AOCNP Test question with answers
Most common surgical approach to SCC - -Anterior decompression with mechanical
stabilization followed by RT
-Preferred imaging technique to evaluate for suspected hemorrhage or hydrocephalus - -CT
head
-Most common site of mets in the brain - -Cerebrum, then cerebellum, then brainstem
-Who is at greatest risk for increased ICP? Which cancer types? - -Patient with brain tumors
Lung cancer and melanoma
-What is cushing's triad a late sign of? What is it? - -Increased ICP
Cushing's Triad: HTN with widening pulse pressure (rising systolic, declining diastolic),
bradycardia, abnormal respirations
-Late sign of ICP that occurs in 70% of patients with brain tumors - -papilledema (1-5 days
unless related to subarachnoid hemorrhage in which case it develops within 2-8 hours)
-When is headache worse with increased ICP? - -in the morning
with bending, coughing, valsalva
-Early symptom of increased ICP - -headache accompanied by nausea, vomiting
-Causes of increased ICP in cancer - -Tumor, hemorrhage, ischemic stroke, abscess,
autoimmune inflammatory process
-Classic signs of autonomic dysfunction - -HTN, bradycardia, punding headache, flushing,
profuse sweating above level of spinal involvement
-What are patients at risk for with spinal lesions at T6 or higher? - -autonomic dysreflexia
-Minimally invasive surgeries for SCC - -Kyphoplasty: balloon inflation followed by PMMA
injection
Vertebroplasty: PMMA injection only
-Indications for surgical intervention of SCC - -1) Rapidly progressing paraplegia
2) worsening neuro dysfunction while undergoing RT
3) pathologic fracture with bone dislocation
4) need biopsy
5) radioresistant tumors
6) recurrence after previous RT
, 7) prognosis of 3 months or greater
-Where would you suspect a cord compression to be if patient was experiencing bilateral
sensory loss following dermatome path involving the buttocks, perineal area, posterior thigh,
and lateral leg - -Cauda equina
-How to treat SVC caused by thrombus? - -thrombolytic therapy (tPA) followed by heparin gtt,
remove CVC
-Most common etiology for SVC / cancer - -mediastinal malignancy (right sided lung cancers),
SCLC (followed by SCC of lung then adenocarcinoma of lung)
-Beck's Triad - -hypotension, distant heart sounds, JVD
-Emergent management of pericardial effusion - -Pericardiocentesis
-Late symptoms of SVC - -Stridor, vocal cord paralysis, hemoptysis, cyanosis, periorbital edema,
CHF, Cerebral Edema (seizure, headache, confusion)
-Which oncologic emergency is Horner Syndrome associated with? - -SVC syndrome
-Conditions that often develop because of SVC? - -Pleural and pericardial effusions
-Most common s/s of SVC - -Facial or neck swelling
upper extremity swelling
Dyspnea
Cough
Dilated chest vein collaterals
-Extrinsic causes of SVC syndrome - -compressive tumor, mediastinal lymph node
-Intrinsic causes of SVC syndrome - -Thrombosis or tumor, intraluminal
-More permanent management of pericardial effusion - -Pericardial sclerosis
PC balloon pericardiostomy
Pericardial window
Pericardiectomy
-Transudative vs exudative pericardial fluid - -Transudative: low protein in fluid, leakage due to
mechanical factor such as CHF, cirrhosis
Exudative: rich in protein, leaked due to increased permeability, contains blood/debris from
cancer cells/tumors
Most common surgical approach to SCC - -Anterior decompression with mechanical
stabilization followed by RT
-Preferred imaging technique to evaluate for suspected hemorrhage or hydrocephalus - -CT
head
-Most common site of mets in the brain - -Cerebrum, then cerebellum, then brainstem
-Who is at greatest risk for increased ICP? Which cancer types? - -Patient with brain tumors
Lung cancer and melanoma
-What is cushing's triad a late sign of? What is it? - -Increased ICP
Cushing's Triad: HTN with widening pulse pressure (rising systolic, declining diastolic),
bradycardia, abnormal respirations
-Late sign of ICP that occurs in 70% of patients with brain tumors - -papilledema (1-5 days
unless related to subarachnoid hemorrhage in which case it develops within 2-8 hours)
-When is headache worse with increased ICP? - -in the morning
with bending, coughing, valsalva
-Early symptom of increased ICP - -headache accompanied by nausea, vomiting
-Causes of increased ICP in cancer - -Tumor, hemorrhage, ischemic stroke, abscess,
autoimmune inflammatory process
-Classic signs of autonomic dysfunction - -HTN, bradycardia, punding headache, flushing,
profuse sweating above level of spinal involvement
-What are patients at risk for with spinal lesions at T6 or higher? - -autonomic dysreflexia
-Minimally invasive surgeries for SCC - -Kyphoplasty: balloon inflation followed by PMMA
injection
Vertebroplasty: PMMA injection only
-Indications for surgical intervention of SCC - -1) Rapidly progressing paraplegia
2) worsening neuro dysfunction while undergoing RT
3) pathologic fracture with bone dislocation
4) need biopsy
5) radioresistant tumors
6) recurrence after previous RT
, 7) prognosis of 3 months or greater
-Where would you suspect a cord compression to be if patient was experiencing bilateral
sensory loss following dermatome path involving the buttocks, perineal area, posterior thigh,
and lateral leg - -Cauda equina
-How to treat SVC caused by thrombus? - -thrombolytic therapy (tPA) followed by heparin gtt,
remove CVC
-Most common etiology for SVC / cancer - -mediastinal malignancy (right sided lung cancers),
SCLC (followed by SCC of lung then adenocarcinoma of lung)
-Beck's Triad - -hypotension, distant heart sounds, JVD
-Emergent management of pericardial effusion - -Pericardiocentesis
-Late symptoms of SVC - -Stridor, vocal cord paralysis, hemoptysis, cyanosis, periorbital edema,
CHF, Cerebral Edema (seizure, headache, confusion)
-Which oncologic emergency is Horner Syndrome associated with? - -SVC syndrome
-Conditions that often develop because of SVC? - -Pleural and pericardial effusions
-Most common s/s of SVC - -Facial or neck swelling
upper extremity swelling
Dyspnea
Cough
Dilated chest vein collaterals
-Extrinsic causes of SVC syndrome - -compressive tumor, mediastinal lymph node
-Intrinsic causes of SVC syndrome - -Thrombosis or tumor, intraluminal
-More permanent management of pericardial effusion - -Pericardial sclerosis
PC balloon pericardiostomy
Pericardial window
Pericardiectomy
-Transudative vs exudative pericardial fluid - -Transudative: low protein in fluid, leakage due to
mechanical factor such as CHF, cirrhosis
Exudative: rich in protein, leaked due to increased permeability, contains blood/debris from
cancer cells/tumors
