Test 5 Flashcards
Which types of cancers are treated with selective estrogen receptor modulators (SERMS)?
a. Lung cancer
b. All breast cancers
c. Leukemia
d. ER+ breast cancer
ER+ breast cancer
(T or F) Tamoxifen and raloxifene increase risk of venous thrombosis.
T
Which of the following is a pyrimidine analog that interferes with the biosynthesis of thymine?
a. 5-fluorouracil
b. Cyclophosphamide
c. None of these
d. Methotrexate
5-fluorouracil
Which of the following is a monoclonal antibody against the human epidermal growth factor 2 receptor (HER2)?
a. Cetuximab
b. Rituximab
c. Panitumumab
d. Trastuzumab
Trastuzumab
What are some of the adverse effects of cytokine therapy? (multiple)
a. Low blood counts
b. GI upset
c. Neurotoxicity
d. Flu-like symptoms
Low blood counts
GI upset
Flu-like symptoms
IL-2 cytokine therapy is used for which types of cancers? (multiple)
a. Renal cell carcinoma
b. Lymphoma
c. Cervical cancer
d. Melanoma
Renal cell carcinoma
Melanoma
Who is affected by a cancer diagnosis?
a. The patient
b. The friends of the individual diagnosed
c. The family of the individual diagnosed
d. Everyone will be affected
Everyone will be affected
Which of the following is an example of bad news?
a. Hearing it will be sunny for the rest of the week
b. Each of these can be bad news to different people
c. A cancer diagnosis
d. Discovering you’re pregnant
Each of these can be bad news to different people
Why is the ability to deliver bad news an important skill to develop?
a. Patients have a right to know about their health
b. Doctors need to provide/receive informed consent
c. Neither of these is true
d. Both of these are true
Both of these are true
Which of the following is NOT a goal of a “bad news” interview?
a. Convey information clearly
b. Involve the patient in decision making
c. Respond to the patient’s emotional reaction
d. Provide hope in every situation
Provide hope in every situation
Which of the following are NOT optimal ways a provider prepares for the delivery of bad news?
a. There is no need to prepare to give bad news to a patient
b. Write down recommendations
c. Gather referrals for the patient
d. Perform any necessary research
There is no need to prepare to give bad news to a patient
After a patient oncology referral is made, The next step is:
a. Check in with the patient, make sure they got the referral, then move on
b. Continue to provide support and care for the patient in the capacity you can and they want
c. Nothing. The referral is complete
d. None of these are appropriate
Continue to provide support and care for the patient in the capacity you can and they want
What is the intended use of the SPIKES protocol?
a. It allows providers to feel more confident in their medical skills
b. It allows clear and organized conversations about bad news
c. It provides a care protocol for stab wound victims
d. It provides compassionate care to children
It allows clear and organized conversations about bad news
What is important about setting?
a. Creating a space for eye contact to happen naturally
b. Ensuring comfortable chairs
c. Ensuring the patient has water
d. Providing tissues
Creating a space for eye contact to happen naturally
Which aspect of the SPIKES protocol is associated with discovering what the patient already knows about their condition?
a. Perception
b. Empathy
c. Setting
d. Strategy
Perception
Which stage in the SPIKES protocol allows for the patient to ask questions about the plan?
a. Setting
b. Strategy
c. Knowledge
d. Empathy
Strategy
Which of the following directs the type of treatments given in a medical emergency?
a. Advance directives
b. POLST
c. Will
d. Living will
POLST
Which of the following is done for any patient who is over 18 years old, independent of the patient’s condition?
a. Advance directives
b. Will
c. Living will
d. POLST
Advance directives
(T or F) NDs can sign POLSTs in Oregon.
T
What is the location or philosophy that uses palliative care at the end of life?
a. Hospital
b. Hotel
c. Hospice
d. Health Care
Hospice
Which of the following is the life expectancy used to determine who is recommended for hospice?
a. 4 weeks or less
b. 1 year or less
c. 6 months or less
d. A terminal diagnosis at any stage
6 months or less
Where is hospice located?
a. In a hospital
b. In-patient facilities
c. In a patient’s home
d. Any of these locations are possible
Any of these locations are possible
What is the next step when a patient tells you they are ready to die?
a. Discuss options for assisted suicide
b. Ensure their depression is adequately managed
c. Ensure their pain is being adequately managed
d. Each and potential all of these options are indicated in some situations
Each and potential all of these options are indicated in some situations
Which of the following atr TRUE about Oregon’s death with dignity act?
a. The patient must be at least 18 years old
b. Anybody can come to Oregon to receive this service
c. Any licensed medical provider can provide the medication
d. The individual must have a terminal illness with a life expectancy less than 1 year
The patient must be at least 18 years old
Concerning the Death with Dignity Act, if a physician believes the patient is experiencing a psychiatric disorder, what is the next step?
a. Refer the patient to another provider
b. Provide assisted suicide medication
c. Treat the suspected condition
d. Referral for psychological evaluation
Referral for psychological evaluation
(T or F) As a provider, you should not provide any care to a family member of any patient who as died in your care.
F
Tamoxifen MOA and adverse effects
MOA: Pro-drug, activity from metabolites. Used to block effects of estrogen in cancers that are estrogen responsive (ER+ breast cancer)
AE: Drug interactions with CYP2D6 inhibitors (prevent its activation), hot flashes, uterine bleeding, venous thrombosis
Raloxifene MOA and adverse effects
MOA: Used to block effects of estrogen in cancers that are estrogen responsive (ER+ breast cancer)
AE: hot flashes, venous thrombus, hot flashes
Anastrozole MOA and adverse effects
MOA: Prevent the conversion of androgens to estrogens
AE: Mimic those of menopause
Leuprolide MOA and AE
MOA: Causes desensitization of the GnRH receptor in pituitary, inhibiting release of LH and FSH. > Causes the inhibition of sex hormone synthesis by the testes and ovaries.
AE:
Men:
Impotence
Men + Women:
Hot flashes, osteoporosis
Corticosteroids MOA and AE
MOA: Glucocorticoid agonists (mimic effects of cortisol)
AE:
Risk of drug-induced Cushing syndrome with long-term/high dose use
Short Term (days/weeks): Increased blood sugar, BP, blood lipids, risk of infection. Poor wound healing, Edema, Hypokalemia, Mood disturbance, Suppression of HPA axis (if used longer that 2-3 wks)
Long Term (months/years) Osteoporosis, DM, HTN, Ulcers/GI Bleed, Inc risk of heart disease, Skin changes (atrophy, ecchymoses, striae), Redistribution of body fat (central adiposity, buffalo hump, moon facies), Muscle wasting, Decreased growth in children, Cataracts, Glaucoma, Suppression of HPA axis
Pernbrolizumab MOA and AE
MOA: Bind to PD-1 and CTLA-4 so that the T cells can kill the tumor cells
AE: Lupus erythematosus, Sjogern’s syndrome, and rheumatoid arthritis
Interferon -alpha
Interleukin-2
MOA and AE
MOA: Broad immune response
AE: Fatigue, headache, fever, chills, myalgias, depression, low blood count, liver toxicity, GI upset
Which of the following has research to support it is protective against colon cancer?
a. Juice cleanses
b. Fiber rich diets
c. Coffee enemas
d. Ketogenic diets
Fiber rich diets
Which of the following was found to extend the survival time for individuals with lung cancer from 4.5 months to 15.5 months?
a. Daily exercise
b. Turmeric
c. Intermittent fasting
d. Dried vegetable soup packets
Dried vegetable soup packets
(T or F) Excessive animal sources of protein have been linked to increased risk of colon and prostate cancer.
T
When reviewing a supplement that a patient has asked you about, which of the following are concerning findings that would make you question the supplement and its efficacy?
a. Anecdotal reports and testimonials
b. All of these are questionable
c. Research articles that are not peer reviewed
d. Products that claim to cure cancer
All of these are questionable
(T or F) Cancer survivors have an increased risk for mental health comorbidities including anxiety, depression, and suicide.
T`
Which of the following risk factors contributes to the greatest amount of cancer diagnoses?
a. Infections
b. Genetics
c. Diet
d. Tobacco
Diet
When talking about organic produce with patients which of the following are good advice to give?
a. Eating all organic produce is important; it is more harmful to have the exposure to pesticides.
b. Pesticides on food are not in high enough concentration to contribute to cancer.
c. Eating fruits and vegetables is important for nutrient intake even if they are not organic.
d. Learning the dirty dozen and the clean fifteen to help guide organic purchases and reduce food costs.
Learning the dirty dozen and the clean fifteen to help guide organic purchases and reduce food costs.
Eating fruits and vegetables is important for nutrient intake even if they are not organic.
Which of the following are considered protective factors against cancer?
a. Supplements that support the immune system
b. Healthy fats
c. Dietary fiber
d. Antioxidants
dietary fiber and antioxidants
(T or F) Exercise should be a priority in patients recovering from cancer even when they are fatigued.
T
What diet is best supported by research for cancer prevention?
Mediterranean
What percentage of cancer patients have signs and symptoms of malnutrition?
80-90%
(T or F) Advise your patients to eat their favorite foods prior to receiving chemotherapy.
F
Which is the most important dietary intake to focus on in cancer patients with malnutrition?
Protein
(T or F) Patient with weight loss during cancer treatments have an improved survival rate.
F
Which supplement is the most effective at decreasing cachexia in cancer patients?
EPA
What recommendations may be helpful for individuals with oral mucositis?
Honey
Glutamine
Which of the following helps with nausea from cancer treatments?
a. Ginger capsules
b. Eat small frequent meals
c. Eat your favorite food before cancer treatment
d. Eat simple fried foods
eat small frequent meals
Ginger capsules
Which of the following is the most well rounded and safest recommendation to provide to someone with cancer who is asking for nutritional advice?
a. Eat a whole foods based diet
b. There aren’t any supporting adjunctive treatments for cancer
c. Take green tea extract, vitamin C and tumeric
d. Try water fasting
Eat a whole foods based diet
Patients in cancer treatment should avoid dairy, GMOs, and non-organic foods
a. False, dairy can be a well-tolerated nutrient that helps with fat and caloric intake. Food access is more important than avoiding GMOs and non-organic foods.
b. False, none of these foods are dangerous for cancer patients and we do not need to make recommendations for avoidance.
c. True, we should recommend avoidance of all of these foods regardless of the patient preferences.
d. True, GMOs and non-organic foods should be avoided when possible. Dairy is harmful and contributes to inflammation.
False, dairy can be a well-tolerated nutrient that helps with fat and caloric intake. Food access is more important than avoiding GMOs and non-organic foods.
Patients diagnosed with hormone sensitive cancers should
a. Limit themselves to 3 servings of soy per week
b. Not supplement with any forms of soy
c. Continue to eat unlimited soy in the diet
d. Avoid soy in foods and supplements
Limit themselves to 3 servings of soy per week
(T or F) Following strict diets like the Budwig diet or the Gerson protocol have been proven support cancer recovery.
F
Which is true of oral alkalizing agents or alkalizing diets?
a. Drinking baking soda and alkaline water is a more powerful way to alkalinize the body than through foods.
b. They can reduce tumor growth by creating alkaline environments, urine pH can be used to track and guide dietary intake.
c. They can be high in fruits and vegetables and be beneficial for overall nutrient intake.
d. The pH of the body and blood is a tightly regulated homeostatic mechanism that cannot be altered by dietary intake.
They can be high in fruits and vegetables and be beneficial for overall nutrient intake.
The pH of the body and blood is a tightly regulated homeostatic mechanism that cannot be altered by dietary intake.
Which hormone is involved in the pathway triggering vomiting?
Serotonin
Why do people continue to have nausea and vomiting following chemotherapy treatment?
Higher cortical centers have memory
Which of the following is NOT a treatment option for nausea due to chemotherapy?
a. Homeopathics
b. Each of these can be used to treat nausea
c. Supplements
d. None of these
e. Diet
diet, supplements, homeopathic
Which of the following are helpful recommendations for individuals experiencing nausea due to chemotherapy?
a. Each of these may be helpful
b. None of these
c. Decrease the amount of food eaten at any one time
d. Increase water consumption
e. Referral for mental/emotional support
Referral for mental/emotional support
Decrease the amount of food eaten at any one time
Increase water consumption
Which food offered as a supplement has been shown in studies to reduce nausea and vomiting in individuals who are on chemotherapy?
ginger
Which of the following was acupuncture found to effect in a 2015 study?
a. Delayed nausea
b. Fewer doses of chemotherapy needed
c. Lower nausea score
d. Decrease in quality of life score
Lower nausea score
(T or F) Adjunctive naturopathic treatments cure chemotherapy associated nausea?
F
Which UNDA numbers are used for nausea?
4, 46
Which of the following is a potential cause of fatigue?
a. Each of these can cause fatigue
b. Diabetes
c. Panic disorder
d. None of these
e. Menopause
Diabetes
Panic disorder
Menopause
What regions might you consider and therefor cover in a ROS for someone who’s chief complaint is fatigue?
GI
Pulmonary
Cardiovascular
Which of the following is NOT a holistic approach to the treatment of fatigue?
a. Exposure to sunshine
b. Optimizing sleep patterns
c. Increase caffeine intake
d. Increasing dietary protein
Increase caffeine intake
(T or F) Exercise is contraindicated in cancer patients.
F
(T or F) The timing of treatment is an important variable in the expected outcome a patient might expect.
T
Which of the following supplements may improve fatigue associated with cancer and cancer treatments?
a. Ginger
b. Ginseng
c. Each of these has been shown to improve fatigue
d. None of these
e. Ashwagandha
Ashwagandha
Ginseng
How is glutamine prescribed for mouth sores?
Swish and swallow
What did the study comparing aloe and Benzydamine mouthwash conclude?
Aloe is as effective as Benzydamine
What is the general dose of melatonin used in oncology?
20 mg
Individuals presenting with mucositis may benefit from a diet rich in
Protein
(T or F) Optimizing hydration can improve symptoms of chemotherapy induced peripheral neuropathy.
T
Which supplement has been shown to improve nerve damage and reduce associated pain?
Alpha lipoic acid
Which of the following are contraindications to using glutamine?
a. Brain cancer
b. Colon cancer
c. Metastatic cancer or increased tumor burden
d. Breast cancer
Metastatic cancer or increased tumor burden
Brain cancer
