Oncology Emergency Management Questions

In-Training Examination Questions

• A 45-year-old female with a 1-week history of facial swelling, progressive dyspnea with exertion, and newly diagnosed non-Hodgkin lymphoma presents to the emergency department. A chest radiograph shows signs of a mediastinal mass. The most appropriate urgent next step in management is Echocardiography (B).

Explanation

• Echocardiography is the most appropriate next step to evaluate for cardiac tamponade, a potential complication of mediastinal masses, which can cause dyspnea and facial swelling.
• Intravenous antibiotics (A) are not indicated in the absence of infection.
• Plasmapheresis (C) is a treatment for autoimmune disorders and not indicated for this patient.
• Bronchoscopy (D) may be considered if there is suspicion of airway obstruction, but echocardiography is a more urgent procedure.
• Radiation (E) is a treatment option for certain types of cancer, including lymphoma, but is not an immediate intervention for this patient.

Asthma Management

• A 22-year-old male with moderate persistent asthma is being considered for a single maintenance and reliever therapy (SMART) approach. The appropriate prescription is Budesonide/formoterol (Symbicort) (B).

Explanation

• Symbicort (B) is a combination of an inhaled corticosteroid (budesonide) and a long-acting beta-agonist (formoterol), which is a suitable option for SMART therapy in moderate persistent asthma.
• Pulmicort (A) is an inhaled corticosteroid that may be used for asthma maintenance but doesn't provide relief during an asthma exacerbation.
• Advair Diskus (C) and Breo Ellipta (D) are also combination inhalers but contain different long-acting beta-agonists.
• Stiolto Respimat (E) is a combination of a long-acting muscarinic antagonist (tiotropium) and a long-acting beta-agonist (olodaterol), which is not typically considered for SMART therapy.

Proton Pump Inhibitor Therapy

• The indication for long-term proton pump inhibitor (PPI) therapy is Gastroprotection in users of high-dose NSAIDs at high risk for gastrointestinal bleeding (B).

Explanation

• PPIs are used for a variety of gastrointestinal conditions, but long-term therapy is primarily indicated for the prevention of NSAID-induced ulcers.
• Helicobacter pylori eradication (A) often involves a short course of antibiotics and PPI therapy.
• Prevention of rebleeding from Mallory-Weiss tear (C) may require a short course of PPI therapy, but long-term therapy is not typically indicated.
• Prevention of ulcers after band ligation of esophageal varices (D) may require a short course of PPI therapy but not long-term therapy.
• Treatment of an NSAID-related gastric ulcer (E) often involves a short course of PPI therapy.

Cognitive Impairment in the Elderly

• An 85-year-old male with cognitive decline, including repeating himself, buying the same item multiple times, and difficulty completing tasks is evaluated for his annual Medicare examination. The greatest risk factor for his condition is Advanced age (A).

Explanation

• Advanced age is the most significant risk factor for age-related cognitive decline, including Alzheimer's disease and other forms of dementia.
• While atrial fibrillation (B), diabetes mellitus (C), history of head trauma (D), and smoking (E) can contribute to cognitive decline, they are not primary risk factors compared to advanced age.

Temporomandibular Disorder Management

• The most appropriate initial pharmacotherapy for a temporomandibular disorder in a 54-year-old male is Naproxen, 500 mg twice daily (C).

Explanation

• Naproxen, a non-steroidal anti-inflammatory drug (NSAID), is a common first-line treatment for temporomandibular disorder (TMD) due to its anti-inflammatory and analgesic properties.
• Amitriptyline (A) is an antidepressant that can be helpful for TMD pain, but naproxen is a more appropriate initial therapy.
• Gabapentin (B) is an anticonvulsant that may be used for TMD pain, but it is not typically the first-line treatment.
• Tramadol (D) is an opioid analgesic and is generally not recommended for chronic pain conditions like TMD due to its potential for addiction and side effects.
• Corticosteroid injection into the temporomandibular joint (E) may be considered if other treatments are ineffective, but it is not the most appropriate initial therapy.

Hypothyroidism in a Young Woman

• A 33-year-old female presents with fatigue, feeling cold, intermittent joint discomfort, and weight gain. She has a mild goiter and normal CBC and comprehensive metabolic panel. Her TSH level is 6.48 U/mL (N 0.4–4.5) and a thyroid peroxidase antibody level is 378 IU/mL (N < 35). These findings suggest Hypothyroidism (Hashimoto's Thyroiditis) as the most likely underlying condition.

Explanation

• Elevated TSH level and positive thyroid peroxidase antibody level are consistent with hypothyroidism, particularly Hashimoto's thyroiditis, an autoimmune condition that can cause hypothyroidism.
• Other possible causes of hypothyroidism are less likely given the patient's history and laboratory test results.

This quiz focuses on urgent management steps in oncology emergencies, particularly in cases involving mediastinal masses. Participants will evaluate scenarios to determine the most appropriate immediate interventions, with a specific emphasis on the role of echocardiography. Enhance your understanding of acute presentations in cancer patients.