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Questions and Answers
What is one potential outcome of chemotherapy for treating tumors associated with pleural effusions?
What is one potential outcome of chemotherapy for treating tumors associated with pleural effusions?
Which symptom is not typically associated with SVC Syndrome?
Which symptom is not typically associated with SVC Syndrome?
What is the first step in the management of small asymptomatic pleural effusions?
What is the first step in the management of small asymptomatic pleural effusions?
Which pathological processes can directly cause obstruction of blood flow through the SVC?
Which pathological processes can directly cause obstruction of blood flow through the SVC?
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Which treatment option is used for symptomatic relief if the tumor is resistant to chemotherapy?
Which treatment option is used for symptomatic relief if the tumor is resistant to chemotherapy?
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What is a common symptom indicative of pericardial tamponade?
What is a common symptom indicative of pericardial tamponade?
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Which imaging method is considered the standard for diagnosing spinal cord compression?
Which imaging method is considered the standard for diagnosing spinal cord compression?
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Which of the following is one of the primary treatments for increased intracranial pressure?
Which of the following is one of the primary treatments for increased intracranial pressure?
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What is a potential consequence of untreated spinal cord compression?
What is a potential consequence of untreated spinal cord compression?
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Which symptom is associated with increased intracranial pressure due to a primary brain tumor?
Which symptom is associated with increased intracranial pressure due to a primary brain tumor?
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What is one characteristic finding on a chest X-ray that suggests pericardial tamponade?
What is one characteristic finding on a chest X-ray that suggests pericardial tamponade?
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Which of the following malignancies is most commonly associated with spinal cord compression?
Which of the following malignancies is most commonly associated with spinal cord compression?
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Which treatment option may be utilized for pericardial tamponade?
Which treatment option may be utilized for pericardial tamponade?
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What neurological symptom might precede other signs in patients with increased intracranial pressure?
What neurological symptom might precede other signs in patients with increased intracranial pressure?
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Which of the following diagnoses could be assessed using a lumber puncture?
Which of the following diagnoses could be assessed using a lumber puncture?
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What characterizes disseminated intravascular coagulation (DIC)?
What characterizes disseminated intravascular coagulation (DIC)?
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Which of the following conditions is NOT a feature associated with DIC?
Which of the following conditions is NOT a feature associated with DIC?
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What percentage of patients with DIC experience bleeding as a feature?
What percentage of patients with DIC experience bleeding as a feature?
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What is the most common cause of DIC?
What is the most common cause of DIC?
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What is a potential outcome of the consumption of clotting factors and platelets in DIC?
What is a potential outcome of the consumption of clotting factors and platelets in DIC?
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Which organ dysfunction occurs in the least percentage of patients with DIC?
Which organ dysfunction occurs in the least percentage of patients with DIC?
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DIC can lead to which of the following complications?
DIC can lead to which of the following complications?
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What is the estimated incidence of DIC in hospitalized patients?
What is the estimated incidence of DIC in hospitalized patients?
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Which condition is NOT considered an oncologic emergency?
Which condition is NOT considered an oncologic emergency?
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What is a common cause of malignant pleural effusion?
What is a common cause of malignant pleural effusion?
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What is the role of antithrombin III concentrate in treating DIC?
What is the role of antithrombin III concentrate in treating DIC?
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Which of the following conditions is associated with elevated liver enzymes and low platelet count?
Which of the following conditions is associated with elevated liver enzymes and low platelet count?
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Which infectious agent is NOT listed as a risk for these complications?
Which infectious agent is NOT listed as a risk for these complications?
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What could be a consequence of obstructed lymphatic flow by a tumor?
What could be a consequence of obstructed lymphatic flow by a tumor?
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In which circumstance is heparin contraindicated?
In which circumstance is heparin contraindicated?
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What is the primary purpose of E-aminocaproic acid in critical care?
What is the primary purpose of E-aminocaproic acid in critical care?
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Which form of trauma is most directly related to oncological complications discussed?
Which form of trauma is most directly related to oncological complications discussed?
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What is a potential complication of acute hepatic failure?
What is a potential complication of acute hepatic failure?
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Which symptom indicates a potential pleural effusion related to necrotic tumor cells shedding into the pleural space?
Which symptom indicates a potential pleural effusion related to necrotic tumor cells shedding into the pleural space?
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What is a potential reason why most small asymptomatic pleural effusions recur even if initially left untreated?
What is a potential reason why most small asymptomatic pleural effusions recur even if initially left untreated?
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Which of the following treatment options can provide immediate symptom relief in cases where the tumor is resistant to chemotherapy?
Which of the following treatment options can provide immediate symptom relief in cases where the tumor is resistant to chemotherapy?
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Which of the following conditions is most likely to lead to SVC syndrome?
Which of the following conditions is most likely to lead to SVC syndrome?
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What clinical symptom is characterized by non-pulsating congested neck veins?
What clinical symptom is characterized by non-pulsating congested neck veins?
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What is the primary process involved in the pathophysiology of disseminated intravascular coagulation (DIC)?
What is the primary process involved in the pathophysiology of disseminated intravascular coagulation (DIC)?
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Which of the following best describes the relationship between bleeding and thrombotic events in patients with DIC?
Which of the following best describes the relationship between bleeding and thrombotic events in patients with DIC?
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What percentage of DIC patients is reported to experience renal dysfunction?
What percentage of DIC patients is reported to experience renal dysfunction?
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In terms of risk factors, which is considered the most common cause of DIC?
In terms of risk factors, which is considered the most common cause of DIC?
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Which of the following organs has the lowest percentage of dysfunction in patients with DIC?
Which of the following organs has the lowest percentage of dysfunction in patients with DIC?
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What underlying issue primarily leads to multiple organ dysfunction syndrome (MODS) in DIC?
What underlying issue primarily leads to multiple organ dysfunction syndrome (MODS) in DIC?
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What defines the consumption of clotting factors and platelets in the context of DIC?
What defines the consumption of clotting factors and platelets in the context of DIC?
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How does disseminated intravascular coagulation (DIC) typically manifest in terms of clinical features?
How does disseminated intravascular coagulation (DIC) typically manifest in terms of clinical features?
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Which type of infection is most commonly associated with sepsis in patients experiencing oncologic emergencies?
Which type of infection is most commonly associated with sepsis in patients experiencing oncologic emergencies?
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E-aminocaproic acid is primarily used in DIC to achieve which of the following effects?
E-aminocaproic acid is primarily used in DIC to achieve which of the following effects?
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What is the primary mechanism through which malignant pleural effusion develops?
What is the primary mechanism through which malignant pleural effusion develops?
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Which condition is characterized by the obstruction of lymphatic flow due to a tumor?
Which condition is characterized by the obstruction of lymphatic flow due to a tumor?
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In managing DIC, which treatment is considered controversial due to potential risks?
In managing DIC, which treatment is considered controversial due to potential risks?
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Which type of leukemia is an identified risk factor for developing oncologic emergencies?
Which type of leukemia is an identified risk factor for developing oncologic emergencies?
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Which complication is typically associated with elevated liver enzymes and low platelet count during pregnancy?
Which complication is typically associated with elevated liver enzymes and low platelet count during pregnancy?
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What is the recommended treatment approach for patients with DIC who are bleeding?
What is the recommended treatment approach for patients with DIC who are bleeding?
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The presence of retained dead fetus syndrome can lead to which type of complication?
The presence of retained dead fetus syndrome can lead to which type of complication?
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Which of the following is not a risk factor for infections in patients with compromised immunity in oncologic settings?
Which of the following is not a risk factor for infections in patients with compromised immunity in oncologic settings?
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Which of the following symptoms is a classic sign of pericardial tamponade?
Which of the following symptoms is a classic sign of pericardial tamponade?
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What imaging technique is considered the first-line method for diagnosing spinal cord compression?
What imaging technique is considered the first-line method for diagnosing spinal cord compression?
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Which treatment option is indicated for managing increased intracranial pressure?
Which treatment option is indicated for managing increased intracranial pressure?
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Which symptom is NOT typically associated with spinal cord compression?
Which symptom is NOT typically associated with spinal cord compression?
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Which malignancy is most likely to cause spinal cord compression in patients?
Which malignancy is most likely to cause spinal cord compression in patients?
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Which clinical finding is characteristic of pericardial tamponade on a chest X-ray?
Which clinical finding is characteristic of pericardial tamponade on a chest X-ray?
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What condition can lead to irreversible paralysis if not treated immediately?
What condition can lead to irreversible paralysis if not treated immediately?
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Which of the following is a common treatment for increased intracranial pressure?
Which of the following is a common treatment for increased intracranial pressure?
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What is a potential outcome of untreated increased intracranial pressure?
What is a potential outcome of untreated increased intracranial pressure?
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Which diagnostic procedure is essential for a definitive diagnosis of pericardial tamponade?
Which diagnostic procedure is essential for a definitive diagnosis of pericardial tamponade?
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Study Notes
Oncologic Emergencies 2: Disseminated Intravascular Coagulation (DIC)
- DIC is an acquired syndrome characterized by intravascular coagulation activation, leading to loss of localization.
- It arises from different causes and can damage the microvasculature, potentially causing organ dysfunction.
- DIC is estimated to affect approximately 1% of hospitalized patients.
- DIC isn't an independent illness; it's a complication arising from the progression of other underlying diseases.
- DIC is characterized by systemic blood coagulation activation, fibrin generation and deposition resulting in microvascular thrombi in various organs.
- DIC can lead to multiple organ dysfunction syndrome (MODS).
- Consumption of clotting factors and platelets in DIC can lead to life-threatening hemorrhage.
- Patients with DIC often exhibit both thrombotic and bleeding problems, complicating treatment.
Clinical Picture of DIC
- Bleeding (64%)
- Renal dysfunction (25%)
- Hepatic dysfunction (19%)
- Respiratory dysfunction (16%)
- Shock (14%)
- Central nervous system dysfunction (2%)
Risk Factors for DIC
- Infections (bacterial, fungal, viral; sepsis from gram-negative bacteria is most common)
- Intravascular hemorrhage (blood transfusion reaction)
- Acute leukemia and adenocarcinomas (lung, breast, stomach, prostate)
- Liver disease (leading to liver failure)
- Prosthetic devices (shunts)
- Heat stroke and hyperthermia
- Retained dead fetus syndrome
Risk Factors by Type
- Infectious: Gram-negative sepsis, Gram-positive infections, Rickettsial, Histoplasma
- Malignancy: Hematologic (acute myelocytic leukemia), metastatic (mucin-secreting adenocarcinoma), Amniotic fluid embolism, Abruptio placentae, Acute peripartum hemorrhage, Preeclampsia/eclampsia, Elevated liver enzymes/low platelets (HELLP syndrome), Retained stillbirth, Septic abortion
- Obstetric: Acute fatty liver of pregnancy
- Trauma: Burns, Motor vehicle accidents, Snake envenomation
- Transfusion: Hemolytic reactions
- Others: Liver disease/acute hepatic failure, Prosthetic devices, Shunts (Denver or LeVeen), Ventricular assist devices
Treatment of DIC
- Patients with DIC should be treated in hospitals with critical care and subspecialty expertise.
- Platelets and fresh frozen plasma (FFP) are often administered.
- Antithrombin III concentrates may be used to neutralize excess thrombin.
- Heparin therapy is frequently used, but use should be carefully considered for patients with intracranial bleeding, open wounds, or recent surgery.
- E-aminocaproic acid (an antifibrinolytic agent) may be used.
Malignant Pleural Effusion
- Common causes include pleural surface implantation, lymphatic flow obstruction, tumor-related vascular obstruction, and necrotic tumor cells.
- Thoracic duct perforation is a possible cause.
Clinical Picture (Malignant Pleural Effusion)
- Dyspnea (shortness of breath)
- Orthopnea (difficulty breathing when lying down)
- Dry, non-productive cough
- Chest pain or heaviness
- Tachypnea (rapid breathing)
- Dullness to percussion
- Restricted chest wall expansion
- Impaired transmission of breath sounds
Treatment (Malignant Pleural Effusion)
- Small asymptomatic effusions may be monitored.
- Chemotherapy for a specific tumor type
- Pleurodesis (if tumor is chemo-resistant or refractory)
- Thoracocentesis (for short-term relief)
- Thoracostomy tube insertion
- Pleuroperitoneal shunt
- External beam radiation therapy (XRT)
SVC Syndrome
- Obstruction of superior vena cava (SVC) by direct invasion or external compression due to pathological process (e.g., Lymphoma, Hodgkin's, Lung, Breast)
Clinical Picture (SVC Syndrome)
- Facial edema
- Periorbital edema
- Cyanosis (with pattern related to collateral blood flow)
- Congested, non-pulsating neck veins
- Pressure symptoms (e.g., dyspnea, hoarseness)
Pericardial Tamponade
- Pericardial effusion (excess fluid around the heart) compresses the heart, impairing its function.
Clinical Picture (Pericardial Tamponade)
- Dyspnea on exertion
- Orthopnea
- Cough
- Chest pain
- Palpitations
- Edema
- Syncope
- Symptoms of primary cancer
- Tachycardia
- Hypotension
- Neck vein distension
- Pulsus paradoxus
- Distant heart sound
- Pericardial friction rub
- Signs of right-sided heart failure (hepatomegaly, ascites, edema)
Increased Intracranial Pressure
- Causes include primary or metastatic intracranial tumors or meningitis.
Clinical Picture (Increased Intracranial Pressure)
- Headaches
- Personality changes
- Lethargy
- Coma
- Papilledema
Spinal Cord Compression
- Tumor or collapsed fragments in the epidural space.
Clinical Picture (Spinal Cord Compression)
- Localized pain to the spine
- Exacerbated by movement, recumbency, coughing, sneezing, straining
- Radicular pain (pain radiating along nerves)
- Weakness and/ or sensory loss
- Autonomic dysfunction (problems with bladder and bowel control)
- Urinary retention
- Constipation
Diagnosis (Various Conditions)
- X-ray (entire spine, to identify bony abnormalities, erosion, loss of pedicles)
- MRI (standard for evaluating suspected spinal cord compression)
- Radionuclide SVC (to rule out superior vena cava syndrome)
- CT scans
- Tissue diagnosis (if required)
Treatment (Various Conditions)
- Goal is to restore normal neurological function, stabilize the spine, and control the underlying tumor.
- Steroids, sometimes in high doses
- Surgery and radiation depending on the severity of the condition and other factors
- Additional treatments may vary (e.g., diuretics in increased intracranial pressure)
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