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MC II > week 2 > Flashcards

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
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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
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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
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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
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5
Q

lymph nodes

A
  • should not be normally visible or palpable
  • enlarge due to infections, allergies, viruses, THA, cancer
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6
Q

lymph nodes with malignancy tend to be

A
  • firm, non-tender, matted, fixed
  • increasing in size over time
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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
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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
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9
Q

blood in stool is indicative of

A

lower GI bleed

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10
Q

dysphagia

A

difficulty swallowing
coughing during/after eating

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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

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12
Q

upper vs lower GI

A
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13
Q

hematochezie

A

frank blood in stool

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14
Q

pale or clay colored stool

A

biliary/liver disease

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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
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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)
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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
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18
Q

liver disease

A
  • skin and nail bed changes
  • jaundice
  • neurological symptoms: ataxia, dyscoordination, cognitive effects from ammonia build up in hepatic encephalopathy
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19
Q

gallbladder disease

A
  • cholecystitis: inflammation
  • cholelithiasis: gall stones
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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
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21
Q

what percent of adverse drug events (ADE) are in the GI system

A

10%

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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
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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
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24
Q

OTC NSAIDs

A

aspirin/ASA: bayer, bufferin, excedrin
ibuprofen: advil, motrin
naproxen: aleve

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25
Q

prescription NSAIDs

A
  • oral: katoprofen, diclofena, indomethacin, meloxicam, ansaid
  • injectable: toradol
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26
Q

tylenol

acetaminophen, paracetemol

A
  • 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
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27
Q

the US has []% of the world’s population but uses []% of the world’s opioids

A
  • 4.6%
  • 80%

12 states have more pain prescriptions than people

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28
Q

risk of continued opioid use increases at [] days

A

4-5

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29
Q

opioid involvement in GI

A
  • opioid bowel dysfunction manifests as: constipation, NV, bloating, ileus, pain
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30
Q

opioids

A

codein
fentanyl
hydrocodone
hydromorphine (dilaudid)
meperidine (demerol)
oxycodone

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31
Q

antibiotics and GI

A
  • 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
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32
Q

supplements

A
  • 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
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33
Q

other meds to watch for

A
  • screen GI in presence of:
  • H2 receptor antagonists (Tagamet, Zantac, pepcid)
  • proton pump inhibitor (PPI) - prevacid, nexium, prilosex
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34
Q

exon

A

the portion of a gene that codes for amino acids (building blocks of proteins)
the part of the genetic code that is expressed

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35
Q

transcription

A

DNA to RNA

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36
Q

translation

A

RNA to protein

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37
Q

epigenetics

A
  • 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
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38
Q

does PT influence genotype, phenotype, or epigenetics

A
  • genotype: no
  • phenotype: yes
  • epigenetics: yes
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39
Q

why do cells divide

A
  • reproduction
  • growth
  • repair
40
Q

interphase

A

GI
S
G2
G0

41
Q

G1

A
  • growth phase
  • protein synthesis
  • check points/cyclins: Cyclin D, CDK 4/6
  • G1 –> S: cyclin E, CDK 2
42
Q

S

A
  • synthesis
  • DNA replication
  • check points/cyclins: cyclin A, CDK 2
  • cyclin A/B, CDK 1
43
Q

G2

A
  • microtubules
  • cyclin A/B, CDK 1
44
Q

G0

A
  • quiescent phase
  • senescent cells
45
Q

mitosis

A
  • prophase
  • prometaphase - metaphase
  • anaphase
  • telophase
  • cytokinesis
46
Q

cancer

A
  • 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
Q

cancer is the [] cause of number of deaths

A
  • second (599,108)
  • prostate (m), breast (f)
  • lung and bronchus
  • colon and rectum

overall trends in death rates by sex down

48
Q

oncogene

A
  • cancer genes
  • when oncogenes > tumor suppressor genes = cancer
49
Q

carcinogens – the drivers of cancer

A

“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
Q

carcinogenesis

A
  • 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
Q

6 hallmarks of cancer

A
  • 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
Q

adenocarcinoma

A

originates in glandular tissue

53
Q

blastoma

A

originates in embryonic tissue of organs

54
Q

carcinoma

A

originates in epithelial tissue (tissue that lines organs and tubes)

55
Q

leukemia

A

originates in bone marrow

56
Q

lymphoma

A

originates in lymphatic tissue

57
Q

myeloma

A

originates in bone marrow

58
Q

sarcoma

A

originates in connective or supportive tissue (bone, cartilage, muscle)

59
Q

sarcoma

A

originates in connective or supportive tissue (bone, cartilage, muscle)

60
Q

benign

A
  • slow-growth, non-invasive, no metastasis
  • benign tumors do not spread into or invade nearby tissue
  • usually non-life threatening
61
Q

malignant

A
  • 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
Q

cancer staging

A
  • 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
Q

TMN

A
  • tumor size
  • Tx: tumor cannot be evaluated
  • T0: no evidence of primary tumor
  • T1-4: increasing size of tumor
64
Q

TNM

A
  • tumor size
  • Tx: tumor cannot be evaluated
  • T0: no evidence of primary tumor
  • T1-4: increasing size of tumor
65
Q

TNM

A
  • 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
Q

TNM

A
  • presence of distant metastasis
  • M0: no distant metastasis
  • M1: distant metastasis
67
Q

tumor grades

A
  • 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
Q

diagnostic procedures

A
  • 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
Q

leukemia/lymphoma/myeloma (LLM)

A
  • defined by cell lines
  • defined by stage of development
70
Q

myeloid cell lines

A
  • leukemia of granulocytes
  • neutrophil, eosinophils, basophils, monocyte/macrophage
70
Q

myeloid cell lines

A
  • leukemia of granulocytes
  • neutrophil, eosinophils, basophils, monocyte/macrophage
71
Q

lymphoid/lymphocytic cell line

A

involves lymphocytes and plasma cells

72
Q

acute CA cells

A

immature, undifferentiated cells
(more severe)

73
Q

chronic CA cells

A

mature, more differentiated cells
(less severe)

74
Q

leukemia

A

cancer cells originate and are mainly in the bone marrow and blood

75
Q

lymphoma

A

cancer cells originate and are mainly found in lumph nodes and lymphatic system

76
Q

example: chronic lymphocytic leukemia (CLL)

A

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
Q

leukemia CA

A
  • 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
Q

lymphoma CA

A
  • 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
Q

multiple myeloma

A
  • 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
Q

LLM clinical manifestations

A
  • 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
Q

mastectomy

A
  • 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
Q

implications following mastectomy

A
  • pain, limited ROM, strength, protective postures, trouble sleeping
  • cording: myofascial, axillary web syndrome, mondor’s cording
  • lymphedema
83
Q

lumpectomy

A
  • 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
Q

oncotype testing

A
  • 0-18, 18-30, >31
  • recurrence score
  • women in a gray area do not benefit receiving chemotherapy
85
Q

adriamycin/doxorubicin

red devil

A
  • most cardiotoxic therapeutic agent
  • need follow-up with cardiologist along with CV assessment before regular exercise
86
Q

cytoxan

A

AC typically go together, 3-4 treatments every 3 weeks

87
Q

taxol/taxotere

A

may have T/T every week for up to 12 weeks
permanent hair loss?

88
Q

AI’s

A

tamoxifen
anastrozole, letrozole
can induce menopause in women under 45

89
Q

side effects of chemotherapy

A
  • 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
Q

chemo drugs that induce peripheral neuropathy

A
  • taxanes (taxol/taxotere)
  • platinum-based (carboplastin, cisplatin)
91
Q

ratio of light chains in multiple myeloma

A
  • 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
Q

multiple myeloma chemo

A
  • different cocktails, especially in recurrence
  • daratumumab (darzalex), lenalidomide (revlimid), dexamethasone
  • bortezomib (velcade), lenalidomide, dexamethasone
  • cyclophophamide (cytoxan), bortezomib, dexamethasone - CyBorD
93
Q

hodgkin lymphoma chemo

A
  • CHOP
  • cyclophosphamide, doxorubicin, vincristine (oncovin), prednisone
  • often combined with immunotherapy
94
Q

non-hodgkin lymphoma chemo

A
  • ABVD
  • adriamycin/doxorubicin, bleomycin - lung damage, vinblastine, dacarbazine
  • often combined with immunotherapy
95
Q

exercise programming with cancer survivors

A
  • 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

MC II (7 decks)

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