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Year 2 Hematology > Oncological emergencies II > Flashcards

Oncological emergencies II Flashcards

1
Q

definition: malignant spinal cord compression

A

compression of the spinal cord or cauda equina by an extra dural tumor leading to ischemia

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2
Q

malignant spinal cord compression occurs in what % of cancer patients?

A

5-10%

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3
Q

what are the common cancer etiologies associated with malignant spinal cord compression?

A

lung, breast, prostate, multiple myeloma

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4
Q

85-90% of malignant spinal cord compression cases are due to what cause?

A

metastatic tumor in vertebral column with tumor growing into epidural space

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5
Q

which part of the vertebral column is the most frequent site for malignant spinal cord compression?

A

thoracic

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6
Q

what are the signs and symptoms of malignant spinal cord compression?

A

localized back pain - first symptom
lhermette’s sign - feeling of an electric shock down spine with neck flexion
motor - weakness, spasticity, reflexes
sensory - numbness, paresthesia

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7
Q

what are the signs and symptoms of cauda equina syndrome?

A 
low back pain 
decreased sensation over buttocks, posterior thigh, perineum (saddle) 
bladder and bowel dysfunction 
decreased patella and achilles reflex 
lower extremity weakness
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8
Q

what is the test of choice for malignant spinal cord compression?

A

MRI

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9
Q

what is the test of choice for patients with malignant spinal cord compression who cannot get an MRI (pacemaker)?

A

CT myelogram

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10
Q

MRI can differentiate between which types of tumors?

A

extradural vs intramedullary / leptomeningeal

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11
Q

what are the treatment options for malignant spinal cord compression?

A 
glucocorticoids 
chemo 
radiation 
surgery 
radiofrequency ablation (for pain resulting from collapsed vertebral body, but NOT cord compression)
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12
Q

tumor lysis syndrome is characterized by what findings?

A 
hyperkalemia 
hyperuricemia 
hyperphosphatemia 
hypocalcemia 
metabolic acidosis 
acute kidney injury
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13
Q

what is the most common disease related emergency in patients with hematologic malignancies?

A

tumor lysis syndrome

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14
Q

what are the two types of tumor lysis syndrome?

A

laboratory

clinical

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15
Q

what is the pathophysiology of tumor lysis syndrome?

A

when cancer cells lyse they release potassium, phosphorus, and nucleic acids which are metaboliszed to eventually uric acid

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16
Q

what is the cause for hypocalcemia in tumor lysis syndrome? what is the result?

A

hyperphosphatemia

leads to neuromuscular irritability, dysrhythmia, seizure

17
Q

how can hyperuricemia cause acute kidney injury?

A 
precipitation into tubules 
renal vaoconstriction 
impaired autoregulation 
decreased renal flow 
oxidation and inflammation
18
Q

how does calcium phosphate cause cardiac dysrhythmias?

A

precipitation into cardiac conduction system

19
Q

how does tumor lysis syndrome cause multiorgan failure?

A

cytokines - systemic inflammatory response syndrome

20
Q

what is the main cause of renal insufficiency in tumor lysis syndrome?

A

crystal induced tissue injury

21
Q

what renders patients with tumor lysis syndrome at high risk for crystal associated acute kidney injury?

A

high levels of both uric acid and phosphate

22
Q

which cancers have high potential for cell lysis?

A

high grade lymphomas
acute leukemias
any rapidly proliferating tumor

23
Q

what are the high risk groups for tumor lysis syndrome?

A 
preexisting chronic renal insufficiency 
oliguria 
volume depletion 
hypotension 
acidic urine
24
Q

what is the management for high risk groups in tumor lysis syndrome?

A

hydration - mainstay
allopurinol - blocks uric acid formation
rasburicase - makes uric acid more soluble

25
Q

what are the most common signs for PE?

A

tachypnea
tachycardia
rales
JVD

26
Q

what test can be used to rule out PE?

A

D dimer

27
Q

what is the test of choice for PE?

A

CT pulmonary angiogram

28
Q

what are the treatments for pulmonary embolus?

A

resuscitation
diagnostic studies
initiation of anticoagulation with LMWH

Year 2 Hematology (34 decks)

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