Oncology cancer diagnosis

Question 1

Neutropenic Fever

Answer 1

Cultures from:
- lumens, skin, line sites, blood, urine, sputum and stool
& sent for bacterial, fungal and viral studies

-Chest x-ray – may appear normal in patient with PNA, as it takes neutrophils to create an infiltrate

CBC with differential, CMP, coagulation panel, UA

PE: oral mucosa, teeth, gums, catheter, sinus, ears, genital, perianal. NO DIGITAL RECTAL

Question 2

Spinal cord compression

Answer 2

MRI

Question 3

Hypercalcemia

Answer 3

Labs: Total serum calcium level and ionized calcium levels are elevated
EKG: may show shortened QT, ST depression and AV blocks

Question 4

Tumor Lysis Syndrome

Answer 4

EKG: may show peaked T waves of hyperkalemia, as well as arrhythmias

Clinical - lethargy, N/V, cloudy urine, and neuromuscular irritability, muscular spasm, seizure and altered mentation associated with hypocalcemia

Question 4

Pericardial Effusion/Cardiac Tamponade

Answer 4

PE: Tachycardia, narrowed pulse pressure, hypotension, distended neck veins, muffled heart sounds, and pulsus paradoxus
Chest x-ray may demonstrate an enlarged cardiac silhouette and pleural effusion
EKG may show sinus tachycardia, low QRS voltage and electrical alternans
Transthoracic echocardiogram is *diagnostic tool of choice *and will demonstrate pericardial effusion with RA systolic collapse and RV diastolic collapse (tamponade)

low QRS wave because there’s no room for the ventricle to expand

Question 5

SVC Syndrome

Answer 5

PE:
Distended neck, arm and chest veins, nonpitting edema of the neck, arm swelling, tongue and facial swelling and cyanosis
**Chest x-ray **may show a widened mediastinum
Chest CT **with contrast **is diagnostic test of choice

Question 6

Thromboembolic Event

Answer 6

PE: low-grade fever, tachypnea, tachycardia, pleural rub and unilateral lower extremity swelling

Spiral chest CT with contrast OR V/Q Scan are diagnostic modalities to confirm diagnosis