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K!N4E4 > K!N4E4 Midterm 1 > Flashcards

K!N4E4 Midterm 1 Flashcards

1
Q

What is a disease?

A

an abnormal condition of the body or mind that negatively affects the structure or function of an organism that is not due to an external injury

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2
Q

What does a disease broadly refer to?

A

any condition that impairs the normal functioning of the body or mind

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3
Q

What is a chronic disease?

A
  • a disease that persists for a long time
  • long-lasting conditions that usually can be controlled but not cured
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4
Q

What are chronic diseases defined as?

A

conditions that last >1 year and require ongoing medical attention and/or limit activities of daily living

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5
Q

What are 6 key features of a chronic disease?

A
  • persistent or long duration (at least 1 year)
  • not passed from person to person (no vaccine)
  • not curable by medical treatments (“managed”)
  • does not disappear on its own (can be relapsing)
  • generally gets worse over time (progressive)
  • progression is usually slow (i.e., years)
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6
Q

What are 7 major categories of chronic disease?

A
  • Cardiovascular diseases (CHF, PAD)
  • Respiratory diseases (COPD, asthma)
  • Metabolic diseases (diabetes, obesity)
  • Immunological/hematological (cancer, HIV)
  • Orthopedic diseases (arthritis, lower back pain)
  • Neuromuscular diseases (stroke, Parkinson’s)
  • Cognitive/psychological (mental health)
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7
Q

How many organs and organ systems does the human body have?

A

≈80 organs and ≈12 organ systems

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8
Q

What are 11 key characteristics “steps” of a chronic disease?

A
  • biology / “pathophysiology” of the disease
  • etiology (causes) of the disease
  • subtypes (classifications, categories)
  • severity (mild, moderate, severe)
  • signs/symptoms (indicators of disease)
  • diagnosis (identification) of the disease
  • prognosis of the disease (probable course/outcome)
  • complications (further problems from disease/treat)
  • treatments (pharmacology, medical management)
  • treatment side effects (nausea, diarrhea)
  • scope/epidemiology (incidence, prevalence, mortality)
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9
Q

What 4 terms indicate a “problem”?

A
  • Sign: objective evidence of disease that can be observed by others (especially doctors)
  • Symptom: subjective evidence of disease that is experienced (felt) by the patient
  • Side effect: unintended adverse reactions (effects or events) to a treatment for the disease
  • Complication: a secondary disease/disorder arising as a consequence of another disease (or treatment)
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10
Q

What are 3 types of symptoms?

A
  • Remitting symptoms: symptoms that improve or resolve completely.
  • Chronic symptoms: long-lasting or ongoing symptoms.
  • Relapsing symptoms: symptoms that have occurred in the past, resolved, and then returned
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11
Q

What are 3 types of side effects?

A
  • Acute: side effects that occur during treatment and remit when treatment is stopped.
  • Chronic: side effects that occur during treatment and continue (linger) after treatment is stopped.
  • Late-appearing: side effects that do not occur during treatment but appear long after treatment is stopped.
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12
Q

What are the 2 ultimate outcomes in medicine?

A

longevity and QoL

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13
Q

What is the prevalence of chronic diseases among Canadian adults?

A

44% of adults 20+ have at least 1 of 10 common chronic conditions

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14
Q

What are top 5 most common Canadian chronic conditions for adults 20+?

A

Hypertension (25%)
Osteoarthritis (14%)
Mood / Anxiety Disorder (13%)
Osteoporosis
Diabetes

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15
Q

What is the prevalence of chronic diseases among Canadians ages 65+?

A

73% have at least 1 of 10 common chronic diseases

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16
Q

What are the top 5 most common chronic conditions for adults aged 65+?

A

Hypertension (65.7%)
Periodontal Disease (52%)
Osteoarthritis (38%)
Ischemic heart disease
Diabetes

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17
Q

In women aged 65+, what are they most likely to be diagnosed with for CD? (5)

A

Osteoarthritis
Osteoporosis
Dementia
Asthma
Rheumatoid Arthritis

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18
Q

What CD do women have a 196% higher chance of getting than men?

A

Osteoporosis

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19
Q

What CD do men have a 88% higher chance of getting than women?

A

Gout

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20
Q

In men aged 65+, what are they most likely to be diagnosed with for CD? (5)

A

Hypertension
Ischemic Heart disease
Chronic Obstructive Pulmonary Disease
Diabetes
Heart Failure

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21
Q

How many adults in the US have a CD?

A

6 in 10

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22
Q

How many adults in the US have two or more CD?

A

4 in 10

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23
Q

What is the #1 risk factor for CD?

A

Age

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24
Q

What % of US adults have more than 1 chronic condition? What % have at last 1?

A

42%
60%

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25
Q

What is the estimated amount of years that people will gain by 2040 with a major illness? Any illness?

A

2.5 years longer
5.5 years longer

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26
Q

Exercise may benefit (or harm) patients with CDs by affecting what?

A
  • the disease
  • the symptoms
  • the side effects of other treatments
  • potential complications
    can be direct or indirect
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27
Q

Exercise may benefit (harm) patients with CDs by affecting what exercise-treatment interactions?

A
  • treatment necessity (avoid or require)
  • treatment volume (dose/duration)
  • treatment adherence/completion (tolerance)
  • treatment response (make treatments more/less effective)
  • treatment eligibility (fitness/health)
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28
Q

What 3 things are greater while using exercise as CD management?

A
  • potential benefits are greater
  • potential risks/harms are greater
  • potential barriers are greater
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29
Q

What is the goal of chronic disease management?

A

To prevent or slow down CD

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30
Q

What 4 outcomes is exercise trying to directly or indirectly influence?

A

(1) treat disease
(2) prevent complications,
(3) treat symptoms/side effects
(4) improve general health (fitness, function)

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31
Q

What does the level/quality of evidence inform?

A

the strength of the recommendation, along with other factors

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32
Q

What does quality of evidence indicate?

A

the extent to which one can be confident that estimates of effects are correct

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33
Q

What does the strength of a recommendation indicate?

A

the extent to which one can be confident that adherence to the recommendation will do more good than harm

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34
Q

What is a Systematic Review?

A

an attempt to gather all available empirical research using systematic methods to answer a specific research question

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35
Q

What is a meta-analysis?

A

the statistical process of combining results from several independent but similar studies

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36
Q

What does a SRMA provide?

A

a more precise estimate of effect than any single study

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37
Q

What should SRMA be based on?

A

PICOS

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38
Q

What is PICOS?

A

 Population
 Intervention
 Comparison
 Outcome
 Study quality

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39
Q

What are RCT’s?

A

Developed in 1950s to measure and compare the outcomes of two or more clinical (medical) interventions

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40
Q

What is the goal of RCT’s?

A

Avoid bias (any factor or process that causes the results or conclusions of a trial to divert systematically from the truth)

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41
Q

What are randomized RCT’s?

A

all participants have the same chance of being assigned to each study group

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42
Q

What are controlled RCT’s?

A

one of the study groups does not receive the experimental intervention (standard of care, placebo, no intervention at all)

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43
Q

What is the intervention group in an RCT?

A

also referred to as experimental group, treatment group, or specific intervention group (exercise group)

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44
Q

What is the control group in an RCT?

A

also referred to as comparison group, placebo group, standard care, usual care, wait-list

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45
Q

What are the 2 ethical basis of RCT?

A

Clinical equipoise
Uncertainty principle
- you must have proof, not belief

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46
Q

What is clinical equipoise?

A

“genuine uncertainty in the professional community over whether or not the treatment will be beneficial”

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47
Q

What is the uncertainty principle?

A

“physicians who are convinced that one treatment is better cannot ethically randomize their patients”

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48
Q

What determines external validity or generalizability?

A

Sampling and setting

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49
Q

How do you sample for RCT’s?

A

randomly selected from a well-defined population with minimal eligibility criteria (selection bias)

50
Q

What is the crucial component of high quality RCTs?

A

Randomization! all units have the same chance of being assigned to each study arm

51
Q

What are 2 important steps in randomization?

A
  1. generation of an unpredictable allocation sequence.
  2. concealment from persons enrolling participants
52
Q

What is blinding in an RCT?

A

“any attempt to keep one or more of the people involved in the trial unaware of the group assignment, endpoints (outcomes), or hypotheses”

53
Q

What is the purpose of blinding?

A

to reduce ascertainment or observation bias

54
Q

What 4 things can you blind for group assignment?

A

 (a) participants
 (b) interventionists (care providers)
 (c) outcome assessors
 (d) data analysts

55
Q

What is an intention-to-treat (ITT) analysis?

A

 all participants are analyzed according to their group assignment.
 missing data is estimated (multiple imputation)

56
Q

What are 3 important things when reporting results for RCT’s?

A
  • present baseline demographic/medical variables for each group
  • present all primary and secondary
    endpoints for each group (baseline, posttest, change scores, precision estimates, and exact p level)
  • avoid selective reporting (endpoints, time points, or subgroup analyses)
57
Q

What are 5 limitations of RCT’s?

A
  • difficult to test multiple interactions.
  • labor-intensive and expensive.
  • difficult to standardize across sites.
  • time consuming to complete.
  • some questions do not lend themselves
    to RCTs (natural disasters, negative events or behaviors, rare outcomes, long term effects)
58
Q

What are 6 challenges of exercise RCT’s?

A

 is there really clinical equipoise?
 recruitment/selection biases
 impossible to blind patients/staff.
 adherence/contamination problems.
 problems with drop outs (attrition).
 long term RCTs are challenging

59
Q

What trial provides the highest level of evidence?

A

RCT’s
- should conduct RCT’s whenever feasible

60
Q

What is cancer?

A
  • a series of genetic mutations that allow cells to grow and divide indefinitely
  • cancer cells often accumulate and adhere together to form a “tumor” or “neoplasm”
61
Q

What are benign tumors?

A

 tumors that grow and enlarge only at the site where they began

62
Q

What are malignant tumors?

A

 tumors that invade and destroy normal tissue

63
Q

What are the 2 main categories of cancer?

A

Hematologic (blood) cancers
Solid tumor cancers

64
Q

What are hematologic cancers?

A

cancers of the blood cells, including leukemia, lymphoma, and multiple myeloma

65
Q

What are solid tumor cancers?

A

cancers of any of the other body organs or tissues. Most common are breast, prostate, lung, and colorectal cancers

66
Q

What are the 5 major categories of cancer?

A

Carcinomas
Sarcomas
Leukemias
Lymphomas
Central Nervous System Cancers

67
Q

What are carcinomas?

A

occur on skin or tissues that line internal organs

68
Q

What are sarcomas?

A

occur in the bone, cartilage, fat, muscle, blood vessels, or other connective or support tissue

69
Q

What are leukemias?

A

occur in the cells of the blood and bone marrow

70
Q

What are lymphomas?

A

occur in the cells of the immune system and appear within the lymphatic system

71
Q

What are central nervous system cancers?

A

occur in the cells of the brain and spinal cord

72
Q

How many mutations occur every time a normal cell divides?

A

~3

73
Q

Cancer is caused by what 3 types of mutations?

A

 inherited (5%),
 environmentally induced (29%),
 random errors during normal DNA replication (66%).

74
Q

What % of cancers are preventable?

A

42%
(smoking 19%
obesity 7.8%)

75
Q

How are most cancers detected?

A

by symptoms/signs, incidentally by other medical tests, or screening

76
Q

What is usually needed to confirm cancer?

A

usually a biopsy reviewed by pathologist under a microscope

77
Q

What is a benefit and disadvantage of screening?

A

benefit: screening detects cancers early (asymptomatic)
disadvantage: screening cannot diagnose cancer (suspicious)

78
Q

What is tumor grade?

A

how abnormal tumor cells/tissues look under a microscope
- indicator of how quickly a tumor is likely to grow and spread

79
Q

What is the tumor grading system (GX-G4)?

A

GX: Grade cannot be assessed (undetermined grade)
G1: Well differentiated (low grade)
G2: Moderately differentiated (intermediate grade)
G3: Poorly differentiated (high grade)
G4: Undifferentiated (high grade)

80
Q

What is cancer severity?

A

 severity or extent to which the disease has spread.
 most common is Tumor, Node, Metastasis (TNM)

81
Q

What is TNM?

A

Tumor, Node, Metastasis

82
Q

What is Tumor in TNM?

A

indicates the size of the primary tumor and the degree of spread into nearby tissues (local invasion)

83
Q

What is Node in TNM?

A

indicates whether or not the cancer has spread to nearby lymph nodes, the size of the nodes that contain cancer and how many lymph nodes contain cancer

84
Q

What is metastasis in TNM?

A

indicates whether or not cancer has spread (metastasized) to distant organs

85
Q

What is stage 0?

A

carcinoma in situ

86
Q

What is stage I and II?

A

the cancer is limited to the organ or location where it began or it may have spread to nearby structure (localized spread)

87
Q

What is stage III?

A

the cancer has spread further into a surrounding structure or to the regional lymph nodes (regional spread)

88
Q

What is stage IV?

A

the cancer has spread to a distant site in the body (metastatic spread)

89
Q

What is the #1 “modifiable” cause of cancer?

A

Smoking!

90
Q

What is the situ stage?

A

Abnormal cells are present but have not spread to nearby tissue

91
Q

What is the localized stage?

A

Cancer is limited to the place where it started, with no sign that it has spread

92
Q

What is the regional stage?

A

Cancer has spread to nearby lymph nodes, tissues, or organs

93
Q

What is the distant stage?

A

Cancer has spread to distant parts of the body

94
Q

What is the unknown stage?

A

There is not enough info to figure out the stage

95
Q

What is incidence?

A

how many people get cancer (new cases)

96
Q

What is probability of developing?

A

what % of people get cancer

97
Q

What is mortality?

A

how many people die from cancer

98
Q

What is the probability of dying?

A

what % of people die from cancer

99
Q

What is the relative (net) survival? (short)

A

likelihood of surviving cancer

100
Q

What is the prevalence?

A

how many people have (or survived) cancer

101
Q

What % of cancers that women get are related to sex organs?

A

40%

102
Q

What % of deaths are from cancer? Heart disease? in canada

A

28.2% cancer
18.5% heart disease

103
Q

What is absolute (observed) survival?

A

the percentage of people alive at a certain time point (usually 5 years in cancer)

104
Q

What is the relative (net) survival?

A

the percentage of people alive at a certain time point after accounting for deaths from other causes (usually 5 years in cancer)

105
Q

what does the relative survival rate show?

A

shows whether the disease shortens life

106
Q

How is relative survival calculated?

A

calculated by dividing the % of patients with the disease who are alive at the end of a time period by the % of people in the general population (same sex and age) who are alive at the end of the same time period

107
Q

What are the 2 most common prevalence’s in Canada?

A

Breast 19.4%
Prostate 17.8%

108
Q

How many Canadians are diagnosed with cancer a year?

A

229,200

109
Q

What are the 3 goals of cancer treatment?

A

 cure (i.e., “curative intent”)
 control (slow/reverse the growth/spread)
 relieve symptoms (i.e., “palliative intent”)

110
Q

What are the 7 cancer treatment modalities?

A

 Surgery
 Radiation therapy
 Chemotherapy
 Hormone (endocrine) therapy
 Immunotherapy (biologic therapy)
 Targeted therapy
 Stem cell transplant

111
Q

Cancer treatments are often: (5)

A

 multimodal (more than one type)
 sequential (one after the other)
 and/or concurrent (at the same time)
 with multiple “lines” of treatment (after failed treatments)
 for a disease that can progress or recur multiple times

112
Q

What is the goal of surgery as treatment?

A

 prevent, diagnose, treat, palliate, reconstruct
 removal of tumor and surrounding tissue.
 oldest/most common treatment for cancer
 primary treatment for most “solid” tumors
 generally for “early stage” or “localized” tumors
 often curative on its own (or combined)

113
Q

What is the goal of radiation therapy as treatment?

A

 high-energy particles/waves such as x-rays, gamma rays, electron beams, or protons, damage cancer cells.
 common treatment for many “solid” tumors
 generally for “early stage” or “local” tumors
 external radiation, internal radiation (brachytherapy), or systemic radiation (radioactive drugs).
 external is most common (5-6 weeks)

114
Q

What is the goal of hormone therapy for treatment?

A

 some cancers are “fueled” by sex hormones.
 eliminating/blocking hormones slows the cancer
 done through surgery or drugs (years).
 common treatment for breast and prostate cancers
 common side effect for men is breast enlargement

115
Q

What is the goal of immunotherapy (biologic therapy) for treatment?

A

 boost the body’s immune system in general or train the immune system to attack cancer cells.
 monoclonal antibodies, vaccines, CAR-T, ICIs.
 used in a growing number of cancers (rapid progress).
 given by pills/IV/injection every 2-4 weeks
 side effects are similar to allergic reactions

116
Q

What is the goal of targeted therapy for treatment?

A

 drugs to target specific genes and proteins that help cancer cells survive and grow.
 based on cancer biology and mechanisms.
 there are many different “targets”.
 breast cancer (HER2); colorectal (EGFR; VEGF)
 some may “cut across” cancers (tumor-agnostic)

117
Q

What are the 3 steps in Multimodal Therapy (Treatment Sequencing)?

A

Neoadjuvant therapy - reduce primary tumor size, eliminate cancer cells that spread to other locations
Primary therapy - eliminate tumor
Adjuvant therapy - eliminate remaining cancer cells

118
Q

What are the different cancer treatment responses? (8)

A

 complete response (no evidence of disease)
 clinical vs pathological
 remission vs cure
 partial response (reduction in disease)
 stable disease (no change in disease)
 progressive disease (worsening of disease)
 CR+PR = “objective response” or “major response”
 duration of response (how long response lasts)

119
Q

What does de novo resistance mean?

A

Progressive disease

120
Q

What are the different grades for the side effects of treatment?

A

Mild (grade 1), moderate (grade 2), severe (grade 3), life-threatening (grade 4), and death (grade 5)
- may cause treatments to be reduced, delayed, discontinued, switched, or not offered (especially at/after grade 3)

121
Q
A

K!N4E4 (3 decks)

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