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Haem/Onc > Oncology Emergencies, ASPHO > Flashcards

Oncology Emergencies, ASPHO Flashcards

1
Q

electorlyte changes in TLS?

A

high uric acid
high K
high Phos
low ca

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2
Q

most common emergency in heme malig?

A

TLS

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3
Q

consequences of TLS?

A

renal insuff
cardiac arrythemia
sz
death

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4
Q

5 sx asscoiated with TLS?

A 
nausea/vom
lethargy
edema
fluid overload
sz
arrythymia
muscle cramp
tetany
altered metanl status
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5
Q

why are purine and phosphate buildup due to DNA breakdown a problem in TLS>

A
  • purines–> hypoxanthine + xanthine + uric acid by xanthine oxidase–> uric acid + calcium phosphate crystalize in the kidney–> neprhopathy, volume overload, electoryte issues
  • hyperphsophatemia–> secondary hypocalcemia–> tetany, arrythmia
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6
Q

RFs for TLS?

A 
WBC>50
large tumor burden
high tumor prolif rate
dehydration, existing kidney injury
tumor infiltration of kidney
resp insuff
burkitt's
WBC>100 in b ALL
WBC>50 in AML
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7
Q

TLS management?

A
  • aggressive IVF: 2-4x maintainence WITHOUT K, Ca, Phos
  • maintain urine output of at least 100 ml/m2/hr
  • forced diuresis with lasix if low urine output
  • No urine alkalinzation! can –> metab alk
  • treat electorlyte abnormaliteis: allopurinol, rasburicase; phosphate binders, K+ binders, diuretics, glucose, insulin, albuterol, only treat high ca if symptomatic(!) because can worsen the renal issue
  • dialysis if renal insuff/oliguria/volume overload/acidosis/persistent lyte derangements not responseive to med management
  • follow urine output, fluid status, TLS labs including IONIZED calcium
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8
Q

how does allopurinol work?

A

xantine oxidase inhibitor (prevents formation of NEW uric acid)

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9
Q

how does rasburicase work?

A

recombinant urate oxidase…breaks down exisitng uric acid

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10
Q

screen for what before giving rasburicase?

A

personal/fax hx of g6pd def

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11
Q

hyperluek defn?

A

WBC >100,000 /mm3

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12
Q

clinically signficiant hyperluek in AML vs ALL?

A

AML:>100k
ALL:>400k

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13
Q

4 dx more likely ot have hperluek?

A

infant leuk, KMT2a rearrs, AML FAB M1/4/5, blast phase CML, t-cell ALL, APL, Ph+ ALL, Ph-like ALL

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14
Q

3 complications of hyperleuk?

A

intraparenchymal brain hemorrahge, pulmonary leukostasis syndrome, severe TLS, DIC

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15
Q

4 clinical features of hyperleuk?

A

resp distress, hypoxemia, altered mental status, stroke, RV overload, priapism, dactylitis

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16
Q

3 ways to tx hyperleuk?

A
  • hyperhydration
  • glucocorticoids
  • HU or induction chemo
  • leukapheresis or exchange transfusion
  • manage TLS/DIC
  • keep plts>50k
17
Q

SVC syndrome?

A

compression fo the mediastinal vessels and/or heart

18
Q

superior mediastinal syndrome=?

A

SVC sydnrome + tracheal compression

19
Q

dx where you seen SVC syndrome/SMS?

A

t-cell all, HL, NHL, germ cell tumours, sarcomas, NBL

20
Q

SVC syndrome/SMS dx how?

A

CXR PA and lateral
echocardiogram
drain effusions
bx mass

21
Q

manage SVC syndrome/SMS how?

A
  • IV access in lower extremity
  • resp support, O2, sit up, recemic epi/heliox
  • drain pericardial/pleural effusions
  • emergent tx: glucocorticoids, empiric chemo, radiation
  • anti-coagulate in thrombosis cause or signficant vasc compression
  • avoid anesthesia, sedation, anxiolytics and intubation
22
Q

why can’t you intubate SVC syndrome pt?

A

obstruction can be below level that ETT reaches

23
Q

issue with sedation in mediastinal mass pts?

A
  • relaxes resp smooth muscle–> obstruction

- decreases resp drive

24
Q

2 RFs for anesthesia with SVC syndrome?

A

tumour>45% of thoracic diam
<50% of predicted trach diameter open
<50% of predicted peak expiratory flow

25
Q

3 causes of increased ICP?

A

-brain tumour
-blocked shunt
-leukemic chloromas
-CNS lymphoma
0infection

26
Q

2 tx –> pseudotumor cerebri?

A

retinoic acid, glucocorticoids

27
Q

3 signs of increased ICP?

A

cushing’s triad
cheyne-strokes respiration
resp arrest

28
Q

worried about increased ICP: 4 next steps?

A
  • CT scan +/- MRI brain
  • Dex 1-2 mg/kg IV
  • hyperosmolar therpay like mannitol or hypertonic saline
  • sedation and ETT
  • ventriculostomy/drain/shunt
  • removal of mass if possible
29
Q

Spinal cord compression: 4 tumours at risk?

A

sarcoma, NBL, GCT, medulloblastoma, AT/RT, lymphoma, chloroma, hematoma after LP

30
Q

imaging for suspected spinal cord compression?

A

Stat MRI spine

31
Q

tx for SCC?

A
  • Dex ASAP
  • surgical decompression
  • radiation
  • chemo
32
Q

F&N take blood cultures from?

A

ALL LUMENS of CVC

33
Q

antibx for F&N?

A

-antipseudomonal 4th gen cephalosporin, beta lactam, or carbapenem …add vanco or 2nd gram neg agent if suspect resistant org

34
Q

when do you d/c tx in F&N?

A

48 hours neg cultures and afebrile x 24 hours AND EVIDENCE OF MARROW RECOVERY

35
Q

fungal work up?

A

fungal cultures, ENT exam of the sinuses, CT chest, AUS

36
Q

3 antifungals for F&N?

A

micafungin, vori, ambisome

Haem/Onc (30 decks)

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