Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Cancer Care > Oncological emergencies > Flashcards

Oncological emergencies Flashcards

1
Q

What is the definition of neutropenic sepsis?

A
  • Temp. >38 C or signs/symptoms of sepsis

- Neutrophil count <0.5 x10^9/L

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

Why might some patients with neutropenic sepsis not present with a fever?

A
  • inability to mount inflammatory response e.g. on steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

At what point after a chemotherapy course are patients most at risk of neutropenic sepsis?

A

5-10 days after last dose of chemo when neutrophil count reaches its lowest level.

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

A 38 year old lady who has recently had chemo. for breast cancer presents to rapid access cancer clinic with a fever and feeling generally unwell. What is your immediate management?

A
  1. Start IV TAZOCIN asap (4.5g 6 hrly) - or IV meropenem if penicillin allergy.
  2. Blood cultures (from all lumens of Hickmann line + peripheral vein)
  3. MSU + swabs from any Exit site or other infected foci
  4. Bloods: FBC + CRP + UEs + LFTs +/- ABG (glucose + lactate)

Review at 48-72 hrs.

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

A 47 year old man presents with nausea, vomiting, muscle cramps and palpitations. He has recently been diagnosed with ALL and is on day 3 of his 1st cycle of chemo. What is the likely diagnosis? What are the abnormalities seen in this condition?

A

Tumour lysis syndrome.

Excess cell lysis results in increased release of:

  • uric acid
  • potassium
  • phosphate - this precipitates with calcium to form calcium phosphate, causing hypocalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Suggest possible risk factors for the development of TLS

A
  • haematological malignancies - lymphoma and leukaemia, esp. Burkitt’s lymphoma and ALL
  • recent chemo. usually 3-7 days after start
  • high tumour burden
  • chemosensitive tumours
  • aggressive tumours
  • pre-existing renal compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 47 year old man presents with nausea, vomiting, muscle cramps and palpitations. He has recently been diagnosed with ALL and is on day 3 of his 1st cycle of chemo. Which investigations would you perform?

A
  1. ECG

2. Bloods: UEs, calcium, phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you attempt to prevent TLS in a patient undergoing chemotherapy?

A
  1. Pre-hydration + vigorous hydration throughout Tx
  2. Monitoring of electrolytes + fluid balance
  3. ALLOPURINOL or 1 dose IV RASBURICASE if high risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MOA of allopurinol and rasburicase?

A
  • Allopurinol: xanthine oxidase inhibitor that inhibits catabolism of purine to uric acid
  • Rasburicase: synthetic urate oxidase that degrades uric acid to water-soluble allantoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A 47 year old man presents with nausea, vomiting, muscle cramps and palpitations. He has recently been diagnosed with ALL and is on day 3 of his 1st cycle of chemo. His blood results show raised serum uric acid, potassium and phosphate with low calcium. His ECG shows peaked T waves with a prolonged QTc. How would you manage him?

A 
1. Continuous ECG and UO monitoring
Hyperuricaemia:
2. Aggressive hydration (exc. if renal failure or oliguria)
3. IV rasburicase 
Hyperkalaemia:
4. 10 ml 10% calcium gluconate IV
5. Insulin-glucose IV infusion +/- nebulised salbutamol 
Hyperphosphataemia:
6. phosphate binders
Hypocalcaemia:
7. calcium gluconate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the 2 main ways malignancy can cause spinal cord compression.

A
  1. Collapse or compression of a vertebral body containing metastatic disease (arterial seeding)
  2. Direct tumour/paraspinal mass extension into vertebral column (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the effects of metastatic compression on the spinal cord?

A

Initially: oedema, vascular congestion + demyelination - reversible

Prolonged compression: vascular injury, cord necrosis + permanent damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which cancers have the highest incidence of MSCC?

A

Breast, prostate + lung

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

Suggest possible clinical features of MSCC

A
  • prolonged back pain (exacerbated by straight leg raising, coughing, sneezing or straining)
  • gait disturbance + limb weakness
  • sensory loss + paraesthesia (with well-defined dermatomal level)
  • bladder + anal sphincter dysfunction
  • diminished performance status/generally unwell
  • progressive spasticity (increased tone, clonus and hyperreflexia in limbs below level of MSCC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A 72 year old man with a Hx of prostate cancer presents with a 3 day Hx of back pain + difficulty walking. Which Ix would you request?

A

MRI within 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A 72 year old man with a Hx of prostate cancer presents with a 3 day Hx of back pain + difficulty walking. MRI shows MSCC at T12. How would you manage him?

A
  1. Admit for bed rest with log-rolling
  2. 16 mg DEXAMETHASONE + PPI
  3. Radiotherapy (abnormal area + 1-2 vertebrae) or surgery (e.g. balloon kyphoplasty) if patient fit and good prognosis
  4. analgesia, laxatives etc.
17
Q

How would you manage someone presenting with malignant SVCO (immediate + ongoing)?

A

Immediate:

  1. ensure airway if secure. I + V if required.
  2. DEXAMTHASONE IV 10mg bolus followed by 4mg every 6hrs
  3. RT or percutaneous endovascular stenting

Ongoing:
RT or chemo

18
Q

Suggest different mechanisms through which hypercalcaemia of malignancy can occur.

A
  1. PTHrP secretion (80%) e.g. SCC lung, breast: increased bone resorption + renal Ca2+ reabsorption
  2. osteolytic mets with local cytokine release (20%): increased bone resorption
  3. tumour secretion of 1,25-dihydroxyvitamin D (lymphoma): increased intestinal Ca2+ absorption
  4. PTH secretion (parathyroid hormone)
19
Q

A 54yo woman with known breast cancer presents with constipation, nausea, polydipsia + muscle weakness. Which Ix will you perform?

A

Bloods

  1. Ca2+ and corrected Ca2+
  2. U+Es and creatinine: ?AKI
  3. PTH + PTHrP
  4. phosphate: usually decreased

Bedside tests
5. ECG: ?shortened QT interval or arrhythmias

20
Q

How would you manage someone presenting with hypercalcaemia of malignancy?

A

Initiate Tx if symptomatic or Ca2+ >3 mmol/L:

  1. 0.9% NaCl IV: may require several litres at rate of 250-500 ml/hr
    +/- FUROSEMIDE if risk of fluid overload
  2. 4mg IVI ZOLENDRONIC ACID: block osteoclastic bone resorption, response generally over 2-4/7
  3. +/- CALCITONIN: whilst awaiting effects of bisphosphonates

If advanced kidney disease: renal dialysis +/- DENOSUMAB

Year 4 - Cancer Care (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions