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Oncological Emergencies (SVC Syndrome vs Sepsis): Exam Classics for MRCP Part 1

TL;DR;

In MRCP Part 1, oncological emergencies are tested through pattern recognition and first-step management. Superior vena cava (SVC) syndrome and sepsis can look similar in cancer patients, but they differ fundamentally in physiology and immediate action. This article contrasts both conditions using exam-focused points, a mini-case, common traps, and a practical revision checklist.


Why this topic matters in MRCP Part 1

Oncological emergencies are high-yield because they combine acute medicine, oncology, and decision-making under time pressure. MRCP questions rarely ask for definitive cancer therapy; instead, they test whether you can:

  • Recognise a life-threatening presentation

  • Identify the dominant physiology

  • Choose the most appropriate immediate step

SVC syndrome and sepsis are frequently contrasted because both may present with breathlessness, tachycardia, and systemic unwellness in patients with malignancy—yet the management priorities are entirely different.

For syllabus alignment, see the official MRCP Part 1 overview:https://www.mrcpuk.org/mrcpuk-examinations/part-1


Scope and exam expectations

In MRCP Part 1, expect questions that:

  • Describe a patient with known or suspected malignancy

  • Provide subtle clues pointing toward venous obstruction or distributive shock

  • Ask “What is the next best step?” rather than long-term management

The exam rewards clarity, not over-investigation.


High-yield differences: SVC syndrome vs sepsis

1. Underlying physiology

  • SVC syndrome: Obstruction of venous return → raised upper-body venous pressure

  • Sepsis: Dysregulated immune response → vasodilation, capillary leak, hypotension

2. Typical clinical clues

  • SVC: Facial swelling, periorbital oedema, headache worse when supine, dilated neck veins

  • Sepsis: Fever or hypothermia, rigors, confusion, hypotension, reduced urine output

3. Blood pressure

  • SVC: Often normal initially

  • Sepsis: Hypotension or falling mean arterial pressure

4. Neck veins

  • SVC: Prominent, non-pulsatile jugular veins

  • Sepsis: No characteristic JVP finding

5. First investigation

  • SVC: Contrast-enhanced CT of the chest

  • Sepsis: Blood cultures (if possible) before antibiotics—without delaying treatment

6. Immediate management

  • SVC: Elevate head of bed, oxygen, confirm diagnosis

  • Sepsis: Broad-spectrum IV antibiotics + IV fluids within 1 hour

7. Steroids

  • SVC: Only if lymphoma is suspected

  • Sepsis: Not first-line (consider later in refractory shock)

8. Radiotherapy

  • SVC: Definitive treatment, not the first exam answer

  • Sepsis: No role in acute management


One exam-ready comparison table

Feature

SVC Syndrome

Sepsis

Mechanism

Venous obstruction

Distributive shock

Key signs

Facial swelling, raised JVP

Fever, hypotension

First step

Elevate head, CT chest

IV antibiotics + fluids

Steroids

Selective (lymphoma)

Not initial

Mortality risk

Airway/cerebral oedema

Multiorgan failure

MRCP Part 1 study setup with revision notes and practice questions

Five most tested subtopics

  1. Malignancies causing SVC – Small-cell lung cancer and lymphoma

  2. Neutropenic sepsis – Fever may be absent; treat immediately

  3. Imaging choice in SVC – CT chest over chest X-ray

  4. Steroid misuse – Not routine in SVC

  5. Time-critical care – Sepsis takes priority if suspected

Mini-case (single best answer)

A 64-year-old man with known lung cancer presents with facial swelling, headache worse on lying flat, and dyspnoea. BP is 130/78 mmHg, temperature 36.8 °C, oxygen saturation 96% on air.

What is the most appropriate next step?

A. IV broad-spectrum antibioticsB. Immediate radiotherapyC. High-dose dexamethasoneD. Contrast-enhanced CT chestE. Therapeutic anticoagulation

Correct answer: D

Explanation: This is a haemodynamically stable patient with classic features of SVC syndrome. The next step is to confirm the diagnosis with CT chest. Antibiotics are indicated for sepsis; steroids are only appropriate if lymphoma is suspected.

To practise similar questions, use:


Common exam traps (5 to avoid)

  • Treating all cancer patients with breathlessness as SVC (sepsis is more common)

  • Starting steroids routinely in SVC syndrome

  • Delaying antibiotics in suspected sepsis for imaging

  • Assuming normal temperature excludes sepsis

  • Choosing chest X-ray instead of CT for diagnosing SVC


Practical study-tip checklist

  • Identify the dominant physiology first

  • Memorise first actions, not definitive oncology

  • Practise paired questions (SVC vs sepsis vs PE)

  • Use timed MCQs to reduce overthinking

  • Keep a list of repeated mistakes

Structured revision resources are available in the MRCP Part 1 hub:https://crackmedicine.com/mrcp-part-1/


FAQs

Is SVC syndrome always an emergency in MRCP Part 1?

It is urgent but often initially stable. The exam focuses on diagnosis and supportive measures rather than immediate radiotherapy.

Should steroids be given immediately in SVC syndrome?

No. Steroids are only indicated if lymphoma is suspected.

How does neutropenic sepsis change management?

Antibiotics must be started immediately, even if the patient is afebrile.

What investigation confirms SVC obstruction?

Contrast-enhanced CT of the chest.


Ready to start?

Consolidate these contrasts with targeted practice: attempt mixed emergency stems on /qbank/ and validate timing and accuracy with /mock-tests/. Keep a running list of “first-step” decisions you miss.


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