Palliative oncology emergencies flashcards
8 high-yield MRCP Part 1 cards from the Intellect Medicos Geriatrics & Palliative Care course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the first step in managing symptomatic hypercalcaemia of malignancy?
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IV rehydration with 0.9% sodium chloride.
Why? Patients are volume-depleted from hypercalcaemia-induced polyuria; fluids restore renal calcium excretion.
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After rehydration, what drug lowers calcium in hypercalcaemia of malignancy?
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An IV bisphosphonate, e.g. zoledronic acid or pamidronate.
Why? They inhibit osteoclast bone resorption. Calcium usually starts to fall within about 2 days and normalises over about 5 days.
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What is the most common early symptom of metastatic spinal cord compression?
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Back pain (often worse lying down, at night or on coughing).
Why? Pain usually comes before weakness, sensory loss or sphincter problems, so act on new spinal pain in cancer.
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What is the investigation of choice for suspected metastatic spinal cord compression with neurological signs, and how fast?
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MRI of the whole spine, as soon as possible and always within 24 hours.
Why? Whole-spine imaging is needed because multilevel disease is common (NICE NG234).
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What drug should be given immediately for suspected metastatic spinal cord compression with neurological symptoms?
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Dexamethasone 16 mg (oral or IV), with PPI cover and glucose monitoring.
Why? It reduces cord oedema while definitive treatment (radiotherapy or surgical decompression) is arranged.
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What is the definitive treatment for metastatic spinal cord compression?
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Radiotherapy, or surgical decompression and stabilisation in selected patients.
Why? Choice depends on fitness, prognosis, spinal stability and tumour type; neurological outcome is best when treated before the patient loses mobility.
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What is the most common cause of superior vena cava obstruction?
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Lung cancer, followed by lymphoma.
Why? Mediastinal tumour compresses the SVC, causing facial swelling, distended neck veins and breathlessness. Small cell lung cancer is the type most strongly linked to it.
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What is the main treatment for rapid symptom relief in SVC obstruction due to lung cancer?
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Endovascular SVC stenting (often with dexamethasone).
Why? Stenting relieves symptoms quickly; chemotherapy (e.g. for small cell lung cancer or lymphoma) or radiotherapy treats the cause.