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Exam 3 - 503 > exam 3 > Flashcards

exam 3 Flashcards

1
Q

Non-Pharm Tmtx of fatigue

A 
hydration
exercise
schedules
cluster activities
naps
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2
Q

Pharmacologic tmtx of fatigue in CA patients

A

Ritalin/Adderall (Psychostimulants)

Caffeine

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3
Q

BID stimulants dosing should be when?

A

in AM with breakfast and noon-3pm

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4
Q

when are cancer patients at their lowest point?

A

when chemo is in full effect

—> maximum side effects

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5
Q

What is Pancytopenia

A

Anemia (fatigue/pallor)
Thrombocytopenia (petchiae/purpura/bleeding/bruising)
Neutropenia (fever/infection)

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6
Q

Zofran

A

Treats N/V in cancer patients:

  • created for the purpose of treating nausea in cancer patients
  • 5HT receptor blocker
  • increase in free seratonin, decrease in usable seratonin
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7
Q

Compazine

A

Treats N/V in cancer patients
- dopamine receptor antagonist

side effects:

  • Pseudoparkinsons
  • EPS
  • tremors
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8
Q

Common S/S of brain tumor

A

Dizziness
N/V
HA that wakens from sleep
new onset < 5 or > 50 years

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9
Q

Less common S/S of brain tumor

A

Seizures

Anisocoria

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10
Q

Characteristics of Retinoblastoma

A

Leukocoria (cast eyes - white look with a light)

Absence of red reflex

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11
Q

NHL Objective findings/general info

A
  • painless lump in groin or axilla
  • malignant proliferation of B or T cells
  • mediastinal mass - stridor/dyspnea
  • SVC syndrome
  • enlarged supraclavicular/cervical nodes/epitrochlear
  • weight loss
  • abd distention
  • rebound tenderness
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12
Q

NHL - B or T cells or both

A

both

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13
Q

HL B or T cells or oth

A

B cells only

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14
Q

Risk Factors NHL

A

pesticide exposure (increases HLA antigen)
High birth weight
immunosuppresion
EBV!!!!!!!!!!!!
Hx of treated Hodgkin (effects of chemo+XRT+immunosuppressants)
Malaria exposure (causes T cell suppression and EBV)
Genetics –> chromosomal translocation involving genes for immunoglobulin or T cell receptors

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15
Q

Most Deadly CAs

A

LUNG CA #1

prostate CA

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16
Q

SVC syndrome AND what type of CA do you see it in

A 
increased CVP (pressures above the heart)
increased JVD (neck vein distention)
OCCURS IN NHL
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17
Q

Tumor lysis syndrome

A

tumor cells explode and release K and uric acid in to blood (generally occurs in Renal CAs)

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18
Q

TS genes

A

if mutated or missing/defective = unregulated proliferation of tumor cells

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19
Q

DNA repair geners

A

if missing or defective allows mutations and replication

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20
Q

TMTX NHL (most successful)

A

Chemo + immunotherapy + XRT

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21
Q

“in situ”

A
  • encapsulated
  • has not spread
  • localized
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22
Q

Sentinel node

A
  • draining cancer site

- first node to be metastasized

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23
Q

Sanctuary sites

A

PLACES THAT CANCER CAN HIDE FROM CHEMO

  • CNS
  • testes
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24
Q

Changing from long acting to short acting pain medications

A

When RTC short acting are no longer working effectively - consider Oxycotin or METHADONE

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25
Q

Sanctuary sites and S/S

A

PLACES THAT CANCER CAN HIDE FROM CHEMO

  • CNS: papilledema, vomiting, lethargy, HA, nuchal rigidity
  • testes: unilateral painless enlargement
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26
Q

Patient has a limp, what could this signify?

A

bone pain

bone tumor

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27
Q

Patient has a limp, what could this signify?

A

bone pain

bone tumor

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28
Q

Best medication for bone cancers pain

A

Methadone

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29
Q

Constipation in cancer - treatment

A

HYDRATION

lactulose

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30
Q

Mirtazapine

A

Helps with sleep and increasing appetite in cancer patients

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31
Q

Mirtazapine

A

Helps with sleep and increasing appetite in cancer patients

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32
Q

When to be concerned about an enlarged lymph node

A
  • present > 4 weeks

- > 1 cm in size

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33
Q

onco emergencies

A
  • Neutropenia (WBC < 5) with a fever > 38 degrees
  • SVC syndrome
  • SIADH
  • Tumor lysis syndrome
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34
Q

WILMS TUMOR

A
  • NEPHROblastoma
  • does NOT cross midline
  • presents w/hematuria and HTN
  • may affect other kids
  • DO NOT PALPATE - encapsulated tumor, if you break capsule you will spread CA cells and poorer prognosis
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35
Q

Neuroblastoma

A
  • renal CA
  • seen normally in INFANTS
  • can cross midline
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36
Q

W/U for pediatric abdominal mass

A
  • **Ultrasound (best in peds)
  • CT
  • labs: UA, CBC, lytes
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37
Q

Patho leukemia

A
  • malignant hematologic disease
  • normal bone marrow replaced by blast cells (poorly differentiated, abnormal cells)
  • blast cells take over and cause malignancy
  • PANCYTOPENIA
  • can be B cell or T cell or both
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38
Q

S/S ALL

A
  • bone marrow inflitration and/or extramedullary dz
  • PANCYTOPENIA
  • bone pain
  • limp
  • lymphadenopathy
  • enlarged spleen
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39
Q

When do you see a mediastinal mass in ALL

A
  • when the cancer is T-cell lineage
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40
Q

W/U ALL

A
  • CBC (can have increased leuks w/pancytopenia)
  • CMP (liver and renal panels)
  • CXR IF RESPIRATORY DISTRESS AND/OR STRIDOR R/O MEDIASTINAL MASS
  • U/S (especially if concern for testicular sanctuary site)

ONCOLOGY:

  • bone marry biopsy
  • LP r/o CNS sanctuary site
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41
Q

Role of PCP in ALL

A
  • mgmt of all non-cancer related health questions.
  • routine visits
  • vaccines in coordination w/ oncology
  • manage care of pt after DC from onco service and monitoring for further issues
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42
Q

Presenting S/S of NSCLC

A
  • cough
  • SOB
  • hemoptysis
  • likely smoking history
  • likely hx of symptoms x months
  • ** lung CA patients don’t present normally until CA is advanced)
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43
Q

Objective Findings NSCLC

A
  • absence of breath sounds if lung collapse

- dullness on percussion, decreased breath sounds

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44
Q

Complications of NSCLC

A
  • SVC syndrome
  • metastatic spread to abdomen (N/V/abd pain, wt loss)
  • neuro symptom involvement 2/2 spinal cord compression from mets
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45
Q

How does chemo work

A
  • treats and controls cancer growth at the level of DNA replication and cell division
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46
Q

Side effects of chemo

A
  • N/V/D
  • hair loss
  • fatigue
  • stomatitis
  • decreased appetite
  • constipation
  • pain
  • blood disorders
  • bone marrow suppression
  • cog. dysfunction
  • damage to organs
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47
Q

NHL presentation

A
  • acute abdomen
  • abdominal pain/distention/fullness
  • constipation
  • NON TENDER LYMPH NODE ENLARGEMENT
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48
Q

Dx of NHL / labs

A
  • generally s/s present < 1 mo before dx
  • labs : PANCYTOPENIA on CBC,
  • hypercalcemia, abnormal LFTs on CMP
  • prolonged clotting times on coags
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49
Q

Complications of NHL

A
  • SVC
  • GI obstruction/perforation
  • bleeding (thrombocytopenia)
  • infection (leukopenia)
50
Q

W/U for NHL

A
  • Labs (CBC, CMP, Coags, DDimer)
  • Blood cultures
    CMP (LFTs, Calcium, Phos + assess for tumor lysis syndrome)
  • CXR (PA/lateral)
  • r/o mediastinal mass
    evaluate airway
    exclude other pulm issues such as fibrosis and pneumonia
  • U/S - assess size of kidneys and patency of urinary tract
  • EKG
  • CT scan for staging and to r/o mets
51
Q

MAIN causes of onco issues in kids

A
  • genetics

- mutations (translocations)

52
Q

T/F: Kids are more responsive to chemo

A

True

- they tolerate higher doses because they have better organ function

53
Q

In pediatrics - what causes more issues chemo/XRT or the long term effects of chemo?

A

Long term effects

54
Q

Virus associated with increased cancer risk

A

Epstein-Barr - particularly Lymphoma (HL & NHL)

55
Q

Red Flags Pedi cancer in Primary Care

A 
mass or swelling (especially unilateral adenopathy present > 4 weeks > 1cm)
pallor
decreased energy
bruising
limping
prolonged illness
fever of unknown origin
frequent HA
N/V
56
Q

Extramedullary

A

dz outside of marrow

57
Q

Demographics ALL

A
  • usually age 2-6
  • T-cell > males
  • white > black
58
Q

s/s of bone marrow failure ALL

A 
- PANCYTOPENIA
>> neutropenia (fever/recurrent infection)
>> thrombocytopenia (petechiae, bleeding, purpura)
>> anemia (fatige/pallor)
- bone pain/limp
- lymphadenopathy
hepatosplenomegaly
- decreased testicular size
59
Q

Most common site to find NHL

A

intestinal tract –> hence s/s of acute abdomen and abdominal discomfort/fullness/constipation/ N-V

60
Q

T/F: Bone marrow and CNS involvement is rare in HL

A

True!

61
Q

Age distribution for HL

A

bimodal:

  • teens - 25 years
  • 50 - 60 years
62
Q

Characteristic sign of HL

A

persistent painless adenopathy - USUALLY cervical or mediastinal - unresponsive to ABx

63
Q

Constitutional B signs in HL and significance

A
  • these are the signs and symptoms in symptomatic HL
  • fever of unknown origin 38C > 3 days
  • unexplained wt loss > 10% in 6 months
  • drenching night sweats
64
Q

W/U HL

A 
CBC 
ESR/CRP
Serrum Copper/Ferritin
LFTs
UA (proteinuria)
65
Q

TMTX HL

A
  • often cure with XRT and/or chemo

usually in combo

66
Q

Most common solid tumor of infancy

A

NEUROblastoma

67
Q

Neuroblastomas begin where?

A

embryonal malignancy of SNS

68
Q

Characteristics of neuroblastoma cells

A

small, round, blue tumors

undifferentiate

69
Q

bio marker that is a sign of a bad prognosis

A

MYCN amplification –> rapid tumor progression and poor prognosis

70
Q

Urine in neuroblastoma

A

urinary catecholamines are present

71
Q

poor prognostic histology in neuroblastoma

A
  • stroma-rich w/nodular patterns

- stroma-poor tumors

72
Q

s/s of NEUROblastoma

A
  • abd pain w/or w/o N/V
  • wt loss, anorexia
  • fatigue
  • bone pain, limp
  • **HTN - renal artery compression
  • chronic diarrhea - secretion of vasoactive intestinal peptide
73
Q

Horner syndrome

A
  • neuroblastoma extending into neck
    1. pitosis
    2. miosis (constricted pupil)
    3. absence of sweating on one side of the face
74
Q

opsoclonus

A

random eye mvmt and myoclonus

paraneoplastic syndrome

75
Q

S/S that neuroblastoma has extended to parasinus canal

A
  • weakness
  • limping
  • paralysis
  • bladder/bowel disfunction
76
Q

“blueberry muffin” skin in cancer

A

Stage 4S metastatic neuroblastoma

77
Q

W/U neuroblastoma

A 
CBC
UA
CMP
LFT
RFT
Coags
LDH
78
Q

MBIG test

A
  • picks up on catacholaminergic cells of tumors

- is able to ID primary and metastatic diesase spots

79
Q

Tchnetium - 99 bone scan

A

ID mets to bone

80
Q

MOST COMMON childhood abdominal and renal malignancy

A

WILMS TUMOR

81
Q

Cause of WILMS TUMOR

A
  • neoplastic prolifration of embryonal renal cells

- abnormal TS genes 11p13 and 11p15

82
Q

Other possible abnormals in WILMS TUMOR

A
  • aniridia (absence of iris)
  • hemihyperprophy
  • cryptorchism
  • hypospadias
83
Q

diagnostics WILMS TUMOR

A
  • Xray - lung mets
  • Renal US - check patency of IVC
  • CT/MRI
84
Q

What is the concern if Wilm’s tumor invades IVC

A

mets to right ventricle

85
Q

TMTX Wilms Tumor

A
  • nephrectomy if unilateral
  • surgery to debulk
  • chemo/XRT
86
Q

most common OCULAR malignancy of childhood

A

Retinoblastoma

87
Q

Retinoblastoma has a high mortality if ….

A

extra ocular extension

throug sclera or along optic nerve

88
Q

Leukocoria

A
  • loss of red reflex in eye…white instead

- often called “cats eye”

89
Q

Patho of Parkinsons

A

Destruction of dopamine producing cells

90
Q

TRAP mnemonic Parkinsons

A

T - tremor
R - rigidity
A - Akinesia (slowed movement)
P - postural instability

91
Q

Medication Progression Parkinsons

A
  1. MAO-B (selegine/rasagiline) -gilines
  2. Dopamine agonist (Requip/Neopress)
  3. Carbadopa/Levadopa (Sinemet)
  4. Apokyn (for gait freezing)
  5. Amantadine (anticholinergic)
92
Q

Increase in dopamine causes what?

A
  • Increased Side effects

- increased movement

93
Q

Short term or long term memory goes first win ALZ

A

Short term

94
Q

Antipsychotic Increase risk for:

A
  • Stroke

- Cardiovascular disease

95
Q

What chronic conditions increase risk for vascular dementia

A
  • HTN
  • HLD
  • DM
96
Q

What is mixed dementia

A

reversible dementia (delirium) with underlying progressive disease

97
Q

Treatment for vascular dementia

A

though not reversible nor curable, progression can be slowed by ASA and Plavix

98
Q

Agnosia

A

ALZ

- not able to recognize objects

99
Q

Apraxia

A
  • ability to recognize things but not what to do with them. For example “these are scissors, but what are they for”
100
Q

Issues present in late stages of ALZ

A
  • Wandering
  • increased libido
  • increased strength
  • behavioral disturbances
  • decreased impulse control
101
Q

What may alter the results of the Folstein MMS scoring in either a better or a worse score

A

Educational Level

102
Q

Blessed Dementia Scale

A

Assesses Functional and Cognitive Ability

103
Q

Scoring on Blessed Dementia Scale

A

Higher the number the worse the Dementia

104
Q

T/F Delirium may have an abrupt onset

A

True

105
Q

T/F Dementia symptoms may wax and wane

A

True

106
Q

Hospice vs. Palliative Care

A

Hospice - preparation for death

Palliative Care - supportive, symptomatic tmtx

107
Q

Treatment of Delirium

A

Treat the underlying cause

108
Q

Alteration of the FMR1 protein causes what genetic condition

A

Fragile X

109
Q

What is Down Syndrome testing in the first trimester

A
  • Nuchal translucency
  • pregnancy associated plasma protein A
  • HCG
110
Q

What is the testing for Down Syndrome in the 2nd and 3rd trimester

A
  • Quad Screening - AFP, HCG, Estradiol, Inhibin-A

- Free fetal DNA cells - in blood of mother

111
Q

What are the invasive test for Down Syndrome

A
  • CVS

- Amniocentesis

112
Q

When does screening for ASD start

A

18 months

- MCHAT

113
Q

By what age do you usually see ASD symptoms

A
  • by age 3, but could have a delayed dx
114
Q

Presbycusis

A

most common cause of hearing loss

115
Q

Fall risk

A

PRIMARY PREVENTION

- fall risk interventions - ensure path is clear of items that would increase risk

116
Q

most important aspect to consider in having a drivers license

A
  • visuospatial skill
117
Q

What is the most common complication in dementia

A
  • feeding difficulties

-

118
Q

most common TYPE of dementia

A

ALZ

119
Q

ALZ

A

RAPID forgetfulness, especially of new material

most prevalent dementia

120
Q

Frontotemporal Dementia

A

More trouble planning tasks, more behavioral disturbances and disinhibition

121
Q

Vascular dementia

A
  • Quickest onset, more language problesm

- less forgetful than AD especially with available cues.

122
Q

Lewy Body Dementia

A

May have more psychiatric symptoms (psychosis) early in disease

Exam 3 - 503 (2 decks)

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