exam 3 Flashcards
1
Q
Non-Pharm Tmtx of fatigue
A
hydration exercise schedules cluster activities naps
2
Q
Pharmacologic tmtx of fatigue in CA patients
A
Ritalin/Adderall (Psychostimulants)
Caffeine
3
Q
BID stimulants dosing should be when?
A
in AM with breakfast and noon-3pm
4
Q
when are cancer patients at their lowest point?
A
when chemo is in full effect
—> maximum side effects
5
Q
What is Pancytopenia
A
Anemia (fatigue/pallor)
Thrombocytopenia (petchiae/purpura/bleeding/bruising)
Neutropenia (fever/infection)
6
Q
Zofran
A
Treats N/V in cancer patients:
- created for the purpose of treating nausea in cancer patients
- 5HT receptor blocker
- increase in free seratonin, decrease in usable seratonin
7
Q
Compazine
A
Treats N/V in cancer patients
- dopamine receptor antagonist
side effects:
- Pseudoparkinsons
- EPS
- tremors
8
Q
Common S/S of brain tumor
A
Dizziness
N/V
HA that wakens from sleep
new onset < 5 or > 50 years
9
Q
Less common S/S of brain tumor
A
Seizures
Anisocoria
10
Q
Characteristics of Retinoblastoma
A
Leukocoria (cast eyes - white look with a light)
Absence of red reflex
11
Q
NHL Objective findings/general info
A
- painless lump in groin or axilla
- malignant proliferation of B or T cells
- mediastinal mass - stridor/dyspnea
- SVC syndrome
- enlarged supraclavicular/cervical nodes/epitrochlear
- weight loss
- abd distention
- rebound tenderness
12
Q
NHL - B or T cells or both
A
both
13
Q
HL B or T cells or oth
A
B cells only
14
Q
Risk Factors NHL
A
pesticide exposure (increases HLA antigen)
High birth weight
immunosuppresion
EBV!!!!!!!!!!!!
Hx of treated Hodgkin (effects of chemo+XRT+immunosuppressants)
Malaria exposure (causes T cell suppression and EBV)
Genetics –> chromosomal translocation involving genes for immunoglobulin or T cell receptors
15
Q
Most Deadly CAs
A
LUNG CA #1
prostate CA
16
Q
SVC syndrome AND what type of CA do you see it in
A
increased CVP (pressures above the heart) increased JVD (neck vein distention) OCCURS IN NHL
17
Q
Tumor lysis syndrome
A
tumor cells explode and release K and uric acid in to blood (generally occurs in Renal CAs)
18
Q
TS genes
A
if mutated or missing/defective = unregulated proliferation of tumor cells
19
Q
DNA repair geners
A
if missing or defective allows mutations and replication
20
Q
TMTX NHL (most successful)
A
Chemo + immunotherapy + XRT
21
Q
“in situ”
A
- encapsulated
- has not spread
- localized
22
Q
Sentinel node
A
- draining cancer site
- first node to be metastasized
23
Q
Sanctuary sites
A
PLACES THAT CANCER CAN HIDE FROM CHEMO
- CNS
- testes
24
Q
Changing from long acting to short acting pain medications
A
When RTC short acting are no longer working effectively - consider Oxycotin or METHADONE
25
Sanctuary sites and S/S
PLACES THAT CANCER CAN HIDE FROM CHEMO
- CNS: papilledema, vomiting, lethargy, HA, nuchal rigidity
- testes: unilateral painless enlargement
26
Patient has a limp, what could this signify?
bone pain
| bone tumor
27
Patient has a limp, what could this signify?
bone pain
| bone tumor
28
Best medication for bone cancers pain
Methadone
29
Constipation in cancer - treatment
HYDRATION
| lactulose
30
Mirtazapine
Helps with sleep and increasing appetite in cancer patients
31
Mirtazapine
Helps with sleep and increasing appetite in cancer patients
32
When to be concerned about an enlarged lymph node
- present > 4 weeks
| - > 1 cm in size
33
onco emergencies
- Neutropenia (WBC < 5) with a fever > 38 degrees
- SVC syndrome
- SIADH
- Tumor lysis syndrome
34
WILMS TUMOR
- NEPHROblastoma
- does NOT cross midline
- presents w/hematuria and HTN
- may affect other kids
- DO NOT PALPATE - encapsulated tumor, if you break capsule you will spread CA cells and poorer prognosis
35
Neuroblastoma
- renal CA
- seen normally in INFANTS
- can cross midline
36
W/U for pediatric abdominal mass
* **Ultrasound (best in peds)
- CT
- labs: UA, CBC, lytes
37
Patho leukemia
- malignant hematologic disease
- normal bone marrow replaced by blast cells (poorly differentiated, abnormal cells)
- blast cells take over and cause malignancy
- PANCYTOPENIA
- can be B cell or T cell or both
38
S/S ALL
- bone marrow inflitration and/or extramedullary dz
- PANCYTOPENIA
- bone pain
- limp
- lymphadenopathy
- enlarged spleen
39
When do you see a mediastinal mass in ALL
- when the cancer is T-cell lineage
40
W/U ALL
- CBC (can have increased leuks w/pancytopenia)
- CMP (liver and renal panels)
- CXR IF RESPIRATORY DISTRESS AND/OR STRIDOR R/O MEDIASTINAL MASS
- U/S (especially if concern for testicular sanctuary site)
ONCOLOGY:
- bone marry biopsy
- LP r/o CNS sanctuary site
41
Role of PCP in ALL
- mgmt of all non-cancer related health questions.
- routine visits
- vaccines in coordination w/ oncology
- manage care of pt after DC from onco service and monitoring for further issues
42
Presenting S/S of NSCLC
- cough
- SOB
- hemoptysis
- likely smoking history
- likely hx of symptoms x months
* ** lung CA patients don't present normally until CA is advanced)
43
Objective Findings NSCLC
- absence of breath sounds if lung collapse
| - dullness on percussion, decreased breath sounds
44
Complications of NSCLC
- SVC syndrome
- metastatic spread to abdomen (N/V/abd pain, wt loss)
- neuro symptom involvement 2/2 spinal cord compression from mets
45
How does chemo work
- treats and controls cancer growth at the level of DNA replication and cell division
46
Side effects of chemo
- N/V/D
- hair loss
- fatigue
- stomatitis
- decreased appetite
- constipation
- pain
- blood disorders
- bone marrow suppression
- cog. dysfunction
- damage to organs
47
NHL presentation
- acute abdomen
- abdominal pain/distention/fullness
- constipation
- NON TENDER LYMPH NODE ENLARGEMENT
48
Dx of NHL / labs
- generally s/s present < 1 mo before dx
- labs : PANCYTOPENIA on CBC,
- hypercalcemia, abnormal LFTs on CMP
- prolonged clotting times on coags
49
Complications of NHL
- SVC
- GI obstruction/perforation
- bleeding (thrombocytopenia)
- infection (leukopenia)
50
W/U for NHL
- Labs (CBC, CMP, Coags, DDimer)
- Blood cultures
CMP (LFTs, Calcium, Phos + assess for tumor lysis syndrome)
- CXR (PA/lateral)
- r/o mediastinal mass
evaluate airway
exclude other pulm issues such as fibrosis and pneumonia
- U/S - assess size of kidneys and patency of urinary tract
- EKG
- CT scan for staging and to r/o mets
51
MAIN causes of onco issues in kids
- genetics
| - mutations (translocations)
52
T/F: Kids are more responsive to chemo
True
| - they tolerate higher doses because they have better organ function
53
In pediatrics - what causes more issues chemo/XRT or the long term effects of chemo?
Long term effects
54
Virus associated with increased cancer risk
Epstein-Barr - particularly Lymphoma (HL & NHL)
55
Red Flags Pedi cancer in Primary Care
```
mass or swelling (especially unilateral adenopathy present > 4 weeks > 1cm)
pallor
decreased energy
bruising
limping
prolonged illness
fever of unknown origin
frequent HA
N/V
```
56
Extramedullary
dz outside of marrow
57
Demographics ALL
- usually age 2-6
- T-cell > males
- white > black
58
s/s of bone marrow failure ALL
```
- PANCYTOPENIA
>> neutropenia (fever/recurrent infection)
>> thrombocytopenia (petechiae, bleeding, purpura)
>> anemia (fatige/pallor)
- bone pain/limp
- lymphadenopathy
hepatosplenomegaly
- decreased testicular size
```
59
Most common site to find NHL
intestinal tract --> hence s/s of acute abdomen and abdominal discomfort/fullness/constipation/ N-V
60
T/F: Bone marrow and CNS involvement is rare in HL
True!
61
Age distribution for HL
bimodal:
- teens - 25 years
- 50 - 60 years
62
Characteristic sign of HL
persistent painless adenopathy - USUALLY cervical or mediastinal - unresponsive to ABx
63
Constitutional B signs in HL and significance
- these are the signs and symptoms in symptomatic HL
- fever of unknown origin 38C > 3 days
- unexplained wt loss > 10% in 6 months
- drenching night sweats
64
W/U HL
```
CBC
ESR/CRP
Serrum Copper/Ferritin
LFTs
UA (proteinuria)
```
65
TMTX HL
- often cure with XRT and/or chemo
| usually in combo
66
Most common solid tumor of infancy
NEUROblastoma
67
Neuroblastomas begin where?
embryonal malignancy of SNS
68
Characteristics of neuroblastoma cells
small, round, blue tumors
| undifferentiate
69
bio marker that is a sign of a bad prognosis
MYCN amplification --> rapid tumor progression and poor prognosis
70
Urine in neuroblastoma
urinary catecholamines are present
71
poor prognostic histology in neuroblastoma
- stroma-rich w/nodular patterns
| - stroma-poor tumors
72
s/s of NEUROblastoma
- abd pain w/or w/o N/V
- wt loss, anorexia
- fatigue
- bone pain, limp
- **HTN - renal artery compression
- chronic diarrhea - secretion of vasoactive intestinal peptide
73
Horner syndrome
- neuroblastoma extending into neck
1. pitosis
2. miosis (constricted pupil)
3. absence of sweating on one side of the face
74
opsoclonus
random eye mvmt and myoclonus
| paraneoplastic syndrome
75
S/S that neuroblastoma has extended to parasinus canal
- weakness
- limping
- paralysis
- bladder/bowel disfunction
76
"blueberry muffin" skin in cancer
Stage 4S metastatic neuroblastoma
77
W/U neuroblastoma
```
CBC
UA
CMP
LFT
RFT
Coags
LDH
```
78
MBIG test
- picks up on catacholaminergic cells of tumors
| - is able to ID primary and metastatic diesase spots
79
Tchnetium - 99 bone scan
ID mets to bone
80
MOST COMMON childhood abdominal and renal malignancy
WILMS TUMOR
81
Cause of WILMS TUMOR
- neoplastic prolifration of embryonal renal cells
| - abnormal TS genes 11p13 and 11p15
82
Other possible abnormals in WILMS TUMOR
- aniridia (absence of iris)
- hemihyperprophy
- cryptorchism
- hypospadias
83
diagnostics WILMS TUMOR
- Xray - lung mets
- Renal US - check patency of IVC
- CT/MRI
84
What is the concern if Wilm's tumor invades IVC
mets to right ventricle
85
TMTX Wilms Tumor
- nephrectomy if unilateral
- surgery to debulk
- chemo/XRT
86
most common OCULAR malignancy of childhood
Retinoblastoma
87
Retinoblastoma has a high mortality if ....
extra ocular extension
| throug sclera or along optic nerve
88
Leukocoria
- loss of red reflex in eye...white instead
| - often called "cats eye"
89
Patho of Parkinsons
Destruction of dopamine producing cells
90
TRAP mnemonic Parkinsons
T - tremor
R - rigidity
A - Akinesia (slowed movement)
P - postural instability
91
Medication Progression Parkinsons
1. MAO-B (selegine/rasagiline) -gilines
2. Dopamine agonist (Requip/Neopress)
3. Carbadopa/Levadopa (Sinemet)
4. Apokyn (for gait freezing)
5. Amantadine (anticholinergic)
92
Increase in dopamine causes what?
- Increased Side effects
| - increased movement
93
Short term or long term memory goes first win ALZ
Short term
94
Antipsychotic Increase risk for:
- Stroke
| - Cardiovascular disease
95
What chronic conditions increase risk for vascular dementia
- HTN
- HLD
- DM
96
What is mixed dementia
reversible dementia (delirium) with underlying progressive disease
97
Treatment for vascular dementia
though not reversible nor curable, progression can be slowed by ASA and Plavix
98
Agnosia
ALZ
| - not able to recognize objects
99
Apraxia
- ability to recognize things but not what to do with them. For example "these are scissors, but what are they for"
100
Issues present in late stages of ALZ
- Wandering
- increased libido
- increased strength
- behavioral disturbances
- decreased impulse control
101
What may alter the results of the Folstein MMS scoring in either a better or a worse score
Educational Level
102
Blessed Dementia Scale
Assesses Functional and Cognitive Ability
103
Scoring on Blessed Dementia Scale
Higher the number the worse the Dementia
104
T/F Delirium may have an abrupt onset
True
105
T/F Dementia symptoms may wax and wane
True
106
Hospice vs. Palliative Care
Hospice - preparation for death
Palliative Care - supportive, symptomatic tmtx
107
Treatment of Delirium
Treat the underlying cause
108
Alteration of the FMR1 protein causes what genetic condition
Fragile X
109
What is Down Syndrome testing in the first trimester
- Nuchal translucency
- pregnancy associated plasma protein A
- HCG
110
What is the testing for Down Syndrome in the 2nd and 3rd trimester
- Quad Screening - AFP, HCG, Estradiol, Inhibin-A
| - Free fetal DNA cells - in blood of mother
111
What are the invasive test for Down Syndrome
- CVS
| - Amniocentesis
112
When does screening for ASD start
18 months
| - MCHAT
113
By what age do you usually see ASD symptoms
- by age 3, but could have a delayed dx
114
Presbycusis
most common cause of hearing loss
115
Fall risk
PRIMARY PREVENTION
| - fall risk interventions - ensure path is clear of items that would increase risk
116
most important aspect to consider in having a drivers license
- visuospatial skill
117
What is the most common complication in dementia
- feeding difficulties
| -
118
most common TYPE of dementia
ALZ
119
ALZ
RAPID forgetfulness, especially of new material
| most prevalent dementia
120
Frontotemporal Dementia
More trouble planning tasks, more behavioral disturbances and disinhibition
121
Vascular dementia
- Quickest onset, more language problesm
| - less forgetful than AD especially with available cues.
122
Lewy Body Dementia
May have more psychiatric symptoms (psychosis) early in disease
