Oncological Emergencies

Question 1

When is neutropenic sepsis most likely to occur?

Answer 1

7-14 days after chemotherapy

Question 2

In neutropenic sepsis, the neutrophil count is less than what?

Answer 2

0.5 x 10 to the 9

Question 3

If it is anticipated that a patient will become neutropenic as a result of their treatment, what antibiotic prophylaxis is offered?

Answer 3

A fluoroquinolone (i.e. ciprofloxacin, levofloxacin)

Question 4

Where there is clinical suspicion of neutropenic sepsis, when should antibiotics be offered?

Answer 4

Immediately

Question 5

What is the empirical antibiotic therapy for neutropenic sepsis?

Answer 5

Piperacillin with tazobactam

Question 6

If patients with neutropenic sepsis are still unwell after 48 hours, what antibiotic regimen should be offered?

Answer 6

Meropenem +/- vancomycin

Question 7

If a patient with neutropenic sepsis is not responding after 4-6 days of antibiotics, what should be investigated for?

Answer 7

Fungal infection

Question 8

What is the most common cause of spinal cord compression?

Answer 8

Extradural metastases

Question 9

What is the investigation of choice for suspected spinal cord compression?

Answer 9

Urgent MRI of the whole spine

Question 10

How is spinal cord compression managed initially?

Answer 10

PO dexamethasone

Question 11

What are some longer term options for the treatment of spinal cord compression?

Answer 11

Radiotherapy or decompressive surgery

Question 12

Which malignancy is most likely to cause SVC obstruction?

Answer 12

Lung cancer

Question 13

What happens to the JVP in SVC obstruction?

Answer 13

It is raised, but not pulsatile

Question 14

What is the investigation of choice for a suspected SVC obstruction with airway compromise?

Answer 14

Urgent contrast-enhanced CT

Question 15

How may an SVC obstruction be managed?

Answer 15

Dexamethasone, balloon venuplasty and SVC stenting

Question 16

What are the 3 main causes of hypercalcaemia of malignancy?

Answer 16

Bony mets, myeloma or production of osteoclast activating factor or PTH related peptide by the tumour

Question 17

How is hypercalcaemia managed?

Answer 17

Rehydration and IV bisphosphonates

Question 18

What is the initial treatment for raised ICP?

Answer 18

PO dexamethasone

Question 19

Tumour lysis syndrome is most likely to occur upon starting chemotherapy for which malignancies?

Answer 19

Leukaemia, lymphoma, myeloma

Question 20

In tumour lysis syndrome, there is a rise in what three things?

Answer 20

Urate, potassium and phosphate

Question 21

How is tumour lysis syndrome prevented?

Answer 21

Good hydration and allopurinol 24 hours before chemotherapy

Question 22

What treatment is indicated for patients with tumour lysis syndrome causing renal failure?

Answer 22

Haemodialysis