final exam week 7 Flashcards by Garrett Anderson

Common metastatic sites for tumors (and s/s)
Lung –> (2)
s/s-

Colon–> (1)
s/s

liver, bone, brain?

Lung  bone, brain
Bone - pain
Brain – balance

Colon  liver
Liver - Enzymes, bleeding

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biologic substances (hormones, enzymes, antigens or genes) shed off of some tumors and are measurable

tumor markers

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Certain malignancies are associated with cancer inducing viruses – HPV, HIV, Hep B, Hep C

For any virus to live and propagate – it must insert its genes into the host cell’s genome

The host cell then becomes a manufacturer of the virus

MOA – always involve the activation of growth-promoting pathways or inhibition of tumors suppressors in infected cells

Viral induced cancer

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T/F
1. Early post menopausal years – women experience greatest bone loss and it Continues at gradual rate
2. Women have lower peak bone density
3. Women lose more bone mass compared to men over a lifetime
4. Women reach fracture threshold later then men = increased risk fracture
5. For women
Bone reabsorbed by osteo__lasts > bone formed by osteo__lasts = decreased bone mass

T
T
T
F - earlier
Bone reabsorbed by osteoclasts > bone formed by osteoblasts = decreased bone mass

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risk factors
- open fracture
- recent trauma
- DM
- Hemodialysis
- IV drug use
- Splenectomy

osteomyelitis

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Gout phases
1. Phase 1 – symptoms?
-______ serum uric acid levels
-_______ deposits in tissues
-Crystals accumulate and ______ is damaged
-Acute ______ is triggered
2. Phase 2 – acute _____
-With hyperuricemia
3. Phase 3 – clinically ______
-Until next ______ occurs
-Continued hyperuricemia
-Could be months or years before next flare
-Later attacks get closer and closer
4. Phase 4 – ______ arthritis
-Joint pain and other s/s present most of the time

Gout phases
Phase 1 – asymptomatic
- Elevated serum uric acid levels
- Uric acid deposits in tissues
- Crystals accumulate and tissue is damaged
- Acute inflammation is triggered
Phase 2 – acute flares/attacks
- With hyperuricemia
Phase 3 – clinically inactive
- Until next flare occurs
- Continued hyperuricemia
- Could be months or years before next flare
- Later attacks get closer and closer
Phase 4 – chronic arthritis
- Joint pain and other s/s present most of the time

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_______ are cells that build bone tissue

________ are cells that break down bone tissue.

Osteoblasts

Osteoclasts

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Risk factors of what cancer?
- Obesity – inflammation causes changes to DNA
- Tobacco use
- Physical activity
- Insulin resistance
- Low fiber in the diet
- High amount of animal fat in the diet and processed meats
- Diets low in vitamin A, C, and E
- Ulcerative colitis – inflammation causes changes to DNA
- Alcohol

colorectal cancer

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Carcinogen Classification
_________ - substances or agents that have been definitively linked to causing cancer in humans.
Examples include:
* Tobacco smoke
* Asbestos
* Alcohol
* Estrogen therapy
* Some viruses - HPV, HIV
________- substances or agents that are likely to cause cancer in humans, based on limited evidence.
Examples include:
* Women who work night shift
________ - substances or agents that may be carcinogenic to humans, but the evidence is not strong enough to classify them in another class.
Examples include:
* Engine exhaust

known
Probable
Possible

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fracture complications: delayed healing
1. __________ - takes longer than expected to heal.
2. ________- fracture heals in an incorrect position or alignment.
3. _______ - no healing 4-6 months post fracture

malunion
delayed union
nonunion

delayed union - takes longer than expected to heal.
malunion - fracture heals in an incorrect position or alignment.
nonunion - no healing 4-6 months post fracture

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Osteoporosis patho
1. Increased bone resorption AKA osteo__last activity increased
2. Decreased bone formations AKA osteo__lasts activity decreased
3. Problems:
Failure to make new bone (osteo__lasts)
Too much bone resorption (osteo__lasts)
Both

Osteoporosis patho
1. Increased bone resorption AKA osteoclast activity increased
2. Decreased bone formations AKA osteoblasts activity decreased
3. Problems:
Failure to make new bone (osteoblasts)
Too much bone resorption (osteoclasts)
Both

Osteoclast – bone breakdown
Osteoblast – bone build

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Disorder involves inflammation of one or more joints and then becomes arthritis

Arthropathy

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colorectal cancer - T/F
1. Colon cancer usually starts as a polyp, a tumorous mass that projects into the intestinal lumen
2. polyps can be malignant or benign
3. Starting at age 50, colonoscopy q 10 years

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which cancer
Etiology
- Cigarette smoking (promotor and cause)
- Passive smoke
- COPD – chronic inflammation makes mutation
- Asbestos – carcinogen
- Radon
- Arsenic
- Genetics
- other

lung

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OA Etiology
- _______ applied to joint – weight bearing
- Degeneration of _______ – excessive load of healthy joint or normal loading of previously injured joint
- Chronic disease or acute flare?

OA Etiology
- Stress applied to joint – weight bearing
- Degeneration of cartilage – excessive load of helathy joint or normal loading of previously injured joint
- Chronic disease

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cancer cells vs normal cells?
1. proliferation control
______ – zero population growth and apoptosis (normal death), so they have 1:1 ratio of cell death and birth = no population growth
______ – uncontrolled proliferation, sometimes cells are immortal, die unpredictably

2.proliferation rate
______– unpredictable (fast or slow), depends on differentiation
_____ – predictable

self HLA antigens – how they determine something is self vs non-self
_____ – present themselves to immune system and are recognized as self
_____ – non-self markers, immune system may attack or sometimes they can avoid detection from immune system

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2 hereditary conditions that increase the risk of developing colorectal cancer:
- Familial Adenomatous Polyposis (FAP) - well defined hereditary disorder that predisposes an individual to intestinal _______
- Hereditary Nonpolyposis Colorectal Cancer (HNPCC) - without the extensive _______ formation seen in FAP.

FAP - with polyps
HNPCC - without polyps

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s/s
local
- Tender, warm, red
- Wound drainage
- Restricted movement
- Spontaneous fracture
Systemic
- Fever
- Positive blood culture
- Leukocytosis (high WBC)

osteomyelitis

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OA s/s
- Manifestations are asymmetrical or symmetrical?
- deep aching _____ pain – esp with exertion, relieved with rest
- joint pain with ____ weather
- stiffness in ______
- ______ of joint during motion
- joint swelling – hard or soft?
- ______ gait
- _____ range of motion

OA s/s
Manifestations are asymmetrical (RA is symmetrical)
- deep aching joint pain – esp with exertion, relieved with rest
- joint pain with cold weather
- stiffness in morning
- crepitus of joint during motion
- joint swelling – hard
- altered gait
- limited range of motion

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_______tumor – cancer is located in site of origin

________tumor – cancer is located to a site that it spread to
- We know they have spread bc they will look like cells in the primary location
- Ex: lung cells in brain

primary
secondary

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lupus acute flares =
cycle of acute exacerbation of ________, followed by _________

warning sign of _____
- fatigue
- pain
- h/a

prevention = recognize ______ and avoid ______
- sunlight
- infection
- abruptly stopping a medication
- stress

lupus acute flares
cycle of acute exacerbation of symptoms, followed by remission

warning sign of lupus flare up
- fatigue
- pain
- h/a

prevention – recognize warning signs and avoid triggers
- sunlight
- infection
- abruptly stopping a medication
- stress

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Origin of cancer

Carcinogenesis

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MOA
- Anti-inflammatory processes

Slows progression of RA when used with other DMARDs
slow/stop progression
used along or with methotrexate for early/mid RA

s/e
- Retinopathy

Hydroxychloroquine
DMARDS disease modifying anti-rheumatic drugs
antimalarial
Anti-rhematic

treats RA

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which cancer

Most present with advanced or metastatic cancer
Early dx is key to treatment
Common > 65 years and black

lung

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fracture orientations - __________ – straight line seen in falls - _______ – twisting injury - ________ – shattered - _______ – pressure from both ends of bone - _________ – incomplete break, beaks on one side but not all the way through, common in kids - ________ – tiny cracks in bone impacted greenstick transverse comminuted stress spiral

fracture orientations - transverse – straight line seen in falls - spiral – twisting injury - comminuted – shattered - impacted – pressure from both ends of bone - greenstick – incomplete break, beaks on one side but not all the way through, common in kids - stress – tiny cracks in bone

lung tumor secretion of ACTH resembles MSH – patient may have tanned skin

Paraneoplastic syndrome associated with lung cancer

OA vs RA!!! ___ – asymmetrical manifestations ____ – symmetrical manifestations ___ swelling – hard ___ swelling – spongy and warm

*** know OA vs RA!!! OA – asymmetrical manifestations RA – symmetrical manifestations OA swelling – hard RA swelling – spongy and warm

class: Selective estrogen receptor modulators (SERMs) drug: Raloxifene treatment for?

osteoporosis

Cell spectrum _________- – the extent that neoplastic cells resemble normal cells (structurally and functionally) Ex: ______ tumors are well differentiated = looks and functions like normal cell ________ – lack of differentiation, indicates total cellular disorganization, abnormal cell appearance, and cell dysfunction Ex: _______ cells/tumors = totally different look and function than a normal cell

Differentiation benign Anaplasia malignant

s/s of what cancer - cough - hemoptysis – blood in sputum - wheeze or stridor - chest pain - dyspnea - weight loss - excessive fatigue - Weakness - Hoarseness - Obstructive accumulation of secretions in the bronchioles that appear as pneumonia s/s - Asymptomatic – may find tumor accidentally on CXR for something else - Paraneoplastic syndrome (group of symptoms) may be the 1st sign

lung cancer

Cancer genetics T/F 1. All cancers originate from changes in DNA 2. Normal cell gene mutations = cancer cells 3. Gene mutations can be - ________ – ex: BRCA gene - ________ – acquired during person’s life - ex: carcinogen exposure 4. Immune systems are effective at killing mutated cells But as we age, out immune system isn’t as effective Mutated cells may go unnoticed That’s why Older adults have increased risk for developing cancer

1. T 2. T 3. hereditary, sporadic 4. T

assessment findings - joint deformity - joint tenderness - decreased ROM - herbedens nodes – distal finger (interphalangeal) joints crooked - bouchards nodes – proximal finger (interphalangeal) joints are crooked

osteoarthritis

lung cancer types __________– most common - slow growing ____________ - rapidly growing - metastasizes quickly small cell lung cancer (SCLC) non small cell lung cancer (NSCLC)

types non small cell lung cancer (NSCLC) – most common - slow growing small cell lung cancer (SCLC) - rapidly growing - metastasizes quickly

Most joint disorders affect _______ joints (moveable joints)

synovial

______ are proteins found on the surface of cells. They play a crucial role in the immune system's ability to distinguish between "self" and "non-self" cells. So the immune system can target foreign invaders like viruses, bacteria, and cancer cells. ______ cells present their HLA antigens to the immune system. These antigens act as identification tags, allowing the immune system to recognize them as "self" and avoid attacking them. ______ cells can exhibit abnormal or altered HLA antigens. These deviations from normal self-antigens can trigger an immune response. but some are able to evade detection by the immune system through various mechanisms.

Human Leukocyte Antigens (HLAs) normal cancer

fracture complications: fat embolism syndrome 1. type of __________ 2. fat molecules block blood vessels in the ______ 3. occurs following: ______ BONE FRACTURE (most common) or Major trauma 4. How do fat molecules in legs get to lungs? - Fat molecules are from _______ or ________ - Released into blood stream and travel to lungs 5. s/s o hypoxemia o altered LOC o petechial rash

fracture complications: fat embolism syndrome 1. type of PE 2. fat molecules block blood vessels in the lungs following 3. LONG BONE FRACTURE- big bones in legs most common or Major trauma 4. How do fat molecules in legs get to lungs? - Fat molecules are from bone marrow or traumatized tissue - Released into blood stream and travel to lungs 5. s/s o hypoxemia o altered LOC o petechial rash

Carcinogens T/F 1. Substances that cause development of cancer 2. Often require prolonged exposure 3. Can alter cell DNA = mutation 4. Damage from carcinogens are not cumulative 5. Agents can be carcinogen (cause), promoter, or both

1. T 2. T 3. T 4. F - is cumulative 5. T

drug treatment for OA NSAIDS!!! - Use _______ effective dose possible - Can affect _______ function - Risk for ______ , Risk increased with aging o Contraindication (1) o Use with caution (2) hx of GI bleed on coag therapy has PUD

NSAIDS!!! - Use lowest effective dose possible - Can affect kidney function - Risk for GI bleed o Risk increased with aging o Contraindication – PUD patient o Use with caution – hx of GI bleed or on coag therapy

Hydroxychloroquine DMARDS disease modifying anti-rheumatic drugs antimalarial Anti-rhematic treats?

RA and lupus

what are tumor markers useful for? (4)

- Screen for cancer: For example, PSA (prostate-specific antigen) is used to screen for prostate cancer. - Diagnose cancer: If a tumor marker is elevated, it may indicate the presence of cancer. However, further testing is usually needed to confirm a diagnosis. - Monitor the progress of cancer treatment: Tumor marker levels can be monitored over time to see if the treatment is effective. - Detect recurrence of cancer: If a tumor marker level rises after treatment, it may indicate that the cancer has returned.

Reduces risk of spinal fractures MOA – mimics estrogen by increasing bone density, inhibits bone resorption Used as prevention and treatment s/e - Hot flash - Leg cramping BLACK BOX WARNING - Stroke risk Teaching - Must take adequate calcium and vitamin D replacement for it to work - d/c at least 72 hours before planned procedures, any prolonged immobilization periods, high risk of blood clotting - don’t smoke or drink alcohol - don’t use if pregnant

Raloxifene Selective estrogen receptor modulators (SERMs) for osteoporosis

- Biologic response modifiers - Target parts of the immune system that trigger inflammation that cause joint and tissue damage - Usually given with methotrexate - Can increase risk of severe skin or lung infections, skin cancer, serious allergic reactions - Very expensive

Biologic agents Newer generation of DMARDS disease modifying anti-rheumatic drugs treats RA

metastasis - T/F 1. Cancer cells can travel by lymph, blood, or shed off into local area 2. But it has to have its own blood supply 3. Cancer cells are suited for this bc they secrete vascular endothelial growth factor (gives them ability to develop new blood vessels)

1. T 2. T 3. T

OM Patho - Arterial blood flow brings _______ into bone - _________ = inflammation, bone destruction, pus and edema - Pressure __creases within the bone - Causes local arteries to _________ - Decreases or eliminates supply of o ________ o ________ o _________ - Leads to impaired healing – b/c hard to get _________ to sight of infection, difficult to treat

- Arterial blood flow brings bacteria into bone - Infection = inflammation, bone destruction, pus and edema - Pressure increases within the bone - Causes local arteries to collapse - Decreases or eliminates supply of o Oxygen o Nutrition o Immune cells - Leads to impaired healing – b/c Antibiotics hard to get to sight of infection, difficult to treat

class: Hormone therapy drugs: - Calcitonin-salmon - HRT – no longer used treatment for?

osteoporosis

vascular spread - T/F 1. Cancer cells can enter the bloodstream and travel to distant organs. 2. The cancer cells leave the bloodstream and invade the tissues of a new organ and penetrate local veins 3. ________- The cancer cells stimulate the growth of new blood vessels to support their growth and survival. 4. Often cancer cells in the bloodstream go to the ____ first – bc the_____ filters blood 5. The _______ is also often a secondary site – for the same reason 6. The cancer cells get clumped, trapped and proliferate in the ____

1. T 2. T 3. Angiogenesis 4. liver 5. liver 6. liver

NSAIDS Work by reducing production of________ which promote pain, inflammation, fever 1. Cell damage occurs 2. NSAID arrives 3. _____ is blocked 4. Fewer ________ produced 5. Pain, inflammation, and fever are reduced

Work by reducing production of prostaglandins which promote pain, inflammation, fever 1. Cell damage occurs 2. NSAID arrives 3. COX is blocked 4. Fewer prostaglandins produced 5. Pain, inflammation, and fever are reduced

cancer classification systems: TNM system 2. N - lymph node involvement/spread N0 = N1 = spread to _____ lymph nodes or spread to ____ number of regional lymph nodes N2 = spread to______ lymph nodes or spread to ______ regional lymph nodes

N - lymph node involvement/spread N0 = no spread to regional lymph nodes N1 = spread to closest lymph nodes or spread to small number of regional lymph nodes N2 = spread to most distant lymph nodes or spread to numerous regional lymph nodes

cancer cell or normal cell? 1. No resting stage (Stage G0) - _____ cells are constantly moving through cell cycle stages 2. No checkpoints – for DNA to recognize errors and apoptosis (normal cell death) 3. No regard for growth inhibitors – released by neighboring cells, this prevents cells from invading eachother’s space. _____ cells will just grow on top of each other

1. C 2. C 3. C - As cancer cells proliferate o they accumulate on top, around, and beside each other o take over boundaries of organs o crowd out normal cells o may break free and travel to distant body sites

Osteoporosis pharm Classes: ____________ - Aldendronate ____________ - Raloxifene ___________ - Calcitonin-salmon - HRT – no longer used

Osteoporosis pharm Classes: Bisphosphonates - Aldendronate Selective estrogen receptor modulators (SERMs) - Raloxifene Hormone therapy - Calcitonin-salmon - HRT – no longer used

Gout patho 1. Body makes _____ AND it is also in our diet 2. ______ crystals form from the breakdown of purines 3. Normally uric acid dissolves in the blood and excreted by the _______ 4. _________ – overproduction or under excretion of uric acid 5. Uric acid crystal deposits in _______!!!

Gout patho 1. Body makes purine AND purine is in diet 2. Urice acid crystals form from the breakdown of purines 3. Normally uric acid dissolves in the blood and excreted by the kidneys 4. Hyperuricemia – overproduction or under excretion of uric acid 5. Uric acid crystal deposits in tissues!!!

1. Normal bone density 2. ________ – low bone mass (-1 - -2.5) 3. __________– very low bone mass (-2.5) 4. __________ – extremely low bone – fragility fracture can occur (standing causes broken bone) Osteoporosis, Severe osteoporosis, Osteopenia

1. Normal bone density 2. Osteopenia – low bone mass 3. Osteoporosis – very low bone mass 4. Severe osteoporosis – extremely low bone – fragility fracture can occur (standing causes broken bone)

T/F 1. BRCA is a tumor marker 2. BRCA is a gene that can increase a person's risk of developing breast or ovarian cancer. 3. If you have a mutation in the BRCA gene, you are at a higher risk of developing these cancers. 4. having a BRCA mutation means you will definitely develop cancer

1. F 2. T 3. T 4. F - not definite, just increased

Gout Etiology Hyperuricemia -____ production of uric acid -_____ excretion of uric acid

Gout Etiology Hyperuricemia - Over production of uric acid - Under excretion of uric acid

Common metastatic sites for tumors (and s/s) Breast --> (4) s/s - Prostate --> (1) s/s - Melanoma --> (1) s/s - brain, brain, vertebrae, bone, liver, lung

Breast  bone, brain, liver, lung Bone - pain Brain – balance Liver - Enzymes, bleeding Lung – bloody sputum, coughing Prostate  vertebrae Vertebrae – back pain Melanoma  brain Brain – balance

Predisposing factors - genetic - female - age 20-40 - black - environmental triggers - allergy to abx - hormonal factors – menarche > 10 y/o, oral contraceptives - tobacco use

Lupus

RA Pharm goals: 1. Relieve pain and swelling 2. Slow or stop progression of disease Long term drug therapy requires patient adherence - _________ -__________ – short term -_________– slow/stop progression

- NSAIDS - Glucocorticoids – short term - DMARDS disease modifying anti-rheumatic drugs – slow/stop progression

sequence of growth stages that a cell moves through for mitosis and regeneration

Cell cycle –

OA patho - Prolonged excess pressure on joint wears _______ - _______ bone is exposed - leads to _____ development, which moves through remaining cartilage and destroys the rest of the cartilage - localized ________ leads to more degradation - chondrocytes synthesize ______ called proteoglycans to try and repair – causes swelling - osteoblasts (build bone) activation leads to ________ and synovial fluid thickening (they are trying to fix but cause more damage) - loss of _______ narrows the joint space (bone on bone)

OA patho - Prolonged excess pressure on joint wears cartilage - subchondral bone is exposed - leads to cyst development - cysts move through remaining cartilage and destroys the rest of the cartilage - localized inflammations leads to more degradation - chondrocytes synthesize fluid called proteoglycans to try and repair – causes swelling - osteoblasts (build bone) activation leads to bone spurs and synovial fluid thickening (they are trying to fix but cause more damage) - loss of cartilage narrows the joint space

__________ tumors Need nutrients, oxygen, and access to blood Angiogenesis - The cancer cells stimulate the growth of new blood vessels to support their growth and survival.

Secondary tumors

fracture complications: delayed healing 1. delayed union - takes longer than expected to heal. s/s  bone pain and tenderness increase risk factors  smoking  age?  severe anemia  infection  malnutrition  low vitamins  _____thyroid  uncontrolled DM  ___________ break

 smoking  older adult  severe anemia  infection  malnutrition  low vitamins  hypothyroid  uncontrolled DM  complicated break

cancer classification systems: stages 1. Stage 1 -Small -No _____ involvement -Confined to organ of_____ 2. Stage 2 - > 3 cm - _____ local lymph nodes involved - ______ invasive 3. Stage 3 - _____ number of regional lymph nodes involved - Regional spread to _____ organs/structures 4. Stage 4 - Spread to_____ sites (metastasis)

Stage 1 - Small - No lymph node involvement - Confined to organ of origin Stage 2 - > 3 cm - Some local lymph nodes involved - Locally invasive Stage 3 - Large number of regional lymph nodes involved - Regional spread to nearby organs/structures Stage 4 - Spread to distant sites (metastasis)

slow/stop progression of RA MOA – immunosuppressive Route - PO - SQ - IV s/e - GI - Bone marrow suppression - Shortened life expectancy Teaching - 11 BLACK BOX WARNINGS - Patient needs folic acid supplementation - NO alcohol - Teratogenic – NEVER ok for pregnant - High risk of infection – contact HCP if s/s of infection - Caution with liver and kidney disease - Aplastic anemia risk when using with NSAIDS - Given weekly – death can occur if given daily

Methotrexate DMARDS disease modifying anti-rheumatic drugs Antineoplastic Anti-rhematic treats RA

breast cancer - Most develop from lining in ducts - _____expressed estrogen receptors (ER-pos) - _____expressed human epidermal growth factor receptor (HER2) - Promote mammograms

- Most develop from lining in ducts - Overexpressed estrogen receptors (ER-pos) - Overexpressed human epidermal growth factor receptor (HER2) - Promote mammograms

risk factors - Obesity - Pre-exisitng disease – HTN, DM, renal disease, sickle cell anemia - Alcohol - Diet rich in meats and seafood - organ meats, shellfish, anchovies, herring, asparagus, mushrooms - Diuretics - Male - Black

Gout

2nd line MOA Reduces inflammatory response to the deposits or urate crystals in joint tissues Powerful inhibitor of cell mitosis and can cause short term leukopenia and bone marrow suppression Indications - Gout flares short term - Prophylaxis s/e - Gi bleed - GU bleed Contraindications - Sever renal disorder - GI disorder - Hepatic disorder - Cardiac disorder - Bleeding disorder Route – PO only vomiting = toxicity, stop med

Colchicine for gout

Degeneration of joints caused by aging and stress - Most common disability in US

Osteoarthritis (OA)

A progressive disease - Intensifying inflammatory response - Cartilage destroyed by osteoclasts - Pannus (scar tissue) develops - Inflammation and exuberant proliferation of synovium (hypertrophied synovium) - Pannus leads to o Bone erosion o Bone cysts o Fissure development

Bone mineral density 2.5 standard deviations below peak bone mass (measured with a DEXA scan, results reported in a T score)

Osteoporosis

-raynaud’s phenomena – cold temp restricts blood flow to fingers -butterfly rash – on face

lupus

OA vs RA s/s _______ Early: -Very little -Maybe joint pain Late : -symetrical -Pain, tenderness -Stiffness -Motion limitation -Inflammation -Heat -Swelling – spongy warm Advanced: -Deformity -Disability -Joint subluxation - partial dislocation of a joint ________ -deep aching joint pain – esp with exertion, relieved with rest -joint pain with cold weather -stiffness in morning -crepitus of joint during motion -joint swelling – hard -altered gait -limited range of motion assessment findings -joint deformity -joint tenderness -decreased ROM -herbedens nodes – distal finger (interphalangeal) joints crooked -bouchards nodes – proximal finger (interphalangeal) joints are crooked

RA OA

cancer cell vs normal cell? 1. contact inhibition _____ – respect space ______- no regard to cell space 2. cohesiveness _______– stay in their spot, ex: cardiac cells don’t go to liver _______ – metastasize, cells will go anywhere 3. communication ______ - little to no communication ______ – communicate

1. n, c 2. n, c 3. c, n

Are tumor markers always used as diagnostic? if not - whats an ex

Not always: some non-malignant diseases also produce increased tumor marker levels - PSA prostate specific antigen are increased in both malignant cancers and benign prostate conditions like BPH.

Agents that help promote development of cancer Help mutated gene proliferate Ex: - Diet high in fat - Alcohol - Tobacco (carcinogen and promoter) - Hormones – estrogen (carcinogen and promoter)

Promoters

cancer cells - T/F 1. large # of dividing cells 2. large, variably shaped nuclei 3. large nucleus to cytoplasm ratio 4. variation in size and shape 5. normal cell features 6. disorganized arrangement 7. defined tumor boundary

1. T 2. T 3. T 4. T 5. F - loss of normal cell features 6. T 7. F - poorly defined

________ Involves: - Genes – disorder of gene expression - Carcinogens - Promoters

Carcinogenesis - Origin of cancer

Joint parts _____ – bone just under cartilage _____– covers bone of the joint, allows smooth and slipper surface for free joint movement _____– space between joint bones, fluid that lubricates joint surface and removes debris _______ – surrounds joints, unites joint bones Synovium Subchondral bone plate Joint capsule Articular cartilage

Joint parts - Subchondral bone plate – bone just under cartilage - Articular cartilage– covers bone of the joint, allows smooth and slipper surface for free joint movement - Synovium – space between joint bones, fluid that lubricates joint surface and removes debris - Joint capsule – surrounds joints, unites joint bones

Benign vs malignant tumors 1. remain clustered and can be removed 2. metastasize or break away, and can form more tumors 3. well differentiated, resembles tissues of origin 4. poorly differentiated, does not resemble tissue of origin, “anaplastic” 5. erratic, slow to rapid Rate of growth 6. progressive, slow Rate of growth 7. invasive and infiltrating, surrounding normal tissue 8. cohesive cells, well demarcated tumors, often encapsulated making it removeable 9. no metastasis 10. frequent metastasis 11. no necrosis in Tumor core 12. can have necrotic tumor core, hard to get treatment to this

1. B 2. M 3. B 4. M 5. M 6. B 7. M 8. B 9. B 10. M 11. B 12. M

fracture s/s at site of bone fracture = PED

- pain - edema - deformity – loss of function, abnormal mobility

An inflammatory disease resulting from deposits of uric acid crystals in tissues and fluids within the body (Metabolic problem)

Arthritis: Gout Gouty arthritis

osteomyelitis 1. _________ brings bacteria into bone 2. _________ = inflammation, bone destruction, pus and edema 3. Pressure __creases 4. Ischemia necrosis 5. Osteo__lasts lay new bone around old bone 6. Infection is isolated

1. Arterial blood flow brings bacteria into bone 2. Infection = inflammation, bone destruction, pus and edema 3. Pressure increases 4. Ischemia necrosis 5. Osteoblasts law new bone around old bone 6. Infection is isolated

open = compound closed = simple 1. fractured bone penetrates skin? 2. fractured bone doesn’t break through skin?

open = compound - fractured bone penetrates skin closed = simple - fractured bone doesn’t break through skin

fracture complications: delayed healing what could weight bearing too soon cause? 1. delayed union - takes longer than expected to heal. 2. malunion - fracture heals in an incorrect position or alignment. 3. nonunion - no healing 4-6 months post fracture

2. malunion - fracture heals in an incorrect position or alignment.

biologic agents

treats RA

Lupus Patho 1. ________ are hyperactive and produce autoantibodies (ANA: antinuclear antibody) 2. Activated against _____ 3. _________ form - They can impact all major organ systems 4. Inflammatory response destroys any tissues that they land on – common spot is ______

Lupus Patho 1. B-lymphocytes are hyperactive and produce autoantibodies (ANA: antinuclear antibody) 2. Activated against DNA 3. Immune complexes form - They can impact all major organ systems 4. Inflammatory response destroys any tissues that they land on – common spot is kidneys

any break in the continuity of bone that occurs when more stress is placed on the bone that it is able to absorb

fractures

Osteomyelitis pharm 1. Obtain culture 2. what type of abx first? - Nafcillin - Cefazolin - Vancomycin – sometimes continuous infusions, other times direct therapy such as infusing abx though a wound vac 3. what type of abx are we switching to?

2.Empiric abx therapy - administration of antibiotics based on the most likely diagnosis, b/c 3.Switch to bacteria-specific therapy

Systemic involvement in ____ -Fatigue and malaise -Could affect any and all body systems – if severe enough (Most common) -SJORGRENS SYNDROME – destruction of moisture producing gland (salivary and lacrimal) – dry mouth and eyes -Rheumatoid nodules – immune mediated granulomas, develop around inflamed joints, SQ and firm, maybe painful

risk factors - Aging - Obesity - Hx of long term participation in team sports - Hx of trauma or overuse joints - Heavy occupational work - Repetitive work - Misalignment of pelvis, hip, knee, ankle or foot

OA drug treatment Mild to moderate - ________ - topical ________ - heat sensation - _______ - OTC Moderate to severe - ______ – Rx strength - _______ + colchicine - __________ + tramadol - Opioids - Steroid injections into joint

Mild to moderate - acetaminophen - topical capsaicin - heat sensation - NSAIDS - OTC Moderate to severe - NSAIDS – Rx strength - NSAIDS + colchicine - Acetaminophen + tramadol - Opioids - Steroid injections into joint

Common joints affected by OA (3 are usually spared) T/F - Cervical spine – neck - Lumbosacral spine – lower back - Hip - knees - elbows - wrists - Hands - Big toe – first metatarsal phalangeal joint - ankle

- Cervical spine – neck - Lumbosacral spine – lower back - Hip - knees X- elbows X- wrists - Hands - Big toe – first metatarsal phalangeal joint X- ankle

Reduces fractures MOA – binds permanently to surfaces of bones to inhibit osteoclast activity (reduce bone breakdown) s/e - GI issues – n/v/d - Esophageal ulcerations Teaching - Take with water - Don’t take with food, drinks (other than water), calcium or vitamins for 2 hours – very low bioavailability - Don’t lie down for 30 mins after taking – esophageal ulcers

class: Bisphosphonates drug: Aldendronate treatment for osteoporosis

large hard nodules composed of uric acid crystals deposited in soft tissues o May form below the skin around the joints o Can cause a local inflammatory response o May drain chalky material

Gout complications: Tophi

Clinical course of cervical cancer 1. Long or short asymptomatic period before the disease becomes evident? 2. Commonly an abnormal ____ test alerts to the cancer

long pap

acute or chronic pyogenic (pus producing) infection of bone

osteomyelitis

Thinning of the trabecular matrix of the bone before osteoporosis T score between -1 - -2.5

Osteopenia

Implantation vs Seeding ? ________– tumor erods and shed into body cavities Ex: liver into abdominal cavity ________– direct expansion of the tumor to an adjoining tissue Ex: prostate cancer into bladder cancer

Seeding – tumor erods and shed into body cavities Ex: liver into abdominal cavity Implantation – direct expansion of the tumor to an adjoining tissue Ex: prostate cancer into bladder cancer

_________ spread - Cancer cells can enter the lymphatic system and travel to other parts of the body. - Cancer calls can get trapped in lymph nodes - 3 possible scenarios o Death o Dormancy o Flourish/proliferate = they work their way through the lymph system node to node, and move around the body

lymphatic

fracture complications - delayed _________ - __________ impairment - _________ syndrome - _________ syndrome

fracture complications - delayed healing - bone growth impairment - compartment syndrome - fat embolism syndrome

XOE inhibitor MOA – inhibits the xanthine oxidase enzyme which prevents uric acid production Indications - Gout is r/t excess uric acid production (hyperuricemia) - Prevention only s/e - Agranulocytosis - Aplastic anemia - Fatal skin reactions – SJS/TENS Monitor - WBC - CBC Drug interactions - Increases effect of antidiabetic meds and warfarin when taken with allupurinol Monitor - Sugar and INR levels

Allupurinol for gout

2 major classes of cancer genes: 1. _____________ - Normally function to restrain cell growth (brake pedal) 2. _______________ - Genes that stimulate and regulate a cell’s movement through the cell cycle = cellular growth and proliferation (gas pedal) Tumor suppressor genes Proto-Oncogenes

Tumor suppressor genes Proto-Oncogenes

Osteoporosis pharm Goal = reduce _______ Prevention - _________ - vitamin ___ Treatment with drugs - __crease bone formation - __crease bone resorption – most common

Osteoporosis pharm Goal = reduce fractures Prevention - Calcium - Vitamin D Treatment - Promote bone formation - Decrease bone resorption – most common

osteomyelitis Route of contamination Direct or indirect? - Open wound – gunshot, puncture/stabbing, surgery/sternotomy - Open fracture - Surgery/insertion of metal plates or screws Direct or Indirect? - From bloodstream – most common - Bacteremia

Direct - Open wound – gunshot, puncture/stabbing, surgery/sternotomy - Open fracture - Surgery/insertion of metal plates or screws Indirect - From bloodstream – most common - Bacteremia

non drug OA treamtents – 1. Dietary supplement o Chondroitin sulfate o Glucosamine 2. Artificial joint _____ o Contains hyaluronic acid 3. ______ replacement - Arthroplasty

Other treamtents – - Dietary supplement o Chondroitin sulfate o Glucosamine - Artificial joint fluid o Contains hyaluronic acid - Joint replacement - Arthroplasty

lupus pharm goal = control symptoms agents used depend on system involved -________ = h/a, musculoskeletal, pleuritis, pericarditis -High or low dose corticosteroids? = severe kidney disease, CNS -High or low dose corticosteroids? = arthritis - Antimalarials (_________) = skin, musculoskeletal, prevention of kidney and CNS organ damage -Immunosuppressives (________) = severe organ involvement

lupus pharm goal = control symptoms agents used depend on system involved - NSAIDS = h/s, musculoskeletal, pleuritis, pericarditis - High dose corticosteroids = severe kidney disease, CNS - Low dose corticosteroids = arthritis - Antimalarials (hydroxychloroquine) = skin, musculoskeletal, prevention of kidney and CNS organ damage - Immunosuppressives (methotrexate) = severe organ involvement

tumor markers may be measured in (4) substances

- Blood - Urine - CSF - tumor plasma membrane

3 causes of fractures

- trauma – fall - fatigue – repeated prolonged stress, endurance, stress fracture - pathologic – weakened bone, possible spontaneous, eldery highest risk, osteoporosis, bone tumors, infection, fragility fracture

_______ s/s Early - Very little - Maybe joint pain Late - Symmetrical (OA is asymmetrical) - Pain, tenderness - Stiffness - Motion limitation - Inflammation - Heat - Swelling – spongy warm Advanced - Deformity - Disability - Joint subluxation

Same process as OsteoA (Prolonged excess pressure on joint wears cartilage) but specific to spinal cord Commonly results in pain, motor weakness, and neuropathy Most often occurs in lumbar or cervical spine

Arthritis: Degenerative disc disease (DDD)

Osteoporosis complications Hip fracture - Linked to increased risk of mortality – r/t _________ - More common in >65 y/o, women, in ______ bone proximal/high up towards hip - Loss of independent living

complications femur

fracture complications: delayed healing what could  poor blood supply  repetitive stress  diabetes  infection cause? 1. delayed union - takes longer than expected to heal. 2. malunion - fracture heals in an incorrect position or alignment. 3. nonunion - no healing 4-6 months post fracture

3. nonunion - no healing 4-6 months post fracture

s/s -extreme fatigue -photosensitivity -butterfly rash – on face -fever -weight changes -unusual hair loss -edema – legs, eyes -raynaud’s phenomena – cold temp restricts blood flow to fingers s/s also depends on what tissue the immune complexes land on -CNS (brain) – h/a, dizzy, seizure, stoke -heart – myocarditis and endocarditis -lungs – pleuritis, pleural effusions -kidneys – nephritis -blood vessels – vasculitis -blood – anemia, leukopenia, thrombocytopenia, blood clots -joints – arthritis

lupus

osteoporosis Risk factors Minor - ______ frame - Lack of ______ exercises - Lack of _____ or vitamin ___ - Eating disorders – malnutrition - Gastric bypass surgery – malnutrition - ______ of estrogen/testosterone - Excessive caffeine Major - Aging - Female, especially post menopausal - White - Hx of adult fracture - Family hx - Body weight < 127lbs - Smoking - Alcohol - _______ and _______ drugs

Risk factors Minor - Thin small frame - Lack of weight bearing exercises - Lack of calcium or vitamin D - Eating disorders – malnutrition - Gastric bypass surgery – malnutrition - Lack of estrogen/testosterone - Excessive caffeine Major - Aging - Female, especially post menopausal - White - Hx of adult fracture - Family hx - Body weight < 127lbs - Smoking - Alcohol - Steroids use and immunosuppressant drugs

s/s of what cancer - Single tumor - Nontender tumor - Firm tumor - Irregular borders - Adherence to the skin or chest wall - Upper, outer quadrant of breast - Nipple discharge - Swelling in one breast - Nipple or skin retraction - Peau d’orange – thickening of skin that resembles an orange peel - Paget’s disease of the breast – redness, crusting, pruritis, tenderness of nipple

breast cancer

open = _____ - fractured bone penetrates skin closed = _____ - fractured bone doesn’t break through skin compound vs simple

open = compound - fractured bone penetrates skin closed = simple - fractured bone doesn’t break through skin

BRCA genes - T/F 1. Genetic testing for mutated genes BRCA 1 and BRCA 2 2. Can be preformed in high risk pts with a strong family hx of breast or ovarian carcinoma 3. Many women with BRCA mutated genes choose to have preventative mastectomy and oophorectomy (removal of ovaries)

1. T 2. T 3. T

Immune surveillance - Our immune system constantly surveys the body for foreign substances/non self antigens - When a non self antigen is _________ = the immune system initiates an attack to destroy the invading substance - With age, the immune system gets ______ and tumor development becomes ______

Immune surveillance - Our immune system constantly surveys the body for foreign substances/non self antigens - When a non self antigen is discovered = the immune system initiates an attack to destroy the invading substance - With age, the immune system gets weaker and tumor development becomes easier

Osteoporosis - Porous bone - Common - Serious disease - Low bone density and structural (micro-architectural) deterioration of the bone - Usually bones in the hips, vertebrae, and wrists (____________ bones) - “osteoporosis” used when __________ have occurred - Increase in bone fragility - High susceptibility to fracture

- Porous bone - Common - Serious disease - Low bone density and structural (micro-architectural) deterioration of the bone - Usually bones in the hips, vertebrae, and wrists (trabecular bones) - “osteoporosis” used when actual breaks in trabecular matrix have occurred - Increase in bone fragility - High susceptibility to fracture

Cancer cells form disorganized clumps called

tumors

cancer classification systems: malignant tumors can be - grade 1 - cells are _____ differentiated - grade 2 – cells are ______ differentiated - grade 3 – _____ differentiated or anaplastic cells

- grade 1 - cells are well differentiated - grade 2 – cells are moderately differentiated - grade 3 – poorly differentiated or anaplastic cells

fracture complications: compartment syndrome 1. seen with o crush injuries o casts – watch for ______ 2. results from o compression – increased _______ within limited anatomic space 3. _________ effect o edema at fracture site puts intense pressure on soft tissue o decreased perfusion o can lead to tissue hypoxia of muscles and nerves 4. s/s o FVD or FVE? o ________ pulses o pain (again) 4. treatment o __________ – relieves pressure and improves circulation

fracture complications: compartment syndrome 1. seen with o crush injuries o casts – watch for swelling 2. results from o compression – increased pressure within limited anatomic space 3. tourniquet effect o edema at fracture site puts intense pressure on soft tissue o decreased perfusion o can lead to tissue hypoxia of muscles and nerves 4. s/s o edema o loss or weakened pulses o pain (again) 5. treatment o fasciotomy – relieves pressure and improves circulation

________ is any joint that allows movement

Synovial/diarthrodial joint

lung cancer Patho 1. carcinogen overload and/or genetic predisposition 2. _____ is killed or paralyzed – carcinogen accumulation b/c _____ isn’t sweeping it away 3. _____ development and mutations 4. progress to cancer 5. activation of _______ 6. _______ of tumor suppressor genes 7. rapid proliferation/destruction/invasion of mutated cancer cells

Patho 1. carcinogen overload and/or genetic predisposition 2. cilia is killed or paralyzed – carcinogen accumulation b/c cilia isn’t sweeping it away 3. lesion development and mutations 4. progress to cancer 5. activation of oncogenes 6. deactivation of tumor suppressor genes 7. rapid proliferation/destruction/invasion of mutated cancer cells

fracture complications: bone growth impairment - age? - fracture through epiphyseal plate - can delay ______ bone growth

fracture complications: bone growth impairment - pediatric consideration - fracture through epiphyseal plate - can delay future bone growth

Types of HPV - ________ – causes a persistent infection that progresses to cervical cancer - ________ – causes condylomas (genital warts), does not cause cervical cancer T/F - Almost 100% of people with cervical cancer also have HPV

High risk Low risk T

Gout pharm Goal 1. Decrease symptoms of acute attack and prevent recurrent attacks - NSAIDS – 1st line - _________ - inhibits the xanthine oxidase enzyme which prevents uric acid production - ________ - Reduces inflammatory response to the deposits or urate crystals in joint tissues Probenecid - __________ - Inhibits reabsorption of uric acid in kidneys Promote excretion

Allupurinol Colchicine Probenecid

osteomyelitis cause ________ on skin – _________ – gets into bone with open fracture and causes infection

- bacteria on skin – staph aureus – gets into bone with open fracture and causes infection

Reduces spinal fractures (not as well as raloxifene) and must take at least 5 years to see long term benefits MOA – inhibits bone removal by osteoclasts Treatment ONLY (not prevention) Slows down bone loss and increases spinal bone density Route - intranasal (s/e nasal irritation) can decrease pain in someone with hip fracture

Calcitonin-salmon Hormone therapy for osteoporosis

Risk factors for what cancer - Age >50 - Estrogen exposure - Prolonged reproductive life – early menarche and/or late menopause (estrogen exposure) - Obesity (estrogen storage in fat) - Late childbirth – after age 30 (estrogen exposure) - Nulliparous – no pregnancies (estrogen exposure) - Family hx of breast or ovarian cancer - Jewish women - BRCA1 and BRCA2 mutation

breast cancer

Bone healing phases ________ o Hematoma forms at fracture site o Provides stability o Aseptic inflammation occurs ________ o Fibrous cartilage – granular tissues, containing blood vessels and blasts o Callous – matured granular tissues o Ossification – space in bone is bridged and fracture end united, callus is replaced by trabecular bone _________ o healing is complete -- Reparative, - Remodeling, Inflammatory

- Inflammatory o Hematoma forms at fracture site o Provides stability o Aseptic inflammation occurs - Reparative o Fibrous cartilage – granular tissues, containing blood vessels and blasts o Callous – matured granular tissues o Ossification – space in bone is bridged and fracture end united, callus is replaced by trabecular bone - Remodeling o Remodeling – healing is complete

Cancer cell cycle vs normal cell cycle? 1. Stage G0 normal, cancer, or both have this stage? 2. Stage G1 normal, cancer, or both have this stage? 3. Stage S normal, cancer, or both have this stage? 4. Stage G2 normal, cancer, or both have this stage? 5. Stage M normal, cancer, or both have this stage?

1. only normal cells normal – cell is at rest cancer – no resting period, no G0 stage 2. both 3. both 4. both but - Normal – check point for DNA repair Cancer – mutation inactivates DNA repair gene, proliferation without control occurs 5. both

Methotrexate DMARDS disease modifying anti-rheumatic drugs Antineoplastic Anti-rhematic treats?

DDD s/s Lumbar - Pain in lower back – radiates down to back of leg “________” - Pain in _______ or thigh - Pain that_______ when sitting, bending, lifting, twisting - Pain that ________ when walking, changing positions, or lying down - Numbness, tingling, weakness in ____ - Footdrop Cervical - Chronic neck pain – radiates to ______ and arms - Numbness, tingling, weakness in arm or _____

DDD s/s Lumbar - Pain in lower back – radiates down to back of leg “sciatica” - Pain in buttocks or thigh - Pain that worsens when sitting, bending, lifting, twisting - Pain that is minimized when walking, changing positions, or lying down - Numbness, tingling, weakness in legs - Footdrop Cervical - Chronic neck pain – radiates to shoulders and arms - Numbness, tingling in arm or hand - Weakness of arm or hand

_______ complications: 1. Tophi – large hard nodules composed of uric acid crystals deposited in soft tissues o May form below the skin around the joints o Can cause a local inflammatory response o May drain chalky material 2. Renal calculi – kidney stones

Gout

systemic autoimmune disease that affects multiple organs and tissues. an autoimmune disease, but it primarily affects the joints.

lupus RA

s/s of what cancer? - Fatigue - Weakness - Weight loss - Iron deficiency anemia - Change in bowel habits - Melena – blood stool - Diarrhea - Constipation - hematochezia (rectal bleeding) and narrowing of stool caliber (ribbon like stool)

colorectal cancer

2 major classes of cancer genes: ___________ - Genes that stimulate and regulate a cell’s movement through the cell cycle = cellular growth and proliferation (gas pedal) - If mutated = “oncogenes” = the growth signal is constantly one, stimulating constant and unrelenting cellular proliferation and cell cycling ____________ - Normally function to restrain cell growth (brake pedal) - If defective/inactivated = lose ability to inhibit cell growth and division = allows cancer to form

Proto-Oncogenes Tumor suppressor genes

s/s early - None Late - Fractures - Pain - Loss of height - Stooped posture – kyphosis

Osteoporosis

Systemic autoimmune disease - Type III hypersensitivity - immune reaction mediated by immune complexes - Inflammatory disease of synovium (joints)

rheumatoid arthritis

cancer classification systems: staging system requires biopsy

TNM system staging classifies the tumor according to: - T – tumor size, location, involvement - N – lymph node involvement/spread - M – metastasis to distant organs

Uricosuric agent MOA Inhibits reabsorption of uric acid in kidneys Promote excretion Indications - Treats hyperuricemia with gout Used alone or with allopurinol when not effective alone s/e - GI upset – take with food - Dizzy - h/a - kidney/liver impairment – watch for signs of kidney issues - lots of drug interactions

Probenecid for gout

cancer classification systems: TNM system 1. T - tumor size, location, involvement T0 = TIS (tumor in situ) = stage of cancer where the tumor is _____ and has not _____ T1, T2, T3, T4 = progressive increase in tumor ______ (1cm – 4cm) or involvement (invading)

T0 = no evidence of primary tumor TIS (tumor in situ) = stage of cancer where the tumor is confined to the original tissue and has not spread to nearby tissues or organs. T1, T2, T3, T4 = progressive increase in tumor size (1cm – 4cm) or involvement (invading)

Metastasis – 2 primary routes 1. 2.

1. Lymphatic 2. Vascular

s/s - Pain – mild or sever, usually LE (such as big toe) - Burning - Redness - Swelling and warm - Fever - Symptoms last days to weeks

Gout

Normal cell cycle Stages Stage____ – cell is at rest Stage ___ – cell enters the cell cycle - Prepares for DNA replication - Proto-oncogenes are activated – they control cell replication Stage ____ – synthesis of structures - Structures move to opposite poles in preparation for division into 2 separate cells - 46 chromosomes separate into 23 at each opposite pole Stage ____ – cells prepare to divide Stage ____ – mitosis is complete and 2 daughter cells are created

1. G0 - rest 2. G1- enters cycle 3. S - synthesis of structures 4. G2 - prep for divide 5. M - mitosis is complete

Degenerative discs - Intervertebral disc compression occurs with ____ - Motor and sensory spinal ______ enter and exit from the spinal cord and travel through narrow openings of the vertebral bone - With age intervertebral disc _______ and vertebral bone become compressed = impinges on the entering and exiting of nerves - Dysfunction of motor and sensory spinal nerves impedes movement and sensation in the _______ - May see weakness and parasthesias

Degenerative discs - Intervertebral disc compression occurs with age - Motor and sensory spinal nerves enter and exit from the spinal cord and travel through narrow openings of the vertebral bone - With age intervertebral disc dehydrate and vertebral bone become compressed = impinges on the entering and exiting of nerves - Dysfunction of motor and sensory spinal nerves impedes movement and sensation in the extremities - May see weakness and parasthesias

cancer classification systems: TNM system 3. M – metastasis to distant organs M0 = M1 =

M – metastasis to distant organs M0 = none, cancer hasn’t spread to distant organs M1 = yes, cancer has spread to distant organs

RA, lupus, or both 1.Autoimmune 2.Systemic inflammation 3.Multiple body systems involved 4.NSAIDS 5.corticosteroids 6. hydroxychoroquine 7.methotrexate 8.focus on joints (sometimes organs) 9. focus on organs (sometimes joints)

1. B 2. B 3. B 4. B 5. B 6. B 7. B 8. RA 9. L

treatment for OA goals 1. manage_____ and reduce ______ 2. maintain ________ 3. minimize ________

treatment for OA goals 1. manage pain and reduce swelling 2. maintain mobility 3. minimize disability

Osteoporosis complications: Hip fracture s/s - Sudden onset of hip pain before or after fall? - Inability to ____ - Severe _____ pain = displaced hip fracture (bones of the hip joint are broken and separated from their normal position) - Affected leg is externally ____ and ____ = displaced hip fracture (bones of the hip joint are broken and separated from their normal position) - Tenderness – the break is encapsulated pretty well so may not see anything

- Sudden onset of hip pain before fall – fragility fracture - Sudden onset of hip pain after fall - Inability to walk - Severe groin pain = displaced hip fracture - Affected leg is external rotated and shortened = displaced hip fracture - Tenderness – the break is encapsulated pretty well so may not see anything

class: Bisphosphonates drug: Aldendronate treatment for?

osteoporosis

BRCA 1 and BRCA 2 gene mutations increases risk of (5) cancers

- Breast cancer - Ovarian cancer - Colon cancer - Pancreatic cancer - Prostate cancer

4 phases of carcinogenesis (cancer origin) - _______ – change of genes that arise spontaneously or after exposure to carcinogenic agent -________ – reversible, proliferating cells accumulate ________ – further mutation, invasive, spread potential ________– spread of cancer to distant site Initiation- Metastasis Progression Promotion

4 phases of carcinogenesis - Initiation – change of genes that arise spontaneously or after exposure to carcinogenic agent - Promotion – reversible, proliferating cells accumulate - Progression – further mutation, invasive, spread potential - Metastasis – spread of cancer to distant site

Most common secondary tumors (4)

- Lungs - Bone - Liver - Brain

Corticosteroids for RA -_______sone – most common - Rapid suppression of ___________ - Use only when symptoms not controlled with ___________ - T/F - Not best choice for long term therapy? - T/F - usually large doses?

Corticosteroids - Prednisone – most common - Rapid suppression of inflammation - Use only when symptoms not controlled with NSAIDS - Not best choice for long term therapy – usually small doses

Risk factor for what cancer - Smoking - Hx STD - HPV infection - 2 or more sexual partners - Immunosuppression - Genetics

cervical