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148 Cards in this Set
- Front
- Back
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_____ _____ accounts for 80% of lung ca deaths
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cigarette smoking
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cigarette smoking is _____ _____ to dna mutations by specific metabolite of benzo
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directly linked
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this race is more likely to smoke in the us
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blacks
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name 6 risk factors for developing lung Ca
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1. cigarette smoking
2. second hand smoke 3. eposures to radon, asbestos, and high doses of ionizing radiation 4 gender 5. COPD 6. cultural factors |
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which occupations have a high risk for lung CA
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carpenters
plumbers electricians insulators ship building |
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bronchogenic carcinoma have two histological types
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small cell and non small cell
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non small cell bronchogenic carcinoma are classified into 3 types
hint r/t cell type |
squamous cell
adenocarcinoma large cell carcinoma |
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95% of primary lung tumors are generated from what body structure?
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the lung itself!
the other 5% come from other sources |
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would you expect other cancers to metasisize to the lungs?
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yes. common site.
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your patient has advanced lung CA. your patient asks where the CA is likely to travel from the lungs?
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to the brain.
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is lung CA agressive?
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yes
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lung CA starts from the _____ and works its way _____
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inside
out |
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survival rate of lung CA pt is about what %?
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10. outcome is not good enless caught early and encapsulated by the body
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lung CA starts as small _____ which spread and invade _____
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leasions
mucosa |
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after lung CA invades mucosa it spreads _____ towards the _____
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outward
periphery |
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some lung CA begin to _____ in the middle of the mass and it becomes _____
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die
necrotic |
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when a lung CA mass becomes necrotic there is a chance that it will h_____ and b_____ into the p_____ cavity
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hemmorhage
bleed plueral |
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some tumors produce b_____ labled as conditions that have other effects on the body
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bi products
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perineoplastic syndromes are what?
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effects that a tumor would have on the body when it produces a substance that effects other areas
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small cell carcinoma accounts for _____% of carcinomas
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25
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cigarette smoking is closely associated with which type of cancer?
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small cell carcinoma
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your patient has been dx with small cell carcinoma. what are the chances that it has metastisized?
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high. this CA begins metastisizing very early and is widely disseminated
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small cell carcinoma has the best or worst prognosis of CA?
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worst
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small cell carcinma grow in a way that resembles this common food
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what is grapes
lol |
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small cell carcinoma are neither g_____ or s_____ in their orientation
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glandular
squamous |
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small cell carcinoma appear to have n_____ which sugessts that they are able to secrete _____
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neurosecretory capabilities
hormones |
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neuroendocrine markers of a neursecretory capable CA are:
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^acth
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an increase in ^acth can resemble what disease process?
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cushing syndrome
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cushings syndrome is caused by an increase in what ? and how is it charecterized?
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acth
increase fat in torso and along shoulders moon shaped face |
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small cell carcinoma are very m_____ tumors
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malignant
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treatment for small cell CA is likely..
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radiation and chemo
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your pt has been dx with sm cell ca. what tx do you expect and which would you not expect?
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radiation and chemo
you would not expect sx |
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people dx with sm cell ca typically die within _____ weeks of dx
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15
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non sm cell (squamous)'s #1 etiology is _____
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smoking
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non sm cell is more prevelent in which gender?
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men
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nscc originates in the cental b_____ e_____ m_____
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bronchial epithelial mucosa
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nscc is _____ growing
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slow
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nscc is _____ malignant
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highly
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nscc metasisizes to the _____
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chest
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dx of nscc can be made early with c_____ from a s_____ sample or get a b_____ of bronchi
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citology
sputum brush |
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nsccs creates this perineoplastic syndrome
mooooooo |
elevated calcium blood levels
as cells are destroyed calcium levels are dumped into the blood |
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nscca occurs where in the lung?
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periphery
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nscca is associeeated with areas of _____
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scarring
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nscca is _____ growing
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slow
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nscca invades b_____ v_____ which is an avenue for m_____
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blood vessels
metastasis |
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nscca is on the rise in this gender
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women
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nscca is most common in _____ and non_____
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women
smokers |
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_____ is the most common lung CA in north america
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nscca
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this type of lung CA originates in the bronchiolar and alveoli tissue
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nscca
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nscca can be related i_____ that have scarred over, m_____ foreign objects, and wounds/infections like _____
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infarcts
metalic tb |
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does nscca have a good or bad prognosis?
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bad
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lcc is _____ differenciated
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poorly. aka anaplastic
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lcc has late/early metastasis
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early
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50% of _____ metastasize to the brain by the time cancer is dx
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lcc
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lcc has a good/bad prognosis
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bad
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lcc occur in the _____ of the lung
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peripheri
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lcc moves from the periphery of the lung to the _____ branches of the bronchi and _____ airways
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smaller
larger |
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the gender difference in lcc is..
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none. there is no gender difference
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this cancer is the most symptomatic out of the lung CA
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lcc
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s/s of lcc
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cough
sputum dysnea wheeze obstructive pulmonary hemoptysis hoarseness pain brain, bone, liver mets superor vena cava syndrom |
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pain receptors in the chest are in the _____ space and the m_____ s_____
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pleural
media stinum between lungs and heart |
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pain associated with lung CA is typically..
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dull and intermittent but then becomes constant
as ca spreads so does the pain |
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other non specific s/s of lcc
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unexplained weight loss
anorexia blood tinged sputum dysnea on exertion wheeze (especially when tumor blocks airway) obstructive pneumonia hoarseness (tumore is resint on laryngeal nerve) that doesnt go away |
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svcs does what?
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prevents blood return to the heart
dialation of peripherial vessels drop in bp this is a medical emergency |
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dx of ca is made by..
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chest xray
ct scan pet scan mri bone scan breath sound analysis system |
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breath sound analysis system is..
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under development
measures volatile compounds emitted by breath cancer makes the body emit a high level of alkanes |
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TNM
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TUMOR size
NODES METASTASIS |
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Ca tx options
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surgery
radiation chemo combo of r and c |
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sx tx can happen only in certain stages.. whcih are they?
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I and II
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the overall survival rate for all lung ca at 5 years is _____%
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15
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COPD is a group of c______ i______ disorders
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chronic
inflammatory |
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COPD is charecterized by an airflow o______ with e______
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obstruction
exhalation |
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what does FEV stand for?
what what does it measure? |
forced
expiratory volume it measures large central airway functionality |
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what is FVC?
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forced vital capacity
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what does RV stand for?
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residual volume
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what does the FEV do with COPD?
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decreases
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what does the FEV/FVC do in COPD?
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decreased ratio
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what does the RV do with COPD?
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increased
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asthma is a c______ i______ disorder that is irreversible/reversible airway obstruction
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chronic inflammatory
reversible |
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incidence of asthma is lower/higher in children than adults
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higher
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those at increased risk for mortality/morbidity r/t asthma are those who are...
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low SES
co morbidities black hispanic males |
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some factors that increase the risk for increased morbidity/mortality are...
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previous...
intubation ventilation |
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what are some risk factors for the devlopment of asthma?
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genetics
exposure that triggers phenotype RSV virus as a child female after adolescents obesity |
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atopic asthma has a ______ cause like ______
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extrinsic
allergens |
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the classic type of atopic asthma is type ______
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IgE
mediated hypersensativity reaction |
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some asthma is triggered by ingesting THIS type of drug..
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ASA
NSAID |
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which Ig is key in mediating asthmatic responses
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IgG
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your patient is short of breath, wheezing, has chest tightness and pain. they also have complained about a cough in the morning that gets better. their eosinophils are elevated. which common COPD problem do you suspect?
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asthma
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asthmatics have a decrease in respiratory function about ______ (this time of day) due to increased ______ levels
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4am
cortisol |
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immediate phase of asthma attack does what to the airway?
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10-20 mins
-mast cells release IgE -vagal nerve is irratated |
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during the acute phase of an asthma attack, IgE is released. what does this do to the airway?
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breaks down junction at epithelial cells
causes cells to become leaky and penetratable |
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during the acute phase of an asthma attack, the vagal nerve is irrated, what does this do to the airway?
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smoothe muscle constriction
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the later phase of an asthma attack happens when and what does it do?
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4-8 hours later
epithelial cells become denuted macrophages leak into lamina propria cilliary function is impaired |
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an increase in serum eosinophils may indicate ______ responsiveness
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steroid
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an asthmatic typically has a d______ h______ c______ that devlopes into a p______ cough
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dry hacking cough
productive |
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the maxiumum amount of air that can be inspired in excess of the normal tidal volume is called what
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inspiratory reserve volume (IRV)
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the maxiumum amount that can be exhaled in excess of the normal tidal volume is the
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expiratory reserve volume (ERV)
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about 1200 mL of air always remains in the lungs after forced expiration; this air is the ..
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residual volume (RV)
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RV increases/decreases with age
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increaes.
there is more trapping of air in the lungs at the end of expiration |
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vital lung capacity equation
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IRV+ TV+ERV
the amount of air that can be exhaled from the point of maximal inspiration |
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use the p______ f______ test to diagnos asthma
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pulmonary function test
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the pulmonary function tests include these 3 procedures
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pre/post bronchodilator tests
methacholine challenge excercise test on cycle ergometer |
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methacholine does what to the lungs
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constricts. used in asthma diagnostics
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what would one see in serum levels in a person with asthma
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increased eosinophils, NO
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intermittent mild asthma
sx awakened tx |
sx: <2x/wk
awake: < 2x/mo tx: b2 agonist prn (bronchodilator) |
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mild persistent asthma
sx awake tx |
sx: >2x/wk
awake: >2x/mo tx: glucocorticoid/beta 2 prn |
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moderate persistent asthma
sx awake tx |
sx: qd, exacerbation 2x/wk
awake: frequently tx: gluco/beta 2/ long acting bronchodilator |
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severe astma
sx awake tx |
sx: continous, limits phsy activity, freq exacerbations
tx: oral gluco/ beta 2/ long acting |
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bronchodilators are ______ drugs
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sympathomimetic
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bronchodilators stimulate the ______ recptor and increase c______ via ______ protein activation
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beta 2
cAMP G protein |
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bronchodilators do what to smooth muscle?
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releax
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a common example of the bronchodialtors is e______. used in severe cases of bronchoconstriction
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epinephrine
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epinephrine activates these cells
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beta 1/2 alpha 1/2
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beta 2 agonist MDI are long/short acting
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short
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a common example of a beta 2 agonist used in MDI's is
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albuterol
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the onset of albuterol is
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3-5 mins
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albuterols effetivness lasts about..
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4-6 hours
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common side effects of albuterol include..
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tremors
nervousness ^HR |
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during an asthma attack a c______ reaction takes place
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cholinergic
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s______memetic drugs cause bronchial relaxation
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sympathomemetic
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when should a bronchodilator be used is you have EIA
a. at the begining of symptoms b. after the workout c. before the workout d. only as needed (prn) |
before the workout
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a common LABA is s______
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serevent
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your patient is perscribed serevent discus prn.
whats wrong with this? |
serevent is a LABA not a SABA. therefore it is used for asthma maintenence and not as a rescue med
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serevent comes in the form of..
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MDI diskus
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serevent, a LABA, has an onset, peak, and duration of
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5 mins
3 hours 12 hours remember dosing is BID |
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side effects of a LABA are..
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same as SABA
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your patient is perscribed albuterol q4prn and serevent discus BID.
is this safe to administer? |
yes. SABA's and serevent are safe to use together
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foradil is a SABA/LABA?
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LABA
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the onset and duration of foradil is..
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5 mins
12 hours same as serevent. they're both LABA |
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caution use of volmax with which drug class
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beta 1 antiHTN blocking agents
volmax is a LABA |
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when teaching a patient how to use his MDI, what should the rate of inhalation be?
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slow. and hold breath for 10 seconds.
this is critical for drug delivery |
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how often should you rinse your patients MDI?
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qwk in warm water
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a nebulizer delivers drug in larger/smaller particles than an MDI
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smaller
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what device would you need to deliver budesonide via neb
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pari lc jet
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what are some examples of drugs that come in a dry powder device?
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pulmocort
serevent advair spiriva foradil |
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4 functions of glucocorticoids in the body
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permit maintence of blood sugar
anti inflam inhibit immune adaption to stress |
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5 functions of glucocorticoids in the RT
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decrease inflam mediators
reduce mucosal edema decrease mucus thin mucus increase sensitivity of beta 2 receptors |
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examples of oral glucocorticoids
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predinsone
methylprednisolone |
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glucocort are used for a______ a______ e______ m______
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acute
asthma episode management |
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onset/maximum effect of glucocort occurs at
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6hr
48hr |
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short term AE r/t oral glucocort use
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GI irritation
bruising emotional lability sleep disturbance ^BGL |
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long term AE r/t oral glucocort use
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redistribute body fat
Na/H20 retention bone thinning DM cataracts |
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oral glucocort use can reduce what normal body reaction for up to one year
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ability to respond to crisis/ trauma
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inhaled glucocort are meds for ______ term management of asthma
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long term
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if glucocorts are used for long term asthma control, how often would you expect the dosing to be scheduled?
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qd
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side effects of inhaled glucocort include
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dysphonia
candida infxn |
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examples of glucocorts able to be nebed
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budesonide, symbicort
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your patient is a COPDer. the family says his body has changed over the past 5 years. what kind of changes would you expect
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redistrubution of body fat to the trunk and the arm/legs thin out r/t long term inhaled glucocort
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