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39 Cards in this Set
- Front
- Back
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When does a patient with hypercalcemia become symptomatic?
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Serum calcium above 12 mg/dL
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What are the two most common causes of hypercalcemia in oncology?
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Osteolysis
Parathyroid hormone-related peptide |
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What percentage of oncology patients develop hypercalcemia?
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20-30%
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What are the usual symptoms of hypercalcemia?
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Bone pain, nausea/vomiting, constipation, anorexia
Later: Altered mental status |
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Osteolysis is common in what cancer?
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Multiple myeloma
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What are the treatments for hypercalcemia?
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Hydration
Biphosphonate Calcitonin Steroids Lasix |
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What is the name for the metabolic disturbance due to rapid breakdown of malignant cells?
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Tumor Lysis Syndrome
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What cancers is tumor lysis syndrome usually a problem in?
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Acute leukemias & lymphomas
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When is tumor lysis syndrome usually seen after treatment?
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48-72 hours after treatment
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What are the metabolic effects of tumor lysis syndrome?
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Hyperkalemia
Hyperuricemia Hyperphosphatemia Hypocalcemia |
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What is usually the first sign of hypocalcemia?
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Perioral numbness
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What are the treatments for tumor lysis syndrome?
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Prevention w/EKG, Allopurinol
Hydration IV glucose/insulin IV calcium gluconate/calcium chloride Hemodialysis |
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What is the MOA of allopurinol?
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Inhibits xanthine oxidase to prevent production of uric acid
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What is the second most common cause of death in cancer patients?
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DVT/PE
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What percentage of cancer patients have a clot sometime during their disease process?
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15%
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Post-surgery, hormonal therapies, chemo, indwelling catheters, and decreased activity are all risk factors for what?
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DVT
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DVT is usually bilateral, true or false?
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False
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Acute SOB, chest pain, tachycardia, syncope, and swelling in an extremity are signs of what?
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PE
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What test is performed to rule out a clot?
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D-Dimer
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What tests can be performed to diagnose the actual problem if it is not a PE?
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Spiral CT
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What is the first test that should be performed in suspicion of a DVT?
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Doppler ultrasound
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Which drugs can be given for DVT?
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Lovenox (LMW Heparin) or Arixtra
NOT both! |
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What drug should be started after initial treatment of a DVT?
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Warfarin (Coumadin)
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Febrile neutropenia includes a fever of what?
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101.3 for one hour OR
100.3 for over one hour |
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What is nadir?
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Period of time following chemo when counts are lowest, usually 7-10 days post treatment
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What tests should be ordered for febrile neutropenia?
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CXR
Urinalysis & culture Blood cultures x 2 Stool culture & C diff toxin Culture of any drainage or suspicious lesion |
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What are the treatments for febrile neutropenia?
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Prevention w/Neupogen or Neulasta
Hospitalization Hydration Broad spectrum ABX (Primaxin) Anti-fungals Anti-virals Neutropenic precautions |
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Back pain in cancer patients is what until proven otherwise?
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Spinal Cord Compression
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Spinal cord compression affects what percentage of cancer patients?
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5-10%
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What cancers most often cause spinal cord compression?
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Prostate
Breast Lung |
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What is the most common region for spinal cord compression?
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Thoracic (70%)
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What is the most effective therapy for spinal cord compression?
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Radiation
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What surgical procedure for spinal cord compression is not typically used due to immunosuppression?
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Laminectomy
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What cancer is most often associated with superior vena cava syndrome?
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Bronchogenic carcinoma (80%)
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How long is the life expectancy for patients with superior vena cava syndrome?
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20-24 months
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What is the first symptom of superior vena cava syndrome?
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SOB
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SOB, edema of the face/neck/upper extremities, superficial veins on thorax, jugular venous distension, headache, chest pain, and dizziness are symptoms of what?
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Superior vena cava syndrome
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What tests are used to diagnose superior vena cava syndrome?
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Physical exam
CT CXR Doppler Invasive contrast venography |
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What are the treatments for superior vena cava syndrome?
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Symptom management
Radiation Chemo SVC stent |
