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Medical SLP > Module 10 > Flashcards

Module 10 Flashcards

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USMLE® Step 1 flashcards
1
Q

National cancer Institute - COVID
people with blood cancers may be at higher risk of ? and ? from covid than people with solid tumors. That is because people with blood cancers often have abnormal or depleted levels of ?

NCI is conducting a large study of people with cancer who have COVID to learn more about the ? and to help doctors better manage treatment for people with ?

if you had cancer in the past you may also be at higher risk for ?

A

prolonged infection / death
-immune cells that produce antibodies against the virus

risk factors for covid/ cancer and covid

severe covid

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2
Q

patients with cancer were… included in initial vaccine trials

nearly half the patients with blood cancers did not produce ?

the findings confirm what we have suspected all along which is that immunocompromised people aren’t going to have the same ?

patients in the study had ? leumkemia, lymphomas, multiple myeloma, and other ?

those with B-cell chronic lymphocytic leukemia were the least likely to ?

A

not

detectable antibodies to the SARS-CoV2 spike protein

immune responses to covid vaccines

B-cell chronic lymphocytic

respond to the vaccine

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3
Q

Changes in cancer patient care:

less ? 
less ? 
endoscopy: 
-
-
-
...
A

in-person follow-up visits for cancer surveillance

assessments completed for cancer surveillance during shutdowns:
-head and neck
esophageal
colon

mammograms

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4
Q 
Cancer patients the role of SLP: 
issues with ? 
-..tumor 
...cancedr 
surgical complications from ? 
-
-
-

-
-

A

comm. and swallowing related to cancedr
-brain tumor
head and neck cancer
surgery for
-lung cancer
-esophageal cancer
-pancreatic cancer

medical complications/ cancer/cancer treatment
-stroke
-head injury
repiratory illness

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5
Q 
Head and Neck cancer care: 
emergency stenting of the TE tract:use of ? 
size depends on ? 
normal tract diameter ranges from ? 
FR:

french sizing system
one increment on french scale equal to ?

A

red rubber catheter
size of TE tract
16 Fr-22 Fr
french

1/3 millimeter

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6
Q

Head and neck cancer accounts for about .. of all cancers in the US

this year an estimated …. will be diagnosed with head and neck cancer

worldwide an estimated … were diagnosed in 2020

A

4%

66,470 people

562, 328

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7
Q 
Squamous cell cancer: 
squamous cell cancer: 
line the ? of ? 
SCCA is the most common type of ? 
makes up about .. of head and neck cancers 
this type of cancer is more common in ?
A

mucosal surfaces of mouth throat larynx

cancer in head and neck
90%

menn

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8
Q

Risk factors for head and neck cancer:
tobacco?

…products

…refluz

chemicals
-
-
-
-
-

other factors

A

tobaccoo products

ethanol products

laryngopharyngeal reflux

chemicals 
abestos 
chromium 
nickel 
arsenic 
formaldehyde

ionizing radiation
epstein barr
HPV

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9
Q

.. cancer rates while smoking rates decline

rates of certain orophrayngeal cancers have ? from age ? from …
…increase base of tongue
… increase tonsil

A

increasing

increased among men and women/ 20-44/ 1973 to 2001

  1. 1%
  2. 9%
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10
Q

Increasing incidents of HNSCC

the incidence of some types of ? has been gradually increasing over the past 3 decades

A

oral, head, and neck squamous cell carcinoma

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11
Q

HPV?
HPV is one of th emost ?

greater than .. strains or genotypes of HPV have been identified , different types known to infect ?

the most visible forms of the virus produce ? on the ?
most HPV’s of this type are very ?

A

HPV 16

common virus groups affecting skin and mucosal areas of the body

150 strains / different parts of the body

wars (papillomas) on hands, arms, legs, and other areas of skin

very common, harmless, non-cancerous, and treatable

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12
Q

HPV
most HPV infections do not cause ? the immune system ?

if a high risk HPV infection is not controlled by the immune system it can result in ?

A

cancer/ clears from body

changes within cells that can develop into cancer over time

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13
Q

HPV
there are about.. types of HPV that are considered to be ?

-
these are the same types of HPV associated with ? in females

A

14/ high risk

hpv 16 and 18

cervical cancer

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14
Q

More about HPV:
a .. virus
16 and 18 associated with ?
in cervicaland oropharyngeal CA, HPV results in ? and abnormal?

A

DNA

cervical and oropharyngeal CA

inactivation of tumor supressor generes/ duplication of cells induced

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15
Q

HPV prevalence in oral, head and neck cancer:
overall prevalence of HPV in Head and Neck squamous cell carcinoma was estimated at ?
of the HPV positive cancers HPV 16 was the most ?
… of oropharyngeal cancers
… of oral cancers
…of laryngeal cancers

HPV 18 was the next most common, but far less ?
.. of oropharyngeal cancers
… of oral cancers
… of laryngeal cancers

A 
26% 
prevalent 
86.7%
68.2%
69.2%

prevalent
1%
8.0%
3.9%

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16
Q

what is known:
HPV has a strong association with ?
HPV has associations with ?

patients with HPV positive oropharynx tumors:
present at a relatively
do not have
may have better

A

oropharyngeal squamous cell cancer (particularly tonsil)
oral and laryngeal cancer

younger age
excessive tobacco use
survival rates

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17
Q

Historical LInks to HPV cancer:
1933: identified the first ?

1976: proposed that cervical cancer might be

1983: proposed a link between ?
they noted that .. of cancers in their study contained ? associated ?

A

DNA virus tumors in mammals

caused by HPV

HPV and head and neck SCCA

40% histological and morphological similarities with HPV / lesions

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18
Q

Most people with HPV do not know they are ? and never develop?
some people find out when they get ?
women may find out when they get an abnormal ?
others may find out when they have developed more serious problems from HPV such as ?

HPV the virus: HPV is so common that almost every person who is sexually active will get HPV at some time if they don’t get?

health problems related to HPV include :

genital warts: before HPV vaccines roughly… women and men affected by genital warts caused by HP V every year
- also about .. in every 100 sexually active adults in US has .. at any given time

cervical cancer: every year nearly .. women in US will be diagnosed andmore than … die from cervical cancer

A

symptoms

genital warts

Paps

cancer

HPV vaccine

genital warts and cervical cancer

340,000 to 360,000
1 in 100 / genital warts

12,000 women / 4,000

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19
Q

70% of cancers of the oropharynx may be linked to

A

HPV

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20
Q

Treatment of HPV+ tumors:
HPV positive tumors more ? than HPV negative tumors treated with ?

more rapid tumor ? than HPV negative tumors

why? HPV infected cells are not ? that are repeatedly exposed to ?

need for further ? possibel implications for decreasing ?

these patients are ? what will long term effects of treatment be

A

radiosensitive / intensity modulated radiotherapy

regression

damaged as severely as cells/ carcinogens

clinical trials / intensity of raidiation

younger

21
Q

In the US high risk HPVs cause… of all cancers in women and … of all cancers in men

each year there are … new cases of cancer in parts of the body where HPV is often? HPV is estimated to cause about t… of these according to the CDC

worldwide the burden of HPV related cancers is much? high risk hPV causes.. of cancer world-wide, with an estimated … women nd .. men getting HPV-related cancer each year

what is the most common cancers and a leading cause of cancer related deaths in low and middle income countries where screening and treatment of early cervical cell changes are not ?

A

3%/ 2%

45,000

36,000

greater/ 5% /570,000 women/ 60,000 men

Cervical cancer/ readily available

22
Q

Smokers with HPV+ tutors have the overall?

A

worst prognosis of these HPV+ tumors

23
Q

Sexual transmission of HPV:
Based increase in oropharyngeal cancer incidence behavioural epidemiologists hypothesise that changing ? led to increased ?

several studies indicate that oral HPV infection is ?
D’Souza and colleagues found that individuals with a higher number of sex partners have an ?

A

sexual behaviours beginning in 1996/ HPV exposure

sexually acquired / increased risk of positive head and neck SCCA

24
Q

Links to HPV transmission in Head and Neck CA

women with cervical cancer were monitored for occurrence of ?
these women found to be more likely to have a subsequent cancer in ? including:

in husbands of wives with cervical cancer an increased incidence of ? was found

A

second cancer / head and neck / mouth, oropharynx, hypo pharynx, and larynx

mouth, tongue, oropharynx, hypo pharynx and larynx

25
Q

HPV transmission:
HPV found in

benign skin warts caused by some types of HPV are transmitted via

research is currently ongoing to determine transmission of ?

A

saliva, semen, genital secretions

skin to skin contact

of oral HPV infection (still not completely understood)

26
Q

it is unknown how long it takes to clear ? some hypothesise that they may clear at. faster rate than in other areas due to the presence of ?

A

oral HPV infections/ lymphoid tissue in the area

27
Q

Testing for HPV

testing of patients with known SCCA for HP V may improve ?

molecular typing for HPV 16 and EGFR expression may provide important

A

treatment protocol and provide important prognostic info

prognostic info

28
Q

HPV has strong association with ?

HPV has associations with

patients with HPV positive oropharynx tumors :
present at
patients typically do not have
may have better

A

oropharyngeal squamous cell cancer (particularly tonsil)
oral and laryngeal cancer

relatively younger age
excessive tobacco/ETOH use
survival rates

29
Q

Researchers estimated an average latency period from infection to development of HPV positive orophrayngeal cancer was approximately ?

A

10 to 30 years

30
Q

HPV disease onset at younger age:
higher ?
long term treatment effects will be experienced

more potential for ?

radiation therapy may not be an option at a ? if there is a new ? or recurrence of

A

functional status at time of diagnosis

through a longer life span

socio-economic implications affecting family during prime wage-earning years

later time/ primary tumour or recurrence of cancer

31
Q

Screening for HPV:
annual ?
screening also exists for
for oral HPV infections: there is currently not an accepted

A

Pap smear of cervix

anal HPV infections

clinical test that is utilised

32
Q

Salivary testing for HPV:
how accurate is testing:

if a pt found to be HPV positive how much of predictor is this for oral cancer ?
thus far presence of ? does not ?

A

variability in saliva make up

HPV in saliva/ establish risk for developing cancer

33
Q

Oral rinse and gargle sample:
results: oncogenic oral HPV DNA was detected in ? of all adults 20-69

findings showed that men of 50-59 , .. had oncogenic oral HPV, … had oral HPV16 infection

of those only… will develop oropharyngeal cancer in lifetime

screenings based upon oncogenic oral HPV detection would be ?
most groups have low ?
in addition to the large numbers of individuals who would need to be screened to identify prevalent oncogenic oral HPV, the lifetime risk of developing oropharyngeal cancer among those remains?

A

3.5%

  1. 1%
  2. 7%

challenging
low

34
Q

Use of saliva testing to detect HPV positive CA recurrence:
HPV DNA can be detected in the saliva of patients after their ?
the presence of HPV predicted cancer recurrence nearly?
blood testing for HPV DNA increased accuracy of predicting recurrence to ?
blood dan saliva testing combined predicted recurrence … of time

A

cancer treatment

20%
55%

70%

35
Q

HPV vaccination:
….
a vaccine that is FDA approved to prevent ? with the … types of HPV that most often cause ?
-may also prevent HPV-related cancers of the?
Gardasil 9 has been approved for use in ?females and males aged ? BUT is typically only recommended up to age ?
since 2016 Gardasil 9 has been the only vaccine available in ?

A

Gardasil 9

infection/ 9 types/ cancers of cervix, vagina, vulva and anus
penis and oropharynx

9-45/ 26

US

36
Q

Other hPV vaccines not available in US

A

Gardasil

cervarix

37
Q

HPV vaccine history:
vaccination for HPV was initiated in mid? for females to prevent cervical cancer ?

vaccination was initiated for males ages 9-26 starting in

A

2006 (ages 11-12 up to 26)

2009

38
Q

Current HPV vaccination rates CDC data:
HPV vaccination rates are ?
in 2017: roughly ? of adolescents were up to date on hPV vaccine and … 13-17 years received the first dose to start the vaccine series

still … have not completed the HPV vaccine series and … of adolescents have not received both doses

also fewer adolescents in rural areas, compared with urban areas are getting the ?

A

increasing
49% (half) / 66%

51%/ 56%

HPV vaccines

39
Q

Investigation - HPV vaccine and HPV oral infection rates (not cancer)
the researchers analysed most rinse samples from all study participants for the presence of ? including types ? which are covered by Gardasil

the prevalence of oral infection with these four hPV types was > in unvaccinated young adults versus … in vaccinated young adults an … reduction in HPV prevalence

among men, the prevalence of oral infection with the 4 HPV types was ? in unvaccinated and .. in vaccinated

A

37 HPV types/ 6,11, 16, and 18

  1. 61%/ 0.11%/ 88%
  2. 1% and 0.0%
40
Q

Thinking ahead: future endeavours:
further defining role of ?
determine reliable ? and knowing?
determining the effect of HPV vaccination on ?
determining whether vaccines will have a ? on already ?

A

HPV in laryngeal and oral cancer

screening tests/ implications of findings

incidence of head and neck cancers in females and males

therapeutic effect / infected pts

41
Q

preventable public health risks:
head and neck cancer prevention strategies have been a ?
primarily targeting ?

hpv exposure can also be a
target education of ?

A

public health issue for years
decreaing/eliminating tobacco use

preventable health risk
public

42
Q 
SLP intervention for oropharyngeal cancer: 
assessment of ? Prior to ? 
patient ? 
-what to expect 
swallowing 
importance of 
importance of 
potential impact of ?
A

swallowing function / surgery and radiation

education: 
during and after assessment 
exercise program 
maintaining PO intake during tx
monitoring size of jaw opening 
treatment on speech and voice production
43
Q 
Role of SLP during course of HNC Tx: 
prior to radiation therapy, SLP performs a ? 
patient ? 
-explaining 
changes that could potentially
balance...
assist with setting ? 
reduce fears or misconception about ?
A

clinical eval of speech, voice, swallowing
counseling

A&P of head and neck 
occur due to tx
education with fear 
realistic expectations 
process and outcomes associated with radiation
44
Q

Prior to radiation patient should be provided with

  2. a .. rehab pan
  3. … protocol to minimize tx effects
during tx and post treatment recommendations made for 
-... products 
how to alleviate sx of ? 
swallow .. or ?? 
collaboration with ? 
establish ? reinforce ? ... and ...
A

education
swallow
vocal hygiene

saliva substitute products 
xerostomia 
strategies or diet modification 
clinical dietitian regarding supplements
swallow exercise schedule/ reinforce swallow exercises/ vocal hygiene and oral care
45
Q

intervention during tx has been found to … effects on speech and swallowing
prevent or reduce
avoid ?

maintain the ?
-sliding
…
…other

A

minimise long term effects
formation of fibrosis
trismus

range of motion of oropharynx and larynx through manoeuvres
sliding glissandos
falsetto
mendelsohn

46
Q 
side effects of Radiation:
...
.. - impact on function of ?
-
- ... loss of ? 
...
changes ot ? 
...
A 
mucostitis 
xerostomia (salivary glands) 
odynophagia 
dysphagia (oesophageal lumen) 
fibrosis 
soft tissue 
trismus
47
Q 
Trismus: 
what I normal MMO
men 
women 
wat width?

in the head and neck cancer literature MMO of … has been found to be associated with decrease QOL

A

42.0 -68.0
40.0-57.0mm
3 fingers

35

48
Q

Prevention/monitoring onset of trismus:
during radiation:
educate patients to complete ? and monitor ?
check ?

educate patients to alert the medical team at first signs of ?
.. ,matters

A

stretches of jaw daily/ jaw opening
baseline prior to onset of tx

onset of truisms
timematter

49
Q

Late effects of XRT
late effects of organ preservation become more apparent as the epidemiology and survivorship rates of oropharyngeal cancer change ?

lat effects still somewhat ? and not fully ? late-toxicities from XRT that result in ?

these effects result in significant ? and reduced ? with a significant impact on

-long term means of

A

in era of HPV associated disease

rare/ understood/ cranial neuropathies

dysphagia / speech and voice function/ QOL

nonfunctional larynx

  • tracheostomy
  • non-oral nutrition

Medical SLP (11 decks)

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