

Question 37

Symptoms in Beck's triad?

Answer 37

Jugular vein distention Muffled heart sounds Decreased blood pressure

Question 38

What is carcinoid syndrome?

Answer 38

Well-differentiated neuroendocrine tumor

Question 39

What does carcinoid tumor release?

Answer 39

serotonin, bradykinin, histamine, chromogranin a

Question 40

Symptoms of carcinoid syndrome?

Answer 40

Flushing Diarrhea Dyspnea Heart palp

Question 41

FIRST diagnostic test in carcinoid syndrome?

Answer 41

24 H urine test --> 5 HIAA

Question 42

Tx of carcinoid syndrome?

Answer 42

Octreotide (serotonin analogue)

Question 43

Which dangerous complication of carcinoid syndrome?

Answer 43

Valvular disease

Question 44

MC cause of pericardial tamponade?

Answer 44

Lung ca with metastatic tumors

Question 45

Symptoms of pericardial tamponade?

Answer 45

Becks triad Pulsus paradoxus Pericardial friction rub

Question 46

Tx of pericardial tamponade?

Answer 46

Pericardocentesis prolonged drainage decompression intrapericardial chemotx

Question 47

Cause of tumor lysis syndrome (TLS)?

Answer 47

Massive tumor lysis --> release of K+, phosphate, nucleic acids

Question 48

WHen does TLS occur?

Answer 48

72 hours after chemo start

Question 49

What labs can confirm diagnosis?

Answer 49

25 increase in uric acid, potassium, phosphorus 25% decrease in calcium

Question 50

RF for TLS?

Answer 50

Rapidly growing tumors Very chemosensitive tumor Parient characteristics

Question 51

Most important tx of TLS?

Answer 51

PREVENTION! - IV hydration - Allopurinol - Rascubirase

Question 52

When is Rascubirase contraindicated?

Answer 52

In G6PD deficiency

Question 53

How many of cancer patients get VTE?

Answer 53

10%

Question 54

Tx of VTE?

Answer 54

LMWH