ONC Prep

Small-cell lung cancer + hyponatremia + low serum osmolality + inappropriately concentrated urine = what syndrome?

SIADH (syndrome of inappropriate antidiuretic hormone secretion). Excess ADH causes water retention → dilutional hyponatremia. Fluid restriction is a key intervention.

“Small cells SQUEEZE the sodium.”

SCLC → SIADH → ↓ Na⁺

What are two major toxicities associated with cisplatin?

Nephrotoxicity and ototoxicity. Monitor renal function and assess for hearing changes/tinnitus. Cisplatin can also cause significant nausea/vomiting and electrolyte abnormalities.

Cisplatin → renal injury → electrolyte wasting → hydration considerations

Cisplatin → ototoxicity → tinnitus/hearing changes

What important adverse effect should be monitored in a patient receiving bevacizumab?

Hypertension. Monitor BP and report/manage significant elevations. Severe hypertension, especially with neurologic symptoms, requires prompt evaluation.

What clinical findings should make you suspect metastatic spinal cord compression?

New/worsening back pain + neurologic changes, especially weakness, sensory changes, difficulty walking, bowel/bladder dysfunction. Treat as an oncologic emergency requiring urgent evaluation/imaging

What imaging is typically used to urgently evaluate suspected spinal cord compression?

MRI of the spine

What laboratory pattern is classic for tumor lysis syndrome?

↑ Potassium, ↑ uric acid, ↑ phosphorus, ↓ calcium, often with rising creatinine/acute kidney injury.

Why does tumor lysis syndrome cause hyperuricemia?

Rapid destruction of tumor cells releases nucleic acids → purine breakdown → uric acid accumulation, which can contribute to renal injury.

Opioid-induced constipation: what type of bowel regimen is commonly needed?

A stimulant laxative, often with other bowel-regimen measures; stool softener alone may be inadequate. Encourage fluids/activity when appropriate.

Cisplatin — important electrolyte toxicity?

Hypomagnesemia due to renal magnesium wasting. Can cause weakness, muscle cramps, neuromuscular irritability, and dysrhythmias.

Hypomagnesemia — clinical manifestations?

Weakness, muscle cramps, tremors, neuromuscular irritability, and cardiac dysrhythmias.

Irinotecan — major toxicity to recognize?

Diarrhea, which can become severe and cause dehydration/electrolyte abnormalities. Assess severity, hydration status, and initiate appropriate management promptly.

Severe chemotherapy-associated diarrhea — priority concern?

Fluid volume depletion and electrolyte abnormalities. Assess hydration/hemodynamic status and replace fluids/electrolytes as indicated.

Which ABVD drug is associated with pulmonary toxicity?

Adriamycin (doxorubicin) + Bleomycin + Vinblastine + Dacarbazine.

Bleomycin. Watch for new cough, dyspnea, hypoxemia, or other pulmonary symptoms.

New/worsening respiratory symptoms → possible bleomycin pulmonary toxicity.

What is the clinical significance of an activating EGFR mutation in NSCLC?

It is a predictive biomarker that can identify patients who may benefit from EGFR-targeted therapy and can guide treatment selection.

APL + bleeding/petechiae + ↓ fibrinogen + ↑ PT/PTT + ↑ D-dimer = ?

acute promyelocytic leukemia

DIC (disseminated intravascular coagulation). APL carries a high risk of life-threatening coagulopathy. Recognize urgently and escalate.

Special association: APL → ATRA is critical therapy.

APL is strongly associated with life-threatening coagulopathy/DIC

Hodgkin lymphoma + dry cough + dyspnea + pulmonary infiltrates → which ABVD drug?

Bleomycin → pulmonary toxicity.

Patient on pembrolizumab with fatigue, weight loss, orthostatic symptoms, ↓Na, ↑K, and ↓glucose — what should you suspect?

Immune-mediated adrenal insufficiency.
Checkpoint inhibitors can cause endocrine immune-related adverse events.

Pattern:
↓ Na + ↑ K + ↓ glucose + fatigue/weakness/weight loss/orthostasis → adrenal insufficiency

Checkpoint inhibitor + headache + visual changes + fatigue + hypotension + ↓Na/↓glucose → think what?

Immune-mediated hypophysitis → pituitary dysfunction can cause adrenal insufficiency and other endocrine abnormalities.

Checkpoint inhibitor + new polyuria + polydipsia + weight loss → what immune-related complication should you consider?

Immune-mediated diabetes mellitus. Check serum glucose promptly and assess for possible DKA if clinically indicated.

What electrolyte pattern strongly suggests primary adrenal insufficiency?

↓ Na + ↑ K, often with hypotension/orthostasis, fatigue, weakness, weight loss, anorexia, nausea, and sometimes hypoglycemia.

What is y intended to reduce methotrexate toxicity?

Administer leucovorin rescue according to the prescribed protocol.

mesna is for uroprotection for what meds?

Ifosfamide/cyclophosphamide