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Specialties > Oncology > Flashcards

Oncology Flashcards

1
Q

What is neutropenic sepsis?

A

Neutropenia (<0.5) + Fever >38.5

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2
Q

What causes neutropenic sepsis?

A

Chemotherapy leads to bone marrow suppression, most commonly due to R-CHOP. Usually occurs 5-12 days (up to weeks) after chemotherapy. Altered microbiome in gut, bacteria enters blood stream.

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3
Q

Management of patient presenting with neutropenic sepsis.

A

Sepsis 6
FBC - to monitor leukocyte level
D dimer and fibrinogen to rule out DIC
Immediate IV broad spec antibiotics eg Tazocin
Granulocyte-colony stimulating factor (stimulates bone marrow to produce granulocytes)

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4
Q

What do you give for neutropenic sepsis prophylaxis post chemotherapy?

A

Ciprofloxacin

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5
Q

What are the risk factors for neutropenic sepsis?

A

Elderly

High dose/long course of chemotherapy

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6
Q

Causes of spinal cord compression

A

Spinal mets
Primary tumour in spine
Crush fracture (associated with spinal mets and steroids)

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7
Q

Presentation of spinal cord compression

A 
Pain - worse on lying down
Weakness
Altered sensation
Cauda equina symptoms
If lesion is below L1 you get LMN symptoms, if above UMN symptoms.
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8
Q

Investigations for spinal cord compression

A

Urgent MRI

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9
Q

Management of spinal cord compression

A

Oral dexamethasone (8mg BD)
Radiotherapy
Decompression surgery
(VTE prophylaxis, catheterisation, bisphosphonates)

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10
Q

Causes of SVC obstruction

A

Primary causes: Lung, thymus, lymphoma, other mediastinal disease, thrombotic disorders (Bechet’s, central line)
Most common in children are ALL and Non-hodgkin’s lymphoma

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11
Q

Presentation of SVC obstruction

A 
Face and arm swelling
Plethora
Cyanosis
Dyspnoea
Engorged veins
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12
Q

Investigation for SVC obstruction

A

Urgent contrast CT

CXR

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13
Q

What special test can you do on examination for SVC obstruction?

A

Pemberton’s sign

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14
Q

How do you treat SVC obstruction?

A

Elevate head
Oxygen
Dexamethasone
Stent

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15
Q

How does malignancy cause hypercalcaemia?

A

Boney mets, myeloma and paraneoplastic tumours eg small cell lung cancer increase osteoclast activity.

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16
Q

Presentation of hypercalcaemia

A 
Stones
Bones
Groans
Thrones
Moans
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17
Q

Investigations of hypercalcaemia

A 
Bone profile (alcium, albumin, phosphate, magnesium and ALP)
PTH
FBC, U+Es, LFTs, 
ECG - short QT 
X-ray - to look for bone mets
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18
Q

Management of hypercalcaemia

A

IV fluids (couple of hours)
Bisphosphonates
Calcitonin
Denosumab

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19
Q

What cells produce calcitonin?

A

Parafollicular cells (C cells)

20
Q

Which cells produce PTH?

A

Chief cells

21
Q

What is Tumour Lysis Syndrome?

A

Rapid breakdown of tumour causes the contents to be release causing raised serum urate, phosphate and potassium. This occurs 12-72 hours after chemotherapy.

22
Q

What are the risk factors for Tumour Lysis Syndrome?

A

Larger tumour

Poor renal function

23
Q

Presentation of Tumour Lysis Syndrome

A 
Fatigue
N+V
Cramps
Weakness
Palpitations
Seizures 
?Chest pain
24
Q

What changes do you see in the blood for Tumour Lysis Syndrome?

A

High urate, phosphate, potassium

Low calcium

25
Q

Management of Tumour Lysis Syndrome

A 
Prophylactic Allopurinol or Rasburicase (to prevent raised urate, if high risk give IV immediately before starting chemotherapy, oral allopurinol during chemotherapy to lower risk groups)
Active management:
IV fluids
IV Rasburicase
Calcium gluconate
Insulin + glucose 
Nebulised salbutamol
Acetazolamide (alkalinises the urine, urate is more soluble at higher pH)
26
Q

Causes of SIADH

A

Small cell lung cancer
Brain - Meningitis, cerebral abscess, tumour
Lung - Pneumonia, TB, sarcoidosis
Metabolic - Alcohol withdrawal, porphyria, hypothyroidism
Drugs - Opiates, carbamazepine, vincristine, cyclophosphamide

27
Q

What does ADH do?

A

ADH acts on distal convoluted tubule and increases aquaporin channels so water is transported into blood.

28
Q

What is the difference between hyperaldosteronism and SIADH?

A

Electrolytes are not affected by SIADH, only dilutional. Where as aldosterone acts on sodium potassium pump

29
Q

How does SIADH present?

A

Mild: Nausea, Malaise, Anorexia
Moderate: Muscle cramps, weakness, confusion, ataxia
Severe: Drowsiness, seizures, coma

30
Q

What causes the cerebral symptoms in SIADH?

A

Dilutional hyponatremia

When sodium levels in the blood become very low, water enters the brain cells and causes them to swell (cerebral edema)

31
Q

Diagnostic criteria of SIADH

A 
Hyponatraemia
Plasma hypo-osmolality 
Urine hyper-osmolality 
Persistent high sodium in urine 
Euvolaemia
Normal thyroid and adrenal function
Elevated ADH level
Low blood uric acid level
32
Q

Investigations for SIADH

A 
U&amp;Es
BP
Urine sodium
Serum ADH
TFTs
Trial of saline - sodium depletion with respond, SIADH will not
33
Q

Treatment for SIADH

A 
Water restriction (0.5-1L/24hr)
Correct sodium deficit (NaCl)
Tolvaptan (competitive vasopressin receptor 2 antagonist)
34
Q

Management of anaphylaxis

A

ABCDE
Adrenaline 1:1000 0.5ml IM - Repeat 3 times
Hydrocortisone 200mg IV
Chlorphenamine 10mg IV
Fluid challenge - 500ml bolus over 5-10 mins

35
Q

Presentation of anaphylaxis

A 
Urticaria 
Angioedema
Stridor
Palpitation
Cyanosis
Hypotension
Tachycardia
Reduced cap refill
36
Q

What type of reaction is anaphylaxis?

A

Type 1 hypersensitivity reaction IgE mediated

37
Q

Causes of haemorrhage in cancer

A

Bone marrow suppression
Liver damage - reduced production of coagulation factors
Anticoagulation prophylaxis
Steroids and NSAIDs

38
Q

What causes massive haemoptysis?

A

Squamous cell lung cancer - floods bronchial tubes so drown on it.

39
Q

What is a frequent complication of head and neck cancers?

A

Carotid artery rupture

40
Q

What causes carotid artery rupture in cancer?

A

Post surgical infection
Ligature failure
Wound breakdown after radiotherapy
Direct tumour invasion

41
Q

How do you prevent carotid artery rupture?

A

Prophylactic ligature of carotid artery rupture

42
Q

How do you treat haemorrhage in cancer?

A 
ABCDE - DON'T LEAVE PATIENT'S BEDSIDE
Tranexamic acid
Fluid
Topical adrenaline 
Midazolam 
Use dark towels
43
Q

Causes of increased ICP

A

Primary CNS tumour

Secondary mets: Breast, bowel, kidney, lung, skin

44
Q

Presentation of increased ICP

A

Headache worse in the morning, worse on sneezing, bending over
Focal neurological signs

45
Q

How do you treat increased ICP

A

Dexamethasone

Manitol

46
Q

Which cancers metastasise to the brain?

A 
Breast
Bowel
Kidney
Lung
Skin

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