BAN QUIZ 4

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164 Terms

1
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G2 and M checkpoints, growth/replication controlled by signalling, tumor suppressors, programmed cell death

how does the body prevent cancer

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rituximab

monoclonal antibody targeting CD20 protein on B cells, leading to their destruction.

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elevated WBCs on CBC with differential

what lab test would make you suspicious of leukemia

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lymph node biopsy

how is definitive diagnosis of lymphoma determined

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pembrolizumab

a immune checkpoint inhibitor that inhibits the PD-1 pathway, enhancing T-cell responses against cancer

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Non-hodgkin lymphoma

hematologic condition associated with invasion of Waldeyer’s ring

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oral hygiene, chlorohexidine, chemotherapy (kills blast cells)

treatment of leukemic gingivitis

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acute leukemias

rapid onset and progress, REQUIRE treatment within hours and days

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aphthous major, diffuse ecchymosis

initial presentation of AML

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stage III lymphoma

spread of cancer to lymph nodes below diaphragm

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swollen, painless, fixed or rubbery mobile nodes

characteristics of lymphadenopathy

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dysphagia, paresthesia (numbness), pain

symptoms of oropharyngeal lymphoma

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MALT lymphoma

sjogrens disease increase risk of what

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non-hodgkin lymphoma

second most common ORAL cancer

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larger than 1 cm

size of lymph nodes persisting for more than 4 weeks that should be biopsy

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myeloid sarcoma

a solid tumor of myeloid cells, often associated with acute myeloid leukemia (AML). Can cause EXPANSION OF MANDIBLE

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rapid progression, bilateral viral infection, decreased inflammation (neutropenia)

in what ways can infection present abnormally in leukemia

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tumor encroaching on nerve

what is numb chin syndrome an indication of

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blast crisis

a life-threatening phase of chronic myeloid leukemia (CML) where immature blood cells proliferate uncontrollably, resembling acute leukemia.

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oral ulcerations (stomatitis), dry mouth, opportunistic infections

adverse effects of immunotherapies

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budesonide

corticosteroid can be CONTINOUSLY used to treat Immunotherapy-induced stomatitis/mucositis

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stomatitis/mucositis

most prevalent adverse effect of mTOR inhibitors (immunotherapy)

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Bevacizumab

immunotherapy that can cause mucocutaneous bleeding

<p>immunotherapy that can cause mucocutaneous bleeding </p>
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swelling, progressive infection, pain, trauma, suspicious lesion

examples of when treatments would be medically necessary

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late onset dryness

what raises suspicion for salivary GVHD

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mucoceles

non dangerous clear fluid filled bumps that can develop at sites of minor salivary glands, may realte to GVHD or decreased salivary function

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pilocarpine (salagen)

sialogogue used to manage dry mouth as a result of radiation-induced hyposalivation

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elective treatment

Any treatment that does not need to be completed for a medical reason

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acute iritis, narrow angle glaucoma, uncontrolled asthma

Siagologues should not be used when pts have which conditions

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head and neck radiation with chemotherapy

what causes most severe MUCOSITIS with longest duration

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removal of potential irritants

general management for Mucositis caused by cytotoxic chemotherapy and/or head & neck radiation

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viscous lidocaine, benzocaine, magic mouthwash

topical anesthetic that may be used for pain associated with mucositis

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recurrent HSV

In immunocompromised hosts, lesions may be widespread (not isolated to bone-bound tissue) and are EXTREMELY painful

<p><span>In immunocompromised hosts, lesions may be widespread (not isolated to bone-bound tissue) and are EXTREMELY painful</span></p>
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microdontia (small teeth/roots) or hypodontia/oligodontia (missing teeth)

potential effect of chemotherapy and radiation in pediatric pts

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severe aplastic anemia, severe combined immunodeficiency, sickle cell disease

non-malignancies that require HCT

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at least 28 days before transplant

when should pre HCT dental health stabilization occur

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prevent acute infection

goal of dental treatment prior to HCT

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pre treatment antibacterial rinse (chlorohexidine), limit aerosols during procedure

dental treatment protocol when treating pt with neutropenia

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Acute Myeloid Leukemia (AML)

Leukemic gingivitis is most likely to be seen in which type of leukemia?

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without immunosuppression pts develop GVHD

why is immunosupression important after transplant

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mild-moderate

GVHD level associated with highest survival rates

42
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Multiple Myeloma (MM)

“Punched out” radiolucencies are a characteristic feature of which hematologic malignancy?

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chronic GVHD

presents with similar symptoms to many autoimmune diseases (dry eyes, sclerosis, xerostomia)

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recognize neoantigens on tumor cells

how do T cells prevent cancer

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create antibodies against damaged cells

how do B cells prevent cancer

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when they touch similar cells

when do cells normally stop growing

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stimulate growth, resist inhibition, avoid apoptosis, angiogenesis, metastasis, mutation

properties of cancer cells

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cytotoxic chemotherapy

kills ALL rapidly dividing cells

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targeted chemotherapy

interferes with specific proteins involved in cancer growth and spread

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hormone chemotherapy

slows or stops the growth of sex-hormone related cancers

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adjuvant therapy

chemotherapy given AFTER surgery or radiation to kill remaining cancer cells

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neoadjuvant therapy

chemotherapy given to shrink a tumor BEFORE surgery

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blood, GI,hair, skin, epithelial

CELLS other than cancer cells that are AFFECTED by CYTOTOXIC CHEMOTHERAPY

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gives patient time to recover (from adverse effects)

why would cytotoxic chemotherapy is administered in cycle

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toxicities and time needed for body to recover

important considerations for length of treatment

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imatinib (Gleevec)

A targeted therapy used primarily used to treat Philadelphia chromosome associated chronic myeloid leukemia (CML)

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fewer side effects

benefit of targeted chemotherapy

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small molecule drugs (nibs)

targeted chemotherapy drugs that ENTER CELL and target specific substance within cell

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large molecule drugs/monoclonal antibodies (mabs)

targeted chemotherapy that target proteins or enzymes from CELL SURFACE

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immunotherapy

a type of Targeted treatment that uses the body's own immune system to fight cancer,

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angiogenesis inhibitors

targeted chemotherapy that inactivates vascular endothelial growth factor (VEGF)

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mucositis (mucous membrane inflammation)

ADR of angiogenesis inhibitors

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signal transduction inhibitors

targeted chemotherapy that interferes with intracellular signaling pathways to inhibit cancer cell growth

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proteasome inhibitors/monoclonal immunoglobulins (mibs)

targeted chemotherapy that activate cell signaling to cause apoptosis

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synthetic cytokines

immunotherapy that is a synthetic version of IL-2 that increases growth and activity of T and B cells

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checkpoint inhibitors

immunotherapy that blocks checkpoint proteins to enhance T and B cell responses against tumors

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Chimeric antigen receptor (CAR) T-cell therapy

immunotherapy that modifies T cells to find specific tumor cell

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monoclonal antibodies

can be both targeted chemotherapy and immunotherapy

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ceritinib, crizotinib

drugs that target ALK in non-small cell lung cancer

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tobacco use

Which modifiable risk factor has the greatest impact on overall cancer incidence in the United States?

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tumor supressor, mutation leads to loss of regulation

How does p53 mutation influence cancer risk?

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Non-Hodgkin Lymphoma

Which type of lymphoma is more common?

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bone marrow biopsy

most definitive study for the diagnosis of acute myeloid leukemia (AML)

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myelodysplastic syndrome

A group of disorders caused by poorly formed or dysfunctional blood cells, often leading to ineffective hematopoiesis and an increased risk of AML

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infection (neutropenia) and bleeding (thrrombocytopenia)

risks of myelodysplasia (pancytopenia related)

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blood smear and bone marrow biopsy

tests for differential diagnosis of blood disorders/ cancers

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hypercellular marrow

hallmark of MDS characterized by many abnormally shaped,
immature forms of blood cells and a high number of myeloid progenitors.

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flow cytometry

test used to look for specific marker of disease

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gentetic

test to look for specific muations realted to disease

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0.8

threshold ANC under which a pt would require antibiotics

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50

threshold PLT under which a pt would require platelet transfusion

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24

threshold HCT under which pt would require RBC transfusion

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oral hygiene, antibiotics, chlorhexidine, EXT when safe

how would you treat a periodontal abscess oin a pt with pancytopenia

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platelet transfusion, prophylactic antibiotics, no NSAIDs, anti-fibrinolytic agent

what is the treatment plan for a pt with pancytopenia who requires emergent extraction

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discuss with oncology, temporary stabilization if possible

approach for extraction in pts with cancer

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allogenic hematopoietic stem cell transplant

a procedure that infuses healthy stem cells from a DONOR into a patient to replace damaged or diseased bone marrow, usually for LEUKEMIA

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autologous hematopoietic stem cell transplant

a procedure that infuses a patient's OWN healthy stem cells back into their body after high-dose chemotherapy or radiation therapy, typically used for LYMPHOMA and MYELOMA

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conditioning/myeloablation

the process of preparing a patient for a stem cell transplant by destroying diseased bone marrow and suppressing the immune system, often using chemotherapy or radiation.

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infection,bleeding mucositis, xerostomia, taste dysfunction, acute GVHD

acute oral complications that may occur after ALLOGENIC HCT

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Chronic GVHD, 2nd malignancies (oral squamous cell carcinoma), infections ect.

chronic complications that may occur after ALLOGENIC hematopoietic cell transplantation (HCT)

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xerostomia, decay, relapse, 2nd malignancies

chronic complications that may occur with AUTOLOGOUS HCT

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HLA matching

How are donors chosen for Allogeneic HCT?

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decreased survival and increased graft rejection and risk of GVHD

risks with single antigen mismatch in A,B,C, or DR in HLA region

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infection risk, bleeding risk, long term dental prognosis, timing of procedures

main considerations for treating oncology pts

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open and broach, SDF, perio therapy (scaling)

examples of temporary stabilization in dentistry

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dental stabilization, conditioning, transplant, recovery

order of events of HCT treatment

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oral mucositis

complication of cancer therapies, especially HCT and head and neck radiation that causes painful inflammation and ulceration of the mucous membranes in the mouth

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non-keratinized tissues

most suscptible tissue to mucositis

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within 3 weeks

when does mucositis typically develop after HCT

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palifermin

used to decrease severity of mucositis by thickening epithelial tissue before chemo