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ANE 8510 - Principles of Anesthesia II > Exam 3 - Oncology and Chemotherapy (Andy's) > Flashcards

Exam 3 - Oncology and Chemotherapy (Andy's) Flashcards

1
Q

What is the progression from normal cells to cancerous cells?

A
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2
Q

What are the three “drivers”/genes that increase the proliferation of cancer cells?
A. germ cells
B. stem genes
C. tumor suppressor genes
D. DNA repair genes
E. palisade genes
F. proto-oncogenes

A

C. tumor suppressor genes - alterations allow genes to divide uncontrollably
D. DNA repair genes - incorrect damage repair; cause other mutations
F. proto-oncogenes - involved in normal cell growth and division…allow cells to grow and survive

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3
Q

Name the cancer:

Originates at basal (base) layer of epidermis.
A. lymphoma
B. adenocarcinoma
C. sarcoma
D. basal cell
E. squamous cell

A

D. Basal cell

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4
Q

Name the cancer:

Originate from squamous cells that lie just beneath skin, and also line stomach, intestine, lung, and bladder.
A. lymphoma
B. adenocarcinoma
C. sarcoma
D. basal cell
E. squamous cell

A

E. squamous cell

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5
Q

Name the cancer:

Originate from cells that produce mucus and in glandular tissue like breast and prostate.
A. lymphoma
B. adenocarcinoma
C. sarcoma
D. basal cell
E. squamous cell

A

B. adenocarcinoma

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6
Q

Name the cancer:

Originate from bone and soft tissue.
A. lymphoma
B. adenocarcinoma
C. sarcoma
D. basal cell
E. squamous cell

A

C. sarcoma (ex: osteosarcoma)

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7
Q

Name the cancer:

Begins in blood-forming tissue of the bone marrow.
A. leukemia
B. lymphoma
C. sarcoma
D. basal cell
E. adenocarcinoma

A

A. leukemia

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8
Q

Name the cancer:

Begins in lymphocytes (T or B cells).
A. adenocarcinoma
B. leukemia
C. sarcoma
D. lymphoma

A

D. lymphoma - tend to build up on lymph nodes and lymph vessels

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9
Q

Absolute risk measures cancer risk by:
A. % of ppl in exposed group with disease / % of ppl in unexposed group with disease
B. how many ppl get “X” in a certain period
C. how many ppl get “X” in a certain period / how many ppl have ever had “X”
D. % of ppl with disease / % of ppl with late stage disease

A

B. how many ppl get “X” in a certain period

Ex. If 4 people out of a group of 100,000 get “X” then absolute risk is 4 in 100,000

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10
Q

Relative risk of cancer is measured by:

A. % of ppl in exposed group with disease / % of ppl in unexposed group with disease
B. how many ppl get “X” in a certain period
C. how many ppl get “X” in a certain period / how many ppl have ever had “X”
D. % of ppl with disease / % of ppl with late stage disease

A

A. % of ppl in exposed group with disease / % of ppl in unexposed group with disease

this either correlates the exposure to the disease or not..

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11
Q

Relative risk that is greater than 1 would have a:
A. negative correlation with the exposure and disease
B. positive correlation with the exposure and disease
C. trait is not linked to disease

A

B.
for example: If there are higher % of cigarette smokers with lung cancer / % of non-smokers with lung cancer = then there’s a positive correlation with smoking and having lung cancer..

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12
Q

left from last class…but turned it into multiple choice lol

An example of a relative risk that is less than 1 would be:
A. smoking
B. air pollution
C. exercise

A

C. Exercise - b/c there is a lower % of ppl that exercise with cancer… vs higher % of ppl that do NOT exercise with cancer.
RR < 1 = exercise is linked to a decrease in disease

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13
Q

What are the factors measured in tumor staging?
T:
N:
M:

A
  • T: size/extent of primary tumor
  • N: # of nearby lymph nodes which are +
  • M: is there metastasis

The staging is done at diagnosis; doesnt change after that.

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14
Q

Describe staging of primary tumor (T):

TX:
T0:
T1-T4:

A
  • TX: tumor cannot be measured.
  • T0: tumor cannot be found
  • T1-T4: refers to size and/or extent of primary tumor. the higher the number, the larger the tumor.
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15
Q

Decribe staging of regional lymph nodes (N):

NX:
N0:
N1-N3:

A
  • NX: cancer in nearby lymph nodes cannot be measured.
  • N0: no cancer in nearby lymph nodes
  • N1-N3: number and location of lymphs that contain cancer. the higher the number, the more lymphs that contain cancer.
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16
Q

Describe staging of distant metastasis:

MX:
M0:
M1:

A
  • MX:cannot be measured.
  • M0: has not spread to other parts of the body.
  • M1: has spread to other parts of the body.
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17
Q

What is the staging term that describes abnormal cells are present but have not spread to nearby tissue?
A. localized
B. distant
C. in situ
D. regional

A

C. In situ

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18
Q

For determining cancer prognosis, what two factors are more important than the type of cancer?
A. quality of life/mental health
B. functional status
C. age
D. lab values
E. gender

A

B. Functional status
D. Laboratory values (esp serum calcium, serum albumin)

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19
Q

Select all that apply:

What factors are associated with a median survival rate of 6 months or less?
A. patient spends more than half a day in bed
B. pleural effusion
C. alopecia
D. serum Ca++ > 11.2 mg/dL
E. renal failure
F. serum albumin < 3.5 mg/dL

A

A. patient spends more than half a day in bed
D. serum Ca++ > 11.2 mg/dL
F. serum albumin < 3.5 mg/dL

full list ^^^

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20
Q

What (4) type of cancers will frequently radiate to the bone?

A
  • Breast
  • Lungs
  • Kidney
  • Prostate

Osteolytic, osteoblastic or both lesions

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21
Q

What can be helpful in treating cancer metastasis to the bone? select 3.
A. steroids
B. chemo/radiation
C. NSAIDS
D. opioids only
E. possible vertebroplasty
F. discectomy

A

B. Radiotherapy/chemotherapy
C. NSAID +/- opioids
E. Vertebroplasty
hormonal therapy also often helpful!

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22
Q

Cancer pain originates from:
A. cancer pressing on nearby structures
B. invasion of tumor into tissues innervated by afferent neurons
C. the body developing hyperalgesia
D. brain metastasis affecting primary somatosensory cortex

A

B. Invasion of tumor into tissues innervated by afferent neurons - like tumor in pleura or peritoneaum directly invading nerve plexus

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23
Q

WHO “Cancer Pain Stepladder” is about 80-90% effective. What are strategies mentioned by WHO?
A. pain meds should be promptly administered and on schedule
B. start with opioids ASAP for mild to moderate pain
C. pain meds should be PRN
D. add anti-anxiety as necessary

A

A. pain meds should be promptly administered and on schedule (not PRN!)
D. Add antianxiety drugs as necessary
start w/ non-opioid +/- adjuvants!

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24
Q

What type of RA might be done for a patient with unresectable pancreatic cancer, hepatic or gastric cancer?
A. intercostal block
B. lumbar sympathetic ganglion block
C. epidural catheter
D. celiac plexus block

A

D. celiac plexus block

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25
Q

What areas are anesthetized with a celiac plexus block? select 2.
A. sympathetic fibers of t4 - t10
B. parasympathetic lumbar plexus fibers
C. sympathetic fibers of t5 - t12
D. parasympathetic celiac plexus fibers

A

C. sympathetic fibers of t5 - t12
D. parasympathetic celiac plexus fibers

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26
Q

What neurolytic drug is used for a celiac plexus block?
A. lidocaine
B. dexamethasone
C. isopropyl alcohol
D. clonidine

A

C. Isopropyl alcohol = Destruction of nerves
pain relief typically lasts 3-6 months.

side effects: diarrhea and HYPOTENSION!!!

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27
Q

What type of RA might be done for a patient with rib metastasis?
A. intercostal block
B. lumbar sympathetic ganglion block
C. intrathecal catheter
D. epidural catheter

A

A. intercostal block

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28
Q

What type of RA might be done for a patient with pelvic tumors?
A. intercostal block
B. lumbar sympathetic ganglion block
C. intrathecal catheter
D. epidural catheter

A

B. lumbar sympathetic ganglion block

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29
Q

While continuous catheters (epidurals or intrathecals) are helpful for treatment of cancer pain, what is a drawback?
A. risk of opioid addiction
B. more systemic side effects
C. limited duration of therapy
D. equipment is limited

A

C. limited duration of therapy d/t migration, granulomas, lack of homogenous drug distribution

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30
Q

Which disease process besides cancer may also benefit from chemotherapy? select 2.
A. lupus
B. type 1 diabetes
C. rheumatoid arthritis
D. sickle cell anemia

A

A. lupus
C. rheumatoid arthritis
chemo may used to control overactive immune disease

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31
Q

How do alkylating agents work?
Whats a subtype of alkylating agents that can cross the BBB?

A

nitrosoureas … like Cisplatin!
- Damage cell DNA in all phases of cell cycle = cancer unable to reproduce

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32
Q

What is a severe side effect of alkylating agents?
A. permanently damage heart in large doses
B. pulmonary toxicity
C. dose dependent leukemia
D. hyponatremia

A

C. Dose-dependent leukemia can occur 5-10 years after treatment.

other side effects w/ Cisplatin: peripheral neuropathy; acute renal failure w/ NSAID use.

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33
Q

What (4) types of cancers do antimetabolites treat?

A
  • Breast
  • Ovary
  • Intestines
  • Leukemias

BOIL

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34
Q

How do antimetabolites work?

A

Interfere with DNA and RNA and act as substitute for normal building blocks…

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35
Q

Two examples of antimetabolites include:
A. bleomycin
B. cisplatin
C. methotrexate
D. 5-fluorouracil
E. carboplatin

A

C. Methotrexate
D. 5-Fluorouracil

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36
Q

Anti-tumor antibiotics interfere with enzymes copying DNA. What are some examples of this type of chemotherapy agent? select 2.
A. doxorubicin
B. methotrexate
C. 5-FU
D. cisplatin
E. bleomycin
F. carboplatin

A

A. doxorubicin (Lipodox)
E. bleomycin

and mitomycin-C

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37
Q

Which chemotherapy agents have life-time dosing limits?
Why?

A

Anti-tumor antibiotics (doxorubicin, bleomycin, mitomycin)
- because they permanently damage the heart in large doses.

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38
Q

Which chemotherapy agent increases the risk of a second cancer developing?
A. miotic inhibitors
B. topoisomerase inhibitors
C. anti-tumor abx
D. nitrosoureas

A

B. Topoisomerase Inhibitors

plant alkaloids that prevent strands of DNA from being seperated to copy

39
Q

Which chemotherapeutic agents are plant alkaloids and damage cells in all phases through the prevention of protein synthesis?
A. topoisomerase inhibitors
B. nitrosoureas
C. miotic inhibitors
D. bleomycin

A

C. Mitotic Inhibitors (-Taxels and vincristine, vinblastine)

may cause peripheral neuropathy

40
Q

What cells are most likely to be damaged due to chemotherapy?

A
  • Bone marrow
  • Hair follicles
  • GI tract (including mouth)
  • Reproductive systems
41
Q

Which drug can help patients with N/V related to chemo but can inhibit hormonal contraceptives for up to 28 days?
A. clonidine
B. dexamethasone
C. aprepitant
D. droperidol

A

C. Aprepitant (Emend) - neurokinin-1 antagonist

42
Q

Marijuana can help pts with N/V related to chemotherapy by depressing the CNS vomiting center. It may also:
A. be more effective than metoclopramide
B. decrease anesthetic requirements by 15-30%
C. inhibit hormonal contraceptives
D. boost the immune system

A

B. decrease anesthetic requirements by 15-30%

and more effective than phenothiazines at helping n/v related to chemo

43
Q

Radiation can affect the peripheral vasculature by causing:
A. frequent bleeding
B. more third spacing
C. sclerosis
D. increase in embolic events

A

D. increase (6x) in embolic events

44
Q

Radiation on head & neck cancers can specifically cause: select 3.
A. peripheral neuropathy
B. hypothyroidism
C. hypoalbuminemia
D. issues with airway mgmt
E. hyperthyroidism
F. carotid artery disease

A

B. hypothyroidism - get thyroid fxn tests!
D. issues with airway mgmt
F. carotid artery disease - auscultate for bruits, carotid doppler

45
Q

Radiation’s effects on the chest wall and/or breasts would cause the CRNA to: select 2.
A. get an EKG
B. ask for a chest CT
C. place a swan ganz catheter
D. order a stress test and/or echo as needed
E. notify the cardiothoracic surgeon

A

A. get an EKG
D. order a stress test and/or echo as needed

  • b/c of the Pericarditis, Cardiomyopathy, valve and/or conduction abnormalities that could occur from radiation here
46
Q

Radiation on the lungs, breast or mediastinum may cause radiation pneumonitis. What should the CRNA consider for this pt?
A. order incentive spirometry for post-op
B. a CXR and PFTs if needed
C. serial ABGs
D. place pt on biPAP

A

B. a CXR and PFTs if needed, oh and o2 sats of course

47
Q

What chemotherapeutic agent is known to cause cardiomyopathy?
A. bleomycin
B. cisplatin
C. adriamycin
D. doxorubicin

A

C. Adriamycin

48
Q

What chemotherapeutic agent is known to cause pulmonary toxicity?
A. bleomycin
B. cisplatin
C. adriamycin
D. doxorubicin

A

A. Bleomycin - keep FiO2 LOW!

49
Q

What chemotherapeutic agents are known to cause peripheral neuropathy? select 2.
A. bleomycin
B. cisplatin
C. adriamycin
D. doxorubicin
E. vincristine

A

B. Cisplatin (nitrosoureas)
E. Vincristine (mitotic inhibitor)

50
Q

What preoperative abnormalities might be seen in a cancer patient? select 2.
A. hyperkalemia
B. hypoglycemia
C. hypocalcemia
D. anemia
E. hypercalcemia
F. elevated WBCs

A

D. anemia (↓ RBCs)
E. hypercalcemia - drugs toxic to bone marrow causing breakdown and releasing Ca⁺⁺ into bloodstream.

Also: neutropenia (↓ WBCs) and thrombocytopenia (↓ PLTs)

51
Q

What test is useful to determine if a patient needs a stress dose of steroids preoperatively?
A. dobutamine stress test
B. adrenocorticotropin hormone stimulation test
C. hemostasis test
D. HbA1c

A

B. adrenocorticotropin hormone (ACTH) stimulation test

tests adrenal insufficiency r/t steroid treatment

52
Q

Why is inflammation and surgical stress bad for cancer patients?

A

Surgical stress → elevation COX expression → PG’s and thromboxanes → promoted cell survival and cancer cell growth

53
Q

β adrenergic receptors at the sites of tumor growth will upregulate activity of cancer cells via nerve fiber delivery of ____.
A. serotonin
B. epinephrine
C. ACh
D. norepinephrine

A

D. norepinephrine - and not blood delivery

54
Q

What drug class directly stimulates cancer cell proliferation and invasion, inhibits leukocyte migration, and inhibits apoptosis of cancer cells?
A. propofol
B. NSAIDs
C. opioids
D. volatiles

A

C. Opioids

55
Q

What drug class may induce chemo resistance and inhibit NK cells?
A. propofol
B. volatiles
C. opioids
D. NSAIDs

A

B. volatiles

56
Q

Which drug actually decreases migration and promotes apoptosis of cancer cells?
A. propofol
B. opioids
C. volatiles
D. NSAIDs

A

A. propofol

57
Q

Long term administration of what drug class can actually decrease proliferation of cancer cells?
A. propofol
B. volatiles
C. NSAIDs
D. opioids

A

C. NSAIDs - but obviously come w their own risks if used long term

58
Q

After all the studies we talked about in class regarding effects of anesthesia on cancer patients, what was the final agreement?
A. recurrence of cancer occurs regardless of which anesthesia used
B. general anesthesia is preferred over regional
C. degree of biologic upset depends on degree of surgical insult
D. every cancer patient should only receive TIVA with propofol

A

C. degree of biologic upset depends on degree of surgical insult - so the longer the surgery and overall stress on the body, the more problems/recurrence

59
Q

What is the major cause of lung cancer?

A

Tobacco smoke

3 decade lag time in cancer occurrence

asbestos and radon gas are the other (less common) causes

60
Q

What are the (4) types of lung cancer?

A
  • Small cell
  • Non-small cell = 80%!!!
  • Carcinoid & Mesothelioma = least common
61
Q

What are the 3 subtypes of non-small-cell lung cancer?
A. squamous
B. adenocarcinoma
C. mesotheliomas
D. carcinoid
E. large cell

A

A. Squamous
B. Adenocarcinoma
E. Large cell

62
Q

This type of lung cancer is neuroendocrine in origin and considered metastatic on presentation…
A. NSCLC
B. small cell
C. large cell
D. carcinoid

A

B. small cell

63
Q

Treatment options for small cell lung ca include: select 2.
A. radiation of tumor and cranium
B. immunosuppressive
C. excision of tumor
D. chemotherapy

A

A. radiation of tumor and cranium
D. chemotherapy
unfortunately always recurs and is resistant to further tx

64
Q

What are possible side effects of small cell lung cancer? select 3.
A. hypernatremia
B. hyponatremia
C. hypercorticolism
D. adrenal insufficiency
E. myasthenia gravis
F. myasthenic syndrome

A

B. hyponatremia
C. Hypercortisolism (Cushings)
F. myasthenic syndrome aka Lambert-Eaton Syndrome

65
Q

Symptoms r/t Lambert-Eaton syndrome like proximal lower limb weakness tend to:
A. improve with ACh-esterase inhibitors
B. feel best in the morning
C. require neostigmine
D. improve with exercise

A

D. improve with exercise - and does NOT improve with AChesterase inhibitors like neostigmine!

66
Q

A patient with Lambert-Eaton syndrome is scheduled for surgery. Which muscle relaxer will you opt to use for them?
A. high-dose rocuronium
B. cistatracurium
C. succinylcholine
D. vecuronium

A

C. succinylcholine

67
Q

What lung cancer is mostly benign and has great (>90%) 5 year survival rates?
A. NSCLC
B. small cell
C. carcinoid
D. adenocarcinoma

A

C. carcinoid

68
Q

Carcinoid Syndrome, which is usually caused by tumors of gut not lung, is defined by: select 2.
A. frequent hemoptysis
B. tumor secretion of serotonin, histamine, and prostaglandins
C. rapid metastasis
D. hemodynamic collapse unresponsive to vasopressors
E. superior vena cava syndrome

A

B. Tumor secretion of serotonin, histamine, PG’s, tachykinins, kallikrein
D. Hemodynamic collapse unresponsive to pressors
and Coronary artery spasm!!

69
Q

What is the treatment for Carcinoid syndrome? select 2.
A. atorvastatin
B. protonix
C. octreotide
D. somatostatin

A

C. Octreotide (sandostatin)
D. Somatostatin

to inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.

70
Q

Which type of NSCLC grows to a large size but metastasizes late?
A. adenocarcinoma
B. carcinoid
C. squamous cell
D. large cell

A

C. squamous cell

71
Q

Since squamous cell lung cancers grow large, they have a mass effect. What are symptoms r/t this effect? select 3.
A. obstructive pneumonia
B. osteoporosis
C. superior vena cava syndrome
D. hemoptysis
E. avascular necrosis of femoral head
F. coronary artery spasm

A

A. obstructive pneumonia
C. superior vena cava syndrome
D. hemoptysis

72
Q

What is the most common subtype of NSCLC?
A. adenocarcinomas
B. squamous cell
C. large cell
D. mesotheliomas

A

A. adenocarcinomas

73
Q

T/F: Adenocarcinomas usually metastasize late.

A

False. Adenocarcinomas metastasize early!

(squamous cell are the kind that metastasize late)

74
Q

What two hormones are typically secreted by adenocarcinomas?

A
  • Growth Hormone
  • ACTH - causing Cushings (moon facies, buffalo hump, insulin resistance)
75
Q

What is the least common non-small cell lung cancer subtype?

A
  • Large cell - these Metastasizes rapidly and grow into large cavitating tumors
76
Q

NSAIDs can induce acute renal failure when combined with what chemotherapeutic agent?

A

Cisplatin

77
Q

What are the 4 M’s - assessment of pts with lung cancer?

A
  • mass effect
  • metabolic abnormalities - hypercalcemia, hyponatremia, hyperglycemia
  • metastases
  • medications - rmbr considerations w bleomycin and cisplatin…
78
Q

what are some preop considerations for a pt with lung cancer? select 2.
A. get an ABG
B. look at V/Q scan to assess hypoxemia risk during 1-lung ventilation
C. use rocuronium for muscle relaxant
D. consider glycopyrrolate (Robinul) for help with DLT placement

A

B. look at V/Q scan to assess hypoxemia risk during 1-lung ventilation
D. consider an antisialogue (glycopyrrolate or scopalamine!) for help with DLT placement

79
Q

What are the 3 factors that predict one lung desaturation?

A
  • High % of V/Q to operative lung on the preoperative V/Q scan
  • Poor PaO₂ during two lung ventilation - especially in the lateral position
  • Right sided thoracotomy
80
Q

What is the formula for predicted post-operative FEV₁ ?

A
81
Q

What anticoagulative drug class requires discontinuation 7 days prior to surgery?

A

-grel drugs ( P2Y12 Inhibitors) = Ticagrelor (Brillinta), Clopidogrel (Plavix), prasugrel, etc*

82
Q

Flip card to see anticoagulative medication hold times.

A
83
Q

How many dermatomes are typically covered via a paravertebral block?

A

4-6 dermatomes

84
Q

Why are the spinal nerves blocked in a paravertebral block more sensitive to local anesthetics?
A. innervate musculature of chest and abdominal wall
B. closest within the dura of the spine
C. lack fascia
D. it’s a highly vascular area

A

C. lack fascia

85
Q

What are 4 specific contraindications for paravertebral blocks?

A
  • Site infection
  • Empyema (collection of pus in pleural cavity)
  • Tumor in paravertebral space
  • Chest deformities (kyphoscoliosis)
86
Q

What is the level of paravertebral block required for sternotomy?

A

T4

87
Q

What is the level of paravertebral block required for thoracotomy?

A

T6

88
Q

What is the level of paravertebral block required for abdominal procedures?

A

T10

89
Q

select all that apply:

What is required for intercostal nerve block?
A. a single shot
B. blockade 2 dermatomes above incision
C. continuous catheter placement
D. blockade 2 dermatomes below incision

A

B. Blockade 2 dermatomes above AND
D. 2 dermatomes below incision.

90
Q

What are indications for intercostal nerve block?

A
  • Thorax surgery
  • Upper abdomen surgery
  • Mastectomy
91
Q

select all that apply:

Disadvantages associated with intercostal nerve block include:
A. risk of pneumothorax
B. surgeons prefer general anesthesia for thoracic procedures
C. bowel perforation could occur
D. risk of LA toxicity is high

A

A. risk of pneumothorax
D. risk of LA toxicity is high - b/c requires multiple levels of blockade AND this area super vascular so absorption is greater!!!

92
Q

What are the landmarks to identify when performing an intercostal nerve block?

A

spinous process, tip of scapula, angle of rib

93
Q

Flip for intercostal nerve block pictures.

A

ANE 8510 - Principles of Anesthesia II (17 decks)

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