OCN Study Guide 2023 with complete solution

Pleural Effusion fluid in pleural space pneumothorax air in the pleural space Which chemo has a high risk for pulmonary toxicity? bleomycin (Blenoxane) For which pulmonary toxicity does bleomycin have a high risk? Pneumonitis Hypocapnia reduced carbon dioxide in the blood Signs and Symptoms of pleural effusion tachypnea (fast breathing) decreased breath sounds dullness to percussion Define Lymphedema obstruction of lymphatic system that caused overload of lymph in the interstitial space Define Edema fluid in the interstitial space Cancer most commonly associated with lymphedema Breast Stage 1 Lymphedema less than 3 cm difference pitting edema Stage 2 Lymphedema 3-5 cm difference skin stretched and shiny nonpitting Stage 3 Lymphedema greater than 5 cm difference skin discolored, stretched, firm nonpitting Lymphedema treatment compression garment manual lymphatic drainage elevation aerobic exercise with strength training low sodium diet Sentinel lymph node dissection removal of the first lymph node that contains cancer cells Hematoma abnormal collection of blood in tissues Pericardial effusion excess fluid around the heart Tumors associated with malignant pericardial effusions Lung High dose cyclophosphamide cardiac effects damaged cardiac endothelium Paclitaxel cardiac effects asymptomatic bradycardia 5FU cardiac effects coronary artery spasm Anthracycline (Daunorubicin, doxorubicin, and epirubicin) cardiac effects cardiomyopathy Diagnostic test for pericardial effusion Echo Abnormalities of what electrolyte and what mineral interfere with cardiac function? Potassium and Calcium What med can be used to protect heart against effects of doxorubicin Dexrazoxane Spiral CT Diagnostic test for pulmonary emboli D-DImer test used to diagnose or rule out conditions that cause hypercoagulability (inappropriate clotting) DIC Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection Platelet count, Fibrinogen level, D Dimer, FDP Titer Tests to diagnose DIC How to treat DIC Treat underlying cause What does FFP do? Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC. Most common cancer associated with DIC? Leukemia, specifically APL Signs/Symptoms of DIC bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities Causes of DIC Delivery (of baby) Infection Cancer How does Heparin help DIC? Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds) S/S of septic shock Fever Tachycardia Hypotension Most common cause of sepsis Gram (-) bacteria DIC Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection Platelet count, Fibrinogen level, D Dimer, FDP Titer Tests to diagnose DIC How to treat DIC Treat underlying cause What does FFP do? Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC. Most common cancer associated with DIC? Leukemia, specifically APL Signs/Symptoms of DIC bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities Causes of DIC Delivery (of baby) Infection Cancer How does Heparin help DIC? Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds) S/S of septic shock Fever Tachycardia Hypotension Most common cause of sepsis Gram (-) bacteria Granulocytopenia failure of the bone marrow to make enough white blood cells (neutrophils) Highest risk factor for sepsis Prolonged granulocytopenia (less than 500/mm3) What cancer commonly produces TLS? High grade lymphoma Define Tumor Lysis Syndrome (TLS) metabolic imbalance that occurs with rapid tumor kill Lab results indicating DIC Increased D Dimer Increased FDP Decreased fibrinogen Decreased platelets Lab results indicitave of TLS Hyperkalemia (5.0) Hyperphosphatemia (4.5) Hyperuricemia (8.0) Hypocalcemia (10.5) Increased BUN (20) Increased creatinine (1.2) Increased LDH (333) Lab tests done to monitor TLS K Phos Uric Acid Calcium LDH Renal function (BUN, Creatinine) How to treat severe hyperkalemia hypertonic glucose and insulin. Shifts extracellular K back into intracellular stores How does Allopurinol work? decreases uric acid production and decreases uric acid deposits in kidney How does Rasburicase work? catalyses the conversion of uric acid to allantoin S/S of hyperkalemia muscle weakness muscle cramps bradycardia tall T waves S/S of hypokalemia decreased reflexes irregular pulse fatigue N/V flat t wave V fib if severe Calcium normal range 8.5-10.5 meq/L S/S of hypercalcemia fatigue lethargy muscle weakness impaired concentration confusion constipation polyuria/polydipsia S/S of hypocalcemia diarrhea neuromuscular irritability (Chvostek's sign) tingling of fingers and toes seizures Potassium normal range 3.5-5.0 meq/L Sodium normal ranges 135-145 meq/L S/S of hypernatremia polydipsia low grade fever dry skin dry/sticky mucous membrane S/S of mild hyponatremia anorexia HA N/V S/S of moderate hyponatremia nausea weakness anorexia fatigue muscle cramps S/S of severe hyponatremia seizures AMS First treatment for hyponatremia Fluid restrict 500-1000 ml per day Magnesium normal range 1.8-2.4 mg/dl S/S of hypermagnesia lethargy flushing diaphoresis S/S of hypomagnesia similar to hypocalcemia neuromuscular and CNS changes seizures SIADH syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) Most common cause of SVC Cancer, especially non-Hodgkins and lung cancer Signs of SVCS JVD edema of face, neck, upper thorax dyspnea tachycardia SVCS diagnostic tests CT and MRI Tx of SVCS RT, chemo, steroids, surgery Superior Vena Cava Syndrome compromised venous drainage of the head, neck, upper extremities due to compression or obstruction of the vessel Most common cause of SVC Cancer, especially non-Hodgkins and lung cancer Signs of SVCS JVD edema of face, neck, upper thorax dyspnea tachycardia SVCS diagnostic tests CT and MRI Tx of SVCS RT, chemo, steroids, surgery Cushings Triad HTN bradycardia abnormal respirations Pupil changes in ICP unequal, dilated, pinpoint, nonreactive Cardiac tamponade definition excessive fluid in pericardial space decreases hearts ability to fill and pump Cardiac Tamponade s/s muffled heart sounds weak apical pulse mild tachycardia mild peripheral edema Pericardial effusion diagnostic test 2-D echo Define spinal cord compression Compression of the thecal sac by a tumor in the epidural space Cauda Equina structure within the lower end of the spinal column, that consists of nerve roots and rootlets Most common loca for malignant invasion of spinal cord that cause SCC Outside of the spinal cord (extradural) Most common early symptom of SCC neck or back pain Progression of SCC symptoms pain motor weakness sensory loss motor loss Pain during SCC usually occurs during what position? Lying down supine Diagnostic tests for SCC Plain Xray bone scan MRI CT scan Antiangiogenesis factors suppress tumors ability to grow new blood vessels Cancer malignant disease with 3 characteristics 1. abnormal cell proliferation 2. unchecked local growth and invasion of surrounding tissue 3. ability to metastasize Sarcomas originate is what tissue? Connective Proto-oncogenes definition gene that regulates normal cell growth and repair tumor suppressor gene gene that stops, inhibits, or suppresses cell division Neoadjuvant Therapy definition given before primary tx to control potential mets CA 125 tumor marker in ovarian cancer, evaluates treatment Difference between benign and malignant tumors Malignant can metastasize Dysplasia loss of uniformity in the appearance of cells Define hematopoesis body's ability to regulate, produce, and develop cells Define immune surveillance The body's ability to scan for and destroy malignant or altered cells Hematopoesis begins with which cell? Pluripotent stem cells Monoclonal Antibodies Fab vs Fc Fab is the antigen binding site. Fc signals cells to destroy the cell it is bound to Which antineoplastic categories of drugs are nonspecific? Alkylating Nitrosureas Antitumor antibiotics Hormonal therapies What is AUC? Amount of drug exposure or total drug concentration over time. What percent of patients receiving below diaphragm RT have sterility? 25% What dose of radiation will affect serility in: Males? Females? Males: 4 cGy temp 5 cGy permanent Females 40 yrs, 20 cGy over 5-6 weeks 40 yrs, 6 cGy Chemos that affect fertility Lomustine Doxorubicin Melphalan Cyclophosphamide 5FU Cytarabine What chemos are worst for use 1st trimester of pregnancy? Folic acid antagonists- MTX Antimetabolites - MTX, 5FU, Cytarabine, Gemcitabine Alkylating - Cyclophosphamide, Ifex, Melphalan, Thiotepa, Carmustine, Carboplatin, Cisplatin PLISSIT Permission to discuss Limitied Information Specific Suggestion Intensive Therapy Federal Rehab Act of 1973 federally funded employers can't discriminate against handicapped COBRA Provides insurance for employees for 18 months and dependants for 36 months Social Security Disability Insurance Program If patient has paid in previously, they are eligible 6 months after being impaired Late effects of RT on Abdomen Adhesions Fibrosis Late effects of RT on Bladder Fibrosis Hyperplasia (increase in cells) Late effects of RT on CNS Stroke Blindness Late effects of RT on chest Breast Ca soft tissue sarcoma dysphagia pulmoanry fibrosis Late effects of RT of Head/Neck hypo or hyperthyroid mandibular osteonecrosis alopecia cavities decreased hearing Late effects of RT on Heart pericarditis CAD cardiomyopathy pericardial effusion MI Late effects of RT on Liver Fibrosis cirrhosis Late effects of RT on Ovaries failure premature menopause Late effects of RT on Skeletal Late fx osteonecrosis Late effects of RT on Skin fibrosis necrosis basal cell hyperpigmentation Late effects of RT on testicles oligospermia azoospermia decreased testosterone Late effects of RT on urinary fibrosis strictures Late effects of RT on testicles oligospermia azoospermia decreased testosterone Late effects of RT on urinary fibrosis strictures Late effects of RT on vagina fibrosis decreased vaginal secretions Myeloid cell line In hematopoiesis, myeloid describes any leukocyte that is not a lymphocyte. Primary lymphoid organs Bone marrow - B Cells Thymus - T Cells Define Lymphoid cell line Develop T cells and B cells Key for all immune responses Define Humoral Immunity B cell immunity that is meditaed by Define Cell Mediated Immunity T cell driven immune response that does not involve antibodies or complement but involves activating macrophages, NK cells, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen Define NK Cells kill cells by releasing small proteins that cause the target cell to die by apoptosis. Define Apoptosis programmed cell death Define Cytokines protein released by cells that has specific effect on the interactions, communications, Types of cytokines interleukins lymphokines cell signal molecules (tumor necrosis factor interferons (trigger inflammation and respond to infections Define Innate immunity immunity that occurs before the onset of infection Describe B cells Develop in bone marrow Differentiate into plasma cells, which produce immunoglobulins (IgG, IgA, IgM, IgE, IgD) Define phagocytes cells that engulf and consume pathogens Define interferons a type of cytokine limit spread of viral infections first resistance Can innate immunity target specific pathogens? No Define gene individual unit of hereditary info Genes responsible for family cancer syndrome are what gene? tumor suppressor gene How many chromosomes in human body? 46 23 pairs What are autosomes when talking about genetics? Chromosomal pairs 1-22 Do not determine gender What are sex chromosomes? Chromosomes that decide sex Women are X X Men are XY