AOCNP Oncologic Emergencies 1 — Questions and Answers
Question 1: A patient with multiple myeloma presents with severe back pain, lower extremity weakness, and urinary retention. Which oncologic emergency does this presentation suggest?
- Spinal cord compression (Correct answer)
- Superior vena cava syndrome
- Tumor lysis syndrome
- Hypercalcemia of malignancy
Correct answer: Spinal cord compression
Spinal cord compression presents with back pain, motor weakness, and autonomic dysfunction such as urinary retention or incontinence.
Question 2: Which laboratory finding is NOT part of the classic tumor lysis syndrome (TLS) triad?
- Hypocalcemia
- Hyperkalemia
- Hyperphosphatemia
- Hypernatremia (Correct answer)
Correct answer: Hypernatremia
TLS is characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia — hypernatremia is not a feature.
Question 3: A patient receiving high-dose methotrexate suddenly develops fever, rigors, and hypotension. Which oncologic emergency is most likely?
- Anaphylaxis
- Septic shock (Correct answer)
- Cardiac tamponade
- Disseminated intravascular coagulation
Correct answer: Septic shock
Febrile neutropenia with hemodynamic compromise meets criteria for septic shock and requires immediate broad-spectrum antibiotics and fluid resuscitation.
Question 4: Which first-line intervention is indicated for hypercalcemia of malignancy with corrected serum calcium > 14 mg/dL?
- IV bisphosphonate alone
- Aggressive IV normal saline hydration followed by bisphosphonate (Correct answer)
- Oral calcitonin
- Furosemide alone
Correct answer: Aggressive IV normal saline hydration followed by bisphosphonate
Aggressive IV normal saline rehydration is the immediate priority, followed by a bisphosphonate such as zoledronic acid to lower calcium.
Question 5: A patient with lung cancer develops facial plethora, arm edema, and distended neck veins. Which imaging study is the priority?
- CT chest with contrast (Correct answer)
- MRI brain
- Bone scan
- Echocardiogram
Correct answer: CT chest with contrast
CT chest with contrast delineates the extent of superior vena cava (SVC) obstruction and identifies the underlying mass causing it.
Question 6: Rasburicase is contraindicated in which patient population due to risk of hemolytic anemia?
- Patients with G6PD deficiency (Correct answer)
- Patients with renal impairment
- Patients with hepatic failure
- Patients receiving steroids
Correct answer: Patients with G6PD deficiency
Rasburicase generates hydrogen peroxide as a byproduct, which causes oxidative hemolysis in patients with G6PD deficiency.
AOCNP Oncologic Emergencies 1
A patient with multiple myeloma presents with severe back pain, lower extremity weakness, and urinary retention.
Which oncologic emergency does this presentation suggest?