Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Block 3b1 PHM > Lung Cancer, BCM & Paraneoplastic Syndromes > Flashcards

Lung Cancer, BCM & Paraneoplastic Syndromes Flashcards

1
Q

Describe the pathogenesis of paraneoplastic syndromes (5)

A

Tumor production of protein hormones, enzymes, or fetal proteins

Tumor stimulation of antibody production

Metabolism of steroids by the tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a neurological paraneoplastic syndrome?

A

Immune mediated attack on central, peripheral, autonomic nervous systems

“Auto-antibodies” may be involved, mainly vs intracellular antigens; the presence of which indicates w/ certainty that there is an associated malignant tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After CXR, what other diagnostic tests might you might do if neurological paraneoplastic syndrome is suspected?

A

Imaging: PET, CT, MRI*esp for neurological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you test & what do you test for in neurological paraneoplastic syndromes?

A

Spinal fluid: 80% will have “onconeural antibodies”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 2 main autoantibodies in neurological paraneoplastic syndromes? Antigen? Associated syndromes & symptoms and cancers?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical presentations of Anti-NMDA receptor encephalitis?

A

Neurological paraneoplastic syndrome w/ flu like prodrome followed by psychiatric sx, behavioral abnormalities, memory deficits, seizures, progressive loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What 2 conditions are associated w/ Anti-NMDA receptor encephalitis?

A

(Ovarian) teratoma & lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pathogenesis of subacute cerebellar degeneration?

A

Neurological paraneoplastic syndrome involving Anti-Hu and Anti-Yo antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does subacute cerebellar degeneration present clinically?

A

Ataxia, dysarthria (motor speech disorder), nystagmus (eye bounce at periphery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are malignancies associated w/ subacute cerebellar degeneration?

A

Lung, Ovarian & Breast Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What paraneoplastic syndrome is associated w/ Non-Hodgkin’s Lymphoma & what autoantibodies are involved?

A

Subacute Cerebellar Degeneration; anti-Tr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does Limbic Encephalitis present clinically?

A

Seizures, short term memory & behavioral deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which antibodies are involved in Limbic Encephalitis & their respective malignancies?

A

GABA receptor antibodies: lung cancer (adults)

Anti-Hu: SCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which malignancy is associated w/ Opsoclonus Myoclonus in children specifically?

A

Neuroblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does Lambert-Eaton Myasthenic Syndrome present clinically?

A

Progressive proximal weakness, diminished reflexes, autonomic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which antibodies are associated w/ Lambert-Eaton Myasthenic Syndrome?

A

VGCC-P/Q ab’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which malignancy is Lambert-Eaten Myasthenic Syndrome associated with?

A

SCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If Myasthenia Gravis is paraneoplastic, what conditions is it associated with? How might it present clinically?

A

Thymoma & Pure Red Cell Aplasia

Ptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which paraneoplastic syndrome does this person present with?

A

Poly/dermatomyositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In an elderly male patient with anemia/iron deficiency, what might you recommend?

A

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is pemphigus & what other diseases might it resemble?

A

Autoimmune blistering disease

Erythema multiforme, graft vs. host disease, lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the pathogenesis of pemphigus

A

Autoantibodies target desmoplakin, bullous pemphigoid antigen, envoplakin, periplakin plectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which malignancy is pemphigus associated w/ and what is the prognosis?

A

Lymphoproliferative diseases; poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does Sweet Syndrome present clinically?

A

Cutaneous plaques on neck, face, upper extremities w/ fever & neutrophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What might a biopsy in suspected Sweet Syndrome reveal?
Just neutrophilic infiltrate, biopsy may not show malignancy
26
What is the type of associated malignancy in Sweet Syndrome? Give 1 ex
Hematologic; MDS
27
How does acanthosis nigricans maligna present? & What are its associated malignancies?
Grey brown hyperpigmented plaques Adenocarcinoma of GI tract, but also lung, breast, lymphoma, myeloma
28
How does a neuropathic itch present & what is its associated malignancy?
Just itch, no rash *Hodgkin* Lymphoma
29
What do the blue & red circles reveal in the CT respectively?
Blue: mass obstructing bronchus Red: post-obstructive pneumonia
30
What is the pathogenesis of Cushing's Syndrome & its associated malignancies?
Inappropriate ACTH secretion SCLC, Bronchial Carcinoid, Thymic Carcinoma, Pancreatic Cancer, Pheochromocytomas (hormone secreting tumor in adrenal glands), Medullary Thyroid Cancer, GI Carcinoid
31
How does Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) present clinically? Which malignancy is it most commonly associated with?
Water retention & low Na-\> fatigue, anorexia, altered mental status SCLC association
32
What is the pathogenesis of Hypercalcemia?
PTHrP Calcitonin secreting tumors Bone metastasis
33
How does Hypercalcemia present clinically?
Constipation, confusion, bone pain
34
What malignancies are associated w/ Hypercalcemia?
Lung, Carcinoid, Colorectal, Breast, Medullary Thyroid Cancer
35
What does the red circle identify on this CT? What is the consequence?
Mass in upper pole of R kidney Excess EPO secretion
36
What kind of paraneoplastic syndrome is erythrocytosis? & What is the associated malignancy?
Hematologic; Increased EPO secretion Associated w/ renal cell cancer
37
What kind of paraneoplastic syndrome is Pure Red Cell Aplasia? & What is its associated malignancy?
Hematologic; Thymoma
38
What kind of paraneoplastic syndrome is DIC? & What are its associated malignancies?
Hematologic; Metastatic Adenocarcinoma, Acute Promyelocytic/Monocytic Leukemia
39
Which malignancy is the paraneoplastic syndrome Autoimmune Hemolytic Anemia associated with?
Low grade lymphoproliferative disease
40
What group of malignancies is the paraneoplastic syndrome Thrombophlebitis associated w/?
Adenocarcinomas
41
Which malignancies is the hematologic paraneoplastic syndrome "Acquired Factor VIII Deficiency" associated w/?
Solid & Plasma Cell Tumors, Multiple Myeloma
42
What are 2 ex's of paraneoplastic syndromes related to the heart?
Carcinoid Heart Disease & Marantic Endocarditis
43
What is the pathogenesis of the cardiac paraneoplastic syndrome marantic endocarditis?
Central arterial embolization-\> cerebral & myocardial infarctions
44
What is Meigs Syndrome associated with?
NOT cancer Benign ovarian fibroma w/ hydrothorax
45
How is Meigs Syndrome treated?
Removal of benign tumor-\> fluid elimination
46
What might paraneoplastic syndromes signify?
Presenting signs/symptoms when cancer recurs
47
How are paraneoplastic syndromes treated generally?
1st treat the acute problem Then, treat the malignancy
48
How is hypercalcemia treated acutely?
Fluids, corticosteroids, furosemide (Lasix)
49
How is Hyponatremia in SIADH treated acutely?
Fluid restriction, hypertonic saline
50
How is erythrocytosis treated acutely?
Phlebotomy
51
What are 2 examples of epigenetic modifications & how do they differ?
Acetylation: releases DNA from histones by changing charge; loosening effect Methylation: tightens DNA making DNA inaccessible to transcription; silencing effect
52
What is the function of miRNA?
Degrades/translationally inhibits DNA Can decrease expression of tumor suppressor genes in tumor cells
53
What types of DNA damage call for base excision repair?
O2 radicals, deamination, spontaneous base loss, gamma irradiation & alkylating agents
54
What are the consequences of DNA damage that call for BER?
Damaged bases/SSB
55
What types of DNA damage call for NER?
UV radiation, smoking, Platinum drugs
56
What are the consequences of DNA damage that call for NER?
Pyrimidine dimers, bulky adducts
57
What are the main players in BER?
DNA glycosylase APE1 Endo DNA polymerase beta LigaseIII and XRCC1 (X Ray Cross Complementation Protein I)
58
How is the 8-oxo-guanine base lesion repaired?
OGG1 glycosylase removes GO- when it is paired w/ C MutY removes A when paired w/ GO: backup if OGG1 doesn't repair
59
What clinical condition results if MutY fails to repair base lesion 8-oxo-guanine?
MutYH-associated polyposis colon cancer
60
Which 2 compounds from cigarette smoke can impair DNA structure?
Nitrosamines & Benzo[a]pyrene
61
How does UV radiation induce DNA damage?
Mutations in dypyrimidine sequences
62
Describe the steps in NER
**TFIIH** complex (helicases + endonucleases) recognize site of intrastrand cross-link Deoxynucleotides DNA Polymerase & DNA Ligase
63
What is an example of a disease due to impaired NER?
Xeroderma Pigmentosum
64
What is an ex of a platinum chemotherapeutic drug & what is its MOA?
Cisplatin: forms intrastrand crosslinks between G's
65
What are 2 ex's of TKI's that inhibit EGFR?
Gefitinib & Osimertinib
66
What is the issue w/ the problematic TKI of EGFR?
Secondary EGFR mutation: **T790M** Prevents inhibition by Gefitinib
67
What drug can be used to work around the EGFR mutation that confers resistance vs. Gefitinib?
Osimertinib: can **inhibit EGFR** w/ the **T790M mutation**
68
What is the most common mutation of BRAF & what is the consequence?
**BRAFV600E** Induction of MEK & ERK pathways
69
What is the acronym & the steps to remember the **MAP Kinase pathway**?
**R**igh**t**eous (**RTK**) **Ra**i**s**ins (**RAS**) **Raf**fle & (**RAF**) **M**a**k**e (**MEK**) **Er**gonomics (**ERK**)
70
What is the drug that can be used to work around the BRAF V600E mutation?
**Vemurafenib** inhibits BRAFV600E "Very fed up with him"
71
What drug can be given in combination w/ **Vemurafenib** to reduce the chance of melanoma remission in the face of BRAF mutation? What is this drug's MOA?
**Trametinib**: inhibits _MEK_ downstream from RAF
72
In the PI3K/AKT pathway, what is **AKT** activated by?
**pDK** & **mTOR**
73
What are 3 general capabilities of AKT when it phosphorylates various products?
**Cell cycle progression:** stabilizes cyclin D1 via phosphorylation of GSK3B **Growth/Proliferation:** phosphorylates mTOR **Inhibits apoptosis**: phosphorylates MDM2, NF-KB, etc
74
What is the pathogenesis of Cowden's Disease & the clinical consequences?
LOF mutation in PTEN, PIP3 accumulates-\> cancer High risk of multiple cancers (ie: breast, thyroid, endometrium & kidney)
75
What is the most common oncogenic ALK fusion protein?
EML4-ALK
76
What is the first-line Tx vs. ALK rearrangements? 1 other ex?
**Alectinib:** 1st line vs. ALK rearrangements ## Footnote **Crizotinib**
77
What drug is given to treat **Malignant Hyperthermia?** What is its MOA?
**Dantrolene:** muscle relaxant that decreases Ca release
78
What is the genetic polymorphism that can cause **6 mercaptopurine** to accumulate and lead to myelosuppressive effects when the minor pathway of metabolism is also inhibited?
Thiopurine Methyltransferase Deficiency (TPMT)
79
What is the _minor pathway_ in metabolizing myelosuppressive drugs like **6 mercaptopurine** & why might this pathway be inhibited?
**Xanthine Oxidase** may be inhibited by **Allopurinol** to treat concomitant gout
80
What is the pathogenesis of Acute Intermittent Porphyria?
Accumulation of Amino Levulinic Acid **(ALA)** and **Porphobilinogen**
81
What genetic polymorphism causes **ALA** and **Porphobilinogen** to accumulate in **Acute Intermittent Porphyria**?
**HMB Synthase**
82
What are the clinical presentations of **Acute Intermittent **_P_**orphyria**?
5 P's **P**ainful Abdomen **P**ort wine-colored urine **P**olyneuropathy **P**sychological Disturbances **P**recipitated by drugs (cytochrome P450 inducers), alcohol, *estrogen/progesterone*\*
83
How is Acute Intermittent Porphyria treated?
**Glucose** & **Heme** can treat AIP, which inhibits **ALA Synthase**
84
How is the chemotherapy drug Irinotecan metabolized?
* *Carboxylesterase** converts Irinotican (prodrug) into * *SN-38** (active drug)-\> conjugated metabolite-\>bile
85
What is the genetic polymorphism that converts *Irinotecan's* active form **SN-38** into *conjugated metabolites* that can be excreted into *bile*? What is its MOA?
**UGT1A1** involved in *glucorinidation* of **SN-38**
86
What can be done before a drug like Irinotecan is administered to ensure proper metabolism?
*Genetic testing* vs. polymorphisms like **UGT1AL1** to _inhibit myelosuppresive effects_ from accumulating
87
Which stains (+) in SCLC?
AE1/E3, CD56, Leukocyte Common Antigen (LCA) Metastatic: also BER-EP4 and Synaptophysin
88
Which stains (+) in NSCLC-adenocarcinoma?
TTF-1 & Napsin-A
89
What stains (+) in mesothelioma?
Calretinin
90
What should be done to address a brain tumor?
Steroids (ex: dexamethasone) can decrease H2O in brain & sx Whole brain radiation therapy Targeted therapy if there is an ALK rearrangement
91
What are 2 Tx options for brain metastases in NSCLC, for ex?
Resection for single brain metastasis Whole brain radiation therapy, for multiple disease sites beyond scope of Stereotactic Radiosurgery
92
Categorize the type of brain metastasis in this MRI
Dural based metastasis
93
What are the top 3 types of cancers to develop in 15-29 year olds?
1) Lymphomas (20%) 2) Invasive Skin (15%)- 76% Melanoma 3) Endocrine System (11%)- 96% Thyroid
94
If a PET scan reveals a right lower lobe nodule, what is the diagnostic test to consider?
CT guided biopsy
95
What is standard of care to test in metastatic disease?
Genetic driver mutations (ie: EGFR, ALK, ROS, RET, BRAF)
96
What are the 3 things that are tested for to check for driver mutations in metastatic disease?
Blood, Urine, Tissue
97
What are 3 techniques to test for driver mutations in metastatic disease in tissue?
Next Generation Sequencing Immunohistochemistry for Proteins Florescence in Situ Hybridization
98
What 2 changes might you expect to see in the EGFR gene in metastatic cancer?
Exon 19 deletion Point mutation L858R
99
Which change might you expect to see in ALK and ROS1 genes in metastatic cancer?
Rearrangement
100
Who decides what is a good screening test?
US Preventative Services Task Force, American Cancer Society, among other groups

Block 3b1 PHM (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions