Objectives:

• Recognize and initiate treatment for some oncologic emergencies, including spinal cord compression, tumor lysis syndrome, and neutropenic fever
• Assess needs of patients with cancer, and initiate appropriate supportive and symptomatic care
• Recognize late complications of cancer and cancer therapy, including distant radiation and chemotherapy
• Identify important aspects of pain control in patients with metastatic disease

1		A 40-year-old man who has just received his first course of chemotherapy for non-Hodgkin's lymphoma (NHL) presents to your emergency department complaining of weakness, cramps, and decreased urine output. He has no other medical problems and takes no medications except for prochlorperazine as needed for nausea. He has been eating and drinking well. His physical examination reveals a tired-appearing male, with temperature 37.4 C, pulse 90, blood pressure 134/72, respirations 16. His head and neck exam is unremarkable, except for bilateral palpable cervical lymph nodes approximately 2 cm in diameter. His lungs are clear in the upper lung fields with crackles bilaterally at the bases; muscle strength is normal, reflexes are symmetrical and 3/4 bilaterally. He exhibits 6 beats of clonus at the ankles. Chest radiograph shows evidence of early pulmonary edema. What is the most likely set of laboratory values you will find for this patient?
			A)	Potassium 2.3 meq/L, phosphorus 3.1 mg/dl, uric acid 4 mg/dl, calcium 9 mg/dl.
			B)	Potassium 2.6 meq/L, phosphorus 6 mg/dl, uric acid 5 mg/dl, calcium 12 mg/dl.
			C)	Potassium 6.5 meq/L, phosphorus 7 mg/dl, uric acid 18 mg/dl, calcium 6 mg/dl.
			D)	Potassium 6 meq/L, phosphorus 6.8 mg/dl, uric acid 5 mg/dl, calcium 6.7 mg/dl.
			E)	Potassium 4.5 meq/L, phosphorus 3.2 mg/dl, uric acid 9 mg/dl, calcium 8 mg/dl.
2		The patient is found to have a creatinine of 8 mg/dl. What is the most likely cause of this patient's renal failure?
			A)	Dehydration.
			B)	Uric acid nephropathy.
			C)	Rhabdomyolysis related to chemotherapy.
			D)	Hemoglobinuria.
			E)	None of the above.
3		Which of the following is MOST LIKELY to help his current condition?
			A)	Administration of normal saline 200 ml/hr.
			B)	Administration of D5W with 2 amps bicarbonate.
			C)	Administration of allopurinol 300 mg orally.
			D)	Consideration for emergent hemodialysis.
			E)	Administration of calcium carbonate 500 mg orally.