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5. Senior Block- Cancer Care > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are the 3 main criteria for diagnosing neutropenic sepsis?

A

Patient undergoing anticancer treatment
Neutrophils <0.5x10˄9/L
Temperature >38

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2
Q

How many days after chemotherapy does neutropenic sepsis tend to occur?

A

7-14 days

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3
Q

Give 4 risk factors for neutropenic sepsis

A 
Active chemotherapy
Extensive field radiotherapy 
Haematological malignancy
Infection risk increased ie. increased exposure to pathogens 
Autoimmune predisposition
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4
Q

Give 3 examples of pathogens that commonly are the cause of neutropenic sepsis

A 
80% are endogenous flora
Staph. aureus
Staph. epidermidis
Enterococcus
Streptococcus
MRSA
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5
Q

How does neutropenic sepsis present?

A 
Tachycardia
Hypotension 
Tachypnoea
Fever
Drowsy
Confused
Sx related to site of infection eg. cough, painful line
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6
Q

What scoring system is used to score neutropenic sepsis?

A

MASCC

Score out of 26, if >21 then low risk

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7
Q

What investigations will be done for a patient with neutropenic sepsis?

A 
FBC
U+Es
LFTs
Lactate
CRP
Blood culture
Urine culture
Sputum culture
Line/wound swab
ABG
Imaging --> CXr, AXr, CAP CT
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8
Q

How is neutropenic sepsis managed?

A

Empirical IV broad spectrum Abx within the hour –> Tazocin or Meropenem
IV fluids –> 0.9% saline 500ml over 1 hour
Catheterise
Escalate to senior

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9
Q

What other longer term management can be given to patients with neutropenic sepsis?

A

Granulocyte Colony Stimulating Factor (GCSF) makes bone marrow produce WBCs

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10
Q

How can neutropenic sepsis be prevented?

A

Patient education
Antibiotic prophylaxis
Decrease dose of further chemotherapy cycles

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11
Q

Describe the pathophysiology of metastatic spinal cord compression

A

Caused by the collapse or compression of a vertebral body that contains metastatic disease or the growth of a primary tumour. This results in compression of the spinal cord.

Over time this leads to vascular injury, cord necrosis and permanent damage .

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12
Q

Which cancers commonly metastasise to bone?

A 
Breast
Prostate
Lung 
Myeloma 
Lymphoma
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13
Q

What are the clinical features of metastatic spinal cord compression?

A 
Back pain --> radicular, prolonged, exacerbated by straight leg raise, coughing, sneezing or straining. 
 Limb weakness
Sensory loss (dermatomal) 
Bladder and anal sphincter dysfunction
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14
Q

Describe the features of cauda equina

A 
Bilateral sciatica 
Impotence
Bladder dysfunction 
Saddle anaesthesia 
Loss of anal tone
Weakness of gluteal muscles
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15
Q

What is the main investigation needed in metastatic spinal cord compression?

A

MRI Spine within 24 hours

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16
Q

How is metastatic spinal cord compression managed conservatively?

A 
Bed rest with log-rolling 
Bladder care 
Physiotherapy 
OT 
VTE prophylaxis
17
Q

How is metastatic spinal cord compression managed medically?

A

Dexamethasone 16mg + PPI protection
Analgesia
Laxatives

18
Q

How is metastatic spinal cord compression managed surgically?

A

Surgery –> relieves compression, removes tumour, stabilises spine

19
Q

How is metastatic spinal cord compression managed palliatively?

A

Radiotherapy

20
Q

What is the pathophysiology of superior vena cava obstruction?

A

Obstruction of blood through the SVC causing occlusion which leads to reduced venous return to the heart.

21
Q

Give 2 causes of extrinsic superior vena cava obstruction?

A

Right sided lung tumour

Superior mediastinal lymphadenopathy –> lymphoma, thymoma, germ cell tumour

22
Q

Give 2 causes of intrinsic superior vena cava obstruction?

A

Thrombosis
Foreign body (central venous catheter)
Tumour

23
Q

Give 4 features of superior vena cava obstruction

A 
Shortness of breath 
Swelling of face, neck and arm 
Choking sensation 
Headache 
Lethargy 
Cough 
Chest pain 
Dysphagia 
Distended neck and chest wall veins
24
Q

What investigations are required in superior vena cava obstruction?

A

Chest x-ray
CT chest with contrast (urgent)
Angiography

25
Q

How is acute superior vena cava obstruction managed?

A

Sit patient up
IV access
100% O2
Dexamethasone 8mg BD

26
Q

How is stable superior vena cava obstruction managed?

A

Chemotherapy
Radiotherapy
Stent

27
Q

What cancers are commonly associated with malignant hypercalcaemia?

A 
Breast 
Squamous cell lung cancer 
Prostate 
Lymphoma 
Myeloma 
Leukaemias
28
Q

What are the 3 main pathological mechanisms of malignant hypercalcaemia?

A

Tumour secretion of parathyroid hormone related peptide

Osteolytic metastases with local cytokine release

Tumour production of vitamin D metabolites

29
Q

Give some clinical features of malignant hypercalcaemia

A 
*Very non-specific*
Fatigue 
Drowsiness
Anorexia 
Dehydration 
Weakness 
Depression 
Seizures 
Nausea
Vomiting 
Polyuria 
Postural hypotension 
Constipation
30
Q

What investigations are required in diagnosing malignant hypercalcaemia?

A 
FBC
U+Es
Ca2+ (corrected) 
PTH/PTHrP
Phosphate 
Myeloma screen 
ECG
31
Q

How is malignant hypercalcaemia managed?

A

Rehydration –> 0.9% saline 3-6L in 24 hours
Monitor U+Es
Bisphosphonates –> 30-60 mg Pamidronate IV over 24 hours
Treat underlying malignancy

32
Q

Describe the pathophysiology of Tumour Lysis Syndrome

A

Massive lysis of rapidly proliferating tumour cells resulting in the release of intracellular contents into the circulation. Occurs 3-7 days after chemotherapy

33
Q

What cancers are commonly associated with Tumour Lysis Syndrome?

A 
High grade lymphoma 
ALL 
Myeloma 
Germ cell tumour 
Breast cancer
34
Q

Give 5 metabolic abnormalities associated with Tumour Lysis Syndrome

A 
Hyperuricemia 
Hyperkalemia 
Hyperphosphatemia 
Hypocalcaemia 
Hypomagnesaemia

Leads to metabolic acidosis

35
Q

What 3 characteristics of a tumour are most likely to predispose to Tumour Lysis Syndrome?

A

Large tumour
Large tumour burden
High proliferation rate

36
Q

Give 5 clinical features of Tumour Lysis Syndrome

A 
N+V
Diarrohea 
Flank pain 
Arrythmias 
Lethargy 
Confusion 
Haematuria 
Syncope 
Hallucinations 
Seizures
Oedema 
Oliguria 
Coma 
Muscle cramps 
Heart failure 
Anorexia
37
Q

What investigations will be carried out to diagnose Tumour Lysis Syndrome?

A 
FBC
U+Es
Ca2+ 
Phosphate 
Magnesium 
Urate 
ABG
ECG
LDH --> tumour burden assessment
38
Q

How is Tumour Lysis Syndrome managed?

A

Urgent correction of hyperkalaemia (with calcium gluconate, insulin)
Monitor fluid balance via U+Es
Need for haemodyalysis

39
Q

How is Tumour Lysis Syndrome prevented?

A

Identify high risk patients early
Keep well hydrated

Low risk –> allopurinol 300mg PO od

High risk –> rasburicase 200 micrograms/kg OD

5. Senior Block- Cancer Care (12 decks)

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