AOCNP Oncologic Emergencies 2 — Questions and Answers
Question 1: A patient develops sudden-onset dyspnea, muffled heart sounds, hypotension, and jugular venous distension. Which emergency is this?
- Pulmonary embolism
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Acute heart failure
Correct answer: Cardiac tamponade
Beck's triad of hypotension, muffled heart sounds, and jugular venous distension is the hallmark of cardiac tamponade requiring urgent pericardiocentesis.
Question 2: Which cancer type is most commonly associated with disseminated intravascular coagulation (DIC) in adults?
- Acute promyelocytic leukemia (APL) (Correct answer)
- Renal cell carcinoma
- Colorectal cancer
- Melanoma
Correct answer: Acute promyelocytic leukemia (APL)
APL releases tissue factor and procoagulant granules, causing the most severe DIC of any malignancy.
Question 3: In febrile neutropenia, an absolute neutrophil count (ANC) below which threshold defines high-risk neutropenia?
- < 500 cells/mm³ (Correct answer)
- < 1000 cells/mm³
- < 1500 cells/mm³
- < 2000 cells/mm³
Correct answer: < 500 cells/mm³
An ANC < 500 cells/mm³ (or < 1000 with predicted decline to < 500) defines high-risk neutropenia requiring prompt empiric antibiotics.
Question 4: Which agent is used as first-line prophylaxis against tumor lysis syndrome in high-risk patients?
- Allopurinol (Correct answer)
- Rasburicase
- Sodium bicarbonate
- Hydroxyurea
Correct answer: Allopurinol
Allopurinol inhibits xanthine oxidase and is the standard first-line prophylactic agent for intermediate- and high-risk TLS.
Question 5: A patient with a known brain metastasis develops sudden-onset severe headache, vomiting, and altered consciousness. What is the priority intervention?
- Dexamethasone IV and urgent CT head (Correct answer)
- Lumbar puncture
- Oral analgesics and observation
- Antiemetics alone
Correct answer: Dexamethasone IV and urgent CT head
Increased intracranial pressure from cerebral herniation requires immediate dexamethasone to reduce edema and urgent imaging to guide further management.
Question 6: Which electrolyte abnormality most immediately threatens cardiac function in tumor lysis syndrome?
- Hyperkalemia (Correct answer)
- Hyperphosphatemia
- Hyperuricemia
- Hypocalcemia
Correct answer: Hyperkalemia
Hyperkalemia causes fatal arrhythmias and is the most immediately life-threatening electrolyte disturbance in TLS.
AOCNP Oncologic Emergencies 2
A patient develops sudden-onset dyspnea, muffled heart sounds, hypotension, and jugular venous distension.
Which emergency is this?