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SAM II Exam 1 > Oncology: Principles of Oncology and Therapeutics of oncology > Flashcards

Oncology: Principles of Oncology and Therapeutics of oncology Flashcards

1
Q

Which of the following is being described? -Agents IRREVERSIBLY convert an initiated cell into a cell exhibiting malignancy A) Initiation B) Promotion C) Progression D) None of the above

A

C

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2
Q

Which of the following is false regarding cytopathology? A) It is non-invasive and carries low risk B) Results are rapidly obtained and at a low cost C) The sensitivity is high, a negative result supports a negative finding D) It is highly specific, a positive result supports a positive finding

A

C= low sensitivity, can have false positives!!

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3
Q

T/F: About 80% of dogs experience the BAG adverse effects when receiving chemo.

A

false- this many experience no or minimal SE such as decreased apetitieenergy, nausea/vom, diarrhea

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4
Q

T/F: Metronomic chemo elimantes the break period present with MTD chemotherapy by giving low dose continuous chemotherapy, aims at preventing recurrence.

A

TRUE

pro= lower toxicit,reduced SE, PO admin, lower cost

cons= not as cytotoxic (potent)> not designed to cure

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5
Q

Clients should be advised to wear gloves when handling urine/feces of treated animals for up to ___hr after administration and to wash the area with diluted bleach.

A

48 hrs

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6
Q

T/F: Mentronomic chemotherapy does not cause direct cytotoxicity of cancer cells.

A

False- just not to a great extent, still likely to have some direct effect= also blocks angiogensis this way to decrease GF produce by tumor

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7
Q

When surgery is not indicated and chemotherapy is used as the primary treatment, for example with LSA, this is said to be ___ therapy.

A) Adjuvant

B) Neoadjuvant

C) Palliative

D) Induction/maintenance

A

D= sole treatment

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8
Q

Aside from it’s characteristic of being a vesicant what is the most notable side effect of doxorubicin?

A) Cardiotoxicity

B) Nephrotoxicity

C) Bone marrow suppression

D) Alopecia

A

A

prescreen boxers/dobies for DCM> perorm echo prior!

other SE= tinnitus (in ppl at least)

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9
Q

T/F: After about 7 days after the 1st chemo treatment, a CBC should be evaluated to discover the nadir which is the expected highest levels of cells made by the bone marrow.

A

False- all is true except the nadir is the time for the expected lowest values of these cells…neutrophil counts usually rebound from the nadir about 1-3 days later >> do not perform another treatment until this rebound has occurred, measure with CBC

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10
Q

Which of the FNA techniques is preferred as it diminishes blood contamination and allows better control of the needle? A) Needle off (coring) B) Needle on (suction) C) Both yield the same results

A

A

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11
Q
A
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12
Q

Which of the following must be performed in the patient on the morning of prior to receiving chemotherapy?

A) Biochemistry panel

B) Radiographs

C) CBC

D) Urinalysis

A

C- check neutrophil count!!!

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13
Q

List the 3 most common adverse effects that animals undergoing chemotherapy experience.

A

BAG

bone marrow suppression

alopecia- only in non-shedding dog breeds (poodles, OESD, shih tzus); cats lose whiskers and gaurd hairs

GI signs (intestinal crypt cell destruction= vom/diarrhea)

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14
Q

Can you list 3 tumors, with the most common being the first, that cause hypoglycemia as a PNS?

A

Intestinal leiomyosarcoma= #1

insulinoma

LSA

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15
Q

Which of the following is being described? - Original carcinogens or normal growth promoters/hormones cause REVERSIBLE tissue and cell changes A) Initiation B) Promotion C) Progression D) None of the above

A

B

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16
Q

Can you think of the two ways that chemo drugs cause GI signs?

A
  • direct stimulation of CRTZ in the brain> instantaneous ( or w/in <24hrs) emetic effect
  • damages crypt cells= anorexia, vomiting, diarrea w/in first 2-5 days of tx
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17
Q

Which of the following tumors is least likely able to be confirmed via cytopathology? A) Lymphoma B) Squamous cell carcinoma C) Osteosarcoma D) Mast cell tumor

A

C= mesenchymal cell tumors= difficult to establish type with cytopatholgy; epithelial tumors can also be difficult but exfoliate better than mesenchymal

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18
Q

Sarcomas are composed of ____ cells. A) Round B) Mesenchymal C) Epithelial

A

B

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19
Q

An animal coming in for its 3rd chemotherapy treatment has a neutrophil count of 900, is non-febrile and clinically well. Which of the following actions is most appropriate?

A) Delay chemotherapy for a few days to 1 week

B) Delay chemo and prescribe oral antimicrobials

C) Hospitalize providing IV antimicrobials and supportive care

D) None of the above

A

B- too low to give chemo, and although active infection is not present it is likely to occur at this level of neutropenia

if <1,000 prescribe Abx!

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20
Q

There is a large movement in vet med to make strides in which of the following types of immunotherapy?

A) Monoclonal Abs

B) Oncolytic virus therapy

C) Interferon therapy (immunomodulation)

D) Tumor vaccines

E) T-cell therapy

A

D

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21
Q

Which of the following methods is an incorrect form to write a dose when dealing with chemo drugs? May be multi answers

A) 10

B) .05

C) 0.6

D) 20.0

A

B/D

no naked decmial points or trailing zeros!!

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22
Q

Different methods for identifying sentinel LNs

A
  • injection of iodized oil> x-ray 24 hrs later
  • 4 quadrant injection around tumor w/ lipoidol= x-rays 24 hrs later> then inject NMB into tumor at time of surgery to easily find the SLN> resect SLN and biopsy to determine if metastasis is present
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23
Q

Which of the following breeds has the highest incidence of the ABCD-1 gene and therefore is at increased risk of toxicity to certain drugs (including chemo)?

A) German shepherd

B) Long-haird Whippet

C) Austrialian shepherd

D) Collie

E) Border collie

A

D

then C/B

this gene encodes for a pump that removes drugs from cells

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24
Q

A doberman with DCM requires chemotherapy for LSA. Which agent is most appropriate?

A) Doxorubicin

B) Mitoxantrone

A

B- cardiac sparing

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25
Q

Which of the following is most significantly impacted by chemotherapeutics due to the high number of rapidaly dividing cells?

A) Bone marrow

B) GIT

C) Hair follicles

D) None of the above

A

A

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26
Q

T/F: You aspirate what you think is a mammary cell carcinoma in an intact cat and the cells do not appear malignant, this means you are able to conclude that no further steps must be taken because this mass is benign.

A

False! these tumors do not exfoliate their malignant cells very well= provides a misleading false negative >85% are malignant!!

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27
Q

Which of the following 2 drugs are the most emetic?

A) Cisplatin

B) Vincristin

C) Chlorambucil

D) Doxorubicin

A

A D

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28
Q

What type of staining differentiates OSA from other sarcomas?

A

ALP staining (ALP is required by osteoblasts for bone mineralization)

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29
Q

T/F: Prior to administering chemotherapy, drug calculations must be performed twice by that indiividual prior to administration.

A

false- they should be done by 2 different people

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30
Q

Term used for altering dossing to allow recovery of normal tissue between Tx intervals

A

fractionation

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31
Q

What is the name of the mushroom that contains PSP which causes cell-cycle arrest> net effect is to reduce proliferation and increase apoptosis in cancer cells?

A

Coriolus versicolor (turkey tail)

shown to delay progression of abdominal metastases of HSA

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32
Q

Which of the following are ankylating agents meaning they bind DNA strands, insert an akyl group, and change the strucutre of the DNA to interefere with its function.

A) Chlorambucil

B) Vincristine/Vinblastine

C) Doxorubicin

D) Mitoxantrone

E) Cyclophosphamide

A

A/E

others in this class= Lomustine, melphalan

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33
Q

Specific staging for oral tumors

A
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34
Q

Which of the following chemotherapeutics are antibiotic agents?

A) Cytosine arabinoside

B) Vincristine/Vinblastine

C) Doxorubicin

D) Mitoxantrone

E) Gemcitabine

A

CD are the most common ones

actionmycin-D and idarubicin are others

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35
Q

What is the average number of cells formed during an average lifetime?

A

Ten quadrillion= 10^16….this means 10 million cells are being replaced every second 1 in every 20 million cell divisions contains 1 mutation in a gene normally

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36
Q

Which drug releases a toxic metabolite, acrolein, causing sterile hemorrhagic cystitis?

A

Cyclophophamide

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37
Q

What is the unique SE of the ankylating agent, used most commonly in MC protocols, cyclophosphamide?

A

sterile hemorrhagic cystitis (SHC)

this will be on the exam!!

d/t formation of ACROLEIN

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38
Q

T/F: Metronomic chemotherapy works to increase Tregs.

A

False- decrease them

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39
Q

T/F: Cytopathology is not recommended for tumors of the bone.

A

False- tumors of the oral cavity

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40
Q

What is the role of dexrazoxane (zinecard) when given concurrently with doxorubicin?

A

reduces cardiac toxicity, given when extravasation occurs

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41
Q

T/F: Use of small molecule inhibitors, such as Palladia, is beneficial due to fewer cytotoxic side effects.

A

True! targets specific receptors and not all dividing cells

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42
Q

Because of it’s association w/ liver toxicity, lomustine/CCNU should be given with what drug?

A

Denamarin

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43
Q

T/F: Cancer is mostly caused by random genetic mutations.

A

False! Life style and environment play a role as well High fat, low fiver diets! UV exposure! Viruses! Age! = Decreased immune surveillance … random genetic mutations accumulate over time

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44
Q

What are the 4 most common tumors associated with causing hypercalcemia of malignancy?

A

Anal sac ACA

LSA

MM

Mammary tumors

45
Q

List the round cell tumors.

A

Please help me learn this Plasma cell tumors, histocytomas, mast cell/melanoma, lymphoma, TVT

46
Q

Which of the following are the main adverse effects associated with vincristine?

A) Bone marrow suppresion

B) Vesicant

C) Alopecia

D) Neuropathy

E) GI damage

A

B/D/E

47
Q

If the neutrophil count at the nadir is below 1500 or the platelet count is below 60,000 then the doses of the drug should be decreased by __-__%.

A

20-25%

48
Q

Which of the following is the first tool we look to in establishing a tissue diagnosis of a tumor after a complete history and physical exam are performed? A) Radiographs B) Surgical excision and histopathology C) Diagnostic cytopathology D) Ultrasonography

A

C

49
Q

Main side effect of alkylating agents as a group?

A

Bone marrow suppresison

50
Q

A dog presents to you with a grade II recurrent cutaneous mast cell tumor. Which of the following drugs is approved to use for this tumor?

A) Vincristine

B) Tanovea

C) Toceranib

D) Doxorubicin

A

C (aka palladia)

B= for LSA

51
Q

Which of the following should NEVER be used in cats?

A) Cyclophosphamide

B) Chlorambucil

C) Vincristine

D) Cisplatin

E) Carboplatin

A

D- SPLATS CATS= dose related primary pulmonary toxicity>> fatal pulmonary edema

also nephrotoxic in cats and dogs= vigorous diuresis

E= okay in cats and no nephrotoxicity

52
Q

L-asparaginase (Elspar) inhibits protein synthesis in cells and is used to treat LSA relapses. Which of the following considerdations is MOST important when adminstering this drug?

A) Cannot be given IV

B) It has been found to cause pancreatitis and DIC

C) It is nephrotoxic

D) It is a vesicant

A

A= d/t hypersensitivty reaction

B is true

C/D are not true of this drug

53
Q

Which of the following is being described? -Carcinogens induce DNA damage but not enough to induce neoplastic transformation, this is a rapid process A) Initiation B) Promotion C) Progression D) None of the above

A

A

54
Q

T/F: Doxorubicin, melphalan, and cis/carboplatin carry an increased risk in small dogs when BSA is used to calculate dose and thus using mg/kg dosing should be considered.

A

true

55
Q

What are the 3 distinct cell types composing tumors?

A

Round cell, Mesenchymal, Epithelial

56
Q

An animal coming in for its 2nd round of chemotherapy is non-febrile, clinically well and has a neutrophil count of 2,900. Which of the following actions is most appopriate?

A) Delay chemotherapy for a few days to 1 week

B) Delay chemo and prescribe oral antimicrobials

C) Hospitalize providing IV antimicrobials and supportive care

D) None of the above

A

A

too low for chemo! (needs to be >3,000)

is not febrile and not <1,000 so antibiotics may be withheld for now

57
Q

Can you list the 6 hallmarks of a cancer cell?

A

-Evasion of apoptosis - Self- sufficiency in growth signals - Insensitivity to ANTI-growth signals - Angiogenesis - Tissue invasion/metastasis - Limitless replicative potential

58
Q

Name the two chemo drugs that are most damaging if they extravasate

A

Doxorubicin and Vincristine

59
Q

Which of the following statements is correct? A) Epithelial tumors are composed of spindle-shaped cells arranged individually or in non-cohesive aggregates B) Mesenchymal tumors are composed of individualized round cells arranged in a monolayer C) Epithelial tumors are composed of cells arranged in sheets/clusters while round cell tumors have cells arranged in a monolayer D) Mesenchymal tumors contain cuboidal shaped cells arranged in sheets/clusters and round cell tumors contain spindle shaped cells

A

C (A describes a mesenchymal cell tumor; B describes a round cell tumor; D mesenchymal cell tumors have spindle shaped cells and are arranged individually or non cohesive aggregates)

60
Q

When chemo is used after surgery to target microscopic disease this is term ___ therapy.

A) Adjuvant

B) Neoadjuvant

C) Palliative

D) Induction/maintenance

A

A

(C is to improve QOL)

61
Q

Which if the following is the most reliable method in detecting lung metastasis?

A) X-ray

B) MRI

C) CT

D) U/S

A

C

x ray cannot pick up masses smaller than 7 mm

CT picks up a great # of smaller nodules

62
Q

Can you list the 3 steps that occur in formation of malignancy?

A

Initiation, promotion, progression

63
Q

What organ is the most common receptacle of blood borne metastasis?

A

liver

64
Q

A listeria-based antigen delivery system is being tested experimentally in clinical trials in approved veterinary hospitals for what tumor?

A

osteosarcoma

65
Q

How are chemotherapeutics dosed?

A

based on body surface area (still doesn’t predict drug metabolism..smaller patients receive a higher dose based on this method)

66
Q

In terms of ultrasound guided FNA, which of the following tumors is diagnosed with the least accuracy (negatives should be interrupted with caution)? A) GIT tumors B) Bone tumors C) Liver tumors D) Splenic tumors

A

C= < 50% accurate

67
Q

T/F: Chemotherapeutics are dosed based on efficacy and not toxicity.

A

false- vice versa

to decrease tx failures drugs are given at the highest possible tolerable dose (maximum tolerated dose)

68
Q

T/F: Yunan baiyao is an OTC chinese medication used for hemostasis and may increase survive times in dogs with HSA.

A

true

cancer effects only shown in vitro

69
Q

T/F: The lymph node closest to the tumor located downstream is the sentinel LN.

A

False! the LN that is first actually draining the tumor is the sentinel LN, doesn’t necessarily mean this is the closest LN… individual to each patient

70
Q

Antiangiogenesis, immunomodulation, and direct targeting are methods used in:

A) Metronomic chemotherapy

B) Maximum tolerated dose chemotherapy

A

A

71
Q

Thrombosponin-1:

A) blocks COX and circulating endothelial progenitor cells

B) upregulates COX and circulating endothelial progenitor cells

A

A

72
Q

T/F: An animal may have a systemic infection and still not display a fever due to neutropenia.

A

true- neutrophils are responsible for making IL-1 and TNF which stimulate the fever, if they are too low they will not produce a fever

73
Q

Which type of cancer was the first to receive an FDA approved DNA-based vaccine for animals and humans?

A) Lymphoma

B) Melanoma

C) Hemangiosarcoma

D) Mammary carcinoma

A

B

works to generate an immune response direct against protein on canine melanoma cells (vaccine uses human tyrosinase)

74
Q

With FNA the incidence of tumor seeding is low however it has been found at a higher incidence with what organ system and thus is not always recommended as a diagnostic method?

A

urogenital neoplasms= TCC

75
Q

T/F: As long as one of the two, biological safety cabinets or closed-system drug transfer devices, are used, your practice is considered to be properly handling chemotherapeutics.

A

False- need both!

76
Q

T/F: PNS are often the first sign of malignancy

A

true dat

these are tumor associated alterations in the body that occur distant to the tumor

77
Q

Which of the following is the first FDA approved drug for blocking tyrosine kinase receptors (c-kit is an important one in dogs).

A) Palladia

B) Tanovea

C) Cyclophosphamide

D) Doxorubicin

A

A (aka toceranib)

c-kit is in MCTs!!

Palladia= classified as a small molecule inhibitor> not only inhibts TKR but others as well, can be used off-label

78
Q

Which of the following tumors is associated w/ causing nodular dermatofibrosis?

A) LSA

B) Thymoma

C) Renal cyadenocarcinoma

D) Primary lung tumors

A

C

thymoma= MG

primary lung tumors (+ esophageal tumors)= hypertrophic osteodrystrophy

79
Q

Which of the following is true of Tregs?

A) They are downregulated by tumor cells resulting in suppression of host tumor surveillance

B) They are responsible for the cytotoxic killing of tumor cells

C) They are upregulated by cancer cells causing suppression of the host tumor surveillance

D) All of the above

A

C

(normal function= prevent autoimmune dz)

80
Q

What is true of tyrosine kinase?

A) When switched on they decrease growth of tumor cells

B) They are growth receptors, mutation and activation results in perpetual cell growth

C) Toceranib phosphate (Palladia) is an FDA approved drug to upregulate them

D) All are true

A

B

C: this drug blocks these recptors by acting as a reversible competitive inhibitor of adenosine triphosphate binding

81
Q

If chemo is used to shrink a tumor prior to removal this is said to be ____ therapy.

A) Adjuvant

B) Neoadjuvant

C) Palliative

D) Induction/maintenance

A

B

82
Q

Which of the following is a severe vesicant?

A) Gemcitabine

B) Chlorambucil

C) Mitoxantrone

D) Vincristine

A

D

+ Doxorubin= are very damaging if they extravasate

83
Q

Lomustine (CCNU) is most notably associated with which side effect?

A) Diarrhea

B) Vesicant

C) Liver toxicity

D) Renal failure

A

C

84
Q

Which of the following drugs has been proven to selectively decrease regulatory T cells and inhibit angiogenesis in dogs with soft tissue sarcomas?

A) Cyclophosphamide

B) Chlorambucil

C) Vincristine

D) Cisplatin

A

A

85
Q

An animal received its first chemotherapy treatment 7 days ago and presents with a fever, lethargy, and anorexia. They are due for another treatment at this time. The neutrophil count is 2,500. Which of the following actions is most appropriate?

A) Delay chemotherapy for a few days to 1 week

B) Delay chemo and prescribe oral antimicrobials

C) Hospitalize providing IV antimicrobials and supportive care

D) None of the above

A

C

neutropenia and febrile= IV abx!!

if neutrophils are <3,000 AND they are sick= take immediate action!

86
Q

Which of the following cells of the bone marrow are depleted first when chemo is used?

A) RBCs

B) Platelets

C) Neutrophils

D) All are depleted at the same time

A

C

first neutrophils then platelets then RBCs (anemia is rare as RBCs have such a long life span)

first thing to evaluate on CBC prior to giving chemo are neutrophils!!

87
Q

Which of the following classes of drugs are antimitotic?

A) Chlorambucil

B) Vincristine/Vinblastine

C) Doxorubicin

D) Mitoxantrone

A

B

88
Q

T/F: The stomach has a lower accuracy of tumor diagnosis through FNA.

A

True, higher in with intestinal tumors

89
Q

You perform a CBC of a dog undergoing chemotherapy for lymphoma and the neutrophils are 4,000 and the PLTs are 90,000. According to the recommended minimum values, can this dog receive it’s treatment at this time?

A) No the neutrophils are too low

B) No the platelets are too low

C) No the neutrophils and platelets are too low

D) Yes these values are within the acceptable range

A

B

Plts should be >100,000, neutrophils should be >3,000

90
Q

Can you list in order from least to most accurately diagnosed the presence of a tumor via ultrasound guided FNA?

A

Liver (<50%)> Spleen (68%)> GIT (70%)>Bone (100%)

91
Q

Staging with the TNM system

T0= no evidence of primary tumor

N0= no regional LN involvement

M0= no distant metastasis

if T,N,M X then this cannot be evaluated/measured

A
92
Q

T/F: If a LN is not enlarged in the region of the tumor then local metastasis is not present.

A

false- some LNs are normal size and still contain cancerous cells

93
Q

Of the drugs listed, which are dogs with ABCB-1 gene mutations most sensitive to? 3 ans

A) Doxorubicin

B) Melphalan

C) Vincristine/vinblastine

D) Cisplatin/carboplatin

E) Paclitaxel

A

A C E

94
Q

Which slide preparation technique is preferred for most FNA? A) Vertical pull-apart B) Horizontal pull-apart

A

B= feathered edge A is preferred for very fragile cells= when aspirating LN

95
Q

Thrombospondin-1 is an endogenous inhibitor of:

A) Tyrosine kinase

B) Angiogenesis

C) Cell replication

D) all of the above

A

B> upregulation of this in the tumor’s environment= cuts off blood supply to tumor

96
Q

What is the MOA of carboplatin/cisplatin?

A) Inhibits proliferation of lymphocytes and LSA cell lines by inhibiting DNA synthesis

B) Inhibits the S phase of the cell cyle

C) Platinum agents that covalently bind to DNA strands causing cytotoxicity

D)Disrupt and immobilize the mitotic spindle which plays a critical role in cell function and division

A

C- cell cycle non specific

A is MOA of Tanovea

97
Q

T/F: When a dose is reduced by 50% then efficiacy is reduced by 50%.

A

false- when it is reduced by just 20% the efficacy is reduced by 50%

98
Q

Which of the following is the MOST effective way in preventing sterile hemorrhagic cystitis associated with cyclophosphamide use?

A) Encourage frequent water intake and urination

B) Give glucocorticoids

C) Give furosemide

D) None of the above

A

C

others are ways but C is the best

99
Q

What is the action of Nupogen (Filgrastim)?

A) Decreases release of IL-1 and TNF

B) Inhibits the action of chemotherapy on the bone marrow

C) Stimulates bone marrow production of WBC’s

D) All of the above

A

C

100
Q

T/F: The treatment of extravasation of doxorubicin is the same as with vincristine (dilute and dispurse)

A

false!! want to apply cold to cause vasocontriction and prevent dispersion> give zinecard

= “localize and neutralize”

101
Q

Which of the following tumors are the least likely to exfoliate cells? A) Round B) Mesenchymal C) Epithelial

A

B, least sensitive results w/ cytopathology most exfoliating= round= most sensitive results w/ cytopathology; epithelial are good too

102
Q

What is the first FDA conditionally approved lymphoma treatment for dogs?

A

Tanovea

currently used as a rescue therapy once pt fails remission after stanard chemo

103
Q

List the steps that should be taken if extravasation of vincristine occurs.

A
  • aspirate any residual fluid into IV catheter and remove catheter
  • apply dry warm compress to distribute and increase absorption of the drug into circulation
  • administer hyaluronidase to aid in improving absorption
104
Q

Which of the following are antimetabolites and act on the S-phase of the cell cycle?

A) Cytosine arabinoside

B) 5-fluorouracil

C) Tanovea

D) Carboplatin/cisplatin

E) Gemcitabine

A

A

B

E

105
Q

Is this staging or grading? - Establishes if the tumor is localized, regional, or diffusely spread; based on the TNM system (tumor, node, metastasis)

A

Staging

106
Q

Which of the following is true regarding thrombocytopenia occurring d/t chemotherapy?

A) It is not a commonly seen occurrence

B) Classified as platelet number of 25,000

C) If experienced, the animal should be monitored for bleeding and have restricted exercise

D) All of the above

A

D

107
Q

Which of the following is not a characteristic of malignancy? A) Homogenous cell type B) Monomorphic cell type C) Anisocytosis D) Anisokaryosis E) Mitotic spindles

A

B= this is more likely to be benign…pleomorphism=maligant

108
Q

Which of the following statements is false? A) Tumor grading establishes inherent aggressiveness of a tumor B) Staging permits prognostication and appropriate therapeutic planning C) Grading requires a series of non-invasive testing D) Grading is from I-III with I being least aggressive

A

C= requires a block of tissues! cannot grade off cytologist grading allows for DEFINITIVE prognostication

109
Q

Which is the proper order to degown after administering chemotherapeutics?

A) Remove goggles/face shield>gloves>gown

B) Remove gloves>gown>goggles/face shield

C) Remove gown>goggles/face shield>gloves

D) none of the above

A

C

SAM II Exam 1 (5 decks)

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