final exam week 7 Flashcards
Common metastatic sites for tumors (and s/s)
Lung –> (2)
s/s-
Colon–> (1)
s/s
liver, bone, brain?
Lung bone, brain
Bone - pain
Brain – balance
Colon liver
Liver - Enzymes, bleeding
biologic substances (hormones, enzymes, antigens or genes) shed off of some tumors and are measurable
tumor markers
Certain malignancies are associated with cancer inducing viruses – HPV, HIV, Hep B, Hep C
For any virus to live and propagate – it must insert its genes into the host cell’s genome
The host cell then becomes a manufacturer of the virus
MOA – always involve the activation of growth-promoting pathways or inhibition of tumors suppressors in infected cells
Viral induced cancer
T/F
1. Early post menopausal years – women experience greatest bone loss and it Continues at gradual rate
2. Women have lower peak bone density
3. Women lose more bone mass compared to men over a lifetime
4. Women reach fracture threshold later then men = increased risk fracture
5. For women
Bone reabsorbed by osteo__lasts > bone formed by osteo__lasts = decreased bone mass
- T
- T
- T
- F - earlier
- Bone reabsorbed by osteoclasts > bone formed by osteoblasts = decreased bone mass
risk factors
- open fracture
- recent trauma
- DM
- Hemodialysis
- IV drug use
- Splenectomy
osteomyelitis
Gout phases
1. Phase 1 – symptoms?
-______ serum uric acid levels
-_______ deposits in tissues
-Crystals accumulate and ______ is damaged
-Acute ______ is triggered
2. Phase 2 – acute _____
-With hyperuricemia
3. Phase 3 – clinically ______
-Until next ______ occurs
-Continued hyperuricemia
-Could be months or years before next flare
-Later attacks get closer and closer
4. Phase 4 – ______ arthritis
-Joint pain and other s/s present most of the time
Gout phases
Phase 1 – asymptomatic
- Elevated serum uric acid levels
- Uric acid deposits in tissues
- Crystals accumulate and tissue is damaged
- Acute inflammation is triggered
Phase 2 – acute flares/attacks
- With hyperuricemia
Phase 3 – clinically inactive
- Until next flare occurs
- Continued hyperuricemia
- Could be months or years before next flare
- Later attacks get closer and closer
Phase 4 – chronic arthritis
- Joint pain and other s/s present most of the time
_______ are cells that build bone tissue
________ are cells that break down bone tissue.
Osteoblasts
Osteoclasts
Risk factors of what cancer?
- Obesity – inflammation causes changes to DNA
- Tobacco use
- Physical activity
- Insulin resistance
- Low fiber in the diet
- High amount of animal fat in the diet and processed meats
- Diets low in vitamin A, C, and E
- Ulcerative colitis – inflammation causes changes to DNA
- Alcohol
colorectal cancer
Carcinogen Classification
_________ - substances or agents that have been definitively linked to causing cancer in humans.
Examples include:
* Tobacco smoke
* Asbestos
* Alcohol
* Estrogen therapy
* Some viruses - HPV, HIV
________- substances or agents that are likely to cause cancer in humans, based on limited evidence.
Examples include:
* Women who work night shift
________ - substances or agents that may be carcinogenic to humans, but the evidence is not strong enough to classify them in another class.
Examples include:
* Engine exhaust
known
Probable
Possible
fracture complications: delayed healing
1. __________ - takes longer than expected to heal.
2. ________- fracture heals in an incorrect position or alignment.
3. _______ - no healing 4-6 months post fracture
malunion
delayed union
nonunion
- delayed union - takes longer than expected to heal.
- malunion - fracture heals in an incorrect position or alignment.
- nonunion - no healing 4-6 months post fracture
Osteoporosis patho
1. Increased bone resorption AKA osteo__last activity increased
2. Decreased bone formations AKA osteo__lasts activity decreased
3. Problems:
Failure to make new bone (osteo__lasts)
Too much bone resorption (osteo__lasts)
Both
Osteoporosis patho
1. Increased bone resorption AKA osteoclast activity increased
2. Decreased bone formations AKA osteoblasts activity decreased
3. Problems:
Failure to make new bone (osteoblasts)
Too much bone resorption (osteoclasts)
Both
Osteoclast – bone breakdown
Osteoblast – bone build
- Disorder involves inflammation of one or more joints and then becomes arthritis
Arthropathy
colorectal cancer - T/F
1. Colon cancer usually starts as a polyp, a tumorous mass that projects into the intestinal lumen
2. polyps can be malignant or benign
3. Starting at age 50, colonoscopy q 10 years
- T
- T
- T
which cancer
Etiology
- Cigarette smoking (promotor and cause)
- Passive smoke
- COPD – chronic inflammation makes mutation
- Asbestos – carcinogen
- Radon
- Arsenic
- Genetics
- other
lung
OA Etiology
- _______ applied to joint – weight bearing
- Degeneration of _______ – excessive load of healthy joint or normal loading of previously injured joint
- Chronic disease or acute flare?
OA Etiology
- Stress applied to joint – weight bearing
- Degeneration of cartilage – excessive load of helathy joint or normal loading of previously injured joint
- Chronic disease
cancer cells vs normal cells?
1. proliferation control
______ – zero population growth and apoptosis (normal death), so they have 1:1 ratio of cell death and birth = no population growth
______ – uncontrolled proliferation, sometimes cells are immortal, die unpredictably
2.proliferation rate
______– unpredictable (fast or slow), depends on differentiation
_____ – predictable
- self HLA antigens – how they determine something is self vs non-self
_____ – present themselves to immune system and are recognized as self
_____ – non-self markers, immune system may attack or sometimes they can avoid detection from immune system
- n,c
- c,n
- n,c
2 hereditary conditions that increase the risk of developing colorectal cancer:
- Familial Adenomatous Polyposis (FAP) - well defined hereditary disorder that predisposes an individual to intestinal _______
- Hereditary Nonpolyposis Colorectal Cancer (HNPCC) - without the extensive _______ formation seen in FAP.
FAP - with polyps
HNPCC - without polyps
s/s
local
- Tender, warm, red
- Wound drainage
- Restricted movement
- Spontaneous fracture
Systemic
- Fever
- Positive blood culture
- Leukocytosis (high WBC)
osteomyelitis
OA s/s
- Manifestations are asymmetrical or symmetrical?
- deep aching _____ pain – esp with exertion, relieved with rest
- joint pain with ____ weather
- stiffness in ______
- ______ of joint during motion
- joint swelling – hard or soft?
- ______ gait
- _____ range of motion
OA s/s
Manifestations are asymmetrical (RA is symmetrical)
- deep aching joint pain – esp with exertion, relieved with rest
- joint pain with cold weather
- stiffness in morning
- crepitus of joint during motion
- joint swelling – hard
- altered gait
- limited range of motion
_______tumor – cancer is located in site of origin
________tumor – cancer is located to a site that it spread to
- We know they have spread bc they will look like cells in the primary location
- Ex: lung cells in brain
primary
secondary
lupus acute flares =
cycle of acute exacerbation of ________, followed by _________
warning sign of _____
- fatigue
- pain
- h/a
prevention = recognize ______ and avoid ______
- sunlight
- infection
- abruptly stopping a medication
- stress
lupus acute flares
cycle of acute exacerbation of symptoms, followed by remission
warning sign of lupus flare up
- fatigue
- pain
- h/a
prevention – recognize warning signs and avoid triggers
- sunlight
- infection
- abruptly stopping a medication
- stress
Origin of cancer
Carcinogenesis
MOA
- Anti-inflammatory processes
Slows progression of RA when used with other DMARDs
slow/stop progression
used along or with methotrexate for early/mid RA
s/e
- Retinopathy
Hydroxychloroquine
DMARDS disease modifying anti-rheumatic drugs
antimalarial
Anti-rhematic
treats RA
which cancer
- Most present with advanced or metastatic cancer
- Early dx is key to treatment
- Common > 65 years and black
lung
fracture orientations
- __________ – straight line seen in falls
- _______ – twisting injury
- ________ – shattered
- _______ – pressure from both ends of bone
- _________ – incomplete break, beaks on one side but not all the way through, common in kids
- ________ – tiny cracks in bone
impacted
greenstick
transverse
comminuted
stress
spiral
fracture orientations
- transverse – straight line seen in falls
- spiral – twisting injury
- comminuted – shattered
- impacted – pressure from both ends of bone
- greenstick – incomplete break, beaks on one side but not all the way through, common in kids
- stress – tiny cracks in bone
lung tumor secretion of ACTH
resembles MSH – patient may have tanned skin
Paraneoplastic syndrome
associated with lung cancer
OA vs RA!!!
___ – asymmetrical manifestations
____ – symmetrical manifestations
___ swelling – hard
___ swelling – spongy and warm
*** know OA vs RA!!!
OA – asymmetrical manifestations
RA – symmetrical manifestations
OA swelling – hard
RA swelling – spongy and warm
class: Selective estrogen receptor modulators (SERMs)
drug: Raloxifene
treatment for?
osteoporosis
Cell spectrum
_________- – the extent that neoplastic cells resemble normal cells (structurally and functionally)
Ex: ______ tumors are well differentiated = looks and functions like normal cell
________ – lack of differentiation, indicates total cellular disorganization, abnormal cell appearance, and cell dysfunction
Ex: _______ cells/tumors = totally different look and function than a normal cell
Differentiation
benign
Anaplasia
malignant
s/s of what cancer
- cough
- hemoptysis – blood in sputum
- wheeze or stridor
- chest pain
- dyspnea
- weight loss
- excessive fatigue
- Weakness
- Hoarseness
- Obstructive accumulation of secretions in the bronchioles that appear as pneumonia s/s
- Asymptomatic – may find tumor accidentally on CXR for something else
- Paraneoplastic syndrome (group of symptoms) may be the 1st sign
lung cancer
Cancer genetics
T/F
1. All cancers originate from changes in DNA
2. Normal cell gene mutations = cancer cells
3. Gene mutations can be
- ________ – ex: BRCA gene
- ________ – acquired during person’s life - ex: carcinogen exposure
4. Immune systems are effective at killing mutated cells
But as we age, out immune system isn’t as effective
Mutated cells may go unnoticed
That’s why Older adults have increased risk for developing cancer
- T
- T
- hereditary, sporadic
- T
assessment findings
- joint deformity
- joint tenderness
- decreased ROM
- herbedens nodes – distal finger (interphalangeal) joints crooked
- bouchards nodes – proximal finger (interphalangeal) joints are crooked
osteoarthritis
lung cancer types
__________– most common
- slow growing
____________
- rapidly growing
- metastasizes quickly
small cell lung cancer (SCLC)
non small cell lung cancer (NSCLC)
types
non small cell lung cancer (NSCLC) – most common
- slow growing
small cell lung cancer (SCLC)
- rapidly growing
- metastasizes quickly
Most joint disorders affect _______ joints (moveable joints)
synovial
______ are proteins found on the surface of cells. They play a crucial role in the immune system’s ability to distinguish between “self” and “non-self” cells. So the immune system can target foreign invaders like viruses, bacteria, and cancer cells.
______ cells present their HLA antigens to the immune system. These antigens act as identification tags, allowing the immune system to recognize them as “self” and avoid attacking them.
______ cells can exhibit abnormal or altered HLA antigens. These deviations from normal self-antigens can trigger an immune response. but some are able to evade detection by the immune system through various mechanisms.
Human Leukocyte Antigens (HLAs)
normal
cancer
fracture complications: fat embolism syndrome
1. type of __________
2. fat molecules block blood vessels in the ______
3. occurs following:
______ BONE FRACTURE (most common) or Major trauma
4. How do fat molecules in legs get to lungs?
- Fat molecules are from _______ or ________
- Released into blood stream and travel to lungs
5. s/s
o hypoxemia
o altered LOC
o petechial rash
fracture complications: fat embolism syndrome
1. type of PE
2. fat molecules block blood vessels in the lungs following
3. LONG BONE FRACTURE- big bones in legs most common or Major trauma
4. How do fat molecules in legs get to lungs?
- Fat molecules are from bone marrow or traumatized tissue
- Released into blood stream and travel to lungs
5. s/s
o hypoxemia
o altered LOC
o petechial rash
Carcinogens
T/F
1. Substances that cause development of cancer
2. Often require prolonged exposure
3. Can alter cell DNA = mutation
4. Damage from carcinogens are not cumulative
5. Agents can be carcinogen (cause), promoter, or both
- T
- T
- T
- F - is cumulative
- T
drug treatment for OA
NSAIDS!!!
- Use _______ effective dose possible
- Can affect _______ function
- Risk for ______ , Risk increased with aging
o Contraindication (1)
o Use with caution (2)
hx of GI bleed
on coag therapy
has PUD
NSAIDS!!!
- Use lowest effective dose possible
- Can affect kidney function
- Risk for GI bleed
o Risk increased with aging
o Contraindication – PUD patient
o Use with caution – hx of GI bleed or on coag therapy
Hydroxychloroquine
DMARDS disease modifying anti-rheumatic drugs
antimalarial
Anti-rhematic
treats?
RA and lupus
what are tumor markers useful for? (4)
- Screen for cancer: For example, PSA (prostate-specific antigen) is used to screen for prostate cancer.
- Diagnose cancer: If a tumor marker is elevated, it may indicate the presence of cancer. However, further testing is usually needed to confirm a diagnosis.
- Monitor the progress of cancer treatment: Tumor marker levels can be monitored over time to see if the treatment is effective.
- Detect recurrence of cancer: If a tumor marker level rises after treatment, it may indicate that the cancer has returned.
Reduces risk of spinal fractures
MOA – mimics estrogen by increasing bone density, inhibits bone resorption
Used as prevention and treatment
s/e
- Hot flash
- Leg cramping
BLACK BOX WARNING
- Stroke risk
Teaching
- Must take adequate calcium and vitamin D replacement for it to work
- d/c at least 72 hours before planned procedures, any prolonged immobilization periods, high risk of blood clotting
- don’t smoke or drink alcohol
- don’t use if pregnant
Raloxifene
Selective estrogen receptor modulators (SERMs)
for osteoporosis
- Biologic response modifiers
- Target parts of the immune system that trigger inflammation that cause joint and tissue damage
- Usually given with methotrexate
- Can increase risk of severe skin or lung infections, skin cancer, serious allergic reactions
- Very expensive
Biologic agents
Newer generation of DMARDS disease modifying anti-rheumatic drugs
treats RA
metastasis - T/F
1. Cancer cells can travel by lymph, blood, or shed off into local area
2. But it has to have its own blood supply
3. Cancer cells are suited for this bc they secrete vascular endothelial growth factor (gives them ability to develop new blood vessels)
- T
- T
- T
OM Patho
- Arterial blood flow brings _______ into bone
- _________ = inflammation, bone destruction, pus and edema
- Pressure __creases within the bone
- Causes local arteries to _________
- Decreases or eliminates supply of
o ________
o ________
o _________
- Leads to impaired healing – b/c hard to get _________ to sight of infection, difficult to treat
- Arterial blood flow brings bacteria into bone
- Infection = inflammation, bone destruction, pus and edema
- Pressure increases within the bone
- Causes local arteries to collapse
- Decreases or eliminates supply of
o Oxygen
o Nutrition
o Immune cells - Leads to impaired healing – b/c Antibiotics hard to get to sight of infection, difficult to treat
class: Hormone therapy
drugs:
- Calcitonin-salmon
- HRT – no longer used
treatment for?
osteoporosis
vascular spread - T/F
1. Cancer cells can enter the bloodstream and travel to distant organs.
2. The cancer cells leave the bloodstream and invade the tissues of a new organ and penetrate local veins
3. ________- The cancer cells stimulate the growth of new blood vessels to support their growth and survival.
4. Often cancer cells in the bloodstream go to the ____ first – bc the_____ filters blood
5. The _______ is also often a secondary site – for the same reason
6. The cancer cells get clumped, trapped and proliferate in the ____
- T
- T
- Angiogenesis
- liver
- liver
- liver
NSAIDS
Work by reducing production of________ which promote pain, inflammation, fever
1. Cell damage occurs
2. NSAID arrives
3. _____ is blocked
4. Fewer ________ produced
5. Pain, inflammation, and fever are reduced
Work by reducing production of prostaglandins which promote pain, inflammation, fever
1. Cell damage occurs
2. NSAID arrives
3. COX is blocked
4. Fewer prostaglandins produced
5. Pain, inflammation, and fever are reduced
cancer classification systems: TNM system
- N - lymph node involvement/spread
N0 =
N1 = spread to _____ lymph nodes or spread to ____ number of regional lymph nodes
N2 = spread to______ lymph nodes or spread to ______ regional lymph nodes
N - lymph node involvement/spread
N0 = no spread to regional lymph nodes
N1 = spread to closest lymph nodes or spread to small number of regional lymph nodes
N2 = spread to most distant lymph nodes or spread to numerous regional lymph nodes
cancer cell or normal cell?
1. No resting stage (Stage G0) - _____ cells are constantly moving through cell cycle stages
2. No checkpoints – for DNA to recognize errors and apoptosis (normal cell death)
3. No regard for growth inhibitors – released by neighboring cells, this prevents cells from invading eachother’s space. _____ cells will just grow on top of each other
- C
- C
- C - As cancer cells proliferate
o they accumulate on top, around, and beside each other
o take over boundaries of organs
o crowd out normal cells
o may break free and travel to distant body sites
Osteoporosis pharm
Classes:
____________
- Aldendronate
____________
- Raloxifene
___________
- Calcitonin-salmon
- HRT – no longer used
Osteoporosis pharm
Classes:
Bisphosphonates
- Aldendronate
Selective estrogen receptor modulators (SERMs)
- Raloxifene
Hormone therapy
- Calcitonin-salmon
- HRT – no longer used
Gout patho
1. Body makes _____ AND it is also in our diet
2. ______ crystals form from the breakdown of purines
3. Normally uric acid dissolves in the blood and excreted by the _______
4. _________ – overproduction or under excretion of uric acid
5. Uric acid crystal deposits in _______!!!
Gout patho
1. Body makes purine AND purine is in diet
2. Urice acid crystals form from the breakdown of purines
3. Normally uric acid dissolves in the blood and excreted by the kidneys
4. Hyperuricemia – overproduction or under excretion of uric acid
5. Uric acid crystal deposits in tissues!!!
- Normal bone density
- ________ – low bone mass (-1 - -2.5)
- __________– very low bone mass (-2.5)
- __________ – extremely low bone – fragility fracture can occur (standing causes broken bone)
Osteoporosis, Severe osteoporosis, Osteopenia
- Normal bone density
- Osteopenia – low bone mass
- Osteoporosis – very low bone mass
- Severe osteoporosis – extremely low bone – fragility fracture can occur (standing causes broken bone)
T/F
1. BRCA is a tumor marker
2. BRCA is a gene that can increase a person’s risk of developing breast or ovarian cancer.
3. If you have a mutation in the BRCA gene, you are at a higher risk of developing these cancers.
4. having a BRCA mutation means you will definitely develop cancer
- F
- T
- T
- F - not definite, just increased
Gout Etiology
Hyperuricemia
-____ production of uric acid
-_____ excretion of uric acid
Gout Etiology
Hyperuricemia
- Over production of uric acid
- Under excretion of uric acid
Common metastatic sites for tumors (and s/s)
Breast –> (4)
s/s -
Prostate –> (1)
s/s -
Melanoma –> (1)
s/s -
brain, brain, vertebrae, bone, liver, lung
Breast bone, brain, liver, lung
Bone - pain
Brain – balance
Liver - Enzymes, bleeding
Lung – bloody sputum, coughing
Prostate vertebrae
Vertebrae – back pain
Melanoma brain
Brain – balance
Predisposing factors
- genetic
- female
- age 20-40
- black
- environmental triggers
- allergy to abx
- hormonal factors – menarche > 10 y/o, oral contraceptives
- tobacco use
Lupus
RA Pharm
goals:
1. Relieve pain and swelling
2. Slow or stop progression of disease
Long term drug therapy requires patient adherence
- _________
-__________ – short term
-_________– slow/stop progression
- NSAIDS
- Glucocorticoids – short term
- DMARDS disease modifying anti-rheumatic drugs – slow/stop progression
sequence of growth stages that a cell moves through for mitosis and regeneration
Cell cycle –
OA patho
- Prolonged excess pressure on joint wears _______
- _______ bone is exposed
- leads to _____ development, which moves through remaining cartilage and destroys the rest of the cartilage
- localized ________ leads to more degradation
- chondrocytes synthesize ______ called proteoglycans to try and repair – causes swelling
- osteoblasts (build bone) activation leads to ________ and synovial fluid thickening (they are trying to fix but cause more damage)
- loss of _______ narrows the joint space (bone on bone)
OA patho
- Prolonged excess pressure on joint wears cartilage
- subchondral bone is exposed
- leads to cyst development
- cysts move through remaining cartilage and destroys the rest of the cartilage
- localized inflammations leads to more degradation
- chondrocytes synthesize fluid called proteoglycans to try and repair – causes swelling
- osteoblasts (build bone) activation leads to bone spurs and synovial fluid thickening (they are trying to fix but cause more damage)
- loss of cartilage narrows the joint space
__________ tumors
Need nutrients, oxygen, and access to blood
Angiogenesis - The cancer cells stimulate the growth of new blood vessels to support their growth and survival.
Secondary tumors
fracture complications: delayed healing
1. delayed union - takes longer than expected to heal.
s/s
bone pain and tenderness increase
risk factors
smoking
age?
severe anemia
infection
malnutrition
low vitamins
_____thyroid
uncontrolled DM
___________ break
smoking
older adult
severe anemia
infection
malnutrition
low vitamins
hypothyroid
uncontrolled DM
complicated break
cancer classification systems: stages
1. Stage 1
-Small
-No _____ involvement
-Confined to organ of_____
2. Stage 2
- > 3 cm
- _____ local lymph nodes involved
- ______ invasive
3. Stage 3
- _____ number of regional lymph nodes involved
- Regional spread to _____ organs/structures
4. Stage 4
- Spread to_____ sites (metastasis)
Stage 1
- Small
- No lymph node involvement
- Confined to organ of origin
Stage 2
- > 3 cm
- Some local lymph nodes involved
- Locally invasive
Stage 3
- Large number of regional lymph nodes involved
- Regional spread to nearby organs/structures
Stage 4
- Spread to distant sites (metastasis)
