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Surgery; Restart, ABSITE (BASIC) > Oncology, Transplantation > Flashcards

Oncology, Transplantation Flashcards

1
Q

The annual age-adjusted cancer incidence rates among men and women are decreasing for all of the ff EXCEPT

A

melanoma of skin
liver cancer
thyroid cancer
breast cancer

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2
Q

8 essential alterations in cell physiology that dictate malignant growth

A
  1. Self-sufficiency of growth signals
  2. Insensitivity to growth-inhibitory signals
  3. Evasion of apoptosis
  4. Potential for limitless replication
  5. Angiogenesis
  6. Invasion and metastasis
  7. Reprogramming of energy metabolism
  8. Evading immune destruction
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3
Q

Factors that suggest the presence of a hereditary cancer

A
  1. Tumor development at a much younger age than usual
  2. Presence of bilateral disease
  3. Presence of multiple primary malignancies
  4. Presentation of a cancer in the lesss affected sex (e.g. male breast cancer)
  5. Clustering of the same cancer type in relatives
  6. Occurrence of cancer in association with other conditions such as mental retardation or pathognomonic skin lesions
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4
Q

Benign extracolonic manifestation of FAP

A

Congenital hypertrophy of retinal poigment epithelium
Epidermoid cysts
Osteomas

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5
Q

Malignant associations of FAP

A 
Duodenal cancer
Periampullary cancer
Hepatoblastoma
Pancreatic cancer
Cholangiocarcionama
Thyroid ca
Desmoid tumor
Medulloblastoma
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6
Q

Mutation in RET gene

A

MEN2 syndrome

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7
Q

Mutation of TP53

A

Li-Fraumeni syndrome

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8
Q

Mutation in p16

A

Melanoma
Pancreaitc CA
Esophageal CA

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9
Q

Risk factors for breast cancer

A

Age at menarche
Ate at first live birth
First degree relative with cancer
Breast biopsies

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10
Q

Routine cancer screening is recommended for

A 
Thyroid
Testicles
Ovaraies
Lymph nodes
Oral cavity
Skin
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11
Q

Remarks on FAP

A

CELECOXIB has been shown to reduce polyp number and polyp burden

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12
Q

Remarks on head and neck cancer

A

13-cis-retinoic acid has been shown both to reverse oral leukoplakia and to reduce second primary tumor dev’t

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13
Q

Hyperacute rejection is caused by

A

Preformed antibodies

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14
Q

MOA of azathioprine

A

Converted to 6 mercaptopurine and inhibits both the de novo purine synthesis and salvage purine synthesis
relegated to adjunct after the introduction of cyclosporine and mycophenolate mofetil for transplant recepients
AZA is preferred in recepients who are considering conceiving a child

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15
Q

Drug interactions of azathioprine

A

Allopurinol, which blocks AZA’s metabolism, increasing the risk of pancytopenia.
If unavoidable, decrease the dose of AZA by 75%

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16
Q

Side effects of cyclosporine

A 
Hypertension
Nephrotoxicity
Hirsutism
Neurotoxicity (tremor, headache, seizure)
Gingival hyperplasia
Hypomagnesemmia
Hyperkalemia
17
Q

Postrenal transplant graft thrombosis usually occurs within

A

2-3 days

*doppler ultrasound may help confirm diagnosis

18
Q

The 1-year graft survival after renal transplantation is

A

92% - deceased donor kidney

96.5% - living donor kidney

19
Q

After compoletion of the vascular anastomoses, drainage of a transplanted pancreas is accomplished by anastomosis

A

Of the duodenal segment to the bladder (bladder drainage)
Or to the small bowel (enteric drainage)
^pancreatic secretions
*for the venous drainage, systemic venous drainage is preferred over portal venous drainage

20
Q

Contraindications to a liver transplant

A 
Insufficient cardiopulmonary reserve
Uncontrolled malignancy or infection
Refractory medical noncompliance
Severe COPD with O2 dependence
Severe refractory pulmonary hypertension with a mean pulmonary artery perssure >35mmHg
21
Q

Heart donors and recipiens are matchd via

A

Status on the UNOS waiting list
Size match
Blood type

22
Q

Heart is assessed if it can withstand up to ___ hours of cold ischemic time during procurement, transport, and surgery

A

4

23
Q

Most common mechanism for transplant rejection

A

Cellular rejection, in which damage is done by activated T lymphocyts

24
Q

In thre prevention of graft rejection, cyclosporine…

A

Selectively inhibits T cell activation.
Cyclosporine binds with its cytoplasmic receptor protein, CYCLOPHILIN, which subsequently inhibits the activity of CALCINEURIN, thereby decreasing the expression of several critical T-CELL ACTIVATION GENES, the most important being for IL-2. As a result, t-cell activation is suppressed

25
Q

Remarks on kidney transplant and death

A

30-42% of deaths with a functioning kidney graft are due to CVD

26
Q

The best method of monitoring the development of acute rejection in a patient after cardiac transplantation is

A

Endomyocardial biopsy

Both T-cell mediated and B-cell mediated rejection are monitored

27
Q

First organ to be transplanted from living donors

A

Kidney

28
Q

The most common organ donated

A

Kidney

29
Q

Remarks on kidney transplant

A

The donor’s left kidney is usually preferable because of the long vascular pedicle. ⭐️
Donor kidneys with multiple renal arteries should be avoided to decreases the COMPLEXITY of the vascular reconstruction and to hel avoid GRAFT THROMBOSIS

30
Q

Risk of death with donation

A

Nephrectomy: <0.05%

Partial hepatectomy: 0.2%

31
Q

The single most important factor in determining whether to perform a transplant between a specific donor and recipient is

A

ABO blood types of the donor and recipent ✅

32
Q

The most common diagnosis leading to a heart transplant is

A

Ischemic dilated cardiomyopathy

Followed by idiopathic dilated myopathy and congenital heart disease

33
Q

The most significant side effect of sirolimus is

A

Hypertriglyceridemia, a condition that may be resistant to statins and fibrates

34
Q

Most common type of rejectiotn

A

Acute rejection
Occurs within days to weeks
Divided into cellular and humoral rejection

35
Q

Most common side effect of MMF

A

GI in nature, diarrhea, nausea, dyspepsia, bloating

36
Q

Backbone of most immunosuppressive regimens

A

Calcineurin inhibitor tacrolimus (Prograf)
-acts by binding PKBPs, causing roughly 10-100x more potent inhibition of IL-2 production than cyclosporine (which acts by binding cyclophilins)
*tracrolimus causes a higher incidnece of new-onset diabetes posttransplant than does cylcosporine
Other s/e: alopecia, nephrotoxicity, neurotoxicity, hypertension, hyperK, hypoMg, increased incidence of certain types of INFECTION

Surgery; Restart, ABSITE (BASIC) (9 decks)

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