Carcinogenesis and tobacco

Question 1

Who gets lung cancer more, women or men?

Answer 1

women

note: lung cancer has the highest estimated cancer deaths

Question 2

characteristics of solitary pulmonary nodule

Answer 2

● Lesion

Question 3

ERB-1 or EGFR mutation treated with what?

Answer 3

erlotinib
gefitinib
cetuximab

• mut is associated with 50-80% of NSCLC

Question 4

Her2/ERB-2 mutation treated with?

Answer 4

trastuzumab (herceptin)

Question 5

VEGF mut treated with?

Answer 5

bevacizumab (avastin)

Question 6

Most lung cancer presents in what stage?

Answer 6

stage 3 - too late to operate on

Question 7

hallmark of obstructive apnea

Answer 7

pharyngeal occlusion during sleep

• lipid accumulation in soft tissue of the pharynx –> upper airway narrowing
  (in day time, pharyngeal dilator muscles maintain patency)

Question 8

Most common therapy for sleep apnea

Answer 8

aside from weight loss its
continuous positive airway pressure (CPAP), mask worn during sleep
- delivers positive pressure into nasal and oral pharynx, pushing tongue forward and dilating collapsing lateral and posterior pharyngeal walls.

Question 9

transudative:
protein rich or poor?
Δ in what?
LDH, Prot?
Caused by?

Answer 9

non-protein rich
non-inflammatory

Δ in hydrostatic forces

LDH

Question 10

Exudative:
protein rich or poor?
Δ in what?
LDH, Prot?
Caused by?

Answer 10

protein rich - inflammatory process

Δ in permeability forces

LDH > 0.6
Prot > 5

Caused by:
neoplasm,
infxn
PE
GI, Drugs
Autoimmune

Question 11

Ave airway size in kids vs adults?

- where is it narrowest?

Answer 11

child: 4mm diameter
adults: 8mm in diam

big deal with narrowing/edema
R= 1/r4

cricoid is the narrowest part of airway in kids (adults is glottis)

Question 12

larynx diff in kids vs adults?

Answer 12

kids:
 larynx is higher + more anterior 
epiglottis is floppy,
 intercostals weaker,
diaphragm flatter

Question 13

laryngomalacia

Answer 13

most common cause of chronic stridor

big floppy epiglottis

outgrown by 1-2 yrs

Question 14

Most common form of acute airway obstruction in children?

What is its most common cause?

Answer 14

Croup
- parainfluenza
(its a cold in adults)

Question 15

90% of People with generalized anxiety disorder (GAD) will answer yes to what ?

Answer 15

during the past 4 weeks, have you been bothered by feeling worried, tense, or anxious most of the time?

Question 16

Panic disorder (PD) has suicide rate comparable to what? 
- what % of the population experiences panic attacks?

Answer 16

Major depression
20-40% of people with PD have made an attempt

20% of pop exp. panic attacks (not disorder) –> anticipatory anxiety

Question 17

hallmark of panic disorder?

Answer 17

unexpected panic attacks - spontaneous unpredictable

Question 18

Who experiences unexpected panic attacks?

Answer 18

pts w/ phobia, post-traumatic stress disorder

Question 19

what biologic parameters can cause panic disorder?

Answer 19

1. excess NE + dysregulation of noradrenergic system (ie hypersensitivity to a-2-antagonist)
2. caffeine, adenosine antagonist
3. dysregulation of GABA

Question 20

pharmacotherapy for panic disorders

Answer 20

1. Controlled breathing therapy (CBT)
2. SSRI- SNRI - first line
3. Benzodiazepines (dependence =( )
4. GABAergic meds

Question 21

tobacco accounts for what % of all cancers?

Answer 21

25-30%

170,000 cancer deaths per year

Question 22

Which types of cancers is tobacco an imp risk factor for?

Answer 22

Lung (~85%)
Oral cavity, larynx, pharynx
Esophagus
Bladder

Question 23

Cessation during which period of pregnancy can reduce risk of low birth weight to that of never smokers?

Answer 23

w/in 3-4 months

Question 24

How can we help pts quit smoking?

Answer 24

MPOWER
Monitor
protect
offer
warn
enforce
raise

AHQR guidelines: 5 A's
Ask
Advise
Assess
Assist
Arrange

Question 25

Factors that increases risk of teens to start smoking

Answer 25

exposure to second hand smoke or smoker in household

usually pts, would not wish addiction on kids

Question 26

FDA approved drug to help reduce cravings/symptoms of withdrawl in tobacco use

• MOA
• contraindic

Answer 26

FDA approved Bupropion (zyban or welbutrin SR)

• inhibits reuptake of dopamine/norepi, reduce cravings/symptoms
• contraindication: seizure disorder, mood disorder

*this is actually an antidepressant that can help quit smoking

Question 27

First designer drug for tobacco dependence

Answer 27

Vernicline (chantix)

• partial agonist at nicotine receptor –> release dopamine (not inhibit the reuptake like bupropion)
• blocks binding of exogenous nicotine (decreases smoking reward)