Oncological emergencies Flashcards

1
Q

epidural spinal cord compression

definition

A

tumors found within the vertebral bodies compressing the dural sac
can be primary or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

95% of spine tumors are METS from 3 primary sources

A

breast
lung
prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ssx of cord compression

A
new onset back pain
pain may be localized or radicular
pain worsened by movement
pain unimproved with rest
urinary and bowel incontinence may develop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

which portion of the spine if most often affected in spinal cord compression?

A

thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

examination findings for spinal cord compression?

A
  • the quality of pain is often mimicked by percussion over the affected vertebra
  • the intensity of the pain is often worsened upon valsalva
  • DTR’s may be increased
  • Lower extremity spasticity may develop
  • Babinski’s sign may be positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cauda equina syndrome

definition

A

a subset of spinal cord compression when the nerve roots in the lumbar spine are compressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

examination findings for cauda equina syndrome?

A
  • lower extremity weakness
  • diminished DTR’s
  • lower extremity flaccidity
  • leg and perianal sensory loss
  • urinary retention (instead of incontinence) and constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Imaging of choice for the spine?

A

MRI or CT

Lumbar puncture may be necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx of spinal cord compression?

A

if neurological sx are present –> IV steroids

radiation and/or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ssx of brain tumor?

A
  • altered mental status
  • new onset of h/a or h/a with increasing intensity or frequency
  • visual field changes
  • focal neurologic deficits such as weakness, diminished function or sensation
  • persistent nausea and vomiting
  • stroke
  • seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MC cancers to lead to brain METS are

A
lung 
breast
renal cell
colon
melanoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

work-up for brain tumor?

A
MRI or CT scan
IV Dexamethasone (steroid)
surgery
gamma-knife radiosurgery
IV Mannitol (diuretic to dec spinal fluid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Superior vena cava syndrome/obstruction (SVCS or SVCO)

definition

A

obstruction of the superior vena cava by malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MC malignancy causing SVCS?

A

bronchogenic carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SSX of SVCS?

A
  • SOB
  • facial or arm swelling
  • h/a
  • edema of face, neck, upper extremity
  • venous distention in the neck and distended veins in the upper chest and arms
  • lightheadedness
  • cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DX and Tx of SVC syndrome?

A
MRI
steroids
diuretics
bed rest with elevation of head
chemotherapy to tumor mass
tx with intravenous stents (increasingly common)
17
Q

SSX of cardiac tamponade?

A

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

18
Q

DX cardiac tamponade?

A

CXR- reveals cardiomegaly
US- reveals pericardial effusion
EKG- reveals electrical alternans + low voltage T waves

19
Q

Febrile neutropenia

definition

A

one of the most common complications related to chemotherapy
bacterial infxn common
increasing incidence of fungal infxn

20
Q

SSX of febrile neutropenia?

A

101 degree fever or greater

absolute neutrophil count (ANC)

21
Q

TX of febrile neutropenia?

A

inpatient tx with empiric abx until ANC > 500

22
Q

lab work up for febrile neutropenia?

A

cbc
CMP w/ renal and liver functions
U/A and targeted cultures

23
Q

Tx of cardiac tamponade?

A
  • pericardiocentesis
  • sclerotic tx
  • surgical placement of a pleuropericardial window or pericardiectomy
  • low dose radiation tx
24
Q

hypercalcemia may result from different pathologic processes due to malignancy

A
  • bone lysis + resorption- metastatic breast or prostate CA
  • cytokine production- multiple myeloma
  • tumor production of Parathyroid hormone related protein (PTH-rP)
25
effects of hypercalcemia?
``` stones (renal or biliary) bones (bone pain) groans (abdominal pain, n/v) thrones (constipation & polyuria) psychiatric overtones (depression, anxiety, cognitive dysfunction, coma) ```
26
sx of hypercalcemia?
``` lethargy anorexia n/v confusion obtundation coma ```
27
tx of hypercalcemia?
- saline infusion (to correct dehydration) - IV Lasix (promote renal excretion of calcium) - bisphosphonates (to block bone resorption)
28
Syndrome of inappropriate anti-diuretic hormone (SIADH) | due to
small cell carcinoma of lung
29
Hallmark electrolyte finding of SIADH?
hyponatremia
30
Tx of SIADH?
- fluid intake restriction - demeclocycline (ADH antagonist) - treat CA
31
Tumor lysis syndrome | definition
- occurs in pts with large tumor burden that is very sensitive to chemotherapy - circulating lysed tumor cells may result in hyperuricemia (high uric acid levels NOT urea), hyperkalemia, and hyperphosphatemia
32
Deep venous thrombosis | defintion
thrombosis within the deep veins of the calf, thigh, or pelvis
33
SSX of DVT?
swelling, tenderness, and redness in the calf or thigh or groin a palpable cord Homan's sign- discomfort in the calf or behind the knee on dorsiflexion of the foot
34
Risk factors for DVT?
``` obesity smoking use of HRT long flight local trauma surgery hx of coagulopathy hx of prior DVT ```
35
SSX of pulmonary embolism?
- SOB - pleuritic chest pain, worse with inhalation or cough - tachypnea and tachycardia