Oncology emergencies & markers flashcards
15 high-yield MRCP Part 1 cards from the Intellect Medicos Haematology & Oncology 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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How is neutropenic sepsis defined (NICE)?
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Neutrophil count 0.5 × 10⁹/L or lower, with temperature above 38 °C or other signs or symptoms of sepsis.
Why? Without neutrophils, bacteria multiply and translocate unchecked; sepsis can progress to shock within hours.
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What is the empirical antibiotic for suspected neutropenic sepsis, and how quickly must it be given?
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IV piperacillin–tazobactam monotherapy, given immediately (UK target: within 1 hour).
Why? Broad anti-pseudomonal cover given early reduces mortality.
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What antibiotic prophylaxis is offered to adults expected to become profoundly neutropenic from chemotherapy?
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A fluoroquinolone (e.g. levofloxacin).
Why? Prophylaxis during the expected neutropenic period reduces febrile episodes and infection-related deaths.
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Is G-CSF routine treatment for established neutropenic sepsis?
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No — it is rescue therapy only, e.g. profound neutropenia (<0.1 × 10⁹/L) with severe sepsis or fungal infection.
Why? Routine G-CSF in established neutropenic sepsis has not improved survival; its main role is prophylaxis with some chemotherapy regimens.
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What tumour lysis prophylaxis is given to a HIGH-risk patient (e.g. Burkitt lymphoma or bulky ALL) starting chemotherapy?
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Aggressive IV hydration plus rasburicase.
Why? Rapid tumour cell death releases potassium, phosphate and urate; rasburicase clears urate quickly to protect the kidneys.
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How does rasburicase work, and in which enzyme deficiency is it contraindicated?
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Recombinant urate oxidase that converts uric acid to soluble allantoin; contraindicated in G6PD deficiency.
Why? The reaction produces hydrogen peroxide, which can cause haemolysis and methaemoglobinaemia in G6PD deficiency.
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What drug is given immediately for suspected metastatic spinal cord compression with neurological signs?
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Dexamethasone 16 mg (oral or IV).
Why? Steroids reduce vasogenic oedema around the cord, protecting neurological function until definitive treatment.
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What is the first-line imaging for suspected metastatic spinal cord compression, and how quickly?
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MRI of the whole spine, within 24 hours.
Why? Whole-spine imaging is needed because compression is often at more than one level.
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What is the first-line management of symptomatic hypercalcaemia of malignancy?
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IV rehydration with 0.9% sodium chloride, then an IV bisphosphonate (e.g. zoledronic acid or pamidronate).
Why? Rehydration restores calcium excretion; bisphosphonates block osteoclast bone resorption.
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What is the first-line blood test in a woman aged 40 or over with symptoms suggestive of ovarian cancer (e.g. persistent bloating)?
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Serum CA125; if it is at or above the AGE-SPECIFIC threshold, arrange an urgent abdominal and pelvic ultrasound.
Why? CA125 is a useful triage marker for ovarian cancer, though it can also rise with endometriosis, menstruation and other benign conditions.
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Which tumour marker is raised in hepatocellular carcinoma and in non-seminomatous germ cell tumours?
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Alpha-fetoprotein (AFP).
Why? AFP is a fetal protein re-expressed by some liver and germ cell tumours; it is used for diagnosis and monitoring.
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What is the commonest malignant cause of superior vena cava obstruction?
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Lung cancer.
Why? Non-small cell is the commonest cause in absolute numbers (it is more common overall), while small cell lung cancer is the type most prone to cause it. Right-sided tumours and mediastinal nodes compress the thin-walled SVC, causing facial swelling, distended neck veins and breathlessness.
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What is the commonest mechanism of hypercalcaemia of malignancy?
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Tumour secretion of PTH-related peptide (humoral hypercalcaemia), e.g. squamous cell lung cancer.
Why? PTHrP mimics PTH, increasing bone resorption and renal calcium reabsorption, while PTH itself is suppressed.
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Which tumour marker is associated with pancreatic cancer?
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CA 19-9.
Why? It supports diagnosis and monitoring but is not a screening test; it also rises in biliary obstruction.
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A 30-year-old man has a painless testicular mass. β-hCG is mildly raised and AFP is normal. Which germ cell tumour type is more likely?
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Seminoma.
Why? Pure seminomas can secrete β-hCG (from syncytiotrophoblast cells) but never AFP.