Download OCN Study Guide Questions with Answers latest 2025 and more Exams Medicine in PDF only on Docsity!
OCN Study Guide Questions with
Answers latest 2025
Pleural Effusion โ fluid in pleural space pneumothorax โ air in the pleural space Which chemo has a high risk for pulmonary toxicity? โ bleomycin (Blenoxane) For which pulmonary toxicity does bleomycin have a high risk? โ Pneumonitis Hypocapnia โ reduced carbon dioxide in the blood Signs and Symptoms of pleural effusion โ tachypnea (fast breathing) decreased breath sounds dullness to percussion Define Lymphedema โ obstruction of lymphatic system that caused overload of lymph in the interstitial space Define Edema โ fluid in the interstitial space Cancer most commonly associated with lymphedema โ Breast Stage 1 Lymphedema โ less than 3 cm difference pitting edema Stage 2 Lymphedema โ 3-5 cm difference skin stretched and shiny nonpitting
Stage 3 Lymphedema โ greater than 5 cm difference skin discolored, stretched, firm nonpitting Lymphedema treatment โ compression garment manual lymphatic drainage elevation aerobic exercise with strength training low sodium diet Sentinel lymph node dissection โ removal of the first lymph node that contains cancer cells Hematoma โ abnormal collection of blood in tissues Pericardial effusion โ excess fluid around the heart Tumors associated with malignant pericardial effusions โ Lung High dose cyclophosphamide cardiac effects โ damaged cardiac endothelium Paclitaxel cardiac effects โ asymptomatic bradycardia 5FU cardiac effects โ coronary artery spasm Anthracycline (Daunorubicin, doxorubicin, and epirubicin) cardiac effects โ cardiomyopathy Diagnostic test for pericardial effusion โ Echo Abnormalities of what electrolyte and what mineral interfere with cardiac function? โ Potassium and Calcium What med can be used to protect heart against effects of doxorubicin โ Dexrazoxane
Tachycardia Hypotension Most common cause of sepsis โ Gram (-) bacteria DIC โ 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 โ Tests to diagnose DIC How to treat DIC โ Treat underlying cause What does FFP do? โ 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? โ Leukemia, specifically APL Signs/Symptoms of DIC โ bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities Causes of DIC โ Delivery (of baby) Infection Cancer How does Heparin help DIC? โ Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18- 28 seconds) S/S of septic shock โ Fever Tachycardia Hypotension
Most common cause of sepsis โ Gram (-) bacteria Granulocytopenia โ failure of the bone marrow to make enough white blood cells (neutrophils) Highest risk factor for sepsis โ Prolonged granulocytopenia (less than 500/mm3) What cancer commonly produces TLS? โ High grade lymphoma Define Tumor Lysis Syndrome (TLS) โ metabolic imbalance that occurs with rapid tumor kill Lab results indicating DIC โ Increased D Dimer Increased FDP Decreased fibrinogen Decreased platelets Lab results indicitave of TLS โ 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 โ K Phos Uric Acid Calcium LDH Renal function (BUN, Creatinine) How to treat severe hyperkalemia โ hypertonic glucose and insulin. Shifts extracellular K back into intracellular stores How does Allopurinol work? โ decreases uric acid production and decreases uric acid deposits in kidney
dry/sticky mucous membrane S/S of mild hyponatremia โ anorexia HA N/V S/S of moderate hyponatremia โ nausea weakness anorexia fatigue muscle cramps S/S of severe hyponatremia โ seizures AMS First treatment for hyponatremia โ Fluid restrict 500-1000 ml per day Magnesium normal range โ 1.8-2.4 mg/dl S/S of hypermagnesia โ lethargy flushing diaphoresis S/S of hypomagnesia โ similar to hypocalcemia neuromuscular and CNS changes seizures SIADH โ syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) Most common cause of SVC โ Cancer, especially non-Hodgkins and lung cancer Signs of SVCS โ JVD edema of face, neck, upper thorax dyspnea
tachycardia SVCS diagnostic tests โ CT and MRI Tx of SVCS โ RT, chemo, steroids, surgery Superior Vena Cava Syndrome โ compromised venous drainage of the head, neck, upper extremities due to compression or obstruction of the vessel Most common cause of SVC โ Cancer, especially non-Hodgkins and lung cancer Signs of SVCS โ JVD edema of face, neck, upper thorax dyspnea tachycardia SVCS diagnostic tests โ CT and MRI Tx of SVCS โ RT, chemo, steroids, surgery Cushings Triad โ HTN bradycardia abnormal respirations Pupil changes in ICP โ unequal, dilated, pinpoint, nonreactive Cardiac tamponade definition โ excessive fluid in pericardial space decreases hearts ability to fill and pump Cardiac Tamponade s/s โ muffled heart sounds weak apical pulse mild tachycardia mild peripheral edema
โ gene that regulates normal cell growth and repair tumor suppressor gene โ gene that stops, inhibits, or suppresses cell division Neoadjuvant Therapy definition โ given before primary tx to control potential mets CA 125 โ tumor marker in ovarian cancer, evaluates treatment Difference between benign and malignant tumors โ Malignant can metastasize Dysplasia โ loss of uniformity in the appearance of cells Define hematopoesis โ body's ability to regulate, produce, and develop cells Define immune surveillance โ The body's ability to scan for and destroy malignant or altered cells Hematopoesis begins with which cell? โ Pluripotent stem cells Monoclonal Antibodies Fab vs Fc โ Fab is the antigen binding site. Fc signals cells to destroy the cell it is bound to Which antineoplastic categories of drugs are nonspecific? โ Alkylating Nitrosureas Antitumor antibiotics Hormonal therapies What is AUC? โ Amount of drug exposure or total drug concentration over time. What percent of patients receiving below diaphragm RT have sterility? โ 25% What dose of radiation will affect serility in:
Males? Females? โ Males: 4 cGy temp 5 cGy permanent Females
40 yrs, 20 cGy over 5-6 weeks < 40 yrs, 6 cGy Chemos that affect fertility โ Lomustine Doxorubicin Melphalan Cyclophosphamide 5FU Cytarabine What chemos are worst for use 1st trimester of pregnancy? โ Folic acid antagonists- MTX Antimetabolites - MTX, 5FU, Cytarabine, Gemcitabine Alkylating - Cyclophosphamide, Ifex, Melphalan, Thiotepa, Carmustine, Carboplatin, Cisplatin PLISSIT โ Permission to discuss Limitied Information Specific Suggestion Intensive Therapy Federal Rehab Act of 1973 โ federally funded employers can't discriminate against handicapped COBRA โ Provides insurance for employees for 18 months and dependants for 36 months Social Security Disability Insurance Program โ If patient has paid in previously, they are eligible 6 months after being impaired Late effects of RT on Abdomen โ Adhesions Fibrosis Late effects of RT on Bladder โ Fibrosis
โ oligospermia azoospermia decreased testosterone Late effects of RT on urinary โ fibrosis strictures Late effects of RT on testicles โ oligospermia azoospermia decreased testosterone Late effects of RT on urinary โ fibrosis strictures Late effects of RT on vagina โ fibrosis decreased vaginal secretions Myeloid cell line โ In hematopoiesis, myeloid describes any leukocyte that is not a lymphocyte. Primary lymphoid organs โ Bone marrow - B Cells Thymus - T Cells Define Lymphoid cell line โ Develop T cells and B cells Key for all immune responses Define Humoral Immunity โ B cell immunity that is meditaed by Define Cell Mediated Immunity โ 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 โ kill cells by releasing small proteins that cause the target cell to die by apoptosis. Define Apoptosis
โ programmed cell death Define Cytokines โ protein released by cells that has specific effect on the interactions, communications, Types of cytokines โ interleukins lymphokines cell signal molecules (tumor necrosis factor interferons (trigger inflammation and respond to infections Define Innate immunity โ immunity that occurs before the onset of infection Describe B cells โ Develop in bone marrow Differentiate into plasma cells, which produce immunoglobulins (IgG, IgA, IgM, IgE, IgD) Define phagocytes โ cells that engulf and consume pathogens Define interferons โ a type of cytokine limit spread of viral infections first resistance Can innate immunity target specific pathogens? โ No Define gene โ individual unit of hereditary info Genes responsible for family cancer syndrome are what gene? โ tumor suppressor gene How many chromosomes in human body? โ 46 23 pairs What are autosomes when talking about genetics? โ Chromosomal pairs 1- Do not determine gender What are sex chromosomes?
โ inflammatory breast cancer Least common sign of breast cancer? โ Pain Modified radical mastectomy โ removal of the entire breast and the lymphatic-bearing tissue in the armpit Can women with breast cancer have estrogen replacemtn therapy? โ No, women who have had HRT have 3 x the recurrence risk Most common sites of mets from breast cancer? โ IN ORDER Bone Lung Liver Brain What do biphosphonates do? โ prevent the loss of bone mass, used to treat osteoporosis, hypercalcemia, bone pain, and prevention of fractures What does Arimidex do? โ used to treat breast cancer in women who have gone through menopause. Stops estrogen production Clinical Trial Phase 0 โ 10-12 people Identify drugs that do not produce desired effect Limited doses Low doses Less risk Useful for molecularly target drugs Useful for drugs that require biomarker development Clinical Trial Phase 1 โ 20-25 people Evaluate tozicity Establish max dose without side effects Determine route (PO or IV) Variety of tumor types Clinical Trial Phase 2
โ More than 100 people Determine if treatment has benefit Groups of patients with same tumors will be used Assess response rate Clinical Trial Phase 3 โ 100-1000's of people Compare new drug to current standard Establish efficacy by assessing survival and time to progression LAst step before FDA consideration Usually double blind trials Clinical Trial Phase 4 โ Can it do anything else? Expand off label use Assess toxicity and long term effects Usually after FDA approval Most common cancer among women โ Breast Describe Invasive breast ca โ no longer contained by breast capable of metastases Most frequent site of breast cancer mets โ Bone What age should mammograms start? โ 40 Triple test for diagnosing breast cancer โ Physical Exam Mammography FNA Breast Cancer Staging Classification โ Stage 0 - In Situ Stage 1 - Under 2 cm with (-) nodes Stage 2 - <5 with ( ) nodes or >5 with (-) nodes Stage 3 - > 5 with ( ) or any size with breast wall extension Stage 4 - any distant mets
CA 15-3 and CA 27- โ tumor marker used to monitor response to treatment of invasive breast cancer CA 27- โ tumor marker CEA โ tumor marker used to monitor the treatment of cancer patients, especially those with colon cancer Most aggressive type of lung cancer โ small cell lung cancer (SCLC) Which cancer is leading cause of death for men and women? โ Lung What risk factor accounts for 90% of lung cancers? โ Smoking Which cancers have highest incidence rates? โ Men - Prostate Women - Breast 5 year survival rate for lung cancer. โ 15% Which treatment option offers the best chance for cure of lung cancer? โ Surgery Diagnostic tests to stage lung cancer โ CXR CT or MRI Bronch Chemos used in SCLC โ Etoposide Cisplatin Carboplatin Cytoxan Doxorubicin Vincristine Ifex Combo are used most of the time
What type of chemo is standard of care in NSCLC? โ Platinum based with Cisplatin or Carboplatin Why are most lung cancer patients good candidates for clinical trials? โ Low cure rates with current treatments. Why are ADH and ACTH levels sometimes higher in lung cancer patients, especially small cell? โ The tumor can release mimics of these hormones. When maintaining a chest tube, what 2 things would you report to MD? โ Bubbling in water seal chamber Air leak noises After lobectomy, what position should the patient not be in? โ The patient should not lay on operative side. Decreases expansion. After pneumonectomy, how should patient be positioned? โ On back or on operated side. DO NOT let patient lay on unoperated side. Tumor marker CEA โ Tumor marker elevated in colon cancer, can be used to monitor treatment or recurrence CA 19- โ tumor marker for pancreatic cancer CA 27- โ tumor marker for breast cancer Tumor marker AFP โ For testicular and primary liver Early symptoms of colorectal cancer โ change in bowel habits blood in stool Most common site of mets from colorectal cancer โ Liver Why are ADH and ACTH levels sometimes higher in lung cancer patients, especially small cell? โ The tumor can release mimics of these hormones.
