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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
what is vincristine & how work
chemotherapy causes premature release of platelets from marrow
26
how does human IVIG work
temp block of Fc receptors of phagocytes
27
what is mycophenolate mofetil
alternative to azathioprine enzyme suppressor leads to depletion of guanosine
28
short term Px for IMTP
short term = w/i 1 mo of dx good w/ immunosuppression & supportive care relapses can occur
29
name 1mary hemostasis disorder 2dary
vWF Vit K rodenticide toxicity
30
Tx for DIC
get rid of underlying dz, +/- plasma, +/- heparin
31
what toxin causes Vit K antagonism
warfarin or related compounds
32
the 4 Vit K dependent coag factors
1972 = X, IX, V!!, II
33
if Factor VII has shortest t1/2 what will be prolonged 1st
PT & more severly incr
34
tx for 2dary hemostasis disorder rodenticide toxicity
Vit K & blood product w/ coag factors
35
IMHA
immune mediated hemolytic anemia AB are directed at antigens on surface of RBCs promotin accelerated destruction
36
CS IMHA
lethargy, weakness, tachypnea/tachycardia ## Footnote **icterus**
37
how IMHA dx
clinical & lab evidenc of hemolytic anemia w/ regenerative response evidence of accelerated immune-mediated destruction of RBCs
38
classic signalment for IMHA
young to middle age dog = female, cat = either Am. Cocker Span.
39
3 tests commonly used to id accelerated immune destruction of RBCs
Coombs auto agglutination blood smear = presence of spherocytes
40
what is prevalence of 1mary IMHA v 2dary causes
**2/3 of IMHA 1mary = genetic predisp, acquired disreg** **1/3 of IMHA 2dary = infection, neoplasia, drugs**
41
addtl tests to Dx & Tx goals IMHA
serum biochem coag panel radiographs BM cytology titers for rickettsial dz *specific, supportive, symptomatic*
42
steps in the diagnostic work up of the cancer patient
Hx PE +/- imaging FNA & cytology Bx & histopathology
43
methods, limitations and advantages of different tumor sampling techniques and how to choose between them for a given patient.
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
how the biologic behavior of a tumor influences the diagnostic testing that is required for patient evaluation
biological behavior trumps grade
45
techniques for collection and assessment of cytology specimens.
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
diff btwn clinical stage and histological grade
Clincal stage = extent of body affected, determined by clinician w/ diag testing Grade = hisotpathologic scoring by pathologist
47
information desired in a pathology report, understand how to interpret the information, understand the limitations of pathology
dx grade, if applicable for tumor type margin assessment prognostic factors - when evidence based
48
what is incisional bx
bx of a selected portion of lesion
49
what is excisional bx
removal of mass primarily for diagnostic purposes equiv to "narrow excision
50
what can be seen with cytology of epithelial tumors ## Footnote **types**
exfoliate easily, cellular * sheets, clusters, acinar * round, cuboidal, polyhedral * ***Vacuoles = adenocarcinoma*** **adenoma, carcinoma**
51
what can be seen with cytology of mesenchymal tumors ## Footnote **types**
exfoliate poorly * individual, loose aggregates * spindle, stellate, round * indistinct cell margins **sarcomas**
52
what can be seen with cytology of Round cell neoplasia ## Footnote **types**
exfoliate easily, highly cellular samples * individual, round or oval cells **histiocytoma** **lymphoma** **plasmacytoma** **MCT** **TVT** **sometimes melanoma**
53
indications for chemotherapy
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
principles of applying chemotherapy
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
general mechanisms of chemotherapy
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
general toxicities with chemotherapy
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
unique toxicities with chemotherapy
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
measures to safely handle & administer chemotherapy
prevent aerosolization * closed system * Phaseal system * Equashield PPE **NEVER split/open tablets/capsules** **NO LIQUID/ORAL FORMULATIONS**
59
discuss the individual categories of traditional chemotherapy drugs
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
cylclophosphamide toxicity
BAG ## Footnote **sterile hemorrhagic cystitis**
61
CCNU toxicity
BAG ## Footnote **2/3 of dogs develop neutropenia** **hepatotoxic**
62
Doxorubicin "red death" toxicity
BAG ## Footnote **irreversible Cardiotoxicity in dogs (cumulative dose)** **nephrotoxicity in cats** **histamine release** **extravasation injury**
63
Spindle toxin toxicity
Vincristine: BAG **ileus (common)** tx: metaclopramide **peripheral neuropathy (rare)** **extravasation injury**
64
Platinum toxicity
BAG cisplatin : **nephrotoxicity in dogs** **FATAL idiosyncratic pulmonary edema in cats** **(Cats go** s**PLAT!)**
65
non-traditional systemic cancer therapy: immunotherapy/molecular targeted therapy/NSAIDs
NSAIDs: piroxicam w/ some carcinomas immunotherapy: tumor vx ie. canine melanoma targeted therapy: paladia for receptors on MCTs
66
Wht tx? What are the differences b/w surgical, radiation & chemotherapy tx for cancers
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
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
Accidental injection
68
what is dose in radiation terminology
amount of radiation absorbed by the patient (Gray = Gy= 1 Joule/kg)
69
what is Fraction in radiation terminology
individual administration of dose of radiation
70

My 2017 RUSVM SAM 2 (8 decks)

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