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Stressors (work-life balance, constant availability, abuse, trauma, loss of job, illness, etc) Depends on the individual's age, health, stressor, genetics, social support, etc Perception of stress Some researchers feel that acute stress is immunoenhancing and chronic stress is immunosuppressive

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Physiologic stress

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Dr. Selye termed the _________ as the general adaption syndrome

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Stress response

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GAS three stages:

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1. Alarm stage 2. Stage of resistance or adaption 3. Stage of exhastion

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◦Arousal of body defenses—fight or flight ◦Stressor triggers the hypothalamic-pituitary-adrenal (HPA) axis. ◦Catecholamines (epinephrine and norepinephrine) and cortisol are released Cortisol will break down proteins, release lipids, and increase circulating glucose ◦Activates the sympathetic nervous system (SNS):HR, BP, RR, GI function

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Alarm stage

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◦Follows persistent stress ◦Characterized by decreased levels of cortisol due to negative feedback mechanisms ◦Long-term hypercortisolism: Impaired inflammatory and immune responses, tissue breakdown and glucose intolerance ◦Continued suppression of thyroid, growth and reproductive hormones alters growth, metabolism and reproduction

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Stage of resistance or adaption

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◦Occurs only if stress continues and adaptation is not successful. ◦Progressive breakdown of compensatory mechanisms ◦Characterized by energy depletion, tissue degeneration and poor health

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Stage of exhaustion

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causes psychologic and physical responses A person experiences this when a demand exceeds the person's coping abilities can results in reactions such as disturbances of cognition, emotion, and behavior that can adversely affect well-being

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Stress

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Involves physiologic response and psychologic stressors.

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Reactive response

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Physiologic response develop in anticipation of a disruption in homeostasis.

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Anticipatory response

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◦Associates a stimulus with danger. ◦May cause posttraumatic stress disorder (PTSD) or phobias.

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Conditional response

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◦Are interactions of consciousness, the brain and spinal cord, and the body's defense mechanisms. Stressors: Elicit a stress response or stress system through actions of the nervous and endocrine systems. ◦Pain, cold, trauma, malnutrition, excitement, drugs, surgery, and other stressors

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Psychoneuroimmunologic Mediators

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Is initiated by the central nervous system and the endocrine system. Corticotropin-releasing hormone (CRH) is released from the hypothalamus. ◦CRH is also peripherally released at inflammatory sites. Stressor can be a perceived or real threat. Norepinephrine ◦Promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses.

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Stress response

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Glucocorticoids from the adrenal cortex in response to adrenocorticotropic hormone (ACTH) from the pituitary gland

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Major stress hormones

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-Balances the sympathetic nervous system -Influences the adaptation or maladaptation to stress

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Parasympathetic system

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Adaptive physiologic response to stressful events

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Allostasis

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-Long-term or chronic exaggerated responses to stress -Can lead to disease

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Chronic or disregulated allostasis

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-aroused during the stress response. ◦Causes the adrenal gland medulla to release catecholamines.

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SNS

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◦Mimic sympathetic stimulation. ◦Are released from the adrenal medulla. Large amounts of epinephrine Small amounts of norepinephrine

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Catecholamines

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Raises blood pressure Dilates the pupils of the eye Increases sweat gland action Binds primarily to α-adrenergic receptors

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Norepinephrine

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Influences cardiac function Inotropic- increases myocardial contractility Chronotropic- increases heart rate Vasodilation of skeletal muscle Metabolic regulation occurs, increasing the glucose level Binds and activates both α- and β-adrenergic receptors

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Epinephrine

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◦Is activated by ACTH. ◦Stimulates gluconeogenesis. ◦Elevates the blood glucose level. Has a protein anabolic effect in the liver and a catabolic effect in other tissues. ◦Contributes to the development of metabolic syndrome and obesity ◦Chronic excess can result in type 2 diabetes and central obesity

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Cortisol

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Is a powerful antiinflammatory or immunosuppressive agent. Causes poor wound healing and an increased susceptibility to infection. Systemic responses to stress may cause a decrease in innate immunity and enhance adaptive immunity Local responses to stress, under certain conditions, can induce proinflammatory activities

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Cortisol and the Immune system

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◦Are proteins found in the brain that have pain-relieving capabilities. ◦In a number of conditions, individuals not only experience insensitivity to pain, but they also have increased feelings of excitement, positive well-being, and euphoria when endorphins and enkephalins are increased.

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Endorphins

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Many immune-related conditions and diseases are associated This and negative emotions increase levels of proinflammatory cytokines, providing a possible link among stress, immune function, and disease. affect immune cell functions. ◦Causes decreased natural killer cell and T-cell cytotoxicity and impaired B-cell function.

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Stress and the immune system

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General state of unpleasant stimulation after life events that result in physiologic, emotional, cognitive, and behavior changes.

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Psychologic distress

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◦Is managing stressful demands and challenges that are appraised as taxing or exceeding the resources of the person. ◦May be adaptive or maladaptive.

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Coping

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◦Increased smoking ◦Change in eating habits ◦Disturbances in the sleep-wake cycle ◦Social support ◦Relaxation techniques ◦Many other strategies

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Methods of coping

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Is another name for malignant tumor However, it is not always a tumor and a tumor is not always it Is an abnormal growth resulting from uncontrolled proliferation; it serves no physiologic function Is also referred to as a neoplasm: New growth

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Cancer

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-Slow growth -Not invasive -Well differentiated -Low mitotic index -Does not metastasize

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Benign

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-Rapid growth -Invasive -Poorly differentiated: anaplasia -High mitotic index -Can spread distantly

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Malignant

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◦Named according to the tissues from which they arise and include the suffix, -oma. Lipoma: Fat Leiomyoma: Smooth muscle

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Benign tumors

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◦Are named according to the tissues from which they arise. -Malignant epithelial tumors: Carcinomas Adenocarcinoma: Ducts or glands Malignant connective tissue tumors: Sarcomas -Cancers of lymphatic tissue: Lymphomas

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Malignant tumors

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Are substances produced by benign or malignant cells. Are found on or in a tumor cell, in the blood, in the spinal fluid, or in urine.

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Tumor markers

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◦Liver and germ cell tumors Secrete a protein known as alpha fetoprotein (AFP) into the blood. ◦Prostate tumors Secrete prostate-specific antigen (PSA) into the blood. ◦If a tumor marker, itself, has biologic activity: Symptoms are expressed. May contribute to paraneoplastic syndrome.

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Tumor marker examples

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◦Screen and identify individuals at high risk for cancer. ◦Diagnose specific types of tumors. ◦Observe the clinical course of cancer

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What tumor markers are used for

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◦Is the process during which a normal cell becomes a cancer cell. ◦Autonomy: Is the cancer cell's independence from normal cellular controls. ◦Lacks contact inhibition. ◦Is anchorage independent. ◦Is immortal. ◦Anaplasia occurs (loss of differentiation).

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Transformation of cancer cells

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◦Self-renew. Cell divisions create new stem cells. ◦Multipotent. Have the ability to differentiate into multiple different cell types.

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Cancer stem cells

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-Cancer is predominantly a disease of agin -Clonal proliferation or expansion occurs -Multiple mutations are requires before cancer can develop -Active growth-promotion pathways -Block antigrowth signals -Allow tissue invasion and distant metastasis

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cancer-causing mutations

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-Are mutant genes that, in their nonmutant state, direct protein synthesis and cellular growth. -Activation of proto-oncogenes, resulting in hyperactivity of growth-related gene products

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Oncogenes

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◦Encode proteins that, in their normal state, negatively regulate proliferation. ◦Are also referred to as anti-oncogenes. ◦Mutation of genes, resulting in the loss or inactivity of gene products that would normally inhibit growth

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Tumor-suppressor genes

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Are normal nonmutant genes that code for cellular growth.

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Proto-oncogenes

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◦Changes occur in one or a few nucleotide base pairs ◦Ras gene converts a regulated proto-oncogene to an unregulated oncogene, accelerating growth.

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Point mutations

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Piece of one chromosome is transferred to another

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Chromosome translocation

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◦A piece of chromosome is duplicated over and over ◦Results in an increased expression of an oncogene Oncogene activation

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Gene amplification

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◦Allows unregulated cellular growth ◦Takes two hits to inactivate the two alleles of a tumor-suppressor gene

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Inactivation of tumor-suppressor genes

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◦Whole regions of chromosomes are shut off while the same regions in other cells remain active ◦Does not require mutations or changes in the DNA sequence

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Gene silencing

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◦Are responsible for the maintenance of genomic integrity. ◦Encode proteins that are involved in repairing damaged DNA. ◦Loss of function of caretaker genes leads to increased mutation rates.

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Caretaker genes

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Is the growth of new vessels. Is also called neovascularization.

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Angiogenesis

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Immunization with tumor antigens to elicit the immune response against a particular cancer

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Active immunotherapy

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Injecting the patient diagnosed with cancer with antibodies or lymphocytes directed against the tumor-associated antigens

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Passive imunotherapy

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Is the spread of cancer cells from the site of the original tumor to distant tissues and organs through the body.

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Metastasis

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Is a complex process that requires cells to have many new abilities. ◦Invade ◦Survive ◦Proliferate in a new environment ◦Recruit new blood vessel growth

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Metastasis

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◦Is a prerequisite for metastasis and the first step in the metastatic process. ◦Cancer often spreads first to regional lymph nodes through the lymphatic system and then to distant organs through the bloodstream. ◦Invasion then requires that the cancer attach to specific receptors and survive in the specific environment.

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Invasion: Local spread

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-Cancer cells secrete protease -Proteases digest the extracellular matrix and basement membranes -Must be able to withstand physiologic stresses of travel in the blood and lymphatic circulation

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Detachment and Invasion

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An attempt to describe how far the cancer has spread within the body

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Staging

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A measure of how abnormal the cells appear.... generally the higher the grade, the more aggressive or fast-growing the cancer.

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Grading

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Confined to its organ of origin

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Stage 1

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Locally invasive

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Stage 2

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Has advanced to regional structures

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Stage 3

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Has spread to distant sites

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Stage 4

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◦Symptom complexes are triggered by a cancer but are not caused by direct local effects of the tumor mass. ◦Are caused by biologic substances released from the tumor (e.g., hormones) or by an immune response triggered by the tumor. ◦Can be life threatening.

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Manifestation of cancer: Paraneoplastic syndromes

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◦Little or no pain is associated with early stages of malignancy. ◦Is associated with the late stage of cancer. ◦Mechanisms Pressure, obstruction, invasion of sensitive structures, stretching, tissue destruction, and inflammation

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Clinical manifestation of cancer: Pain

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◦Is the most frequently reported symptom of cancer and cancer treatment. ◦Suggested causes Sleep disturbance, biochemical changes that are secondary to the disease and its treatment, psychosocial factors, level of activity, nutritional status, and environmental factors

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Manifestation of cancer : Fatique

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◦Is the most severe form of malnutrition. ◦Leads to protein-calorie malnutrition and progressive wasting. ◦Manifestations Anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism

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Manifestations of cancer: Cachexia

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◦Is a decrease of hemoglobin in the blood. ◦Mechanisms Chronic bleeding that results in iron deficiency, severe malnutrition, chemotherapy, radiation, or malignancy in blood-forming organs

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Manifestations of cancer: Anemia

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Chemotherapy drugs and radiation are toxic to bone marrow

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Manifestation of cancer: Leukopenia

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Oral ulcers (stomatitis), malabsorption, diarrhea

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Manifestation of cancer: GI tract

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◦Is a result of the chemotherapeutic effects on hair follicles. ◦Is usually temporary. ◦Hair may initially regrow with a different texture.

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Manifestation of cancer: Hair loss

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◦Eradicates enough tumor cells to enable the body's natural defenses to eradicate the remaining cells. ◦Can be a single-agent or combination

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Chemotherapy

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Causes shrinkage or the disappearance of tumors

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Induction chemotherapy

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Administered after the surgical excision with a goal of eliminating micrometastases

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Adjuvant chemotherapy

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Administered before localized treatment

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Neoadjuvant chemotherapy

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Used to kill cancer cells while minimizing the damage to normal structures

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Radiation Therapy

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-Damages cells by impairing enough ionizing radiation to cause molecular damage to DNA -Causes irreversible damage to normal cells

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Ionizing radiation

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Indicated for relief of symptoms

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Palliative

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Catecholamines are released from where? A: Cerebellum B: Hypothalamus C: Adrenal medulla D: Medulla oblongata

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Adrenal Medulla

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Stress induced tachycardia is a result of which of the following? A: Decreased secretion cortisol B: Increased secretion ADH C: Decreased secretion norepinephrine D: Increased secretion of catecholamines

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Increased secretion of catecholamines

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During a stress response, the helper T1 response is suppressed by which hormone? A: prolactin B: ADH C: cortisol D: growth hormone

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Cortisol

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Mr. Jones is experiencing a state of stress due to his hospitalization. He has contracted an infection that is most likely due to increases in what hormone? A: endorphins B: enkephalins C: cortisol D: epinephrine

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Cortisol

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Which of the following is NOT seen with increased release of epinephrine? A: Increased glucose B: Vasodilation of skeletal muscle C: Bronchodilation D: Miosis (pupil constriction)

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Miosis

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The stage of exhaustion occurs in which circumstances? A: Follows the initial alarm stage B: Occurs only when adaption is unsuccessful C: Occurs due to sympathetic stimulation D: Follows persistent stress

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Occurs only when adaption is unsuccessful

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Decreased levels of cortisol accompany what stage of general adaption syndrome? A: Stage of resistance or adaption B: Alarm stage C: Stage of exhaustion D: Fight or flight mechanism

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Stage of resistance or adaption

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What is the effect of increased secretions of epinephrine, glucagon, and growth hormone? A: hypertension B: hyperglycemia C: bronchodilation D: pupil dilation

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Hyperglycemia

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Your patient is anxious about the bone marrow biopsy scheduled for the afternoon. Which hormone, released from the hypothalamus, initiates the stress response? A: Antidiuretic hormone B: Adrenocorticotropic hormone C: Corticotropin releasing hormone D: Cortisol

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Corticotropin releasing hormone

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Which is true of the parasympathetic response? A: There is increased gastric motility B: There is increased release of norepinephrine C: It is controlled by the sympathetic nervous system D: It is aroused during the stress response

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There is increased gastric motility

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Perceived stress elicits an emotional, anticipatory response in the brain that is controlled by: A: pineal gland B: cerebellum C: limbic system D: anterior pituitary

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Limbic System

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The most significant factor in whether a person will experience a stress reaction is: A: Intelligence level B: Coping ability C: History of stress D: Overall health

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Coping ability

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Diagnostic bloodwork on individuals who perceive themselves to be in a chronic stress state will likely demonstrate: A: decreased hepatocytes B: increased platelets C: decreased cytotoxic T cells D: increased erythrocytes

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decreased cytotoxic T cells

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The alarm stage of the stress response involves hormone production from which target organ? A: Pancreas B: Ovary C: Thyroid D: Adrenal

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Adrenal

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Which of the following findings would you expect from a patient experiencing stress-age syndrome? A: Decreased appetite from increased cortisol B: Deep vein thrombosis from increased coagulation C: Increased adaptive capacity from previous experience D: Decreased blood pressure from decreased release of catecholamines

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Deep vein thrombosis from increased coagulation

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An increase in HR and blood pressure occur in this state. A: Sympathetic response B: Parasympathetic response C: Both A and B D: Neither

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Sympathetic response

question

Which physiological system is activated with the ³fight-or-flight´reaction to danger? A: central nervous system B: sympathetic nervous system C: parasympathetic nervous system D: reproductive system

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Sympathetic nervous system

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Stress-induced stimulation of the sympathetic nervous system triggers endocrine system secretion of: A: epinephrine and aldosterone B: norepinephrine and cortisol C: epinephrine and norepinephrine D: acetylcholine and cortisol

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epinephrine and norepinephrine

question

Stress-induced release of cortisol will stimulate changes in metabolism. Some of the expected short term changes include: A: low serum glucose B: hyperglycemia C: hypoalbuminemia D: low serum lipid levels

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hyperglycemia

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What is the definition of a reactive response? A: mounting a response in anticipation of a stressor B: mounting a response in reaction to a stressor C: mounting a response to a learned stressor D: mounting a response to a physical stressor

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mounting a response in reaction to a stressor

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Malignant tumor cells generally have poor cellular differentiation and they do NOT look like the tissue of origin. This is known as: A: autonomy B: anaplasia C: tropism D: proliferation

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anaplasia

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The neoplasms loss of differentiation: A: autonomy B: anaplasia C: tropism D: proliferation

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anaplasia

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Mr. Frank was told by his physician that his pancreatic cancer is growing due to new blood vessels providing nutrients and oxygen to the tumor. This phenomenon is known as? A: Anaplasia B: Angiogenesis C: Leukopenia D: Thrombocytopenia

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Angiogenesis

question

Which of the following statements is true? A: Benign tumors are never fatal. B: Benign tumors metastasize to the brain and bone marrow. C: Benign tumor cells resemble the neighboring cells. D: Benign tumors are only found in the pituitary, brain, and prostate.

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Benign tumor cells resemble the neighboring cells

question

Brachytherapy is a type of cancer treatment. It works by A: Excision of cancerous tissue B: It is a radiation technique utilized by implantation of seeds C: It is a type of chemotherapy to eradicate cancer cells D: It is a nuclear medical scan used to detect cancer

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It is a radiation technique utilized by implantation of seeds

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The Papanicolaou (Pap) test is used to screen for which cancer? A: Ovarian B: Cervical C: Vaginal D: Uterine

answer

Cervical

question

Which type of chemotherapy is used AFTER surgical excision to eliminate micrometastases? A: Brachytherapy B: Neoadjuvant chemotherapy C: Adjuvant chemotherapy D: Introduction chemotherapy

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Adjuvant chemotherapy

question

If a mutagen occurs in germline cells, which of the following is true? A: It may be passed to future generations B: It cannot be passed to future generations C: It can be passed to future generations only when somatic cells also have mu

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It may be passed to future generations

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Chemotherapy targets rapidly dividing cells. Thus, patients may experience hair loss, GI upset, and immunosuppression. A low WBC count is known as: A: thrombocytopenia B: leukemia C: leukocytosis D: leukopenia

answer

leukopenia

question

Based on accepted nomenclature, which one of the following represents a malignant cancer of glandular cells? A: Epithelioma B: Adenoma C: Adenocarcinoma D: Glioma

answer

Adenocarcinoma

question

Which of the following is characteristic of a malignant rather than a benign tumor? A: Can be fatal B: Undergoes metastasis C: Develops a blood supply D: Cells divide an unlimited number of times

answer

Undergoes metastasis

question

Cancer prognosis has improved most dramatically when treatment plans include which of the following? A: aggressive chemotherapy B: multiple types of treatment C: surgical procedures D: pinpointed radiation

answer

multiple types of treatment

question

Which of the following genes promote cancer and is NOT a normal´gene? A: Tumor suppressor gene B: Mutator gene C: Protooncogene D: Oncogene

answer

Oncogene

question

A tumor secretes a substance that mimics antidiuretic hormone, resulting in water and sodium retention which leads to edema. The altered fluid and electrolyte balance is considered an example of a: A: Paraneoplastic syndrome B: Local spread C: Metastases D: Direct extension

answer

Paraneoplastic syndrome

question

A large tumor in the breast that has not spread to distant sites but has been detected in the internal mammary lymph nodes is: A: T3, N1, M0 B: T3, D0, M1 C: T3, N0, M0 D: B3, S0, M1

answer

T3, N1, M0

question

Which of the following is the primary advantage of targeted cancer therapy? A: It has a shorter course of treatment than other therapies B: It is unlikely to cause nausea and vomiting C: It uses drugs that selectively attack only malignant cancer cells D: It can be administered on an outpatient basis

answer

It uses drugs that selectively attack only malignant cancer cells

question

Burkitt lymphomas designate a chromosome that has a piece of chromosome 8 fused to a piece of chromosome 14. This is an example of which mutation of normal genes to oncogenes? A: Point mutation B: Chromosome translocation C: Gene amplification D: Gene silencing

answer

Chromosome translocation

question

Which of the following tumor markers is beneficial with identification of prostate cancer? A: hCG B: AFP C: CA-125 D: PSA

answer

PSA

question

When in its normal state, which gene negatively regulates proliferation? A: Oncogenes B: Tumor suppressor genes C: Proto-oncogenes D: Telomeres

answer

Tumor suppressor genes

question

Which of the following cancers is associated with Epstein- Barr virus? A: Kaposi sarcoma B: Liver cancer C: Burkitt lymphoma D: Cervical cancer

answer

Burkitt lymphoma

question

Which of the following is NOT a stage of the general adaptation syndrome? A: exhaustion B: alarm C: resistance D: plateau

answer

Plateau

question

Which statement is true regarding the effects of circulating epinephrine in the body? A: the heart rate will slow down B: the heartಬs contractility will decrease C: transient hyperglycemia will result D: blood vessels to skeletal muscle will constrict

answer

transient hyperglycemia will result

question

The system that regulates emotions like fear, anger, excitement and anxiety: A: Limbic system B: Cerebral cortex C: Autonomic nervous system D: Reticular activating system

answer

Limbic system

question

Epinephrine stimulates the: A: parasympathetic nervous system B: sympathetic nervous system C: somatic nervous system D: pyramidal motor system

answer

sympathetic nervous system

question

The NCLEX is in 10 minutes. Your heart rate and respiratory rate are elevated slightly. Your hands are sweaty. You are experiencing a(n): A: anticipatory response B: reactive response C: conditional response D: phobia

answer

anticipatory response

question

What does TNM stand for?

answer

Tumor node metastasis

question

When neoplasms have spread to distant sites by way of the lymph system or blood vessels: A: Carcinoma in situ B: Angiogenesis C: Local spread D: Metastases

answer

Metastases

question

Substances that can be detected in cells or body fluids and can provide clues to the presence, extent, and treatment response of certain neoplasms: A: teratogens B: tumor markers C: telomerase D: tropism

answer

tumor markers

question

Carcinoma in situ is characterized by which changes? A: Cells have broken through the local basement membrane. B: Cells have invaded immediate surrounding tissue. C: Cells remain localized in the glandular or squamous cells D: Cellular and tissue alterations indicate dysplasia.

answer

Cells remain localized in the glandular or squamous cells

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