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Year 2 Hematology > Oncological emergencies I > Flashcards

Oncological emergencies I Flashcards

1
Q

what is the cause of superficial thoracic varicosities?

A

venous blockage

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2
Q

what is SVC syndrome?

A

any condition benign or malignant that is caused by obstruction of blood flow through to the SVC

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3
Q

the SVC accounts for what % of venous return to the heart?

A

33%

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4
Q

when the SVC is obstructed, how does blood flow back to the heart?

A

venous collateral networks and via IVC or azygous system

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5
Q

what are the signs and symptoms of SVC symptoms that represent true oncological emergencies?

A
  1. edema of larynx and brain

2. confusion, coma

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6
Q

what is the etiology of SVC syndrome?

A
  1. malignancy - 70%
  2. benign - SVC stenosis and/or thrombosis due to intravascular devices
  3. fibrosing mediastinitis - histoplasma capsulatum
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7
Q

what is the most common malignancy causing SVC syndrome?

A

lung cancer

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8
Q

what is the diagnostic test of choice for SVC syndrome?

A

contrast enhanced CT with multiplanar reformation (to outline vasculature)

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9
Q

what is the course of action if thrombosis from an indwelling central venous device is suspected in SVC syndrome?

A

catheter based venography

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10
Q

what are the treatments for SVC

A
  1. alleviate symptoms - early stenting

2. treat underlying disease (radiation, chemo)

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11
Q

what is the treatment of choice for SVC syndrome?

A

endovascular stenting

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12
Q

the success of endovascular stenting depends on what factors?

A

tumor type and anticipated response

severity of symptoms

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13
Q

what is the temperature for a patient with neutropenic fever?

A

single - over 38.3 oral

sustained temp for over an hour over 38

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14
Q

in which case will a patient with neutropenic fever not show a fever?

A

glucocorticoid

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15
Q

what is the absolute neutrophil count in a patient with neutropenic fever?

A

less than 500 cells / microliter

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16
Q

what are the neutropenic fever syndromes?

A
  1. microbiologically documented infection
  2. clinically documented infection
  3. unexplained fever
17
Q

definition: microbiologically documented infection

A

neutropenic fever with a clinical focus of infection AND an associated pathogen

18
Q

definition: clinically documented infection

A

neutropenic fever with a clinical focus but without isolation of an associatedpathogen

19
Q

neutropenic fever is usually induced by what cause?

A

cytotoxic antineoplastic therapy sufficient to suppress myelopoiesis and affect integrity of GI mucosa allowing translocation of bacteria and fungi across intestinal mucosal surfaces

20
Q

what is the immediate treatment for neutropenic fever?

A

empiric antibiotics

21
Q

what lab studies should be performed for neutropenic fever?

A

CBC with differential
LFTs
CMP cultures

22
Q

what radiological test should be performed for neutropenic fever?

A

CXR

23
Q

what are the three main causes of neutropenic fever?

A
  1. direct effect of chemo - majority
  2. obstruction of lymph, bile, GI, urinary
  3. breech in host defense
24
Q

an infection source is found in what % of patients with neutropenic fever?

A

20-30%

25
Q

80% of documented infections in neutropenic fever are believed to arise from what source?

A

endogenous gut flora

26
Q

endogenous gut flora are implicated in what % of neutropenic fever cases?

A

80%

27
Q

risk of infection in a neutropenic fever patient is usually related to what factors?

A
  1. disruption of skin and mucosal membrane barriers
  2. immunological impairment
  3. virulence of pathogen
  4. severity of neutropenia
28
Q

which types of microbes are implicated in neutropenic fever?

A

gram positive
gram negative
fungal
viral

29
Q

which fungal species of account for most of the cases of neutropenic fever?

A

candida and aspergillus

30
Q

which fungal species is the most common cause of central venous catheter-associated infection?

A

candida

31
Q

what is the most common viral cause of neutropenic fever?

A

herpes viruses

32
Q

when should antibiotics be given to a patient with neutropenic fever?

A

immediately after blood cultures are drawn but before other investigations are completed

WITHIN 60 MINUTES OF PRESENTATION

33
Q

what is variable pulse strength with respiration?

A

pulsus paradoxus

34
Q

malignant pericardial disease is most commonly associated with what causes?

A 
lung cancer 
breast cancer 
leukemia 
lymphoma 
previous chemo or radiation
35
Q

what is the diagnostic test of choice for pericardial tamponade?

A

echocardiogram

36
Q

the severity of pericardial tamponade symptoms depend on what main factor?

A

how rapid the accumulation of fluid occurs

37
Q

what is the minimum amount of fluid that can cause tamponade?

A

200 mL

38
Q

what are the signs and symptoms of cardiac tamponade?

A

cough, chest pain, SOB, weakenss

tachycardia, neck vein distension, peripheral edema, diminished heart sounds

39
Q

what is the treatment for cardiac tamponade?

A

drainage via

pericardiocentesis - treatment of choice 
pericardial window (surgery) - for recurrence

Year 2 Hematology (34 decks)

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