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Tumour lysis syndrome — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesTumour lysis syndromeSCE Acute Medicine

A 82-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show hyperkalaemia, hyperphosphataemia, hypocalcaemia and high urate after chemotherapy. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give rasburicase, intravenous fluids and treat hyperkalaemia

The key discriminator is that hyperkalaemia, hyperphosphataemia, hypocalcaemia and high urate after chemotherapy, which makes Give rasburicase, intravenous fluids and treat hyperkalaemia the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Optimise chronic medication and discharge would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BCSH tumour lysis guideline; BNF