AOCNP Oncologic Emergencies 5 — Questions and Answers
Question 1: A patient with lymphoma undergoing induction chemotherapy develops rising creatinine, oliguria, and uric acid of 12 mg/dL. Allopurinol was started 24 hours ago. Which agent should be added to address established hyperuricemia?
- Colchicine
- Rasburicase (Correct answer)
- Febuxostat
- Probenecid
Correct answer: Rasburicase
Rasburicase is a recombinant urate oxidase that rapidly converts existing uric acid to allantoin (a soluble metabolite) and is preferred when hyperuricemia is already established, unlike allopurinol which only prevents new formation.
Question 2: Superior vena cava (SVC) syndrome with acute airway compromise and cerebral edema should be treated FIRST with which intervention?
- Anticoagulation with unfractionated heparin
- Emergent SVC stenting or radiation therapy (Correct answer)
- Surgical bypass grafting of the SVC
- High-dose systemic corticosteroids alone
Correct answer: Emergent SVC stenting or radiation therapy
Emergent endovascular SVC stenting provides the fastest relief of obstruction and is preferred for acute life-threatening SVC syndrome; radiation may follow once airway is stabilized.
Question 3: A patient with multiple myeloma develops acute flaccid paraplegia with urinary retention. MRI shows vertebral compression at T6 with epidural extension. Surgical evaluation is obtained. What is the PRIMARY factor determining eligibility for surgical decompression over radiation alone?
- Duration of neurological symptoms less than 24 hours
- Patient's overall performance status and life expectancy (Correct answer)
- Sensitivity of the underlying malignancy to radiation
- Presence of pathological fracture at the affected level
Correct answer: Patient's overall performance status and life expectancy
Patient performance status and prognosis (expected survival >3 months) are the primary determinants of whether surgical decompression is appropriate, as surgery offers no benefit to patients who cannot tolerate the procedure or have very limited life expectancy.
Question 4: Which statement about neutropenic enterocolitis (typhlitis) in oncology patients is CORRECT?
- It exclusively affects the sigmoid colon
- CT scan showing bowel wall thickening ≥4 mm supports the diagnosis (Correct answer)
- Immediate surgery is required in all confirmed cases
- Oral antibiotics are sufficient for mild cases
Correct answer: CT scan showing bowel wall thickening ≥4 mm supports the diagnosis
CT findings of bowel wall thickening ≥4 mm (particularly of the cecum/right colon) combined with neutropenia and abdominal pain support the diagnosis of typhlitis; initial management is usually conservative with bowel rest and broad-spectrum IV antibiotics.
Question 5: A patient with SCLC and SIADH has a serum sodium of 115 mEq/L with severe neurological symptoms (seizures). What is the appropriate rate of sodium correction?
- Correct sodium at any rate needed to stop seizures
- Increase sodium by no more than 8-10 mEq/L per 24 hours (Correct answer)
- Increase sodium by 20 mEq/L in the first 4 hours
- Maintain correction below 5 mEq/L per 24 hours to avoid rebound
Correct answer: Increase sodium by no more than 8-10 mEq/L per 24 hours
The safe rate of sodium correction is ≤8-10 mEq/L per 24 hours (up to 1-2 mEq/L/hr in acute symptomatic cases) to prevent osmotic demyelination syndrome while managing neurological symptoms.
Question 6: Which malignancy is MOST commonly associated with malignant pericardial effusion and cardiac tamponade?
- Colorectal carcinoma
- Lung and breast cancer (Correct answer)
- Hepatocellular carcinoma
- Cervical cancer
Correct answer: Lung and breast cancer
Lung cancer and breast cancer account for the majority of malignant pericardial effusions due to their high incidence and tendency for mediastinal and pericardial involvement.
Question 7: A patient with colon cancer on bevacizumab presents with sudden-onset severe abdominal pain, tachycardia, and signs of peritonitis. Which bevacizumab-associated oncologic emergency should be suspected?
- Bevacizumab-induced thrombocytopenia
- Gastrointestinal perforation (Correct answer)
- Hypersensitivity anaphylaxis
- Venous thrombosis of mesenteric vessels
Correct answer: Gastrointestinal perforation
Gastrointestinal perforation is a serious known complication of bevacizumab (VEGF inhibitor) due to impaired wound healing and mucosal integrity, occurring in approximately 1-2% of treated patients.
AOCNP Oncologic Emergencies 5
A patient with lymphoma undergoing induction chemotherapy develops rising creatinine, oliguria, and uric acid of 12 mg/dL.
Allopurinol was started 24 hours ago.
Which agent should be added to address established hyperuricemia?