Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

phase 4 > oncology emergencies > Flashcards

oncology emergencies Flashcards

1
Q

cause of febrile neutropenia

A

chemotherapy in past 1-3 weeks as chemo kills WBC
bone marrow involvement
blood cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

definition of febrile neutropenia

A

fever >38
neutrophils <1x10^9
(or other signs of sepsis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

signs of sepsis

A 
wcc <1
temp >37.5
hypotension
confusion
reduced urine output
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

investigations in febrile neutropenia

A

identify source of pathogen
FBC + culture
CXR
MC+S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

treatment of febrile neutropenia

A 
ABCDE
isolation and barrier nurse 
sepsis 6
abx IV within 1 hr - tazocin + gentamycin 
reduce chemo dose with subsequent cycles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

prophylaxis of fertile neutropenia

A

GCSF (granulocytic colony stimulating factor) or co-trimoxazole or fluroquinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

causes of spinal cord compression

A

extradural metastases
crush fracture
haematagenous spread of malignancies
trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

symptoms of spinal cord compression

A

back pain (worse lying down, at night and coughing)
radicular pain
motor, reflex and sensory level
bladder and bowel dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

investigations in spinal cord compression

A

urgent MRI spine

peripheral nerve exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treatment of spinal cord compression

A 
dexamethasone (with PPI cover)
discuss with neuro and oncology
consider radiotherapy or surgery 
analgesia 
bisphosphonates 
anticoagulation/VTE prevention 
hormone deprivation if prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of SVCO

A

lung cancer
thymus malignancy
SVC thrombosis (from central lines, nephrotic syndrome)
fibrotic bands (lung fibrosis after chemo)
thoracic lymph node mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

symptoms of SVCO

A 
headache
dyspnoea 
orthopnoea 
plethora 
thread viens in SVC distribution 
swollen face and arms
engorged neck veins 
purple/blue face congestion
raised fixed non pulsatile JVP
blurred vision
hoarse voice 
worse lying down
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is pemberton’s sign

A

lifting arms above head for >1 min leads to facial plethora, increased JVP and inspiratory stridor due to narrowing of the thoracic inlet - seen in SVCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

investigations in SVCO

A 
sputum cytology
CXR - widespread mediastinum or mass in lung 
CT chest with contrast 
venography
biopsies (US or bronchoscopy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

treatment of SVCO

A 
dexamethasone 
balloon venoplasty 
SVC stenting
radical or palliative chemo/radio
anticoagulation 
keep head up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how would treatment of SVCO differ in SCLC and NSCLC

A 
SC = chemo and radio
NSC = radio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of hypercalcaemia in cancer

A

myeloma - increase osteoclast activity
lymphoma - production of calcitrol leads to increase calcium absorption
ectopic PTH in squamous lung cancer
bony mets - causing osteoclast activity and bone desturction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

which cancers often cause bone mets

A

breast, lung, prostate, thyroid, myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

symptoms of hypercalcaemia

A

BONES - bone pain
STONES - renal stones
MOANS - depression, lethargy, confusion
GROANS - abdo pain, constipation, anorexia, N+V
THRONES - polyuria, polydipsia, dehydration, CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

investigations in hypercalcemia

A 
increase Ca
decreased PTH (need this to exclude primary HPT)
CXR
isotope bone scan 
ECG - short QT, arrhythmias, j wave?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

treatment of hypercalcaemia

A

1) aggressive hydration - NaCl to reduce serum calcium
2) IV furosemide - makes room for more fluid
3) if HPT excluded, give maintenance bisphosphonates to reduce osteoclast activity
4) monitor electrolytes
5) calcitonin? denosumab? steroids?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what would primary HPT show?

A

increase PTH and calcium but normal urinary calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

action of PTH

A

increases bone, kidney and small intestine reabsorption of calcium
increase phosphate excretion from kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

complications of increased calcium

A

renal stones and CKD
arrhythmias
weakness
confusion, coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
symptoms of cauda equina syndrome
bladder and bowel dysfunction back pain lower limb weakness and reduced sensation loss of anal tone
26
symptoms of raised ICP
headache - worse in morning and bending over N+V focal neurological symptoms and fits papilloedema
27
management of raised ICP
CT/MRI dexamethasone radio/chemo
28
what is tumour lysis syndrome
a rapid breakdown of many tumour cells usually in chemo leading to metabolic and electrolyte abnormalities
29
metabolic/electrolyte abnormalities in tumour lysis syndrome
increase in potassium (due to cell degradation) increase in urate increase in phosphate (due to nephrocalcinosis and urinary obstruction) decrease in calcium (due to increased phosphate)
30
risk factors of tumour lysis syndrome
chemotherapy, worse if poor renal function as cannot clear toxins
31
symptoms of tumour lysis syndrome
MURDER muscle cramps/weakness (as increased K) urine abnormalities/AKI/reduced urine output (as uric acid and calcium phosphate crystals in renal tubules) respiratory distress decreased cardiac contractions (palpitations and chest pain) ECG change (tall t waves, short QT, ST seg depression) reflexes fluid overload pulmonary oedema paralytic ileus (abdo pain and constipation)
32
prevent of tumour lysis syndrome
``` IV allopurinol (xanthine oxidase inhibitor, therefore decreases conversion of xanthine to uric acid) IV fluids IV rasburicase (recombinant urate oxidase so metabolises uric acid into allantoin which is more soluble and easily secreted by kidneys ``` give 24hrs before chemo
33
treatment of tumour lysis syndrome
``` IV allopurinol IV fluids IV rasburicase acetazolamide phosphate binders dialyse ```
34
management of chemo anaphylaxis
``` discontinue drug ABCDE fluid resus, O2, IV access 0.5mg 1:1000 IM adrenaline (repeat if no improvement) IV hydrocortisone 100mg IV chlorophenamine 10mg salbutamol ```
35
symptoms of chemo anaphylaxis
oedema, N+V, shock serum tryptase will be high for 12hrs after if true anaphylaxis biphasic reaction cardiac arrhythmia
36
why does cancer cause DVT/PE
surgery and chemo cause vessel wall damage to increase clots immobile change in platelets and clotting factors
37
what is carcinoid syndrome
when neuroendocrine tumours secrete serotonin and kinins e.g. MEN1, gastric carcinomas and bronchial adenoma
38
symptoms of carcinoid syndrome
flushing, diarrhoea, wheeze and palpitations
39
investigations of carcinoid syndrome
increase in 24hr urinary 5 hydroxyindoleatic acid | serum chromogramin A/B
40
treatment of carcinoid syndrome
ocreotide (a somatostatin analogue) pre op | surgical resection
41
what is extravasation
when in chemotherapy the cannula dislodges and the drug causes erosion of the soft tissue, presenting with blistering, pain, redness and inflammation
42
treatment of extravasation
stop drug, steroids, apply cold pack, surgical debridement and plastics
43
how does cancer cause DIC
leads to microvascular thrombosis and consumption of haemostatic factors
44
what are the clotting results in DIC
``` increased PT, APTT and TT reduced fibrinogen thrombocytopenia increased fibrin degradation products fragments RBC ```
45
treatment of DIC in cancer
transfusion of platelets or FFP or recombinant FVIIa or cryoprecipitate
46
AFP tumour marker
HCC, teratoma | hepatitis, cirrhosis, pregnancy
47
CA 125 tumour marker
ovary, uterus, breast | cirrhosis, pregnancy
48
CA 15-3 tumour marker
breast | benign breast disease
49
CA 19-9 tumour marker
pancreas, cholangiocarcinoma, colorectal | cholestasis, pancreatitis
50
CA 27-29 tumour marker
breast
51
neuron specific enolase tumour marker
SCLC
52
CEA tumour marker
colorectal cancer | pancreatitis, cirrhosis
53
BhCG tumour marker
germ cell tumour | pregnancy
54
PSA tumour marker
prostate | BPH
55
mono Ig tumour marker
multiple myeloma
56
S-100 tumour marker
melanoma, schwanomma | sarcoma
57
PLAP tumour marker
seminoma
58
acid phosphatases tumour marker
prostate
59
thyroglobulin tumour marker
thyroid
60
calcitonin tumour marker
medullary thyroid
61
what is neoadjuvant chemo used for
to shrink tumour | control early micro mets
62
what is adjuvant chemo used for
to decrease chance of relapse
63
what is palliative chemo used for
provide relief of symptoms and prolong survival
64
examples of monoclonal antibodies
trastuzumab (anti-Her2) for breast cetuximab (anti-EGFR) for colorectal rituximab (anti-CD20) for NHL
65
examples of tyrosine kinase inhibitors
erlotinib for lung | imatinib for CML
66
examples of endocrine modulators
tamoxifen | anastrazole
67
common chemo side effect
acute = tumour lysis syndrome, neutropenic sepsis, extravasation, anaphylaxis chronic = secondary malignancies, infertility, pulmonary fibrosis, cardiotoxicity, renal impairment MANNA - myleosuppression, alopecia, N+V, neuropathy, anaphylaxis
68
treatment of chemo N+V
prophylactic granisetron/ondansetron (a 5HT3 antagonist) and dexamethasone
69
how does radiotherapy work
ionising radiation forms free radicals which damage DNA, give in daily fractions and use india ink tattoo for reproducible targeting
70
radical vs palliative radio
radical for curative intent | palliative for symptom relief e.g. bone pain, haemoptysis, cough, dyspnoea, bleeding
71
acute side effects of radiotherapy
tired, erythema, ulceration, mucositis, n+v, diarrhoea, cystitis, BM suppression
72
late reactions of radiotherapy
brachial plexopathy, lymphedema, pneumonitis, xerostomia, benign strictures, fistulae, decreased fertility, panhypopituitarism
73
types of surgery used in cancer treatment
diagnostic e.g. tissue biopsy/removal excision palliation e.g. bypass, stenting
74
when should you 2ww
PR bleed >50, PMB, breast changes, frank haematuria
75
what is the assessment called to assess performance status in oncology treatment
ECOG/WHO | 1 = fully active 5 = dead
76
what cytotoxic agent causes pulmonary fibrosis
bleomycin - as it degrades preformed DNA
77
BRCA 2 gene is a RF for what cancers
breast and prostate
78
BRCA 1 gene is a RF for what cancers
breast and colorectal
79
what increases chances of chemo side effects
anxiety, <50 years, opioid use, type of chemo
80
what cytotoxic agent causes haemorrhage cystitis
cyclophosphamide
81
what cytotoxic agent causes peripheral neuropathy
vincristine
82
what cytotoxic agent causes cardiomyopathy
doxorubicin
83
how does a PET scan work
uses flurodeoxyglucose as a radio tracer to see glucose uptake
84
most common cancers to metastasise
prostate breast lung
85
what is the p53 gene
a tumour suppressor gene, cause Li Fraumeni syndrome if it is a germline mutation
86
virus linked to cancer
``` HHV-8 = kaposis HPV = cervical EBV = Hodgkins, nasopharyngeal, Burkitt's H.pylori = MALT Hep B = HCC ```
87
internal vs external beam radiotherapy
``` internal = brachytherapy - radiation source placed near external = high energy X-ray - causes DNA damage and used CT/MRI to target ```

phase 4 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions