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UWorld REview > Oncology > Flashcards

Oncology Flashcards

1
Q

hemosiderin-def and patient population (2)

A

accumulation of iron. common in pt with hemolytic anemia or those who undergo frequent blood transfusions

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2
Q

Fas (CD95)-def, family, another family member example, function

A

death receptor. member of tumor necrosis factor family. along with type 1 TNF receptor (TNFR1). Fas cross links with it’s ligand to induce caspase via the extrinsic apoptosis pathway

cytochrome c works through intrinsic pathway

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3
Q

what should be given to pts receiving platinum-based chemotherapy? what is an example of such a chemotherapy agent?

A 
aggressive hydration (cisplatin stays in non-reactive state when in higher chloride concentration) and amifostine (free-radical scavenger) to prevent neurotoxicity
cisplatin-can cause acute tubular injury
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4
Q

filgrastim

A

granulocyte-colony-stimulating factor (G-CSF)

stimulates proliferation and differentiation of granulocytes

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5
Q

purine analog drug of choice for hair cell leukemia. mech of action and resistance

A

cladribine-purine analog that achieves high intracellular concentrations b/c of resistance to degradation by adenosine deaminase

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6
Q

name three families of antimetabolites

A

folate antagonist, purine analogs, pyrimidine analogs

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7
Q

name a folate antagonist

A

methotrexate

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8
Q

name 3 purine analogs

A

6-thiopurines (6-MP, 6-GP), Fludarabine-CLL, and Cladribine-HCL

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9
Q

name 4 pyrimidine analogs

A

5-FU, capecitabine, cytrabine, gemcitabine

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10
Q

metalloproteinases

A

Zn-containing enzymes that degrade components of ECM and basement membrane- active in tissue remodeling, embryogenesis and tumor metastasis

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11
Q

encapsulation

A

when a tumor pushes against but does not invade fibrous tissue- i.e. meningioma

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12
Q

in an Receiver Operating Characteristic (ROC) curve adjusting the cut off line to the right changes SEN and SPE how? moving curve to the left?

A
  • right shift increases SPEC at expense for SEN

- left shift increases SEN at expense of SPEC

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13
Q

name carcinoma associated with: which one is reactivated in HIV

  • EBV
  • H. Pylori
  • HTLV-1 (Human T-lymphtrophic virus)
  • Hepatitis B
  • BK virus
A
  • non-Hodgkin’s diffuse B-cell lymphomas (reactivated in HIV pts)
  • MALToma and gastric adenocarcinoma
  • adult-T cell leukemia
  • hepatocellular carcinoma
  • nephropathy (post-transplant) or hemorrhagic cystitis
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14
Q

two key growth factors that promote angiogenesis in neoplastic and granulation tissue. why not EGF which cytokines? what poses a barrier?

A

FGF and VEGF

  • EGF has mitogenic influence on epithelial cells hepatocytes and fibroblasts but doens’t stimulate angiogenesis
  • IL-1 and INF gamma can stimulate VEGF expression
  • laminin in basement membrane may pose a physical barrier to new blood vessel growth
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15
Q

equation for RRR=

-risk of using relative risk reduction alone

A

absolute risk(control)-absolute risk (treatment)/ absolute risk (control)

note that relative risk reduction may overstate effectiveness of an intervention. use absolute risk reduction instead

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16
Q

topisomerase I vs II. inhibited by which enzymes

A
  • I causes single stranded nicks to relive negative supercoiling. itrinotecan and topotecan
  • II causes double standed nicks to relieve both positive and negative supercoiling. etoposide and podophyllin
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17
Q

what inhibits thymidylate synthase and what inhibits dihydrofolate reductase. enzyme class

A
  • 5-FU
  • MTX
  • antimetabolites
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18
Q

uses for etoposide and podophyllin

A
  • inhibits topoisomerase II
  • treats testicular cancer and small cell lung cancer
  • genital warts
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19
Q

185-kD transmembrane glycoprotein that has intracellular tyrosine kinase activity. define class and cancers associated with it’s mutation.

A
  • HER2/neu oncogene
  • epidermal growth factors
  • breast and ovarian cancer
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20
Q

what is useful in determining prognosis of cancer? not differentiation b/c?

A

-progonsis is better measured by staging. (how far has it spread) vs gradin how much as it differentiated

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21
Q

two cancers of bladder and causes

A
  • mc is transitional cell carcinoma aka urothelial
  • squamous cell caused by schistosoma haematobium
  • pt will complain of painless hematuria
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22
Q

vimentin

A

intermediate filament found in cells of mesenchymal origin

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23
Q

LCA aka

A

leukocyte common antigen. aka CD 45

-diiferentiates malignant lymphomas from poorly differentiated neoplasms of other types

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24
Q

name skull foramen in anterior cranial fossa and structures that transverse them

A

-ciribiform plate- CN I olfactory bundles

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25
Q

name skull foramen in middle cranial fossa and structures that transverse them

A
  • optic canal-CN II, opthalmic artery, central retinal vein
  • superior orbital fissure, CN III,IV, V, VI, opthalmic vein, sympathetic fibers
  • foramen rotundum CV V2 (maxillary)
  • foramen ovale (CN V3) mandibular
  • foramen spinosum- middle meningeal art and vein
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26
Q

name skull foramen in posterior cranial fossa and structures that transverse them

A
  • internal acoustic meatus CN VII, CNVIII
  • jugular foramen CN IX, X, XI, jugular vein
  • hypoglossal canal CN XII
  • foramen magnum spinal roots of CN XI, brain stem, vertebral arteries
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27
Q

symptoms of jugular foramen (vernet) syndrome

A
  • CN IX, X, and XI are affected
  • loss of taste from posterior 1.3 of tongue 9
  • reduced parotid gland secretion 9
  • loss of gag reflex 9,10
  • dysphagia 9,10
  • dysphonia/hoarseness 10
  • soft palate drop with deviation of the uvula towards the normal side 10
  • SCM and trapezius muscle paresis, 11
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28
Q

lipid peroxidation- define and then explain using carbon tetrachloride as a n example

A
  • when free radical reaction with lipids to form peroxide which leads to damage
  • P-450 system breaks down CCL4 into CCL3 a free radical that causes lipid peroxidation leading to hepatocyte necrosis
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29
Q

which HY drug causes hemorrhagic cystitis?

A

-cyclophosphamide

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30
Q

chronic MTX use for RA and anti-inflammatory process is associated with what toxicity

A

-cirrhosis

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31
Q

used to mark b lymphocytes and t lymphocytes

  • myeloid cells
  • neuroentrocrine tumors
A
  • CD 20/ CD3
  • MPO
  • chromogranin A
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32
Q

name diseases associated with:

  • defect in UV-specific endonuclease (nucleotide excision repair)
  • 3’-5’ exonuclease defect (defect in mismatch repair)
A
  • xeroderma pigmentosum

- hereditary nonpolyposis colorectal cancer (HNPCC)

33
Q

similarity of molecular pathophysiology of non-small cell carcinoma and CML?

A
  • in both cases a chromosomal rearrangement creates a fusion protein gene leading to constitutive tyrosine kinase activity
  • NSCLC results in EML4 (echinoderm mictotubule-assocaited protein like 4)-ALK (anaplastic lymphoma kinase)
  • CML results in a BCR-ABL fusion protein
34
Q

how to determine benign lymph node enlargement vs neoplasm?

A

use PCR to search for poissible gene rearrangments to determine if it’s polycolonal or monoclonal growth

35
Q

“waxing and wanning” painless lymphadenopathy. translocation, overexpression molecule

A
  • follicular lymphoma
  • t(14,18)
  • results in overexpression of bcl-2
36
Q

presentation of hairy cell leukemia

A
  • splenomegaly and pancytopenia in older men
  • cells with hair like projection
  • positive of TRAP (tartrate resistance acid phosphatase)
37
Q

presentation of diffuse large cell lymphoma- define, masses are commonly where?

A

aggressive non-H lymphomas of B origin

  • large lymph or extranodal mass
  • common seen in waldeyer ring (oropharyngeal lymphoid tissue) and GI tract
38
Q

mycosis fundgoidies- define, presentation, differential diag

A

cutaneous T-celll lymphoma

  • CD4+ in dermis and epidermis causes Pautrier microabcesses. can result in erythema, scaling, and thickening of skin
  • confused with eczema or psoriasis
39
Q

secretion of wht from where causes cachexia? presentation? mech

A

TNF- alpha from mac in response to infection and some tumor cells

  • anorexia, malaise, anemia, and weight loss
  • suppresses appetite, inhibits lipoprotein lipase and increases insulin resistance to peripheral tissues
40
Q

IFN alpha vs TNF alpha

A
  • from leukocytes and has antiviral as well as anti-tumor activity
  • from mac or tumor cells causing cachexia
41
Q

HHV-8 associated with? pt pop. presentation

A
  • kaposi’s sarcoma
  • HIV positive pts
  • blue violet or brownish skin plaques on extremities and mucous membranes
  • spindle and endothelial cell proliferation, RBC extravasation*, and inflammation
42
Q

human T-cell leukemia virus type-1. family.pt pop

A
  • retroviridae

- causes T-cell leukemia esp in pts from southern Japan

43
Q

CD 34 and vWF stain for

A

endothelium

44
Q

what causes chemical carcinogens to become ROS?

A

cytochrome P-450 mooxygenase

45
Q

benx(o) pyrene

A

chemical carcinogen

46
Q

how to prevent hemorrhagic cystitis? presentation

A
  • frequent urination, suprapubic pain, dsyruia, and hematuria
  • aggressive hydration, bladder irrigation, and mensa
47
Q

mensa- define and aka

A
  • a sulfhydryl compound that bind acrolein (toxic substance) in urine
  • aka 2-mercatopethansulfonate
48
Q

hereditary breast cancer is associated with mutation in which gene? function of gene? associated with which other cancer?

A
  • BRAC-1 and BRAC-2
  • tumor supressors that function in gene repair and regulation of cell cycle
  • ovarian
49
Q

APC gene is responsible for? associated cancers

A
  • cell attachment

- colon

50
Q

why can OCP decrease risk of ovarian cancer? what other things reduce risk of ovarian cancer?

A
  • b/c it reduces the number of times a woman ovulates decreasing the number of time that the ovary has to repair itself
  • multiparity and breast-feeding (reduced cycles)
51
Q

promotor or suppressor? ras

A

promoter

bladder, lung, colon, pancreas, kidney

52
Q

promotor or suppressor? N-myc

A

promoter

neuroblastoma, small cell, carcinoma of lung

53
Q

P or S? Nf-1

A

supressor

neuroblastoma type 1, sarcomas

54
Q

P or S? BRCA-1, BRAC-2

A

suppressors

breast and ovarian

55
Q

P or S? APC/beta catenin?

A

suppressors
gastric, colon, pancreatic
familial adenomatous polyposis coli

56
Q

P or S? ERB-B1?

A

promoter

squamous cell carcinoma of lung

57
Q

P or S ERB B2?

A

promoter

breast and ovarian cancer

58
Q

P or S? DCC

A

suppressor

colon

59
Q

P53 P or S?

A

suppressor

majority of cancers Li Fraumeni syndrome

60
Q

P or S? TGF-alpha

A

promoter

astrocytoma, heptocellular carcinoma

61
Q

P or S? sis

A

promoter

astrocytoma and osetocarcoma

62
Q

P or S? WT-1?

A

suppressor

wilms tumor

63
Q

P or S? RB?

A

suppressor

retinoblastoma and osterosarcoma

64
Q

P or S? abl

A

promoter

CML, ALL

65
Q

fibronectin-define, secreted from, bind to (3) to mediate (2)?

A
  • large glycoprotein
  • produced by fibroblasts and some epithelial cells
  • binds to integrins, matric collagen and glycosaminoglycans to mediate cell adhesion and mirgration
66
Q

hyaluronic acid-contains, role in ECM

A

glucronic acid containing glycosaminoglycan in ECM

-helps with water retention giving matrix lubricant properties and a viscous, gel like consistency

67
Q

keratin sulfate

A

galatcose- containing glycoaminoglyca in ECM

-help to maintain type 1 collagen fibril organization in cornea

68
Q

integrin mediated adhesoin of cells to basement membrane involves

A

-fibronectin, collagen, and laminin

69
Q

heparin sulfate- define and role in ECM

A

proteoglycan component of ECM

-vascular endothelial cell attachment to BM

70
Q

most common primary brain tumors in adults (3, origin, location, prognosis)

A
  • glioblastoma multiforme- from astrocytes, hemispheres, cross midline highly malignant, poor prognosis
  • meningiomas-arachnoid cells, brain surfaces, benign and well circumscribed,
  • acoustic neuromas- from Schwann cells of CN VIII, cerebellopontine angle
71
Q

sequence of epithelial malignancies. reversible step

A
  • low grade dysplasia (doesn’t involve entire thickness of epithelium)
  • high grade aka carcinoma in situ (entire epithelium but doesn’t penetrate BM)
  • invasive carcinoma ( breached BM)
  • can’t be reversed after cells have breached BN
72
Q

pseudopalisading around areas of necrosis

A

glioblastoma multiforme

73
Q

histological appearance of Burkitt’s lymphoma

A

“starry sky”

-diffuse infiltrate of lymphoid cells with numerous mitotic figures and interspersed mac surrounded by a clear space*

74
Q

what enzymes are responsible for repairing deamination of bases in DNA. not specific endonucleases b/c?

A
  • specific glycosylases

- specific endonucleases repair thymidine dimers

75
Q

caspases cleave where?

A

Cysteine-ASPartic acid proeASES

76
Q

role of ras in tumor generation

A

ras protein is a component of MAP-kinase pathway

-if overactive it’s makes the cell more sensitive to mitogenic stimuli

77
Q

when is RB active? when is it not?

A
  • active when hypophosphorylated

- inactive can phosphorylated

78
Q

folinic acid vs folic acid. how to cure MTX toxicity?

A
  • aka leuvocorin. folinic (N5-formyl-THF) enters in cycle as methylene THF and is converted to DHF by thymidylate synthetase
    -folic acid is converted to DHF with DHF reductase.
    -MTX inhibits DHF reductase so give
    folinic acid
79
Q

treatment for side effects of chemo

  • granulocytopenia
  • vomiting and nausea
  • cardiotoxicity
  • nephrotoxicity
  • tumor lysis syndrome
A
  • filgrastim (G-CSF analog)
  • ondansteron (block vagus-mediated vomiting and serotonin in chemo trigger zone)
  • dexrazoxane (antracycline aka doxorubicin)
  • amifostine (platinum-containing and alkylating chem agents)
  • allopurinol and hydration (for chemo against tumors with high turnover rate leukemias and lymphomas)

UWorld REview (17 decks)

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