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Step 1 Journal RC > DIT Part 3 > Flashcards

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
Q

HSV-1 causes what

A 
Oral herpes labialis (cold sores)
Gingivostomatitis
Keratoconjunctivitis
Temporal lobe encephalitis
Genital herpes
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26
Q

Monospot test

A

Detects heterophile antibodies
Antigens found in horse, sheep, and beef RBCs
High sensitivity and specificity

(for Epstein Barr Virus)

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27
Q

fever, jaundice, black vomit

A

yellow fever

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28
Q

EBV associated malignancies

A 
Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma
Diffuse large cell lymphoma
Oral hairy leukoplakia
Lymphoproliferative disorders
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29
Q

where is latency established

HSV-1
HSV-2
VZV
CMV
EBV
A 
HSV1:trigeminal ganglia
HSV2: sacral ganglia
Varicella zoster: DRG or trigeminal ganglia
CMV: Mononuclear cells
EBV: B Cells
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30
Q

fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash

A

measles

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31
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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32
Q

nephritis, hearing loss, cataracts

A

alport syndrome

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33
Q

Retrovirus

A

HIV

Human T cell leukemia (HTLV)

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34
Q

thyroglossal duct cyst presentation

A
  • asymptomatic mass in the midline neck
  • moves with swallowing
  • often in pt
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35
Q

painful raised lesions on finger pads and fever

A

osler’s nodes (infective endocarditis)

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36
Q

Bamboo spine on xray

A

ankylosing spondylitis

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37
Q

fever, jaundice, black vomit

A

yellow fever

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38
Q

diarrhea in children during winter months

A

rotavirus

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39
Q

small irregular blue gray spots on the buccal mucosa surrounded by a base of red

A

koplik spots in measles

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40
Q

fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash

A

measles

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41
Q

Ring enhancing lesions in the brain

A

Toxoplasmosis

Non-Hodgkin lymphoma (primary CNS lymphoma)

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42
Q

toxoplasmosis prophylaxis,

when is it given

A

TMP-smx
or
dapstone+pentamadine+leucovorin

when CD4 is less than 100

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43
Q

nephritis, hearing loss, cataracts

A

alport syndrome

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44
Q

What regulates prolactin secretion

A

TRH increase

Dopamine inhibits

Prolactin also inhibits by increasing dopamine

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45
Q

thyroglossal duct cyst presentation

A
  • asymptomatic mass in the midline neck
  • moves with swallowing
  • often in pt
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46
Q

Protease inhibitors

A 
Saquinavir
Ritonavir
Indinavir
Nelfinavir
Amprenavir
Fosamprenavir
Lopinavir
Tipranavir
Atazanavir
Darunavir
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47
Q

NRTI

A 
Zidovudine
Didanosine
Lamivudine
Abacavir
Emtricitabine
Tenofovir
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48
Q

NNRTIs

A 
Nevirapine
Delavirdine
Efavirenz
Etravirine
Rilpivirine
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49
Q

Protease inhibitor SE

A

GI intolerance
Hyperlipidemia/hypertriglyceridemia
Lipodystrophy

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50
Q

Ritonavir SE

protease inhibitor

A

Inhibits cytochrome P450

Pancreatitis

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51
Q

Nephrolithiasis side effect from what drugs

A

Idinavir
Atazanavir

(protease inhibitors)

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52
Q

Increased bilirubin SE from what drug

A

Atazanavir

Protease inhibitor

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53
Q

Bone marrow suppression from what drugs for HIV

A

Zidovudine

NRTI

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54
Q

Pancreatitis and peripheral neuropathy from what drugs for HIV

A

Didanosine,
Zalcitabine
Stavudine

(NRTIs)

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55
Q

Hepatic steatosis from what drugs for HIV

A

Didanosine
Stavudine
(NRTIs)

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56
Q

Hypersensitivity from what drugs for HIV

A

Abacavir (NRTI)

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57
Q

Side effect of NNRTIs

A

Rash

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58
Q

SE of efavirenz (NNRTI)

A

Neuropsychiatric
False positive cannabinoid drug test
Teratogenic

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59
Q

Enfuvurtide
Mech

SE

A

Fusion inhibitor by binding gp41, inhibiting viral entry

se:
injection site reaction
increased risk of bacterial pneumoniae

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60
Q

Raltegravir Mech

SE

A

Integrase inhibitor

SE:
nausea
rash
myopathy

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61
Q

Maraviroc mech

who can use it?

A

CCR5 antagonist, inhibiting gp120 conformational change so virus cannot bind host cell effectively.

only patients with all R5 virus

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62
Q

Cancers assoc with asbestos

A

mesothelioma

bronchogenic carcinoma

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63
Q

owl’s eye inclusions

A

cmv

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64
Q

owl’s eye nucleus

A

reed sterberg cells (hodgkin lymphoma)

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65
Q

owl’s eye protozoan

A

Giardia lamblia

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66
Q

Howell-Jolly bodies

A

DNA remnants (asplena)

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67
Q

Treatment for PCP

A

TMP-SMX (bactrim)

or if sulfa allergy:

Pentamidine

or

unofficially Clindamycin and primaquine

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68
Q

Treat rhizopus/mucormycosis

A

Surgery and amphotericin B

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69
Q

most common opportunistic infection in HIV patients

A

PCP

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70
Q

treatment for systemic candidasis

A

Fluconazole for immunocompetent

Amphotericin B or caspofungin for immunocompromised

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71
Q

animal urine you should think of

A

leptospira

hantavirus for rodent urine

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72
Q

what hormones arise from anterior pituitary

A 
FSH
LH
TSH
PROLACTIN
GH
ACTH
MSH or melanotropin
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73
Q

what effect does adipocyte generated leptin have on the hypothalamus

A

INHIBITS LATERAL THALAMUS TO STOP HUNGER

STIMULATES VENTROMEDIAL THALAMUS FOR SATIETY

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74
Q

treatment for sporothrix schenckii

A

itraconazole
or
KOH

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75
Q

councilman bodies

A

apoptotic liver cells (viral hepatitis, yellow fever)

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76
Q

Anti-dsDNA antibodies

A

lupus nephritis

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77
Q

Dementia and eosinophilic inclusions in neurons

A

Lewy body dementia

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78
Q

Side effects of orlistat

A

steatorrhea
GI disturbances
Decreased absorption of fat soluble vitamins

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79
Q

Enzyme converting glucose to sorbitol

A

Aldose reductase

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80
Q

Amphotericin B Mechanism

Use

SE

How to avoid some SE

A

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)

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81
Q

Nystatin Mechanism

Clinical uses

A

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

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82
Q

Azole mechanism

A

inhibits fungal sterol (ergosterol) synthesis by inhibiting cytochrome P450 that converts lanosterol to ergosterol

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83
Q

Clinical use for Itraconazole

A

First line therapy

  • Blastomyces
  • Coccidoides
  • Paracoccidoides
  • Histoplasma
  • Sporothrix
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84
Q

Clinical use for Ketoconazole

A

NOT FIRST LINE

  • Blastomyces
  • Coccidoides
  • Histoplasma
  • Candida
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85
Q

Clinical use for Fluconazole

A
  • Cryptococcal meningitis (can cross BBB)

- Candidal infections

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86
Q

Clinical use for Posaconazole

A

Active against many fungi refractory to other treatments

-Mucor

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87
Q

Clinical use for Clotrimazole and microconazole

A

Used for topical fungal infections

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88
Q

Clinical use for Voriconazole

A

Aspergillus

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89
Q

SE of azoles

A
  • Decrease production of cortisol and testosterone
  • Gynecomastia
  • Impotence
  • Drug Drug interactions
  • Increased hepatic enzymes
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90
Q

Flucytosine mechanism

Clinical use

SE

A

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

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91
Q

caspofungin mechanism

Use

SE:

A

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

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92
Q

Terbinafine (lamisil) mechanism

Use

SE

A

Inhibits fungal enzyme squalene epoxidase leading to decreased ergosterol synthesis

Use:
TOPICAL
-Tinea pedis
-Tinea corporis
ORAL
-Onychomycosis
-Tinea capiti

SE:
GI symptoms
Hepatotoxicity

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93
Q

Griseofulvin mechanism

Use

A

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
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94
Q

Strawberry tongue

A

Scarlet fever/
Kawasaki disease/
Toxic shocks syndrome

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95
Q

Rash on palms and soles

A

2ndary syphilis
Rocky mountain spotted fever
Coxsackie A virus

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96
Q

Name for thyroid hormone secreting teratoma

A

struma ovarii

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97
Q

medx to shrink prolactinomas

A

Dopamine agonists

  • Bromocriptine
  • Cabergoline
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98
Q

Treatment for Entamoeba histolytica

A

Kill Trophozoites with
-Metronidazole
or
-Tinidazole

Kill asymptomatic cyst passers with
-Iodoquinol
or
-Paromomycin

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99
Q

Uses for metronidazole

A

GET GAP on the Metro

Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobic bacteria
Pylor (H. pylori)
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100
Q

Treatment for Toxoplasma gondii

A

Sulfadiazine+ Pyrimethamine+Folinic acid

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101
Q

treatment for Trypanosoma brucei

A

Suramin for blood borne disease

Melarsoprol for CNS penetration

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102
Q

Treat P. vivax and P. ovale

A

Primaquine

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103
Q

Treat of malaria

A

Chloroquine

+primaquine if Pvivax or Povale

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104
Q

Treatment of Chloroquine resistant malari

A

Quinine + Doxycycline
Atovaquone-proguanil
Artemether-Lumefantrine
Mefloquine

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105
Q

Treatment of Babesiosis

A

Quinine+clindamycin

106
Q

most common protozoal infection in the US

A

Trichomonas vaginalis

107
Q

Diarrhea with liver abcess?

A

Not Giardia but Entamoeba histolytica

108
Q

Names for the stages in the malaria life cycle

A

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
Q

Smudge cell

A

CLL

110
Q

Port-wine stain in ophthalmic division of trigeminal ganglion

A

Sturge-Weber syndrome

111
Q

S3 heart sound

A 
Dilated cardiomyopathy
Post MI
Left ventricular failure
Mitral regurgitation
Left to right shunt (VSD/ASD/PDA)
112
Q

Subepithelial humps on EM

A

poststreptococcal glomerulonephritis

113
Q

Spike and dome on EM

A

Membranous glomerulonephritis

114
Q

Adv. rxn from mixing succinylcholine and inhaled anesthetics

A

Malignant hyperthermia

tx with dantrolene

115
Q

Currant jelly stool

A

Intussusception

116
Q

Ketoconazole inhibits what enzyme of the adrenal steroid synthesis pathway

A

Desmolase (Cholesterol–>Pregnenolone)

117
Q

Treatment for Pinworm/Enterobius Vermicularis

Ascaris Lumbricoides

A

Albendazole
Mebendazole
Pyrantel Pamoate

(same for both)

118
Q

Treatment of Trichinella spiralis

A

Benzimidazoles

119
Q

Treatment of Strongyloides stercoralis

A

Ivermectin

Mebendazole

120
Q

What are the hookworms

tx?

A

Necator Americanus
Ancyclostoma duodenale

tx
Albendazole
Mebendazole
Pyrantel Pamoate

121
Q

Tx of taena solium

A

Praziquantel
Albendazole +
dexamethasone (neurocysticercosis)

122
Q

Treatment of Echinococus granulosus

A

injection of scolicidal agent (ethanol, hypertonic saline)
followed by surgical removal

-Albendazole in conjuction w the procedure

123
Q

Most common helminthic infection in US

2nd most common helminthis infxn in the US

A

Enterobius vermicularis is most common in the US

Ascaris lumbricoides is the 2nd most common helminthic infxn in the US

124
Q

1/4 of world infected with it

A

Ascaris lumbricoides

125
Q

Snail host swimmers itch

A

Schistosoma species

126
Q

Most common predisposing factor for bladder cancer in 3rd world countries

A

Schistosoma haematobium

127
Q

Giant roundworm

A

Ascaris lumbricoides

128
Q

responsible for lymphatic filariasis

A

Wuchereria bancrofti

129
Q

Adult pt from Mexico with new onset seizures and brain calcifications

A

Taena solium (neurocystercosis)

130
Q

hematuria in patient form developing country

A

Schistosoma haematobium

131
Q

Treat giardia, entamoeba, trichomonas

A

Metronidazole

132
Q

Treat most all flukes and tapeworms

A

Praziquantel

133
Q

Treat hookworm, pinworm, roundworm

A

Benzimidazoles (Mebendazole)

Pyrantel Pamoate

134
Q

Treat chagas disease

A

Benznidazole

Nifurtimox

135
Q

Best guess for roundworms

A

Benzimidazoles

136
Q

Treat Leishmaniasis

A

Cutaneous-Sodium stibogluconate

Visceral-Liposomal amphotericin B

137
Q

Contracted by eating undercooked fish and causes an inflammation of the biliary tract

A

Clonorchis

138
Q

Which 2 agents are usually used in the treatment of peduculosis capitis and pediculosis pubis

A

Pyrethrin

Permethrin

139
Q

Why is lindane not the preferred agent in the treatment of lice

A

Neurotoxicity and Resistance

140
Q

Incidences of cancer in men

mortality in men

A

INCIDENCE
Prostate
Lung
Colon

MORTALITY
Lung
Prostate
Colon
Pancreas
141
Q

Incidences of cancer in women

mortality in women

A 
INCIDENCE
Breast
Lung
Colon
Uterus
MORTALITY
Lung
Breast
Colon
Pancreas
142
Q

DPC mutation also known as

what does DPC mean?

A

SMAD4

Deleted in pancreatic cancer

143
Q

DCC mutation means

A

Deleted in colon cancer

144
Q

K-RAS

H-RAS

N-RAS

A

K-RAS: Colon, lung, pancreatic tumors

H-RAS: Bladder and kidney tumors (Hematuria)

N-RAS: Melanomas and hematologic malignancies

145
Q

Follicular thyroid carcinoma is associated with what mutations?

A

RAS mutations

146
Q

BCR-ABL

A

t9;22
philadelpha chromosome
CML

Tyrosine kinase constitutively on

147
Q

ret mechanism

associations

A

tyrosine kinase always on

MEN2A and 2B
-Pheochromocytoma
-Medullary thyroid cancer
Papillary carcinoma of the thyroid

148
Q

HER2/new (c-erbB2) associations

tx

A

Breast cancer
Ovarian cancer
Gastric cancer

Tx with trastuzumab

149
Q

L-myc association

A

lung tumors

150
Q

N-myc association

A

Neuroblastoma (sounds like a brain tumor but really is one of the adrenal medulla)

151
Q

Most common causes of hypocalcemia

A 
vitamin d deficiency
chronic renal disease
parathyroidectomy
autoimmune destruction of parathyroid glands
digeorge syndrome
pseudohypoparathyroidism
acute pancreatitis
152
Q

cancer assoc with hashimoto thyroiditis

A

Marginal cell lymphoma

153
Q

What is iron bound to in human cells

A

myoglobin and ferritin

154
Q

What is iron bound to in blood

A

hemoglobin and transferrin

155
Q

arsenic risks for cancer

A

Squamous cell skin cancer
Angiosarcoma of the liver
Lung cancer

156
Q

vinyl chloride risk for cancer

A

angiosarcoma

157
Q

Naphthalene (moth balls) risk for cancer

A

Transitional cell bladder cancer

158
Q

smoking increases risk for same cancer type that naphthalene does

A

Transitional cell bladder cancer

159
Q

Asbestos increases risk for

A 
Bronchogenic carcinoma (MOST COMMON!!_
Malignant mesothelioma
160
Q

In asbestosis what is the most common cancer

A

BRONCHOGENIC CARCINOMA not malignant mesothelioma

161
Q

Most common cancers assoc with ionizing radiation

A

Myeloid leukemias

  • AML
  • CML

Thyroid cancer (all types, papillary is just the most common in general)

162
Q

What cancers are assoc with UV radiation exposure?

Which type of UV is most problematic?

A

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
Q

Actinic keratosis is due to what?

Precursor to what?

Tx with what?

A

Due to sun exposure

Precursors to squamous cell skin cancer

Tx: 5-FU

164
Q

Dysplastic nevi progress to

A

Melanoma

165
Q

Adenomatous colon polyps progress to

A

colon cancer

166
Q

Barretts esophagus progresses to

A

Esophageal adenocarcinoma

167
Q

Tuberous sclerosis presentation

neoplasms?

A 
Facial angiofibromas 
-Adenoma sebaceum
Seziures
Intellectual disability
Ash Leaf Spots

Neoplasms include:

  • Cardiac rhabdomyoma
  • Renal angiomyolipoma
  • Astrocytoma
168
Q

HBV and HCV increase risk for

A

Hepatocellular carcinoma (HBV can without cirrhosis)

169
Q

HCV increases risk for

A

Papillary thyroid carcinoma

170
Q

HTLV increases risk for

A

T-cell lymphoma

171
Q

EBV increases risk for

A

Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma

172
Q

Schistosoma haematobium increases risk for

A

SCC of bladder (not transitional as in smoking)

173
Q

Clonorchis sinensis increases risk for

A

Biliary cancer

174
Q

Down syndrome associated with what neoplasm

A

ALL

AML

175
Q

Ataxia-telangiectasia assoc with what neoplasm

A

Leukemia

Lymphoma

176
Q

Paget disease of bone assoc with what neoplasm

A

Osteosarcoma

177
Q

Nitrosamines assoc with what neoplasm

A

Esophageal cancer
Gastric cancer
Colon cancer

178
Q

HPV cancer risk

A 
Vulvar cancer
Vaginal cancer
Cervical cancer
Anal cancer
Penile cancer
(16 and 18)
179
Q

Most common side effect is hypoglycemia in this oral type 2 diabetes drug

A

Sulfonylureas

180
Q

Primarily effects postprandial hyperglycemia (oral diabetes type II drug)

A

alpha-glucosidases

181
Q

MOA: closes K+ channels on beta cells

A

sulfonylureas

182
Q

MOA: inhibits alpha-glucosidase at intestinal brush border

A

alpha-glucosidase inhibitors

183
Q

MOA: agonist at PPARgamma receptor

A

TZD

184
Q

features of anaplasia

A

High nucleus:cytoplasm ratio
Prominent nucleoli
Clumping of nuclear chromatin
Many mitotic figures

185
Q

Malignant tumor from epithelium

Stain?

A

adenocarcinoma
papillary carcinoma

stain with cytokeratin

186
Q

Epithelial tumors spread by:

Mesenchymal tumors spread:

A

Lymphatics for epithelial tumors

Hematogenously for mesenchymal tumors

187
Q

CEA

A

Colon cancer

Pancreatic cancer

188
Q

CA 19-9

A

Pancreatic cancer

189
Q

alpha-fetoprotein

A

Hepatocellular carcinoma and testicular tumors

190
Q

CA-125

A

Ovarian cancer (but also elevated with anything irritating peritoneum…)

191
Q

S-100

A

Melanoma

Schwannoma

192
Q

Alkaline phosphatase

A

Metastasis to bone
Biliary disease
Paget disease of bone

193
Q

Psammoma bodies

A

Papillary thyroid cancer
Serous papillary cystadenocarcinoma of the ovary
Meningioma
Malignant mesothelioma

194
Q

what hormones use steroid receptors

A 
Estrogens
Progesterone
Testosterone
Aldosterone
Vitamin D
Thyroid hormones
Glucocorticoids
195
Q

What hormones use tyrosine kinase receptors

A 
insulin
insulin like growth factor
fibroblast growth factor
platelet derived growth factor
prolactin
growth hormone
196
Q

RLS in purine synthesis

A

glutamine PRPP amidotransferase

197
Q

RLS in pyrimidine synthesis

A

CPS2

198
Q

What are two cofactors involved in the ability to induce angiogenesis in tumors

A

Basic fibroblast growth factor (bFGF)

Vascular endothelial growth factor (VEGF)

199
Q

Most common liver metastatic cancers

A

Cancer Sometimes Penetrates Benign Liver

Colon
Stomach
Pancreas
Breast
Lung
200
Q

most common brain metastatic cancers

A

Lots of Bad Stuff Kills Glia

Lung
Breast 
Skin (melanoma)
Kidney (renal cell carcinoma)
GI tract (colon cancer)
201
Q

most common bone metastatic cancers

A

Permanently Relocated Tumors Like Bones

Prostate
Renal cell carcinoma
Testes/Thyroid
Lung
Breast
202
Q

What is Cachexia and why does it happen?

A

Profound wt loss

Loss of fat and lean muscle, b/c tumor produces cytokines that raise the BMR

203
Q

Paraneoplastic effects of tumors

A

Small cell lung cancer (ACTH–>Cushing syndrome)
(ADH–>SIADH)
(Lambert-Eaton syndrome)

Squamous cell lung cancer
(Humoral hypercalcemia of malignancy: PTHrp)

204
Q

Lambert-Eaton syndrome is associated with what?

Mechanism?

Clinical presentation?

A

Assoc with small cell lung cancer

Antibodies against presynaptic ca2+ channels at the NMJ

Weakness improves with use (c/f with myasthenia gravis)

205
Q

What can release PTHrp

A

Squamous cell lung cancer

Squamous cell cancers of head and neck

Breast cancer

Renal cell carcinoma

206
Q

How does multiple myeloma cause hypercalcemia?

A

Secretes local osteolytic factors causing lytic bone lesions and hypercalcemia

207
Q

EPO secreting conditions?

A

Potentially Really High Hematocrit

Pheochromocytoma
Renal cell carcinoma
Hepatocellular carcinoma
Hemangioblastoma

also Uterine fibroids (leiomyoma)

208
Q

most common cause of hypercalcemia

A

Primary hyperparathyroidism

209
Q

What malignancies cause hypercalcemi

A 
Squamous cell  lung cancer
squamous of head and neck
breast cancer
renal cell carcinoma
multiple myeloma
hodgkin lymphoma
lytic bone metastases
210
Q

RLS for urea cycle

A

CPS I (carbamoyl phosphate synthetase I)

211
Q

RLS fo fatty acid synth

A

Acetyl-CoA carboxylase

212
Q

RLS for beta-oxidation of fatty acids

A

CAT 1 (Carnitine acyltransferase I)

213
Q

RLS for bile acid synthesis

A

7-alpha hydroxylase

214
Q

RLS for heme synthesis

A

Amino levulinate synthase

215
Q

5 most important lifestyle factors that impact cancer risk

A 
Smoking
Obesity
Poor diet
Inactivity
Sun exposure
216
Q

Smoking increases risk for what types of cancers

A 
Lung cancer
Laryngeal cancer
Oral cancer
Esophageal cancer
Pancreatic cancer
Renal Cell carcinoma
Bladder cancer
217
Q

What cancers are increased with obesity

in both women and men

In women

In men

A 
Men and women:
Esophageal adenocarcinoma
Renal cell carcinoma
Women:
Endometrial cancer
Gallbladder cancer
Men:
Thyroid cancer
Colon cancer
218
Q

Screening recommendations for the following cancers according to USPSTF

Breast cancer
Cervical cancer
Prostate cancer
Colon cancer
Ovarian cancer
Smoking
A

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
Q

What immune cells are involved in killing cancer cells

A

CD8+ Cytotoxic T lymphocytes MOST IMPORTANT!

NK cells
Macrophages

220
Q

treatment for homocystinuria?

A

Decrease methionine
Increase cysteine
Increase B6 and B12
Add folate

221
Q

what irrev enzymes are involved in gluconeogenesis

A

Pyruvate carboxylase

PEP carboxykinase

Fructose 1,6 bisphosphatase

Glucose 6 phosphatase

222
Q

Rescue agent for 5-FU toxicity

A

Uridine

223
Q

SE of Methotrexate

SE of 5-FU

A

Fibrosis of lung for methotrexate

Photosensitivity for 5-FU

224
Q

6-MP can become toxic when given with

A

allopurinol

225
Q

How to get around the CI of allopurinol with 6mp?

A

give 6-Thioguanine, b/c not metabolized by xanthine oxidase

226
Q

Cytarabine is what

what does it do

A

Pyrimidine analog

Inhibiting DNA polymerase

227
Q

Cyclophosphamide mechanism

Use

SE

Any special characteristics?

A

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

228
Q

Ifosfamide

A

same as cyclophosphamide except used for testicular cancer and not as immunosuppressant

229
Q

Nitrosureas

use

SE

A

put nitro in your MUSTANG (-MUSTINE)

alkylating agent that crosses BBB, so use for brain tumors

SE: CNS toxicity

230
Q

Busulfan mech

Use

SE

A

Cross links DNA

Use:
CML, also ablate BM before transplant

SE:

  • severe myelosuppression
  • pulmonary fibrosis
  • hyperpigmentation
231
Q

Doxorubicin and Daunorubicin Mech

Use

SE

A

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

232
Q

Dexrazoxane

A

Prevent cardiotoxicity with Daunorubicin and doxorubicin

233
Q

Dactinomycin mechanism

Use

A

Intercalates DNA

Use:
Wilms tumor
Ewing Sarcoma
Rhabdomyosarcoma

234
Q

Bleomycin

Use:

Mech

SE

A

Use: with etoposide and cisplatin, treats testicular cancer

Mechanism: Generates free radicals

SE: Pulmonary fibrosis

235
Q

What oncology drugs cause pulmonary fibrosis and what are their mechanisms?

A

Bleomycin (generates free radicals)
Busulfan (cross links DNA)
Methotrexate (inhibits dihydrofolate reductase))

236
Q

Uses for methotrexate

A

Leukemias
Lymphomas
Choriocarcinomas
Sarcomas

Abortion
Ectopic pregnancy
RA
Psoriasis
IBD
237
Q

6-MP uses

A

prevent organ rejection
RA
Leukemia
IBD

238
Q

5-FU uses

A

Colon cancer
Pancreatic cancer
Basal cell skin cancer
Actinic keratosis

239
Q

Azathioprine use

A

SLE

240
Q

folic acid analog

A

methotrexate

241
Q

pyrimidine analog

A

5-FU

242
Q

3 most common types of thyroid cancer

A

Papillary carcinoma
Follicular carcinoma
Medullary carcinoma

243
Q

what cancers are assoc with RET gene mutation

A

MEN 2A and 2B
Medullary thyroid carcinoma
Papillary thyroid carcinoma

244
Q

Cisplatin, Carboplatin, Oxaliplatin

Uses

SE

A

Mech: Cross link DNA

Uses:

  • Testicular cancer
  • Ovarian cancer
  • Bladder cancer

SE:
-Nephrotoxicity (prevent with amifostine and chloride diuresis)

-Acoustic nerve damage

245
Q

What drugs are nephrotoxic/ototoxic

A

Vancomycin
Aminoglycosides
Loop diuretics
Cisplatin and carboplatin

246
Q

Etoposide, Teniposide
Mech:
Use:

A

Mech: Inhibit Topoisomerase 2–> DNA degradation

Use:

  • Small cell lung cancer
  • Prostate cancer
  • Testicular cancer
247
Q

regimen for treating testicular cancer

A

Eradicate Ball Cancer

Etoposide+Bleomycin+Cisplatin

or

Etoposide+Ifosfamide+Cisplatin

248
Q

Irinotecan, Topotecan
Mech

Use

A

Mech: Inhibit topoisomerase I

Use
Irinotecan: Metastatic colon cancer

Topotecan: Small cell lung cancer/Ovarian cancer/Cervical cancer

249
Q

Vincristine
mech
uses
and what are drugs that also treat these same conditions

SE

A

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
Q

Vinblastine
Mech

se:

A

Mech: blocks microtubule polymerization

SE: Myelosuppression (vinblastine BLASTS BONE MARROW)

251
Q

Paclitaxel mech

use

SE

A

mech: stabilizes microtubules

Use:
-Ovarian and breast carcinomas

SE: myelosuppression and hypersensitivity

252
Q

Microtubule drugs

A 
Vincristine
Vinblastine
Paclitaxel
Mebendazole
Albendazole
Griseofulvin
Colchicine
253
Q

Hydroxyurea Mech

use

A

Mech: Inhibits ribonucleotide reductase, inhibiting DNA synthesis)

use:

  • Melanoma
  • CML
  • increases HbF in sickle cell patients
254
Q

Prednisone mech

Use

SE

A

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
255
Q

glucocorticoid SE

A

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
Q

Tamoxifen mech

Use

SE

A 
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)

257
Q

SERMs

A

Tamoxifen, Raloxifene

258
Q

Raloxifene mech

USe

A 
ER antagonist
-Breast
-Endometrium
ER agonist
-Bone

Use:
Treat osteoporosis

259
Q

Trastuzumab mech
Use

SE

A

HER-2 monoclonal antibody

Use: Treat breast cancer that overexpress HER-2

SE:
Cardiotoxic (HERts THE HEART

260
Q

Rituximab
mech

Use

A

Antibody against CD20

Uses:

  • Lymphomas and leukemias
  • RA
  • Vasculitis
  • Pemphigus vulgaris
  • ITP
261
Q

Imatinib mech

Use

A

Enzyme inhibitor targets mutant BCR-ABL tyrosine kinase produced by philadelphia chromosome t(9;22)

Use:

  • CML
  • ALL
  • AML

Step 1 Journal RC (9 decks)

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