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Differential diagnosis > Oncology > Flashcards

Oncology Flashcards

1
Q

what is a rare disease?

A
  • any disease, disorder, illness or condition affecting fewer than 200,000 people in the US is considered rare.
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2
Q

what is cancer?

A
  • group of diseases characterized by the uncontrolled growth and spread of abnormal cells.
  • if the spread of abnormal cells is not controlled, can result in death
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3
Q

benign

A
  • localized
  • slow growing
  • encapsulated
  • not invasive
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4
Q

malignant

A
  • invasive rapidly growing

- usually encapsulated in the early stages

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5
Q

survivor

A
  • anyone who is living with active cancer or having had a diagnosis of cancer
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6
Q

chemo brain

A
  • a colloquial term for difficulties with concentration and memory that may follow the administration of some forms of chemo
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7
Q

epidemiology of cancer

A
  • 2nd most common cause of death in the US: Prostate , breast, lung, colon
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8
Q

cancer survival rate

A
  • 5 year survival rate for all cancer is 69%

- 5+ years, survival rate returns to near their non-cancer peers

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9
Q

comorbidities

A
  • most survivors have more than 1 comorbidity
  • chemo toxicities: muscle atrophy, paralysis, chemo brain
  • late effects of radiation therapies
  • adverse sequela of surgical interventions
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10
Q

risk factors for cancer

A
  • tabacco use
  • sun exposure
  • obesity/ food/ fitness
  • HPV and cervical cancer
  • emvironmental carcinogens
  • genetics
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11
Q

roles of PT in oncology

A
  • Bone health
  • Pre-hab
  • pelvic floor
  • orthopedic
  • CIPN
  • Steroid induced myopathy
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12
Q

Pre-hab for oncology patients is….

A
  • physical and psychological assessments prior to the onset of acute cancer treatment
  • baseline level of function-enables therapist to repeat and identify change
  • pre-existing functional impairments
  • provides targeted interventions to improve functional status prior to cancer treatment
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13
Q

steroid induced myopathy

A

-muscle weakness and atrophy caused by high doses of glucocorticoids

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14
Q

myopathy

A
  • a nonspecific muscle weakness secondary to an identifiable disease or condition
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15
Q

glucocorticoid alters protein metabolism

A
  • decrease muscle protein anabolism
    • they limit amino acid transport into muscles.
    • they inhibit the stimulatory action of insulin, insulin-like growth factor- 1 and amino acids. these factors play key roles in protein synthesis by governing the initial step of mRNA translation.
    • can cause muscle atrophy by inhibiting myogenesis
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16
Q

increased muscle protein catabolism

A
  • the main effects is to induce muscle protein catabolism
    • myofibrillar proteins are degraded
  • -actin and myosin are dissociated
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17
Q

glucocorticoid

A
  • common man made steroids used in cancer treatment
  • typically prescribed for a short duration of time, a few days to a few weeks.
  • bone marrow and stem cell transplant patients are required to take steroids for a longer duration
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18
Q

use of steroids in cancer treatment

A
  • treat cancer itself in tandem with chemo
  • reduce inflammation
  • reduce immune response such as after a transplant
  • to help relieve sickness secondary to chemo
  • to help boost appetite
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19
Q

Type I

A
  • slow twitch
  • muscles appear red
  • the redness is the result of high amounts of myoglobin and a high capillary content
    • myoglobin and capillary content in red muscles contributes to the greater oxidative capacity
  • -rich in mitochondria, lipids, and oxidative enzymes
20
Q

Type II

A
  • fast twitch
  • larger fibers
  • rich in phosphorylase and glycogen
  • poor in mitochondria and oxidative enzymes
  • steroids affect Type IIB muscle fibers no effect Type I. type IIB are less active than type I = more atrophy rate
21
Q

-acute steroid induce myopathy

A
  • occurs most often in the intensive care unit
  • rapidly progressive weakness of the proximal and distal muscle groups

-rapid onset of weakness and wasting, also referred to as acute illness myopathy, is the result of multiple factors:

22
Q

chronic steroid induced myopathy

A
  • muscle weakness develops insidiously
  • progresses slowly
  • usually painless or mildly painful
  • weakness is primarily proximal: pelvic girdle muscles more severely involved than arms, cranial nerves innervated muscles and sphincters are spared
  • rarely distal muscles affected
  • muscle atrophy that regresses only after a matter of weeks or months
  • patients who received steroids for less than 4 weeks rarely develop steroid myopathy
23
Q

psychological considerations after steroids

A
  • irritability, euphoria, nervousness
  • serious depression and psychosis
  • insomnia is often a complaint
  • when intense changes are observed a physician should be notified
24
Q

PT aerobic exercise

A
  • training along with proper nutrition
  • most patients receiving glucocorticoids are often too sick to exercise
  • those who are able to exercise cannot do so to the intensity required to prevent myopathy
  • 150 min aerobic moderate
  • 75 min high intensity
25
Q

PT strength training

A
  • strength and stair training
  • maintain larger muscle group of the legs
  • most effective at preventing atrophy
26
Q

PT close chain exercise

A
  • Prevents shearing forces across joints
  • allows for normal joint loading
  • prevents vertebral compression fractures
27
Q

PT avascular necrosis of femoral head

A
  • exercise the surrounding joint muscles in non-weight bearing
  • openchain exercise
28
Q

Acute myeloid luekemia

A
  • group of heterogeneous hematopoietic stem cell disorders whch are characterized by incomplete maturation of blood cells and reduced production of other normal hematopoietic cells
29
Q

Who is at risk for AML?

A
  • AML is most common in older people >65 yr old
  • slightly higher incidence in males
  • slightly higher incidence in populations of European descent
  • exposure to ionizing radiation
  • chemicals known to cause DNS damage
  • predisposing conditions: myelodysplastic processes or other chronic bone marrow stem cell disorders
30
Q

Signs and symptoms of AML

A
  • low blood count
  • fatigue
  • dyspnea
  • infection
  • bleeding
31
Q

physical exam of AML

A
  • petechiae
  • ecchymoses
  • fever
  • pallor
  • confusion
  • visual changes
  • sternal tenderness
32
Q

lymphoma

A
  • umbrella term describing dozens of cancers that begin in the immune system. lymphoma are the most common type of blood cancer, and are broadly categorized as Hodgkin or non-hodgkins.
33
Q

Hodgkin lymphoma

A
  • occurs when white blood cells called B-lymphocytes become abnormal and begin growing and dividing so fast that normal cells in the immune system cannot keep up.

-

34
Q

non-Hodgkin lymphoma

A
  • occurs when either rB or T cell lymphocytes become abnormal. in most cases it is the B cells that are defective.
  • nonhodgkin lymphomas are categorized based on a spectrum of how they behave in the body
35
Q

who is at risk of non-hodgkins lymphoma

A
  • underlying immune system conditions
  • older individuals
  • males are more likely to be diagnosed than females
  • exposure to chemo and radiation
  • previous infections
  • exposure to chemicals
  • obesity
36
Q

signs and symptoms of non-Hodgkin lymphoma

A
  • fever
  • swollen lymph nodes
  • severe itching
  • excessive sweating
  • unexplained weight loss
  • fatigue
  • abdominal discomfort
  • shortness of breath
  • chest pain or pressure
37
Q

treatment of non-Hodgkin

A
  • induction chemo
    -radiation
    immunotherapy
  • central access catheter
  • blood products
  • lumbar punctures
  • imaging studies
38
Q

post surgical/radiation edema and fibrosis teatment

A
  • gentle stretching
  • good skin care
  • botox injections can relieve pain and reduce muscle spasms
39
Q

tx for chest and arm pain

A
  • myofascial release
  • stetching of arm, chest, back , rib cage
  • posture , core, ergonomics
  • massage
  • strengthening of shoulder blades and back muscles
  • physician referral?: acupuncture, injections, muscle relaxants, pain medictaions
40
Q

tx for CIPN

A
  • medications
  • acupuncture
  • reflexology
  • e-stim
  • balance
  • exercise
41
Q

tx for cancer related fatigue

A 
- cognitive behavioral therapy
exercise
acupuncture
medications
reverse underlying medical condition: anemia, low vitamin D, pain, low thyroid, insomnia, depression/anxiety/distress
42
Q

tx for mild cognitive impairment

A
  • cognitive therapy
  • organization and structures
  • life management skills
  • support groups
43
Q

cancer prevention recommendations

A
  • be a healthy weight
  • physically active
    eat a rich diet in whole grains veggies, fruit, and beans
    -limit consumption of fast foods and other processed
    -limit consumption of red and processed meat
44
Q

thrombotic thrombocytopenic purpura

A
  • rare blood disorder that is considered a true medical emergency.
  • TTP is diagnosed at a rate of 3-4 in 1 million people per year
  • potentially fatal complications can result from internal blood clottin, with damage to critical organs such as the brain and heart
45
Q

types of TTP

A
  • hereditary: inherited deficiency or abnormality of the ADAMTS
  • immune -mediated TTP: 99% have no defined cause. in all cases, there is a decreased levels of the ADAMTS 12 enzyme as a result of antibodies attacking the enzyme
46
Q

TTP symptoms

A
  • fatigue
  • fever
    -bleeding
    diarrhea
    -chest apin
    abdominal pain
    -neurologic symptoms
    -thrombocytopenia

Differential diagnosis (8 decks)

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