Oncological Emergencies

Question 1

Which cancers are most likely to metastasize to the spinal cord

Answer 1

Lung, breast, prostate

Question 2

Where is the most common location of spine mets

Answer 2

Thoracic spine

Question 3

What are signs of spinal mets (spinal cord compression)

Answer 3

Pain that worsens when lying down or with coughing or bowel movement, Late neurologic signs such as incontinence and loss of sensory function

Question 4

What are PEs to do with suspected spinal cord compression

Answer 4

vertebral percussion, DTRS (increased), Babinski’s, valsalva maneuver.

Question 5

What are ssx of caudal equina

Answer 5

Although it is a compression, it has a lower motor neuron lesion presentation, with decreased DTRs and flaccidity, along with urinary and bowel incontinence or retention, saddle paresis

Question 6

What imaging is done for suspected spinal lesion

Answer 6

X-ray may reveal lytic areas, but CT and MRI are better for intra spinal lesions and compression fractures

Question 7

What common complain should be taken more seriously when in a cancer patient

Answer 7

Complaints of back pain must be thoroughly worked up regardless of whether they think there is a reasonable etiology for said back pain

Question 8

What is appropriate treatment for someone with local pain from indwelling catheter, especially if catheter was for chemotherapy

Answer 8

Send them to the ER for eval since chemo agents tend to be so toxic

Question 9

What are pertinent negatives in a headache workup for R/O of brain tumor or other space occupying brain lesion

Answer 9

Visual field changes, vomiting (projectile or not), focal neurological deficits (weakness, numbness), seizures, mental status change

Question 10

What cancers most commonly metastasize to the brain (5)

Answer 10

lung cancer, breast cancer, renal cell cancer, colon cancer and melanoma

Question 11

What normally causes Superior Vena Cava Syndrome/Obstruction

Answer 11

Usually the result of the direct obstruction of the superior vena cava by malignancies such as compression of the vessel wall by lung cancer, thyroid mass (multi nodular goiter), thymoma, etc

Question 12

What is the most common cause of Superior vena cava syndrome (SVCS)

Answer 12

bronchogenic carcinoma

Question 13

What is the most common cause of paraneoplastic syndrome

Answer 13

bronchogenic carcinoma

Question 14

What are the ssx of SVCS

Answer 14

• Shortness of breath is the most common symptom, followed by facial or arm swelling
• Headache
• Venous distention in the neck and distended veins in the upper chest and arms.
• Lightheadedness
• Cough
• Sleeping propped up

Question 15

What is Trousseau’s sign of malignancy

Answer 15

Episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time

Question 16

What is Trousseau’s sign of hypocalcemia

Answer 16

Carpal spasm from maintaining BP cuff above systolic BP. May also have Chvostek’s sign (tapping of the inferior portion of the cheekbone will produce facial spasms)

Question 17

What is Horner’s syndrome

Answer 17

unilateral anhydrosis, ptosis, myosis

Question 18

What is the classical finding of cardiac tamponade

Answer 18

Beck’s triad: hypotension, muffled heart sounds, JVD

Question 19

What is seen on CXR in cardiac tamponade

Answer 19

Cardiomegaly, clear lung fields “water bottle heart”

Question 20

What labs/imaging are ordered in cardiac tamponade

Answer 20

CXR, then U/S and EKG

Question 21

What is the classic EKG fringing in cardiac tamponade

Answer 21

EKG classically shows electrical aternans as well as low voltage (diminished height) of T waves

Question 22

What is febrile neutropenia

Answer 22

temperature of 101° F (38.3° C) or more and an absolute neutrophil count (ANC) less than 500 per mm3

Question 23

How is cardiac tamponade treated

Answer 23

Cut a hole in the pericardial sack, or use a sclerosis agent to scar down the pericardial sack

Question 24

What are common effects of hypercalcemia

Answer 24

stones (renal or biliary), bones (bone pain), groans (abdominal pain, nausea and vomiting, thrones (constipation and polyuria) and psychiatric overtones (depression 30-40%, anxiety, cognitive dysfunction, coma).

Question 25

What is the most common cause of outpatient hypercalcemia

Answer 25

hyperparathyroid (parathyroid adenoma

Question 26

What is the most common cause of inpatient hypercalcemia

Answer 26

malignancy, and this dramatically reduces their prognosis

Question 27

What is the number one reason malignancy causes hypercalcemia

Answer 27

paraneoplastic production of parathyroid hormone-related hormone, which the body responds to just like it is PTH

Question 28

What are frontline treatments for hypercalcemia

Answer 28

Vigorous saline infusion, Lasix (increases renal calcium excretion), bisphosphonates (to block bone resorption)

Question 29

What is the main finding of SIADH

Answer 29

hyponatremia

Question 30

What is the number one cause of SIADH

Answer 30

small cell lung cancer

Question 31

What medication can induce SIADH

Answer 31

Lithium, d/t its effect on the Kidney

Question 32

What causes tumor lysis syndrome

Answer 32

A result of therapeutic intervention that causes the tumor to die off very quickly

Question 33

What blood electrolyte imbalances are seen in tumor lysis syndrome

Answer 33

Circulating lysed tumor cells may result in hyperuricemia, hyperkalemia, and hyperphosphatemia

Question 34

What are risk factors for DVT

Answer 34

malignancy, oral birth control, stasis, hx of DVT, smoking

Question 35

What are the ssx of DVT

Answer 35

The classic signs of a DVT are unilateral swelling, tenderness and redness in the calf or thigh or groin.
A palpable cord is an added bonus.
deep aching pain is worse with standing or walking

Question 36

What is Homan’s sign

Answer 36

Homan’s sign – discomfort in the calf or behind the knee on dorsiflexion of the foot.