Hematology/Oncology?Psych102 Flashcards
1
Q
normocytic anemias are due to
A
decreased production (ACD) or increased destruction (hemolytic) of normal rbcs, or an increase in plasma volume or acute blood loss
2
Q
Normocytic anemiia with an increased reticulocyte count is due to
A
acute blood loss
3
Q
normocytic anemia with normal or decreased reticulocyte count
A
ACD or hemolytic anemia
4
Q
high iron foods
A
meat, beans, raisins, spinach
5
Q
AE of iron supplementation and how to avoid
A
can stain teeth–dilute liquid and use straw
heartburn, constipation, black tarry stool
TO avoid take with only a little food, best absorbed with acid/vit c; take with stool softener
6
Q
small abnormally shaped rbs and decreased Hgb
A
microcytic anemia
IDA, thalassemias
7
Q
large rbcs; due to defective DNA synthesis resulting in ineffective hematopoeisis
A
Macrocytic anemia
(large cells (megaloblasts) become trapped in marrow, decreased in life span and in #-megaloblastic anemia)
Pernicious anemia, folate deficiency anemia, alcohol-related anemia
8
Q
quickly acquired anemia can be fatal in adults in Hgb is under
A
8
9
Q
foods high in folate
A
leafy green vegetables, bran, dry beans, nuts
10
Q
most common cause of megaloblastic anemia
A
folate deficiency
11
Q
folate needed by women of childbearing age to avoid
A
neural tube defects, spina bifida
12
Q
this anemia results in myelin degeneration causing neurological signs: paresthesias, gait disturbances, weakness, confusion
A
vitamin B12 deficiency anemia
13
Q
infection and bleeding precautions will be needed with this anemia
A
aplastic anemia
14
Q
enzyme made by kidneys in response to decreased oxygen carrying capacity that simulates myeloid stem cells in marrow
A
erythropoeitin (EPO)
15
Q
Jaundice is seen in these anemias
A
hemolytic, sickle-cell anemia
16
Q
abnormal increase in rbcs, wbcs, and plts
A
polycythemia
17
Q
two types of polycythemia
A
Vera- caused by chromosomal mutation
Secondary- caused by hypoxia causing release of too much EPO
18
Q
major danger of polycythemia
A
increased blood viscosity increases risk of clot
19
Q
after treatment for polycythemia pts tend to develop
A
acute leukemia
20
Q
dangerous plt levels
A
<10 risk for spontaneous bleeding
21
Q
Disease where antibodies destroy platelets faster than they can be replaces
A
Immune Thrombocytopenic Purpura
22
Q
ITP triggers
A
viral illness, SLE, pregnancy
often self-limiting in children
can be acute or chronic
23
Q
Disease in which platelets clump abnormally and clog capillaries, causing tissue ischemia
A
Thrombotic Thrombocytopenic Purpura
24
Q
often first sign of HIT is
A
breathing problem
25
sensitivity to heparin that forms in up to 25% of pts; antibodies formed to heparin-plt complex increasing risk of DVT or PE
Heparin-induced Thrombocytopenia
26
how to monitor for HIT
watch for decreased plt count to less than 50% of baseline 4-14 days after beginning therapy
27
In a pt with HIT, this anticoagulant is used instead of heparin
Agatroban
28
Classic hemophilia (80%) is this type, and is related to this CF
Hemophilia A; Factor VIII
29
Often is first sign of hemophilia
hemiarthrosis-joint bleeding
30
most common bleeding disorder; less severe than hemophilia, equally common in men and women
VonWillebrand's Disease
| also involves Factor VIII
31
Hemophilia B aka and involves what CF
Christmas disease
| Factor IX
32
Vitamin K is needed
by liver to synthesize clotting factors
33
common sign of Vitamin K deficiency
bleeding mucous membranes
34
population at most risk for vitamin K deficiency
newborns-don't have intestinal bacteria to make vitamin K
35
Granulocytes
Neutrophils, Eosinophils, and Basophils
36
agranulocytes
Lymphocytes and monocytes
37
stab/band cells
immature neutrophils
| when body senses an infection band count will increase
38
involved in allergic reaction and parasite infection
Eosinophils
39
Philadelphia chromosome mutation results in
CML
40
Mutation in myeloid stem cell increases production of blast cells
CML
41
% of neutrophils and lymphocytes in diff
neutrophils: 60-70%
lymphocytes: 20-40%
42
Oral treatment for CML that inhibits cell division in only cells with the Phildelphia chromosome mutation
Gleevec
43
CML prognosis directly related to ability to
maintain a remission
44
acute exacerbation of CML
blast crisis
45
excess development of granulocytes, expanding marrow into the long bones, and inducing hematopoesis in liver and spleen causing them to enlarge occurs in
CML
46
major complication of chemotherapy treatment in any leukemia
Tumor Lysis Syndrome (increased uric acid, K, phos, and decreased Ca)
47
BMT for CML?
only in young, is a chronic disease
48
Leukemia of too many baby wbcs (granulocytes)
CML
49
Leukemia of too many non-functional adult lymphocytes
CLL
50
Leukemias are classified according to
which type of leukocyte is involved
51
malignant clone of (usually B) lymphocyte produces a non-functional adult appearing cell
CLL
52
In CLL, these become infiltrated with dysfunctional lymphocytes and enlarge
Lymph nodes, spleen and liver
53
CLL prognosis related to
extent of organ infiltration and patient wishes (no cure)
54
Typical presenting symptom on Hodgkin's Lymphoma
Painless enlargement of lymph nodes
55
Reed-Sternberg cells are the malignant cell and diagnostic criterion for
Hodgkin's Lymphoma
56
Lymphomas have increased incidence with exposure to
chronic immunosuppressive drugs and agent orange; EBV?
57
Abnormal, giant, multinucleated cells that replace other cells in the lymph nodes
Reed-Sternberg cells in Hodgkin's
58
Hodgkin's Lymphoma ususally presents in
20-40 years of age, more men
59
which leukemias present older?
Both 60+
CLL
Non-Hodgkin
60
Group of cancers originating from malignant lymphoid tissue with extensive infiltration of nodes and cells in many stages of development
Non-Hodgkin Lymphoma
61
Lymphoma diagnosed by
lymph node and/or BM biopsy
62
Suspect CLL instead of CML if these three s/s
splenomegaly, hepatomegaly, and presents at an older age
63
CBC results of pt with leukemia
WBC count 15-500
| increased plts
64
unique symptom of pernicious anemia
tingling and numbness in extremeties
65
difference between benign and malignant neoplasm
tissue invasiveness
66
increased fluid requirement with these two ostomies
Ileostomy and ascending colostomy
67
no laxatives, EC or XL/XR meds with this
Ileostomy
68
mucus fistula
non-functioning stoma of double barrel stoma
69
this colostomy must be irrigated for regularity
descending colostomy
70
Ileostomy with and internal pouch and tube that connects to outside
Koch pouch
71
This ostomy produces formed stool
sigmoid
72
after bladder removal this is used for urinary diversion
Ileal conduit
73
a pale stoma indicates
anemai
74
a dark red/purple stoma indicates
inadequate perfusion
75
an edematous stoma indicates
obstruction or gastroenteritis
76
a bleeding stoma indicates
a clotting problem, GI bleed, or varices.
77
distal bowel to ostomy not sewn over and may be reconnected, may have mucus discharge
Hartman's Pouch
78
acid base balance is maintained in the body by 3 systems
Buffers-immediate
Respiratory-minutes to hours
Renal-2 to 3 days, but most effective
79
normal arterial pH
7.35-7.45
80
normal PaCO2
35-45 mmHg
81
normal HCO3-
22-26 mEq/L
82
normal PaO2
80-100 mmHg
83
respiratory imbalance: opposite movement of
pH and PaCO2
84
metabolic imbalance: same movement of
pH and HCO3-
85
Causes of respiratory acidosis
Hypoventilation:
| respiratory depression, inadequate chest expansion, airway obstruction, COPD/severe asthma
86
Respiratory Alkalosis caused by
Hyperventilation:
| anxiety, fear, pain, fever/sepsis, fever, mechanical ventilation
87
Causes of metabolic acidosis
severe/prolonged diarrhea
DKA
starvation/malnutrition/excess exercise (lactic acid)
trauma/shock/cardiac arrest
88
Body compensates for metabolic acidosis by
compensatory hyperventilation
| medulla increases RR and depth to blow of CO2
89
watch this electrolyte in acid/base imbalance because of the possibility of fatal arrhythmia
K
90
causes of metabolic alkalosis
severe vomiting
excess GI suctioning
excess bicarbonate intake
91
inability to recognize reality with the creation of a new reality
psychosis
92
psychoactive drugs vs. psychotropic drugs
psychoactive-alter brain chemistry
| psychotropic-alter brain chemistry for the purpose of treating a mental illness
93
schizophrenia-increase in two NTs
dopamine and serotonin
94
Delusion/Illusion/Hallucination
Delusion-false belief
Illusion-misperception of what is there
Hallucination-false perception (nothing there)
95
first generation antipsychotics
"typicals"
increased risk of side effects
thorazine, haldol
96
second generation antipschotics
"atypicals"
decreased side effects
Risperdal, Zyprexa, Seroquel, Geodon
97
third generation antipsychotic
Abilify-also augment for depression
98
Two types of side effects of antipsychotics
Anticholinergic and Extrapyramidal
99
anticholinergic side effects
Blurred vision
urinary retention
constipation
dry mouth
100
what are EPS
extrapyramidal side effects of antipsychotics--drug-induced movement disorders--
dystonia, pseudoparkinsonism, akatheisa, and tardive dyskinesia
101
spasm of neck, jaw, and shoulders...can be fatal if tongue gets thick and eyes roll back and airway is cut off
Dystonia
102
generalized restlessness
akathesia
103
irreversible disfiguring involuntary facial movements with chronic antipsychotic use
tardive dyskinesia
104
Meds to counteract/prevent EPS (not TD or akath)
Artand
Benadryl
Cogentin
105
cancer rates higher in these two groups
men
| Blacks
106
angular cheilosis and brittle spoon shaped nails occur in
IDA
107
pts with this are prone to iron overload, so don't give iron supplements
thalassemia
108
defective Hgb synthesis causes theses
thalassemia
sicle-cell anemia
small # hemolytic anemias
109
why give steroids with thrombocytopenia?
decrease phagocyte response and decrease antibody formation
110
multi-step orderly process of changing a normal cell into a cancer cell
malignant transformation
111
first stage of malignant transformation
Initiation--mutation occurs
irreversible change in DNA, cell has the potential to develop into a clone
due to carcinogens
112
initiation stage of malignant transformation inhibited by
tumor suppressor genes (ex. BRCA-1 and -2, p53)
113
hinder cell division and cause cell death; should stop a mutated cell from dividing
Tumor Suppressor gene
114
Second stage of malignant transformation
Promotion--reversible proliferation of altered cells
| can follow latency period of altered cell laying dormant
115
Third stage of malignant transformation
Progression: increased growth rate of tumor, invasion and metastasis
Detectable tumor is formed (primary tumor) , with tumor angiogenesis
metastasis-formation of secondary tumors
116
the immune system can ID normal vs. abnormal cells by
tumor-associated antigens and immune surveillance
117
system of cancer staging
TNM-tumor node metastasis
| indicates extent of disease
118
the grade of a tumor indicates
```
degree of differentiation of cells based on histology--how closely do the cells resemble the tissue of origin
Less differentiation (anaplasia), worse prognosis
```
119
cancer of epithelial tissue--skin, glands, brain, mucous membranes of GI/GU and respiratory tracts
Carcinoma
| most common cancer type
120
cancer of connective tissue-muscle, bone, fat
Sarcoma
121
cancer of lymph tissue (especially nodes)
Lymphoma
122
cancer of hematopoeitic tissue--bone marrow, spleen
Leukemia
123
Definitive diagnosis of cancer is made by
biopsy
124
internal radiation treatment
brachytherapy
125
thrombocytopenia (most common cause of bleeding in cancer) is a medical emergency when plt count is <
50
126
most serious adverse effect of chemo
leukopenia
127
in leukopenic pt report right away a fever of
>100.4
128
normal wbc count
4.2-12.5
129
normal Hct
women 37-47%
| men 42-52%
130
normal Hgb
women 12-16
| men14-18
131
normal wbc count
women 4.2-5.4
| men 4.7-6.1
132
inflammatory response causing erythema/edema to painful ulcers of mouth, secondary to chemo destroying quickly-dividing cells of oral mucosa
Mucositis/Stomatitis
133
BMX mouth rinse
Benadryl
Maalox
Xylocaine
coats oral mucosa and decreases pain and inflammation
134
these cause alterations in taste of salt, sour and metallic taste in cancer pts
cell wastes from treatment
135
cachexia
wasting syndrome common in cancer pts
136
interventions for anorexia in cancer pts
small frequent meals-high cal and high PRO, supplements
follow preferences
Megace-appetite stimulant
137
most common side effect of chemo, usually stops when chemo is done
nausea
138
skin reaction to radiation that resembles sunburn
dry desquamation
| resolves on its own, use plain lotion
139
skin reaction to radiation that results in skin sloughing off
wet desquamation
140
two types of oncologic emergencies
metabolic and obstructive
141
s/s hypercalcemia
fatigue, a/n/v
| more severe--muscle weakness, EKG changes
142
treatment of hypercalcemia
lots of fluids to promote excretion of calcium; Zometa
143
metabolic oncologic emergencies (4)
Hypercalcemia
Septic Shock
SIADH
Tumor Lysis Syndrome
144
oncologic emergency with high mortality rate than can be further complicated by DIC
Septic shock
145
SIADH-def and treatment
Syndrome of Inappropriate Antidiuretic Hormone
too much ADH is produced, causing a dilutional state that can lead to water intoxication and coma. The excessive water retained dilutes Na.
Treatment:Fluid restriction and high dose NaCl IV
146
biochemical changes resulting from destroyed cell contents quickly entering bloodstream after effective cancer treatment.
Tumor Lysis Syndrome
147
untreated Tumor Lysis syndrome can lead to
increased K level and cardiac dysfunction
148
how does ARF develop from Tumor Lysis syndrome?
purines released from cells become uric acid
uric acid precipitates in kidneys to form
sludge in tubules
149
4 hallmark signs of TLS
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
150
treatment for TLS
Hydrate to increase production of urine and excretions
| Allopurinol to decrease uric acid concentration
151
Obstructive oncologic emergencies (3)
SVC Syndrome
Spinal cord compression
Pericardial Effusion/Tamponade
152
SVC syndrome
tumor compresses SVC
blocks venous return from head, neck, and arms
head and trunk swell
153
first sign of spinal cord compression
```
Back pain
then-paresthesias
loss of urethral/rectal sensation and control
muscle weakness
permanent paralysis
```
154
Philadelphia chromosome mutation occurs in
CML
154
cause of pericardial effusion in cancer
secondary to tumors or radiation pericarditis
155
this condition can cause intense itching as bvs vasodilate/histamine is released and dark red skin
polycythemia vera
156
microcytic anemias are characterized by (2)
| and 2 types are
small abnormally shaped rbcs and decreased Hgb
| IDA and thalassemias
157
3 types of macrocytic anemai
B12 deficiency anemia
folate deficiency anemia
alcohol-related anemia
158
two types of normocytic anemia
ACD and hemolytic anemia
159
elderly pts with impaired CP reserves my show these s/s of anemia
CP, DOE, palpitations and dizziness
160
smooth red tongue, angular cheilosis, and brittle spoon-shaped or ridged nail beds, and pica can be seen in
IDA
