Oncologic Emergencies Quiz
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A 74-year-old woman who has a history of breast cancer presents to the clinic with complaints of mild headache for the past few weeks. She describes daily retro-orbital headaches that get worse in the morning. In addition, she does vomits. MRI of the brain reveals multiple metastatic lesions. Which of the following is the most appropriate initial management for this patient?
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Repeat MRI in 6 months
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Biopsy the lesions
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Surgical resection
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Dexamethasone
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About This Quiz
Do you know what an oncologic emergency is, and do you think you can pass this oncologic emergencies quiz? An oncologic emergency can be described as any acute, potentially morbid, or life-threatening emergency or event which is directly or indirectly related to a patient's tumor or its treatment. Here are some test questions to see your understanding of oncologic emergencies. See moreTake these questions and give your best as you attempt them.
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- 2.
A 25-year-old man was recently diagnosed with leukemia. He is admitted to the hospital for further evaluation and chemotherapy initiation. He only complains of fatigue and malaise. Laboratory evaluation reveals pancytopenia, hyperkalemia (K 6.8), uric acid 13, hyperphosphatemia (12), and elevated lactate dehydrogenase (LDH). What is the most likely cause of his electrolyte abnormalities?
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Laboratory error
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Tumor lysis syndrome
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Hypercalcemia
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Acute renal failure
Correct Answer
A. Tumor lysis syndromeExplanation
The most likely cause of the patient's electrolyte abnormalities is tumor lysis syndrome. Tumor lysis syndrome is a condition that occurs when cancer cells release their contents into the bloodstream, leading to the release of large amounts of potassium, phosphate, and uric acid. This can result in hyperkalemia, hyperphosphatemia, and elevated uric acid levels. Additionally, the elevated lactate dehydrogenase (LDH) is a marker of cell breakdown, further supporting the diagnosis of tumor lysis syndrome. The patient's symptoms of fatigue and malaise are also consistent with this condition.Rate this question:
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- 3.
A 39-year-old man who has a medical history significant for lung cancer comes to an emergency room for altered mental status. His family reports that the man altered mental status for a few days. He has been lethargic and difficult to arouse. Which of the following is the most appropriate initial management for this patient?
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Pamidronate
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0.45% saline bolus
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0.9% saline bolus
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Furosemide
Correct Answer
A. 0.9% saline bolusExplanation
The most appropriate initial management for this patient is a 0.9% saline bolus. The patient's altered mental status and lethargy may be indicative of dehydration or electrolyte imbalances, which can be addressed by administering IV fluids. A 0.9% saline bolus is commonly used to rapidly expand intravascular volume and correct hypovolemia. This can help improve the patient's mental status and overall condition. Pamidronate is a bisphosphonate used for the treatment of hypercalcemia, which is not indicated in this case. Furosemide is a loop diuretic that may be used to treat fluid overload, but it is not the most appropriate initial management in this patient.Rate this question:
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- 4.
A 75-year-old man with lung cancer was admitted to the hospital with worsening dyspnea. He has complained of progressive dyspnea for 2 months. On physical examination, he has distended jugular veins, a plethoric face, venous collaterals on his chest wall, and distant heart sounds. What is the most likely diagnosis?
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Pericardial tamponade
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Constrictive pericarditis
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Congestive heart failure
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Superior vena cava (SVC) syndrome
Correct Answer
A. Superior vena cava (SVC) syndromeExplanation
Based on the given information, the most likely diagnosis is Superior vena cava (SVC) syndrome. The patient has distended jugular veins, a plethoric face, venous collaterals on his chest wall, and distant heart sounds. These findings are consistent with SVC syndrome, which occurs when there is obstruction or compression of the superior vena cava, leading to impaired venous return from the upper body. This can be caused by lung cancer, as in this case, due to tumor invasion or compression of the SVC. Pericardial tamponade, constrictive pericarditis, and congestive heart failure do not typically present with these specific findings.Rate this question:
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- 5.
A 42-year-old man with a medical history significant for lung cancer is brought to an emergency room for altered mental status. His family reports he altered his mental status for 3 days. He has been lethargic and difficult to arouse. On examination, he has orthostatic blood pressure and dry mucous membranes. Laboratory evaluation reveals Ca 14.5 mg/dl and Cr 2.0 mg/dl. Which of the following is the most appropriate initial management for this patient?
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0.9% saline bolus
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Furosemide
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Pamidronate
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0.45% saline bolus
Correct Answer
A. 0.9% saline bolusExplanation
The most appropriate initial management for this patient is a 0.9% saline bolus. The patient's altered mental status, orthostatic blood pressure, dry mucous membranes, and laboratory findings of hypercalcemia and elevated creatinine suggest that he is experiencing hypercalcemic crisis, which is a life-threatening condition. Hypercalcemia can cause dehydration and impaired renal function, leading to altered mental status. A 0.9% saline bolus is given to correct the dehydration and increase renal perfusion, which can help lower the serum calcium levels. Furosemide is a loop diuretic that can be used to enhance calcium excretion, but it should be used cautiously and after volume repletion. Pamidronate is a bisphosphonate that inhibits bone resorption and can be used for long-term management of hypercalcemia, but it is not the most appropriate initial intervention in this acute situation. A 0.45% saline bolus is hypotonic and not appropriate for a patient with hypercalcemia and dehydration.Rate this question:
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- 6.
A 28-year-old man was recently diagnosed with leukemia. He is admitted to the hospital for further analysis and chemotherapy initiation. He only complains of fatigue. Laboratory evaluation reveals pancytopenia, hyperkalemia (K 6.8), uric acid 13, hyperphosphatemia (12), and elevated lactate dehydrogenase (LDH). What is the most likely cause of his electrolyte abnormalities?
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Tumor lysis syndrome
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Acute renal failure
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Hypercalcemia
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None of these
Correct Answer
A. Tumor lysis syndromeExplanation
The most likely cause of the patient's electrolyte abnormalities is tumor lysis syndrome. Tumor lysis syndrome occurs when large amounts of tumor cells are destroyed rapidly, leading to the release of intracellular contents such as potassium, phosphate, and uric acid into the bloodstream. This can result in hyperkalemia, hyperphosphatemia, and elevated uric acid levels. Additionally, the increased breakdown of cells can lead to elevated lactate dehydrogenase levels. Acute renal failure and hypercalcemia can also cause electrolyte abnormalities, but the given clinical presentation and laboratory findings are more consistent with tumor lysis syndrome.Rate this question:
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- 7.
A 30-year-old woman with leukemia presents to the emergency room with fever for less than 24 hours. A week previously, she completed a course of chemotherapy through a Hickman catheter. She only complains of a fever and fatigue. On examination, she is pale and febrile (101.5° F). Laboratory evaluation reveals a leukocyte count of 780 with 25% polymorphonuclear cells. Which of the following is the most appropriate therapy?
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Caspofungin
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Vancomycin
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Amphotericin
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Vancomycin, piperacillin-tazobactam, and gentamicin
Correct Answer
A. Vancomycin, piperacillin-tazobactam, and gentamicinExplanation
The most appropriate therapy for this patient is Vancomycin, piperacillin-tazobactam, and gentamicin. The patient's presentation with fever, fatigue, and a low leukocyte count suggests neutropenic fever, which is a common complication of chemotherapy. Neutropenic patients are at high risk for serious bacterial infections, including sepsis. Therefore, broad-spectrum antibiotics that cover both gram-positive and gram-negative bacteria, such as Vancomycin, piperacillin-tazobactam, and gentamicin, are the most appropriate choice to provide coverage against a wide range of pathogens. Caspofungin and Amphotericin are antifungal agents, which are not indicated in this scenario.Rate this question:
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- 8.
An 82-year-old woman with a history of breast cancer presents to the clinic with complaints of headaches for the past 2 weeks. She describes daily retro-orbital headaches that are worse in the morning. In addition, she notes severe nausea and vomiting. MRI of the brain reveals multiple metastatic lesions. Which of the following is the most appropriate initial management for this patient?
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Biopsy the lesions
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Surgical resection
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Dexamethasone
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Repeat MRI in 6 months
Correct Answer
A. DexamethasoneExplanation
Dexamethasone is the most appropriate initial management for this patient because the presentation of daily retro-orbital headaches that are worse in the morning, along with severe nausea and vomiting, suggests increased intracranial pressure. The multiple metastatic lesions seen on the MRI indicate that the breast cancer has spread to the brain. Dexamethasone is a glucocorticoid that can help reduce inflammation and edema in the brain, thereby alleviating the symptoms and reducing intracranial pressure. This can provide immediate relief to the patient while further treatment options are considered.Rate this question:
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- 9.
A 34-year-old woman who has leukemia presents to the emergency room with a mild fever for less than 36 hours. A week previously, she completed a course of chemotherapy through a Hickman catheter. She only complains of fever and body pain. On examination, she is pale and febrile (101° F). Laboratory evaluation reveals a leukocyte count of 780 with 25% polymorphonuclear cells. Which of the following is the most appropriate therapy?
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Vancomycin, piperacillin-tazobactam, and gentamicin
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Amphotericin
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Both A & B
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None of these
Correct Answer
A. Vancomycin, piperacillin-tazobactam, and gentamicinExplanation
The most appropriate therapy for this patient is Vancomycin, piperacillin-tazobactam, and gentamicin. This patient is presenting with a fever and leukopenia, which are concerning for neutropenic fever, a common complication of chemotherapy. Neutropenic fever is often caused by bacterial infections, and the combination of Vancomycin, piperacillin-tazobactam, and gentamicin provides broad-spectrum coverage against both gram-positive and gram-negative bacteria. Amphotericin is an antifungal agent and would not be the first-line treatment for this patient. Therefore, the correct answer is Vancomycin, piperacillin-tazobactam, and gentamicin.Rate this question:
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- 10.
A 71-year-old man who has lung cancer was admitted to the hospital with worsening dyspnea. He complains of progressive dyspnea for a few months. What is the most likely diagnosis?
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Pericardial tamponade
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Congestive heart failure
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Superior vena cava (SVC) syndrome
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None of these
Correct Answer
A. Superior vena cava (SVC) syndromeExplanation
The most likely diagnosis for a 71-year-old man with lung cancer who presents with worsening dyspnea is Superior vena cava (SVC) syndrome. SVC syndrome occurs when the superior vena cava, which is responsible for returning blood from the upper body to the heart, becomes obstructed. In patients with lung cancer, the tumor can compress or invade the SVC, leading to symptoms such as dyspnea, facial swelling, and dilated veins in the upper body. This condition can cause significant respiratory distress and is a common complication in patients with lung cancer.Rate this question:
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Current Version
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Aug 18, 2023Quiz Edited by
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Nov 30, 2009Quiz Created by
Uscsom_im