Oncology Emergencies

Question 1

Three mechanisms for hypercalcemia in malignancy

Answer 1

Bone destruction (multiple myeloma, bony mets)
Paraneoplastic syndrome (pth like substance)
Osteoclast activation (lymphoma, leukaemia)

Question 2

Blood work for hypercalcemia

Answer 2

Calcium, pth, get ECG (shortened QT)

Question 3

4 ER treatments of hypercalcemia

Drugs to avoid

Answer 3

Aggressive iv fluid is mainstain
Bisphosphonates (pamidronate, zolendronate)
Calcitonin for first 48-72 hours until bisphophonates are therapeutic
Lasix as needed for volume overload from fluids
No thiazides, no lithium

Question 4

Which conditions are associated with hyperviscosity syndrome

Answer 4

Waldnenstrom macroglobinemia
Multiple myeloma
Leukaemia with blasts
Polycythemia Vera

(Causes of thrombocytopenia, lymphocytosis, neutrophilia, polycythemia)

Question 5

Clinical presentation hyperviscosity syndrome

Answer 5

Blurred vision
Mucosal bleeding
Neuro (AMS, Headache, dizziness)

Question 6

Treatment of hyperviscosity syndrome

Answer 6

Phlebotomy as temporizing measure (or definitive for polycythemia
Plasmapheresis for dysproteinemias
Leukaphoresis for blast transformation
Chemo

Question 7

Most common sources infection and bugs implicated in febrile neutropenia

Answer 7

Resp, GI, urinary, line infection 
Bugs: GP (staph, strep)
GN(uti bugs, pseudomonas)
Consider CMV, herpes
Opportunistic (pjp, fungal)

Question 8

What is typhlitis

Answer 8

Inflammation or necrosis of ileum and cecum in neutropenic patients
High mortality rate 40-50%

Question 9

Management of febrile neutropenia

Answer 9

Hemodynamic support
Broad spectrum iv antibiotics eg piptaz vanco
Source control

Question 10

Which malignancies tend to cause spinal cord compression

Answer 10

Multiple myeloma
Lymphoma
Metastatic cancer (breast, lung, prostate)

Question 11

Presentation of superior vena cava syndrome

Answer 11

Periorbital edema 
Conjunctival suffusion
Facial swelling (usually worst in morning)
Dyspnea from tracheal edema
Neuro symptoms (headache, AMS, coma)

Question 12

Imaging modalities for SVC syndrome

Answer 12

Cxr
CT chest
MRI if thoracic or cervical pain to rule out spinal cord compression (Rubin syndrome)

Question 13

Management of SVC syndrome

Answer 13

Oxygen
Elevate head of bed
Vascular stents for CNS involvement

Question 14

What is the morbidity associated with tumor lysis syndrome

Answer 14

Metabolic derangements can lead to cardiac dysrrhythmias

Renal failure

Question 15

What lab tests suggest tumor lysis syndrome

Answer 15

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

Question 16

Treatment of tumor lysis syndrome

Answer 16

Hyperuric acid: iv hydration, allopurinol
Consider alkalizatiln of urine but controversial as can worsen other metabolic issues
Correct hypo cal and hyper k as usual
Consider hemodialysis for refractory lyte disturbances, volume overload, symptomatic hypocalcemia