Oncology - Emergencies

Question 1

SVC Obstruction - Signs

Answer 1

• Dilated chest wall vessels
• Face and arm swelling
• Cyanosis
• Cough
• Pemberton’s sign (red when lift arms above head)

Question 2

SVC Obstruction - Red Flags

Answer 2

STRIDOR

• Upper airway obstruction
• ABCDE approach
• Fast bleep anaesthetist

Question 3

SVC Obstruction - Imaging

Answer 3

• CT abdo and chest w/ contrast

- MRI if pt allergic

Question 4

SVC Obstruction - Management

Answer 4

ABCDE Approach

• 16mg Dexamethasone with PPI cover
• Stop NSAIDs
• Discuss with seniors
• Refer to clinical oncology for radiotherapy

Question 5

MSCC - Red Flags

Answer 5

• Severe, localised back pain
• Worse when lying down
• Bilateral weakness
• Urinary retention/incontinence
• Constipation/faecal incontinence
• Saddle anesthesia

Question 6

MSCC - Examination

Answer 6

• PR

- Full neurological exam

Question 7

MSCC - Imaging

Answer 7

MRI whole spine

Question 8

MSCC - Managenment

Answer 8

ABCDE Approach

• 16mg Dexamethasone with PPI cover
• Analgesia
• Laxative if constipated, catheter if in retention
• Bisphosphonates to reduce risk of fracture
• Urgent referral to clinical oncology
• Discuss with seniors

Question 9

Multiple Myeloma - Signs

Answer 9

C - High Calcium
R - Renal dysfunction
A - Anaemia
B - Bony pain

Question 10

Multiple Myeloma - Investigations

Answer 10

• Multiple myeloma screen (serum/urine electrophoresis - Bence Jones protein)
• Bone marrow biopsy (diagnostic)

Question 11

Multiple Myeloma - Management

Answer 11

ABCDE

• Pain relief
• Fluid resus
• Treat hypercalcaemia and anaemia if present
• Discuss with seniors - for chemotherapy

Question 12

Hypercalcaemia - Signs

Answer 12

Normal = 2.2 - 2.6

BONES - bone pain
GROANS - abdo pain and constipation
MOANS - confusion, delerium, psychosis
STONES - renal calculi
THRONES - Polyuria

Question 13

Hypercalcaemia - Complications

Answer 13

• Dehydration due to polyuria

- Cardiac arrhythmia, short QT

Question 14

Hypercalcaemia - Investigations

Answer 14

Check corrected calcium (high) and PTH (low)

- If PTH high in high calcium = primary hyperparathyroidism

Question 15

Hypercalcaemia - Management

Answer 15

ABCDE Approach

Rehydration

• 3L per day (250ml/hour)
• Observe for overload

Pamidronate over 2 hours (caution in low eGFR)

Question 16

Neutropenic Sepsis - Classification

Answer 16

Receiving chemotherapy
Fever >38
Neutrophils <0.5

Question 17

Neutropenic Sepsis - Screen

Answer 17

• Chest
• Bowels
• Menigism
• Urinary
• CHECK LINES

Question 18

Neutropenic Sepsis - Management

Answer 18

ABCDE Approach

Broad spectrum Abx

• Consult local guidelines
• Tazocin if no allergies