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Med Surg 2 > med surg exam 1 > Flashcards

med surg exam 1 Flashcards

1
Q

What is cellular regulation?

A

process that controls cellular growth, replication, differentiation, and function to maintain homeostasis

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2
Q

Why do normal cells divide? (orderly and well regulated growth)

A

to develop normal tissue or to replace lost, damaged or aged normal tissue

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3
Q

What stops rounds of division when dividing results in being completely surrounded or touching other cells ?

A

contact inhibition

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4
Q

What is neoplasia ?

A

any new or continued cell growth not needed for normal replacement of dead and damaged tissues

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5
Q

What is hypertrophy?

A

enlargement of same number of cells (body builders)

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6
Q

what is atrophy ?

A

shrinkage of cells

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7
Q

What is hyperplasia ?

A

overproduction of cells (Calluses)

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8
Q

What is metaplasia?

A

gene and DNA changes (malignant)

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9
Q

What is the feature in which a normal cell has a distinct and recognizable appearance ?

A

specific morphology

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10
Q

What is a small nuclear to cytoplasmic ratio?

A

nucleus of a normal cell occupies a little space in the cell

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11
Q

What is tight adherence ?

A

normal cells make sticky cell adhesion molecules (CAM’s) that bind them to one another

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12
Q

What type of cell does NOT adhere to the nonmigratory rule ?

A

RBC

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13
Q

What do cyclins do ?

A

make proteins to promote cells to enter and complete division

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14
Q

What are cyclins controlled by ?

A

suppressor gene

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15
Q

what occurs that causes apoptosis to happen ?

A

DNA shortens each time it is divided so when it is all out the cell responds to the cell regulation signal to die

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16
Q

what is the term for a normal number of chromosomes ?

A

euploidy

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17
Q

what is the term for when chromosomes are not normal ?

A

aneuploidy

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18
Q

what is a benign tumor cell?

A

normal cells growing in wrong place at wrong time

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19
Q

what are some examples of a tumor cell?

A

moles, fibroids, skin tags, endometriosis, nasal polyps

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20
Q

do tumor cells retain the specific morphology of their parent ?

A

yes

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21
Q

are the specific function of a tumor cell still going to occur ?

A

yes

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22
Q

do tumor cells have tight adherence ?

A

yes

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23
Q

do tumor cells migrate ?

A

no

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24
Q

do tumor cells invade ?

A

no

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25
Q

do tumor cells tend to have euploidy or aneuploidy ?

A

euploidy

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26
Q

can tumor cells still have defects that cause them to become CA cells?

A

yes

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27
Q

what are CA cells ?

A

cells that abnormal, serve no function, and are harmful to the body

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28
Q

What is anaplasia of a CA cell?

A

loss of specific appearance to parent cell

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29
Q

what is the nucleus like with a CA cell?

A

larger and takes up more cytoplasm

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30
Q

do CA cells have a function ?

A

no- they’re lost partially or completely

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31
Q

what is the adherence like for CA cells ?

A

loose- so they migrate

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32
Q

does contact inhibition occur for CA cells ?

A

no

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33
Q

if CA cells don’t respond to checkpoints for control, then what happens to their mitosis schedule ?

A

they re-enter mitosis continually

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34
Q

what makes the CA cells not respond to apoptic signals ?

A

enzyme- telomerase

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35
Q

what is carcinogenesis ?

A

when things like tobacco affect DNA

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36
Q

What is oncogenesis ?

A

certain genes that are either under suppressed or over expressed

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37
Q

what is a good way to remember oncogenes ?

A

think “on go” genes that allow the cells to get to mitosis

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38
Q

what does an over expression of oncogenes lead to ?

A

overgrowth of cells

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39
Q

what does an under suppression of oncogenes lead to ?

A

the oncogene is always active - so nothing stops it

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40
Q

what is malignant transformation?

A

when a normal cell becomes a CA cell

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41
Q

What is the first step in carcinogenesis ?

A

initiation

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42
Q

what occurs during initiation?

A

genes promote cell division and become oncogenes which produces more cyclins

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43
Q

what type of event is initiation considered to be ?

A

irreversible event that causes CA

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44
Q

if growth conditions are right, can metastatic CA come from one cell ?

A

yes

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45
Q

what are carcinogens ?

A

substances that change the activity of a cells genes so the cell becomes a CA cell

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46
Q

what is the second step of carcinogenesis ?

A

promotion

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47
Q

what occurs during promotion?

A

enhanced growth of initiated cell by promoters, it can become a tumor when growth enhanced

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48
Q

what are promoters?

A

hormones such as insulin and estrogen that make cell division more frequently

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49
Q

What is a latency period ?

A

time between a cells initiation and the development of an overt tumor

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50
Q

what can shorten a latency period ?

A

promoters

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51
Q

what is the 3rd step of carcinogenesis ?

A

progression

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52
Q

what is progression?

A

continued change of a CA, making it more malignant

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53
Q

what things need to be done in order for a tumor to become a health problem ?

A

1- tumor needs own blood supply so it makes EDGF, 2- mutations form to make it more malignant

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54
Q

what mutations need to occur to make a tumor a health problem ?

A

driver mutation and passenger mutation

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55
Q

what is a driver mutation?

A

provide cell with advantages that allow cell to live and divide no matter conditions

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56
Q

what is a passenger mutation?

A

these are used as CA identifiers for therapies

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57
Q

what is a primary tumor ?

A

original group of CA cells or tumor caused by carcinogenesis

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58
Q

what are secondary tumors ?

A

when primary tumor breaks off and makes own colony

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59
Q

how do tumors extend into surrounding tissues/ blood vessels ?

A

they secrete enzymes

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60
Q

what is a common cause of CA spread?

A

bloodborne metastasis

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61
Q

when a tumor invades surrounding tissues, what develops ?

A

secondary tumor

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62
Q

where do solid tumors come from ?

A

specific tissues (breast CA and lung CA)

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63
Q

where do hematologic CA’s come from?

A

blood- cell forming tissues (leukemias and lymphomas)

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64
Q

what does Ploidy classify?

A

number and structure of tumor chromosomes

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65
Q

what does staging classify?

A

clinical aspects of CA

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66
Q

why is grading needed ?

A

b/c some CAs are more malignant than others

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67
Q

what does grading compare ?

A

appearance and activity of CA cell to parent cell

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68
Q

what is the purpose of grading ?

A

evaluating the pt with CA for prognosis and right therapy

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69
Q

the degree of aneuploidy also increases with what?

A

malignancy

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70
Q

what chromosome abnormality is present in leukemia cells ?

A

philadelphia chromosome abnormality

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71
Q

what does staging determine?

A

the exact location and whether metastasis has occured

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72
Q

what does clinical staging assess?

A

pts sx and evaluates tumor size and possible spread

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73
Q

what type of staging is the most definitive ?

A

pathological staging

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74
Q

how does pathological staging occur ?

A

looks at tissues obtained at surgery

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75
Q

what system is used to describe the anatomical extent of cancers ?

A

tumor node metastasis (TNM)

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76
Q

what type of tumor does the TNM system have specific prognostic types for?

A

solid tumors

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77
Q

how is tumor growth assessed ?

A

doubling time

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78
Q

what is doubling time ?

A

amount of time it takes for tumor to double in size

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79
Q

What is the mitotic index?

A

% of actively dividing cells in a tumor

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80
Q

how fast does a tumor with a mitotic index of 10% grow compared to 85%?

A

10%= slow, 85%=fast

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81
Q

how small is the smallest detectable tumor ?

A

1 cm (containing 1B cells)

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82
Q

what 3 factors influence CA development ?

A

carcinogens, genetics, and immunity

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83
Q

what is the main mechanism of carcinogenesis ?

A

proto-oncogene to activation to oncogene status (comes from overexpression)

84
Q

what type of factor makes up the most % of CA pts ?

A

environmental (by 80%)

85
Q

how does chemical carcinogenesis occur ?

A

exposure to chemicals, drugs, and products used in every day life

86
Q

what % of CA is r/t tobacco?

A

30%

87
Q

what does physical carcinogenesis come from?

A

physical agents or events that damages DNA

88
Q

what are the 2 main things that cause physical carcinogenesis ?

A

radiation and chronic irritation

89
Q

how does viral carcinogenesis occur ?

A

when viruses affect body cells and break DNA strands

90
Q

what are viruses that cause CA?

A

oncoviruses

91
Q

what diet factors can increase risk of CA?

A

low fiber and high red meat and animal fat

92
Q

what does Tx mean ?

A

tumor cant be assessed

93
Q

what does T0 mean ?

A

no evidence of primary tumor

94
Q

what does Tis mean?

A

carcinoma in situ

95
Q

what does it mean if we see a tumor that was classified as T1 go to T3?

A

its increasing in size and local extent of primary tumor

96
Q

what does Nx mean ?

A

lymph nodes cant be assessed

97
Q

what does N0 mean ?

A

no regional lymph node metastasis

98
Q

what does it mean when we see a lymph node classified as N1 go to N3?

A

there is increasing involvement in nodes around

99
Q

what does Mx mean ?

A

presence of distant metastasis cant be assessed

100
Q

what does M0 mean ?

A

no distant metastasis

101
Q

What does M1 mean ?

A

distant metastasis

102
Q

if the grading of a malignant tumor (G) goes from G1 to G4 then what has happened to the cell?

A

we cant really see what parent cell they came from anymore

103
Q

what about G0- what happened?

A

we cant determine the grade of the tumor

104
Q

what does cell mediated immunity (NK and T cells) provide ?

A

immune surveillance

105
Q

what is the most important risk factor for CA?

A

aging

106
Q

what is primary CA prevention?

A

prevent actual occurence of CA, things we can modify and changewh

107
Q

what are some examples of primary prevention?

A

stop smoking, vaccinations, using sunscreen, avoid asbestos)

108
Q

what is secondary CA prevention?

A

use of screening strategies to detect CA early, at a time when cure or control is more likely

109
Q

what are some examples of secondary CA prevention?

A

genetic screening, cervical screening, self breast exams, FOBT, digital rectal exam (DRE), mammograms, and colonoscopies

110
Q

what is chemoprevention?

A

strategy that uses drugs, chemicals, natural nutrients to disturb one or more steps in CA development

111
Q

what type of prevention is chemoprevention?

A

primary

112
Q

what is superior vena cava syndrome (SVC) ?

A

it is an oncologic emergency that occurs when a tumor is compresses this vessel

113
Q

what does prophylactic surgery do ?

A

removes potentially CA tissues as a means of preventing CA development (removing opposite breast in a pt with breast CA gene)

114
Q

what does diagnostic surgery dO?

A

removal of all or part of a suspected lesion for examination and testing to confirm or rule out CA dx

115
Q

what does curative surgery do?

A

removes all CA tissues

116
Q

what is curative surgery most effective on?

A

small localized tumors or non-invasive skin CA

117
Q

what does debulking surgery do?

A

removes part of the tumor if removal of entire mass is not possible

118
Q

what does palliative surgery do?

A

providing sx relief and improving quality of life (NOT CURATIVE)

119
Q

what does restorative or reconstructive surgery do?

A

increases function, enhances appearance or both

120
Q

an organ loss reduces _____

A

function

121
Q

why do we want to teach the pt about exercises after surgery ?

A

to get them to regain as much function as possible

122
Q

what type of tx is radiation considered to be when the effects are seen in tissues within radiation path?

A

local

123
Q

when is radiation considered systemic ?

A

when IV radioactive substance travels throughout the body to target CA cells

124
Q

what is an example of a short term effect of radiation?

A

redness and desquamation

125
Q

what is an example off long term effect of radiation ?

A

pulmonary fibrosis (from rad to the chest)

126
Q

what is exposure ?

A

the amount of radiation delivered to a tissue

127
Q

what is radiation dose?

A

amount of rad absorbed by the tissue

128
Q

why is the rad dose always less than the exposure ?

A

because some energy is lost as it travels to its destination

129
Q

what 3 factors determine the absorbed dose ?

A

intensity, duration, and closeness

130
Q

what is the unit that is used to describe absorbed radiation rays ?

A

grays

131
Q

what determines the total dose of radiation used?

A

the tumor size, location, and sensitivity of tumor and tissues nearby

132
Q

what is fractionation?

A

when rad therapy is given as series of divided doses over a set time

133
Q

what does fractionation allow for ?

A

great destruction of CA cells while reducing the damage to normal tissues (intensity of dose increases with distance of rad source)

134
Q

What is cachexia ?

A

extreme body wasting and malnutrition that may occur during tx with advanced CA

135
Q

how does a tumor obstruction affect the absorption of nutrient ?

A

they reduce it

136
Q

how does CA tx affect sensory perception?

A

neurotoxic chemical agents injure peripheral nerves and lead to peripheral neuropathy

137
Q

how does CA cause motor and sensory deficits ?

A

when CA invades the bone, brain, or compresses nerves

138
Q

when CA invades the bone, what can it cause ?

A

pain, fractures, spinal cord compression (SCC), or hypercalcemia (from bone breaking down) which reduces mobility

139
Q

what 2 ways can radiation be delivered ?

A

external (external beam) or internal (brachytherapy)

140
Q

what is the external beam?

A

radiation delivered from a source outside of the patient

141
Q

is the pt with external radiation radioactive? why or why not ?

A

no because the source is external

142
Q

what does intensity modulated radiation therapy (IMRT) do for external radiation?

A

reduces amount of normal tissue exposed to radiation by breaking up single beam into thousand smaller ones allowing for diff intensity levels

143
Q

what does stereotactic body radiation therapy do for external radiation?

A

it is a 3 dimensional tumor imaging to identify the tumor location, which allows precise delivery of high doses and spares more surrounding tissue

144
Q

what is radio surgery ?

A

tx that uses ionizing radiation as surgical instrument instead of cutting blade

145
Q

what are some examples of radiosurgery?

A

gamma knife and the cyberknife which are used for tx of brain tumors by carefully aiming radiation

146
Q

what is the “tattoo” pts are marked with before a procedure ?

A

the skin is marked at the exact tumor location

147
Q

what is brachytherapy also known as ?

A

ionizing internal radiation

148
Q

what is the radiation source like with brachytherapy ?

A

it comes into direct continuous contact with tumor for a specific time period (seeds, ribbons, capsules)

149
Q

how does radiation work with brachytherapy ?

A

it provides higher dose of rad in the tumor over a specific period of time, while limiting dose to normal tissues

150
Q

how does brachytherapy use the radioactive isotopes ?

A

either solid or within body fluids, like external catheter in tumor bed or ingestion of radioactive source

151
Q

what is different about pts on brachytherapy compared to the external beam ?

A

these pts emit radioactive material while source is intact

152
Q

are the solid sources for brachytherapy temporary or permanent ?

A

they can be both

153
Q

what type of radiation do traditional implants deliver ?

A

low dose rate radiation (LDR)

154
Q

How does high dose rate (HDR) radiation occur ?

A

pt comes into rad therapy couple times a week and a stronger implant is planed near catheter near CA bed for short duration

155
Q

what is radiation dermatitis ?

A

MOST COMMON SE of CA tx, is changes to the skin that can range from redness and rash to skin desquamation

156
Q

what can radiation damage to normal tissues start ?

A

they can lead to inflammation processes that leas to tissue fibrosis and scarring

157
Q

what do we tell pts to avoid the day of tx?

A

deodorants and lotions

158
Q

what are the most sensitive normal tissues to radiation?

A

bone marrow, skin, mucous membranes, hair follicles, and germ cells (ovum and sperm)

159
Q

how often are we going to wash radiation area ?

A

wash once a day with either water and mild soap as prescribed (no scrubbing)

160
Q

what are we going to use to wash radiation area ?

A

hand not washcloth

161
Q

what clothing do we want the pts to avoid ?

A

tight clothing (belts, buckles, straps)

162
Q

when are sun rays most intense ?

A

from 10AM to 4PM

163
Q

what is the function of cytotoxic systemic therapy ?

A

to kill CA cells (unlike surgery or radiation)

164
Q

what is neoadjuvant therapy?

A

when chemo is used to shrink tumor cell before surgery or radiation

165
Q

what type of tumors are more sensitive to chemo?

A

tumors with rapid growth

166
Q

What is adjuvant chemotherapy ?

A

kill remaining CA cells after surgery or radiation

167
Q

What is Nadir?

A

the time when bone marrow and WBC levels are low after therapy

168
Q

What is the function of alkylating agents ?

A

stops cell division by preventing DNA and RNA synthesis

169
Q

What is the function of anti metabolic agents ?

A

impair cell division, blocks metabolic actions

170
Q

What is the function of anti-mitotic agents ?

A

they dont let cell complete mitosis

171
Q

what is the function of anti tumor antibodies ?

A

blocks dna or rna synthesis

172
Q

What is the function of topoisomerase inhibitors ?

A

disrupt topoisomerase which is essential for DNA synthesis which leads to cell death

173
Q

What is dose dense chemo?

A

giving chemo rounds closer together that is supplemented with bone marrow growth factor

174
Q

what is the intrathecal route?

A

delivers drugs to CSF

175
Q

what is the intraperitoneal route ?

A

drugs go into ABD cavity (mostly used for ovarian CA)

176
Q

what is the intravesicular route ?

A

drugs instilled directly into the bladder

177
Q

what do intra-arterial infusions do ?

A

deliver high doses locally

178
Q

how long does the nurse need to wear approved PPE when taking care of a pt on chemo?

A

within 48 hours of their last treatment

179
Q

when a pt appears to have extravasation occur to their arm, what can we do to help the area BESIDES stop the infusion?

A

we may be able to inject the antidote directly into the site of extravasation

180
Q

if a PO CA drug was missed, when does the pt take the next dose ?

A

they take it at the scheduled time - NOT when they remember suddenly

181
Q

where do most infections come from when a pt has neutropenia ?

A

their own overgrowth of natural gut flora

182
Q

what is odd about the s/s of neutropenia ?

A

the pt normally does not have a fever

183
Q

how often should the pt with neutropenia have hygienic care?

A

PO, perineal, and axillary care needs to happen every 12 hrs

184
Q

when does the acute type of chemo induced n/v (CINV) occur ?`

A

within first 24 hrs after chemo

185
Q

when does the delayed type of chemo induced n/v (CINV) occur ?`

A

after the first 24 hrs

186
Q

when does the breakthrough type of chemo induced n/v (CINV) occur ?`

A

intermittently

187
Q

what does emetogenic mean ?

A

vomit inducing

188
Q

when does Dacarbazine trigger n/v?

A

as soon as drug is started

189
Q

what type of CINV does cisplatin induce ?

A

delayed n/v

190
Q

what drug therapy works the best for CINV?

A

serotonin agonist drugs (5-HT3)

191
Q

what is a SE that the pt on ondansetron (serotonin agonist) needs to be aware of ?

A

prolongs QT interval

192
Q

what do we need to watch for when a pt is on granisetron transdermal patches ?

A

HA

193
Q

what do we need to watch for when a pt is on palonosetron?

A

assess bowel habits, ensure stool softeners or laxatives are ordered

194
Q

what do we need to watch for when a pt is on aprepitant (neuronkin 1 receptor agonist)?

A

have INR checked and be aware in interferes with warfarin

195
Q

what do we need to watch for when a pt is on Esoaprepitant (neuronkin 1 receptor agonist)?

A

interferes with birth control

196
Q

what do we need to be aware of when a pt is on dexamethasone ?

A

it can cause NA retention and HTN, can affect sleep, and need to monitor blood sugar

197
Q

what is mucositis ?

A

inflammatory process that affects mucous membranes of the oral mucosa and GI tract that begins after chemotherapy

198
Q

what can be used for the prevention of oral cryotherapy?

A

ice water or ice chips before therapy starts, during, or after rapid infusions

199
Q

what is the function of biologic response modifiers ?

A

they use bodys own defense system to attack foreign cells, it prevents tumors from hiding from immune system

200
Q

what do interleukins do ?

A

help immune system recognize and destroy CA cells

201
Q

What do interferons do?

A

slow down tumor cell division, stimulate growth and activation of NK cells

202
Q

What is the function of monoclonal antibodies ?

A

improves immune function while blocking cell receptors on cell surface, preventing cell division

203
Q

how long does it normally take for hypersensitivity reactions (HSR’s) or infusion reactions to occur ?

A

during the procedure- anywhere from 30 min to 2 hours

204
Q

what can decrease the incidence of infusion reactions ?

A

premedication with acetaminophen and diphenhydramine

205
Q
A

Med Surg 2 (1 decks)

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