Oncological Emergencies

Question 1

What medication can use in partial but not complete malignant bowel obstruction?

Answer 1

Metoclopramide

Question 2

What is the definition of febrile neutropenia?

Answer 2

Single temp > or = 38.3 OR temperature > or = 38.0 for > 1 hour AND ANC < or = 0.5 or < 1 with predicted nadir < 0.5

Question 3

What is the inpatient management of febrile neutropenia?

Answer 3

Broad spectrum:
1. Piptazo +/- gentamycin/tobra +/- Vancomycin

OR

2. Meropenem +/-Vancomycin

Question 4

What is the regimen for outpatient treatment of febrile neutropenia?

Answer 4

Ciprofloxacin (fluoroquinolones) + amoxicillin-clavulanate OR clinda if they are allergic to penicillins

Question 5

What are the most common malignancies that cause hypercalcemia? (3)

Answer 5

Breast CA
Lung CA
MM

Question 6

What are the most common malignancies that metastasize to the epidural space? (4)

Answer 6

Breast
Lung
Prostate
MM

Question 7

How do you work up and treat spinal cord compression suspected to be secondary to malignancy?

Answer 7

1. Urgent MRI whole spine
2. Steroids - Dex 10 mg IV x 1 then 4 mg IV/PO QID
3. Pain Control
4. Consult Spine surgical service and radiation oncology

Question 8

What are the requirements for a diagnosis of TLS?

Answer 8

Requires > or = 2 lab abnormalities within 7 days post-chemo:

1. Hyper K+ (>6.0)
2. Hyper PO4 (>1.45)
3. Hyperuricemia (>476)
4. Hypo Ca2+ (< 1.75)

Question 9

What are the most common malignancies that cause TLS?

Answer 9

Leukemia
Lymphoma
Testicular Ca
Small Cell Lung Ca

Question 10

What are the life-threatening/Grade 4 symptoms of SVC syndrome?

Answer 10

Confusion/Decreased LOC
Stride
Hemodynamically Compromise (including syncope w/o precipitating factor)
Hypotension
Renal Insufficiency

Question 11

Which medication should you use in a complete, malignant bowel obstruction?

Answer 11

Octreotide

Question 12

If medical management fails, what other interventions are available to individuals with malignant bowel obstruction?

Answer 12

Depending on location, intraluminal stent or consideration of a venting G-tube.

Question 13

What is a contraindication to the use of rasburicase?

Answer 13

G6PD deficiency

Question 14

What are the indications for dialysis in tumor lysis syndrome (4)?

Answer 14

(1) Severe oliguria/Anura
(2) Intractable fluid overload
(3) Persistent hyperK
(4) HyperPO4 induced symptomatic hypoCa

Question 15

What is the most common cause of SVC syndrome?

Answer 15

NSCLC