exam 1 Flashcards
1
Q
In cancer, damage to the genome can be caused by what?
A
- errors in replication of DNA 2. intrinsic chemical instability of certain DNA bases 3. attack by free radicals generated during metabolism
2
Q
What causes a normal cell to transition to a malignant one?
A
genes involved in normal homeostatic mechanisms that control proliferation and cell death suffer mutational damage which results in the activation of genes stimulating proliferation or protection against cell death, and inactivation of tumor suppressor genes.
3
Q
DNA trans/trans
A
double helix DNA unwound and transcription performed to make single strand mRNA. Translation then turn the mRNA code into proteins
4
Q
Mitotic phases
A
prophase, metaphase, anaphase, telophase, cytokinesis
5
Q
Cell cycle phases
A
Interphase (first growth phase, synthesis phase, second growth phase), Mitosis
6
Q
Why do cells divide?
A
reproduction, growth, repair
7
Q
cell differentiation
A
process by which less specialized cell becomes more specialized type
8
Q
cell that is able to differentiate into all cell types
A
pluriopotent ie stem cells change to Blood cells through hematopoiesis
9
Q
neoplasia
A
abnormal cell division and growth
10
Q
malignant
A
rapid growth, invasive, potential for metastasis
11
Q
benign
A
slow growth, non-invasive, no metastasis
12
Q
proto-oncogenes and oncogene
A
genes that are expressed at high levels in tumor cells
regulate cell proliferation and differentiation
inhibit cell death/apoptosis
13
Q
anti-oncogenes/tumor suppressors
A
inhibit cell proliferation and growth
halts cell division if DNA damaged and allows DNA to be repaired if minor damage
if damage is significant, triggers apoptosis
14
Q
external factors as carcinogens
A
environmental: chemicals/radiation, lifestyle and habits: food/smoking/alcohol
invading organism: viral exposure
15
Q
genetics affecting cancer rates
A
family history: breast, colon, ovarian, prostate
16
Q
6 hallmarks of cancer
A
- self-sufficient growth signals (activated growth factor signal)
- resistance to anti-growth signals (inactivated cell checkpoint)
- immortality: inactivated cell death pathway
- resistance to cell death: activated anticell death signal
- sustained angiogenesis: activated VEGF signaling
- invasion and metastasis: loss of cell-to-cell interactions
17
Q
p53 signaling pathway
A
p53 is a tumor suppressor protein that induces cell cycle arrest in response to DNA damage.
18
Q
cyclins
A
family of proteins that control the progression of cells through the cell cycle by activating cyclin-dependent kinase enzymes
19
Q
primary cancer
A
neoplasia of a specific tissue
20
Q
secondary cancer
A
cancer cells from another tissue that have metastasized to a different location
21
Q
in situ cancer
A
glandular or squamous cells
remain within the basement membrane
22
Q
staging
A
describes severity of person’s cancer based on extents of primary tumor and whether or not cancer has metastasized
23
Q
reasons staging is important
A
- treatment planning
- prognosis
- common terminology
24
Q
TNM staging
A
T=tumor size
N- spread to region of lymph nodes
M- presence of distant metastasis
25
procedures to diagnose cancer
blood values: cancer markers
imaging: radiographs, CT, MRI, PET scan
biopsy
26
PET scan
assesses metabolic activity- assesses glucose uptake prior to radioactive decay
27
Goals during cancer medical intervention
```
diagnose tumor
remove lesion
debulk tumor
correct life-threatening condition caused by cancer
fracture prevention
palliation
cure
chemotherapy
radiation therapy
surgery
```
28
common side effects of chemo
```
immunosuppression
anemia
throbocytopenia (increased bleeding risk)
organ damage
n/v
alopecia
diarrhea
mucositis/mouth sores
sterility
neuropathies
```
29
symptoms of peripheral neuropathy
motor: sense of heaviness in legs, tripping difficulty holding/manipulating objects, shakiness
sensory : pins/needles, cold extremities, burning sensation, electrical shooting pain
autonomic: orthostasis, feeling flush, tachycardia
30
radiotherapy
damaging the DNA of exposed tissue
| non-selective
31
brachy therapy
internal radiotherapy- localized and precise
32
common side effects of radiation therapy
```
immunosuppression
skin changes
GI changes
fatigue
avascular necrosis
radiation myelitis: damage small bloodvessels in spinal column resulting in loss of blood flow, necrosis, and demyelination
```
33
Types of breast cancer
1. human epidermal growth factor receptor + HER-2 - too much HER-2
2. mutation of BRCA 1 and BRCA
3. estrogen/progesterone (+)- tumors grown in response to estrogen and progesterone
34
triple negative breast cancer
breast cancer cells that do not have estrogen or progesterone receptors, or large amounts of HER2
35
triple positive
breast cancer cells that are postivite for estrogen receptors, progesterone receptors and HER2
36
Types of surgical options in breast cancer
lumpectomy: surgical removal of discrete tumor
mastectomy: surgical removal of entire breast; axillary contents intact
radical mastectomy: removal of breast and pectorals linen w/ axillary node dissection
modified radical mastectomy/skin sparing: breast tissue removed but skin remains for reconstruction, axillary node dissection
37
side effects of breast cancer surgery
```
axillary cording, scar tissue development/adhesions
msucle atrophy
pain
postural changes
lymphedema/lympatic system compromise
```
38
prostate cancer common symptoms
associated with : age greater than 60, family history, alcohol. elevated PSA
symptoms: urinary changes (weak, increased, pain, bloody)
pain in back, hips, pelvis that doesn't go away
39
pathophysiology of urinary innocence after prostatectomy
sphincter weakness, detrusor dysfunction, anastomotic structure, central disturbance of fine control of muscle function
40
pelvic floow muscle training in prostatectomy?
pre and post pelvic floor exercises can significantly help with urinary incontinence and erectile dysfunction
41
pelvic exercises for prescription following prostatectomy
- endurance with long hold contractions of pelvic floor
- quick contraction, power function with short hold contractions
- walk for 30 minutes, up to 5x weekly
- pt ed postural incontinence
42
root origin of leukemias
bone marrow
43
types of lung cancer
1. small cell lung cancer: faster growth rate, worse prognosis
2. non-small cell lung cancer: associated w/ smoking, genetics, exposures. Symptoms include cough DOE
44
which type of lung cancer has worse prognosis?
small cell lung cancer
45
3 expected pulmonary exam findings in patient post RUL resection?
atelectasis, decreased breath sounds, crackles on right side
46
common s/s colorectal cancer?
bleeding, pressure/pain w/ defecation, change in elimation. Often starts w/ benign polyp. Associated w/ age, family history, diet, exercise, ulcerative colitis/crohn's
3rd most common!
47
describe leukemia
malignant disease characterized by unregulated proliferation of one cell type. Hematological disorder affecting leukocytes
48
2 major groups of leukemias
chronic: onset insidious, disease less aggressive, mature cells
actue: rapid onset, aggressive, cells usually poorly differentiated
49
myeloid
leukemia of granulocytes
50
origin of leukemias vs lymphomas and multiple myelomas
leukemias come from common myeloid progenitor while lymphomas come from common lymphoid progenitor
51
acute stage l/l/m cells
immature, undifferentiated cells
52
chronic stage l/l/m cells
mature, more differentiated cells
53
type of leukemia most common with childhood cases
acute lymphocytic
54
most common with adult cases?
acute myelogenous
55
4 types of leukemia?
acute lymphocytic
acute melogenous
chronic lymphocytic
chronic mylelogenous
56
lymphoma
hematological disorder from lymphoid system
57
2 main categories of lymphoma
1. hodgkin's lymphoma
| 2. non hodgkin's lymphoma
58
multiple myeloma
disease of the plasma cells of the immune system
hypercalcemia
symptoms: pain, bruising, lytic lesions/fracture
59
process of bone marrow transplant
chemotherapy/radiation--transplant--engrafment
60
autologous/autogeneic
transplant cells come from patient themselves
61
allogeneic
transplant cells come form donor
| -matched unrelated donor (MUD), HLA, sibling/family
62
side effect of bone marrow transplant
GVHD-0 graft versus host disease: donated cells recognize recipients as foreing- immune response
63
chronic fatigue
pathologic condition, unable to recover even after rest
64
ways to measure fatigue
```
Visual analog fatigue scale
MD anderson symptom inventory
european organization for reseal nd treatment of cancer
rotherian symptom checklist
FACIT fatigue scale (fill out form)
```
65
ECOG scale
0=normal activity
| 5= death
66
karnofsky performance status scale
100=normal, no complaints
| 0= dead
67
interventions for CRF?
exercise (aerobic/strength), compleimentary therapies (acupuncture/yoga), ymphedema management
68
characteristics of cancer pain
1. directly related: director invasion or compression of structures by cancer
2. related to cancer therapy
3. related to effects of cancer (bed sores, etc.)
4. age-related, comofbicdities (chronic lbp, OA)
69
breakthrough pain
acute exacerbation of pain of short duration on the background of stable pain pattern
70
things to examine in cancer related pain
1. temporal- last? better? worse?
2. intensity- scale 0-10, pain now?, etc.
3. topography: where, referred,
4. quality: have pt describe pain- burning, throbbing
71
lymphedema
injury/blockage to lymphatic vessels, nodes, etc.
72
explanation for swelling
starling-s forces- balance b/w filtration and absorption
| Filtration-absorption
73
More filtration/absorption with capillaries/veins/arteries
more filtration with capillaries
| and arterymore absorption with beans
74
filtration
pressure inside vessel + osmotic pressure of interstitial fluid
75
absorption
pressure outside the vessel + osmotic pressure of capillary
76
When are lytic bone lesions common?
multiple myeloma and bone metastasis
77
causes of spinal cord compression
primary or secondary disease spreads to the vertebra and impinges on the spinal column. Can be direct invasion, disruption of vascular supply, or veterbral collapse
78
general s/s of spinal cord compression
back pain- increase w/ supine
increases w/ valsalva
motor>sensory changes bowel/bladder, DTR's
79
location of spine most common for metastatic tumor
thoracic spine (70%)- pain in check/back, loss of sensation below level of tumor, increased above, weakness, babinski (?), b/b problems, sexual dysfunction
80
normal WBC count
5,000-10,000
81
normal hemoglobin
12-16 g/dl female
| male
82
normal platelets
150,000-350,000
83
hematocrit
37-47% female
| 41-53% male
84
leukocytosis
WBC > 10,000
85
leukopenia
WBC
86
thrombocytopenia
87
thrombocytosis
>350,000
88
anemia
low RBC, Hb, and/or Hct
89
polycythemia
high RBC count
90
explain study in which Hb was taken from 13 to 5
showed that reductio of Hb in conscious healthy resting humans does not produce evidence of inadequate systemic O2 delivery and myocardial ischemia would occur infrequently.
In healthy individuals, CO compensated by increasing HR
91
Transfusion Requirements in Critical Care
patients stratified according to center
- restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill. Patients w/ acute MI or angina are the exception
* **no difference 30 day mortality
92
types of transfusion reactions
1. febrile non-hemolytic: benign and most common
2. acute hemolytic reaction-rapid destruction of donor erythrocytes: fever, pain
3. anaphylactic reaction: shock, hypotension, angioedema
4. transfusion-associated acute lung injury: pulmonary edema- life threatening
93
hemostasis
stopping of bleeding
| 1st step of wound healing
94
4 steps of hemostasis
1. vessel injury
2. vascular spasm
3. platelet plug: primary hemostasis
4. coagulation cascase: secondary hemostasis
95
thrombocytes
platelets
| important in preventing blood loss: platelet plugs and prote formation and contraction of clots
96
thrombocytopenia therapy considerations
5-,000-150,000- low intensity PRE and aerobic exercise
| 30,000-50,000: ARO
97
thrombocytosis considerations
no distinct recommendation, but paradoxical risk of bleeding exists
98
extrinsic pathway
damage to tissues
| measured by PT, and INR
99
intrinsic pathway
PTT
| damage to endothelium
100
end result of final common pathway of coagulation cascade
(thrombin to fibrinogen) to fibrin
101
Prothrombin time
12-15 seconds
| measures effectiveness of oral (coumadin)
102
international normalized ration
.8-1.2
| normalization of PT to reference
103
partial thrboplastin time (PTT)
32-70 seconds
| measures overall rate of intrinsic and extrinsic pathway and measures effectiveness of IV heparin
104
higher or lower INR with valve replacement or DVT?
higher time (want blood to clot less)
105
When considering PT/PTT values, when is therapy considered contraindicated?
when at 5x the reference range
106
prevalence of VTE
PE is the most common preventable cause of hospital death, accounting for up to 10% of hospital deaths
DVT/PE more common in hospitalized patient compared to community
107
virchow's triad
change of one of 3 characteristics of venous circulation may precipitate a thromboembolic event. 3 characteristics:
1. venous/circulatory stasis
2. activation of blood coagulation (hypercoagulatbility)
3. vein (endothelial) damage
108
what is performed with there is a low probability of DVT?
d-dimer assay
109
high probability of DVT?
duplex ultrasound imaging
110
probability for DVT likely
greater than or equal to 2
111
probability for PE likely
greater than 4
112
3 hallmark clinical features of PE
1. sudden onset dyspnea
2. tachypnea
3. chest pain
113
mechanical management DVT
compression 30-40 mmhg pressure (TED=18)
| ambulation
114
medical management DVT
heparin, warfarin (coumadin), aspirin, arixtra
115
effect on bleeding time from aspirin, heparin, warfarin, liver failure, thrombocytopenia
bleeding time is PROLONGED
116
what of the mentioned factors decreases platelet count?
liver failure and thrmbocytopenia
117
What factors do not affect PTT?
thrombocytopenia and aspirin
118
major complications of dvt
venous stasis syndrome
venous ulcer
chronic thromboembolic disease/plumonary hypertension
119
Post thrombotic syndrome
normal venous valves promote unidirectional flow. When damaged, valves can become regurgitant. The leg can then become painful, red, and swollen
120
symptoms of PTS
pain, heaviness, cramps, itching, tingling, aggravated by standing and walking
121
impact of PTS
impaired Q?OL, poorer health perceptions, worse physical functioning
122
risk factors PTS
```
obesity
prolonged DVT
recurrent DVT
proximal DVT
inadequate anticoagulation
```
123
study looking at early ambulation in DVT
no difference in PE/thrombus
| pain level an dleg circumference decreased by day 2 in walking groups (9 in bed rest)
124
important aspect of cellular signaling focused on in oncology
second messenger pathways- important for proliferation and differentiation
125
describe the process of tumor/cancer growth
growth is exponential
126
anti-cancer approaches
surgery (remove), radiation (kill tumor cells and tumor cells in adjacent tissues), chemotherapy (kill dividing tumor cells), targeted therapy (specifically inhibit processes required for tumor cell growth), hormonal therapy
127
toxicity criteria for cancer
numerical scale from 1-5 1=mild, 5= death
128
chemotherapy side effects
myelosuppression: WBC/platelets, RBC's
neutropenia: low level of neutrophils; neutropenic precautions
thrombocytopenia: low level of platelets, decrease fall risks, increased bruising, prolonged bleeding
anemia: fatigue, may need transfusions
alopecia: loss of hair on scalp greater than body hair
diarrhea
n/v
129
types of n/v
acute: resolves within 24 hrs
delayed: greater than 24 hrs after chemo, can last 6-7 days
anticipatory: conditioned response to past experience CINV
breakthrough: despite emetic prophylaxis therapy
refractory: despite prophylaxis and breakthrough emsis treatment
130
exercise in cancer related fatigue
beneficial intervention: decrease in fatigueat 12 weeks
| programs involved mod intensity, resistance exercise
131
chemotherapy related cognitive dysfunction
chemo brain: found in 1/4 of patients. subtle shifts in cognitive function- early or late in treatment
132
effects of chemo brain
difficulty concentrating
difficulty handling/performing multiple tasks
difficulty with memory
133
methods to help with chemo brain
decrease work load, avoid multi tasking, make lists/write everything down, encourage more sleep
134
4 main drug classes for chemotherapy
1. alkylating agents
2. antimetabolites
3. mitotic spindle agents
4. proteasome inhibitors
135
actions of alkylating agents
crosslinking DNA
misreading DNA
breaking strands of DNA
136
Specific alkylating agents (N's)
```
nitrogen mustards (involved with neurotoxicity)
lethargy, dizziness, confusion, ataxia, coma
```
137
platinum compounds
also alkylating agents?
PLATIN
cisplating and carboplatin
oxaiplatin
138
side effects of cisplatin and carboplatin
peripheral neuropathy and vestibular ototoxicity
139
oxaliplatin side effects
acute and persist neuropathies
140
mechanism of antimetabolites
act as structural analogues for DNA base pairs
inhibit critical enzymes in DNA synthesis
- cause apoptosis of cells
141
types of antimetabolites
BINE
1. cytarabine: cerebellar syndrome
2. gemitabine: no significant neurotoxicity
142
neurotoxicity of methotrexate
headach, n/v, motor paralysis, cranial nerve palsy
143
mechanism of action mitotic spindle agents
interfere with mitosis
| promote and stabilize microtubule assembly and interfere w/ disassembly
144
types of mitotic spindle agents
taxanes: -xel
epothilones: -pilone
vinca alkaloids: vincristine, vinblastine, vinorelbine
145
side effects of mitotic spindle agents
peripheral neuropathies - stocking and glove
| and alopecia- total body
146
proteasome inhibitors
breaks down bad proteins and regulatory proteins
| interfere/cause conflict with cellular regulatory signals
147
types of proteasome inhibitors
boretexomib, carflizomib
148
cases when proteasome inhibitor used
multiple myeloma and non-hidgkin's lymphoma
149
side effects of proteasome inhibitor
peripheral neuropathy
150
chemotherapy agents associated w/ cardiotoxicity
antitumor antibiotics
monoclonal antibodies (some)
signal transduction inhibitors (some)
151
mechanism of action for anti tumor antibiotics
intercalation into DNA
interact w/ toposiomerase
free radical production
152
which anti tumor antibiotics may cause cardiotoxicity and CHF?
rubicins- doxorubicin
153
molecularly targeted agents
treatment strategies directed against molecular pathways considered involved in neoplastic transformation
154
molecularly targeted agents drug classes
monoclonal antibodies
| signal transduction inhibitors
155
monoclonal antibodies
-mab (many): HER-2
indicates breast cancer
reversible cardiomyopathy
OR VEGF receptor indicating coloan and lung cancer
156
signal transductor inhibitors
growth factor affected at binding site
-NIB's
Indications for renal cancer
side effects of hypertension
157
overall different side effect of monoclonal antibodies
heart affects
| rash
158
side effects signal transductor inhibitors
hypertension
159
describe hand-foot syndrome
erythema and swelling
sydsesthesia/blistering
caused by antimetabolites, TKI's , anti tumor antibiotics
160
hormonal agents
```
antiestrogens (breast cancer)
aromatase inhibitors (breast cancer)
androgen ablation (prostate cancer)
```
161
immunotherapy
tumors adaps and able to evade immune system
| block the cells that cause t-cells to turn off
162
agents of immunothearpy
-MAB
163
immune related adverse events
associated w/ tumor regression and prolonged time to relapse
| timing variable- can occur after
164
signs/symptoms of GI toxicity
diarrhea, blood/mucus in stool, constipation, stomach cramps, n/v
165
skin organ toxicity
rash, peeling,pruritus
| shortest time to onset***
166
hepatic signs/symp
abnormal liver fxn, sclera
167
neurological toxicity s/s
neuropathies, weakness,
168
endocrine toxicity
headache, weakness, visual defects, behavioral changes, electrolyte imbalance
longest time to onset***
169
lymphedema
abnormal accumulation of protein rich fluid in interstitial causing chronic inflammation and reactive fibrosis
170
edema
excess fluid in body tissues which is a result of abnormal leakage of fluid across capillaries from the plasma to interstitial spaces
can be generalized or local
can be pitting
171
primary lympedema
malformation of lymphatic system
can be familial
more systemic presentation
172
secondary lymphedema
due to another condition (lymph node dissection , radiation)
| often localized presentation
173
complete docongestive therapy
manual lymph drainage
exercise
self care
compression
174
contraindications of CDT
```
acute infection (cellulitis) decompensated CHF, acute DVT
relative: kidney disease, malignant disease
```
175
lymphedema LOS
acute 3-5 days depending
| average treatment 1-5 days
176
outcome measures used for lymphedema
UE- quickDASH
| LE- LEFS
177
stages of lymphedema
mild 1.5-3 cm stage I- responds wel to tx
mod 3-5 cm stage II
severe >5 stage III- slow response
178
9 conditions you don't want to miss in screen
```
major depression
suicide risk
femoral head and neck fractures
cauda equina syndrome
cervical myelopathy
abdominal aortic aneurysm
DVT
PE
atypical MI
```
179
systems review cardiopulm
HR, RR, BP, edema
180
integumentary systems review
pliability/texture, scar formation, skin color , skin integrity
181
MSK review
symmetry, ROM, strength, height weight
182
common sites for metastases
lymph nodes, liver, lung, bone, and brain
183
sites for bone metastases
lung, breast, prostate, thyroid, kidney, lymphatics
184
3 most common sites of metastases to bone
vertebrae, pelvis, ribs, skull, femur
| thoracic spine>lumbar>cervical
185
CAUTIONS (for cancer)
```
changes in b/b
a sore that does not heal in 6 weeks
unusual bleeding/discharge
thickening or lump
indigestion or difficulty swallowing
obvious change in wart or mole
nagging cough or hoarseness
```
186
additional CA considerations
```
history CA
fail PT
recent weight loss
pain unknown cause
pain at night
painless neurological deficits
age (>50 yrs)
```
