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DIT Part 3 Flashcards

1
Q

What is the DNA structure of most all of the DNA viruses?

What are the exceptions

A

Most are double stranded and linear

exceptions include:
Parvovirus B19 is ssDNA
Papillomavirus (circular DNA)
Polyomavirus (circular DNA)
Hepadnavirus (circular DNA)
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2
Q

What is the DNA structure of most all of the DNA viruses?

What are the exceptions

A

Most are double stranded and linear

exceptions include:
Parvovirus B19 is ssDNA
Papillomavirus (circular DNA)
Polyomavirus (circular DNA)
Hepadnavirus (circular DNA)
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3
Q

Examples of live atteuated vaccines?

A 
MMR
Sabine polio vaccine (oral)
varicella zoster vaccine
yellow fever vaccine
smallpox vaccine
intranasal influenza vaccine
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4
Q

What live virus vaccines should be considered for HIV positive patients?

A

Rotavirus recommended for all infants with HIV

MMR and varicella for CD4 counts >200

Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts

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5
Q

where do most get their envelope?

exception?

A

usually from plasma membrane but herpes virus gets its envelope from nuclear membrane

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6
Q

which families virus do not have an envelope

A

Naked (non-enveloped)

Adenovirus
Calicivirus
Papilloma
Parvovirus
Picornavirus
Polyomavirus
Reovirus
Hepevirus
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7
Q

signet ring cells

A

gastric adenocarcinoma

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8
Q

nutmeg liver

A

right sided heart failure and budd chiari syndrome

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9
Q

maternal elev of AFP

A

anencephaly, spina bifida, omphalocele, gastroschisis

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10
Q

RBC cast in urine

A

acute glomerulonephritis

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11
Q

Currant-Jelly sputum

A

klebsiella

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12
Q

Dog or cat bite

A

pasteurella multocida

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13
Q

Examples of live atteuated vaccines?

A 
MMR
Sabine polio vaccine (oral)
varicella zoster vaccine
yellow fever vaccine
smallpox vaccine
intranasal influenza vaccine
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14
Q

What live virus vaccines should be considered for HIV positive patients?

A

Rotavirus recommended for all infants with HIV

MMR and varicella for CD4 counts >200

Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts

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15
Q

EBV associated malignancies

A 
Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma
Diffuse large cell lymphoma
Oral hairy leukoplakia
Lymphoproliferative disorders
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16
Q

which families virus do not have an envelope

A

Naked (non-enveloped)

Adenovirus
Calicivirus
Papilloma
Parvovirus
Picornavirus
Polyomavirus
Reovirus
Hepevirus
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17
Q

signet ring cells

A

gastric adenocarcinoma

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18
Q

nutmeg liver

A

right sided heart failure and budd chiari syndrome

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19
Q

benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark

A

Alkaptonuria

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20
Q

RBC cast in urine

A

acute glomerulonephritis

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21
Q

Currant-Jelly sputum

A

klebsiella

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22
Q

Dog or cat bite

A

pasteurella multocida

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23
Q

Retrovirus family members

A

HIV

Human T cell leukemia (HTLV)

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24
Q

MC cause of fatal infantile gastroenteritis

A

rotavirus

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25
HSV-1 causes what
``` Oral herpes labialis (cold sores) Gingivostomatitis Keratoconjunctivitis Temporal lobe encephalitis Genital herpes ```
26
Monospot test
Detects heterophile antibodies Antigens found in horse, sheep, and beef RBCs High sensitivity and specificity (for Epstein Barr Virus)
27
fever, jaundice, black vomit
yellow fever
28
EBV associated malignancies
``` Hodgkin lymphoma Burkitt lymphoma Nasopharyngeal carcinoma Diffuse large cell lymphoma Oral hairy leukoplakia Lymphoproliferative disorders ```
29
where is latency established ``` HSV-1 HSV-2 VZV CMV EBV ```
``` HSV1:trigeminal ganglia HSV2: sacral ganglia Varicella zoster: DRG or trigeminal ganglia CMV: Mononuclear cells EBV: B Cells ```
30
fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash
measles
31
benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark
Alkaptonuria
32
nephritis, hearing loss, cataracts
alport syndrome
33
Retrovirus
HIV | Human T cell leukemia (HTLV)
34
thyroglossal duct cyst presentation
- asymptomatic mass in the midline neck - moves with swallowing - often in pt
35
painful raised lesions on finger pads and fever
osler's nodes (infective endocarditis)
36
Bamboo spine on xray
ankylosing spondylitis
37
fever, jaundice, black vomit
yellow fever
38
diarrhea in children during winter months
rotavirus
39
small irregular blue gray spots on the buccal mucosa surrounded by a base of red
koplik spots in measles
40
fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash
measles
41
Ring enhancing lesions in the brain
Toxoplasmosis | Non-Hodgkin lymphoma (primary CNS lymphoma)
42
toxoplasmosis prophylaxis, when is it given
TMP-smx or dapstone+pentamadine+leucovorin when CD4 is less than 100
43
nephritis, hearing loss, cataracts
alport syndrome
44
What regulates prolactin secretion
TRH increase Dopamine inhibits Prolactin also inhibits by increasing dopamine
45
thyroglossal duct cyst presentation
- asymptomatic mass in the midline neck - moves with swallowing - often in pt
46
Protease inhibitors
``` Saquinavir Ritonavir Indinavir Nelfinavir Amprenavir Fosamprenavir Lopinavir Tipranavir Atazanavir Darunavir ```
47
NRTI
``` Zidovudine Didanosine Lamivudine Abacavir Emtricitabine Tenofovir ```
48
NNRTIs
``` Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine ```
49
Protease inhibitor SE
GI intolerance Hyperlipidemia/hypertriglyceridemia Lipodystrophy
50
Ritonavir SE | protease inhibitor
Inhibits cytochrome P450 Pancreatitis
51
Nephrolithiasis side effect from what drugs
Idinavir Atazanavir (protease inhibitors)
52
Increased bilirubin SE from what drug
Atazanavir | Protease inhibitor
53
Bone marrow suppression from what drugs for HIV
Zidovudine | NRTI
54
Pancreatitis and peripheral neuropathy from what drugs for HIV
Didanosine, Zalcitabine Stavudine (NRTIs)
55
Hepatic steatosis from what drugs for HIV
Didanosine Stavudine (NRTIs)
56
Hypersensitivity from what drugs for HIV
Abacavir (NRTI)
57
Side effect of NNRTIs
Rash
58
SE of efavirenz (NNRTI)
Neuropsychiatric False positive cannabinoid drug test Teratogenic
59
Enfuvurtide Mech SE
Fusion inhibitor by binding gp41, inhibiting viral entry se: injection site reaction increased risk of bacterial pneumoniae
60
Raltegravir Mech SE
Integrase inhibitor SE: nausea rash myopathy
61
Maraviroc mech who can use it?
CCR5 antagonist, inhibiting gp120 conformational change so virus cannot bind host cell effectively. only patients with all R5 virus
62
Cancers assoc with asbestos
mesothelioma | bronchogenic carcinoma
63
owl's eye inclusions
cmv
64
owl's eye nucleus
reed sterberg cells (hodgkin lymphoma)
65
owl's eye protozoan
Giardia lamblia
66
Howell-Jolly bodies
DNA remnants (asplena)
67
Treatment for PCP
TMP-SMX (bactrim) or if sulfa allergy: Pentamidine or unofficially Clindamycin and primaquine
68
Treat rhizopus/mucormycosis
Surgery and amphotericin B
69
most common opportunistic infection in HIV patients
PCP
70
treatment for systemic candidasis
Fluconazole for immunocompetent Amphotericin B or caspofungin for immunocompromised
71
animal urine you should think of
leptospira hantavirus for rodent urine
72
what hormones arise from anterior pituitary
``` FSH LH TSH PROLACTIN GH ACTH MSH or melanotropin ```
73
what effect does adipocyte generated leptin have on the hypothalamus
INHIBITS LATERAL THALAMUS TO STOP HUNGER | STIMULATES VENTROMEDIAL THALAMUS FOR SATIETY
74
treatment for sporothrix schenckii
itraconazole or KOH
75
councilman bodies
apoptotic liver cells (viral hepatitis, yellow fever)
76
Anti-dsDNA antibodies
lupus nephritis
77
Dementia and eosinophilic inclusions in neurons
Lewy body dementia
78
Side effects of orlistat
steatorrhea GI disturbances Decreased absorption of fat soluble vitamins
79
Enzyme converting glucose to sorbitol
Aldose reductase
80
Amphotericin B Mechanism Use SE How to avoid some SE
Binds ergosterol in cell membrane of fungi, forms pores in membrane, loss of electrolytes and small molecules, fungal death Can be used intrathecally for fungal meningitis ``` SE: Fever/chills hypotension nephrotioxicity Arrhythmias Anemia IV phlebitis ``` Avoid nephrotoxicity by increased hydration Avoid toxicity by liposomal amphotericin (but expensive)
81
Nystatin Mechanism Clinical uses
same as amphotericin B. But topical form b/c too toxic for systemic use. Swish and swallow for oral candidiasis (thrush), topical for diaper rash or vaginal candidiasis
82
Azole mechanism
inhibits fungal sterol (ergosterol) synthesis by inhibiting cytochrome P450 that converts lanosterol to ergosterol
83
Clinical use for Itraconazole
First line therapy - Blastomyces - Coccidoides - Paracoccidoides - Histoplasma - Sporothrix
84
Clinical use for Ketoconazole
NOT FIRST LINE - Blastomyces - Coccidoides - Histoplasma - Candida
85
Clinical use for Fluconazole
- Cryptococcal meningitis (can cross BBB) | - Candidal infections
86
Clinical use for Posaconazole
Active against many fungi refractory to other treatments | -Mucor
87
Clinical use for Clotrimazole and microconazole
Used for topical fungal infections
88
Clinical use for Voriconazole
Aspergillus
89
SE of azoles
- Decrease production of cortisol and testosterone - Gynecomastia - Impotence - Drug Drug interactions - Increased hepatic enzymes
90
Flucytosine mechanism Clinical use SE
converted into 5-FU by cytosine deaminase Inhibitng DNA and RNA biosynthesis Use:Used in combo with amphotericin B to treat systemic candidal and cryptococcal infections SE: BM toxicity and GI symptoms
91
caspofungin mechanism Use SE:
inhibits cell wall synthesis by inhibiting synthesis of Beta-1,3-D Glucan leading to cell lysis and death Use: Invasive aspergillosis, candida infection SE: GI upset and flushing
92
Terbinafine (lamisil) mechanism Use SE
Inhibits fungal enzyme squalene epoxidase leading to decreased ergosterol synthesis ``` Use: TOPICAL -Tinea pedis -Tinea corporis ORAL -Onychomycosis -Tinea capiti ``` SE: GI symptoms Hepatotoxicity
93
Griseofulvin mechanism Use
Targets microtubule function inhibiting mitosis Deposits in keratin-containing tissues Use: - Tinea corporis - Tinea capitis - Onychomycosis ``` SE: -Teratogenic -Headache -GI symptoms Confusion -Cytochrome P450 inducer ```
94
Strawberry tongue
Scarlet fever/ Kawasaki disease/ Toxic shocks syndrome
95
Rash on palms and soles
2ndary syphilis Rocky mountain spotted fever Coxsackie A virus
96
Name for thyroid hormone secreting teratoma
struma ovarii
97
medx to shrink prolactinomas
Dopamine agonists - Bromocriptine - Cabergoline
98
Treatment for Entamoeba histolytica
Kill Trophozoites with -Metronidazole or -Tinidazole Kill asymptomatic cyst passers with -Iodoquinol or -Paromomycin
99
Uses for metronidazole
GET GAP on the Metro ``` Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobic bacteria Pylor (H. pylori) ```
100
Treatment for Toxoplasma gondii
Sulfadiazine+ Pyrimethamine+Folinic acid
101
treatment for Trypanosoma brucei
Suramin for blood borne disease Melarsoprol for CNS penetration
102
Treat P. vivax and P. ovale
Primaquine
103
Treat of malaria
Chloroquine | +primaquine if Pvivax or Povale
104
Treatment of Chloroquine resistant malari
Quinine + Doxycycline Atovaquone-proguanil Artemether-Lumefantrine Mefloquine
105
Treatment of Babesiosis
Quinine+clindamycin
106
most common protozoal infection in the US
Trichomonas vaginalis
107
Diarrhea with liver abcess?
Not Giardia but Entamoeba histolytica
108
Names for the stages in the malaria life cycle
Sporozoites injected In liver early schizonts, late schizonts, Merozoites rupture Trophozoites resemble diamond ring, in RBC Early schizont, late schizont in RBC Merozoites released with lysis Gametocytes (falicparum is banana shaped) Taken up by mosquito
109
Smudge cell
CLL
110
Port-wine stain in ophthalmic division of trigeminal ganglion
Sturge-Weber syndrome
111
S3 heart sound
``` Dilated cardiomyopathy Post MI Left ventricular failure Mitral regurgitation Left to right shunt (VSD/ASD/PDA) ```
112
Subepithelial humps on EM
poststreptococcal glomerulonephritis
113
Spike and dome on EM
Membranous glomerulonephritis
114
Adv. rxn from mixing succinylcholine and inhaled anesthetics
Malignant hyperthermia | tx with dantrolene
115
Currant jelly stool
Intussusception
116
Ketoconazole inhibits what enzyme of the adrenal steroid synthesis pathway
Desmolase (Cholesterol-->Pregnenolone)
117
Treatment for Pinworm/Enterobius Vermicularis Ascaris Lumbricoides
Albendazole Mebendazole Pyrantel Pamoate (same for both)
118
Treatment of Trichinella spiralis
Benzimidazoles
119
Treatment of Strongyloides stercoralis
Ivermectin | Mebendazole
120
What are the hookworms tx?
Necator Americanus Ancyclostoma duodenale tx Albendazole Mebendazole Pyrantel Pamoate
121
Tx of taena solium
Praziquantel Albendazole + dexamethasone (neurocysticercosis)
122
Treatment of Echinococus granulosus
injection of scolicidal agent (ethanol, hypertonic saline) followed by surgical removal -Albendazole in conjuction w the procedure
123
Most common helminthic infection in US 2nd most common helminthis infxn in the US
Enterobius vermicularis is most common in the US Ascaris lumbricoides is the 2nd most common helminthic infxn in the US
124
1/4 of world infected with it
Ascaris lumbricoides
125
Snail host swimmers itch
Schistosoma species
126
Most common predisposing factor for bladder cancer in 3rd world countries
Schistosoma haematobium
127
Giant roundworm
Ascaris lumbricoides
128
responsible for lymphatic filariasis
Wuchereria bancrofti
129
Adult pt from Mexico with new onset seizures and brain calcifications
Taena solium (neurocystercosis)
130
hematuria in patient form developing country
Schistosoma haematobium
131
Treat giardia, entamoeba, trichomonas
Metronidazole
132
Treat most all flukes and tapeworms
Praziquantel
133
Treat hookworm, pinworm, roundworm
Benzimidazoles (Mebendazole) | Pyrantel Pamoate
134
Treat chagas disease
Benznidazole | Nifurtimox
135
Best guess for roundworms
Benzimidazoles
136
Treat Leishmaniasis
Cutaneous-Sodium stibogluconate | Visceral-Liposomal amphotericin B
137
Contracted by eating undercooked fish and causes an inflammation of the biliary tract
Clonorchis
138
Which 2 agents are usually used in the treatment of peduculosis capitis and pediculosis pubis
Pyrethrin | Permethrin
139
Why is lindane not the preferred agent in the treatment of lice
Neurotoxicity and Resistance
140
Incidences of cancer in men mortality in men
INCIDENCE Prostate Lung Colon ``` MORTALITY Lung Prostate Colon Pancreas ```
141
Incidences of cancer in women mortality in women
``` INCIDENCE Breast Lung Colon Uterus ``` ``` MORTALITY Lung Breast Colon Pancreas ```
142
DPC mutation also known as | what does DPC mean?
SMAD4 | Deleted in pancreatic cancer
143
DCC mutation means
Deleted in colon cancer
144
K-RAS H-RAS N-RAS
K-RAS: Colon, lung, pancreatic tumors H-RAS: Bladder and kidney tumors (Hematuria) N-RAS: Melanomas and hematologic malignancies
145
Follicular thyroid carcinoma is associated with what mutations?
RAS mutations
146
BCR-ABL
t9;22 philadelpha chromosome CML Tyrosine kinase constitutively on
147
ret mechanism associations
tyrosine kinase always on MEN2A and 2B -Pheochromocytoma -Medullary thyroid cancer Papillary carcinoma of the thyroid
148
HER2/new (c-erbB2) associations tx
Breast cancer Ovarian cancer Gastric cancer Tx with trastuzumab
149
L-myc association
lung tumors
150
N-myc association
Neuroblastoma (sounds like a brain tumor but really is one of the adrenal medulla)
151
Most common causes of hypocalcemia
``` vitamin d deficiency chronic renal disease parathyroidectomy autoimmune destruction of parathyroid glands digeorge syndrome pseudohypoparathyroidism acute pancreatitis ```
152
cancer assoc with hashimoto thyroiditis
Marginal cell lymphoma
153
What is iron bound to in human cells
myoglobin and ferritin
154
What is iron bound to in blood
hemoglobin and transferrin
155
arsenic risks for cancer
Squamous cell skin cancer Angiosarcoma of the liver Lung cancer
156
vinyl chloride risk for cancer
angiosarcoma
157
Naphthalene (moth balls) risk for cancer
Transitional cell bladder cancer
158
smoking increases risk for same cancer type that naphthalene does
Transitional cell bladder cancer
159
Asbestos increases risk for
``` Bronchogenic carcinoma (MOST COMMON!!_ Malignant mesothelioma ```
160
In asbestosis what is the most common cancer
BRONCHOGENIC CARCINOMA not malignant mesothelioma
161
Most common cancers assoc with ionizing radiation
Myeloid leukemias - AML - CML Thyroid cancer (all types, papillary is just the most common in general)
162
What cancers are assoc with UV radiation exposure? Which type of UV is most problematic?
Squamous cell carcinoma Basal cell carcinoma Melanoma UVC is the shortest wavelength and filtered out by ozone layer UVB causes pyrimidine dimers in DNA. MOST PROBLEMATIC UVA is the longest wave length, inducing generation of free radicals. contributes only slightly to skin cancer risk.
163
Actinic keratosis is due to what? Precursor to what? Tx with what?
Due to sun exposure Precursors to squamous cell skin cancer Tx: 5-FU
164
Dysplastic nevi progress to
Melanoma
165
Adenomatous colon polyps progress to
colon cancer
166
Barretts esophagus progresses to
Esophageal adenocarcinoma
167
Tuberous sclerosis presentation neoplasms?
``` Facial angiofibromas -Adenoma sebaceum Seziures Intellectual disability Ash Leaf Spots ``` Neoplasms include: - Cardiac rhabdomyoma - Renal angiomyolipoma - Astrocytoma
168
HBV and HCV increase risk for
Hepatocellular carcinoma (HBV can without cirrhosis)
169
HCV increases risk for
Papillary thyroid carcinoma
170
HTLV increases risk for
T-cell lymphoma
171
EBV increases risk for
Hodgkin lymphoma Burkitt lymphoma Nasopharyngeal carcinoma
172
Schistosoma haematobium increases risk for
SCC of bladder (not transitional as in smoking)
173
Clonorchis sinensis increases risk for
Biliary cancer
174
Down syndrome associated with what neoplasm
ALL | AML
175
Ataxia-telangiectasia assoc with what neoplasm
Leukemia | Lymphoma
176
Paget disease of bone assoc with what neoplasm
Osteosarcoma
177
Nitrosamines assoc with what neoplasm
Esophageal cancer Gastric cancer Colon cancer
178
HPV cancer risk
``` Vulvar cancer Vaginal cancer Cervical cancer Anal cancer Penile cancer (16 and 18) ```
179
Most common side effect is hypoglycemia in this oral type 2 diabetes drug
Sulfonylureas
180
Primarily effects postprandial hyperglycemia (oral diabetes type II drug)
alpha-glucosidases
181
MOA: closes K+ channels on beta cells
sulfonylureas
182
MOA: inhibits alpha-glucosidase at intestinal brush border
alpha-glucosidase inhibitors
183
MOA: agonist at PPARgamma receptor
TZD
184
features of anaplasia
High nucleus:cytoplasm ratio Prominent nucleoli Clumping of nuclear chromatin Many mitotic figures
185
Malignant tumor from epithelium Stain?
adenocarcinoma papillary carcinoma stain with cytokeratin
186
Epithelial tumors spread by: Mesenchymal tumors spread:
Lymphatics for epithelial tumors Hematogenously for mesenchymal tumors
187
CEA
Colon cancer | Pancreatic cancer
188
CA 19-9
Pancreatic cancer
189
alpha-fetoprotein
Hepatocellular carcinoma and testicular tumors
190
CA-125
Ovarian cancer (but also elevated with anything irritating peritoneum...)
191
S-100
Melanoma | Schwannoma
192
Alkaline phosphatase
Metastasis to bone Biliary disease Paget disease of bone
193
Psammoma bodies
Papillary thyroid cancer Serous papillary cystadenocarcinoma of the ovary Meningioma Malignant mesothelioma
194
what hormones use steroid receptors
``` Estrogens Progesterone Testosterone Aldosterone Vitamin D Thyroid hormones Glucocorticoids ```
195
What hormones use tyrosine kinase receptors
``` insulin insulin like growth factor fibroblast growth factor platelet derived growth factor prolactin growth hormone ```
196
RLS in purine synthesis
glutamine PRPP amidotransferase
197
RLS in pyrimidine synthesis
CPS2
198
What are two cofactors involved in the ability to induce angiogenesis in tumors
Basic fibroblast growth factor (bFGF) Vascular endothelial growth factor (VEGF)
199
Most common liver metastatic cancers
Cancer Sometimes Penetrates Benign Liver ``` Colon Stomach Pancreas Breast Lung ```
200
most common brain metastatic cancers
Lots of Bad Stuff Kills Glia ``` Lung Breast Skin (melanoma) Kidney (renal cell carcinoma) GI tract (colon cancer) ```
201
most common bone metastatic cancers
Permanently Relocated Tumors Like Bones ``` Prostate Renal cell carcinoma Testes/Thyroid Lung Breast ```
202
What is Cachexia and why does it happen?
Profound wt loss | Loss of fat and lean muscle, b/c tumor produces cytokines that raise the BMR
203
Paraneoplastic effects of tumors
Small cell lung cancer (ACTH-->Cushing syndrome) (ADH-->SIADH) (Lambert-Eaton syndrome) Squamous cell lung cancer (Humoral hypercalcemia of malignancy: PTHrp)
204
Lambert-Eaton syndrome is associated with what? Mechanism? Clinical presentation?
Assoc with small cell lung cancer Antibodies against presynaptic ca2+ channels at the NMJ Weakness improves with use (c/f with myasthenia gravis)
205
What can release PTHrp
Squamous cell lung cancer Squamous cell cancers of head and neck Breast cancer Renal cell carcinoma
206
How does multiple myeloma cause hypercalcemia?
Secretes local osteolytic factors causing lytic bone lesions and hypercalcemia
207
EPO secreting conditions?
Potentially Really High Hematocrit Pheochromocytoma Renal cell carcinoma Hepatocellular carcinoma Hemangioblastoma also Uterine fibroids (leiomyoma)
208
most common cause of hypercalcemia
Primary hyperparathyroidism
209
What malignancies cause hypercalcemi
``` Squamous cell lung cancer squamous of head and neck breast cancer renal cell carcinoma multiple myeloma hodgkin lymphoma lytic bone metastases ```
210
RLS for urea cycle
CPS I (carbamoyl phosphate synthetase I)
211
RLS fo fatty acid synth
Acetyl-CoA carboxylase
212
RLS for beta-oxidation of fatty acids
CAT 1 (Carnitine acyltransferase I)
213
RLS for bile acid synthesis
7-alpha hydroxylase
214
RLS for heme synthesis
Amino levulinate synthase
215
5 most important lifestyle factors that impact cancer risk
``` Smoking Obesity Poor diet Inactivity Sun exposure ```
216
Smoking increases risk for what types of cancers
``` Lung cancer Laryngeal cancer Oral cancer Esophageal cancer Pancreatic cancer Renal Cell carcinoma Bladder cancer ```
217
What cancers are increased with obesity in both women and men In women In men
``` Men and women: Esophageal adenocarcinoma Renal cell carcinoma Women: Endometrial cancer Gallbladder cancer Men: Thyroid cancer Colon cancer ```
218
Screening recommendations for the following cancers according to USPSTF ``` Breast cancer Cervical cancer Prostate cancer Colon cancer Ovarian cancer Smoking ```
Breast: mammogram every 2 years 50-75 Cervical: pap smear every 3 years, 21-65 Prostate: no recommendation 75 do not Colon: Colonoscopy every 10 years, 50-75. but if family hx then 40 or 10 yrs before that of dx for family member Ovarian: no recommendation Smoking: annual chest CT for age 55-80 with 30 pack year smoking history or current smoker or quit within last 15 years
219
What immune cells are involved in killing cancer cells
CD8+ Cytotoxic T lymphocytes MOST IMPORTANT! NK cells Macrophages
220
treatment for homocystinuria?
Decrease methionine Increase cysteine Increase B6 and B12 Add folate
221
what irrev enzymes are involved in gluconeogenesis
Pyruvate carboxylase PEP carboxykinase Fructose 1,6 bisphosphatase Glucose 6 phosphatase
222
Rescue agent for 5-FU toxicity
Uridine
223
SE of Methotrexate SE of 5-FU
Fibrosis of lung for methotrexate Photosensitivity for 5-FU
224
6-MP can become toxic when given with
allopurinol
225
How to get around the CI of allopurinol with 6mp?
give 6-Thioguanine, b/c not metabolized by xanthine oxidase
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Cytarabine is what what does it do
Pyrimidine analog | Inhibiting DNA polymerase
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Cyclophosphamide mechanism Use SE Any special characteristics?
Alkylates guanine residues on DNA, crosslinking it ``` Use: Cancer Immunosuppresion for -Lupus nephritis -Polyarteritis nodosa ``` SE: -Hemorrhagic cystitis because metabolite acrolein is toxic Give mesna to prevent -Increases risk of TCC of bladder REQUIRES BIOACTIVATION IN LIVER
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Ifosfamide
same as cyclophosphamide except used for testicular cancer and not as immunosuppressant
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Nitrosureas use SE
put nitro in your MUSTANG (-MUSTINE) alkylating agent that crosses BBB, so use for brain tumors SE: CNS toxicity
230
Busulfan mech Use SE
Cross links DNA Use: CML, also ablate BM before transplant SE: - severe myelosuppression - pulmonary fibrosis - hyperpigmentation
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Doxorubicin and Daunorubicin Mech Use SE
Anthracyclines that generate free radicals, intercalate DNA, Use: Solid tumors Leukemias Lymphomas SE: -Cardiotoxic (dilated cardiomyopathy, b/c heart is susceptible to free radical damage due to deficiency in superoxide dismutase) PREVENT THIS WITH DEXRAZOXANE
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Dexrazoxane
Prevent cardiotoxicity with Daunorubicin and doxorubicin
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Dactinomycin mechanism Use
Intercalates DNA Use: Wilms tumor Ewing Sarcoma Rhabdomyosarcoma
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Bleomycin Use: Mech SE
Use: with etoposide and cisplatin, treats testicular cancer Mechanism: Generates free radicals SE: Pulmonary fibrosis
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What oncology drugs cause pulmonary fibrosis and what are their mechanisms?
Bleomycin (generates free radicals) Busulfan (cross links DNA) Methotrexate (inhibits dihydrofolate reductase))
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Uses for methotrexate
Leukemias Lymphomas Choriocarcinomas Sarcomas ``` Abortion Ectopic pregnancy RA Psoriasis IBD ```
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6-MP uses
prevent organ rejection RA Leukemia IBD
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5-FU uses
Colon cancer Pancreatic cancer Basal cell skin cancer Actinic keratosis
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Azathioprine use
SLE
240
folic acid analog
methotrexate
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pyrimidine analog
5-FU
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3 most common types of thyroid cancer
Papillary carcinoma Follicular carcinoma Medullary carcinoma
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what cancers are assoc with RET gene mutation
MEN 2A and 2B Medullary thyroid carcinoma Papillary thyroid carcinoma
244
Cisplatin, Carboplatin, Oxaliplatin Uses SE
Mech: Cross link DNA Uses: - Testicular cancer - Ovarian cancer - Bladder cancer SE: -Nephrotoxicity (prevent with amifostine and chloride diuresis) -Acoustic nerve damage
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What drugs are nephrotoxic/ototoxic
Vancomycin Aminoglycosides Loop diuretics Cisplatin and carboplatin
246
Etoposide, Teniposide Mech: Use:
Mech: Inhibit Topoisomerase 2--> DNA degradation Use: - Small cell lung cancer - Prostate cancer - Testicular cancer
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regimen for treating testicular cancer
Eradicate Ball Cancer Etoposide+Bleomycin+Cisplatin or Etoposide+Ifosfamide+Cisplatin
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Irinotecan, Topotecan Mech Use
Mech: Inhibit topoisomerase I Use Irinotecan: Metastatic colon cancer Topotecan: Small cell lung cancer/Ovarian cancer/Cervical cancer
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Vincristine mech uses and what are drugs that also treat these same conditions SE
mech: blocks polymerization of microtubules ``` use: -Hodgkin lymphoma -Wilms tumor -Ewing sarcoma (Dactinomycin can also work for these childhood cancers) ``` -Choriocarcinoma (methotrexate works also) se: - Neurotoxicity - Peripheral neuritis
250
Vinblastine Mech se:
Mech: blocks microtubule polymerization SE: Myelosuppression (vinblastine BLASTS BONE MARROW)
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Paclitaxel mech use SE
mech: stabilizes microtubules Use: -Ovarian and breast carcinomas SE: myelosuppression and hypersensitivity
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Microtubule drugs
``` Vincristine Vinblastine Paclitaxel Mebendazole Albendazole Griseofulvin Colchicine ```
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Hydroxyurea Mech use
Mech: Inhibits ribonucleotide reductase, inhibiting DNA synthesis) use: - Melanoma - CML - increases HbF in sickle cell patients
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Prednisone mech Use SE
Mech: triggers apoptosis use: lymphoid tumors -CLL -hodgkin lymphoma ``` SE: BAM CUSHINGOID -Buffalo hump -Amenorrhea -Moon facies -Crazy (psychosis/agitation) -Ulcers -Skin changes -HTN -Infection -Necrosis of femoral head -Glaucoma and cataracts -Osteoporosis -Immunosuppression -Diabetes ```
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glucocorticoid SE
BAM CUSHINGOID - Buffalo hump - Amenorrhea - Moon facies - Crazy (psychosis/agitation) - Ulcers - Skin changes - HTN - Infection - Necrosis of femoral head - Glaucoma and cataracts - Osteoporosis - Immunosuppression - Diabetes
256
Tamoxifen mech Use SE
``` Tamoxifen ER antagonist -Breast ER agonist -Bone ER partial agonist -Endometrium ``` Use: - ER + Breast cancer - Prevention in pt with BRCA mutation - Endometrial cancer (b/c partial agonist) SE: -Increase risk of endometrial carcinoma (b/c partial agonist)
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SERMs
Tamoxifen, Raloxifene
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Raloxifene mech USe
``` ER antagonist -Breast -Endometrium ER agonist -Bone ``` Use: Treat osteoporosis
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Trastuzumab mech Use SE
HER-2 monoclonal antibody Use: Treat breast cancer that overexpress HER-2 SE: Cardiotoxic (HERts THE HEART
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Rituximab mech Use
Antibody against CD20 Uses: - Lymphomas and leukemias - RA - Vasculitis - Pemphigus vulgaris - ITP
261
Imatinib mech Use
Enzyme inhibitor targets mutant BCR-ABL tyrosine kinase produced by philadelphia chromosome t(9;22) Use: - CML - ALL - AML

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