Superior Vena Cava Syndrome Quiz

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Created by Connor Bohlken and Chris Galbraith
Edited by Dr. Paris Ingledew

You are working with radiation oncologist Dr. Sam Veesea. Dr. Veesea has just received a call from the emergency department about one of their cancer patients, who is presenting with an oncologic emergency. Excitedly Dr. Veesea asks you to come along. On the way to the emergency department you are asked what the 3D’s of Superior Vena Cava (SVC) syndrome are. You answer:

1 point

Distant Heart Sounds, Distended Neck Veins, Decreased Blood Pressure

Dyspnea, Distension, Dilated Chest Wall Veins

Dermatitis, Diarrhea, Dementia

Dysmenorrhea, Dyschezia, Dyspareunia

Dementia, Dysregulated Gait, Dyscontinence

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You’re a R1 Emergency Medicine Resident working a 23:00 - 07:00 shift, your favorite! Your next patient presented with acute onset of shortness of breath without exertion, a swollen face, and what appears to be bulging veins on their chest. You astutely suspect SVC syndrome. Your attending gives you a fist bump, as this is what he was thinking. He then asks: which of the following is the most common etiology for SVC syndrome?

1 point

Non-hodgkin lymphoma

Compression of the SVC by a aortic aneurysm

Partial occlusion of the SVC by a thrombosis.

Compression of the SVC via a expanding small cell lung cancer

Compression of the SVC via a expanding non-small cell lung cancer

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After seeing a case of SVC syndrome you are reviewing with your attending. Particularly, you are interested in the management of SVC syndrome. Your attending stresses that histologic diagnosis should take precedence over initiation of anti-tumor therapy. However, they emphasize that there are a few exceptions if a patient presents with severe symptoms. In this setting endovenous stent placement and radiotherapy should be emergently performed. Your attending then asks you which of the following is NOT a reason to pursue emergent treatment. You answer:

1 point

Central Airway Obstruction

Respiratory Compromise

Chest Pain

CNS Depression

Stridor

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