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My 2017 RUSVM SAM 2 > Oncology > Flashcards

Oncology Flashcards

1
Q

what is diff btwn 1o & 2o hemostasis

A

Primary = Platelets (number and function) &
formation of platelet plug

Secondary = Fibrin mesh that stabilizes the
platelet plug

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2
Q

so why aren’t we 1 super huge clot?

A

there are anti-clotting factors at play

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3
Q

what are coag defects that cause clinical bleeding

A

defects in 1mary = decr platelets/ thrombocytopenia

poorly functional platelets

lack of vWF (platelet & collagen derived)

defects in 2dary = lack of 1 or more coag factors

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4
Q

CS of 1mary defect

A

petechia

ecchymosis

oozing from mucosal sites

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5
Q

Cs of 2dary defects

A

bleeding into body cavity

Lg SQ hematomas

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6
Q

what is this?

A

scleral hemorrhage

1mary defect

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7
Q

what type of defect are:

melena

mucosal & gingival petichia & epistaxis

A

1mary

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8
Q

what type of defect would pleural bleeding be

A

2dary

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9
Q

how to dx 1mary hemostatis

A

platelet count

norm = >140,000

ALWAYS assess slide manually (platelet clumping will decr = artifact

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10
Q

how low a platelet count before we are concerned

A

20-30,000

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11
Q

how low platelets before we worry about spontaneous bleeding

A

<10,000

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12
Q

how to asses platelet function

A

BMBT

norm canine = <3.5 min

feline = <2.5 min

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13
Q

rapid POC test to assess 2dary hemostasis

A

Activated clotting time

only assesses intrinsic pathway

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14
Q

which test assesses intrinsic pathway

A

aPTT

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15
Q

which test assesses extrinsic pathway

A

PT

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16
Q

which test assesses common pathway

A

fibrinogen

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17
Q

what is dime store mnemonic

A

it’s not 12 but 11.98

intrinsic factors:

XII, XI, IX, VII

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18
Q

thrombocytopenia

A

1mary disorder

not generating enough = BM dz - mild to severe thrombocytopenia

leaving circ too quick = consumption (DIC) - mild to severe t-penia

destruct/immune mediated - severe t-penia

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19
Q

immune mediated thrombocytopenia (IMTP)

A

aka ITP (idiopathic t-penia purpura (human term)

platelet ct <15,000

can be 1mary IMTP = idiopathic

or 2dary

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20
Q

causes of 2dary IMTP

A

rickettsial dz

vx/meds w/i 30 days

systemic lupus erthematosus

2dary to neoplasia

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21
Q

what are addtl diag for IMTP

A

antiplatelet antibody testing (like Coombs for platelets)

antinuclear antibody (ANA) - used to screen for SLE (lupus)

Coombs - if concurrent IMTP w/ IMHA (Evans syndrome)

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22
Q

what is serologic test & why done

A

screen for rickettsial cause

Snap 4DX (HW, E. canis, Lyme, E. equi (Anaplasma phagocytophilium))

+ test = exposure NOT infection

need serial titer levels (4 fold incr)

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23
Q

Tx for IMTP

A

tx empirically w/ doxycycline while waiting for lab results

then immunosuppressants:

glucocorticoids

vincristine

human immoglobulin

mycophenolate

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24
Q

what happens with immunosuppressive doses of glucocorticoids

side effects

A

results in decr phagocytosis

Mainstay of tx for immune mediated dz

PP, PU, PD, wt gain

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25
Q

what is vincristine & how work

A

chemotherapy

causes premature release of platelets from marrow

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26
Q

how does human IVIG work

A

temp block of Fc receptors of phagocytes

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27
Q

what is mycophenolate mofetil

A

alternative to azathioprine

enzyme suppressor

leads to depletion of guanosine

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28
Q

short term Px for IMTP

A

short term = w/i 1 mo of dx

good w/ immunosuppression & supportive care

relapses can occur

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29
Q

name 1mary hemostasis disorder

2dary

A

vWF

Vit K rodenticide toxicity

30
Q

Tx for DIC

A

get rid of underlying dz, +/- plasma, +/- heparin

31
Q

what toxin causes Vit K antagonism

A

warfarin or related compounds

32
Q

the 4 Vit K dependent coag factors

A

1972 = X, IX, V!!, II

33
Q

if Factor VII has shortest t1/2 what will be prolonged 1st

A

PT & more severly incr

34
Q

tx for 2dary hemostasis disorder rodenticide toxicity

A

Vit K & blood product w/ coag factors

35
Q

IMHA

A

immune mediated hemolytic anemia

AB are directed at antigens on surface of RBCs promotin accelerated destruction

36
Q

CS IMHA

A

lethargy, weakness, tachypnea/tachycardia

icterus

37
Q

how IMHA dx

A

clinical & lab evidenc of hemolytic anemia w/ regenerative response

evidence of accelerated immune-mediated destruction of RBCs

38
Q

classic signalment for IMHA

A

young to middle age

dog = female, cat = either

Am. Cocker Span.

39
Q

3 tests commonly used to id accelerated immune destruction of RBCs

A

Coombs

auto agglutination

blood smear = presence of spherocytes

40
Q

what is prevalence of 1mary IMHA v 2dary

causes

A

2/3 of IMHA 1mary = genetic predisp, acquired disreg

1/3 of IMHA 2dary = infection, neoplasia, drugs

41
Q

addtl tests to Dx & Tx goals IMHA

A

serum biochem

coag panel

radiographs

BM cytology

titers for rickettsial dz

specific, supportive, symptomatic

42
Q

steps in the diagnostic work up of the cancer patient

A

Hx

PE

+/- imaging

FNA & cytology

Bx & histopathology

43
Q

methods, limitations and advantages of different tumor sampling techniques and how to choose between them for a given patient.

A

methods:

FNA & cytology

  • Adv: least invasive, inexpensive, quick, safe
  • Disadv: can’t grade, false +, false -

must consider results in clincal context “ biological behavior trumps grade”

needle core bx

  • trucut needle
  • adv: bigger sample than FNA
  • disadva: seed tumor in bx track

punch bx

Jamshidi bone bx

surgical bx - incisional vs excisional

44
Q

how the biologic behavior of a tumor influences the diagnostic testing that is required for patient evaluation

A

biological behavior trumps grade

45
Q

techniques for collection and assessment of cytology specimens.

A

non-aspiration

  • first attempt
  • LN
  • round cell tumors
  • highly vascular tumors

aspiration

  • hard/firm lesions
  • very sm lesions whre multiple passes = impossible
  • 2nd attempt
46
Q

diff btwn clinical stage and histological grade

A

Clincal stage = extent of body affected, determined by clinician w/ diag testing

Grade = hisotpathologic scoring by pathologist

47
Q

information desired in a pathology report, understand how to interpret the information, understand the limitations of pathology

A

dx

grade, if applicable for tumor type

margin assessment

prognostic factors - when evidence based

48
Q

what is incisional bx

A

bx of a selected portion of lesion

49
Q

what is excisional bx

A

removal of mass primarily for diagnostic purposes

equiv to “narrow excision

50
Q

what can be seen with cytology of epithelial tumors

types

A

exfoliate easily, cellular

  • sheets, clusters, acinar
  • round, cuboidal, polyhedral
  • Vacuoles = adenocarcinoma

adenoma, carcinoma

51
Q

what can be seen with cytology of mesenchymal tumors

types

A

exfoliate poorly

  • individual, loose aggregates
  • spindle, stellate, round
  • indistinct cell margins

sarcomas

52
Q

what can be seen with cytology of Round cell neoplasia

types

A

exfoliate easily, highly cellular samples

  • individual, round or oval cells

histiocytoma

lymphoma

plasmacytoma

MCT

TVT

sometimes melanoma

53
Q

indications for chemotherapy

A

Patients with measurable tumor known to be sensitive to chemotherapy.

Adjuvant therapy to suppress occult micrometasisafter local therapy.

Palliate unresectableor metastatic cancer.

Occasionally, to downstage/reduce a chemosensitivetumor before definitive therapy (i.e. surgery).

Occasionally, to sensitize tissues to radiation.

hematopoietic cancers (usually systemic) - highly responsive to chemo tx

  • lymphoma
  • leukemia
  • myeloma

solid tumors - adjunctive to sx a/o radiation

  • carcinomas
  • sarcomas
54
Q

principles of applying chemotherapy

A

As a result of the Goldie Coldman Hypothesis and what we know from the Gompertzian Growth…

Chemotherapy should be initiated as early in the course of the disease (before obvious metastasis are apparent).

Due to the likelihood of mutated/“resistant” cancer cells, a protocol containing multiple agents is ideal

55
Q

general mechanisms of chemotherapy

A

General characteristics of tumor cells:

  • Loss of growth control
  • Rapid proliferation

DNA or cell division mechanism-ultimately leading to apoptosis

Cell cycle specific drugs and nonspecific drugs

Rationale for combination chemotherapy
Different drugs exert their effect through different mechanisms and at different stages of the cell cycle, thus maximize cell kill

56
Q

general toxicities with chemotherapy

A

Dose dependent

Self-limiting in most cases

Rapidly dividing tissues –non-selective

  • Bone marrow - cytopenia
  • Hair follicles - alopecia
  • GI tract - v/d

“BAG”of adverse effects

Toxicity = patient dependent, drug dependent, and dose dependent

57
Q

unique toxicities with chemotherapy

A

Vomiting - cisplatin, strepsitatoci, decarbazine

tx w/ maropitant (cerenia), metaclopramide (reglan), ondansetron (zofram)

diarrhea - (colitis) - doxorubicin

tx w/ metronidazole

dog breeds with MDR1 mutation - Vincristine & vinblastine, doxorubicin & mitoxantrone

58
Q

measures to safely handle & administer chemotherapy

A

prevent aerosolization

  • closed system
  • Phaseal system
  • Equashield

PPE

NEVER split/open tablets/capsules

NO LIQUID/ORAL FORMULATIONS

59
Q

discuss the individual categories of traditional chemotherapy drugs

A

Alkylating agents:

  1. Cyclophosphamide
  2. Chlorambucil
  3. CCNU

MOA: induce apoptosis

Platinums

  1. cisplatin
  2. carboplatin

MOA: cause crosslinks

Antimetabolites

Antitumor antibiotics/ anthracyclines

  1. Doxorubicin
  2. Mitoxantrone

MOA: cell membrane damage

spindle toxins:

  • vinca alkaloids
    • periwinkle
    • vincristine
    • vinblastine
  • taxanes
    • pacific yew tree
    • paclitaxel, docetaxel

misc

60
Q

cylclophosphamide toxicity

A

BAG

sterile hemorrhagic cystitis

61
Q

CCNU toxicity

A

BAG

2/3 of dogs develop neutropenia

hepatotoxic

62
Q

Doxorubicin “red death” toxicity

A

BAG

irreversible Cardiotoxicity in dogs (cumulative dose)

nephrotoxicity in cats

histamine release

extravasation injury

63
Q

Spindle toxin toxicity

A

Vincristine:

BAG

ileus (common)

tx: metaclopramide

peripheral neuropathy (rare)

extravasation injury

64
Q

Platinum toxicity

A

BAG

cisplatin : nephrotoxicity in dogs

FATAL idiosyncratic pulmonary edema in cats

(Cats go sPLAT!)

65
Q

non-traditional systemic cancer therapy: immunotherapy/molecular targeted therapy/NSAIDs

A

NSAIDs: piroxicam w/ some carcinomas

immunotherapy: tumor vx ie. canine melanoma

targeted therapy: paladia for receptors on MCTs

66
Q

Wht tx? What are the differences b/w surgical, radiation & chemotherapy tx for cancers

A

surgery cures more cancer than radioation or chemo/systemic tx

radiation used to control local recurrence or progression of certain tumors

chemotherapy suppresses cancer cells for some time, but cure rates are low

67
Q

Preventative measures should be used to minimize exposure of chemotherapy agents to veterinary staff. The greatest risk of systemic absorption of chemotherapy agents by staff is via which of the following routes:

A: Absorption through the skin

B: Accidental injection

C: Inhalation of an aerosol

D: Accidental ingestion

A

Accidental injection

68
Q

what is dose in radiation terminology

A

amount of radiation absorbed by the patient (Gray = Gy= 1 Joule/kg)

69
Q

what is Fraction in radiation terminology

A

individual administration of dose of radiation

70
Q
A

My 2017 RUSVM SAM 2 (8 decks)

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