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Questions and Answers
Which of the following symptoms is typically associated with central neurological issues?
Which of the following symptoms is typically associated with central neurological issues?
What sign is indicative of renal complications?
What sign is indicative of renal complications?
Which of the following symptoms is NOT a gastrointestinal symptom?
Which of the following symptoms is NOT a gastrointestinal symptom?
What is a cardiovascular sign related to slow cardiac conduction?
What is a cardiovascular sign related to slow cardiac conduction?
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Which of the following is a renal symptom indicating hydration issues?
Which of the following is a renal symptom indicating hydration issues?
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Which sign or symptom is considered the most common in cases of pulmonary embolism?
Which sign or symptom is considered the most common in cases of pulmonary embolism?
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What is the initial management step for suspected pulmonary embolism?
What is the initial management step for suspected pulmonary embolism?
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What is the significance of maintaining a PTT of 1.5 to 2 times the control value during treatment?
What is the significance of maintaining a PTT of 1.5 to 2 times the control value during treatment?
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What diagnostic tool is highly sensitive and specific for detecting emboli in the proximal pulmonary arteries?
What diagnostic tool is highly sensitive and specific for detecting emboli in the proximal pulmonary arteries?
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What is the duration of therapy with warfarin that appears to decrease the risk of recurrent pulmonary embolism?
What is the duration of therapy with warfarin that appears to decrease the risk of recurrent pulmonary embolism?
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Which of the following factors is least likely to contribute to fungal infections?
Which of the following factors is least likely to contribute to fungal infections?
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What is a common treatment for herpes simplex virus and varicella zoster virus infections?
What is a common treatment for herpes simplex virus and varicella zoster virus infections?
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Which of the following conditions might indicate the need for empiric addition of vancomycin in a treatment protocol?
Which of the following conditions might indicate the need for empiric addition of vancomycin in a treatment protocol?
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What should be prioritized in the immediate treatment for suspected severe infections in cancer patients?
What should be prioritized in the immediate treatment for suspected severe infections in cancer patients?
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Which virus is NOT commonly associated with viral infections in cancer patients?
Which virus is NOT commonly associated with viral infections in cancer patients?
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Which oncologic emergency is characterized by fluid accumulation in the pericardial space?
Which oncologic emergency is characterized by fluid accumulation in the pericardial space?
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What type of oncologic emergency is likely indicated by elevated intracranial pressure?
What type of oncologic emergency is likely indicated by elevated intracranial pressure?
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Which of the following is NOT categorized as a gastrointestinal oncologic emergency?
Which of the following is NOT categorized as a gastrointestinal oncologic emergency?
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Which metabolic disorder is associated with tumor lysis syndrome?
Which metabolic disorder is associated with tumor lysis syndrome?
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What causes humoral hypercalcemia of malignancy?
What causes humoral hypercalcemia of malignancy?
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Which oncologic emergency is typically related to the obstruction of urine flow?
Which oncologic emergency is typically related to the obstruction of urine flow?
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Which oncologic emergency is defined by the presence of systemic infectious processes in patients with low white blood cell counts?
Which oncologic emergency is defined by the presence of systemic infectious processes in patients with low white blood cell counts?
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Which of the following conditions is categorized under symptomatic oncologic emergencies?
Which of the following conditions is categorized under symptomatic oncologic emergencies?
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What is the primary goal of therapy for complete heart block?
What is the primary goal of therapy for complete heart block?
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Which of the following is considered the drug of choice for treating certain conditions related to hyperviscosity syndrome?
Which of the following is considered the drug of choice for treating certain conditions related to hyperviscosity syndrome?
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What symptom is part of the classic triad associated with hyperviscosity syndrome?
What symptom is part of the classic triad associated with hyperviscosity syndrome?
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What defines leukostasis in a clinical context?
What defines leukostasis in a clinical context?
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When is calcitonin recommended in relation to hyperviscosity syndrome treatment?
When is calcitonin recommended in relation to hyperviscosity syndrome treatment?
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What is the most common symptom associated with hyperviscosity syndrome?
What is the most common symptom associated with hyperviscosity syndrome?
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Which treatment is commonly used for pulmonary embolism?
Which treatment is commonly used for pulmonary embolism?
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What is a typical etiology of leukostasis?
What is a typical etiology of leukostasis?
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What is a key metabolic triad associated with tumor lysis syndrome?
What is a key metabolic triad associated with tumor lysis syndrome?
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Which of the following is NOT typically a sign or symptom of tumor lysis syndrome?
Which of the following is NOT typically a sign or symptom of tumor lysis syndrome?
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Which treatment is recommended for preventing hyperuricemia in tumor lysis syndrome?
Which treatment is recommended for preventing hyperuricemia in tumor lysis syndrome?
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Which patient factors are associated with a higher risk for tumor lysis syndrome?
Which patient factors are associated with a higher risk for tumor lysis syndrome?
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What is the primary goal of treatment in patients experiencing tumor lysis syndrome?
What is the primary goal of treatment in patients experiencing tumor lysis syndrome?
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What rare complication can arise from hyperphosphatemia and hyperuricemia in tumor lysis syndrome?
What rare complication can arise from hyperphosphatemia and hyperuricemia in tumor lysis syndrome?
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Which treatment option breaks down uric acid to a more water-soluble form in tumor lysis syndrome?
Which treatment option breaks down uric acid to a more water-soluble form in tumor lysis syndrome?
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When monitoring metabolic status during treatment of tumor lysis syndrome, which situation requires careful observation?
When monitoring metabolic status during treatment of tumor lysis syndrome, which situation requires careful observation?
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What is the typical clinical approach to assessing for the risk of deep vein thrombosis (DVT) in patients with suspected pulmonary embolism?
What is the typical clinical approach to assessing for the risk of deep vein thrombosis (DVT) in patients with suspected pulmonary embolism?
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Which of the following findings is most indicative of pulmonary embolism when observed on an ECG?
Which of the following findings is most indicative of pulmonary embolism when observed on an ECG?
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In the management of pulmonary embolism, what is the primary purpose of maintaining a PTT of 1.5 to 2 times the control value?
In the management of pulmonary embolism, what is the primary purpose of maintaining a PTT of 1.5 to 2 times the control value?
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What is the recommended duration for continuation of warfarin therapy following a pulmonary embolism to reduce the risk of recurrence?
What is the recommended duration for continuation of warfarin therapy following a pulmonary embolism to reduce the risk of recurrence?
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Which diagnostic test is specifically noted for detecting emboli in the proximal pulmonary arteries?
Which diagnostic test is specifically noted for detecting emboli in the proximal pulmonary arteries?
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Which of the following factors does NOT contribute to fungal infections?
Which of the following factors does NOT contribute to fungal infections?
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Which medication is indicated for managing cytomegalovirus infections?
Which medication is indicated for managing cytomegalovirus infections?
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In which situation would the empiric addition of vancomycin be considered appropriate?
In which situation would the empiric addition of vancomycin be considered appropriate?
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Which of the following treatments is NOT commonly part of combination antibiotic therapy?
Which of the following treatments is NOT commonly part of combination antibiotic therapy?
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What is a critical initial step in treating infections in cancer patients?
What is a critical initial step in treating infections in cancer patients?
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Which type of oncologic emergency is characterized by obstruction of blood flow due to tumor-related compression?
Which type of oncologic emergency is characterized by obstruction of blood flow due to tumor-related compression?
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What is the primary underlying mechanism of humoral hypercalcemia of malignancy?
What is the primary underlying mechanism of humoral hypercalcemia of malignancy?
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Which condition is least associated with the hematologic oncologic emergencies?
Which condition is least associated with the hematologic oncologic emergencies?
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Which type of oncologic emergency involves the presence of excess fluid in the pericardial cavity?
Which type of oncologic emergency involves the presence of excess fluid in the pericardial cavity?
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What is the most common cause of local osteolytic hypercalcemia?
What is the most common cause of local osteolytic hypercalcemia?
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Which symptomatic oncologic emergency is characterized by excruciating pain and inflammation of the oral mucosa?
Which symptomatic oncologic emergency is characterized by excruciating pain and inflammation of the oral mucosa?
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Which type of oncologic emergency involves the obstruction of the spinal cord due to tumor compression?
Which type of oncologic emergency involves the obstruction of the spinal cord due to tumor compression?
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In which oncologic emergency would you expect to encounter systemic symptoms of infection in a patient with low white blood cell count?
In which oncologic emergency would you expect to encounter systemic symptoms of infection in a patient with low white blood cell count?
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Which pharmacological intervention is often the drug of choice for treating elevated calcium levels?
Which pharmacological intervention is often the drug of choice for treating elevated calcium levels?
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In hyperviscosity syndrome, what is the most common symptom triad?
In hyperviscosity syndrome, what is the most common symptom triad?
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What is a primary treatment approach for leukostasis in acute leukemia?
What is a primary treatment approach for leukostasis in acute leukemia?
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Which of the following symptoms is often associated with hyperviscosity syndrome?
Which of the following symptoms is often associated with hyperviscosity syndrome?
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When is calcitonin recommended in the treatment protocol related to elevated serum creatinine?
When is calcitonin recommended in the treatment protocol related to elevated serum creatinine?
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What lab monitoring is essential when administering Zolendronate?
What lab monitoring is essential when administering Zolendronate?
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What defines hyperviscosity syndrome?
What defines hyperviscosity syndrome?
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Which factor is NOT considered a risk factor for neutropenic fever?
Which factor is NOT considered a risk factor for neutropenic fever?
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What does a MASCC score of less than 21 indicate?
What does a MASCC score of less than 21 indicate?
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Which bacterial infection is primarily associated with granulocytopenic patients?
Which bacterial infection is primarily associated with granulocytopenic patients?
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Which condition is associated with an increased risk of infections in patients with cancer?
Which condition is associated with an increased risk of infections in patients with cancer?
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What is a common fungal infection risk factor in cancer patients?
What is a common fungal infection risk factor in cancer patients?
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Which of the following is classified as a gram-negative bacterium related to neutropenic fever?
Which of the following is classified as a gram-negative bacterium related to neutropenic fever?
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Which of the following indicates that neutropenia is anticipated to last 7 days or less?
Which of the following indicates that neutropenia is anticipated to last 7 days or less?
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What percentage of patients with neutropenic fever typically experience bacterial infections?
What percentage of patients with neutropenic fever typically experience bacterial infections?
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What is the best management strategy for tumor lysis syndrome?
What is the best management strategy for tumor lysis syndrome?
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Which of the following metabolic abnormalities is NOT included in the metabolic triad of tumor lysis syndrome?
Which of the following metabolic abnormalities is NOT included in the metabolic triad of tumor lysis syndrome?
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Which treatment option specifically reduces uric acid levels in tumor lysis syndrome?
Which treatment option specifically reduces uric acid levels in tumor lysis syndrome?
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Which cancer types are particularly associated with a higher risk of developing tumor lysis syndrome?
Which cancer types are particularly associated with a higher risk of developing tumor lysis syndrome?
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What is a potential secondary complication of tumor lysis syndrome?
What is a potential secondary complication of tumor lysis syndrome?
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Which of the following signs and symptoms is typically associated with severe hypocalcemia in tumor lysis syndrome?
Which of the following signs and symptoms is typically associated with severe hypocalcemia in tumor lysis syndrome?
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What immediate action should be considered when managing a patient with prolonged neutropenia and severe mucositis?
What immediate action should be considered when managing a patient with prolonged neutropenia and severe mucositis?
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Which of the following treatments would NOT be appropriate in the management of hyperkalemia in tumor lysis syndrome?
Which of the following treatments would NOT be appropriate in the management of hyperkalemia in tumor lysis syndrome?
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Study Notes
Oncology [Medicine] - Oncologic Emergencies 1
- Level 4, Semester 7 course
- Lecture 02 covers various oncologic emergencies
- Cardiovascular Emergencies: Pericardial Tamponade, Superior Vena Cava Syndrome, Increased Intracranial Pressure, Spinal Cord Compression
- Central Nervous System Emergencies: Increased Intracranial Pressure, Spinal Cord Compression
- Gastrointestinal Emergencies: Bowel Obstruction, Bowel Perforation, Ascites, Esophageal Obstruction and Perforation
- Hematologic Emergencies: Disseminated Intravascular Coagulation (DIC), Leukostasis, Thrombocytopenia, Sepsis in leukopenic patient, Disseminated Viral Infections, Fungal and Parasitic Diseases
- Infectious Emergencies: Sepsis in the leukopenic patient, Disseminated Viral Infections, Fungal and Parasitic Diseases
- Metabolic Emergencies: Hyperuricemia, Hypercalcemia, Hypoglycemia, Lactic Acidosis, Tumor Lysis Syndrome
- Orthopedic Emergencies: Pathologic Fracture, Ureteral Obstruction, Pelvic Tumors
- Renal Emergencies: Ureteral Obstruction, Pelvic Tumors
- Respiratory Emergencies: Airway Obstruction, Pneumothorax, Effusion
- Symptomatic Emergencies: Pain, Vomiting, Mucositis, Dyspnea
Hypercalcemia
-
Types:
- Humoral hypercalcemia of malignancy (paraneoplastic syndrome): 80% of cases, may or may not have bone metastasis, tumors secrete hormones and cytokines that cause calcium resorption
- Local Osteolytic Hypercalcemia: occurs in patients with extensive osteolytic bone metastasis
-
Symptoms and Signs:
- Impaired concentration, confusion, apathy, drowsiness or lethargy, muscle weakness, hypotonia, decreased or absent deep-tendon reflexes
- Increased gastric acid secretion, nausea, vomiting, anorexia, constipation, polyuria, polydipsia, dehydration (thirst, dry mucosa, decreased/absent sweating, concentrated urine)
Hyperviscosity Syndrome
- Definition and Etiology: Elevated blood viscosity due to increased serum proteins, red blood cells (RBCs), white blood cells (WBCs), or platelets. Waldenstrom macroglobulinemia (WM) is a common cause
- Symptoms: Triad of neurological deficits, visual changes, and mucosal bleeding
- Management: Supportive care (intravenous fluids), plasmapheresis, and treatment of underlying hematological condition
Pulmonary Embolism (PE)
- Clinical Picture: Similar presentation as other cardiac/pulmonary disorders: Dyspnea (most common), tachypnea, pleuritic/non-retrosternal chest pain, hemoptysis, pleural rub, arterial oxygen saturation less than 92% on room air, low-grade temperature, tachycardia.
- Diagnostic Workup: Assess clinical probability (risk factors and symptoms of DVT), D-dimer, pulmonary angiogram (highly sensitive/specific for proximal PE), magnetic resonance pulmonary angiography, ECG changes (S1Q3T3 pattern).
- Management: Rapid institution of fractionated heparin or LMWH, maintain PTT 1.5-2 times control value, monitor platelet counts. Oral warfarin concurrently with heparin for 3-5 days (until warfarin reaches therapeutic level). Warfarin continued for 3-6 months. If high risk for recurrent PE, long-term therapy may be necessary
Neutropenic Fever
- Definition: ANC < 1500 cells/microL or <500 (severe), single temp of 38.3°C (101.0°F) and sustained temp of 38.0°C (100.4°F) for more than 1 hour.
- Risk Stratification: High (ANC < 100 anticipated > 7 days, hemodynamic instability), low risk (e.g., neutropenia anticipated ≤ 7 days, no active medical co-morbidity). Use of scoring systems
- Management: Immediate empiric antibiotic therapy IV, isolation, protected environment, colony-stimulating factors, supportive care, monitor fluid and electrolytes
Tumor Lysis Syndrome (TLS)
- Definition: Metabolic triad of hyperuricemia, hyperkalemia, hyperphosphatemia. Can lead to renal failure and hypocalcemia as secondary complications
- Mechanism: Cytotoxic therapy or spontaneous lysis of tumor cells releases purine nucleic acids, which are metabolized to uric acid, phosphate, and potassium.
- Who Gets It: High tumor cell proliferation rates, large tumor burden, tumor chemosensitivity (e.g., ALL, AML, NHL, Burkitt's Lymphoma, some solid tumors, breast, GI, prostate)
Infections - Oncologic Emergencies
- Common Types: Gram-positive bacteria ( Staphylococcus aureus, Staphylococcus epidermidis), Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa), Fungal.
- Risk Factors: Prolonged granulocytopenia, implanted vascular access devices, administration of parenteral nutrition, corticosteroids, and prolonged antibiotic therapy.
- Viral infections: Herpes simplex virus (HSV), Varicella zoster virus (VZV), CMV, Hepatitis A or B. Treatment: Acyclovir, valcyclovir, famciclovir, ganciclovir.
General Treatment Principles in Oncologic Emergencies
- Fluid Management: Aggressive hydration and diuresis, electrolyte monitoring, monitor for hypovolemia/obstructed uropathy
- Allopurinol and Rasburicase: Inhibit xanthine oxidase or degrade uric acid, careful monitoring
- Treatment for Hyperkalemia: Calcium gluconate, sodium bicarbonate, glucose + insulin, hemodialysis
- Other important measures: Empiric antibiotic therapy, Isolation, colony-stimulating factors, Supportive care, monitoring fluid and electrolytes, combination antibiotic therapy
Specific Treatment of underlying conditions
- Hyperphosphatemia: phosphate binders (aluminum hydroxide), minimize phosphate intake, hemodialysis
- Hypocalcemia: treat only if symptomatic, 10% calcium gluconate, use with caution; hemodialysis (oliguric renal failure)
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