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Oncology > Oncology & Hematologic Emergencies > Flashcards

Oncology & Hematologic Emergencies Flashcards

1
Q

Right This Minutes Emergencies

A

Neutropenic Fever

Cardiac Tamponade

Cord Compression

CNS metastasis with symptoms

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2
Q

Emergencies for Today

A

Coagulopathy

Tumor lysis

Leukostasis

Hyperviscosity

Severe Thrombocytopenia (<20,000)

INR >9

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3
Q

Urgent Emergencies - by tomorrow

A

SVC Syndrome

Hypercalcemia

CNS metastasis without edema

INR 5-9

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4
Q

Spinal Cord Compression

A

Prostate, Breast, Multiple Myeloma to bone

Sx: Back pain -> inflammation, paresthesias, ANS dysfunction late

Rapid deterioration (days) predicts worse outcome

Usually vertebral metastasis

Dx: MRI/CT

Tx: Decadron (steroids), neurosurgery - especially w/ rapid, radiation

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5
Q

CNS Metastasis with symptoms

A

Lung or breast cancer - adult (most common adult CNS tumor)

Kids = carcinoma, neuroblastoma, germ cell tumor

Sx: HA, seizure, AMS, focal deficits

Dx: MRI

Tx: Decadron for edema or focal sx

  • Dilantin w/ seizure
  • Surgery + radiation improves survival
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6
Q

Vascular event - hyperviscosity

A

Waldenstom’s Macroglobulinemia most common

-also Polycythemia Vera (PV) or Essential Thrombocytosis (ET)

Sx: nonspecific - somnolence, HA, blurry vision, dizzy

Serum viscosity >5 w/ Wald; Hgb >19/20 PV; Platelets >106 ET

Tx: Hydrate, IgM + Chemo

-PV = phlebotomy; ET = hydroxyurea + ASA

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7
Q

Vascular Event - Leukostasis

A

AML/ALL with wbc >100,000 common - CLL/CML rare

Sx: AMS, coma, hypoxia, renal insufficiency

-May worse w/ induction chemo in AML

Tx: Hydrate, chemo for rapid cytoreduction

-Have to watch for tumor lysis syndrome

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8
Q

Cardiac Tamponade

A

Lung & Breast Cancer common - malignant effusions common

Becks Triad: low BP, JVD, muffled heart sounds

Sx: R/L side failure, pulses paradoxus, pericardial rub

EKG: electrical alternans, diffuse ST elevation

Dx: Immediate echo

Tx: Drainage + chemo or CT surgery for chronic

-Simple effusion - NSAIDs and watch for a few days

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9
Q

SVC Syndrome

A

Usually lung cancer - bronchogenic carcinoma

-Also thymoma, breast, mediastinal lymphadenopathy

Sx: Facial edema, asymmetric/symmetric UE edema, SOB w/ hypoxia

Pancoast tumor (apex of lung) presents w/ this

Dx: CT

Tx: Chemo, radiation, heparin/steroids, consider stent

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10
Q

Tumor Lysis Syndrome

A

Tumors w/ high burden/chemosensitivity - leukemia, lymphoma

Or directly related to chemotherapy

Cause HYPERuricemia, HYPERkalemia, HYPERphosphatemia, and HYPOcalcemia - get gout and renal tubule injuries

Sx: N/V/D, anorexia, hematuria, cardiac arrhythmias (Ca and K)

Tx: Hydrate, bicarb for urine pH >7; CMP baseline and monitoring

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11
Q

Treating Hypokalemia

A

Insulin + D50 for quick reversal

-pushes potassium back into cells, D50 to prevent hypoglycemia

Kayexalate binds to potassium in gut and excretes

  • takes time to work, pts develop a tolerance
  • Also treatment for constipation?

Consider dialysis as last-resort

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12
Q

Hypercalcemia

A

Breast, lung, MM common cancers

Can also get PTHrP production - Squamous cell, NHL most common

Sx: Gradual onset - fatigue, N/V/C, anorexia, apathy, decreased consciousness

Tx: volume replete - furosemide

-IV Pamidronate or IV Zoledronic (GFR ok) to prevent bone breakdown

Predicts short survival if w/ cancer

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13
Q

SIADH

A

SCLC most common

Causes dilutional hyponatremia w/ water retention

Labs: Decreased BUN and serum osmolarity with increased urine osmolarity and sodium

Tx: Treat tumor, water restriction, furosemide, parenteral Na replacement if severe

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14
Q

SIADH Na <120 Symptoms

A

Anorexia

Irritable

N/V

Constipation

Muscle weakness

Myalgias

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15
Q

SIADH Na <100 Symptoms

A

Seizure

Coma

Death

Abnormal reflexes

Papilledema

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16
Q

Neutropenic Fever

A

Usually a result of chemo rather than marrow malignancy

Sx: Subtle then rapid development HOTN, dyspnea, sepsis

Short-term more likely gram negative; Long-term fungal, viral, opportunistic

Tx: IMMEDIATE, admit w/ empiric Abx, look for source

  • No suspected source = empiric for gut flora
  • Cefepime, Moxifloxacin, Pip/Gent, Aztreonam
17
Q

Severe Thrombocytopenia

A

Usually idiopathic or immune w/ isolated case

Labs: CBC, PT/PTT, INR, D-dimer, LDH, Fibrinogen, heparin

Tx: Transfuse w/ active bleeding or platelets <7, prednisone

-Possible splenectomy in children to prevent recurrence

18
Q

Platelet Defect Clinical Characteristics

Bleeding site

Minor cut bleeds

Petechiae

Ecchymoses

Hemarthrosis/muscle hematomas

Bleeding after surgery

A

Bleeding site: skin, mucous membranes

Minor cut bleeds: yes

Petechiae: Present

Ecchymoses: Small, superficial

Hemarthrosis/muscle hematomas: rare

Bleeding after surgery: Immediate, mild

19
Q

Clotting Factor Deficiency Clinical Characteristics

Bleeding site

Minor cut bleeds

Petechiae

Ecchymoses

Hemarthrosis/muscle hematomas

Bleeding after surgery

A

Bleeding site: Deep in soft tissue

Minor cut bleeds: Not usually

Petechiae: Absent

Ecchymoses: Large, palpable

Hemarthrosis/muscle hematomas: Common

Bleeding after surgery: Delayed, severe

20
Q

Distinguishing

TTP

DIC

HIT

HELLP

A

TTP: thrombotic thrombocytopenia -normal PT/PTT, neuro sx & fever - platelet deficiency

DIC: Prolonged PT/PTT & INR with increased D-dimer - bleeding & clotting @ same time

HIT: Heparin-induced

HELLP: Pregnancy -hemolysis, elevated LFTs, low platelets

21
Q

Factor 5 Leiden

Von Willebrand disease

Hemophilia A & B

A

Factor 5 Leiden: inherited hypercoagulopathy - factor 5 resistant to breakdown by activated C protein

Von Willebrand disease: vWF deficient - no factor 8 degradation

-ineffective platelet adhesion - bleed @ dentist

Hemophilia A & B: A = 8, B = 9 factor deficient

22
Q

Overanticoagulation

A

Cancer pts clot easily - often on Warfarin but INRs difficult to stabilize

Coumadin (Warfarin) is Vitamin K dependent (2,7,9,10-extrinsic)

  • Monitor w/ PT & INR
  • Vitamin K + FFP for quick reversal

Non-warfarin agents

  • LMWH = FFP+Protamin
  • Fondaparinux = recombinant active Factor 8

Oncology (7 decks)

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