Oncological Emergencies + neutropenic sepsis

Which cancers most commonly cause MSCC?

Prostate, breast, and lung.

What are early symptoms of MSCC?

 Back pain, motor weakness (paresis), sensory changes, gait disturbance, hyperreflexia.

 Initial pharmacological management of MSCC?

Dexamethasone 16mg + analgesia.

Why is D-dimer not used in oncology?

It is often falsely elevated in malignancy.

What is the role of G6PD testing in TLS management?

 Needed before rasburicase (risk of haemolytic anaemia in deficiency). Rarely done in emergencies as results take ~3 weeks.

 Symptoms of hypercalcaemia?

Polyuria, thirst, confusion, renal impairment, nephrolithiasis, arrhythmias, muscle weakness.

 First-line treatment for hypercalcaemia? and What drugs are used if fluids are insufficient?

• IV saline 0.9% (4–6L/24h).

• Bisphosphonates (zoledronic acid), calcitonin, denosumab.

Symptoms of immune-related myasthenia gravis?

Ptosis, diplopia, dysarthria, dysphagia, limb weakness, respiratory paralysis

 Drugs to avoid in myasthenia gravis?

Macrolides, quinolones, gentamicin, beta-blockers, anticholinergics, statins, tetracyclines.

 How does febrile neutropenia differ from neutropenic sepsis?

FN = fever + neutropenia; NS = sepsis criteria + neutropenia (life-threatening organ dysfunction).

What is the “3 in 3 out” approach to sepsis management?

• Three out: blood cultures (central + peripheral, or 2 peripheral if no central), lactate, urine output.

• Three in: oxygen (if required), IV antibiotics, IV fluids.

 First-line antibiotics for neutropenic sepsis?

 Antipseudomonal β-lactam (e.g. piperacillin-tazobactam).

When should vancomycin be added in neutropenic sepsis?

 Suspected catheter infection, skin/soft tissue infection, pneumonia, or haemodynamic instability

Role of GCSF in neutropenic sepsis?

Continue prophylaxis; consider in profound FN (ANC <0.1). No mortality benefit when added to antibiotics.