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MC II > exam 1 > Flashcards

exam 1 Flashcards

1
Q

In cancer, damage to the genome can be caused by what?

A
  1. errors in replication of DNA 2. intrinsic chemical instability of certain DNA bases 3. attack by free radicals generated during metabolism
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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.

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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

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4
Q

Mitotic phases

A

prophase, metaphase, anaphase, telophase, cytokinesis

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5
Q

Cell cycle phases

A

Interphase (first growth phase, synthesis phase, second growth phase), Mitosis

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6
Q

Why do cells divide?

A

reproduction, growth, repair

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7
Q

cell differentiation

A

process by which less specialized cell becomes more specialized type

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8
Q

cell that is able to differentiate into all cell types

A

pluriopotent ie stem cells change to Blood cells through hematopoiesis

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9
Q

neoplasia

A

abnormal cell division and growth

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10
Q

malignant

A

rapid growth, invasive, potential for metastasis

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11
Q

benign

A

slow growth, non-invasive, no metastasis

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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

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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

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14
Q

external factors as carcinogens

A

environmental: chemicals/radiation, lifestyle and habits: food/smoking/alcohol
invading organism: viral exposure

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15
Q

genetics affecting cancer rates

A

family history: breast, colon, ovarian, prostate

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16
Q

6 hallmarks of cancer

A
  1. self-sufficient growth signals (activated growth factor signal)
  2. resistance to anti-growth signals (inactivated cell checkpoint)
  3. immortality: inactivated cell death pathway
  4. resistance to cell death: activated anticell death signal
  5. sustained angiogenesis: activated VEGF signaling
  6. invasion and metastasis: loss of cell-to-cell interactions
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17
Q

p53 signaling pathway

A

p53 is a tumor suppressor protein that induces cell cycle arrest in response to DNA damage.

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18
Q

cyclins

A

family of proteins that control the progression of cells through the cell cycle by activating cyclin-dependent kinase enzymes

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19
Q

primary cancer

A

neoplasia of a specific tissue

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20
Q

secondary cancer

A

cancer cells from another tissue that have metastasized to a different location

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21
Q

in situ cancer

A

glandular or squamous cells

remain within the basement membrane

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22
Q

staging

A

describes severity of person’s cancer based on extents of primary tumor and whether or not cancer has metastasized

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23
Q

reasons staging is important

A
  • treatment planning
  • prognosis
  • common terminology
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24
Q

TNM staging

A

T=tumor size
N- spread to region of lymph nodes
M- presence of distant metastasis

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25
Q

procedures to diagnose cancer

A

blood values: cancer markers
imaging: radiographs, CT, MRI, PET scan
biopsy

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26
Q

PET scan

A

assesses metabolic activity- assesses glucose uptake prior to radioactive decay

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27
Q

Goals during cancer medical intervention

A 
diagnose tumor
remove lesion
debulk tumor
correct life-threatening condition caused by cancer
fracture prevention
palliation
cure
chemotherapy
radiation therapy
surgery
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28
Q

common side effects of chemo

A 
immunosuppression
anemia
throbocytopenia (increased bleeding risk)
organ damage
n/v
alopecia
diarrhea
mucositis/mouth sores
sterility
neuropathies
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29
Q

symptoms of peripheral neuropathy

A

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

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30
Q

radiotherapy

A

damaging the DNA of exposed tissue

non-selective

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31
Q

brachy therapy

A

internal radiotherapy- localized and precise

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32
Q

common side effects of radiation therapy

A 
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
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33
Q

Types of breast cancer

A
  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
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34
Q

triple negative breast cancer

A

breast cancer cells that do not have estrogen or progesterone receptors, or large amounts of HER2

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35
Q

triple positive

A

breast cancer cells that are postivite for estrogen receptors, progesterone receptors and HER2

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36
Q

Types of surgical options in breast cancer

A

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

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37
Q

side effects of breast cancer surgery

A 
axillary cording, scar tissue development/adhesions
msucle atrophy
pain
postural changes
lymphedema/lympatic system compromise
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38
Q

prostate cancer common symptoms

A

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

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39
Q

pathophysiology of urinary innocence after prostatectomy

A

sphincter weakness, detrusor dysfunction, anastomotic structure, central disturbance of fine control of muscle function

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40
Q

pelvic floow muscle training in prostatectomy?

A

pre and post pelvic floor exercises can significantly help with urinary incontinence and erectile dysfunction

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41
Q

pelvic exercises for prescription following prostatectomy

A
  • 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
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42
Q

root origin of leukemias

A

bone marrow

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43
Q

types of lung cancer

A
  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
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44
Q

which type of lung cancer has worse prognosis?

A

small cell lung cancer

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45
Q

3 expected pulmonary exam findings in patient post RUL resection?

A

atelectasis, decreased breath sounds, crackles on right side

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46
Q

common s/s colorectal cancer?

A

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!

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47
Q

describe leukemia

A

malignant disease characterized by unregulated proliferation of one cell type. Hematological disorder affecting leukocytes

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48
Q

2 major groups of leukemias

A

chronic: onset insidious, disease less aggressive, mature cells
actue: rapid onset, aggressive, cells usually poorly differentiated

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49
Q

myeloid

A

leukemia of granulocytes

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50
Q

origin of leukemias vs lymphomas and multiple myelomas

A

leukemias come from common myeloid progenitor while lymphomas come from common lymphoid progenitor

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51
Q

acute stage l/l/m cells

A

immature, undifferentiated cells

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52
Q

chronic stage l/l/m cells

A

mature, more differentiated cells

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53
Q

type of leukemia most common with childhood cases

A

acute lymphocytic

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54
Q

most common with adult cases?

A

acute myelogenous

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55
Q

4 types of leukemia?

A

acute lymphocytic
acute melogenous
chronic lymphocytic
chronic mylelogenous

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56
Q

lymphoma

A

hematological disorder from lymphoid system

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57
Q

2 main categories of lymphoma

A
  1. hodgkin’s lymphoma

2. non hodgkin’s lymphoma

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58
Q

multiple myeloma

A

disease of the plasma cells of the immune system
hypercalcemia
symptoms: pain, bruising, lytic lesions/fracture

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59
Q

process of bone marrow transplant

A

chemotherapy/radiation–transplant–engrafment

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60
Q

autologous/autogeneic

A

transplant cells come from patient themselves

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61
Q

allogeneic

A

transplant cells come form donor

-matched unrelated donor (MUD), HLA, sibling/family

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62
Q

side effect of bone marrow transplant

A

GVHD-0 graft versus host disease: donated cells recognize recipients as foreing- immune response

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63
Q

chronic fatigue

A

pathologic condition, unable to recover even after rest

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64
Q

ways to measure fatigue

A 
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)
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65
Q

ECOG scale

A

0=normal activity

5= death

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66
Q

karnofsky performance status scale

A

100=normal, no complaints

0= dead

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67
Q

interventions for CRF?

A

exercise (aerobic/strength), compleimentary therapies (acupuncture/yoga), ymphedema management

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68
Q

characteristics of cancer pain

A
  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)
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69
Q

breakthrough pain

A

acute exacerbation of pain of short duration on the background of stable pain pattern

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70
Q

things to examine in cancer related pain

A
  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
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71
Q

lymphedema

A

injury/blockage to lymphatic vessels, nodes, etc.

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72
Q

explanation for swelling

A

starling-s forces- balance b/w filtration and absorption

Filtration-absorption

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73
Q

More filtration/absorption with capillaries/veins/arteries

A

more filtration with capillaries

and arterymore absorption with beans

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74
Q

filtration

A

pressure inside vessel + osmotic pressure of interstitial fluid

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75
Q

absorption

A

pressure outside the vessel + osmotic pressure of capillary

76
Q

When are lytic bone lesions common?

A

multiple myeloma and bone metastasis

77
Q

causes of spinal cord compression

A

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
Q

general s/s of spinal cord compression

A

back pain- increase w/ supine
increases w/ valsalva
motor>sensory changes bowel/bladder, DTR’s

79
Q

location of spine most common for metastatic tumor

A

thoracic spine (70%)- pain in check/back, loss of sensation below level of tumor, increased above, weakness, babinski (?), b/b problems, sexual dysfunction

80
Q

normal WBC count

A

5,000-10,000

81
Q

normal hemoglobin

A

12-16 g/dl female

male

82
Q

normal platelets

A

150,000-350,000

83
Q

hematocrit

A

37-47% female

41-53% male

84
Q

leukocytosis

A

WBC > 10,000

85
Q

leukopenia

A

WBC

86
Q

thrombocytopenia

A
87
Q

thrombocytosis

A

> 350,000

88
Q

anemia

A

low RBC, Hb, and/or Hct

89
Q

polycythemia

A

high RBC count

90
Q

explain study in which Hb was taken from 13 to 5

A

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
Q

Transfusion Requirements in Critical Care

A

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
Q

types of transfusion reactions

A
  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
Q

hemostasis

A

stopping of bleeding

1st step of wound healing

94
Q

4 steps of hemostasis

A
  1. vessel injury
  2. vascular spasm
  3. platelet plug: primary hemostasis
  4. coagulation cascase: secondary hemostasis
95
Q

thrombocytes

A

platelets

important in preventing blood loss: platelet plugs and prote formation and contraction of clots

96
Q

thrombocytopenia therapy considerations

A

5-,000-150,000- low intensity PRE and aerobic exercise

30,000-50,000: ARO

97
Q

thrombocytosis considerations

A

no distinct recommendation, but paradoxical risk of bleeding exists

98
Q

extrinsic pathway

A

damage to tissues

measured by PT, and INR

99
Q

intrinsic pathway

A

PTT

damage to endothelium

100
Q

end result of final common pathway of coagulation cascade

A

(thrombin to fibrinogen) to fibrin

101
Q

Prothrombin time

A

12-15 seconds

measures effectiveness of oral (coumadin)

102
Q

international normalized ration

A

.8-1.2

normalization of PT to reference

103
Q

partial thrboplastin time (PTT)

A

32-70 seconds

measures overall rate of intrinsic and extrinsic pathway and measures effectiveness of IV heparin

104
Q

higher or lower INR with valve replacement or DVT?

A

higher time (want blood to clot less)

105
Q

When considering PT/PTT values, when is therapy considered contraindicated?

A

when at 5x the reference range

106
Q

prevalence of VTE

A

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
Q

virchow’s triad

A

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
Q

what is performed with there is a low probability of DVT?

A

d-dimer assay

109
Q

high probability of DVT?

A

duplex ultrasound imaging

110
Q

probability for DVT likely

A

greater than or equal to 2

111
Q

probability for PE likely

A

greater than 4

112
Q

3 hallmark clinical features of PE

A
  1. sudden onset dyspnea
  2. tachypnea
  3. chest pain
113
Q

mechanical management DVT

A

compression 30-40 mmhg pressure (TED=18)

ambulation

114
Q

medical management DVT

A

heparin, warfarin (coumadin), aspirin, arixtra

115
Q

effect on bleeding time from aspirin, heparin, warfarin, liver failure, thrombocytopenia

A

bleeding time is PROLONGED

116
Q

what of the mentioned factors decreases platelet count?

A

liver failure and thrmbocytopenia

117
Q

What factors do not affect PTT?

A

thrombocytopenia and aspirin

118
Q

major complications of dvt

A

venous stasis syndrome
venous ulcer
chronic thromboembolic disease/plumonary hypertension

119
Q

Post thrombotic syndrome

A

normal venous valves promote unidirectional flow. When damaged, valves can become regurgitant. The leg can then become painful, red, and swollen

120
Q

symptoms of PTS

A

pain, heaviness, cramps, itching, tingling, aggravated by standing and walking

121
Q

impact of PTS

A

impaired Q?OL, poorer health perceptions, worse physical functioning

122
Q

risk factors PTS

A 
obesity
prolonged DVT
recurrent DVT
proximal DVT
inadequate anticoagulation
123
Q

study looking at early ambulation in DVT

A

no difference in PE/thrombus

pain level an dleg circumference decreased by day 2 in walking groups (9 in bed rest)

124
Q

important aspect of cellular signaling focused on in oncology

A

second messenger pathways- important for proliferation and differentiation

125
Q

describe the process of tumor/cancer growth

A

growth is exponential

126
Q

anti-cancer approaches

A

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
Q

toxicity criteria for cancer

A

numerical scale from 1-5 1=mild, 5= death

128
Q

chemotherapy side effects

A

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
Q

types of n/v

A

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
Q

exercise in cancer related fatigue

A

beneficial intervention: decrease in fatigueat 12 weeks

programs involved mod intensity, resistance exercise

131
Q

chemotherapy related cognitive dysfunction

A

chemo brain: found in 1/4 of patients. subtle shifts in cognitive function- early or late in treatment

132
Q

effects of chemo brain

A

difficulty concentrating
difficulty handling/performing multiple tasks
difficulty with memory

133
Q

methods to help with chemo brain

A

decrease work load, avoid multi tasking, make lists/write everything down, encourage more sleep

134
Q

4 main drug classes for chemotherapy

A
  1. alkylating agents
  2. antimetabolites
  3. mitotic spindle agents
  4. proteasome inhibitors
135
Q

actions of alkylating agents

A

crosslinking DNA
misreading DNA
breaking strands of DNA

136
Q

Specific alkylating agents (N’s)

A 
nitrogen mustards (involved with neurotoxicity)
lethargy, dizziness, confusion, ataxia, coma
137
Q

platinum compounds

A

also alkylating agents?
PLATIN
cisplating and carboplatin
oxaiplatin

138
Q

side effects of cisplatin and carboplatin

A

peripheral neuropathy and vestibular ototoxicity

139
Q

oxaliplatin side effects

A

acute and persist neuropathies

140
Q

mechanism of antimetabolites

A

act as structural analogues for DNA base pairs
inhibit critical enzymes in DNA synthesis
- cause apoptosis of cells

141
Q

types of antimetabolites

A

BINE

  1. cytarabine: cerebellar syndrome
  2. gemitabine: no significant neurotoxicity
142
Q

neurotoxicity of methotrexate

A

headach, n/v, motor paralysis, cranial nerve palsy

143
Q

mechanism of action mitotic spindle agents

A

interfere with mitosis

promote and stabilize microtubule assembly and interfere w/ disassembly

144
Q

types of mitotic spindle agents

A

taxanes: -xel
epothilones: -pilone
vinca alkaloids: vincristine, vinblastine, vinorelbine

145
Q

side effects of mitotic spindle agents

A

peripheral neuropathies - stocking and glove

and alopecia- total body

146
Q

proteasome inhibitors

A

breaks down bad proteins and regulatory proteins

interfere/cause conflict with cellular regulatory signals

147
Q

types of proteasome inhibitors

A

boretexomib, carflizomib

148
Q

cases when proteasome inhibitor used

A

multiple myeloma and non-hidgkin’s lymphoma

149
Q

side effects of proteasome inhibitor

A

peripheral neuropathy

150
Q

chemotherapy agents associated w/ cardiotoxicity

A

antitumor antibiotics
monoclonal antibodies (some)
signal transduction inhibitors (some)

151
Q

mechanism of action for anti tumor antibiotics

A

intercalation into DNA
interact w/ toposiomerase
free radical production

152
Q

which anti tumor antibiotics may cause cardiotoxicity and CHF?

A

rubicins- doxorubicin

153
Q

molecularly targeted agents

A

treatment strategies directed against molecular pathways considered involved in neoplastic transformation

154
Q

molecularly targeted agents drug classes

A

monoclonal antibodies

signal transduction inhibitors

155
Q

monoclonal antibodies

A

-mab (many): HER-2
indicates breast cancer
reversible cardiomyopathy
OR VEGF receptor indicating coloan and lung cancer

156
Q

signal transductor inhibitors

A

growth factor affected at binding site
-NIB’s
Indications for renal cancer
side effects of hypertension

157
Q

overall different side effect of monoclonal antibodies

A

heart affects

rash

158
Q

side effects signal transductor inhibitors

A

hypertension

159
Q

describe hand-foot syndrome

A

erythema and swelling
sydsesthesia/blistering
caused by antimetabolites, TKI’s , anti tumor antibiotics

160
Q

hormonal agents

A 
antiestrogens (breast cancer)
aromatase inhibitors (breast cancer)
androgen ablation (prostate cancer)
161
Q

immunotherapy

A

tumors adaps and able to evade immune system

block the cells that cause t-cells to turn off

162
Q

agents of immunothearpy

A

-MAB

163
Q

immune related adverse events

A

associated w/ tumor regression and prolonged time to relapse

timing variable- can occur after

164
Q

signs/symptoms of GI toxicity

A

diarrhea, blood/mucus in stool, constipation, stomach cramps, n/v

165
Q

skin organ toxicity

A

rash, peeling,pruritus

shortest time to onset***

166
Q

hepatic signs/symp

A

abnormal liver fxn, sclera

167
Q

neurological toxicity s/s

A

neuropathies, weakness,

168
Q

endocrine toxicity

A

headache, weakness, visual defects, behavioral changes, electrolyte imbalance
longest time to onset***

169
Q

lymphedema

A

abnormal accumulation of protein rich fluid in interstitial causing chronic inflammation and reactive fibrosis

170
Q

edema

A

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
Q

primary lympedema

A

malformation of lymphatic system
can be familial
more systemic presentation

172
Q

secondary lymphedema

A

due to another condition (lymph node dissection , radiation)

often localized presentation

173
Q

complete docongestive therapy

A

manual lymph drainage
exercise
self care
compression

174
Q

contraindications of CDT

A 
acute infection (cellulitis) decompensated CHF, acute DVT
relative: kidney disease, malignant disease
175
Q

lymphedema LOS

A

acute 3-5 days depending

average treatment 1-5 days

176
Q

outcome measures used for lymphedema

A

UE- quickDASH

LE- LEFS

177
Q

stages of lymphedema

A

mild 1.5-3 cm stage I- responds wel to tx
mod 3-5 cm stage II
severe >5 stage III- slow response

178
Q

9 conditions you don’t want to miss in screen

A 
major depression
suicide risk
femoral head and neck fractures
cauda equina syndrome
cervical myelopathy
abdominal aortic aneurysm
DVT
PE
atypical MI
179
Q

systems review cardiopulm

A

HR, RR, BP, edema

180
Q

integumentary systems review

A

pliability/texture, scar formation, skin color , skin integrity

181
Q

MSK review

A

symmetry, ROM, strength, height weight

182
Q

common sites for metastases

A

lymph nodes, liver, lung, bone, and brain

183
Q

sites for bone metastases

A

lung, breast, prostate, thyroid, kidney, lymphatics

184
Q

3 most common sites of metastases to bone

A

vertebrae, pelvis, ribs, skull, femur

thoracic spine>lumbar>cervical

185
Q

CAUTIONS (for cancer)

A 
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
Q

additional CA considerations

A 
history CA
fail PT
recent weight loss
pain unknown cause
pain at night
painless neurological deficits
age (>50 yrs)

MC II (3 decks)

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