Oncological emergencies I Flashcards
what is the cause of superficial thoracic varicosities?
venous blockage
what is SVC syndrome?
any condition benign or malignant that is caused by obstruction of blood flow through to the SVC
the SVC accounts for what % of venous return to the heart?
33%
when the SVC is obstructed, how does blood flow back to the heart?
venous collateral networks and via IVC or azygous system
what are the signs and symptoms of SVC symptoms that represent true oncological emergencies?
- edema of larynx and brain
2. confusion, coma
what is the etiology of SVC syndrome?
- malignancy - 70%
- benign - SVC stenosis and/or thrombosis due to intravascular devices
- fibrosing mediastinitis - histoplasma capsulatum
what is the most common malignancy causing SVC syndrome?
lung cancer
what is the diagnostic test of choice for SVC syndrome?
contrast enhanced CT with multiplanar reformation (to outline vasculature)
what is the course of action if thrombosis from an indwelling central venous device is suspected in SVC syndrome?
catheter based venography
what are the treatments for SVC
- alleviate symptoms - early stenting
2. treat underlying disease (radiation, chemo)
what is the treatment of choice for SVC syndrome?
endovascular stenting
the success of endovascular stenting depends on what factors?
tumor type and anticipated response
severity of symptoms
what is the temperature for a patient with neutropenic fever?
single - over 38.3 oral
sustained temp for over an hour over 38
in which case will a patient with neutropenic fever not show a fever?
glucocorticoid
what is the absolute neutrophil count in a patient with neutropenic fever?
less than 500 cells / microliter
what are the neutropenic fever syndromes?
- microbiologically documented infection
- clinically documented infection
- unexplained fever
definition: microbiologically documented infection
neutropenic fever with a clinical focus of infection AND an associated pathogen
definition: clinically documented infection
neutropenic fever with a clinical focus but without isolation of an associatedpathogen
neutropenic fever is usually induced by what cause?
cytotoxic antineoplastic therapy sufficient to suppress myelopoiesis and affect integrity of GI mucosa allowing translocation of bacteria and fungi across intestinal mucosal surfaces
what is the immediate treatment for neutropenic fever?
empiric antibiotics
what lab studies should be performed for neutropenic fever?
CBC with differential
LFTs
CMP cultures
what radiological test should be performed for neutropenic fever?
CXR
what are the three main causes of neutropenic fever?
- direct effect of chemo - majority
- obstruction of lymph, bile, GI, urinary
- breech in host defense
an infection source is found in what % of patients with neutropenic fever?
20-30%
80% of documented infections in neutropenic fever are believed to arise from what source?
endogenous gut flora
endogenous gut flora are implicated in what % of neutropenic fever cases?
80%
risk of infection in a neutropenic fever patient is usually related to what factors?
- disruption of skin and mucosal membrane barriers
- immunological impairment
- virulence of pathogen
- severity of neutropenia
which types of microbes are implicated in neutropenic fever?
gram positive
gram negative
fungal
viral
which fungal species of account for most of the cases of neutropenic fever?
candida and aspergillus
which fungal species is the most common cause of central venous catheter-associated infection?
candida
what is the most common viral cause of neutropenic fever?
herpes viruses
when should antibiotics be given to a patient with neutropenic fever?
immediately after blood cultures are drawn but before other investigations are completed
WITHIN 60 MINUTES OF PRESENTATION
what is variable pulse strength with respiration?
pulsus paradoxus
malignant pericardial disease is most commonly associated with what causes?
lung cancer breast cancer leukemia lymphoma previous chemo or radiation
what is the diagnostic test of choice for pericardial tamponade?
echocardiogram
the severity of pericardial tamponade symptoms depend on what main factor?
how rapid the accumulation of fluid occurs
what is the minimum amount of fluid that can cause tamponade?
200 mL
what are the signs and symptoms of cardiac tamponade?
cough, chest pain, SOB, weakenss
tachycardia, neck vein distension, peripheral edema, diminished heart sounds
what is the treatment for cardiac tamponade?
drainage via
pericardiocentesis - treatment of choice pericardial window (surgery) - for recurrence
