FINAL EXAM REVIEW- AGACNP QUESTIONS
WITH CORRECT ANSWERS 2026
Oncologic Emergency- Hematologic- Febrile neutropenia and sepsis
Febrile Neutropenia- Temp > 100.4F and ANC < 1000
Neutropenia + Infection = Emergency
Considered sepsis until proven otherwise ... Sepsis = Most common cause of
nonmalignant death
Diagnosis
Early recognition is key Think Sepsis Management Guidelines
Q1H after first 60 minutes = 7.6 % increased mortality
Obtain cultures PRIOR to treatment !
Treatment : Broad Spectrum ATB coverage
Gram negative / positive coverage + MRSA
PNA- atypical coverage until ruled out
GI / enteric cause- Need GNB anaerobic coverage
Consider antivirals / antifungals if a possible cause
Oncologic Emergency- Hematologic- Hyperleukocytosis and Leukostasis
Elevated WBC ( > 100K )
Tissue damage occurs due to local hypoxia , hyperpermeability , and release of
lysosomes and procoagulants
Intravascular sludging and leukocytosis can develop along with white thrombus
formation .
Symptoms- most common are neuro / pulm
Dizziness , blurred vision , tinnitus , ataxia , AMS , retinal hemorrhage ,
,papilledema
Fever , tachypnea , dyspnea , hypoxia , CHF , priapism
Diagnosis
CBC ( do a manual platelet count ! )
Chemistry ( falsely elevated potassium- keep on ice ! )
Chest XR / CT
Treatment - goal is to reduce WBC by 20 % to 60 % in the first few hours
Supplemental oxygen , allopurinol , urinary alkalinization , hydration
Whole brain irradiation for CNS involvement .
Immediate cytoreductive therapy + leukapheresis / hydroxyurea
Oncology Emergency- Structural- Leptomenigneal Disease and CNS lesions
Presence of solid tumors or cancer cells in CSF → Cause increased ICP due to :
Mass Effect , Hydrocephalus
Symptoms- ALTERED MENTAL STATUS
Central herniation- due to hemispheric mass
Slow deterioration in LOC , headache , and focal neurologic deficits .
Progression- results in global neurologic changes , Cheyne - Stokes respiration ,
small reactive pupils
Uncal herniation- due to mass in temporal lobe / lateral fossa of the frontal lobe
Rapid loss of consciousness , lateral pupillary dilatation , and ipsilateral
hemiparesis .
Tonsillar herniation- posterior fossa mass
Occipital headache , vomiting , and hiccups → Followed by LOC and respiratory
compromise
Diagnosis : Head CT , Brain MRI
NO Lumbar Puncture - risk for herniation , increased pressure
,Treatment : IV corticosteroids , mannitol , HOB > 30 degrees , decompression /
shunting , consider mass removal
Oncology Emergency- Structural- Superior/Inferior Vena Cava Syndrome
Diminished blood flow through vena cava due to tumor involvement ( 3-15 %
incidence in lung cancer )
Lymphoma , metastasis to mediastinum ... Also- need to consider CVC as cause !!
Can lead to increased ICP / intracranial bleeding , loss of airway
Symptoms
Common- facial edema , dyspnea , couch , orthopnea , edema of neck / arms
Uncommon - hoarseness , dysphagia , HA , chest pain , AMS
Diagnosis
Imaging - widened mediastinum , mass in R chest
Can also see if chronic- collateral circulation present
Treatment
Bx of mass if not yet diagnosed
Radiation / stenting AFTER confirmation of disease
Consider thrombolysis
Oncology Emergency- Structural- Spinal Cord Compression
Mets to vertebral bodies → damage to spinal cord → s / t edema , hemorrhage ,
pressure induced ischemia
Prompt diagnosis key to prevent irreversible damage
High level of suspicion with lung , breast , prostate cancers , epidural tumors
Also can see leptomeningeal disease in lymphoma / myeloma
, High concern with patients with chronic back pain with new / change in pain
characteristic / location
Symptoms
Progressive unrelenting , axial / radicular pain
Worsens on palpation / lying flat / straight leg raise
Cervical compression- quadriplegia
Thoracic compression - paraplegia ( 70 % of lesions )
Upper lumbar compression- bowel and bladder dysfunction / altered extensor
plantar reflexes
Cauda equina involvement - loss of bowel / bladder fx + lower motor weakness w
/ normal plantar reflexes
Diagnosis
CA pts who present with new back pain- consider impending cord compression
until proven otherwise
1st choice for imaging- MRI ... Can use myelography if MRI contraindicated
Treatment
Epidural impingement : Dexamethasone 10-100mg IV initially, Followed by 4-24mg
Q6H IV or PO
Compression Surgery + radiation
Multiple vertebral levels involved → ( Palliative ) Radiation
Oncology Emergency- Metabolic- Hyperuricemia & Tumor Lysis Syndrome
Treatment of patients with high disease burden - lysis of LOTS of cells !
Common with tumors highly sensitive to chemotherapy ( usually follows induction
)
WITH CORRECT ANSWERS 2026
Oncologic Emergency- Hematologic- Febrile neutropenia and sepsis
Febrile Neutropenia- Temp > 100.4F and ANC < 1000
Neutropenia + Infection = Emergency
Considered sepsis until proven otherwise ... Sepsis = Most common cause of
nonmalignant death
Diagnosis
Early recognition is key Think Sepsis Management Guidelines
Q1H after first 60 minutes = 7.6 % increased mortality
Obtain cultures PRIOR to treatment !
Treatment : Broad Spectrum ATB coverage
Gram negative / positive coverage + MRSA
PNA- atypical coverage until ruled out
GI / enteric cause- Need GNB anaerobic coverage
Consider antivirals / antifungals if a possible cause
Oncologic Emergency- Hematologic- Hyperleukocytosis and Leukostasis
Elevated WBC ( > 100K )
Tissue damage occurs due to local hypoxia , hyperpermeability , and release of
lysosomes and procoagulants
Intravascular sludging and leukocytosis can develop along with white thrombus
formation .
Symptoms- most common are neuro / pulm
Dizziness , blurred vision , tinnitus , ataxia , AMS , retinal hemorrhage ,
,papilledema
Fever , tachypnea , dyspnea , hypoxia , CHF , priapism
Diagnosis
CBC ( do a manual platelet count ! )
Chemistry ( falsely elevated potassium- keep on ice ! )
Chest XR / CT
Treatment - goal is to reduce WBC by 20 % to 60 % in the first few hours
Supplemental oxygen , allopurinol , urinary alkalinization , hydration
Whole brain irradiation for CNS involvement .
Immediate cytoreductive therapy + leukapheresis / hydroxyurea
Oncology Emergency- Structural- Leptomenigneal Disease and CNS lesions
Presence of solid tumors or cancer cells in CSF → Cause increased ICP due to :
Mass Effect , Hydrocephalus
Symptoms- ALTERED MENTAL STATUS
Central herniation- due to hemispheric mass
Slow deterioration in LOC , headache , and focal neurologic deficits .
Progression- results in global neurologic changes , Cheyne - Stokes respiration ,
small reactive pupils
Uncal herniation- due to mass in temporal lobe / lateral fossa of the frontal lobe
Rapid loss of consciousness , lateral pupillary dilatation , and ipsilateral
hemiparesis .
Tonsillar herniation- posterior fossa mass
Occipital headache , vomiting , and hiccups → Followed by LOC and respiratory
compromise
Diagnosis : Head CT , Brain MRI
NO Lumbar Puncture - risk for herniation , increased pressure
,Treatment : IV corticosteroids , mannitol , HOB > 30 degrees , decompression /
shunting , consider mass removal
Oncology Emergency- Structural- Superior/Inferior Vena Cava Syndrome
Diminished blood flow through vena cava due to tumor involvement ( 3-15 %
incidence in lung cancer )
Lymphoma , metastasis to mediastinum ... Also- need to consider CVC as cause !!
Can lead to increased ICP / intracranial bleeding , loss of airway
Symptoms
Common- facial edema , dyspnea , couch , orthopnea , edema of neck / arms
Uncommon - hoarseness , dysphagia , HA , chest pain , AMS
Diagnosis
Imaging - widened mediastinum , mass in R chest
Can also see if chronic- collateral circulation present
Treatment
Bx of mass if not yet diagnosed
Radiation / stenting AFTER confirmation of disease
Consider thrombolysis
Oncology Emergency- Structural- Spinal Cord Compression
Mets to vertebral bodies → damage to spinal cord → s / t edema , hemorrhage ,
pressure induced ischemia
Prompt diagnosis key to prevent irreversible damage
High level of suspicion with lung , breast , prostate cancers , epidural tumors
Also can see leptomeningeal disease in lymphoma / myeloma
, High concern with patients with chronic back pain with new / change in pain
characteristic / location
Symptoms
Progressive unrelenting , axial / radicular pain
Worsens on palpation / lying flat / straight leg raise
Cervical compression- quadriplegia
Thoracic compression - paraplegia ( 70 % of lesions )
Upper lumbar compression- bowel and bladder dysfunction / altered extensor
plantar reflexes
Cauda equina involvement - loss of bowel / bladder fx + lower motor weakness w
/ normal plantar reflexes
Diagnosis
CA pts who present with new back pain- consider impending cord compression
until proven otherwise
1st choice for imaging- MRI ... Can use myelography if MRI contraindicated
Treatment
Epidural impingement : Dexamethasone 10-100mg IV initially, Followed by 4-24mg
Q6H IV or PO
Compression Surgery + radiation
Multiple vertebral levels involved → ( Palliative ) Radiation
Oncology Emergency- Metabolic- Hyperuricemia & Tumor Lysis Syndrome
Treatment of patients with high disease burden - lysis of LOTS of cells !
Common with tumors highly sensitive to chemotherapy ( usually follows induction
)
