Quiz 6 (3rd midterm) Flashcards
1
Q
Sty
A
skin infection like a pimple on eyelid - mostly external
2
Q
Cancers in the eye
A
basal and squamous celll carcinoma of the eyelid
- usually slow growing Melanoma -
varying colors and potentially aggressive
- usually occur in older people
3
Q
Glaucoma
A
high intraocular pressure in the anterior chamber: increased pressure within eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hrs: supplies nutrients and removes waste). Can damage optic nerve and cause blindness
4
Q
Open angle glaucoma
A
wide space between iris and cornea
- most common 90%
- slow clogging of drainage canals - symptoms subtle and often undetected
- 3 million cases in US - African Americans especially vulnerable
- Increased risk of diabetes and HP
5
Q
Gonioscopy
A
measures anterior chamber ANGLE *Angle has a G in it
6
Q
Tonometry
A
measures intraocular pressure *intraocular has a T in it
7
Q
Pilocarpine
A
tx for Glaucoma
- cholinomimetic, contracts ciliary muscle and increases outflow of aqueous humor
8
Q
Timolol
A
tx for glaucoma
- Beta blocker that decreases aquous humor secretion secreteion (popular for open angle glaucoma)
9
Q
Alpha agonist - non selective
A
example is epinephrine
10
Q
Latanaprost
A
a PROSTaglandin -increases outflow of aquous humor (popular for open angle glaucoma)
11
Q
Anticholinergic and stimulants (amphetamines
A
WORSEN glaucoma!
12
Q
Carbonic anhydrase inhibitor
A
Acetazolamide : reduces aqueous humor secretion
13
Q
Which drugs decrease aqueous humor secretion?
A
timolol,acetazolamide
14
Q
Which drugs increase outflow of aquous humor?
A
pilocarpine, latanaprost
15
Q
what worsens glaucoma?
A
amphetamines (anticholinergic and stimulant)
16
Q
Cataracts - definition and cause
A
opacification of lens Causes include: Diabetes, UV exposure, aging, tx is usually surgical removal
17
Q
Background diabetic retinopathy
A
-associated with hemoraging and ischemic spots (expressed as cottonwool spots) -
hypertension causes similar retinopathies as diabetes
18
Q
Age related macular degeneration
A
>10% of patients > 80 years old
- Most common cause of severe loss of sight in 60+ pts.
- Almost never occurs in individuals who are less than 50 yrs smoking is a risk factor
19
Q
Tx for wet AMD
A
monoclonal Ab (antiangiogenic Ab)
- ex Bevacizumba (avestatin)
- inject 1-2x a month for wet AMD in vitreous humor *some evidence that vit c or zinc oxide may reduce development as well
20
Q
Retinal detachment
A
usually a retinal tear resulting from trauma
21
Q
Retinoblastoma
A
most common tumor in children
22
Q
Ear is often what
A
involved in referred pain associated with mouth and dental structures because both are innervated by trigeminal complex
23
Q
Meniere disease symptoms pathology dx tests
A
- symptoms: vertigo hearing loss, nausea, migraines sometimes, swimming feeling, tinnitus, balance problems
- Pathology: endolymphatic hydrops- swelling/excess fluid in labrynth *risks : improper inner ear fluid drainage, allergy, viral infection, head trauma, migraines - dx test : hearing and balance assessment
24
Q
Meniere disease surgical intervention pharmacology
A
* d. Some surgical interventions, but extreme
- Pharmacology:
* Meclizine (Antivert): H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, xerostomia
* Diazepam
* Promethazine: H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia
* Hydrochlorothiazide: diuretic-regulate fluid volume and pressure in inner ear
* Dexamethasone; long-acting steroid/inject into the ear—it reduces fluid
25
Meclizine (antivert)
for meinere disease. H1 blocker, anticholinergic, CNS depressent-antimotion sickness med and xerostomia
26
Diazepam
for meniere disease
27
Promethazine
for meniere disease -
H1 blocker, anticholinergic, antinasuea and motion sickness, xerostomia
28
Hydrochlorothiazide
for meniere disease
- diuretic, regulate fluid volume and pressure in inner ear
29
Dexamethasone
for meniere disease - long acting steroid/inject in ear, reduces fluid
30
Otitis media - pathology -symtpoms
- associated with blockage of Eustachian tube. Often associated with infections by strep, pneum, or haemophilus influe
- Symptom: pain, ear discharge, headache, hearing loss, tinnitus, vertigo, immobile eardrum ( swollen and inflammed,) fever.
31
- Tinnitus pharmacology
- Amoxicillin or Amoxicillin + clavulante or ceflaclor for acute OM
- Second level drugs include: trimethoprim (sulfa) or macrolides
32
Cancers
- 2nd leading cause of death in US - Caused by accumulation of DNA mutations in cells acquired spontaneously or induced-usually multiple mutations
- Properties:
- Non-responsive to normal physiologic cues
- Lack of response to growth inhibitory signals
- Avoid normal cell cycle mediated death
- Develops own angiogenesis
- Evades immune detection
33
Neoplasm
1. Uncontrolled growth of cells, progeny of a single cell 2. Names usually end in –oma 3. Benign epithelial tumor is adenoma (if glandular), a papilloma (if papillary) 4. Malignant tumor (metastasizes) -Epithelial= carcinoma -Mesenchymal= sarcoma -Lymphoid= lymphoma -Melanocytic tumor=melanoma -Hematopoietic= leukemia
34
Examples of neoplasms
- Squamous cell carcinomas - Adenosarcomas-grandular epithelium - Lipoma-benign - Liposarcoma-malignant - Osteosarcoma-malignant bone cancer - Rhabdomyosarcoma-malignant skeletal muscles, usually kids - Rhabdomyoma-benign - Leiomyosarcoma-malignant tumor of smooth muscle - Leiomyoma- benign tumor SOARR LLLL
35
Not neoplasm
- Granulomas are an inflammatory mass-not a neoplasm - Hemartoma: mal-developed tissue native to site (e.g., nodular tongue) - Choristoma: mal-developed tissue in other organs
36
Features of cancer
1. Lung cancer is leading cause of cancer death in US, followed by prostate in men and breast in females 2. Environment most common cause of sporadic cancers; a subset are hereditary 3. Solid tumor mutation panels are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses-sometimes can predict prognosis 4. Common for success response not to kill “all” of the cells (e.g., 99.9% kill)-may lead to recurrence months to years later
37
5. Chromosomal changes associated with cancers include:
- Deletions - Translocations - Duplications - Amplifications - Abnormal number of chromosomes a. Cytogenetics used to look for the abnormalities listed above. E.g. there is a 9:22 translocation on the Philadelphia chromosome that leas to chronic myelocytic leukemia -use molecular strategies such as PCR and microarrays to detect.
38
6. What must a malignant tumor do grow grow?
- Develop a signal to proliferate - Avoid apoptosis -Invade stroma (if carcinoma) - Metastasize - Induce angiogenesis - Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling) - Develop telomerase to prevent cellular senescence
39
6. Genetic targets for tumors include:
- Oncogenes (promote proliferation)
- e.g. growth factors or corresponding receptors
- Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary)
\* P53 gene is most common suppressor gene mutation (lost in 50% of malignancies)
\* WT-1 gene- regulates apoptosis such as in Wilms tumor
\* APC-adenomatous polyposis coli-tumors in bowel and pancreas
- Apoptosis regulating genes (P53 gene also affects apoptosis)
- DNA repair genes
- Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer)
- Angioneogenesis (tumors release vascular endothelial growth factor) - Develop properties for invasiveness
40
7. Most chemotherapy targets proliferating cells
- Consequently, good for killing fast growing tumors, not so good for slow or non-growing tumor cells - Injure rapidly proliferating normal cells such as bone marrow, intestinal mucosa, hair
41
8. Metastatic pattern varies between tumors
(e.g., due to varying growth factors)
42
9. Causes of tumors:
9. Causes: a. Mutation (e.g., chemical carcinogens-alkylating agents or nitrosamines in food, UV light-skin cancers, radiation)-
- Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen b. Tumor viruses (e.g., HPV-human papilloma virus-carcinoma of cervix)
c. Bacteria and inflammation (H. pylori, and asbestosis d. Hormonal activation (sex hormones)
e. Lack of immune responses
f. Genetic predisposition
43
How cancers kills
a. Growth and metastasis b. Involve vital organs c. Cachexia
44
Carcinoma (malignant tumor type)
epithelium/endothelium • Most common type of malignancy 1. Most often metastasizes to regional lymph nodes, but can spread through blood-dependent on type
45
Carcinoma (malignant tumor type)
epithelium/endothelium • Most common type of malignancy 1. Most often metastasizes to regional lymph nodes, but can spread through blood-dependent on type
46
2. Squamous Carcinoma (malignant tumor type)
✓ similar appearance regardless of primary site - usually slow growing on skin - associated with lips or lung more dangerous - can form keratin pearls
47
3. Adenocarcinoma (malignant tumor type)
eg, colon or breast adenocarcinoma)
✓ forms glands
✓ forms glands
✓ tumors of cuboidal or columnar cells
✓ types include: - colon \*\*\*
- prostate-fairly innocuous looking
- breast-many positive for estrogen receptors - lung \*\*\*small cell carcinomas are aggressive with poor prognosis
\*\*\*large cell carcinomas are slower with better prognosis
48
4. neuroendocrine tumors- (malignant tumor type)
carcinoids of GI tract and lung
49
Mesenchymal tumors
- sarcomas-Kaposi’s sarcoma [linked with AIDS], - angiosarcoma, malignant tumor of endothelial tissue (vessels); can result from radiation therapy - chondrosarcoma-malignant tumor of cartilage (chondrocytes). - osteosarcoma, - leiomyosarcoma (vs. benign leiomyoma) - malignant tumor of smooth muscle - liposarcoma - Pushing, rather than an invasive cancer
50
E. Sarcomas-
mesenchymal origin • Pushing, rather than an invasive cancer
51
F. Leiomyoma vs. Leiomyosarcoma—
smooth muscle tumors
52
G. Cancer terms: • Incidence: • Mortality: • Prevalence:
• newly diagnosed cases/time • death/time period • # new and pre-existing cases at one moment
53
Cancer Epidemiology
1. 1.5 million new cancers diagnosed in 2011 ~600,000 2. Lung cancer leading cause of cancer deaths in US followed by prostate for men and breast cancer for women 3. Japanese risk of gastric cancer 7X that in US 4. Breast cancer more common in US and Europe than in other countries 5. Liver cell carcinoma most common in Africa due to link with viral hepatitis. 6. The environment seems to be more important in causing cancer than genetics 7. Genetic risks, example: - Familial adenomatous polyposis/colon cancer linked to APC gene - Some breast and ovarian cancers linked to BRCA 1 & 2 genes
54
Cancer Treatment
1. Surgical removal 2. Radiation therapy-maximize exposure of tumor and minimize exposure of normal tissue 3. Chemotherapy - most damage to rapidly proliferating cells - treats whole body - tumor can develop resistance
55
Cancer therapeutics
1. 1/3 patients cured with local treatment (surgery, radiotherapy)
2. Chemotherapy used for advanced disease or as an adjuvant (administered after primary treatment (e.g., surgery or radiation) to prevent secondary tumor development or spread)\*\*
3. Anticancer drugs usually exert action on cells in cell cycle
4. Typically requires combination of drugs (Combine chemo/radiation tx in locally advanced disease)\*\*
5. Need maximal cell kill within the range of toxicity tolerated by host
6. Adjust scheduling and overlapping toxicities to protect the patient.
56
Drug resistance for cancer
Drug resistance - P53 is a mutation that occurs in up to 50% of all human tumors-leads to resistance to radiation therapy and anticancer agents
57
Alyklating agents
1. E.g, Cyclophosphamide
- Hodgkin’s lymphoma
- multiple myeloma
- Leukemia
- Breast cancer /multiple myeloma
2. mech: Transfer their alkyl groups to various cell constituents such as DNA/ alkylation of DNA in nucleus—cause miscoding—can break DNA strands
3. Adverse effects: - Nausea, vomiting
- Damage to rapidly growing tissues (bone marrow, G.I. tract, reproductive tissue)\*\*
- Carcinogenic in nature (increases risk of secondary cancer)\*\*
4. Resistance: increased capacity to repair damaged DNA \*\*
58
E. Nitrosources
D. Nitrosoureas
1. Procarbazine
- used for combination regimens for Hodgkin’s lymphoma \*gets into brain Passes BBB and used to treat brain tumors
59
F. Platinum analogs
1. E.g., Cisplatin
Treats cancer of the testicles, bladder, ovaries, or lung. \*solid tumors
- Used for broad range of solid tumors -nephrotoxic
60
G. Antimetabolites
1. Acts on intermediary metabolism of proliferating cells 2. E.g., methyltrexate-folic analog
- Inhibits tetrahydrofolate
-Interferes with formation of DNA, key proteins -Treats head and neck cancers, breast cancer Toxicity: mucositis, diarrhea
61
H. Natural Product Cancer, chemotherapy Drugs
1. \*\*Vinblastine or vincristine (Vinca Alkaploids)
2. Inhibits tubulin polymerization-cytoskeleton component
- -arrests in cell division and causes cell death\*\*
3. Toxicity: mucositis, myelosuppression\*\*
4. Treat: breast cancer and Kaposi’s lymphoma\*\*
62
I. Antitumor antibiotics
1. Anthracyclines (e.g., doxorubicin/BLEOMYCIN-treat breast cancer)
\*\*• Mechanism: formation of free radicals that bind to DNA, causing breaks
• Treat: lymphomas, breast cancer and thyroid cancer
• Toxicity: nausea and red (not blood) urine
63
J. Treatments:
1. Hodgkin’s lymphoma much better controlled today
2. Breast cancer-much more effective due to early treatments
3. Prostate:
- 1 in 8 men,
- **Elevates PSA and acid phosphatase**
- Treat by eliminating testosterone production through surgery castration
• LH-releasing hormone agonists
64
Gastrointestinal: Esophagus
1. Chemical esophagitis-irritants to squamous mucosa 2. Infectious esophagitis-usually immunosuppressed (often Herpes or Candida)
3. Cytomegalovirus (CMV) affects entire GI tract-elderly or immunocompromised-multiple discrete, well-circumscribed superficial ulcers
65
Reflux Esophagitis
a. Relaxation of gastroesophageal sphincter
b. Symptoms: Burning, Excessive salivation, Choking
c. Aggravating factors: obesity, pregnancy, alcohol/tobacco use
d. Medical treatment: antacids, H2 blockers, PPI -lose weight, stop smoking/drinking
e. Complications: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus
66
Stomach 1. Reactive (erosive) gastropathy
a. Induced by: alcohol, NSAIDS, iron, Stress, bile reflux
67
Stomach 2. acute injury
a. Acute gastritis—asymptomatic with possible significant blood loss
68
Stomach 3. Acute peptic ulceratin
a. Nausea, vomiting, NSAIDs, stress
69
Stomach 4. Chronic gastritis
a. H. pylori gastritis-duodenal and pyloric ulcers; may lead to cancer
b. Autoimmune gastritis
70
Stomach 5. Peptic ulcer disease
a. H. pylori and NSAIDs causative
b. Increased acid
c. Punched our ulcers-potential for perforation and hemorrhage
71
Stomach 6. Polyps
a. Hyperplastic - Response to gastric injury, around ulcers
72
Stomach cancer other name
gastric carcinoma
73
Small bowel intestinal obstruction
1. Intestinal obstruction
a. Usually mechanical (80%)
b. Neoplasm and infarction (20%)
74
Irritable bowel disease (selective diarrheal disease)
a. Irritable bowel syndrome
- Relapsing pain, bloating, constipation/diarrhea
- Diet, abnormal motility and stress are factors
- No gross microscopic abnormalities
75
b. Infectious self-limiting colitis (selective diarrheal disease)
- Caused by microorganisms such as salmonella, E. coli
76
c. Pseudomembranous colitis (selective diarrheal disease)
- Usually caused by clostridium difficile
- Spread via person to person
- Often follows antibiotic therapy
- Most common nosocomial infection in older adults
77
a. Crohn disease: ( Inflammatory Bowel Disease)
- Similar to ulcerative colitis
- It skips lesion and has intermediate constrictures
- Granulomas
- Fistulas and perianal disease - Also affects upper GI tract
78
b. Ulcerative colitis ( Inflammatory Bowel Disease)
- More continuous especially in the colon
79
Tumor viruses
- HPV-human papilloma virus-carcinoma of cervix and oropharyngeal - Epstein-Barr: mononucleosis - Hep B & C viruses: hepatocellular carcinoma - HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS)
80
Bacteria and inflammation can cause what type of cancer?
(H. pylori [gastric adenocarcinoma], and asbestosis)
81
Chemical carcinogens that are involved in causing cancer include?
- Reactive chemical (e.g., free radicals) alter DNA
- Alkylating agents—some of which are used to tx cancer
- Polycarbon aromatics: e.g., benzopyrene in smoke and cooked meat
- Aflatoxin- fungus on peanuts and other foods- not so much in US
- Nitrosamine/nitates in foods
- Metal ions: nickel, arsenic
82
Can Hormonal activation (sex hormones) , Lack of immune responses (i.e., immunocompromised) , Genetic predisposition , and Variation in hepatic susceptibility of CYP1A1 and glutathione activity cause cancer?
Yes note under lack of immune response :
- altered host response to tumor can interfere with natural defense mechanisms
- immunosuppressed children have 200X increased risk for cancer
83
Radiation can cause ...
-skin cancer caused by UV rays
84
X-rays/gamma radiation cause what type of cancer?
-leukemias -papillary thyroid and breast cancers
85
How cancer kils
a. Growth and metastasis
b. Involve vital organs
c. Get a flood of cytokines that shut down organ functions
d. Cachexia
86
Lymphomas 2 main types
Lymphomas \*Hodgkins lymphoma
- younger patients (e.g., lymphoblastic leukemia)
- usually good prognosis
- sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes)
\* Non-Hodgkin’s lymphoma -various levels of aggressiveness/sometimes poor prognosis
- Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma linked to Epstein-Barr infection and can affect maxilla and mandible; very aggressive from B lymphocytes. Prognosis can be poor.
- **Acute leukekmia principally affects bone marrow**
87
Grading of tumors: TNM
- T, size and extent of primary tumor
- N, presence and number of lymph node metastases
- M, presence of distant mestatses
88
Serological tests- PSA CBA CA-125 HCG
most useful for assessing cancer recurrence after treatment
- PSA: prostate specific antigen
- CBA: carcinoembryonic antigen-colon carcinoma
- CA-125: serous ovarian carcinoma
- HCG: choriocarcinoma
89
New cancer treatments strategies
- Imatinib (Gleevec) tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia
- Hormones for breast and prostate cancers
- Erlotinib—blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer
- Retinoic acid-induced differentiation of some leukemias (e.g., promyelocytic leukemia)
90
- Imatinib (Gleevec)
tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia
91
- Retinoic acid
-induced differentiation of some leukemias (e.g., promyelocytic leukemia)
92
What is a risk factor for AMD? What is it associated with? Does wet or dry progress faster?
- Smoking is a risk factor
- Associated with gene polymorphisms, smoking, cardiovascular disease
- Loss of central vision
- Progress of disease faster in wet (hemorrhage and fluid present) than dry (large majority) macular degeneration
93
Closed angle glaucoma
\ this is when the iris is fused to the cornea. Occurs iris fused to cornea.
Occurs less than 10 percent of the time, rapid closing of drainage canals, symptoms noticeable and surgery ncessary
94
Erlotinib—
blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer (new cancer tx)
95
- Imatinib (Gleevec)
tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia (new cancer tx)
96
A. Principle of drug combinations in fighting cancer
Usually single drugs at clinically tolerable doses does not cure cancer alone.
- Efficiency usually better in combinations
- Avoid toxicity overlap
- Design optimal scheduling-e.g., maintain constant intervals with treatment free interval as short as possible, while allowing most sensitive tissue adequate time to recover (e.g., bone marrow).
97
B. Drug resistance cancer that exhibits drug resistance on first go
- Melanoma: exhibits primary resistance on initial exposure (lack of tumor response)
- need multiple exposures to treatment to get response of tumor Sometimes tumor acquires resistance during treatment
98
5-Fluorouracil
1. Inhibits thymidine synthase, decreases NDA synthase and decreases DNA synthasis and function
2. treats: colorectal, anal, breast, head & neck, and hepatocellular cancers
99
IV. Leukemias
A. Acute Lymphoblast Leukemia (ALL)—most common cancer in children.
B. Acute myelogenous leukemia (AML)—most common acute form of leukemia in adult
• Cytarabine is single most active agent
100
C. Hodgkin’s lymphoma
* Hodgkin’s lymphoma much better controlled today
* B-cell neoplasm (Reed-Sternberg cell)
* EBV virus found in ~80%
* Tx: anthracycline, doxorubicin, bleomycin, vinblastine
101
D. Multiple Myeloma
1. Plasma cell malignancy, primarily in bone marrow
2. Symptoms:
• Bone pain
• Fractures
• Anemia
• Tx: alkylating agent; prednisone
102
E. Breast cancer
* Stage I: small, primary tumor --surgery alone is an 80% cure
* Stage II: positive node; post-operative use of chemo (e.g., 6 cycles of cyclophosphamide, methotrexate and fluorouracil).
* Stage III-IV: a major challenge
* Breast cancer-much more effective resolution due to early treatments
103
D. Gastrointestinal
* Colorectal cancer most common GI malignancy
* Tx: 5-fluorouracil (40-50% response rates)
104
E. Secondary malignancies
* Late complication of alkylating agents
* most frequent is acute myelogenous leukemia—observed as early as 2-4 years after; also see Non-Hodgkin’s lymphoma and bladder cancer
