Board Review: Internal Medicine

A 31 year-old male presents to the Emergency Department with fatigue and myalgias that have been worsening over the past two days. Patient has a PMHx of IVDU, HIV and a recent diagnosis of Burkitt Lymphoma for which he started chemotherapy five days ago. Patient denies any fevers, chills, shortness of breath, chest pain, headache, vomiting or diarrhea but admits to nausea. Vital signs: Temp 98.3 F, HR 135, BP 100/60, RR 18, Sp02 97%. Labs demonstrate Creatinine 3.1, Na 142, K 6.3, Cl 90, Mag 2.3, Phosphorus 5. Which classification system is used to help determine the severity of disease in this patient? 


A: Cairo-Bishop Score

B. Alvarado Score

C. Fong Score

D. Oakland Score 














Answer: Cairo-Bishop Score


This patient is presenting with tumor lysis syndrome in the setting of initiation of chemotherapy.  The Cairo-Bishop scoring system is used to classify and grade tumor lysis syndrome. Two or more abnormalities are needed to make the diagnosis. 


Patients with tumor lysis syndrome are at high risk for cardiac arrhythmias and death. Prior to initiation of chemotherapy patients are stratified into low, moderate, and high risk classifications. Depending on their category, IV hydration, allopurinol, or rasburicase are beneficial in preventing this syndrome. Treatment of tumor lysis syndrome is acute management of electrolyte derangements with hyperkalemia being the most life-threatening. Calcium, insulin, dextrose, albuterol, and patiromer are useful for temporizing hyperkalemia. Hemodialysis is necessary for severe cases. These patients should also be started on rasburicase .2mg/kg.


Brock P, & Cruz-Carreras M.T. (2020). Emergency complications of malignancy. Tintinalli J.E., & Ma O, & Yealy D.M., & Meckler G.D., & Stapczynski J, & Cline D.M., & Thomas S.H.(Eds.), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill.

Coiffier, B., Altman, A., Pui, C. H., Younes, A., & Cairo, M. S. (2008). Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 26(16), 2767–2778.

Lopez-Olivo, M. A., Pratt, G., Palla, S. L., & Salahudeen, A. (2013). Rasburicase in tumor lysis syndrome of the adult: a systematic review and meta-analysis. American journal of kidney diseases : the official journal of the National Kidney Foundation, 62(3), 481–492.