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  • Question 1 - What is the threshold MASCC Risk Index Score for identifying patients as low...

    Incorrect

    • What is the threshold MASCC Risk Index Score for identifying patients as low risk for outpatient treatment with early antibiotics in cases of neutropenic sepsis?

      Your Answer: 18

      Correct Answer: 21

      Explanation:

      The MASCC Risk Index Score, developed by the Multinational Association of Supportive Care in Cancer, is a globally recognized scoring system that helps identify patients with neutropenic sepsis who have a low risk of complications and can potentially be treated as outpatients with early administration of antibiotics. This scoring system takes into account various characteristics to determine the risk level of the patient. These characteristics include the burden of febrile neutropenia with no or mild symptoms, absence of hypotension, no history of chronic obstructive pulmonary disease, presence of a solid tumor or hematological malignancy without previous fungal infection, absence of dehydration requiring parenteral fluids, burden of febrile neutropenia with moderate symptoms, being in an outpatient setting at the onset of fever, and age below 60 years. Each characteristic is assigned a certain number of points, and a total score of 21 or higher indicates a low risk, while a score below 21 indicates a high risk. The MASCC Risk Index Score has been validated internationally and has shown a positive predictive value of 91%, specificity of 68%, and sensitivity of 71%. For more detailed information, you can refer to the article titled Identifying Patients at Low Risk for FN Complications: Development and Validation of the MASCC Risk Index Score.

    • This question is part of the following fields:

      • Oncological Emergencies
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  • Question 2 - A middle-aged patient with a previous cancer diagnosis complains of recent onset back...

    Correct

    • A middle-aged patient with a previous cancer diagnosis complains of recent onset back pain. After conducting a thorough examination, your findings raise significant alarm. You begin to suspect the presence of metastatic spinal cord compression (MSCC).
      What specific feature is the strongest indicator of MSCC?

      Your Answer: Localised spinal tenderness

      Explanation:

      Metastatic spinal cord compression (MSCC) occurs when a tumor mass compresses the thecal sac and its components, leading to a spinal emergency. If the pressure on the spinal cord is not relieved promptly, it can result in irreversible loss of neurological function. The most crucial factor for predicting functional outcomes is the patient’s neurological function before treatment. Therefore, delayed treatment can lead to permanent disability and a decrease in quality of life.

      The most common cancers that cause MSCC include prostate, lung, breast, and myeloma. In approximately 10 to 20% of cancer patients, MSCC is the first noticeable symptom. It is important to consider MSCC in any patient with a history of cancer if they experience any of the following symptoms: severe or worsening lower back pain, nocturnal pain that disrupts sleep, localized spinal tenderness, radicular pain, or neurological symptoms.

      Thoracic pain can also be an indicator of MSCC or an aortic aneurysm. In patients aged 60 or older with persistent back pain, myeloma should be considered. For patients aged 60 or older with accompanying weight loss, pancreatic cancer should be taken into consideration.

    • This question is part of the following fields:

      • Oncological Emergencies
      52.9
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  • Question 3 - You assess a patient who has recently undergone a localized lung segmentectomy. A...

    Incorrect

    • You assess a patient who has recently undergone a localized lung segmentectomy. A few days after the procedure, he presents with feelings of illness, and today's blood results reveal the development of hyponatremia.
      What is the most probable cause of this biochemical abnormality?

      Your Answer: Excessive colloid infusion

      Correct Answer: Removal of hormonally active tumour

      Explanation:

      Small cell lung cancer (SCLC) that originates from neuroendocrine tissue has the potential to cause paraneoplastic endocrine syndromes, such as Cushing syndrome. This occurs due to the inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). In this particular case, it is highly likely that the patient underwent surgery to remove an ACTH-secreting neuroendocrine tumor within the lung.

      The tumors associated with the production of ectopic ACTH are as follows:
      – SCLC – 50%
      – Bronchial carcinoid tumors – 10%
      – Thymic carcinoma – 10%
      – Pancreatic islet cell tumors – 5%
      – Phaeochromocytoma – 5%
      – Medullary carcinoma – 5%

      When ectopic ACTH-secreting tumors are present, the typical signs and symptoms of Cushing syndrome may be minimal. The onset of symptoms can be sudden, especially in rapidly growing SCLCs. The typical biochemical profile observed in these cases includes elevated sodium levels, low potassium levels, and metabolic alkalosis.

      The body’s homeostatic mechanism will attempt to compensate for the elevated sodium levels by lowering them. However, after the tumor is removed, a paradoxical period of hyponatremia may occur during the postoperative period. This hyponatremia gradually normalizes until the sodium levels reach a normal range once again.

    • This question is part of the following fields:

      • Oncological Emergencies
      11.8
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  • Question 4 - A patient currently undergoing treatment for a malignant condition comes in with a...

    Incorrect

    • A patient currently undergoing treatment for a malignant condition comes in with a recent weight increase, puffiness in the face, high blood pressure, and acne. Blood tests show high sodium levels, low potassium levels, and metabolic alkalosis.

      Which of the following is the most probable location of this tumor?

      Your Answer: Thymus

      Correct Answer: Lung

      Explanation:

      Small cell lung cancer (SCLC) that originates from neuroendocrine tissue can lead to the development of paraneoplastic endocrine syndromes, such as Cushing syndrome. This occurs due to the inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). In this case, it is highly likely that the patient has a neuroendocrine tumor within the lung that is secreting ACTH.

      The signs and symptoms of Cushing syndrome may be minimal in cases of ectopic ACTH-secreting tumors, and the onset of symptoms may be sudden, especially in rapidly growing SCLCs. The typical biochemical profile observed in these cases includes elevated sodium levels, low potassium levels, and a metabolic alkalosis.

      The tumors associated with the production of ectopic ACTH are as follows:
      – Small cell lung cancer (SCLC) – 50%
      – Bronchial carcinoid tumors – 10%
      – Thymic carcinoma – 10%
      – Pancreatic islet cell tumors – 5%
      – Phaeochromocytoma – 5%
      – Medullary thyroid carcinoma – 5%

    • This question is part of the following fields:

      • Oncological Emergencies
      82.5
      Seconds
  • Question 5 - A 45-year-old man presents with a history of feeling generally unwell and having...

    Incorrect

    • A 45-year-old man presents with a history of feeling generally unwell and having experienced fevers at home. He has a history of lung cancer for which he is currently receiving radiation therapy. His observations are as follows: HR 92 bpm, BP 130/80, SaO2 98% on air, temperature 38.9°C. A diagnosis of neutropenic sepsis is suspected.
      According to the current NICE guidelines what is the cut off point for the neutrophil count for a diagnosis of neutropenic sepsis to be made?

      Your Answer: 2.0 x 109 per litre or lower

      Correct Answer: 0.5 x 109 per litre or lower

      Explanation:

      Neutropenic sepsis is a serious complication that can arise when a person has low levels of neutrophils, which are a type of white blood cell. This condition can be life-threatening and is commonly seen in individuals undergoing treatments such as cytotoxic chemotherapy or taking immunosuppressive drugs. Other causes of neutropenia include infections, bone marrow disorders like aplastic anemia and myelodysplastic syndromes, as well as nutritional deficiencies.

      To diagnose neutropenic sepsis, doctors look for specific criteria in patients receiving anticancer treatment. These criteria include having a neutrophil count of 0.5 x 109 per liter or lower, along with either a body temperature higher than 38°C or other signs and symptoms that indicate a clinically significant sepsis.

    • This question is part of the following fields:

      • Oncological Emergencies
      42.5
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  • Question 6 - You assess a patient who is currently undergoing systemic anticancer treatment. She presents...

    Incorrect

    • You assess a patient who is currently undergoing systemic anticancer treatment. She presents with a high fever, and you have concerns about the potential occurrence of neutropenic sepsis.

      Which of the following statements about neutropenic sepsis is NOT true?

      Your Answer: Patients on anticancer treatments should be offered a fluoroquinolone as prophylaxis

      Correct Answer: Dual therapy with Tazocin and an aminoglycoside is the recommended first-line treatment for confirmed neutropenic sepsis

      Explanation:

      Neutropenic sepsis is a serious condition that can occur when a person has low levels of neutrophils, which are a type of white blood cell. This condition can be life-threatening and is often caused by factors such as chemotherapy, immunosuppressive drugs, infections, and bone marrow disorders. Mortality rates can be as high as 20% in adults.

      To diagnose neutropenic sepsis, doctors look for a neutrophil count of 0.5 x 109 per litre or lower in patients undergoing cancer treatment. Additionally, if a patient has a temperature higher than 38°C or other signs of significant sepsis, they may be diagnosed with neutropenic sepsis.

      Cancer treatments, particularly chemotherapy, can weaken the bone marrow ability to fight off infections, making patients more susceptible to neutropenic sepsis. This risk can also be present with radiotherapy.

      According to the current guidelines from the National Institute for Health and Care Excellence (NICE), adult patients with acute leukemia, stem cell transplants, or solid tumors should be offered prophylaxis with a fluoroquinolone antibiotic during periods of expected neutropenia.

      When managing neutropenic sepsis, it is important to follow the UK Sepsis Trust Sepsis Six bundle, which includes specific actions to be taken within the first hour of recognizing sepsis.

      For initial empiric antibiotic therapy in suspected cases of neutropenic sepsis, the NICE guidelines recommend using piperacillin with tazobactam as monotherapy. Aminoglycosides should not be used unless there are specific patient or local microbiological indications.

      Reference:
      NICE guidance: ‘Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients’

    • This question is part of the following fields:

      • Oncological Emergencies
      37.8
      Seconds
  • Question 7 - A middle-aged patient with a previous cancer diagnosis complains of recently developed back...

    Incorrect

    • A middle-aged patient with a previous cancer diagnosis complains of recently developed back pain. After conducting a thorough examination, your findings raise significant alarm. You begin to consider the likelihood of a metastatic spinal cord compression (MSCC) diagnosis.
      Among the following types of cancer, which one is most frequently associated with MSCC?

      Your Answer: Acute lymphoblastic leukaemia

      Correct Answer: Prostate cancer

      Explanation:

      Metastatic spinal cord compression (MSCC) occurs when a tumor mass compresses the thecal sac and its components, leading to a spinal emergency. If the pressure on the spinal cord is not relieved promptly, it can result in irreversible loss of neurological function. The most crucial factor for predicting functional outcome is the patient’s neurological function before treatment. Therefore, delayed treatment can lead to permanent disability and a decrease in quality of life.

      The most common cancers that cause MSCC are prostate, lung, breast, and myeloma. In approximately 10 to 20% of cancer patients, MSCC is the first noticeable symptom. It is important to consider MSCC in any patient with a history of cancer if they experience any of the following symptoms: severe or progressive lumbar back pain, nocturnal pain that disrupts sleep, localized spinal tenderness, radicular pain, or neurological symptoms.

      Thoracic pain can also be an indicator of MSCC, but it can also be caused by an aortic aneurysm. In patients aged 60 or older with persistent back pain, myeloma should be considered. Similarly, in patients aged 60 or older with accompanying weight loss, pancreatic cancer should be considered.

    • This question is part of the following fields:

      • Oncological Emergencies
      65.5
      Seconds
  • Question 8 - A 45-year-old man presents with a history of feeling generally unwell and having...

    Correct

    • A 45-year-old man presents with a history of feeling generally unwell and having experienced fevers at home. He has a history of lung cancer for which he is currently undergoing radiation therapy. His observations are as follows: HR 92 bpm, BP 126/80, SaO2 98% on air, temperature 38.9°C. A diagnosis of neutropenic sepsis is suspected.
      Which validated scoring system can be used to assess the risk of developing serious complications in adults with febrile neutropenia?

      Your Answer: MASCC Risk Index Score

      Explanation:

      The MASCC Risk Index Score, developed by the Multinational Association of Supportive Care in Cancer, is a tool that can be utilized to identify patients who are at low risk for experiencing serious complications of febrile neutropenia. This score takes into account various characteristics of the patient to determine their risk level. For example, patients who have a minimal burden of febrile neutropenia with no or mild symptoms, no hypotension (with a systolic blood pressure above 90 mmHg), and no chronic obstructive pulmonary disease are assigned higher scores. Additionally, patients with a solid tumor or hematological malignancy and no previous fungal infection, as well as those who do not require parental fluids for dehydration, are also given higher scores. On the other hand, patients with a moderate burden of febrile neutropenia symptoms, those in an outpatient setting at the onset of fever, and those under the age of 60 receive lower scores. It is important to note that the qSOFA Score, CURB-65 Score, SCAP Score, and qCSI Score are different tools used for assessing different conditions and are not specifically used in the context of febrile neutropenia.

    • This question is part of the following fields:

      • Oncological Emergencies
      12.5
      Seconds
  • Question 9 - You assess a patient who is currently undergoing systemic anticancer treatment. She presents...

    Incorrect

    • You assess a patient who is currently undergoing systemic anticancer treatment. She presents with a high fever, and you have concerns about the potential occurrence of neutropenic sepsis.

      Which of the following statements is accurate regarding neutropenic sepsis?

      Your Answer: Patients on anticancer treatments should be offered co-amoxiclav as prophylaxis

      Correct Answer: Specialist management in an acute hospital setting involves implementing the standard UK Sepsis Trust 'Sepsis Six' bundle

      Explanation:

      Neutropenic sepsis is a serious complication that can occur in individuals with low neutrophil counts, known as neutropenia. There are several potential causes of neutropenia, including certain medications like chemotherapy and immunosuppressive drugs, stem cell transplantation, infections, bone marrow disorders, and nutritional deficiencies. In adults, mortality rates as high as 20% have been reported.

      To diagnose neutropenic sepsis, doctors look for a neutrophil count of 0.5 x 109 per litre or lower in patients undergoing cancer treatment. Additionally, patients must have either a temperature higher than 38°C or other signs and symptoms consistent with significant sepsis. Cancer treatments can suppress the bone marrow ability to respond to infections, making neutropenic sepsis more likely. This is most commonly seen with systemic chemotherapy but can also occur after radiotherapy.

      According to the current guidelines from the National Institute for Health and Care Excellence (NICE), adult patients with acute leukemia, stem cell transplants, or solid tumors who are expected to experience significant neutropenia due to chemotherapy should be offered prophylaxis with a fluoroquinolone antibiotic, such as ciprofloxacin. This should be taken during the expected period of neutropenia.

      When managing neutropenic sepsis, it is important to promptly implement the UK Sepsis Trust Sepsis Six bundle within the first hour of recognizing sepsis. This involves specialist assessment and management in an acute hospital setting.

      The NICE guidelines recommend using piperacillin with tazobactam (Tazocin) as the initial empiric antibiotic therapy for patients suspected of having neutropenic sepsis. It is advised not to use an aminoglycoside, either alone or in combination therapy, unless there are specific patient-related or local microbiological indications.

      Reference:
      NICE guidance: ‘Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients’

    • This question is part of the following fields:

      • Oncological Emergencies
      8.7
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  • Question 10 - A 70-year-old woman presents with a 4-day history of feeling generally unwell and...

    Correct

    • A 70-year-old woman presents with a 4-day history of feeling generally unwell and having experienced fevers at home. She has a history of breast cancer for which she is currently undergoing radiation therapy. Her vital signs are as follows: HR 100 bpm, BP 120/80, SaO2 95% on room air, temperature 38.5°C.
      The results of her complete blood count are as follows:
      Hemoglobin (Hb) 9.2 g/dl
      Mean Corpuscular Volume (MCV) 80 fl
      Platelets 60 x 109/l
      White Cell Count (WCC) 1.2 x 109/l
      Lymphocytes 0.4 x 109/l
      Neutrophils 0.6 x 109/l
      Monocytes 0.1 x 109/l
      Which of the following antibiotics would be most appropriate for the initial empiric treatment of this patient?

      Your Answer: Tazocin alone

      Explanation:

      The patient is showing signs of pancytopenia along with a fever, indicating a likely case of neutropenic sepsis. Their blood test results reveal microcytic anemia, leucopenia (with significant neutropenia), and thrombocytopenia. Neutropenic sepsis is a serious condition that can be life-threatening, characterized by a low neutrophil count. There are several potential causes of neutropenia, including cytotoxic chemotherapy, immunosuppressive drugs, stem cell transplantation, infections, bone marrow disorders like aplastic anemia and myelodysplastic syndromes, and nutritional deficiencies.

      To diagnose neutropenic sepsis in patients undergoing anticancer treatment, their neutrophil count should be 0.5 x 109 per liter or lower, and they should have either a temperature above 38°C or other signs and symptoms indicative of clinically significant sepsis. According to the current NICE guidelines, initial empiric antibiotic therapy for suspected neutropenic sepsis should involve monotherapy with piperacillin with tazobactam (Tazocin 4.5 g IV). It is not recommended to use an aminoglycoside, either alone or in combination therapy, unless there are specific patient-related or local microbiological reasons to do so.

      Reference:
      NICE guidance: ‘Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients’

    • This question is part of the following fields:

      • Oncological Emergencies
      10.6
      Seconds

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Oncological Emergencies (3/10) 30%
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