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First aid and emergency medicine > Oncological emergencies > Flashcards

Oncological emergencies Flashcards

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1
Q

What is superior vena cava syndrome

A

Where superior vena cava is blocked, can’t drain head

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2
Q

what type of cancer is in the brain mostly

A

it is mostly metasis from somwhere else

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3
Q

What type of new pain in a cancer payment should be evaluated immediately

A

New onset back pain,

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4
Q

What increases DVT risk in those with ccancer

A

increase viscosity

indwelling cathater

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5
Q

describe cancer pain in back ca

A

Pain may be localized or radicular
worse with percussion of spinus process**
worsened by movement , but unimproved with rest!
urinary or bowel incontinence cant pee
CAN NOT FIND RELIEF!
Lower extremity weakness
Worse with cough

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6
Q

Which level of spine has the most risk of getting cancer from mets

A

Thorasis

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7
Q

What should you think if somone is always constipated who suddenly move to watery diarrhea

A

That bowel obstruction is so great only diarrheah can get by

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8
Q

Side effects from medications

A

Bowel issue

  • constipation, stasis,
  • Diarrhea - - watery diarrhea
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9
Q

Who should you worry about even without feverwhy bluning fever in cancer

A

Who knows, cytokines or receptors

elderly

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10
Q

what percent of bone cancer is thorasic

A

70%

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11
Q

What PE for bone exam, may you see

A 
Percussion of spinous process
Valsalva maneuver: may make worse
DTR:  may be increased
Lower symptom spasticity
Babinski sign positionve
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12
Q

Cauda equina syndrome

A 
Subset of spinal cord compression
**** lower motor neuron presentation**
DTR deminished 
weak lower extemity
urinary retention/constipation
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13
Q

Imaging of spine
MRI
CT scan

A

Plain film: may miss para spinal lesions that a

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14
Q

what may plain film miss

A

para spinal leesion that are impinging upon neuronal foramina
intra-spinal turmor metasis

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15
Q

What is pathologic fracture

A

Fracture due to structural issue of bone

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16
Q

Treatment of spinal cord compression

A

Steroid: limited use
Radiation: indicatated
- may be followed by chemo

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17
Q

sx of brain cancer mets

Tumor, bleed

A

altered mental status: may precede by months
new onset HA or increased freq intensity**
visual field changes
focal neurolgical deficits
persistent neause and vomiting (projectile)
stroke sezures:

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18
Q

Focal neuroligical deficits

A

Weakness

diminished function or sensation

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19
Q

what is the most common type of tumor found in the brain

A

Mets

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20
Q

Drug problem, chemptherapy, because they are very tissue toxic

A
  • extravactions at Chemo IV place, indwelling catheter
    cool compresses.
    Get it checked out urgent care
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21
Q

Nurological symtoms

A

IV steroids

don’t delay treatment

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22
Q

what is a pertinent negative, on ha

A 
pain, 
visuality aquity changes:  use snellen etc
hx of HA
nausing or Vomiting
muscle testing
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23
Q

what does vomitiong for HA brain pressure cause

A

Projectile

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24
Q

Concern with new onset seizures

A

space occupying leasions untill proven otherwize, unless there is some other obvious reasion.

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25
Q

what is found in about 30% of cancer patients

A

Brain mets

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26
Q

what are the most commin cancers that lead to brain mets

A 
lung ca
breast
renal cell
colon ca
melanoma
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27
Q

what are frequenly given for mets to brain

A

IV steroids to diminish pressure

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28
Q

supervena cava syndrome or obstruction ususallly results from what

A

Direct obstruction by malignances

- compression of vellel wal by lung ca

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29
Q

Gamma knife:

A

used for brain tumor

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30
Q

What often causes superior vena cava syncrome

A
  • right upper lobe tumors
  • thymoma
  • mediasinal lymphadenopathy
  • thrombosis around indwelling cathater
31
Q

what is the most common cause of supervena cava syndrome

A

Brochogenic carcinoma

32
Q

what does superior vena cava look light

A 
halmark: facial and neck swelling 
headache
venous distention
varicositys over chest wall 
SOB is most common sx followed by facial or arm swelling
33
Q

Morning headaches
high hematacritic
apnea

A

Sleep apnea

34
Q

anyone with a solid tissue tumor (esp pancreatic cancer) one can develoep

A

trussos effect
veins pop up and come and go all over the body
Trussoes sign of mal

35
Q

what is trussoes signe of malignancy

A

Incerased thrombossis

causeing crazy vericose

36
Q

Trussoes sign of hypocalcemia

A

crossing thumb over to pinky

37
Q

Extream superior vena cava syndrom

A

cerebral edema
altered conciousnes
seizures
airway obstruction

38
Q

horners syndrome

A

PTossis lid drops

anhydrosis: unilateral not
myosis: pinpoint pupils

39
Q

Becks triad***

A

For cardiac tamponade
muffeled heart sound
JVD
Hypotension

40
Q

why does hypotension happen in cardiac tamponade

A

decreased stroke volume

41
Q

what does chest xr reveal for Cardiac tamponade

A

cardiomegaly

should be middle of spine to edge of chest wall max at very boddtom

42
Q

what does ultrasound reveal: cardiac tamponade

A

pericardial effusion, restricted heart wall motion

43
Q

how much fluid can be in the pericardial sack

A

> 250CC

44
Q

EKG of cardiac tambonaide

A

Electrical alterans : low vultage, lower T waves

45
Q

Who gets cardiac tamponade

A

cancer patients

dyallisis

46
Q

Electrical alterans

A

Patter of ever certain beat, QRS shorter

47
Q

Febrile neutripenia

A

most common complications related to cancer treatment chemo

- 50% of deaths associated with leukemia, lymphomas and solid tumors

48
Q

absolute neutropenia

A

what happens for

49
Q

sx of febrile neutropenia

A

temp 101 or more,

50
Q

what should happen for cancer patients who get fever risht after chemo

A

treatmetn until neutorphil count comes up.

51
Q

Treatment od cardiac tamponade

A 
Remove fluid
Pericardiocentesis
Place a windo in sack
low dose radiation
Sclerotic therapy
52
Q

**Normal rance of calcemia

A

9-10.5 mg/dl

53
Q

most common cause of hypercalcemia outpatient

A

hyperparathyroidism

54
Q

effect of hypercalcemia

A

stones: renal
bones: bone pains
groans: abd pain, N/V
thrones: constipation/polyuria
psychiatric overtones: anxity, depression

55
Q

what specificly raises calcium in cancer patients

A

bone lysis - mets breast or prostate
cytokine production
tumor production: PTH-rp

56
Q

PTH-rH

A 
tumore producing hormones PTHrP that causes body to react the same and increase Ca
Bronchogenic carcinoma (lower than expected PTH)
57
Q

prognosis of hypercalcemia with malignancy

A 
grave prognosis,  1-2 mths of survival time
increased lethargy, 
anorexia, 
nausea
vomit
como
confusiton
58
Q

hypercalcemia treatment

A

Saline infusion to correct the dehyration
Iv Lasix t**o promote renal excretion of calcium
Bisphophonates to block bone resorption. (alendronate)

59
Q

what is the treatment of choice for hypercalcemia***

A

Lasix will promote renal excretion of calcium**

60
Q

syndrome of inappropriate anti diruetic homone production

SIADH

A

Sodium is the electrolyte that is effected the most:

due to ectopic prodiction of anti-diruetic hormone ADH aka vassopressin

61
Q

what is the most common cause of SIADH

A

lung cancer : small cell carcinoma of the lung

62
Q

what is the electrolight effected most in siadh

A

sodiim will be really low, effected first.

Hyponatremia

63
Q

What medication can cause SIADH

A

Hyponatemia: lithium can cause them, its a kidney issue

64
Q

Tumor lysis syndrome when

A

in patient with large tumor burden that is sensitive to chemo and is dying off!
worse in leukemia

65
Q

risk factors for tumor lysis syndrmoe

A

Pre exhisting renal dysfunction: major risk factor

66
Q

how can tumor lysis syndrome effect electrolytes

A

Hyper : uremia, kalemia, phosphatemia

high uric acid, K and phosphate

67
Q

sx of tumor lysis syndromia

A

acute renal failure

68
Q

how are risks of tumor lysis syndrome reduced

A

vigarous hydration before chemo
urine allaline ization before chemo
allopurinol

69
Q

DVT classic pain

A

dull deep aching pain

Ususally made worse by standing or walking or when the leg is in a dependend position

70
Q

Risk factors of DVT

A 
malignance
elevated estrogen
smokeing
long sitting
hx of DVT
71
Q

Classic sign of DVT

A

swelling, tenderness and redness (may look like cellulitis)
Palpable coard
Homans sign: discomfor in calf behind knee

72
Q

Pulmnary embolism

A

Anxiety
sob
chest pain pleuritic
tachypnea

73
Q

where does 2/3 of PE happen in

A

1/3 knkown vascular disease

1/3 post operative

74
Q

Not finnished

A

*

First aid and emergency medicine (3 decks)

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