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emergency medicine > oncological emergencies > Flashcards

oncological emergencies Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

what percentage of spine tumors are metastatic?

A

95%

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2
Q

what are the three most common primary sources of metastatic spinal tumors?

A

breast
lung
prostate

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3
Q

what are characteristic signs of spinal cord copmression due to metastatic dz?

A

pain that worsens when lying down
pain that worsens with percussion of vertebral bodies
incontinence
loss of sensory function

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4
Q

what part of the spine is most commonly affected?

A

thoracic

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5
Q

what is epidural spinal cord compression caused by?

A

a tumor compressing the dural sac

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6
Q

examination findings in epidural spinal cord compression

A 
pain mimicked by percussion over the affected vertebra
pain worsened upon valsalva
DTRs may be increased
lower extremity spasticity may develop
babinski's sign may be positive
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7
Q

signs and symptoms of cauda equina syndrome

A 
lower extremity weakness
diminished DTRs
lower extremity flaccidity
leg and perianal sensory loss
urinary retention
constipation
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8
Q

if neurological symptoms are present (due to spinal cord compression) the patient should receive IV ____

A

steroids

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9
Q

treatment of spinal cord compression

A

immediate radiation therapy

surgical intervention

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10
Q

signs and symptoms or primary and metastatic brain lesions

A

altered mental status
new onset headache or headache with increasing intensity or frequency
visual field changes
focal neurologic deficits such as weakness, diminished function or sensation
persitent nausea and vomiting
stroke
seizures

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11
Q

most common cancers that lead to brain mets

A 
lung
breast
renal cell
colon
melanoma
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12
Q

superior vena cava syndrome

A

direct obstruction of the SVC by malignancies such as compression of the vessel wall by lung cancer

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13
Q

what is the most common malignancy causing SVCS

A

bronchogenic carcinoma

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14
Q

signs and symptoms of SVCS

A 
SOB
facial or arm swelling
headache
venous distention in neck
lightheadedness
cough
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15
Q

sequelae of SVCS

A

cerebral edema
altered state of consciousness
seizures
airway obstruction

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16
Q

horner’s syndrome

A

ptosis
anhydrosis
myosis

17
Q

tx for SVCS

A 
steroids
diuretics
bed rest with elevation of head
chemo with or without radiation
intravenous stents
18
Q

signs and symptoms of febrile neutropenia

A

temp of 101 or more

absolute neutrophil count less than 500 per mm3

19
Q

tx for cancer pts with febrile neutropenia

A

inpatient tx with empiric abx until the ANC reaches a level greater than or equal to 500 per mm3 for 72 hours

20
Q

intial lab evaluation for febrile neutropenia

A 
CBC
metabolic panel
renal and liver functions
U/A
targeted cultures
21
Q

tx for cardiac tamponade

A 
removal of fluid from pericardial space
pericardiocentesis
sclerotic therapy
surgical placement of a pleuropericardial window or pericardiectomy
low dose RT
22
Q

bone lysis and resorption are most commonly due to which two types of cancer

A

metastatic breast

prostate

23
Q

effects of hypercalcemia

A 
stones (renal/biliary)
bones (bone pain)
groans (abdominal pain, N/V)
thrones (constipation, polyuria)
psychiatric overtones (depression, anxiety, cognitive dysfunction, coma)
24
Q

cancer related hypercalcemia increases or decreases prognosis

A

dramatically decreases

25
Q

PTHrP is most commonly associated with which cancers

A

lung
breast
kidney

26
Q

tx of hypercalcemia

A

salin infusion
IV lasix
bisphosphonates

27
Q

syndrome of inappropriate anti-diuretic hormone (SIADH) is most commonly caused by

A

small cell lung ca

28
Q

hallmark electrolyte finding of SIADH

A

hyponatremia

29
Q

symptoms of marked hyponatremia

A

fatigue

altered mental status

30
Q

tx of SIADH

A

fluid intake restriction
demeclocycline (ADH antagonist)
tx underlying cancer

31
Q

pre-existing _____ dysfunction is a major risk factor for tumor lysis syndrome

A

renal

32
Q

circulating lysed tumor cells may result in

A

hyperuricemia
hyperkalemia
hyperphosphatemia

33
Q

tumor lysis syndrome risk can be minimized by

A

vigorous hydration before chemo
urine alkalinization before chemo
tx with allopurinol before chemo

34
Q

risk factors for DVT

A 
malignancy
BCPs
smoking
immobilization/stagnation
use of HRT
obesity
recent surgery to hip or knee
35
Q

classic signs of DVT

A 
swelling
tenderness
redness
palpable cord
homan's sign- discomfort in the calf or behind the knee on dorsiflexion of foot
36
Q

common presenting symptoms of PEs

A

chest pain made worse with deep inspiration or cough
SOB
marked anxiety

emergency medicine (4 decks)

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