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302 > Case of unfair diagnosis > Flashcards

Case of unfair diagnosis Flashcards

1
Q

activation of transmembrane tyrosine kinase receptors?

A

growth factor binds to receptor causing dimerisation and autophosphorylation causing downstream activation of signalling cascade

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2
Q

mutations causing dysregulation of tyrosine kinase receptor?

A

ligand independent firing, autocrine growth factors

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3
Q

which tyrosine kinase growth factors are altered in human tumours?

A

erb b2, her2, neu, egfr

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4
Q

common mechanism of resistance to TKIs?

A

T790 mutation

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5
Q

first line for tyrosine kinase mutations?

A

osimertinib

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6
Q

lung cancers can often present with?

A

recurrent chest infections
pleural effusion

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7
Q

how to geta biopsy for lung cancer?

A

EBUS and tbna

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8
Q

appearance of adenocarcinoma?

A

located peripherally columnar glandular cells

BerEP4+, MOC31+, TTF-1 markers
associated with. EGFR, ALK, PDL1 ROS1 changes

lymphovascular invasion- which is why they have hilar lymph nodes involved

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9
Q

squamous cell carcinoma signs?

A

centrally, bronchial trees, squamous cell keratinisation, desmosomes
p40+. p63+, CK5/6+

PDL1 mutation

cavitate and sometime haemorrhage

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10
Q

small cell (neuroendocrine cells)

A

very blue cells, small cells, smudged nuclei

CD56, chromogranin positive
TTF1 nuclear - usually present in lungs

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11
Q

mesothelioma?

A

WT-1, calretinin positive
TTF-1, MOC31, napsin, p40 negative
aggressive, encasement of lung

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12
Q

Metastasis to the lungs?

A

colon- CK20, CDX-2, SATB2 positive
Breast- ER/PR, GATA3 positive
Prostate- PSA positive
Melanoma- s-100, melan A, SOX-10

usually bilateral multiple, appearance like origin, sharply outlined, rapidly growing and necrotic
lymphangitic carcinomatosis

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13
Q

pseudogenes?

A

shares a large amount of DNA with another gene

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14
Q

14 hallmarks of cancer?

A

sustain proliferative signalling
deregulating cellular metabolism
resisting cell death
genome instability and mutation
inducing or accessing vasculature
activating invasion and metastasis
tumour promoting inflammation
enabling replicative immortality
avoiding immune destruction
evading growth suppressors
senescent cells
polymorphic microbiomes
nonmutational epigenetic reprogramming
unlocking phenotypic plasticity

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15
Q

MEN2 is caused by which gene mutation?

A

RET
medullary thyroid cancer -90%
phaechromocytoma-50
parathyroid adenoma- 20-30%
familial medullary thyroid cancer- 100% risk

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16
Q

MEN2B?

A

same risk for medullary thyroid/phaechromocytoma
but other abnormalities 40-40
mucosal neuromas
marfanoid
toxic megacolon
>95%= always de novo

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17
Q

most frequent somatic mutation?

A

LOF- TP53 85% of tumours

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17
Q

most frequent somatic mutation?

A

LOF- TP53 85% of tumours somatic

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18
Q

BRCA1 is?

A

more common as germline

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19
Q

BRCA1?

A

BREAST CANCER ER NEGATIVE 80% OF THE TIME

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20
Q

Li Fraumeni syndrome?

A

inherited alteration in TP53

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21
Q

role of TP53?

A

DMA damage repair
induction of apoptosis
cellular metabolism
transcription
induction of G1 arrest

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22
Q

treatment for angiogenesis?

A

inhibitors of VEGF signalling

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23
Q

treatment for invasion/metastasis?

A

inhibitors of HGF/c-met

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24
Q

treatment for promoting inflammtion?

A

selective anti-inflammatory drugs

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25
Q

target for replicative immortality?

A

telomerase inhibitors

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26
Q

target for avoiding immune destruction

A

immune activating anti-CTLA4 mAB

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27
Q

target for evading growth suppressors?

A

cyclin-dependent kinase inhibitors

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28
Q

target for proliferative signaling?

A

EGFR inhibitors

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29
Q

target for deregulating cellular epigenetics?

A

aerobic glycolysis inhibitors

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30
Q

target for resisting cell death?

A

proapototic BH3 mimetics

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31
Q

target for genome instability?

A

PARP inhibitors

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32
Q

SSRI discontinuation syndrome?

A

agitation, anxiety, dizziness balance problems, nausea diarrhoea, flu like symptoms

commonest with paroxetine- either reassure/ monitor, reintroduce drug and taper or consider alternative

33
Q

dotheipin requires?

A

more ecg monitoring as it is cardiotoxic

34
Q

anticholinergic effects

A

constipation
urinary retention
cognitive effects
dry mouth

35
Q

akathisia can be treated with?

A

propanolol

36
Q

EXAMPLES OF SSRIS?

A

fluoxetine, paroxetine, setraline, citalopram, escitalopram

37
Q

indications for SSRIs?

A

depression, anxiety disorders, panic disorder, obsessive compulsive disorder, PTSD

38
Q

half life of ssris?

A

paroxetine-20 hours
fluoxetine-2/4days

39
Q

fluoxetine side effect

A

agitation

40
Q

mirtazapine is?

A

noradrenergic and specific serotonergic antidepressant
alpha 2 receptor antagonist
helps with insomnia
make neurons activated

41
Q

downside of mirtazapine?

A

more hungry

42
Q

mirtazapine helps by?

A

antidepressant, anxiolytic, sleep restoring, no sexual dysfunction no gi problems

43
Q

adverse effects of tricyclics?

A

dry mouth, constipation, urinary retention, cognitive effects, psychotropic effects agitation and nightmares, sexual dysfunction, akathisia, muscle twitches, cardiac arrhythmias

44
Q

overdose of tricyclics?

A

confusion, tachycardia/arrhythmias, hypotension, mydriasis seizures, coma and cardiorespiratory arrest

45
Q

what is particularly effective for mixed depression and anxiety?

A

venlafaxine

46
Q

side effects on SNRI venlafaxine?

A

headache, nausea, hypertension, discontinuation syndrome

duloxetine - no concerns of hypertension

47
Q

MAOIs interaction?

A

food-cheese, red wine, yeast production liver, broad bean pods,

tyramine, which is not broken down by MAO. causes hypertensive crisis

moclebamide lower risk

Seretonin syndrome- autonomic hyperactivity (hypertension tachycardia), muscle rigidity, fever, confused.

48
Q

how does NASSA work mirtazaoine?

A

release of seretonin and noradrenaline via alpha 2 receptors on presynaptic neurone

49
Q

SNRI examples?

A

venlafaxine, duloxetine

50
Q

MAOI examples?

A

moclebamide, phenelzine

51
Q

What does dopamine control?

A

executive function, lactation, motivation, motor control, reward, nausea

52
Q

dopamine pathways?

A

mesocortical- prefrontal cortex motivation negative symptoms
mesolimbic-nucleus accumbens
positive symptoms
nigrostriatal- caudate nucleus/putamen
parkinsonian symptoms
tuberoinfundibular-pituitary gland- hyperprolactinaemia

53
Q

typical antipsychotics are?

A

d2 receptor antagonist so help with positive symptoms

54
Q

typical antipsychotic side effects?

A

too little dopamine in tuberofundibular- hyperprolactinaemia
amenorrhoea, sexual function, galactorrhoea and osteoporosis
nigrostriatal- extrapyramidal effects

55
Q

seretonin hypothesis?

A

hallucinogenic drugs LSD structurally similar to serotonin

56
Q

glutamate hypothesis?

A

Phencyclidine- glutamate agonist which produces schizophrenia like symptoms, abnormal glutamate activity in schizophrenia

57
Q

typical antipsychotics neurological side effects?

A

extrapyramidal symptoms- parkinsonism, akathisia, dystonia

tardive dyskinesia

58
Q

typical antipsychotic examples?

A

haloperidol, chlorpromazine

59
Q

atypical antipsychotics details?

A

not specific for d2 receptors, can act on seretonin
risperidone, olanzapine, quetiapine, aripiprazole

60
Q

what are the problems with atypicals?

A

weight gain and metabolic syndrome particularly olanzapine

61
Q

muscarinic side effects?

A

dry mouth, constipation, urinary retenion, blurred vision, dry eyes, tachycardia, dyspepsia, dizziness, impaired cognition/memory

62
Q

side effects of adrenergic antagonist alpha blockers?

A

orthostatic hypotension, palpitation, sexual dysfunction and vertigo

63
Q

why is clozapine reserved for treatment resistant cases?

A

haematological side effects
low EPS,
but can cause hypotension, hypersalivation and weight gain and can cause constipation

63
Q

why is clozapine reserved for treatment resistant cases?

A

haematological side effects
low EPS,
but can cause hypotension, hypersalivation and weight gain and can cause constipation

64
Q

Clozapine binds with high affinity to?

A

M1, 5HT21, H1, a1 and a2

65
Q

rapid tranquilisation when patient aggressive?

A

antipsychotics- haloperidol, olanzapine
benzos- lorazepam or midazolam

66
Q

mood stabiliser?

A

lithium
valproate
lamotrigine
carbamazepine

67
Q

lithium method of action?

A

second messenger- inhibition of inositol,
regulation of gene expression, protein kinase c

68
Q

lithium side effects?

A

polydipsia, polyuria
nauseau
fine tremor
loose stools

renal impairment
hypothyroidism
weight gain
acne

69
Q

lithium toxicity?

A

0.4-1 mmol/l
coarse tremor, n/v, ataxia and cerebellar signs and confusion

70
Q

precipitants of lithium toxicity?

A

dehydration
Thiazides, NSAIDs
deteriotating renal function

71
Q

how does valproate work?

A

inhibition of ca/na channels, which enhances inhibitory GABA and reduces excitatory glutamate

72
Q

when is valproate effective?

A

acute mania

73
Q

valproate side effects?

A

vomiting
alopecia
liver dysfunction
pancreatitis
retention of fat
oedema
appetite increase
tremor
enzyme inducer

74
Q

carbamazepine side effects?

A

CYP4%0 inducer
Atazia, diplopia
Bone marrow suppressor
Steven Johnson

Aplastic anaemia
Na- hyponatraemia
Teratogenic

75
Q

benzos used for?

A

anxiolytics, hypnotics, minor tranquiliser, alcohol withdrawal, anticonvuslant, muscle relaxant

76
Q

benzos bind to?

A

BZP at GABA A receptor

77
Q

abrupt withdrawal of benzos can cause?

A

delirium, convulsions, nausea, dizziness, hyperacusis, tinnitus, depersonalisation

78
Q

additional aids to maintain abstinence?

A

acamprosate- reduce cravings
naltrexone
disulfiram- induces severe reaction if consumed
risk of fulminating hepatitis

79
Q

pregabalin is used for?

A

anxiolytics, seizures and neuropathic pain, binds to voltage gated calcium channels

80
Q

buspirone is used for?

A

anxiolytic GAD, partial agonist 5HT1a receptors

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