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Medcon Rehab III > Oncology: Multiple Myeloma > Flashcards

Oncology: Multiple Myeloma Flashcards

1
Q

What IS Multiple Myeloma?

A

Blood Cx that invades BONE

  • Cancerous plamsa cells that weaken bones
  • *more Af. Americans
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2
Q

Keep in mind w/ Multiple Myeloma…

Cx OF blood..

A
  • Cancer OF blood aka Plasma Cx
    • ​plasma is made IN bones
      • SO bones degrade QUICKLY!!!
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3
Q

Multiple Myeloma defined:

A

Cx of plasma cells of bone marrow

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4
Q

Multiple Myeloma has 3 Criteria:

A
  1. Bone marrow infiltrated w/ 10% or GREATER malignant plasma cells
  2. Presence of Monoclonal PRO in semen or urine
  3. Evidence of systemic diseases
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5
Q

PT’s and involvement w/ MM

A

mostly involved w/ RED FLAGS of MM

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6
Q

Etiology of MM:

A
  1. Unknown
  2. Possible link to radiation/chem exposure and AI disorders
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7
Q

Pathology for MM:

aka HOW BONE MARROW IS MADE

A

SEE PICS

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8
Q

Clinical Manifestation: S/S MM

ORTHOPEDIC

A
  • **BONE PAIN (PT involved here)
    • ​>75%
  • Sk mm wasting​
  • Bone loss/osteoporosis
  • Back pain
  • Bone Fx
    • ​thoracic/lumbar vert, pelvis and ribs
  • Neuropathies due to compression fx
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9
Q

Clinical Manifestations: S/S MM

IMMUNE SYSTEM

A

Recurrent infections

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10
Q

Clinical Manifestations: S/S MM

HEMATOLOGICAL SYSTEM

A
  • ANEMIA
    • ​SOB
    • DOE
    • pallor
    • fatigue
    • weakness
  • HypERcalcemia
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11
Q

Clinical Manifestations: S/S MM

RENAL SYSTEM***

A
  • Renal Insuff’s
    • ​INC Cr
    • INC Ca+
    • INC pH
    • INC Na+
    • INC K+
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12
Q

Clinical Manifestations: S/S MM

GENERAL:

A
  • Gen. weakness
  • UNINTENTIONAL Wt. Loss
    • ​ALWAYS RED FLAG FOR Cx IF WT. LOSS ESP UNINTENTIONAL
  • Fatigue

​

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13
Q

How do we RULE OUT MM as diff. dx?

4 Criteria they COULD HAVE it

A

R/O MM as diff dx in pt w/

  1. >50yo
  2. Mod-Severe pain
  3. Wt. Loss (esp unintentional)
  4. Unexplained fatigue
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14
Q

MM Dx

RED FLAGS FOR DIFF’LY DX’ING BACK PAIN

A
  • Insidious onset (just crept up) of Sx’s
  • PAIN
    • ​persistent pain, unable to relieve w/ diff pos’s
    • interferes w/ sleep*** BIG ONE
    • INCs w/ WB
  • Gen. weakness
  • Wt. Loss
  • Fatigue
  • Pt demographic
    • ​age
    • race
    • gender
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15
Q

NOTE: PTs are instrumental in early detection AND referral to oncologist to diff dx, minimize detrimental 2* effects!!!

A

KNOW THIS!!!!!!!!!!

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16
Q

MM

MEDICAL MANAGEMENT

7:

A
  1. Chemo
  2. Immunosuppressant
  3. Stem Cell transplant (often w/ high doses chemo)
  4. Radiation
  5. Bone Marrow transplant
  6. Orthosis (bracing)
  7. Sx: post-fx OR sig tumor
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17
Q

MM

Medical Management

Immunosuppressants

2:

A
    1. Thalidomide
    1. Dexamethasone
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18
Q

MM

Medical Management

Sx: post-fx OR significant tumor

types:

A
  • Vertebroplasty and Kyplasty
    • essentially cement INTO VB which REINFLATES VB
  • ORIF
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19
Q

PT Role in Oncolgy

*Follows ICF!!!

4 different areas we play a role:

A
  1. Preventative/Prehab
    1. ​improve + MAINTAIN
  2. Restorative
    1. maintain and PREVENT
  3. Supportive
    1. PREVENT
  4. Palliative
    1. No cure, do what you can

*NOTE: pts w/ MM will go thru ALL STAGES

20
Q

PT: Along continuum of the Disease

  1. Prehab or
A

Improve + Maintain

  • Therex
    • LOW int PRE
    • SHORT-bout LOW int aerobic
    • stretching
    • balance
    • education for S/S of Fx
    • Postural training
21
Q

PT: Along continuum of the Disease

  1. Restorative or
A

MAINTAIN+PREVENT

  • Therex to DEC fatigue and mm wasting
  • prevention of injury
    • ​WB precautions
    • NO lifting
  • Maint. function, indep, QOL
22
Q

PT: Along continuum of the Disease

  1. Supportive or
A

PREVENT

*Do the best you can w/ their situation

  • Fall prevention w/ focus on balance, AD’s, etc…
  • Fx prevention
    • no stretching
    • no twisting
    • no lifting
    • WB precautions
23
Q

PT: Along continuum of the Disease

4. Palliative or

A

No cure, do what you can

  • Home adaptations
  • Pt/Family education
  • AROM/AAROM/PROM
  • Bed mobility, transfers, ADLs
24
Q

3 MOST COMMON sites of Metastasis:

A
  1. Lungs
  2. Liver
  3. Bone ***
25
Q

Conceptualizing Cx and metastasis

What happens when dx and down the line?

A
  • Cx usually metastasizes w/in 3-5 yrs of initial Dx & Tx for Dx BUT… metastatic lesions CAN OCCUR 15-20yrs AFTER initial dx——> CAN COME BACK
26
Q

There are 3 Modes of Dissemination

aka HOW Cx travels thru body and metastasizes

what are they?

A
    1. Via Cx cells traveling thru blood stream
    1. Via Cx cells traveling thru lymphatic system
    1. Via Cx cells traveling growing into adjacent tissues
      * ​Bones
      * Organs
      * Muscle
27
Q

WHERE does Cx Metastasize?

1st MOST COMMON LOCATION and HOW?

A
  • PULMONARY SYSTEM
    • ​Venous drainage–> Heart–> Lungs
    • S/S
      • dry persistent cough, pleural pain, SOB
28
Q

WHERE does Cx Metastasize?

2nd MOST COMMON LOCATION and HOW?

A
  • HEPATIC SYSTEM (These are your abdominal cx’s)
    • GI/Colon/Pancreas–> liver for filtration
    • S/S
      • ​R upper quadrant pain
      • malaise/fatigue
      • Wt. Loss
29
Q

WHERE does Cx Metastasize?

3RD MOST COMMON LOCATION and HOW?

A
  • SKELETAL SYSTEM
    • ​*Bony Mets affects 50% of Cx pt w/ Mets
    • MOST osteoLYTIC (dec bone density)
      • BUT ​Prostate is osteoBLASTIC (inc scarring)
    • Bones: Spine, pelvis, ribs, prox femur, and prox humerus
    • S/S
      • ​DEEP persistent pain that INCs w/ WB
        • ​if Spine–> LMN sx’s
30
Q

WHERE does Cx Metastasize?

OTHERS

A
  • CNS
  • SC
  • Lymphatic
31
Q

Metastatic Cx: Eval of Bone Metastasis

5 Diff ways we can observe:

A
  1. Radiograph
  2. Bone Scan
  3. CT Scan
  4. MRI
  5. Lab Tests
32
Q

Metastatic Cx: Eval of Bone Metastasis

Radiographs

What should you remember about metastasis and Radiographs???

A

40-50% bone loss BEFORE radiograph can pick it up***

33
Q

Metastatic Cx: Eval of Bone Metastasis

GOLD STANDARD FOR BONE METS???

A

BONE SCAN!!!

34
Q

Metastatic Cx: Eval of Bone Metastasis

MRI for….

A

Vertebral AND Epidural involvement

35
Q

Metastatic Cx: Eval of Bone Metastasis

Lab Tests

such as…..

A

Serum markers

Calcium lvls

36
Q

Mirels’ Scoring System

What is it for??

A

Risk of Fx for Bone Mets

_*_KNOW IT EXISTS!!!

  • >9 == VERY HIGH RISK FOR Fx
  • Keep in mind…
    • ​What are WB precautions???
37
Q

PT MGMT: Ortho WB Guidelines Based on Loc of Mets

A

see pics

  • 0-25%== Full WB
    • ​avoid lift/strain >5-10lbs
  • 25-50%== PWB
    • ​avoid twist or stretch
  • >50%== TTWB or NWB
    • ​amb, functional mobility, ex performed w/ caution
38
Q

Immobility vs. Ambulation/Standing/WB

Bennies vs. Risks

A

see pics

KNOW THE BIG ONES

39
Q

RED FLAGS FOR ANY PATIENT

***Think Bone Metastatic OR Somatic Referral patterns***

PAIN

A
  • Pain w/ valsalve maneuvers
    • ​laugh, cough, sneeze
  • Pain that is NOT responsive to therapy OR worsens w/ therapy
  • Persistent pain—unable to relieve w/ diff pos’s
  • Pain that:
    • interferes w/ sleep
    • INC w/ WB
  • *Pain in a band around T/S
40
Q

RED FLAGS FOR ANY PATIENT

***Think Bone Metastatic OR Somatic Referral patterns***

PAIN W/ NEUROLOGICAL SIGNS

PAIN W/ LMN SX’S

A
  • Numb/tingling
  • MM weakness or paralysis
  • Loss of B&B control
41
Q

PTs role in Oncology

4:

A
  1. Preventative
  2. Restorative
  3. Supportive
  4. Palliative
42
Q

PT Role in Oncology

explain Palliative

A
  • curative measures exhausted and cure no longer poss/avail
    • ​symptom mgmt regardless of how long they have
  • Benefits:
    • ​self-directed medical care
    • LESS LIKELY to exp untreated pain
    • Better psychosocial and spiritual support
    • Prioritizes QOL
43
Q

When Prevention is NO LONGER an option…..

A

Tx becomes intervention

44
Q

Benefits of Hospice

A
  • Live out remaining time w/ QOL and as pain free as possible
45
Q
A

Medcon Rehab III (6 decks)

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