Oncological emergencies

Question 1

epidural spinal cord compression

definition

Answer 1

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

Question 2

95% of spine tumors are METS from 3 primary sources

Answer 2

breast
lung
prostate

Question 3

ssx of cord compression

Answer 3

new onset back pain
pain may be localized or radicular
pain worsened by movement
pain unimproved with rest
urinary and bowel incontinence may develop

Question 4

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

Answer 4

thoracic

Question 5

examination findings for spinal cord compression?

Answer 5

• 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

Question 6

Cauda equina syndrome

definition

Answer 6

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

Question 7

examination findings for cauda equina syndrome?

Answer 7

• lower extremity weakness
• diminished DTR’s
• lower extremity flaccidity
• leg and perianal sensory loss
• urinary retention (instead of incontinence) and constipation

Question 8

Imaging of choice for the spine?

Answer 8

MRI or CT

Lumbar puncture may be necessary

Question 9

Tx of spinal cord compression?

Answer 9

if neurological sx are present –> IV steroids

radiation and/or surgery

Question 10

ssx of brain tumor?

Answer 10

• 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

Question 11

MC cancers to lead to brain METS are

Answer 11

lung 
breast
renal cell
colon
melanoma

Question 12

work-up for brain tumor?

Answer 12

MRI or CT scan
IV Dexamethasone (steroid)
surgery
gamma-knife radiosurgery
IV Mannitol (diuretic to dec spinal fluid)

Question 13

Superior vena cava syndrome/obstruction (SVCS or SVCO)

definition

Answer 13

obstruction of the superior vena cava by malignancies

Question 14

MC malignancy causing SVCS?

Answer 14

bronchogenic carcinoma

Question 15

SSX of SVCS?

Answer 15

• 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

Question 16

DX and Tx of SVC syndrome?

Answer 16

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

Question 17

SSX of cardiac tamponade?

Answer 17

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

Question 18

DX cardiac tamponade?

Answer 18

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

Question 19

Febrile neutropenia

definition

Answer 19

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

Question 20

SSX of febrile neutropenia?

Answer 20

101 degree fever or greater

absolute neutrophil count (ANC)

Question 21

TX of febrile neutropenia?

Answer 21

inpatient tx with empiric abx until ANC > 500

Question 22

lab work up for febrile neutropenia?

Answer 22

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

Question 23

Tx of cardiac tamponade?

Answer 23

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

Question 24

hypercalcemia may result from different pathologic processes due to malignancy

Answer 24

• bone lysis + resorption- metastatic breast or prostate CA
• cytokine production- multiple myeloma
• tumor production of Parathyroid hormone related protein (PTH-rP)

Question 25

effects of hypercalcemia?

Answer 25

stones (renal or biliary)
bones (bone pain)
groans (abdominal pain, n/v)
thrones (constipation & polyuria)
psychiatric overtones (depression, anxiety, cognitive dysfunction, coma)

Question 26

sx of hypercalcemia?

Answer 26

lethargy
anorexia
n/v
confusion
obtundation
coma

Question 27

tx of hypercalcemia?

Answer 27

• saline infusion (to correct dehydration)
• IV Lasix (promote renal excretion of calcium)
• bisphosphonates (to block bone resorption)

Question 28

Syndrome of inappropriate anti-diuretic hormone (SIADH)

due to

Answer 28

small cell carcinoma of lung

Question 29

Hallmark electrolyte finding of SIADH?

Answer 29

hyponatremia

Question 30

Tx of SIADH?

Answer 30

• fluid intake restriction
• demeclocycline (ADH antagonist)
• treat CA

Question 31

Tumor lysis syndrome

definition

Answer 31

• 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

Question 32

Deep venous thrombosis

defintion

Answer 32

thrombosis within the deep veins of the calf, thigh, or pelvis

Question 33

SSX of DVT?

Answer 33

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

Question 34

Risk factors for DVT?

Answer 34

obesity
smoking
use of HRT
long flight
local trauma
surgery
hx of coagulopathy
hx of prior DVT

Question 35

SSX of pulmonary embolism?

Answer 35

• SOB
• pleuritic chest pain, worse with inhalation or cough
• tachypnea and tachycardia