Quiz 6 (3rd midterm) Flashcards
Sty
skin infection like a pimple on eyelid - mostly external
Cancers in the eye
basal and squamous celll carcinoma of the eyelid
- usually slow growing Melanoma -
varying colors and potentially aggressive
- usually occur in older people
Glaucoma
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
Open angle glaucoma
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
Gonioscopy
measures anterior chamber ANGLE *Angle has a G in it
Tonometry
measures intraocular pressure *intraocular has a T in it
Pilocarpine
tx for Glaucoma
- cholinomimetic, contracts ciliary muscle and increases outflow of aqueous humor
Timolol
tx for glaucoma
- Beta blocker that decreases aquous humor secretion secreteion (popular for open angle glaucoma)
Alpha agonist - non selective
example is epinephrine
Latanaprost
a PROSTaglandin -increases outflow of aquous humor (popular for open angle glaucoma)
Anticholinergic and stimulants (amphetamines
WORSEN glaucoma!
Carbonic anhydrase inhibitor
Acetazolamide : reduces aqueous humor secretion
Which drugs decrease aqueous humor secretion?
timolol,acetazolamide
Which drugs increase outflow of aquous humor?
pilocarpine, latanaprost
what worsens glaucoma?
amphetamines (anticholinergic and stimulant)
Cataracts - definition and cause
opacification of lens Causes include: Diabetes, UV exposure, aging, tx is usually surgical removal
Background diabetic retinopathy
-associated with hemoraging and ischemic spots (expressed as cottonwool spots) -
hypertension causes similar retinopathies as diabetes
Age related macular degeneration
>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
Tx for wet AMD
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
Retinal detachment
usually a retinal tear resulting from trauma
Retinoblastoma
most common tumor in children
Ear is often what
involved in referred pain associated with mouth and dental structures because both are innervated by trigeminal complex
Meniere disease symptoms pathology dx tests
- 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
Meniere disease surgical intervention pharmacology
* 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
Meclizine (antivert)
for meinere disease. H1 blocker, anticholinergic, CNS depressent-antimotion sickness med and xerostomia
Diazepam
for meniere disease
Promethazine
for meniere disease -
H1 blocker, anticholinergic, antinasuea and motion sickness, xerostomia
Hydrochlorothiazide
for meniere disease
- diuretic, regulate fluid volume and pressure in inner ear
Dexamethasone
for meniere disease - long acting steroid/inject in ear, reduces fluid
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.
- Tinnitus pharmacology
- Amoxicillin or Amoxicillin + clavulante or ceflaclor for acute OM
- Second level drugs include: trimethoprim (sulfa) or macrolides
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
Neoplasm
- 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
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
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
Features of cancer
- 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
- 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.
- 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
- 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
- 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
- Metastatic pattern varies between tumors
(e.g., due to varying growth factors)
