Oncology and Chemotherapy (Mordecai) Exam III Flashcards
1
Q
The normal behavior of cells is to grow and divide when needed, what happens when they are damaged or old?
A) They continue to grow and divide
B) They die
C) They become cancer cells
D) They stop growing but do not die
A
B) They die
Slide 2
2
Q
What characterizes the behavior of cancer cells compared to normal cells?
A) They die when they should die
B) They form only when needed
C) They survive when they should die
D) They grow at a slower rate
A
C) They survive when they should die
Form when they are NOT needed
Slide 2
3
Q
Matching
Match the stages of tissue changes with their definitions
A
1 → B
2 → D
3 → C
4 → A
Slide 3
4
Q
What is the definition of cancer according to the National Cancer Institute?
A) A single disease caused by viruses
B) A collection of related diseases
C) A genetic disorder with no external causes
D) A disease only affecting solid organs
A
B) A collection of related diseases
Slide 4
5
Q
Cancer cells differ from normal cells because they ________ without stopping and spread into surrounding tissues.
A) Regenerate
B) Die
C) Grow
D) Divide
A
D) Divide
May form solid tumors or not (leukemias like blood cancers)
Slide 4
6
Q
Which factors can cause cancer? Select 2
A) Inherited from parents
B) Direct or indirect contact
C) Excessive cell death
D) Mutations to DNA
E) Mobile phones
A
A) Inherited from parents
D) Mutations to DNA - exposure to things like radiation, chemicals and various drugs
Slide 4
7
Q
Which characteristics describe how cancer cells differ from normal cells? Select 3
A) Cancer cells are less specialized
B) Cancer cells divide for shorter than needed
C) Abnormally influence normal cells
D) Cancer cells stop dividing when they receive apoptosis signals
E) Cancer cells evade the immune system
A
A) Cancer cells are less specialized
C) Abnormally influence normal cells
E) Cancer cells evade the immune system
Slide 5
8
Q
How do cancer cells interact with normal cells?
Select 3
A) They encourage normal cells to die
B) They influence normal cells to feed the tumor by forming blood vessels
C) Can ignore pre-programmed apoptosis signals
D) They destroy blood vessels
E) They use the immune system to prevent cancer cell damage
A
B) They influence normal cells to feed the tumor by forming blood vessels - this is called angiogenesis
C) Can ignore pre-programmed apoptosis signals - these cells can ignore that pre-programmed apoptosis signals that keep them from dividing and multiplying out of control
E) They use the immune system to prevent cancer cell damage - they can basically influence things like the neutrophils and influence phagocyte production and activity to kind of prevent themselves from being broken down and gobbled up the way they should.
Slide 5
9
Q
What are proto-oncogenes involved in under normal conditions?
A) Preventing cell division
B) Normal cell growth and division
C) DNA repair
D) Apoptosis (cell death)
A
B) Normal cell growth and division
Slide 6
10
Q
What happens when proto-oncogenes become altered?
A) They slow down cell division
B) They become tumor suppressor genes
C) They become cancer-causing genes
D) They repair DNA damage
A
C) They become cancer-causing genes, allowing cells to grow and survive
Slide 6
11
Q
What is the function of tumor suppressor genes when they are altered?
A) They allow genes to divide uncontrollably
B) They help the immune system attack cancer cells
C) They repair damaged DNA
D) They stop cell growth entirely
A
A) They allow genes to divide uncontrollably
Slide 6
12
Q
DNA repair gene mutations can cause ________ in the cells.
A) Increased growth
B) Correct repair of damage
C) Other mutations
D) No impact
A
C) Other mutations
M - there can be alterations in DNA repair genes. And so the DNA helixes get damaged. And they replicate. And so this is sort of an incorrect damage repair and causes other mutations to occur along the way.
Slide 6
13
Q
There are more than __________ types of cancers
A) 50
B)75
C) 90
D) 100
A
D) 100
Slide 7
14
Q
How are cancers typically named?
A) Based on the age of the patient
B) Based on where the cancer originates
C) Based on the duration of the illness
D) Based on the color of the tumor
A
B) Based on the organs, tissues, or types of cells where the cancer originates
Slide 7
15
Q
What type of cancer originates from the basal layer of the epidermis?
A) Adenocarcinoma
B) Squamous cell carcinoma
C) Basal cell carcinoma
D) Sarcoma
A
C) Basal cell carcinoma
Slide 7
16
Q
Adenocarcinoma typically affects ________ tissues that produce mucus, like the breast or prostate.
A) Glandular
B) Epithelial
C) Muscular
D) Bone
A
A) Glandular
Slide 7
17
Q
What type of cancer affects epithelial cells, such as those lining the stomach, intestines, and bladder?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Sarcoma
D) Leukemia
A
A) Squamous cell carcinoma
slide 7
18
Q
Sarcomas are cancers that affect the ________.
A) Blood-forming tissues
B) Glandular tissues
C) Epithelial tissues
D) Bone and soft tissues
A
D) Bone and soft tissues
Bone cancer = osteosarcomas
Slide 7
19
Q
What type of cancer begins in blood-forming tissues, such as the bone marrow?
A) Lymphoma
B) Sarcoma
C) Leukemia
D) Squamous cell carcinoma
A
C) Leukemia
Slide 7
20
Q
Which type of cancer begins in lymphocytes (T or B cells) and can build up in lymph nodes and vessels?
A) Leukemia
B) Lymphoma
C) Sarcoma
D) Basal cell carcinoma
A
B) Lymphoma
Slide 7
21
Q
Which of the following are related to environmental exposure as risk factors for cancer?
Select 3
A) Radiation
B) Sunlight
C) Immunosuppression
D) Tobacco
E) Genetics
A
A) Radiation
B) Sunlight
D) Tobacco
Slide 8
22
Q
Which factors are known to contribute to cancer risk through genetic and environmental pathways?
Select 3
A) Genetics
B) Gender
C) Diet
D) Immunosuppression
E) Lack of physical activity
A
A) Genetics
C) Diet
D) Immunosuppression
Obesity
Slide 8
23
Q
Which of the following are general risk factors for cancer?
Select 3
A) Age
B) Alcohol
C) Cachexia
D) Cold weather
E) Hormones
A
A) Age
B) Alcohol
E) Hormones
M - both endogenous hormones and hormone replacement therapy have been linked to cancers
Slide 8
24
Q
Why can some cancer screenings like colonoscopies cause problems?
Select 2
A) Burns
B) Airway complications
C) Perforation
D) Constipation
A
B) Airway complications
C) Perforation
M - There is potential for perforation, although that’s super rare.There’s also potential for airway complications and obstruction, if they lose their airway reflexes and they turned out have some some contents in their stomach, there’s potential for aspiration. So a colonoscopy isn’t completely benign, but usually the benefits outweigh the risk there.
Slide 9
25
Which of the following statements describe potential issues with cancer screenings? Select 2
A) Screenings have rare complications
B) Screenings are always accurate without false results
C) Screenings can produce false-positive results
D) Screenings are only useful for late-stage cancers
E) Screenings can produce false-negative results
C) Screenings can produce false-positive results
E) Screenings can produce false-negative results
## Footnote
Slide 9
26
Cancer screenings are considered effective when they show:
Select 3
A) More early-stage cancers found
B) Less late-stage cancers found
C) More false positives
D) Fewer deaths from cancer
E) Screenings only detecting late-stage cancers
A) More early-stage cancers found
B) Less late-stage cancers found
D) Fewer deaths from cancer
## Footnote
Slide 9
27
What does absolute risk measure?
A) The number of people who avoid cancer in a population
B) How many people get a specific condition in a certain period of time
C) The relative likelihood of developing cancer based on lifestyle
D) The percentage of people in an exposed group who get cancer
B) How many people get a specific condition in a certain period of time
- How many people get “x” in a certain period.
Ex. If 4 people out of a group of 100,000 get “x” then risk is 4 in 100,000
## Footnote
Slide 10
28
Relative risk compares the percentage of people in the ________ group who develop a disease to the unexposed group.
A) Exposed
B) Elderly
C) Control
D) Average
A) Exposed
M - *for example, if the exposure was cigarette smoking and the disease is cancer -> then you would say the number of cigarette smokers with cancer divided by the number of people that don't smoke with cancer*
## Footnote
Slide 10
29
A relative risk greater than 1 means a trait is linked to ________ disease risk.
A) Decreased
B) Increased
C) No change in
D) No relationship to
B) Increased
M - *if RR>1 then there's a positive correlation with the exposure and the disease.*
## Footnote
Slide 10
30
What does a relative risk (RR) of less than 1 suggest?
A) The trait is not linked to the disease
B) The trait is linked to an increased likelihood of disease
C) The trait is linked to a decreased likelihood of disease
D) The trait has no relationship to disease
C) The trait is linked to a decreased likelihood of disease
M - *RR < 1, then there is a negative correlation. If less smokers have cancer than non-smokers*
## Footnote
Slide 10
31
What does a relative risk (RR) of 1 indicate?
A) The trait is linked to an increased risk of disease
B) The trait is linked to a decreased risk of disease
C) The trait has no association with the risk of disease
D) The trait causes the disease in all cases
C) The trait has no association with the risk of disease
M - *RR=1, there are an equal amount of smokers with cancer as non-smokers with cancer, then there would be **no link** between smoking and cancer, then there is a negative correlation.*
## Footnote
Sldie 10
32
Which of the following statements are true about standard cancer screenings that insurance covers based on the research? Select 3
A) Colonoscopies can detect pre-cancerous polyps early.
B) Pap smears are used to detect breast cancer.
C) Mammograms are recommended annually for women over 40.
D) Pap smears are shown to reduce cervical cancers
E) Colonoscopies are generally non-invasive and can be performed at any age.
A) Colonoscopies can detect pre-cancerous polyps early.
C) Mammograms are recommended annually for women over 40.
D) Pap smears are shown to reduce cervical cancers
## Footnote
Slide 11
33
Tumor staging refers to (2):
A) How fast the tumor is growing
B) If the tumor has metastasized
C) The tumor's ability to resist treatment
D) The tumor's recurrence rate
E) How large the tumor is
B) If the tumor has metastasized
E) How large the tumor is
## Footnote
Slide 12
34
# True or False
As cancer progresses it changes in diagnosis and staging.
FALSE
M - *patients don't get restaged as cancer changes and progresses or is treated. You just get one staging and it's done*
## Footnote
slide 12
35
# Matching
Match the tumor staging and its definition
T: size/extent of primary tumor
N: # of nearby lymph nodes which are +
M: is there metastasis
## Footnote
slide 12
36
Which of the following are correct regarding the **Primary tumor or "T"** in the TNM staging system? Select 3
A) TX means the tumor cannot be measured.
B) T0 means the tumor cannot be found.
C) T1-T4 refers to the size and/or extent of the tumor.
D) T1 indicates metastasis.
E) T0 indicates the tumor is very small.
A) TX means the tumor cannot be **measured.**
B) T0 means the tumor cannot be **found.**
C) T1, T2, T3, T4 refer to the size and/or extent of the tumor. **The larger the tumor or the more it has grown into nearby tissues and invasive.**
## Footnote
slide 13
37
Which of the following statements are correct about the **Regional Lymph Nodes "N"** in the TNM staging system? Select 3
A) NX means the lymph nodes cannot be measured.
B) N0 means no cancer in nearby lymph nodes.
C) N3 indicates that there are no lymph nodes involved.
D) N1-N3 means the cancer has spread to distant organs.
E) N1-N3 refer to the number and location of lymph nodes with cancer.
A) NX means the lymph nodes **cannot be measured.**
B) N0 means **no cancer** in nearby lymph nodes.
E) N1-N3 refer to the number and location of lymph nodes with cancer. **The higher the number after the N, the more lymph nodes that contain cancer.**
## Footnote
Slide 13
38
Which of the following are true about the **distant metastasis "M"** in the TNM staging system? Select 3
A) MX means metastasis cannot be measured.
B) M0 indicates that the cancer has not spread to other parts of the body.
C) M1 indicates cancer has spread to the lungs only.
D) M0 means the cancer has spread to distant organs.
E) M1 means the cancer has spread to other parts of the body.
A) MX means metastasis cannot be measured.
B) M0 indicates that the cancer has not spread to other parts of the body.
E) M1 means the cancer has spread to other parts of the body.
## Footnote
Slide 13
39
# Matching
Match the staging name with its definition
In situ = C
Localized = D
Regional = A
Distant = E
Unknown = B
*These are all staged based on the degree of spread.*
## Footnote
Slide 14
40
Which of the following conditions are linked to a median survival of 6 months or less in cancer patients? Select 3
A) Patient spends > ½ day in bed
B) Serum calcium < 10 mg/dL
C) DVT or PE
D) Spleen, muscle, or thyroid metastases
E) Malignant pericardial effusion
A) Patient spends > ½ day in bed
C) DVT or PE
E) Malignant pericardial effusion
## Footnote
Slide 15
41
In cancer patients with a median survival of 6 months or less, serum **albumin** is typically ________.
A) > 3.5 mg/dL
B) < 3.5 mg/dL
C) between 3.5 - 4.5 mg/dL
D) higher than 5 mg/dL
B) < 3.5 mg/dL
## Footnote
Slide 15
42
For cancer patients with poor prognosis, serum **calcium** levels are often above ________.
A) 9.0 mg/dL
B) 10.5 mg/dL
C) 11.2 mg/dL
D) 12.0 mg/dL
C) 11.2 mg/dL
M- *we know there's some bone involvement,breakdown, maybe some kidney involvement as well*
## Footnote
Slide 15
43
Which of the following indicate a poor cancer prognosis? Select 3
A) 2 or more brain metastases
B) Patients spends 10 hrs in bed
C) 2 or less brain metastases
D) Spinal cord compression
E) Weight loss > 10% in 6 months
A) 2 or more brain metastases
D) Spinal cord compression with limited mobility
E) Weight loss > 10% in 6 months
## Footnote
Slide15
44
Which of the following conditions are linked to a median survival of 6 months or less in cancer patients? Select 2
A) Patient spends < ½ day in bed
B) Recurrence of disease after chemotherapy
C) Spinal cord decompression
D) Hepatic, bone, or adrenal metastases
E) Non-Malignant pericardial effusion
B) Recurrence of disease after chemotherapy
D) Hepatic, bone, or adrenal metastases
## Footnote
Slide 15
45
Which types of cancer frequently metastasize to the bone?
A) Breast, lung, kidney, and prostate
B) Colon, liver, and pancreas
C) Skin, liver, and brain
D) Stomach, esophagus, and thyroid
A) Breast, lung, kidney, and prostate
## Footnote
Slide 16
46
One potential intervention for managing bone metastasis pain is ________.
A) Radiation therapy only
B) NSAIDs and/or opioids
C) Surgery only
D) Physical therapy
B) NSAIDs and/or opioids
M - *NSAIDs and opioids can be utilized for pain. There is the risk of addiction with opioids, but if it's a late stage cancer, then we the concern about addiction kind of goes out the window.*
## Footnote
Slide 16
47
Cancer metastasis to the bone can present as _______ lesions.
A) Osteoblastic and osteoclastic
B) Osteclastic and osteolytic
C) Osteolytic and osteoblastic
D) None of the above
C) Both osteolytic and osteoblastic
M - *these metastasis tend to radiate to the bone, and it becomes **very painful**. We can see these osteolytic and osteoblastic lesions as the bone starts to break down and attempts to rebuild itself. We start to see these lesions on X-ray when the cancer has metastasized to the bones.*
## Footnote
Slide 16
48
Which of the following treatments may be used for bone metastasis from cancers like breast or prostate? Select 3
A) Radiotherapy
B) Hormonal therapy
C) Vestibuloplasty
D) Chemotherapy
E) Physical therapy
A) Radiotherapy
B) Hormonal therapy
D) Chemotherapy
## Footnote
Slide 16
49
A potential treatment for spinal fractures caused by bone metastasis is ________.
A) Radiotherapy
B) Vertebroplasty
C) Chemotherapy
D) Hormonal therapy
B) Vertebroplasty
M - mets to the spine, causes the bones to weaken and ultimately start to compress on those spinal nerves. Vertebroplasty is when they inject cement and it builds up collapsed vertrebra and open up the spaces and relieve the nerve pain on those spinal nerves. This can be a good kind of **palliative treatment.**
## Footnote
Slide 16
50
What is the primary cause of cancer pain?
A) Damage from chemotherapy
B) Tumor invading tissues innervated by afferent neurons
C) Treatment with radiation therapy
D) Emotional stress from diagnosis
B) Tumor invading tissues innervated by afferent neurons
## Footnote
Slide 17
51
Which of the following are common causes of higher cancer pain?
(Select 3)
A) Invasion of tumor into the pleura
B) Direct invasion of the nerve plexus
C) Emotional stress
D) Side effects from medication
E) Invasion of tumor into the peritoneum
A) Invasion of tumor into the pleura
B) Direct invasion of the nerve plexus
E) Invasion of tumor into the peritoneum
## Footnote
Slide 17
52
# True or False
Most cancer pain is due to the cancer itself and not the treatment.
True
## Footnote
Slide 17
53
According to the WHO cancer pain stepladder, pain medications should be administered:
Select 2
A) When requested by the patient
B) Promptly and on a regular schedule
C) After a delay to assess the severity of the pain
D) As the patient’s pain decreases
A) When requested by the patient
B) Promptly and on a regular schedule
M - *..when a patient says that they're hurting, they're immediately given something for pain. There's no wait for a schedule. It's prompt administration of pain medicine.*
*The second one is that they also have a pain schedule that's **not PRN but a prophylactic.** You know, every three hour or every four hour around the clock pain medicine that they're receiving.*
## Footnote
Slide 18
54
_________ are added as necessary in cancer pain management.
A) Anxiolytics
B) PPI
C) Antibiotics
D) Anticoagulants
A) Anxiolytics
## Footnote
Slide 18
55
What is the effectiveness of the WHO cancer pain stepladder when all three interventions are applied?
A) 50-60%
B) 70-80%
C) 80-90%
D) 90-100%
C) 80-90%
M - *What they found is that when these patients receive all three of these interventions, (Prompt administration
On schedule; not prn and antianxiety drugs), they we see about an 80 to 90% effectiveness in relieving pain and anxiety associated with cancer.*
## Footnote
Slide 18
56
Nerve blocks for cancer pain are primarily used when:
Select 2
A) The patient does not want to take medications
B) Pharmacologic treatments fails
C) Persistant pain or excessive side effects
D) The patient is allergic to opioids
B) Pharmacologic treatments fails
C) Persistant pain or excessive side effects
## Footnote
slide 19
57
Nerve blocks are mostly used for patients with __________ life expectancy in cancer pain management.
A) Long
B) Short
C) Indefinite
D) Intermediate
B) Short
## Footnote
Slide 19
58
While nerve blocks can decrease opioid usage, the pain relief provided is usually __________.
A) Permanent
B) Effective
C) Complete
D) Incomplete
D) Incomplete
## Footnote
Slide 19
59
Which cancers are commonly treated with a celiac plexus block? select 3
A. Hepatic
B. Gastric
C. Lung
D. Pancreatic
E. Rectal
A. Hepatic
B. Gastric
D. Pancreatic
## Footnote
Slide 20
60
The celiac plexus block involves neurolysis of the sympathetic fibers of ________ and **parasympathetic celiac plexus** fibers.
A. T1-T4
B. T5-T12
C. L1-L5
D. T8-L2
B. T5-T12
## Footnote
Slide 20
61
In celiac plexus neurolysis, __________ is injected to deaden the nerves and block pain transmission signals.
A. Lidocaine
B. Morphine
C. Alcohol
D. Epinephrine
C. Alcohol
## Footnote
Slide 20
62
Pain relief from a celiac plexus block lasts for how long?
A. 1-2 months
B. 3-6 months
C. 6-12 months
D. Over a year
B. 3-6 months
## Footnote
Slide 20
63
Which of the following are side effects of a celiac plexus block? select 2
A. Diarrhea
B. Hypertension
C. Hypotension
D. Bradycardia
A. Diarrhea
C. Hypotension
## Footnote
Slide 20
64
Which nerve block is most often used for rib metastasis?
A. Celiac plexus
B. Intercostal nerves
C. Lumbar sympathetic ganglion
D. Hypogastric plexus
B. Intercostal nerves
## Footnote
Slide 20
65
The lumbar sympathetic ganglion block can help alleviate pain associated with which of the following conditions?
A. Pelvic tumors
B. Rib metastasis
C. Gastric cancer
D. Pancreatic cancer
A. Pelvic tumors
M - *very helpful in pelvic tumors related to things like ovarian cancers and uterine cancers and things like that.*
## Footnote
Slide 20
66
Which of the following are benefits of continuous catheter techniques? (Select 2)
A. Decrease in systemic side effects
B. Lack of homogenous drug distribution
C. Ubiquitous technique and equipment
D. Granulomas
A. Decrease in systemic side effects
C. Ubiquitous technique and equipment
## Footnote
Slide 21
67
Which of the following is **NOT** a drawback of continuous catheter techniques?
A. Granulomas formation
B. Limited duration of therapy
C. Migration of the catheter
D. Unlimited therapy duration
E. Infection rates
F. Lack of homogenous drug distribution
D. Unlimited therapy duration
## Footnote
Slide 21
68
Chemotherapy is used to target cells in different phases of:
A. The immune system
B. The respiratory cycle
C. The cell cycle
D. The digestive system
C. The cell cycle
## Footnote
slide 23
69
Chemotherapy can be used to prepare patients for:
A) Bone marrow transplant
B) Surgery
C) Radiation therapy
D) Immunotherapy
A) Bone marrow transplant
## Footnote
Slide 23
70
Chemotherapy is commonly used to:
Select 2
A) Kill cancer cells
B) Promote cell growth
C) Shrink tumors
D) Regenerate healthy tissue
A) Kill cancer cells
C) Shrink tumors,
## Footnote
Slide 23
71
Chemotherapy is sometimes used to control ________ immune diseases, such as lupus and rheumatoid arthritis.
A) underactive
B) overactive
C) suppressed
D) genetic
B) overactive
M - *certain autoimmune diseases where the immune system is haywire, like lupus, rheumatoid arthritis, multiple sclerosis..*
## Footnote
Slide 23
72
Alkylating agents damage cell DNA, making cells _______ to reproduce.
A) able
B) unable
C) slow
D) programmed
B) unable
## Footnote
Slide 24
73
Which of the following are true about alkylating agents?
Select 3
A) Work in all phases of cell cycle
B) They only work in the S phase of the cell cycle.
C) They treat various types of cancer.
D) They increase the risk of leukemia after treatment.
E) Treat only small amounts of specific cancer
A) Work in all phases of cell cycle
C) They treat various types of cancer.
D) They increase the risk of leukemia after treatment.
## Footnote
Slide 24
74
Alkylating agents can lead to dose dependent leukemia _________ years after treatment.
A) 1-5
B) 1-7
C) 5-10
D) 5-12
C) 5-10
## Footnote
Slide 24
75
Nitrosoureas are alkylating agents that can cross the _______.
A) blood-brain barrier
B) immune system
C) digestive tract
D) lungs
A) blood-brain barrier
Good for brain tumors
## Footnote
Slide 24
76
An example of an alkylating agent that can cross the blood-brain barrier is:
A) Methotrexate
B) Cisplatin
C) Vincristine
D) Paclitaxel
B) Cisplatin
M - *cisplatin has the s/e of peripheral neuropathy and acute renal failure when it's given along with NSAIDs*
## Footnote
slide 24
77
Antimetabolites interfere with ________ and **DNA** by acting as substitutes for normal building blocks.
A) Proteins
B) RNA
C) Lipids
D) Enzymes
B) RNA
## Footnote
Slide 25
78
Antimetabolites are used to treat:
Select 4
A) Breast cancer
B) Fallopian cancer
C) Leukemia
D) Intestinal cancer
E) Liver cancer
F) Ovarian cancer
A) Breast cancer
C) Leukemia
D) Intestinal cancer
F) Ovarian cancer
M - *they are effective on both solid tumors and blood tumors.*
## Footnote
Slide 25
79
Which of the following are examples of antimetabolites?
Select 2
A) Methotrexate
B) Bleomycin
C) Cisplatin
D) 5-FU
A) Methotrexate
D) 5-FU
## Footnote
Slide 25
80
Examples of anti-tumor antibiotics include: select 3
A) Doxorubicin
B) Bleomycin
C) Mitomycin-C
D) Methotrexate
A) Doxorubicin - *adriamycin*
B) Bleomycin
C) Mitomycin-C
**"rubicins"**
## Footnote
Slide 26
81
Anti-tumor antibiotics have a lifetime dose limit because of their potential to damage which organ?
A) Liver
B) Kidneys
C) Heart
D) Lungs
C) Heart
*This happens in large doses*
## Footnote
Slide 26
82
Which chemotherapy agents have the potential to cause pulmonary toxicity?
A) Bleomycin
B) Methotrexate
C) Doxorubicin
D) 5-FU
A) Bleomycin
M - *Instances of pulmonary oxygen toxicity whenever patients are on bleomycin and they receive high levels of oxygen*
## Footnote
Slide 26
83
Topoisomerase inhibitors are a type of _______ alkaloid that prevent DNA strands from separating to copy.
A) Plant
B) Bacterial
C) Fungal
D) Synthetic
A) Plant
## Footnote
Slide 27
84
Topoisomerase inhibitors can be used to treat all of these **except**:
A) Ovarian cancer
B) Leukemias
C) Colorectal cancer
D) Brain cancer
E) Pancreatic cancer
F) GI cancer
G) Lung cancer
D) Brain cancer
## Footnote
Slide 27
85
Topoisomerase inhibitors increase the risk of:
A) Developing a second cancer
B) Increased heart rate
C) Developing resistance to chemotherapy
D) Renal toxicity
A) Developing a second cancer
## Footnote
Slide27
86
Mitotic inhibitors are plant alkaloids that damage cells in **all phases** by:
A) Preventing DNA from being copied
B) Blocking RNA replication
C) Preventing protein synthesis
D) Stimulating immune response
C) Preventing protein synthesis
## Footnote
Slide 28
87
A potential side effect of mitotic inhibitors is ______ neuropathy.
A) Central
B) Peripheral
C) Visceral
D) Autonomic
B) Peripheral
M - *peripheral neuropathy is a pretty mild side effect to have. If a patient can beat cancer and have peripheral neuropathy, I would call that a win.*
## Footnote
Slide 28
88
Which of the following is true about targeted therapy?
A) It affects both cancer cells and normal cells equally.
B) It uses specific proteins or receptors on cancer cells.
C) It suppresses the immune system by targeting specific protiens
D) It targets normal cells to attack cancer cells
B) It uses specific proteins or receptors on cancer cells.
*Normal cells are NOT affected*
## Footnote
Slide 29
89
Hormone therapy is used to:
Select 2
A) Prevent the body from making hormones
B) Speed up cancer cell growth
C) Slow down hormonal tumors
D) Enhance immune response
A) Prevent the body from making hormones
C) Slow down hormonal tumors
## Footnote
slide 29
90
Hormone therapy is commonly used to slow the growth of which types of tumors?
A) Brain, breast and uterine
B) Breast, stomach and liver
C) Breast, prostate, and uterine
D) Prostate, kidney and pancreas
C) Breast, prostate, and uterine
## Footnote
Slide 29
91
Immunotherapy helps (2):
A) Better recognize cancer cells
B) Suppress the immune system
C) Boost the immune system
D) Prevent protein synthesis
A) Better recognize cancer cells
C) Boost the immune system
## Footnote
Slide 29
92
Chemotherapy is most likely to damage cells that form blood in the ______.
A) Liver
B) Kidneys
C) Bone marrow
D) Brain
C) Bone marrow
M - *We see neutropenia, a drop in red blood cell production and white blood cell production. These patients are often on neutropenic precautions and need to be pretty isolated because they are going to be immunocompromised*
## Footnote
Slide 30
93
One of the common side effects of chemotherapy is hair loss, as it damages ______.
A) Skin cells
B) Hair follicles
C) Bone cells
D) Blood vessels
B) Hair follicles
## Footnote
Slide 30
94
Cells in which of the following areas are most susceptible to damage from chemotherapy?
Select 3
A) Mouth
B) Liver
C) Digestive tract
D) Reproductive system
E) Spleen
A) Mouth
C) Digestive tract
D) Reproductive system
M - *these patients experience ulcers in the mouth or the GI tract. This can affect their appetite and their nutrition and they are placed on appetite stimulants to increase their intake to help reduce nutritional deficits while they're trying to get over this cancer.*
## Footnote
Slide 30
95
According to the 2011 American Society of Clinical Oncology Practice Guidelines, one possible addition to treat chemotherapy-induced N/V is a ______ antagonist, which may inhibit hormonal contraceptives for up to 28 days.
A) 5HT3
B) NK1 (neurokinin-1)
C) Dopamine
D) Histamine
B) NK1 (neurokinin-1)
**Aprepitant (neurokinin 1 antagonist)**
*"Third in line drug to give"*
## Footnote
slide 31
96
What class of drugs is recommended for treating N/V in chemotherapy according to the 2011 guidelines?
A) Dopamine antagonists and anxiolytics
B) 5HT3 antagonists and dexamethasone
C) NSAIDs and anxiolytics
D) 5HT3 and anticholinergics
B) 5HT3 antagonists and dexamethasone
## Footnote
slide 31
97
Which of the following is more effective than phenothiazines (prochlorperazine or chlorpromazine) for N/V related to chemotherapy?
A) Antihistamines
B) Marijuana
C) 5HT3 antagonists
D) Proton pump inhibitors
B) Marijuana
## Footnote
slide 31
98
Marijuana has which of the following effects related to chemotherapy-induced N/V?
select 2
A) Depresses CNS vomiting center
B) Is less effective than phenothiazines
C) Decreases anesthetic requirements
D) Increases risk of constipation
A) Depresses CNS vomiting center
C) Decreases anesthetic requirements **by 15-30%**
## Footnote
Slide 31
99
Patients who have had radiation to their neck will need to have their __________ assessed for possible complications during surgery.
A. Heart
B. Airway
C. Circulation
D. Pancreas
B. Airway
M - *if they had radiation to their neck, then we'll need to assess their airway and their range of motion. They have severely limited range of motion d/t their tissues getting stiff and rigid, so they they're going to be more prone to be difficult Airways.*
## Footnote
Slide 33
100
A patient may need to pause chemotherapy treatment due to excessive __________.
Select 2
A. Immunocompromise
B. Hair loss
C. Hypotension
D. Headaches
A. Immunocompromise
C. Hypotension
M - *did they experience during chemo and did they have to pause or stop their treatment for any specific reason due to excessive side effects like significant hypotension, significant immunocompromised to where they're they're more sensitive to just day-to-day viruses, and so if they're if they're too immunocompromised*
## Footnote
Slide 33
101
Radiation treatment can cause a ___ increase in embolic events in the peripheral vascular system.
A. 2x
B. 4x
C. 6x
D. 8x
C. 6x
*Evidence of DVTs?*
## Footnote
Slide 34
102
Which of the following is a condition that may arise after radiation therapy for head/neck cancers?
A. Hypertension
B. Hypothyroidism
C. Hyperthyroidism
D. Diabetes
B. Hypothyroidism
*Get thyroid function tests*
## Footnote
Slide 34
103
During radiation therapy assessments for carotid artery disease, clinicians should ______ for bruits.
A. Palpate
B. Auscultate
C. Inspect
D. Percuss
B. Auscultate
*Carotid doppler studies*
## Footnote
Slide 34
104
# True or False
Cancer patients are more prone to airway management issues because of their stiff tissues due to radiation.
True
## Footnote
Slide 34
105
What are the potential effects of radiation on the chest wall and/or left breast? (Select 4 that apply)
A) Pericarditis
B) Cardiomyopathy
C) Valvular abnormalities
D) Dysrhythmias
E) Pulmonary embolism
F) Aortic dissection
A) Pericarditis
B) Cardiomyopathy
C) Valvular abnormalities
D) Dysrhythmias
*EKG and the stress test and/or echo as needed*
## Footnote
Slide 35
106
Which of the following is a potential complication of radiation therapy to the lungs, breast, or mediastinum?
A) Pulmonary embolism
B) Pleural effusion
C) Radiation pneumonitis
D) Tuberculosis
C) Radiation pneumonitis
## Footnote
Slide 35
107
Which of the following tests may be used to evaluate a patient for radiation pneumonitis? (Select 3 that apply)
A) Oxygen saturation (O2 sats)
B) Chest X-ray (CXR)
C) Pulmonary Function Tests (PFTs)
D) Electrocardiogram (ECG)
E) Blood cultures
A) Oxygen saturation (O2 sats)
B) Chest X-ray (CXR)
C) Pulmonary Function Tests (PFTs) *if needed*
## Footnote
Slide 35
108
# True or False
You'll need to keep FiO₂ at a higher level when a patient is taking Bleomycin.
FALSE
You'll need to keep FiO₂ at a **LOWER level** when a patient is taking Bleomycin.
## Footnote
Slide 36
109
Which chemotherapeutic agent is associated with the development of cardiomyopathy?
A) Methotrexate
B) Paclitaxel
C) Adriamycin
D) Cisplatin
C) Adriamycin
(Doxorubicin)
Morde: *So we talked about Adriamycin, which is Doxorubicin. We want your patients to have a cardiac work up*
Memory Trick: **Adria Cardia**
## Footnote
Slide 36
110
Which chemotherapeutic agent is known to cause pulmonary toxicity?
A) Doxorubicin
B) Cisplatin
C) Methotrexate
D) Bleomycin
D) Bleomycin
Morde: *We talked about Bleomycin.
They're more at risk for pulmonary toxicity related to high oxygen levels.
So this oxygen toxicity causes pulmonary damage in their in these patients.*
Memory Trick: **Bleo Pulmo**
## Footnote
Slide 36
111
Which of the following chemotherapeutic agents are known to cause peripheral neuropathy? (Select 2 that apply)
A) Cisplatin
B) Doxorubicin
C) Vincristine
D) Methotrexate
E) Bleomycin
A) Cisplatin
C) Vincristine (mitotic inhibitor)
## Footnote
Slide 36
112
What preoperative abnormalities might be seen in a cancer patient? (Select 4 that apply)
A) Anemia
B) Neutropenia
C) Thrombocytopenia
D) Hypercalcemia
E) Hypokalemia
**A) Anemia** (↓ RBCs)
**B) Neutropenia** (↓ WBCs)
**C) Thrombocytopenia** (↓ PLTs)
Morde: *Remember 'cause, this chemotherapy isn't usually very precise on which cells it's attacking. So our good immune cells get attacked too.*
**D) Hypercalcemia** (↑ Ca⁺⁺)
Morde: *due to either bone bone breakdown or kidney impairment or both*
## Footnote
Slide 37
113
Why is hypercalcemia common in cancer patients?
A) Increased calcium absorption from the intestines
B) Decreased osteoclast activity
C) Many drugs are toxic to the bone marrow, liver, and kidneys, contributing to calcium imbalances
D) Reduced renal excretion of calcium due to liver toxicity
C) Many drugs are toxic to the bone marrow, liver, and kidneys, contributing to calcium imbalances
## Footnote
Slide 37
114
Why is adrenal insufficiency commonly seen in cancer patients?
A) Chemotherapy-induced renal toxicity
B) Use of steroid treatments
C) Radiation therapy to the brain
D) Bone marrow suppression
B) Use of steroid treatments
## Footnote
Slide 37
115
Which test is commonly used to diagnose adrenal insufficiency?
A) Thyroid function test
B) ACTH stimulation test
C) D-dimer test
D) Serum calcium test
B) ACTH stimulation test
## Footnote
Slide 37
116
Why is tumor resection a risk factor for tumor recurrence? (Select 3 that apply)
A) Tumor cells can spread into the bloodstream
B) Residue remains behind
C) Localized spread via lymphatics
D) Tumor cells are completely eliminated during resection
A) Tumor cells can spread into the bloodstream
B) Residue remains behind
C) Localized spread via lymphatics
## Footnote
Slide 38
117
Which of the following is **NOT** a factor contributing to relative immunosuppression that can occur due to surgery?
A) Inflammatory response
B) Surgical stress
C) Effects of anesthesia
D) Complete immune activation during surgery
E) Administration of opioids
D) Complete immune activation during surgery
## Footnote
Slide 38
118
Which of the following are effects of inflammation from tissue trauma and physiological stress in relation to cancer? (Select 3 that apply)
A) Activation of overexpression of COX-2 genes
B) Suppression of prostaglandin and thromboxane production
C) Catalysis of prostaglandins and thromboxane from arachidonic acid
D) Elevated COX-2 levels promote cell survival and cancer growth
E) Stimulation of NK cells to destroy cancer cells
A) Activation of overexpression of COX-2 genes
C) Catalysis of prostaglandins and thromboxane from arachidonic acid
D) Elevated COX-2 levels promote cell survival and cancer growth
*May suppress NK cells*
## Footnote
Slide 39
119
How long can inflammation and stress last after surgery?
A) Hours
B) Days
C) Weeks
D) Months
C) Weeks
Morde: *It doesn't go away as soon as the surgery is over, but it's going to continue to ride out for for several weeks.*
## Footnote
Slide 39
120
β adrenergic receptors signaled by the fight or flight response at the __ of tumor growth and metastasis will __ cancer cell activity via nerve fiber delivery of __.
A) Center, downregulate, dopamine
B) Margins, inhibit, serotonin
C) Sites, upregulate, norepinephrine
D) Blood vessels, decrease, acetylcholine
C) Sites, upregulate, norepinephrine
norepinephrine
β adrenergic receptors signaled by the fight or flight response at the **sites** of tumor growth and metastasis will **upregulate** cancer cell activity via nerve fiber delivery of **norepinephrine**.
| (summary)
## Footnote
Slide 39
121
Which of the following are effects of opioids related to cancer progression? Select 3
A) Inhibit leukocyte migration
B) Directly stimulate proliferation and invasion of cancer cells
C) Promote apoptosis through NK cell activity
D) Inhibit apoptosis by inhibiting NK cell activity
A) Inhibit leukocyte migration
B) Directly stimulate proliferation and invasion of cancer cells
D) Inhibit apoptosis by inhibiting NK cell activity
## Footnote
Slide 40
122
Which of the following are potential effects of volatile anesthetics related to cancer progression? Select 3
A) Increase migration and invasion by affecting platelets
B) Induce chemo resistance
C) Enhance NK cell activity
D) Inhibit NK cells
A) Increase migration and invasion by affecting platelets
B) Induce chemo resistance
D) Inhibit NK cells
## Footnote
Slide 40
123
What effects does propofol have on cancer cells?
A) Increases cell migration and inhibits apoptosis
B) Decreases cell migration and promotes apoptosis
C) Inhibits apoptosis and enhances invasion
D) Stimulates NK cell inhibition
**B) Decreases cell migration**
*Down regulates signaling pathways*
and
**promotes apoptosis**
*Promotes cytotoxicity of NK cells*
## Footnote
Slide 40
124
Long-term administration of NSAIDs _______ proliferation of cancer cells.
A) Increases
B) Decreases
C) Has no effect on
D) Enhances
B) Decreases
## Footnote
Slide 40
125
According to the study by Weng M. et al., what effect does neuraxial anesthesia have on colorectal cancer outcomes after surgery?
A) Increases cancer recurrence and decreases survival
B) Reduces cancer recurrence and improves survival
C) Has no impact on cancer recurrence or survival
D) Increases cancer recurrence but improves survival
B) Reduces cancer recurrence and improves survival
## Footnote
Slide 41
126
According to the study by Sessler DI et al. on breast cancer recurrence, what was the recurrence rate in patients who received regional anesthesia/sedation with paravertebral block and propofol compared to those who received general anesthesia with sevoflurane and opioids?
A) 20% recurrence in the regional anesthesia group and 10% in the general anesthesia group
B) 15% recurrence in both groups
C) 10% recurrence in both groups
D) 5% recurrence in the regional anesthesia group and 15% in the general anesthesia group
C) 10% recurrence in both groups
## Footnote
Slide 42
127
According to Sessler DI and Riedel BR in their study on anesthesia and cancer recurrence, the degree of biological upset is most dependent on which factor?
A) Type of anesthesia used
B) Duration of surgery
C) Degree of surgical insult
D) Patient's age and comorbidities
**C) Degree of surgical insult**
Anesthetic management potentially influences long-term outcome:
* Regional anesthesia
* B-antagonists, NSAID, lidocaine
* Propofol vs volatile
## Footnote
Slide 43
128
__ is the leading cause of cancer deaths in both genders.
A) Breast cancer
B) Lung cancer
C) Prostate cancer
D) Colorectal cancer
B) Lung cancer
*Due to peak in smoking 1940-1970*
## Footnote
Slide 45
129
What is the primary cause of lung cancer, accounting for approximately 90% of cases?
A) Radon gas
B) Asbestos
C) Tobacco smoke
D) Air pollution
C) Tobacco smoke
*3 decade lag time in cancer occurrence*
## Footnote
Slide 45
130
Which of the following substances, other than tobacco, are known to cause lung cancer? select 2
A) Asbestos
B) Radon gas
C) Lead
D) Carbon monoxide
A) Asbestos
B) Radon gas
## Footnote
Slide 45
131
Which of the following are types of lung cancer? (Select all that apply)
A) Small cell lung cancer
B) Non-small cell lung cancer
C) Carcinoid tumor
D) Mesothelioma
A) Small cell lung cancer
B) Non-small cell lung cancer
C) Carcinoid tumor
D) Mesothelioma
## Footnote
Slide 46
132
Which of the following are subtypes of non-small-cell lung cancer (NSCLC)? (Select 3 that apply)
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Large cell carcinoma
D) Mesothelioma
A) Squamous cell carcinoma
B) Adenocarcinoma
C) Large cell carcinoma
## Footnote
Slide 46
133
# True or False
Non-small cell lung cancer makes up 75-80% of all lung cancer cases.
True
## Footnote
Slide 46
134
Which of the following are true about small cell lung cancer (SCLC)? (Select 2 that apply)
A) It is neuroendocrine in origin
B) It is considered metastatic on presentation
C) It is typically localized on presentation
D) It is mesothelial in origin
E) It is slow-growing
A) It is neuroendocrine in origin
B) It is considered metastatic on presentation
*Staging is only ”limited” or “extensive”*
## Footnote
Slide 47
135
# True or False
Small cell lung cancer is always curable and never recurs after initial treatment.
FALSE
Small cell lung cancer **always recurs and is resistant to further treatment**
Morde: *So there's generally a pretty poor prognosis and low survival rate with small cell lung cancers.*
## Footnote
Slide 47
136
What are the 2 common treatment options for small cell lung cancer (SCLC)?
A) Surgery
B) Chemotherapy
C) Radiation of the tumor and cranium (prophylactically)
D) Immunotherapy
B) Chemotherapy
C) Radiation of the tumor and cranium (prophylactically)
## Footnote
Slide 47
137
Which of the following are potential major side effects of small cell lung cancer (SCLC)? (Select 3 that apply)
A) Hyponatremia (↓ Na⁺)
B) Hypercortisolism
C) Lambert-Eaton Syndrome
D) Hypercalcemia
A) Hyponatremia (↓ Na⁺)
*SIADH*
B) Hypercortisolism
C) Lambert-Eaton Syndrome
## Footnote
Slide 48
138
What is the medical term for hypercortisolism?
A) Addison's Disease
B) Graves' Disease
C) Cushing's Disease
D) Hashimoto's Disease
C) Cushing's Disease
## Footnote
Slide 48
139
Lambert-Eaton syndrome symptoms get __ with exercise throughout the day.
A) Worse
B) Better
C) No change
D) Unpredictable.
B) Better
## Footnote
Slide 48
140
Myasthenia Gravis symptoms get __ throughout the day, especially with exercise and movement.
A) Stronger
B) Weaker
C) No change
D) Better
B) Weaker
## Footnote
Slide 48
141
Which of the following is NOT true about Lambert-Eaton Syndrome?
A) It is also called myasthenic syndrome
B) It is characterized by proximal lower limb weakness and fatigability
C) It is identical to myasthenia gravis
D) It is similar to myasthenia gravis but has distinct differences
C) It is identical to myasthenia gravis
## Footnote
Slide 48
142
Which of the following are true regarding Lambert-Eaton Syndrome? (Select 2 that apply)
A) It does not improve with acetylcholinesterase inhibitors
B) It is extremely sensitive to non-depolarizing neuromuscular blocking agents
C) It worsens with exercise throughout the day
D) It improves with acetylcholinesterase inhibitors
A) It does not improve with acetylcholinesterase inhibitors
B) It is extremely sensitive to non-depolarizing neuromuscular blocking agents
## Footnote
Slide 48
143
Which Carcinoid tumor type is mostly benign and has a greater than 90% five-year survival rate?
A) Small cell lung cancer
B) Non-small cell lung cancer
C) Neuroendocrine tumors
D) Mesothelioma
C) Neuroendocrine tumors
## Footnote
Slide 49
144
Carcinoid syndrome is usually caused by tumors of which part of the body?
A) Lungs
B) Brain
C) GI tract
D) Skin
C) GI tract
## Footnote
Slide 49
145
Which of the following is NOT a characteristic of Carcinoid Syndrome?
A) Tumor secretion of serotonin, histamine, prostaglandins, and tachykinins
B) Hemodynamic collapse unresponsive to pressors
C) Coronary artery spasm
D) Complete cure with simple surgical resection
D) Complete cure with simple surgical resection
## Footnote
Slide 49
146
What are the main treatments for Carcinoid Syndrome?
A) Chemotherapy and radiation
B) Octreotide and somatostatin
C) Corticosteroids and beta blockers
D) Antibiotics and immunotherapy
B) Octreotide and somatostatin
*These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.*
## Footnote
Slide 49
147
Which type of lung cancer is pathologically heterogeneous and has a 5-year survival rate that greatly improves with surgery?
A) Small cell lung cancer
B) Non-small cell lung cancer
C) Mesothelioma
D) Carcinoid tumors
B) Non-small cell lung cancer
- 10% w/o surgery
- 40% w/ surgery
## Footnote
Slide 50
148
Squamous cell lung cancers grow to a large size but __ late.
A) Metastasize
B) Resolve
C) Shrink
D) Proliferate
A) Metastasize
## Footnote
Slide 51
149
Which symptoms are related to the mass effect of squamous cell lung cancer? (Select all that apply)
A) Hemoptysis
B) Obstructive pneumonia
C) Superior vena cava syndrome
D) Endobronchial tumor
A) Hemoptysis
B) Obstructive pneumonia
C) Superior vena cava syndrome
D) Endobronchial tumor
## Footnote
Slide 51
150
What is the most common subtype of non-small cell lung cancers (NSCLC)?
A) Squamous cell carcinoma
B) Large cell carcinoma
C) Adenocarcinoma
D) Small cell lung cancer
C) Adenocarcinomas
## Footnote
Slide 52
151
Which of the following is NOT commonly affected by adenocarcinoma of the lung?
A) Brain
B) Bone
C) Liver
D) Adrenals
E) Chest wall
F) Diaphragm
G) Stomach
H) Pericardium
G) Stomach
## Footnote
Slide 52
152
Adenocarcinomas will typically metastasize ___.
A) Earlier
B) Later
C) Very late
D) At the same time as other cancers
E) Never
A) Earlier
Adenocarcinomas will typically metastasize **earlier**.
## Footnote
Slide 52
153
Which two hormones are typically secreted by adenocarcinomas?
A) Thyroid hormone and cortisol
B) Growth hormone and ACTH
C) Insulin and glucagon
D) Epinephrine and norepinephrine
B) Growth hormone and ACTH
causing:
* Insulin resistance…to diabetes
* Dyslipidemia
* Moon facies
* Buffalo hump
* Delayed wound healing
* Avascular necrosis of the femoral head
* Osteoporosis
## Footnote
Slide 52
154
Which of the following are characteristics of large-cell lung cancer? (Select 3 that apply)
A) It is the least common of the non-small cell lung cancers (NSCLC)
B) It metastasizes rapidly
C) It forms large cavitating tumors
D) It is slow-growing and rarely metastasizes
A) It is the least common of the non-small cell lung cancers (NSCLC)
B) It metastasizes rapidly
C) It forms large cavitating tumors
## Footnote
Slide 53
155
Which of the following should be assessed in patients with lung cancer? (Select 4 that apply)
A) Mass effect
B) Metastases
C) Increased renal function
D) Medication-related complications
E) Decreased risk of blood clots
F) Metabolic abnormalities
A) Mass effect
B) Metastases
D) Medication-related complications
*Bleomycin: oxygen-induced pulmonary toxicity;
Cisplatin: ARF with NSAIDS*
F) Metabolic abnormalities
*Hypercalcemia, hyponatremia, hyperglycemia (Cushings)*
Memory Trick: **"4 Ms of Lung Cancer"**
## Footnote
Slide 54
156
Which chemotherapeutic agent, when combined with NSAIDs, can induce acute renal failure?
A) Bleomycin
B) Doxorubicin
C) Cisplatin
D) Methotrexate
C) Cisplatin
## Footnote
Slide 54
157
Which of the following are preoperative considerations for lung surgery? (Select all that apply)
A) Care with sedation
B) Antisialagogues
C) SCIP antibiotics
D) Assess difficulty of lung isolation
E) Assess risk of hypoxemia during one-lung ventilation
**A) Care with sedation**
*Mild with placement of monitoring lines*
**B) Antisialagogues**
*May help with fiberoscopy for DLT placement*
**C) SCIP antibiotics**
**D) Assess difficulty of lung isolation**
*CXR/CT*
**E) Assess risk of hypoxemia during one-lung ventilation**
## Footnote
Slide 55
158
High % of V/Q to operative lung on the preoperative V/Q scan.Which of the following is **NOT** a factor that can help predict one-lung desaturation?
A) High percentage of ventilation/perfusion (V/Q) to the operative lung on the preoperative V/Q scan
B) Poor PaO₂ during two-lung ventilation
C) Right-sided thoracotomy
D) High PaO₂ during two-lung ventilation
D) High PaO₂ during two-lung ventilation
Factors Predicting 1-lung desaturation:
* High % of V/Q to operative lung on the preoperative V/Q scan.
* Poor PaO₂ during two lung ventilation
*Especially in the lateral position*
* Right sided thoracotomy
## Footnote
Slide 57
159
# True or False
In a V/Q scan, the darker the area, the more perfusion is present in that region.
True
Morde: *So resecting areas that are darker is going to result in a more dramatic change in the VQ*
## Footnote
Slide 58
160
What is the formula for predicted post-operative FEV₁ ?
A) (Preop FEV₁ %) x (1 - % of body weight / 100)
B) (Preop FEV₁ %) x (1 - % of lung tissue removed / 100)
C) (Preop FEV₁ %) ÷ (1 - % of lung tissue removed / 100)
D) (Preop FEV₁ %) ÷ (1 - % of total lung capacity)
B) (Preop FEV₁ %) x (1 - % of lung tissue removed / 100)
## Footnote
Slide 59
161
A patient has had a right upper and right middle lobectomy done. The patients preoperative FEV₁ was 60%. What is the predicted post-operative FEV₁ ?
RUL = 6 segment
RML = 4 segment
6 + 4 = 10 segments
10 / 42 total segments = 23.8 %
ppoFEV₁ = 60 x (1 - 23.8/100)
**ppoFEV₁ = 45.72%**
## Footnote
Slide 59
162
Which of the following are commonly used for post-thoracotomy/thoracoscopy analgesia? (Select all that apply)
A) Epidural
B) Paravertebral blocks
C) NSAIDs
D) Opioids
A) Epidural
B) Paravertebral blocks
C) NSAIDs
D) Opioids
## Footnote
Slide 60
163
According to the American Society of Regional Anesthesia and Pain Medicine guidelines, which of the following factors are included in their protocols regarding epidural management after thrombolytic therapy? (Select 3 that apply)
A) How long you need to wait before placing an epidural after the last dose of thrombolytic therapy
B) How long you need to wait to turn on the epidural
C) How long you need to wait before pulling the catheter out at the end of the case
D) The patient's platelet count before the procedure
E) How long to wait after administering opioids
A) How long you need to wait before placing an epidural after the last dose of thrombolytic therapy
B) How long you need to wait to turn on the epidural
C) How long you need to wait before pulling the catheter out at the end of the case
## Footnote
Slide 61-62
164
How many dermatomes are typically covered by a single shot of a paravertebral block?
A) 1-2 dermatomes
B) 2-4 dermatomes
C) 4-6 dermatomes
D) 6-8 dermatomes
C) 4-6 dermatomes
## Footnote
Slide 63
165
How do paravertebral blocks work?
A) They block spinal nerves as they exit the intervertebral foramen
B) They block the spinal cord directly
C) They block peripheral nerves in the limbs
D) They block the brachial plexus
A) They block spinal nerves as they exit the intervertebral foramen
* more sensitive to LA
## Footnote
Slide 63
166
Which of the following are indications for paravertebral blocks? (Select all that apply)
A) Fractured ribs
B) Benign/malignant neuralgia
C) Lung contusions
D) Major surgeries
A) Fractured ribs
B) Benign/malignant neuralgia
C) Lung contusions
D) Major surgeries
## Footnote
Slide 63
167
Which of the following are contraindications for paravertebral blocks? (Select all that apply)
A) Site infection
B) Empyema
C) Paravertebral tumor
D) Kyphoscoliosis
A) Site infection
B) Empyema
C) Paravertebral tumor
D) Kyphoscoliosis
## Footnote
Slide 63
168
A paravertebral block at which vertebral level is necessary for a sternotomy?
A) T2
B) T4
C) T6
D) T8
B) T4
## Footnote
Slide 64
169
A paravertebral block at which vertebral level is necessary for a thoracotomy?
A) T4
B) T5
C) T6
D) T8
C) T6
## Footnote
Slide 64
170
A paravertebral block at which vertebral level is necessary for abdominal procedures?
A) T6
B) T8
C) T10
D) T12
C) T10
## Footnote
Slide 64
171
What does an intercostal nerve block innervate?
A) Only the abdominal wall
B) Only the chest wall
C) Both the chest and abdominal wall musculature
D) Only the diaphragm
C) Both the chest and abdominal wall musculature
## Footnote
Slide 65
172
What is required for an effective intercostal nerve block?
A) Blockade of only the dermatome at the level of the incision
B) Blockade of 2 dermatomes above and 2 dermatomes below the incision
C) Blockade of 4 dermatomes above the incision only
D) Blockade of 1 dermatome above and 1 dermatome below the incision
B) Blockade of 2 dermatomes above and 2 dermatomes below the incision
## Footnote
Slide 65
173
Which of the following are indications for an intercostal nerve block? (Select 3 that apply)
A) Thorax surgery
B) Upper abdomen surgery
C) Mastectomy
D) Lower extremity surgery
A) Thorax surgery
B) Upper abdomen surgery
C) Mastectomy
## Footnote
Slide 65
174
Which of the following are disadvantages of intercostal nerve blocks? (Select 2 that apply)
A) Pneumothorax
B) Local anesthetic (LA) toxicity with multiple levels of blockade
C) Increased risk of bleeding
D) Limited duration of action
A) Pneumothorax
B) Local anesthetic (LA) toxicity with multiple levels of blockade
## Footnote
Slide 65
175
When performing an intercostal or paravertebral block, which anatomical landmarks are important to identify?
A) Spinous process
B) Tip of the scapula
C) Angle of the rib
D) All of the above
D) All of the above
## Footnote
Slide 65
