P&P 3 Flashcards
(193 cards)
1
Q
which of these would be considered synonyms to quality improvement: continuous quality improvement (CQI), continuous improvement (CI), total quality management (TQM), all of the above.
A
CQI, CI, TQM
2
Q
describe quality assurance
A
QA monitors proper patient scheduling, reception, preparation and involves outcome analysis.
3
Q
what is the recommended frequency of checking audio and video monitors for a treatment machine?
A
daily
4
Q
members of a quality improvement team within the radiation oncology department would include?
A
all personnel in radiation oncology who come in contact with the patient and/or the patient’s family
5
Q
true or false: peer review is done for assessment of an action plan, and can only be done by individuals not in a radiation oncology department.
A
false
6
Q
describe a flowchart and how it works
A
flowchart helps to see the steps of a process.
oval-start/end of a process
rectangle-process
diamond-decision
7
Q
develop a flow chart describing the process of a whole brain external beam tx starting w consultation
A
(SEE CHART)
8
Q
what are the three take away messages from the six sigma process
A
a. its not a problem with the people, it’s the “process”
b. fishbone chart helps to analyze
c. should be continuously done to be most effective
9
Q
we discussed a process improvement method in addition to six sigma. please give the name of this methodology and describe the process and its end goal
A
LEAN- process involves 5 whys to get to the root of a problem. end goal is to improve efficiency
10
Q
how will a QI plan be successful
A
if its continuous and everyone works to solve the problems in the process
11
Q
describe ionizing radiation
A
radiation causes an atom to lose an electron in the outermost shell causing it to be charged or ionized
12
Q
compare and contrast direct and indirect ionizations
A
direct: affects DNA by a particle in one interaction
indirect: affects DNA by 2+ interactions, affecting DNA as well.
13
Q
describe the three main steps in the process of radiolysis
A
ionization of H20 (rad+H20 -> H20+e-)
particles and free radicals separate (H20 -> H+OH)
particles and free radicals rebond (H+OH -> H20 or OH + OH -> H202)
14
Q
which characteristics define damage capability of interacting radiation?
A
mass & charge
15
Q
which would be a characteristic of low LET
A
include charged particles like protons and alpha particles, deposit their energy over a greater distance within tissue
16
Q
true or false: LET is directly proportional to the square of the charge (Q) and inversely proportional to the square of the velocity (V)
A
true
17
Q
in general higher LET equals an increase or decrease in RBE?
A
increase
18
Q
name the three types of single break chromosomal effects due to radiation
A
dicentric, asentric, translocation
19
Q
according to law of bergonie and tribondeau, ionizing radiation is more effective against cells that are
A
actively mitotic, undifferentiated and have a long mitotic future.
20
Q
briefly describe the three manifest illness responses to total body irradiation. include dose ranges at which each occur and the body site most affected.
A
hematopoeitic syndrome (100-1,000 cgy) affects bodys blood system gastrointestinal syndrome (1,000-10,000 cgy) affects GI tract CNS syndrome (5,000-10,000 cgy) affects central nervous system
21
Q
define the main goal of radiation therapy
A
to damage/kill tumor cells while preserving as much healthy tissue/organs as possible
22
Q
in terms of biological effects of fractionated treatment, list the four Rs and briefly describe each one
A
repopulation: growth of normal and tumor cells
redistribution of cells into most radiosensitive phase (metaphase)
repair: repair normal cells from radiation damage
reoxygenation: makes cells more radiosensitive by increasing o2 to tumor cells.
23
Q
increase LET.. increase in RBE–more or less dose?
A
less: probably lower # of fractions which does more damage because the cells can’t recover
24
Q
define stochastic effects and give example
A
stochastic effect does not have a certain threshold at which it occurs. example: secondary malignancy
25
define epidemiology
the study of diseases and the causes in certain populations
26
describe the difference between colonized and infected
colonized: bacteria grow in the body but show no symptoms/signs
infected: present in pts body, shows symptoms
27
name and describe the four main pathogens seen in our clinical environment
bacteria: has dna and rna, fungi is helpful? ex: strept throat/tb
virus: has dna or rna-not both, does not respond to antibiotics. inserts to host cell and host cell spreads pathogen. ex: cold
fungi: larger than bacteria. nucleus and membranous. ex: athletes foot/ringworm
parasitic protozoa: larger than bacteria. not considered plant or animal. lives in/on host at hosts cost. ex: tapeworm/pinworm
28
true or false: malaria is an example of a viral infection
false
29
describe the difference between direct and indirect contact transmission
direct: host spreads pathogen to person
indirect: object/vector between host and person infected
30
true or false:direct contact can only happen when the host is infected or colonized
false
31
droplet transmission can occur when:
talking coughing, sneezing close to someones face, pathogens are exposed to a persons nasal mucosa, oral mucosa, and or conjunctivae of the eye
32
in the context of vector borne transmission, define vector
animal/insect that carries pathogen
33
in class we discussed ways to eliminate transmission of pathogens for each of the five main transmission types. list all give and give one example how we can eliminate transmission of pathogens for that route
contact: gloves, wash in/out
droplet: cover mouth, keep distance
common vehicle: clean objects/table between patients, wash hands, wear gown.
airborne: mask, if pt is sick no tx.
vectorborne: flushot, no bugs in tx center
34
discuss the difference between universal precautions and body substance isolation. what is the current practice or recommendation used in our clinical settings
universal precautions involve keeping the person isolated. body substance isolation ensures safe precautions and sterility if any substance is exposed from pt. current practice is both called standard precautions.
35
aseptic techniques could be defined as
techniques used to keep a sterile environment
36
which of the following are considered aseptic techniques:
sterilization and disinfection
37
this term is defined as a sudden drop in blood pressure caused by a change in a patients body position
orthostatic hypotension
38
name the four types of wheel chair transfers
standing pivot, 2 person lift, full move-w/ a lift device, assisted transfer (watch-pt does most work)
39
what are the key aspects to any patient transfer
keep patient informed, let patient do as much work as they can, feet flat on the ground, feet wide apart, bend and straighten at knees not back, work as a team
40
in the united states nasopharyngeal cancer most commonly affects which group of people?
chinese americans
41
true or false: keratinizing squamous cell carcinoma has the worst prognosis
(nasopharyngeal cancer)
true
42
name three common presenting symptoms for nasopharyngeal cancer
lump/mass in neck, epistaxis,
43
what is the most common histology for oropharyngeal cancer?
squamous cell carcinoma
44
true or false: direct extension is the most common route of spread for oropharyngeal cancer
true
45
what is typical dose for an oropharyngeal radiation treatment
60-70 gy
46
what is the virus most commonly associated with oral cancer
HPV
47
name the three regions that make up the larynx
subglottis, glottis, supraglottis.
48
of the regions of the larynx which is the most common site for laryngeal cancers
glottis
49
name four common presenting symptoms of laryngeal cancer
horseness, sore throat that wont go away, loss of voice, trouble swallowing
50
metastatic cancer of the larynx would be related to which stage
stage IV C
51
in which sinus are 80% of paranasal sinus cancers found
maxillary sinus
52
which of the following are causes of paranasal sinus cancer?
exposure to wood dust, exposure to mustard gas, hpv infection?
53
traditional maxillary sinus treatment consists of what type of beam arraignment?
lateral, ap
54
the most common paranasal sinus pathology is?
squamous cell carcinoma
55
what is the survival rate for stage IV maxillary sinus cancer?
35%
56
name the three largest salivary glands and include the % of salivary gland cancer?
parotid 70-80%
submandibular 10-20%
sublingual <5%
57
true or false, 2/3 of salivary tumors are benign
true
58
the oral cavity includes all of the following except
the posterior 1/3 of the tongue
59
true or false: only the ipsilateral side of the neck as at risk for metastases of oral tumors
false
60
label the three different pharyngeal regions: superior to inferior
nasopharynx, oropharynx, laryngopharynx.
61
name five side effects from radiation therapy that have an affect on a persons ability to eat
dry mouth (dysphasia), sore throat, nausea, diarrhea, loss of appetite (anorexia)
62
describe the difference between enteral and parenteral nutrition
entral: feeding tube to duodenum/stomach/jejunum
parenteral: vascular feeding tube
63
our patients nutritional needs should be met by the intake of which
proteins, fats, carbohydrates, vitamins/minerals
64
define resting energy exposure (REE)
amount of energy (calories) spent at rest. calories someone must intake to maintain body weight if doing no extra activities per 24 hours.
65
which fats are better for you
monounsaturated fats, polyunsaturated fats
66
what is protein used for by our bodies
to rebuild muscle tissue and maintain strength of the body. normal immune health.
67
true or false: when the body needs protein it begins to break down our own muscles to fill its protein needs
true
68
true or false: during treatments our patients dont need as much protein because they are not as active
false
69
name five good sources of protein
lean red meat, beans, eggs, soy products, greek yogurt
70
true or false: carbohydrates are the primary source of energy for our bodies
true
71
name five good sources of carbohydrates
pasta, fruits, breads/wheats, oats/barley, cereals
72
four strategies you would suggest our patient to perform prior to treatment to help them meet their nutritional needs
stock up on frozen foods, have favorite foods available if loss of appetite for other foods, bring snacks to eat while waiting for treatment/traveling to and from, eat a small meal right before treatment
73
four suggestions you would have for our patient during treatment to meet their nutritional needs. include in your discussion possible side effects and how this might affect our patients nutrition
try new goods-apetite and taste may have changed. try to replace meats with beans and soy products for several meals a week to increase nutrition. drink liquids between meals rather than with them because they make you feel more full. pt needs to increase calorie intake whenever possible because of sore throat possibility/loss of appetite. meal replacement drinks/shakes if sore throat. also numbing drink so pt can eat a little without pain.
74
true or false: men with klinefeiters syndrome are at a greater risk of developing breast cancer than the general populace
true
75
treatment for which cancer may lead to an increased risk of breast cancer in men
prostate (hormone tx)
76
what is the most common form of noninvasive breast cancer
DCIS
77
what is the most common form of invasive breast cancer
infiltrating ductal carcinoma
78
what are two known causes of breast cancer
inquired/inherited gene mutation
79
name all three modalities associated with conservative breast cancer management
rt, chemo, lumpectomy
80
when determining field borders in sim what factors influence where these borders fall?
lymph node involvement, surgery (lumpectomy/mastectomy)
81
according to the american cancer society when screening for breast cancer women over the age of 40 should receive a mammogram how often
once a year
82
in terms of quadrants, what is the most common site of breast cancer presentation
upper outer quadrant
83
name five symptoms associated with the clinical presentation of breast cancer
palpable lump/mass, discharge of nipple, sore/swoolen lymph node areas, tender breast tissue, redness/irritation around nipple
84
name and describe the four types of biopsies we discussed in class
incisional: remove part of tumor to test
excisional: remove tumor and margin of tissue around it
core needle aspiration: punch needle, larger section
fine needle aspiration: punch needle, smaller section
85
true or false: metastatic disease can sometimes be revealed ten years after primary treatment
true
86
true or false: all ipsilateral breast tissue is at risk for disease when breast cancer is found
true
87
describe the pattern of spread through lymphatic system for breast cancer. which lymph node chains are at risk.
through direct extension.
| axillary nodes.. internal mammary nodes.. supraclavicular nodes.
88
which T classification is equal to a tumor smaller than 5 cm
T1 and T2
89
what is the goal of conservative breast cancer treatment
maintain breast tissue and cosmesis
90
compare two types of radiation therapy treatment that we discussed. please include side effects, contraindication, and the positives and negatives of each type.
EBRT external beam RT-skin erythema, necrosis, dry itchy skin.
+ basic tangents
contraindications: patient cant lay flat
IMRT-skin erythema, dry itchy skin, necrosis
+easier to avoid heart if left breast
-MLCs
-potential MLC failure
contraindications: too large of breasts
brachytherapy contraindications: tumor too close to skin, cant get balloon in
91
what is the main cause of breast cancer in men
hormone changes
92
describe the rad tx technique for hodgkins lymphoma. include setup instructions & immobilization devices, treatment portals, and special considerations
mantle field AP/PA. supine, headboard, mask, chin up, arms akimbo, large sponge, feet banded. consider blocking (lungs, humoral heads, thyroid), shielding (testis), tenitive (spleen). total nodal tx: para aortic, inverted Y field.
93
identify all lymph node regions involved in hodgkins disease
supraclavicular, axillary, inguinal, illiac, femoral, infraclavicular, mediastinal, hilar, waldyers ring, paraaortic.
94
microscopically what is the distinguishing characteristic between hodgkins and non hodgkins lymphoma
presence of reed sternberg cell in hodgkins
95
in what general anatomical location is waldeyer ring located
near nasopharyngeal/oropharyngeal region
96
the abdominal paraaortic treatment portal includes what organ(s)
spleen
97
what is the standard dose delivered for the treatment of NHL
3000 to 4500 cgy
98
what landmark is typically used to determine the lower border of the mantle field
T10
99
what landmark is typically used to determine the lower border of the abdominal portion of the inverted Y field
L4-5
100
what stage is a hodgkin lymphoma affecting only the right cervical lymph nodes
stage I
101
what stage is a hodgkins lymphoma affecting two lymph node groups on the same side of the diaphragm
stage II
102
what are the symptoms commonly associated with hodgkins disease. please distinguish between b symptoms and non b.
B symptoms include the presence of night sweats, fever, or weight loss
non b symptoms include swelling in the neck region, lump/mass presence
103
what is the most common long term side effect of total lymphoid node irradiation
secondary malignancy
104
what is the most common type of HD
nodular sclerosis lymphoma
105
what is the treatment of choice for non hodgkins lymphoma
chemotherapy
106
name one type of non hodgkins lymphoma that we talked about in class describe two pearls of wisdom about this NHL.
diffuse large b cell lymphoma
- occurrence increases with age
- can begin in organ such as stomach rather than lymph node
- 3-4% of all GI malignancies
107
the collection of vital signs data is quick and non invasive. the usual vital signs measured include? what are their normal ranges
```
mental state: confused/alert
body temperature: 97.7-99.5
respiratory rate: 20-30 adults
blood pressure: 120/80
pulse: 70-120 BPM
```
108
define hyperthermia
body temperature > 99.5
109
which devise is used to monitor the electrical activity of the heart
electrocardiogram
110
define hypotension and give the value for which this condition would exist
low blood pressure. <95/60
111
what is the take away message regarding patients with chest tubes
never bring the reservoir above chest.
112
central lines are common in our patients for what two reasons
easy to administer fluids and chemo drugs if needed. no need to give IV daily/often
113
the term bradypnea is used to describe
a decrease in respiratory rate
114
the objective of oxygen therapy is to
increase the O2 concentration going to the patient
115
the flow rate of oxygen therapy is given in
liters per minute
116
true or false the most common site for CVP line placement is the subclavian artery
false-vein
117
besides blood cells, name five things that can be found in a blood sample
toxins, vitamins, iron, plasma, electrolytes
118
fill in the name of the blood value that goes in the correct spot of the fishbone
hgb
wbc plt
hct
119
what does each of the above abbreviations stand for and what is their normal value range
hgb-hemoglobin-120-175 g/L
hct-hematocrit-31-53%
wbc-white blood cells-3.5-11 x 10^9/L
plt-platelets-140-450 x 10^9/L
120
hormone function: responsible for regulating the bodys retention of water
antidiuretic hormone (ADH)
121
hormone function: involved in sexual reproduction
oxytocin
122
hormone function: controls body growth
growth hormone (GH)
123
hormone function: controls thyroid gland
thyroid stimulating hormone (TSH)
124
hormone function: influences actions of adrenal cortex
adrenocorticotropic hormone (acth)
125
hormone function: stimulates other sexual and reproductive activity
luteinizing hormone (LH)
126
hormone function: stimulates egg and sperm production
follicle-stimulating hormone (FSH)
127
hormone function: relates to skin pigmentation
melanocyte-stimulating hormone (MSH)
128
hormone function: initiates milk production
prolactin (PRL)
129
somatotropin is what type of hormone
GH
130
true or false 1 of 4 people may have a pituitary adenoma and not know it
true
131
hormones of the thyroid gland include?
triiodothyronine (T3), tetraiodothyronine (T4), calcitonin
132
true or false tumors of the thyroid are more common in men than women
false
133
name three risk factors that we discussed for the formation of thyroid tumors
gender (women), low iodine intake, radiation, genetics-inherited syndrome
134
list three common presenting symptoms of a thyroid tumor
lump, pain, hoarseness, dysphagia, persistent cough
135
rank in order from most radiosensitive to least radiosensitive
papillary, follicular, medullary, anaplastic
136
why would you expect to use oral contrast for simulation of a patient with pancreatic cancer. include contraindications for this
to see stomach, duodenum. for dose to past structures, location of pancreas.
contraindications: allergy, bowel perf.
137
what is the most common risk factor for pituitary adenoma
family history of inherited genetic syndrome
138
describe the difference between a functioning and non functioning pituitary tumor
functioning: releasing excess hormones
| non functioning: non releasing hormones
139
name five common general (not hormone associated) symptoms associated with a pituitary tumor
neurologic symptoms: headache, dizziness, loss of consciousness, facial numbness.
vision changes: paralysis of eye movement, double vision, blurred vision, blindness
140
name the staging system used for pituitary tumors
there is non
141
what is the primary goal of treatment for pituitary tumors
normalize pt hormonal function, relieve local compressive discomfort, reduce destructive effects
142
briefly describe the anatomical location of the pituitary gland
sella turcica (sphenoid bone)
143
briefly describe the anatomical location of the adrenal gland
sup of each kidney
144
what is the common staging system of adrenal gland tumors please include specifics
TMRD
t: extent of tumor
m: mets
r: tissue remaining after sx
d: degree of differentiation
145
true or false a drug is any substance that alters physical function, while a medication has a therapeutic goal
true
146
select the organ most commonly used by the body to excrete drugs and their byproducts
kidneys
147
select the most serious allergic reaction to a drug
cardiac or respiratory arrest
148
which of the following are included in the six rights of drug safety
identify the right patient, identify the right medication and right dose, identify the right time, identify the route, right documentation
149
what is teh first duty of a therapist if a patient has an adverse reaction to a drug
call a code
150
select the potential symptoms of an anaphylactic reaction to a drug
nausea and comiting, diarrhea, uriticardia, symptoms of vascular shock
151
select the drugs that may be prescribed to relieve anxiety
ativan, valium, librium
152
in which part of the body is barium sulfate used as a contrast agent
GI tract
153
select potential reasons why a patient may be unable to take oral preparations of a drug
patient is experiencing nausea and comiting, patient has difficulty in swallowing, patient refuses to swallow medication.
154
select the type of medication administration that bypasses the gastrointestinal tract
parenteral administration
155
which of the following is not one of the rights of drug administration
right syringe
156
which of the following is not a patient related variable affecting response to medications
tolerance
157
the way in which drugs affect the body is called
pharmacodynamics
158
which of the following is not a parenteral route of administration for medications
instillation
159
the type of drug given to cancer patients to relieve nausea and vomiting is
antiemetic
160
the way a drug travels through the body to the appropriate receptor site is known as
pharmacokinetics
161
the abbreviation "qod" stands for
once every other day
162
what is the correct category for the drug imodium
antidiamnial
163
what precautions should you follow when administering parenteral drugs
standard precautions (lower risk of infection), needle caution, blood/fluids
164
name a drug that is given to a patient that acts as a blood thinner
warfarin, coumadin, heprin, asprin
165
the escape of fluid from a vessel into the surrounding tissue which can cause localized vasoconstriction is termed
extravasation
166
which of the following is a parenteral route of administration
intravenous
167
compare the gender differences in the absorption of medications
lower avg body weight, hormone profiles differ, amt and dist. of fat, comp of preg in women, men dose higher, weight, metabolic rate, difference in fluid
168
discuss the differences between ionic and nonionic contrast media. when might you use one and not the other? (contraindications)
ionic-high osmolality (bod cant remove as easily, perforations, etc), viscous esp at room temp, discomfort to pt during injection, large amt greater contrast
nonionic-low osmolality, more costly, allergy prone pts, just as effective as ionic
169
anaphylactic shock
severe reaction to a sensitizing substance such as insect stings, contrast media and other drugs
170
contrast media
high density substances used radiographically to visualize internal anatomy for imaging
171
cumulative effect
effect that develops if the body is unable to detox and excrete a drug quickly enough or if too large a dose is taken
172
drug
any substance that alters physiologic function, with the potential for affecting health
173
dyspnea
difficult labored or uncomfortable breathing
174
extravasation
accidental leakage into surrounding tissues, a discharge/escape from a vessel into the tissues
175
generic name
drug name coined by the original manufacturer
176
high osmolality
high number of particles in solution
177
idiosyncratic effects
inexplicable and unpredictable symptoms caused by a genetic defect in the patient.
178
intradermal
shallow injection between layers of skin
179
intramuscular
administrative route for chemo agents used for large amounts/quick effects
180
intravenous
injection directly into the bloodstream providing immediate effect
181
ionic contrast media
media having high osmality or high # of particles in isolation. large amounts of iodine provides greater contrast but also increases toxicity and viscosity
182
low osmolality
refers to contrast agents in which iodides remain intact instead of splitting and therefore agitate cells less
183
nonionic contrast
media having low osmolality. iodides remain intact instead of splitting; agitate cell less-equally as effective but costs more
184
parenteral
medication bypassing the Gi tract. includes topical and some mucous membrane routes, but word has come to mean "by injection"
185
pharmacokinetics
way drugs travel through the body to their receptor sites
186
pharmacodynamics
way drugs affect the body
187
pharmacology
science of drugs and their sources, chemistry and actions
188
phlebitis
inflammation of a vein
189
standard precations
precautions that should be followed because of potential contact with body fluids. ex: wearing gloves, a mask, protective eyewear; properly handling needles; and disposing of used equipment into containers.
190
subcutaneous
tissue just below the skin
191
urticaria
hives
192
venipuncture
puncture of a vein
193
which of the following are associated risk factors for salivary gland canceR?
metal and mineral dust inhalation, previous ionizing radiation treatment, dental radiographs.
