Oncological emergencies

Question 1

Risk factors for neutropenic sepsis

Answer 1

5-10 days post chemo, Haematological malignancy, Clozapine, Co-amoxiclav, Carbimazole, DMARDs

Question 2

Investigations for neutropenic sepsis

Answer 2

Bloods (FBC, U+Es, LFTs, Clotting), Blood cultures, Urine sample, Sputum sample, Stool sample, CXR`

Question 3

Management of neutropenic sepsis

Answer 3

Tazocin 4.5g, G-CSF

Question 4

Common tumours causing cord compression

Answer 4

Prostate, Lung, Breast

Question 5

Symptoms of cord compression

Answer 5

Back pain (Severe, at night), Weakness, Parathesia, Urinary retention, Anal incontince

Question 6

Signs of spinal cord compression

Answer 6

Tenderness, LMN signs at the level of the lesion, UMN signs below the level of the lesion

Question 7

Investigation for cord compression

Answer 7

MRI spine

Question 8

Management of cord compression

Answer 8

Dexamethosone 60mg, Radiotherapy, Laminectomy

Question 9

Common causes of SVCO

Answer 9

Lung tumours, Lymohadenopathy, Thrombosis

Question 10

Symptoms of SVCO

Answer 10

SoB, Orthopnoea, Face and arm oedema, Cough, Headache

Question 11

Signs of SVCO

Answer 11

Raised JVP, Stridor, Pemberton sign

Question 12

Define Pemberton sign

Answer 12

Face flushes when arms held up

Question 13

Investigations for SVCO

Answer 13

CXR, CT, Venogram

Question 14

Management of SVCO

Answer 14

Oxygen, Dexamethosone, Diuretics, Anti-coagulate, Radiotherapy, Stenting

Question 15

Tumours at greatest risk of tumour lysis syndrome

Answer 15

Leukaemia, Lymphoma, Myeloma, Germ cell tumours, Small cell lung cancer

Question 16

Risk factors for tumour lysis syndrome

Answer 16

3-7 days post chemo, Dehydration, Pre-existing renal disease

Question 17

Symptoms of tumour lysis syndrome

Answer 17

Oliguria, Cramps, Weakness, Tetany, Seizures

Question 18

U+E results with tumour lysis syndrome

Answer 18

Raised K, Urate, Phosphate, Cr

Reduced Ca

Question 19

Prophylaxis for tumour lysis syndrome

Answer 19

Allopurinol, Hydration

Question 20

Management of tumour lysis syndrome

Answer 20

Rasburicase, IV fluids, Dialysis (if required)

Question 21

Malignant causes of hypercalcaemia

Answer 21

Lytic lesion, PTHrp, Myeloma

Question 22

Symptoms of hypercalcaemia

Answer 22

Lethargy, Anorexia, Nausea, Polydypsia, Polyuria, Confusion, Constipation, Weakness

Question 23

Management of hypercalcaemia

Answer 23

IV fluids, Bisphosphinates