Exam 4

Question 1

type of breast cancer that is not a “true cancer” - cannot invade tissue: lobular carcinoma in situ or inflammatory breast cancer?

Answer 1

lobular carcinoma

Note: inflammatory breast cancer is found late in disease process, often times no lump and will not show up on mammo

Question 2

what does lump feel like w/ infiltrating ductal carcinoma?

Answer 2

irregular, uneven borders

Question 3

brachy vs tele therapy- internal or external?

+ which one are we concerned about our exposure to?

Answer 3

brachy = internal device :  Patient emits radiation while as long as device is emitting radiation
tele= external

Question 4

sealed vs unsealed radiation - which has body fluids that emit radiation?

Answer 4

Unsealed: Any body fluids are also radioactive
Sealed: Only the patient emits radiation - not excreted into bodily fluids

Question 5

stomatitis vs mucositis?

Answer 5

◦ Stomatitis = irritation in mouth only

◦ Mucositis = irritation in entire GI Tract

Question 6

type of diet that increases risk of colorectal cancer?

Answer 6

high fat, low fiber

heavy alcohol use

Question 7

SCREENING - when do we start?
colon cancer average risk vs high risk=
breast cancer average risk vs high risk=

Answer 7

colon high risk = <45
colon low risk = >45

breast high risk= <40 + MRI + 10 years younger than 1st deegree relative tested + for BC
low risk= annual mammo >40

Question 8

Colorectal cancer TESTING
colonoscopy looks for?
FOBT looks for? What does it tell us?

Answer 8

colonoscopy look for precancerous POLYPS
FOBT looks for blood = bleeding , follow w/ colonoscopy

NOTE: *if test negative on FOBT does not mean you do NOT have cancer, just means no blood

Question 9

most common type colon cancer (think cellular level) and most common cause

Answer 9

> Most are adenocarcinomas

>Polyps form first and can transform into CRCs

Question 10

3 main assessments for colonrectal cancer:

Answer 10

• Rectal bleeding
• Anemia
• Changes in stool

Question 11

colon cancer bleeding:

what does color of blood tell us- mahogany vs bright red?

Answer 11

Mahogany (bleeding further up) vs Bright red (bleeding lower down)

Question 12

Gross blood most common with tumors on _______ side of colon/rectum

Answer 12

left

Question 13

partial vs complete bowel obstruction (sounds and see)

Answer 13

• Partial bowel obstruction

• ->Visible peristaltic waves
• -> Tinkling bowel sounds

• Complete bowel obstruction
–> Absence of bowel sounds

Question 14

anemia is more associated with right or left sided colon cancer?

Answer 14

right

Question 15

blockage w/ colon cancer usually in what colon sections?

Answer 15

transverse, descending

Question 16

rectosigmoid cancer characterized by

Answer 16

• Hematochezia (poo blood)
• Straining
• Narrowing of stools

Question 17

colostomy w/ 2 openings

-What does top drain? what does bottom drain?

Answer 17

Colostomy w/ mucous fistula
= 2 different stomas
‣ mucous fistula= bottom = drains mucous
‣ top fistula= drains stool

Question 18

MATCH THE STOOL TYPE

ASCENDING
TRANSVERSE
DESCENDING
ILEOSTOMY

solid, pasty, liquid

Answer 18

Ileostomy= liquid

Ascending colon= liquid

Transverse colon= pasty

Descending colon= solid stool

Question 19

deficient b12 w/ which 2 GI conditions?

Answer 19

Crohn’s and Chronic Gastritis

Question 20

Hematemesis w/ which diseases

Answer 20

acute gastritis

gastric ulcer

Question 21

blood in stool w/ which diseases

Answer 21

acute gastritis
duodenal ulcer
colon cancer
ulcerative colitis

Question 22

Barrett’s esoph- cells go from ______ to ______

Answer 22

squamous to columnar

columnar tolerate acid better but increase cancer risk

Question 23

random thing: which GI disease we have studied can lead to cardiac disease and pneumonia?

Answer 23

GERD

Question 24

hiatal hernia is risk factor for which GI disease?

Answer 24

GERD

Question 25

meds causing LED/ GERD

Answer 25

``` ◦ Nitrates ◦ NSAIDS ◦ Oral contraceptives ◦ CCB’s ◦ sedatives ‣ Avoid these medications is not always possible! ```

Question 26

random thing: we are concerned about gastric neuropathy related to diabetes w/ which disease process?

Answer 26

GERD

Question 27

GERD- elevated HOB how many inches?

Answer 27

6-12 | 6 is average, 12 is for adult film level elevation

Question 28

on a patho level what is difference b/w acute gastritis and peptic ulcer?

Answer 28

gastritis = inflammation of mucosa | peptic ulcer = lesion of mucosa

Question 29

2 random drugs leading to peptic ulcers

Answer 29

glucocorticoids and theophylline

Question 30

pH exam for what GI disease?

Answer 30

GERD | usually used EGD

Question 31

peptic ulcers: bowel sounds early vs late

Answer 31

Hyperactive bowel sounds (early) | • Hypoactive bowel sounds (late)

Question 32

definitions: crohn's vs UC

Answer 32

``` crohns= Chronic inflammatory disease of the small intestine, colon, or both with periods of remission and exacerbation UC= Chronic inflammation of the rectum and sigmoid colon with periods of remission and exacerbation ```

Question 33

tenesmus is unque to which 2 disease processes

Answer 33

UC, Crohn's

Question 34

UC >10 years = increase chance of developing....

Answer 34

colon cancer

Question 35

UC - monitor for what 2 vital signs in particular

Answer 35

Fever & Tachycardia >> may be sign of worsening or complication: sepsis, bleeding, electrolyte imbalance, dehydration

Question 36

steatorrhea unique to what disease process

Answer 36

crohns

Question 37

4 ways to differentiate crohns s/s from UC

Answer 37

-Diarrhea- **Steatorrhea (fatty diarrhea) -Abdominal pain- **Constant, RLQ and around umbilicus. (Can be in the LLQ if the colon is also affected.) -Fever: Secondary to **when a patient has a fistula, abscess, or severe inflammation. -Weight loss: **Secondary to malabsorption, Anorexia, increased catabolism,…

Question 38

Definitions: diverticulosis vs diverticulitis

Answer 38

* Diverticulosis = pouch-like herniations of mucosa through muscle wall of gut (usually occurs in the colon) * Diverticulitis = Inflammation of diverticula (herniation)

Question 39

usual sxs of diverticulitis

Answer 39

``` Abdominal Pain (LLQ), nausea, constipation Perforation --> Peritonitis ```

Question 40

s/s of peritonitis

Answer 40

``` • Abdominal pain • Rigid Board-like abdomen • Fever • Tachycardia • Low blood pressure (signs of poor perfusion and infection) ``` (diverticulitis, colon cancer)

Question 41

diverticulosis vs itis interventions (esp consider fiber)

Answer 41

-Diverticulosis High Fiber 25-25 g Fluids avoid Foods with seeds ``` -Diverticulitis Avoid fiber Antibiotics Analgesic Opioids IV fluids Bowel rest Rest Avoid increased abdominal pressure ```