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Med Surg I Quiz 2: Oncology

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1. Thrombocytope- deficiency of platelets in the blood. This causes bleeding


nia: into the tissues, bruising, and slow blood clotting after
injury.

2. Nursing petechiae, purpura, or ecchymoses


intervention for gingival bleeding
Thrombocytope- prolonged bleeding from puncture sites
nia: Assess epistaxis, hemoptysis
client for and unusual joint pain
report signs and frank or occult blood in stool, urine, or vomitus
symptoms of increase in abdominal girth
unusual menorrhagia
bleeding: restlessness, confusion
decreasing B/P and increased pulse rate
decrease in Hct and Hb levels.

3. Nursing Monitor platelet count and coagulation test results (e.g.


intervention for bleeding time). Report abnormal values.
Thrombocytope- If platelet count is low, coagulation test results are abnor-
nia: mal, or Hct and Hb levels decrease, test all stools, urine,
and vomitus for occult blood. Report positive results.
Avoid aspirin & NSAIDS

4. Nursing avoid giving injections whenever possible; consult physi-


intervention for cian about prescribing an alternative route for medica-
Thrombocytope- tions ordered to be given intramuscularly or subcuta-
nia: Implement neously
Measures to when giving injections or performing venous and arterial
prevent bleeding punctures, use the smallest gauge needle possible
apply gentle, prolonged pressure to puncture sites after
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injections, venous and arterial punctures, and diagnostic
tests such as bone marrow aspiration
take B/P only when necessary and avoid overinflating the
cuff
caution client to avoid activities that increase the risk for
trauma (e.g. shaving with a straight-edge razor, using stiff
bristle toothbrush or dental floss)
whenever possible, avoid intubations (e.g. nasogastric)
and procedures that can cause injury to rectal mucosa
(e.g. taking temperatures rectally, inserting a rectal sup-
pository or tube, administering an enema)
pad side rails if client is confused or restless
perform actions to reduce the risk for falls (e.g. keep bed
in low position with side rails up when client is in bed,
avoid unnecessary clutter in room, instruct client to wear
slippers/shoes with nonslip soles when ambulating)
instruct client to avoid blowing nose forcefully or straining
to have a bowel movement; consult physician about an
order for a decongestant and/or laxative if indicated
administer the following if ordered:
platelet-stimulating factor (oprelvekin [Neumega])
estrogen-progestin preparations to suppress menses
platelets. Avoid aspirin & NSAIDS, wear close toe shoes
when ambulating, no heat (causes vasodilation) apply
cold

5. Nursing apply firm, prolonged pressure to bleeding area(s) if pos-


intervention for sible
Thrombocytope- if epistaxis occurs, place client in high Fowler's position
nia: If bleeding and apply pressure and ice pack to nasal area
occurs maintain oxygen therapy as ordered
spontaneously: administer whole blood or blood products (e.g. platelets)
as ordered.

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6. Complication of Superior Vena Cava Syndrome (pressure on the superior


Lung Cancer: vena cava by tumor)

7. Superior Vena medical emergency


Cava Syndrome
is considered a:

8. Signs & symp- facial edema, edema in neck, epistaxis, dyspnea, nose
toms of Superior bleeds, purple from the nipples up
Vena Cava Syn-
drome:

9. What is happen- Occludes blood flow to the brain (blocks flow) & puts
ing when the tu- pressure on the airways
mor puts pres-
sure on the supe-
rior vena cava?

10. Nursing Inter- Nurses are in a key position to recognize SVCS ear-
ventions for Su- ly, allowing time for a clear histologic diagnosis prior
perior Vena Cava to starting therapy. Nurses should be able to recognize
Syndrome: those patients at high risk and be aware of the signs
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and symptoms of SVCS. Nursing care encompasses a
variety of tasks: facilitation and coordination of diagnos-
tic procedures, assessment of respiratory, cardiac and
neurologic systems, administration of ordered therapies,
emotional and psychosocial support for the patient and
family, and education regarding treatment. Nurses can
institute measures to help relieve dyspnea, including el-
evating the head of the bed, administering oxygen, and
teaching energy conservation. Intravenous fluids should
not be given through the upper extremities, necessitating
central venous access. Additional nursing interventions
should focus on the side effects caused by the treatment
used (chemotherapy, radiation therapy). Through astute
observation and an understanding of this complication,
nurses can be instrumental in the diagnosis and treat-
ment of SVCS.

11. Side Effects of will vary depending on the areas included in the treatment
Radiation: ( in field, and can include:
a patient with skin irritation, dyspnea, cough, pneumonitis, mucositis,
SVCS) decrease in blood counts, appetite / taste changes, and
fatigue.

12. Treatment for Radiation Therapy


SVCS: Chemotherapy
Medication Therapy
Stent placement

13. Medications corticosteroids, diuretics, and thrombolytic therapy.


used to treat
SVCS:

14. thrombolytic heparin, warfarin, and/or tissue plasminogen activators.


therapy
(medication

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therapy for
SVCS) includes:

15. Early signs & Feeling of fullness in the head, nasal stuffiness,
symptoms of headache, shortness of breath, cough, chest pain,
SVCS: hoarseness and difficulty swallowing.

16. Late signs & respiratory distress, headaches, syncope, visual


symptoms of changes, and mental status changes.
SVCS:

17. What types of Non-small cell lung cancer


lung cancer has
the best progno-
sis?

18. What is the inher- BRCA 1 & BRCA 2


ited gene muta-
tion the identifies
families at sig-
nificant risk for
breast cancer &
ovarian cancer?

19. 1. What diseases Chronic Lymphocytic Leukemia, Acute Lymphocytic


is predominately Leukemia, Hodgkin's Lymphoma, Non-Hodgkin's Lym-
a malignancy of phoma & B. Lymphoma
of the lympho-
cytes? KNOW THESE DISEASES. Anything with 'Lymph' in it

20. What is the SCC is less aggressive, but faster growing and cause it
difference be- invades local tissues. tends to bleed, ulcers (worse) BCC
tween squamous is more aggressive but does not grow as fast so SCC is
cell carcinoma & the worst of the two
basal cell carci-
noma?
SCC is rough, scaly lesion with central ulceration & crust-
ing. Bleeding possible. Localized, may metastasize.

BCC: small waxy, nodule with superficial blood vessels,


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well defined borders. Erythema & ulcerations. Invades
local structures (nerves, bone, cartilage lymphatic & vas-
cular tissue) rarely metastatic but high rate of recurrence.

21. Squamous cell Squamous cell cancer (SCC) starts in the squamous cells
cancer (SCC): in the upper part of the epidermis. It accounts for about
2 in 10 skin cancers. It most often starts on skin that has
been exposed to the sun, like the face, ears, neck, lips,
and backs of the hands. SCC is more likely than BCC to
spread into deeper layers of the skin. It is also more likely
to spread to other parts of the body, but this is not common

22. Basal Cell Carci- About 8 of 10 skin cancers are basal cell cancers (BCCs).
noma: This is not only the most common type of skin cancer,
but the most common type of cancer. BCC begins in the
lowest layer of the epidermis, the basal cell layer.
BCC usually begins on skin exposed to the sun, such as
the head and neck..
BCC tends to grow slowly. It is very rare for BCC to spread
to other parts of the body. But if it is not treated, it can
grow into nearby areas and spread into the bone or other
tissues under the skin.
After treatment, BCC can come back (recur) in the same
place on the skin. New basal cell cancers can also start
in other places on the skin. As many as half of the people
who have one BCC will get a new skin cancer within 5
year

23. What cancer is chronic myelogenous leukemia and sometimes found in


identified with acute lymphocytic leukemia.
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patients having
a philadelphia KNOW THESE DISEASES
chromosome?

24. Complications of Pancytopenia


Hodgkin's Lym- pg. 1021 in ATI med surg
phoma:

25. describe the cell formed by B cells- malignant plasma cells


type for multiple
myeloma:

26. describe the formed by B cells (reed stem berg)


cell type for
hodgkins lym-
phoma:

27. Classic signs weight loss, palpable abdominal mass, enlarged gallblad-
& symptoms of der and liver, hepatomegaly, jaundice (late finding) clay
pancreatic can- or tan colored stools, dark, frothy urine, ascites (swelling,
cer: fluid in peritoneal space, pruritus (build up of bile salt),
early satiety (feeling full) or anorexia Pancreatic Tumor:
pain, jaundice, significant weight loss

28. Hodgkin's Lym- Reed stem berg from B lymphocytes


phoma associat-
ed with:

29. Difference be- lymphoma: lymphocytes, myeloma malignant plasma


tween lymphoma cells
& multiple myelo-
ma

30. Difference be- benign does not invade neighboring tissue. malignant can
tween benin & metastasize
malignant:

31. KNOW ABCDE


for skin cancer

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32. Cervical cancer: bleeding & pain with intercourse

33. screening for CA-125


ovarian cancer:

34. Liver cancer is Hepatitis B or C-ATI


usually associat-
ed with:

35. Test for Liver alpha feta protein (can be a false positive)
Cancer:
More definitive test:

36. Liver signs & right upper quadrant


symptoms -weight loss
-anorexia
-anemia (related to iron absorption)
*remember vitamins are absorbed in the liver so monitor
the lab tests

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37. Surgical removal whipple


of the pancreas:

38. Prostate Cancer: PCA is elevated (released during a cancer) the most
common type of cancer for men. Retention.

39. Treatment for hormone therapy: estrogen


Prostate Cancer:

40. Bladder Cancer: hair color has a chemical carcinogen

41. Intra (bladder monitor for blood in the urine-hematuria


cancer)

42. Most com- breast cancer, colorectal


mon cancer in
women:

43. Growth of Tu- initiation, promotion (enhances the development of can-


mors: cer) then you have a latent period, progression

44. Hodgkin's Lym- alcohol


phoma you
should avoid
drinking....

45.
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Cryothera- a procedure that uses extreme cold (liquid nitrogen) to
py/surgery: destroy tissue. It is often used to treat skin lesions (skin
growths or patches that do not look like the skin around
them). The lesions can be benign (not cancerous) or
precancerous. Cryotherapy can also be used to treat skin
cancer that does not affect deep tissue.

46. Side effects of 5 Pain, itching, burning, irritation, inflammation, dryness,


fluorouracil: swelling, tenderness at the site of application. This will
heal once the treatment is complete.

47. What is 5 fluo- anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy


rouracil? drug. This medication is classified as an "antimetabolite."
(cream, topical)

48. This topical can- 5 fluorouracil


cer treatment will
leave a lesion will
weep, crust and
erode:

49. after this pro- Cryosurgery


cedure Skin be-
comes edema-
tous & tender

50. Patient teaching PRIOR to use: make sure you are not pregnant or breast-
for 5 fluorouracil: feeding, do not use aspirin unless permitted by your doc-
tor.
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During use : Use non-metal applicator or fingertips to


apply cream.
Use care when applying cream or solution around the
eyes, nose, and mouth.
Wash your hands immediately after applying this medica-
tion.
Avoid sun exposure. Wear SPF 15 (or higher) sunblock
and protective clothing.
If you experience symptoms or side effects, be sure to
discuss them with your health care team. They can pre-
scribe medications and/or offer other suggestions that are
effective in managing such problems.

51. Description of are cell-cycle specific. They attack cells at very specific
how Antimetabo- phases in the cycle (inhibit cancer cells from further di-
lites work: viding, so they die)

52. What patients The treated area will become red soon after your proce-
should expect af- dure. It also may blister and swell. If this happens, do not
ter cyrosurgery: break open the blister.
You may also see drainage on the treated area. This is
normal.
The treated area will heal in about 7 to 10 days with min-
imal scarring, but it will take longer for the discoloration
(pinkness, redness, or lighter or darker skin) to go away.

53. After care teach- Starting the day after your procedure, wash the treated
ing for cyro- area gently with fragrance-free soap and water daily.
surgery: Leave the treated area uncovered unless it has ulcers or
drainage. If you see any drainage, apply petroleum jelly
(Vaseline®) on the treated area and cover with a bandage
(Band-Aid®) if necessary.
If you have any bleeding, press firmly on the area with a
clean gauze pad for 15 minutes. If the bleeding doesn't
stop, repeat this step. If the bleeding still hasn't stopped
after repeating this step, call your doctor's office.
Do not use perfumed soaps, cosmetics, or lotions on the
treated area(s) until it has healed. This will usually be at

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least 10 days after your procedure.
You may have hair loss on the treated area. This depends
on how deep the freezing went. The hair loss may be
permanent.
Once the treated area has healed, apply a broad-spec-
trum sunscreen with an SPF of at least 30 to the area to
protect it from scarring.
You may have discoloration (pinkness, redness, or lighter
or darker skin) at the treated area for up to 1 year after
your procedure. Some people may have it for even longer
or it may be permanent

54. Reasons to A temperature of 100.4° F (38° C) or higher


call dr. after Chills
cryosurgery: Any of the following symptoms at your wound or the area
around it:
Redness or swelling that extends to areas of untreated
skin
Increasing pain or discomfort in the treated area
Skin in the treated area that is hot or hard to the touch
Increasing oozing, or drainage (yellow or green) from the
treated area
Foul odor
Bleeding that does not stop after applying pressure
Any questions or concerns
Any problems you did not expect

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55. What happens -nonfunctional white blood cells


to the cells in -Lack ability to differentiate normally
Leukemia/ Lym- -immature stage of production
phoma? -Excessive proliferation

56. What are the -Immunosuppression


risk factors for -Exposure to chemotherapy causing bone marrow sup-
Leukemia & Lym- pression
phoma -Genetic factors
-Ionizing radiation

57. Signs & -Rapid onset


Symptoms of -Fatigue Pallor (anemia)
Acute Lympho- -Infections (bone pain)
cytic Leukemia: -Lymphadenopathy (a disease affecting the lymph
(ALL) nodes)
-Bruising/petechiae

(Remember that the bone pain, lymphadenopathy &


brushing set ALL apart from CLL)

58. Signs & Symp- -Affects people over 50


toms of Chron- -B cells do not respond to antigen activation
ic Lymphocytic -Low antibody count
Leukemia: (CLL)
-Fatigue
-Weight loss
-Fever

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-Night Sweats
-Enlarged Lymph Nodes

(Remember that the flu like symptoms set CLL apart from
ALL as well as the weight loss)

59. Acute Myeloge- -Most common among adults, unchecked proliferation of


nous Leukemia: myeloblasts. Blocked differentiation.
(AML)

60. Acute Myeloge- -Fatigue


nous Leukemia: -Pallor (anemia)
(AML) signs & -Dyspnea (difficult or labored breathing)
symptoms: -Bone pain
-Frequent infections

Remember: difficulty breathing sets this part from other


leukemias

61. 4.Chronic -affects older males


Myelogenous -chromosomal abnormality: PHILADELPHIA CHROMO-
Leukemia: (CML) SOME
-makes a protein that allows a myeloid cell proliferation

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62. Chronic fatigue


Myelogenous night sweats
Leukemia: weight loss
(CML) signs & fever
symptoms: bone pain
abdomen pain
Enlarged spleen (causes abdomen pain?)

Remember if there is weight loss, it is a chronic type of


leukemia

63. Screening & Di- BONE marrow biopsy


agnostic Tests -Look at protein markers: this will differentiate myeloid or
for Leukemia: lymphoid (leukemia)

64. What confirms excessive blast cells


leukemia in a
bone marrow
biopsy?

65. Treatment for Induction


leukemia: Consolidation
Maintenance
Reinduction

66. BRCA 1 gives up 87%, age 70


to a _________%
risk by age
________

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67. BRCA 2 gives up 65%, age 70
to a _________%
risk by age
________

68. Non-small cell Squamous cell (epidermoid) carcinoma


lung cancers in- Adenocarcinoma
clude: Large cell (undifferentiated) carcinoma:
denosquamous carcinoma (less common)
sarcomatoid carcinoma (less common)

*remember that non-small cell has the best prognosis

69. 4. What can- CML-Chronic Myelogenous Leukemia: makes a protein


cer is associat- that allows myeloid cell proliferation which accumulates
ed with patients in bone marrow.
having Philadel-
phia chromo-
some?

70. How do you elim- Continuous drainage into external pouch


inate after an
Ileal Conduit?

71. How do you elim- Intermittent self catheterization


inate after a Con-
tinent pouch?

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72. How do you elim- Intermittent Self catheterization


inate after a blad-
der reconstruc-
tion?

73. What are the sur- Ileal conduit


gical Interven- Continent pouch
tions for Urologi- Bladder Reconstruction
cal Cancer: ureterosigmoidostomy

74. How do you During Bowel Movement


eliminate after
a ureterosigmoi-
dostomy?

75. 16. De- is chemotherapy that is used to treat carcinoma that has
scribe intraves- not metastasized outside of the bladder. Used for bladder
ical chemother- cancer, TB virus must be kept in bladder for 2 hours, sit
apy and un- when you pee so you do not splash. Mask and half a
derstand what gallon of bleach for about 15 min before they pee. No sex
the nurse would for 24 hours.
monitor a patient
for?
Jac's Notes: make them sit down to pee (prevent splash-
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ing) live bacteria N95 mask, put bleach in the toilet (15
min) do not introduce TB into the sewer system), do
not let families, kids, or pregnant women use the same
bathroom. They can't have sex for 24 hours because they
can transmit it to their partner

76. What are the Intravesical includes the medications MED and dwells in
differences be- the bladder for 2 hours.
tween intravesi- M-mytomycin
cal and systemic E-epirubcin
treatments for D-doxorubicin
urological can-
cer? Systemic Chemotherapy: includes the medications CCM
C-cisplatin
C-cisplatin & 5 flourouracil
M-mitomycin & 5 flourouracil

http://www.healthnetworks.health.wa.gov.au/can-
cer/docs/Administration_Intravesical_agents.pdf

77. Systemic uses anti-cancer drugs that are injected into a vein or giv-
Chemotherapy: en by mouth. These drugs travel through the bloodstream
to all parts of the body.

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78. Intravesical With ___________therapy for bladder cancer, drugs are
(blank space) put directly into the bladder through a catheter, instead of
being injected into a vein or swallowed. Both immunother-
apy and chemotherapy drugs can be given this way.

79. 17. What are the Pancytopenia: neutropenia-anc less than 2,000/mm3 in-
complications of creases risk of infection
Hodgkin's Dis-
ease: Thrombocytopenia: bleeding-RISK if count is 50,000 and
spontaneous bleeding at 20,000

Anemia: fatigue & hypoxemia

Now think like a nurse and ask yourself what are the
signs & symptoms of these complications & what are the
nursing interventions?

80. 13. What is the test measures the amount of the protein CA 125 (cancer
purpose of a antigen 125) in your blood. A CA 125 test may be used
CA-125 test? to monitor certain cancers during and after treatment. In
some cases, a CA 125 test may be used to look for early
signs of ovarian cancer in women with a very high risk of
the disease.

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81. 9. Describe the a. Grade I: Cells differ slightly from normal cells and are
various phases well differentiated.
related to the b. Grade II: Cells are more abnormal and moderately
growth of tu- differentiated.
mors: c. Grade III: Cells are very abnormal and poorly differen-
tiated.
d. Grade IV: Cells are immature and primitive and undif-
ferentiated, cell of orgin is difficult to determine.

82. Varies Phas- a. Initiation: mutation of cell's genetic structure (due to


es Related To chemical carcinogens, viral, radiation)
Growth of tu- b. Promotion: characterized by reversible proliferation of
mors: altered cells. Activities of promotion are reversible (obesi-
ty, smoking, alcohol, dietary fat)
c. Latent period: ranges 1-40 years. Cells accumulate and
reach critical mass that can be detected.
d. Progression: increased growth rate of tumor, invasive-
ness, metastasis

83. Burkitt's Lym- Epstein Barr Virus


phoma is always
associated with:

84. Staging of Can- Tumor, Node, Metastasis


cer: What does
the T, N, M stand
for?

85. unable to evaluate primary tumor

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Staging of Can-
cer: TX-

86. Staging of Can- no evidence of primary tumor


cer: T0-

87. Staging of Can- tumor in situ


cer: tis-

88. Staging of Can- size & extent of tumor


cer: T1,T2,T3,T4-

89. Staging of Can- unable to evaluate regional lymph nodes


cer: NX-

90. Staging of Can- no evidence of regional node involvement


cer: N0-

91. Staging of Can- number of nodes that are involved, or & or the extent of
cer: N1,N2,N3- spread

92. Staging of Can- unable to evaluate distant metastasis


cer: MX-

93. Staging of Can- no evidence of distant metastasis


cer: M0-

94. Staging of Can- presence of distant metastasis


cer: M1-

95. Initiation Phase: mutation of cell's genetic structure (due to chemical car-
cinogens, viral, radiation)

96. Promotion characterized by reversible proliferation of altered cells.


Phase: Activities of promotion are reversible (obesity, smoking,
alcohol, dietary fat)

97. Latent Period: ranges 1-40 years. Cells accumulate and reach critical
mass that can be detected.

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98. Progression: increased growth rate of tumor, invasiveness, metastasis

99. Cancer Stages 0-Cancer in situ


0-4: 1-Tumor limited to tissue of origin; localized tumor growth
2-Limited local spread
3-Extensive local regional spread
4- Metastasis

100. Cancer Stage 0: This stage describes cancer in situ, which means "in
place." Stage 0 cancers are still located in the place they
started and have not spread to nearby tissues. This stage
of cancer is often highly curable, usually by removing the
entire tumor with surgery.

101. Cancer Stage 1: This stage is usually a small cancer or tumor that has not
grown deeply into nearby tissues. It also has not spread
to the lymph nodes or other parts of the body. It is often
called early-stage cancer.

102. Cancer Stage 2: These stages indicate larger cancers or tumors that have
grown more deeply into nearby tissue. They may have
also spread to lymph nodes but not to other parts of the
body. (2 & 3 together)

103. Cancer Stage 3: These stages indicate larger cancers or tumors that have
grown more deeply into nearby tissue. They may have
also spread to lymph nodes but not to other parts of the
body. (2 & 3 together)

104. Cancer Stage 4: This stage means that the cancer has spread to other or-
gans or parts of the body. It may also be called advanced
or metastatic cancer.

105. What drug ther- Hormonal Therapy


apy may be as- • GnRH- hormone therapy
sociated with the • Androgen antagonists(flutamide [Euxelin])
development of
gynecomastia?
a. estrogens and androgen
b. digitalis
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c. isoniazid (INH)
d. ranitidine (Zantac)
e. spirolactone (Aldactone).
The use of heroin and marijuana can also cause gyneco-
mastia

*man boobies*

106. Drug to light in- when the drug is given to when the light is applied.
terval:

107. What type of pa- The disease is twice as common in men as in women and
tients are most usually develops after 40 years of age, with and average
at risk for de- of 65 years of age. More commonly in African Americans.
veloping multi- Also, many people with monoclonal gammopathy or ex-
ple myelomas? posed to radiation from an atomic bomb will eventually
develop MM.

108. Alpha fetopro- false positive


tein may give you cirrhosis or hepatitis
a ________posi- CEA test
tive because of liver cancer
_________ or
___________ so
the definitive test
for liver cancer is
the ______ test. If
this test is elevat-
ed, then it indi-
cates _________
cancer with an el-
evated AFP.

109. CEA test stands Carcinoembryonic antigen (tests for cancer)


for

110. Elevated CEA more than 35 units/ml


level

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111. Acute Myeloge- adults (according to ATI)
nous Leukemia:
is most common Lewis says CML
in

112. Hemoglobin Lev- Females 12-16 g/dL


el (Hgb): Males: 14 to 18 g/dL (ATI + Slides)

Female: 11.7-16.0 g/dL


Male: 13.2-17.3 g/dL (Lab Book)

113. Hematocrit Lev- Females 37-47%


el: Hct Males 42-52% (ATI + Slides)

Female: 35%-47%
Male: 39%-50%
(Lab Book)

114. CBC tip: look over the lab values and rationales as they apply to
leukemia and lymphomas

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