week 2 Flashcards
1
Q
cancer risk factors
A
- previous history of CA
- age > 50 or < 20
- environmental/social risk factors
- night pain
- recent unexplained weight loss
- painless neurological deficits
- proximal weakness
- pain of unknown origin: back, pelvic, groin, hip, shoulder, chest, breast, axillary area
- patients who have “failed” PT - no change
2
Q
general concerns that could indicate cancer
A
- insidious onset
- atypical pain pattern
- bilateral symptoms
- inability to alter symptoms + or -
- atypical findings - no matches
3
Q
substance use risks
A
- tobacco - current smoker, previous smoker, exposure to second hand smoke
- other tobacco use
- other smoking
- other drug use
- risk due to mutagenic effects of certain substances
- oncogenic processes induced by substance abuse possibly linked to immune system dysregulation
4
Q
common sites of metastases
A
- common: lymph nodes, liver, lung, bone, brain
- bone: lung, breast, prostate, thyroid, kidney, lymphatics
- most commone sites of bone metastases: vertebrae - TS 60%/LS 30%
- > also pelvis, ribs (posterior), skull, femur (proximal), sternum, cervical spine
5
Q
lymph nodes
A
- should not be normally visible or palpable
- enlarge due to infections, allergies, viruses, THA, cancer
6
Q
lymph nodes with malignancy tend to be
A
- firm, non-tender, matted, fixed
- increasing in size over time
7
Q
UTI
A
- 11% of women have at least 1 diagnosed UTI per year
- 20-30% report multiple recurrences - more in young women who are sexually active
- increased prevalence with age: 20% per year in women > 65
- symptoms: urgency, frequency, dysuria, suprapubic, vaginal, urethral tenderness, hematuria
- upper UTI (kidney infection): NV, flank pain, upper back pain, fever
8
Q
endometriosis
A
- generalized pelvic pain
- dysmenorrhea: painful periods
- dyspareunia: painful intercourse
- 92% with pain in central or lower abdomen
- 50% with lower back pain
- 41% with deep pelvic pain
9
Q
blood in stool is indicative of
A
lower GI bleed
10
Q
dysphagia
A
difficulty swallowing
coughing during/after eating
11
Q
dyspepsia
A
indigestion, heartburn
* acidic foods: heart burn, TS pain
* fatty foods: TS, gallbladder, pancreas
* ETOH: liver
* chocolate, red wine, cheese, caffeine: migraines
12
Q
upper vs lower GI
A
13
Q
hematochezie
A
frank blood in stool
14
Q
pale or clay colored stool
A
biliary/liver disease
15
Q
is back pain MSK?
A
- YES
- does coughing, sneezing, or taking a deep breath make your pain worse? –> disc pathology
- do activities like bending, sitting, lifting, twisting, or turning over in bed make your pain feel worse?
- NO
- has there been any change in your bowel habits since the start of your symptoms?
- also ask if eating certain foods makes pain feel worse or if weight has changed since symptoms started
16
Q
GI conditions that may manifest as back pain
A
- colicky abdominal pain
- severe abdominal pain caused by spasm, obstruction, distnetion of any hollow viscera
- NV
- abdominal distension
- fever/chills/sweats
- constipation or diarrhea
- pain relieved by sitting forward into flexion (pancreatitis)
17
Q
GI conditions that manifest as shoulder pain
A
- diaphragmatic irritation to the shoulder secondary to peptic ulcer, gall bladder disease, hiatal hearnia
- S&S: NV, anorexia or early satiety, melena
- impact of eating felt within 30 minutes - 2 hours
- worsening pain 2-4 hours after NSAIDs
18
Q
liver disease
A
- skin and nail bed changes
- jaundice
- neurological symptoms: ataxia, dyscoordination, cognitive effects from ammonia build up in hepatic encephalopathy
19
Q
gallbladder disease
A
- cholecystitis: inflammation
- cholelithiasis: gall stones
20
Q
hepatic/biliary checklists
A
- for unexplained R shoulder pain
- unexplained scapular/thoracici spine pain
- GI symptoms associated with eating
- bilateral carpal tunnel
- nail bed and skin changes
21
Q
what percent of adverse drug events (ADE) are in the GI system
A
10%
22
Q
risk factors for ADE
A
- age > 65, increases more > 75
- physical size/stature
- sex depending on drug
- renal or hepatic underlying dysfunction
- concomitant alcohol consumption or supplement use
- taking medications prescribed for someone else
- previous ADE
- polypharmacy
- prescribing cascade
- difficulty opening medication bottles, swallowing, reading/understanding directions
- mental deterioration: unintentional repeated doses
23
Q
NSAID
A
- heart and stomach at highest risk
- risk of GI bleeing, renal failure, heart failure, MI
- risk increases if: poor overall health, older age, taking for > 1 week, drinking 3 or more alcoholic beverages per day
24
Q
OTC NSAIDs
A
aspirin/ASA: bayer, bufferin, excedrin
ibuprofen: advil, motrin
naproxen: aleve
25
prescription NSAIDs
* oral: katoprofen, diclofena, indomethacin, meloxicam, ansaid
* injectable: toradol
26
tylenol
| acetaminophen, paracetemol
* liver at highest risk
* absolute maximum daily dosage is 4000 mg
* typically none in presence of liver diagnosis
* found in other medications (can lead to accidental overdose)
* prescription: percocet (oxycodoe + T), vicodin (hydrocodone + T), ulatracet (tramadol + T)
* OTC: nyquil, alka-selzer, cepacol, dayquil, robitussin, vick's, sudafed
27
the US has []% of the world's population but uses []% of the world's opioids
* 4.6%
* 80%
| 12 states have more pain prescriptions than people
28
risk of continued opioid use increases at [] days
4-5
29
opioid involvement in GI
* opioid bowel dysfunction manifests as: constipation, NV, bloating, ileus, pain
30
opioids
codein
fentanyl
hydrocodone
hydromorphine (dilaudid)
meperidine (demerol)
oxycodone
31
antibiotics and GI
* antibiotic associated diarrhea: antibiotics can kill off "good" bacteria, allow *C. difficile* to multiply and release toxins that damage cells lining intestinal wall --> diarrhea, abdominal pain, fever
* hepatic encephalopathy is also a risk for sever diarrhea --> liver failure treated with lactulose
32
supplements
* iron: can cause black stool (possible false + for GI bleed)
* potassium
* calcium
* magnesium
* all have potential variable GI side effects: NV, epigastric pain/irritation, constipation, diarrhea, discolored stools, gas, bloating
33
other meds to watch for
* screen GI in presence of:
* H2 receptor antagonists (Tagamet, Zantac, pepcid)
* proton pump inhibitor (PPI) - prevacid, nexium, prilosex
34
exon
the portion of a gene that codes for amino acids (building blocks of proteins)
the part of the genetic code that is expressed
35
transcription
DNA to RNA
36
translation
RNA to protein
37
epigenetics
* study of changes in organisms caused by modification of gene expression reather than alteration of genetic code itself
* change in phenotype without change in genotype
38
does PT influence genotype, phenotype, or epigenetics
* genotype: no
* phenotype: yes
* epigenetics: yes
39
why do cells divide
* reproduction
* growth
* repair
40
interphase
GI
S
G2
G0
41
G1
* growth phase
* protein synthesis
* check points/cyclins: Cyclin D, CDK 4/6
* G1 --> S: cyclin E, CDK 2
42
S
* synthesis
* DNA replication
* check points/cyclins: cyclin A, CDK 2
* cyclin A/B, CDK 1
43
G2
* microtubules
* cyclin A/B, CDK 1
44
G0
* quiescent phase
* senescent cells
45
mitosis
* prophase
* prometaphase - metaphase
* anaphase
* telophase
* cytokinesis
46
cancer
* abnormal cell division and growth (neoplasia)
* normal cell growth is highly regulated by growth factors and intracellular signaling cascades
* cancer is not just 1 disease, it is many: over 100 different types of cancer often name for organ or cell type
| organ: colon, pancreatic, lung, brest
cell: basal, leukemia
47
cancer is the [] cause of number of deaths
* second (599,108)
* prostate (m), breast (f)
* lung and bronchus
* colon and rectum
| overall trends in death rates by sex down
48
oncogene
* cancer genes
* when oncogenes > tumor suppressor genes = cancer
49
carcinogens -- the drivers of cancer
"drivers" of cancer
* proto-oncogenes and oncogenes: up-regulated in cancer, promote cell proliferation and differentiation, inhibit apoptosis
* tumor suppressor genes (anti-oncogens): down-regulated, inhibit cell proliferation and halts cell division if damaged, triggers repair or apoptosis
* DNA repair genes: down-regulated, fix mutated DNA
50
carcinogenesis
* genetics - family history: breast (BRCA1, colon, ovarian, prostate)
* environmental factors: chemicals (absestos), radiation, lifestyle and habits (food choices/access, smoking, alcohol)
* invading organisms: viral exposurre (human papillomavirus - HPV) --> cervical/vulvar and penile cancers
* many cancers are believed to be a combionation of facotrs (genetics + virus + environment + other factors)
51
6 hallmarks of cancer
* self-sufficient growth signals: activated GF production and signaling, cancer cells produce signals to further own growth
* resistance to anti-growth signals: inactivated cell cyle checkpoints
* immortality: inactivated cell death pathways
* resistance to cell death: activated anti-cell death signaling
* sustained angiogenesis: activated VEGF signaling
* invasion and metastasis: loss of cell-to-cell interaction, contact inhibition
52
adenocarcinoma
originates in glandular tissue
53
blastoma
originates in embryonic tissue of organs
54
carcinoma
originates in epithelial tissue (tissue that lines organs and tubes)
55
leukemia
originates in bone marrow
56
lymphoma
originates in lymphatic tissue
57
myeloma
originates in bone marrow
58
sarcoma
originates in connective or supportive tissue (bone, cartilage, muscle)
59
sarcoma
originates in connective or supportive tissue (bone, cartilage, muscle)
60
benign
* slow-growth, non-invasive, no metastasis
* benign tumors do not spread into or invade nearby tissue
* usually non-life threatening
61
malignant
* rapid growth, invasive, potential for metastasis
* maintains original name even after metastasis (breast cancer to lung is metastatic breast cancer, not lung CA)
* malignant cancers have an increased risk of growing back
62
cancer staging
* describes the severity of a person's cancer based on teh extent of the primary tumor and whether or not cancer has metastasized
* important for planning, prognosis, common terminology
63
**T**MN
* tumor size
* Tx: tumor cannot be evaluated
* T0: no evidence of primary tumor
* T1-4: increasing size of tumor
64
**T**NM
* tumor size
* Tx: tumor cannot be evaluated
* T0: no evidence of primary tumor
* T1-4: increasing size of tumor
65
T**N**M
* spread to regional lymph nodes
* Nx: lymph node cannot be evaluated
* N0: no lymph node involvement
* N1-3: increasing involvement of regional lymph nodes
| once cancer into nodes, probably spreading somewhere else too
66
TN**M**
* presence of distant metastasis
* M0: no distant metastasis
* M1: distant metastasis
67
tumor grades
* Gx: grade cannot be assessed (undetermined grade)
* G1: well differentiated (low grade), slow growing, tissue appears close to normal
* G2: mdoerately differentiated (intermediate grade)
* G3: poorly differentiated (high grade)
* G4: undifferentiated (high grade)
tumors must be 10^8 cells before it is identifiable on MRI
| G3-4 tumors tend to grow/spread rapidly and do not look/act normal
68
diagnostic procedures
* lab values -- cancer biomarkers
* imaging -- radiographs, ultrasound, CT, MRI, PET, FDG (tracer to assess metabolic activity)
* biopsy
* blood work/labs
* cancer specific antigens -- proteins produced in tumor cells
* >> PSA (prostate specific antigen), CEA (carcinoembryonic antigen - GI CA), CA 125 (cancer antigen 125 - ovarian)
69
leukemia/lymphoma/myeloma (LLM)
* defined by cell lines
* defined by stage of development
70
myeloid cell lines
* leukemia of granulocytes
* neutrophil, eosinophils, basophils, monocyte/macrophage
70
myeloid cell lines
* leukemia of granulocytes
* neutrophil, eosinophils, basophils, monocyte/macrophage
71
lymphoid/lymphocytic cell line
involves lymphocytes and plasma cells
72
acute CA cells
immature, undifferentiated cells
(more severe)
73
chronic CA cells
mature, more differentiated cells
(less severe)
74
leukemia
cancer cells originate and are mainly in the bone marrow and blood
75
lymphoma
cancer cells originate and are mainly found in lumph nodes and lymphatic system
76
example: chronic lymphocytic leukemia (CLL)
chronic: mature, differentiated
lymphocytic: in lymphocytes
leukemia: where
invovles partially matured/differentiated lymphocytes, originates in bone marrow and cancerous cells in bone marrow and blood stream
77
leukemia CA
* a hematological disorder affecting leukocytes
* abnormal growth crowds out normal cell lines in the bone marrow
* acute lymphocytic (ALL) - 80% of childhood cases
* acute myelogenous (AML) - 85%
* chronic lymphocytic (CLL)
* chronic myelogenous (CML)
78
lymphoma CA
* hematological disorder arising from the lymphoid system
* **2 categories**
* hodgkin's lymphona: abnormal B cells, Reed sternberg cell, less common, better "cure" rate,diagnosed earlier
* non-hodgkin's lymphoma (NHL): many types, abnormal B or T cells, more common
79
multiple myeloma
* disease of the plasma cells of the immune system
* plasma cells secrete antibodies (immunoglobulins)
* hypercalcemia
* symptoms: pain, bruising, lytic bone lesions/fractures
* overgrowth of plasma cells
* attack immunoglobulins - IgA, IgM, IgG, IgD, IgE
* antibodies have light chains and heavy chains - ratios indicate different things
80
LLM clinical manifestations
* relate to problems caused by
* **bone marrow failure**
* overcrowding by abnormal cells
* inadequate production of normal bone marrow components
* anemia, thrombocytopenia, altered number and functions of WBCs
* fatigue, pallow, weight loss
* **leukemic cells infiltrate other organs**
* bone pain and pathologic fracture
* lymphadenopathy
* oral lesions
* splenomegaly
* hepatomegaly
* meningeal irriation
| "liquid cancers"
81
mastectomy
* unilateral or bilateral
* with or without reconstruction
* **with**
* prec major release from inferior portion of sternal attachment as well as lifted from under
* less and less sub-pectoral - more pre-pectoral but can be more infections?
* **without**
* outcomes are quicker and generally less limited, more of a psychological/cosmetic choice
82
implications following mastectomy
* pain, limited ROM, strength, protective postures, trouble sleeping
* cording: myofascial, axillary web syndrome, mondor's cording
* lymphedema
83
lumpectomy
* remove tumor and often lymph nodes
* sentinel and axillary lymph node dissection -- not specific to lumpectomy, often removed with mastectomy
* noe, 1-2 lymph nodes removed, most likely sentinel and not axillary
* lumpectomy often followed with radiation (depending on final pathology report) to decrease risk of cancer returning
84
oncotype testing
* 0-18, 18-30, >31
* recurrence score
* women in a gray area do not benefit receiving chemotherapy
85
adriamycin/doxorubicin
| red devil
* most cardiotoxic therapeutic agent
* need follow-up with cardiologist along with CV assessment before regular exercise
86
cytoxan
AC typically go together, 3-4 treatments every 3 weeks
87
taxol/taxotere
may have T/T every week for up to 12 weeks
permanent hair loss?
88
AI's
tamoxifen
anastrozole, letrozole
can induce menopause in women under 45
89
side effects of chemotherapy
* joint pain, fatigue, NV, peripheral neuropathy, weakness and deconditioning, osteopenia/osteoporosis (depending on drug) - common with injections for metastatic breast cancer
* low blood counts
90
chemo drugs that induce peripheral neuropathy
* taxanes (taxol/taxotere)
* platinum-based (carboplastin, cisplatin)
91
ratio of light chains in multiple myeloma
* kappa and lambda are light chains of antibodies
* one high and one low: indication that myeloma is active
* both increase: show disease other than myeloma (like kidney disease)
* both normal but ratio abnormal: low level of active myeloma
92
multiple myeloma chemo
* different cocktails, especially in recurrence
* daratumumab (darzalex), lenalidomide (revlimid), dexamethasone
* bortezomib (velcade), lenalidomide, dexamethasone
* cyclophophamide (cytoxan), bortezomib, dexamethasone - CyBorD
93
hodgkin lymphoma chemo
* CHOP
* cyclophosphamide, doxorubicin, vincristine (oncovin), prednisone
* often combined with immunotherapy
94
non-hodgkin lymphoma chemo
* ABVD
* adriamycin/doxorubicin, bleomycin - lung damage, vinblastine, dacarbazine
* often combined with immunotherapy
95
exercise programming with cancer survivors
* cancer survivors have notoriously low levels of activity so need to get moving - based on cardiac rehab
* Phase 1 - active treatment: 30-45%, 22-3 sessions per week, 20-30 minutes
* Phase 2 - done with treatment, completion of phase 1 (3 months): 40-60%, 3 sessions per week, 20-30 minutes
* Phase 3 - after completion of phase 2: 60-80%, 3-4 sessions per week, 30 minutes
* Phase 4: 80% to max effort
