Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

503 > Exam 3: Oncology > Flashcards

Exam 3: Oncology Flashcards

1
Q

Most common histology of cancer in children:

A

Nonepithelial (leukemia, CNS, sarcomas [connective tissue])

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common histology of cancer in adults:

A

Epithelial/Organs (Carcinomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common location of cancer in children:

A

CNS, muscle, bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common location of cancer in adults:

A

Breast, colon, lung, prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common pathogenesis of cancer in children:

A

Genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common pathogenesis of cancer in adults:

A

Environmental & Lifestyle factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cancer pharmacokinetics in children:

A
  • tumors more responsive to chemotherapy
  • tolerate higher doses
  • less difficulty with acute toxicities
  • more long-term consequences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cancer pharmacokinetics in adults:

A
  • less responsive to chemotherapy
  • tolerate lower doses
  • more difficulty with acute toxicities
  • less long-term consequences
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Long term consequences of cancer pharmacotherapy in children:

A
  • secondary cancers

- thyroid problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for cancer in children include:

A
  • prenatal diagnostic radiation
  • DES exposure
  • transplacental transmission of maternal cancers
  • viral exposure (such as EBV)
  • Secondary cancers r/t chemo
  • In utero exposures to meds, pesticides, electromagnetic fields, motor vehicle exhaust
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical manifestations for all cancers:

A
  • unusual mass or swelling
  • unexplained paleness or loss of energy
  • sudden tendency to bruise
  • persistent localized pain or limping
  • changes in coordination or behavior
  • prolonged, unexplained fever or illness and frequent headaches often with vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

General diagnostic workup for cancer:

A
  • Comprehensive history
  • comprehensive physical exam
  • lab work: CBC, CMP, LFTs, among many others
  • Imaging: X-RAYS, CT, MRI, Bone Scan
  • Biopsy
  • Lumbar puncture if CNS involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What information is rendered by biopsy in cancer diagnosis:

A
  • biological characteristics of the tumor or the marrow in staging
  • extent of the disease at the time of diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What information is rendered by bone marrow aspiration/biopsy?

A

-extent of involvement of malignant cells in marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What cells are affected by Acute Lymphoblastic Lymphoma?

A

-Lymphoid cell line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do myeloid cells break down into?

A

RBC, WBC, platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do lymphoid cells break down into?

A

T-cells and B-cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What cells are impacted by Leukemia?

A

-B cells and T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Acute Lymphoblastic Leukemia?

A
  • Neoplastic accumulation of lymphoblasts in the bone marrow
  • Most commonly arises in children: associated with Down syndrome
  • Subclassified into B-ALL and T-ALL based on surface markers.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common presenting symptoms in acute lymphoblastic leukemia (ALL) are d/t disrupted hematopoiesis causing:

A

o Anemia

  • Fatigue
  • Weakness
  • Pallor
  • Dyspnea with exertion
  • Tachycardia
  • Exertional chest pain

o Thrombocytopenia

  • Easy bruising
  • Petechiae/purpura
  • Bleeding mucosa, gums
  • Heavy menstrual bleeding

o Neutropenia

  • Risk of infections: bacterial, fungal, viral
  • Fever
  • Night sweats

o Organ infiltration by leukemic cells

  • Enlarged liver, spleen, lymph nodes
  • Bone marrow infiltration causes bone and joint pain
  • Testicular infiltration causes testicular edema
  • CNS penetration causes cranial nerve palsies, HA, visual or auditory symptoms, AMS, TIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How are ALL classified?

A

-according to cell type and involvement, and by cellular differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Patients with Trisomy 21 are at a much greater risk for which type of cancer?

A

Acute lymphoblastic leukemia (ALL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common type of malignancy diagnosed in children 0 to 14?

A

T-cell acute lymphoblastic leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

In Africa, there is a huge relationship between EBV and what?

A

Lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do patients with ALL present?

A
  • Fatigue and pallor [anemia]
  • bleeding, purpura, ecchymosis [thrombocytopenia]
  • recurrent fevers & infections [neutropenia– typically they are still febrile after couple courses of several ABX-red flag]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Important sanctuary sites for leukemic cells:

A

CNS:
-child can present with headache, vomiting, lethargy, papilledema, nuchal rigidity during abdominal exam [some younger children won’t present with this], as well as cranial nerve deficits

Testes
-unilateral painless testicular enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the 2 sanctuary sites for ALL?

A

CNS, Testes

28
Q

Mediastinal masses tend to be associated with which lineage of ALL?

A

T-lineage

29
Q

Red flag for mediastinal mass:

A

Stridor or respiratory distress

30
Q

How is ALL treated

A

With chemotherapy

31
Q

What are poor prognoses for ALL?

A
  • high WBC at diagnosis
  • age, usually less than 1 or greater than 10 years old
  • T - cell origin is poorer prognosis
  • patients that don’t respond at initial induction
32
Q

What is chemotherapy induction therapy?

A

-treatment geared to get a patient into remission

33
Q

What is consolidation or intensification treatment?

A

-treatment geared to keep a patient in remission

34
Q

How long is the average treatment protocol for a female with standard risk ALL?

A

2.5 years

35
Q

How long is the average treatment protocol for a male with standard risk ALL?

A

-about 3 years because of the sanctuary site of the testicles

36
Q

What are the 4 components of leukemia classification?

A
  • morphology
  • cytochemistry
  • Immunophenotyping
  • cytogenics/chromosomal analysis
37
Q

What treatment methodology has been critical for improving survival rates with ALL/AML?

A

-intrathecal chemotherapy to the CNS, a sanctuary site

38
Q

What are lymphomas?

A

malignant neoplasms of the lymphoid tissue

-hodgkin’s & non-hodgkin’s

39
Q

What is the difference between leukemia and lymphoma?

A

Leukemia is liquid cancer (bone marrow & blood)

Lymphoma is solid cancer (solid tumors of lymphatic tissues)

40
Q

Etiology and risk factors of lymphomas:

A
  • certain human leukocyte antigens (HLAs) will increase or decrease a patient’s risk
  • pesticide exposure
  • high birth weight with subsequent risk of childhood cancers
  • Immunosuppression such as HIV
  • organ or bone marrow transplantation
  • EBV
  • successfully treated for Hodgkin’s lymphoma
  • previous exposure to malaria or genetics (chromosomal translocations involving genes for immunoglobulin or T cell preceptor molecules)
41
Q

Non-hodgkin’s lymphoma accounts for ___ percent of all pediatric cancer and it occurs most frequently during the ______ decade of life

A

6%; second

42
Q

What is the most frequent malignancy in children with AIDs?

A

non-hodgkin lymphoma

43
Q

A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood cell (WBC) of 30,000 cells/mm3 and near normal red blood cell (RBC) and platelet counts.

What will the provider do next to manage this patient?

A. Order coagulation studies to evaluate for coagulopathies
B. Perform biochemical studies to look for hyperuricemias
C. Refer to a specialist for bone marrow aspirate and biopsy
D. Repeat the complete blood count in 2 weeks

A

C

Patients with acute lymphocytic leukemia (ALL) may have normal blood counts even when the marrow has been replaced with leukemic cells, so a bone marrow aspirate and biopsy is required for the definitive diagnosis.

Coagulation and biochemical studies may be performed after the diagnosis is known to evaluate for complications.

Waiting and repeating the CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.

44
Q

A patient reports a neck mass that has been present intermittently for 5 or 6 weeks which varies in size. The provider palpates a lymph node measuring 1.25 cm.

Which test will provide proper histologic diagnosis for this patient?
A. Bone marrow aspirate
B. CT scan with IV contrast
C. Lymph node biopsy
D. PET scan
A

C

The lymph node biopsy is used to provide proper histologic diagnosis and precise classification.

Bone marrow aspirate identifies the presence of dysplastic cells.

PET and CT scans will identify the presence of other lesions.

45
Q

What is the most important role of the primary care provider in cancer management?

A. Counseling about healthy practices to reduce risk factors
B. Perform regular screenings to detect cancer
C. Referring patients for genetic testing to identify those at risk
D. Teaching patients about cancer management once diagnosed

A

A

About three-fourths of cancer risks are related to elements that patients can control themselves and include diet, tobacco, alcohol, sun exposure, physical activity, and risky sexual behaviors. Emphasizing healthy lifestyle practices is a principle component of primary care.

Screenings are next in importance and should be performed according to guidelines based on risk and age.

Genetic testing is useful in a small percentage of patients; a good family history is important before referral for testing.

The primary care provider may assist oncology specialists in teaching patients about cancer management.

46
Q

A patient being treated for cancer has had chemotherapy within the past 2 weeks and comes to the primary care clinic with a fever of 38.5°C.

What is the initial action?
A. Refer immediately to oncology
B. Order a chest radiograph
C. Order blood and urine cultures
D. Prescribe empirical antibiotics
A

A

Patients receiving chemotherapy who have a temperature >38°C and an absolute neutrophil count (ANC) of less than 500/mm3 require immediate hospitalization and treatment. The primary provider should refer immediately to the oncologist who will order a CBC and admit to hospital.

Once hospitalized, the patient will have further workup to determine the cause of the infection and then antibiotics to treat the infection.

47
Q

What is the purpose of radiation treatment prior to surgical resection of a tumor?

A. To debulk the tumor mass
B. To minimize local recurrence
C. To prevent metastases
D. To reduce pain and rectal bleeding

A

A. To debulk the tumor mass

48
Q

Which situations are considered oncologic emergencies in a patient diagnosed with cancer and requires urgent referral to an oncologist? (Select all that apply)

A. Bone marrow suppression
B. Metastasis of cancer cells
C. Superior vena cava syndrome
D. Syndrome of inappropriate antidiuretic hormone
E. Tumor lysis syndrome
A

C, D, E

Superior vena cava syndrome, SIADH, and tumor lysis syndrome are all oncologic emergencies requiring urgent referral to the oncologist.

Bone marrow suppression and metastasis occur with cancer but are not emergencies.

49
Q

What diseases are associated with non-hodgkin lymphoma?

A

AIDs, EBV, CMV

50
Q

The duration of symptoms of ALL before diagnosis is usually about :

A

One month or less

Symptoms develop over days to weeks

51
Q

What is the most common site of origin of lymphoma?

A

-lymphoid structures of intestinal tract

52
Q

Common physical findings of lymphoma:

A
  1. firm, fixed, nontender cervical or supraclavicular masses or adenopathy
  2. thoracic dullness to percussion–> pleural effusion
  3. Dyspnea or stridor–> Mediastinal mass
  4. Abdominal distension or a mass with/without tenderness, rebound tenderness, and/or shifting dullness
  5. Distended neck veins and plethora–> Superior vena cava syndrome
  6. Obtundation, agitation, and meningismus–> CNS involvement
  7. Decreased breath sounds–> bronchial obstruction or pleural effusion
  8. Focal pain or swelling in the extremity –> primary bone lymphoma
53
Q

Purpose of Chest X-Ray (PA & Lateral) with lymphoma:

A
  • Assess for mediastinal masses
  • Evaluate airway
  • Exclude pulmonary parenchymal lesions and associated PNA
54
Q

Patient presents with painless swelling of lymph nodes in the neck, armpits and groin and c/o fever/chills, night sweats, anorexia and unexplained weight loss. What are you thinking?

A

Hodgkin Lymphoma

55
Q

A child presents with headaches upon waking, what could be a possible cause?

A

Brain tumor

56
Q

A mother brings her 8 year old in with complaints of: fever, frequent infections, frequent nose bleeds, swollen lumps around the neck, underarms, abdomen and groin, pale skin, SOB, weakness, fatigue. The CBC shows high WBC, low RBC and low platelets. Possible dx? What tests should be ordered?

A

ALL

Bone Marrow Biopsy

57
Q

Patient presents with a visible abdominal “bump” as the new FNP should you palpate this?

A

NO….possible Wilms Tumor

58
Q

You have a patient who you believe has a Wilms Tumor, the patient has HTN. What test should you order to r/o extension to the IVC?

A

Abdominal US

59
Q

Hypospadias and undescended testes are a risk factor for what?

A

Wilms Tumor

60
Q

Upon physical examination you note Leukocoria when assessing red reflex, what are you thinking?

A

Retinoblastoma

61
Q

What are the “different types” of chemo?

A

Immunotherapy, Targeted Therapy, Hormone Therapy

62
Q

Patient with cancer begins experiencing more pain requiring more frequent dosing of his pain medication. When patients begin requiring more frequent dosing, should the NP begin looking for longer acting pain medications?

A

YES! Increasing pain = more frequent dosing, patient should be started on a longer acting pain medication to stay ahead of the pain and give relief for longer periods.

63
Q

What does the nausea pneumonic VOMITS stand for?

A 
V=Vestibular
O=Obstruction
M=Mass/Motility/Metabolic
I=Infection/Inflammation
T=Toxin (chemo)
S=Stretch (kidney/liver capsule)
64
Q

What is the best nausea medication for chemo induced n/v?

A

5HT3= Zofran

Can also use medical THC

65
Q

How can fatigue caused by Cancer be treated?

A

Stimulants like Ritalin 2.5-5mg BID or Adderall

Help combat “chemo brain” and increase focus and concentration.

503 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions