Quiz 6 (test 3) Flashcards
What is a sty?
Skin infection like a pimple on the edge of the eyelid. Associated with hair follicle
True or false… cancers of the eyelid such as ___ and ___ destroy lashes.
True
Basal cell
Squamous cell
What is glaucoma?
High intraocular pressure in anterior chamber
Increased pressure within eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hours; supplies nutrients and removes waste). Can damage optic nerve and cause blindness
True or false… glaucoma can cause optic nerve damage and cause blindness
True
What is closed-angle glaucoma?
Iris fused to cornea
Often painful
Fast developing
Requires immediate attention to avoid blindness
What is open angle glaucoma?
Wide space between iris and cornea
Reduction in drainage
Slow developing
What is the most common form of glaucoma (90%)?
Open angle glaucoma
What are four risk factors for open angle glaucoma?
Age
African American
Diabetes
Hypertension
_____ measures intraocular pressure
Tonometry
Name three drugs that can be used to treat glaucoma
Pilocarpine
Timolol
Lantanoprost
What is the mechanism of pilocarpine in the treatment of glaucoma?
Cholinomimetic
Contract ciliary muscle and increases outflow of aqueous humor
What is the mechanism of timolol in the treatment of glaucoma?
Beta blocker
Decreases aqueous humor secretion
What is the mechanism of lantanoprost in the treatment of glaucoma?
Prostaglandin
Increase outflow of aqueous humor
What drugs should you avoid in a patient with glaucoma? Why?
Anticholinergics
Stimulants (amphetamines)
These drugs worsen glaucoma
What is the #1 cause of blindness worldwide? What is the #2 cause of blindness?
1 = cataracts
What are cataracts? What causes it?
Opaque lens due to…
Age
UV exposure
Diabetes
Steroid use
What has micro-aneurysms of retina and cotton wool spots from ischemia?
Diabetic retinopathy
What does hypertensive retinopathy look like?
Diabetic retinopathy
> ___% of pts >___ years of age have age-related macular degeneration
10%
80 years old
Age related macular degeneration is a loss of ___ vision which widens ___. It is associated with ___, ___, and ___.
Central vision
Widens laterally
Gene polymorphisms
Smoking
Cardiovascular disease
Age-related macular degeneration progresses faster in ___(which is?..) than ___ (which is?…)
Wet (hemorrhage and fluid present behind retina
Dry (large majority)
True or false… smoking is a risk factor for age-related macular degeneration
True
What are the pharmacological options for age-related macular degeneration?
Minimal options
Some evidence that antioxidants such as vitamin C or zinc oxide may help reduce development, but benefit is minimal
What is the most common cause of retinal detachment?
Usually a retinal tear resulting from trauma
What is the most common tumor in children?
Retinoblastoma
What is meniere disease?
Excess of endolymphatic fluid in inner ear
What are the symptoms of meniere disease?
Vertigo
Healing loss
Nausea
Sometimes migraine
Headaches
Swimming feeling
Tinnitus
What are fours risks for developing meniere disease?
Abnormal immune response
Allergies
Head trauma
Migraines
What are 5 drugs that can be used to treat meniere disease?
Meclizine
Diazepam
Promethazine
Long acting steroids
Hydrochlorothiazide
What is meclizine?
H1 blocker and anticholinergic used to treat…
meniere disease
CNS depressant
Motion sickness
Xerostomia
What is promethazine?
H1 blocker and anticholinergic used to treat..
Meniere disease
Nausea
Motion sickness
Xerostomia
What is hydrochlorothiazide?
Diuretic
Regulates fluid volume and pressure in inner ear
What are the symptoms of otitis media?
Pain (can be mistaken for dental or sinus pain)
Ear discharge
Headache
Hearing loss
Tinnitus
Vertigo
Immobile
Bulging eardrum
What drugs can you use to treat otitis media?
Amoxicillin
Or
Amoxicillin + clavalunate
or
ceftriaxone (rocephin 3rd generation cephalosporin) for acute OM
Drain for chronic with effusion if necessary
What is the cause of otitis media?
It is middle ear inflammation due to blockage of Eustachian tube
Most cancers arise ___, but some come from benign tumors
De novo (starting from the beginning)
What is the second leading cause of death in the US after cardiovascular?
Cancers/tumors
What is cancer caused by?
Accumulation of DNA mutations in cells acquired spontaneously or induced (environment)
What are 5 properties of cancer?
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
What is a neoplasm?
Uncontrolled growth of cells
Progeny of a single cell
Name usually ends in -oma
A benign epithelial tumor of glandular origin is called an _____. What if it is projected?
Adenoma
Papilloma
What is a malignant tumor?
One that metastasizes
In regards to malignant tumors…
Epithelial = ____
Mesenchymal = _____
Lymphoid = ______
Hematopoietic = ______
Carcinoma
Sarcoma
Lymphoma
Leukemia
What is an adenocarcinoma?
Malignancy of glandular epithelial cells
What is a lipoma?
Benign tumor of fat cells
What is an osteosarcoma?
Malignancy of bone cells
What is a leiomyoma?
Benign tumor of smooth muscle
What are granulomas?
Inflammatory mass of immune cells
*not a neoplasm
True or false… skin tags are considered neoplasms
False
What is a hamartoma?
Not a malignancy
Mal-developed tissue in proper tissue
What is a choristoma?
Normal tissue in another organ
What is a myxoma?
Benign tumor usually of fibroblast frequently in the heart
What is a teratoma?
Germ cell tumor that can contain tissue or tissues not associated with surrounding organ (tooth bud in an ovary)
True or false… sarcomas are the most common form of malignancy.
False. Carcinomas are the most common.
Where do carcinomas most often metastasize to?
Regional lymph nodes, but can spread through blood… dependent on type
Carcinomas are [high/low] nuclear: cytoplasmic ratio. What does that mean?
High nuclear: cytoplasmic ratio, which underscores the abnormality of nuclear regulation
Carcinoma [is/is not] invasive, and its pattern of spread is usually [unpredictable/predictable].
Is invasive
Predictable
What is carcinoma in situ?
Not invasive and doesn’t metastasize
What are two forms of carcinoma in situ?
Squamous cell carcinoma
Adenocarcinoma
Squamous cell carcinoma has a similar ___ regardless of primary site. Its prognosis depends on ___.
Appearance
Site
What sites of squamous cell carcinoma has a good prognosis? What has a bad prognosis?
Skin is less dangerous
Lip, oral cavity, lung is dangerous
What type of carcinoma forms glands and cells and often makes protein mucin?
Adenocarcinoma
Name two neuroendocrine tumors
Carcinoid tumors
Small cell
What are carcinoid tumors?
Usually show up in GI tract or lungs (typically low grade)
If well-developed, usually do better. If not well differentiated, they do not do as well
True or false… small cell lung carcinomas are highly malignant
True
Carcinoid tumors of the GI or lung are typically [high/low] grade
Low
Sarcomas are a malignant ___ tumor. It has ___ rather than invasive border. It is [more/less] likely to metastasize - when it does, it is by ____ (not ___).
Mesenchymal
Pushing
Less
Blood, not lymph nodes
What is a smooth muscle malignancy most often in the uterus?
Leiomyosarcoma
What is the most common form of bone cancer?
Osteosarcoma
What is a hepatoma?
Malignancy of hepatocytes in liver
What is rhabdomyosarcoma?
Malignancy of skeletal muscle
Describe the progression of malignancies
Normal - hyperplasia (grows) - dysplasia (grows and cell nuclei charge) - cancer (grows and invades)
What are the cytological features of carcinomas?
Nuclear enlargement
Abundant mitotic figures
Pleomorphic (can exist as multiple cell types and morphologies)
Lipomas are benign, small, and very common. The cells look ___ and usually ___
Normal
Subcutaneous
Ewing sarcoma is most frequently seen in ___
Children
Chondrosarcoma develops from ___
Cartilage
Lymphomas are cancers of ___ and ___.
Blood cells
Bone marrow
___ lymphoma has the presence of reed sternberg cells and [rarely/usually] responds to treatment
Hodgkin
Usually responds to treatment
(Less common than non-hodgkins)
____ lymphoma tends to be more variable and more difficult to treat and lacks reed sternberg cells
Non hodgkins
What is burkitts lymphoma?
A very fast growing cancer which starts with B cells. Typically associated with impaired immunity and rapidly fatal if not treated quickly. A form of non-hodgkins lymphoma and linked to EBV infection
Burkitts lymphoma starts with __ cells. It is a form of ___ lymphoma and is linked to ___
B cells
Non-hodgkins
EBV infection
Define the following…
Incidence:
Mortality:
Prevalence:
Survival:
Incidence: newly diagnosed cases/time
Mortality: deaths/time
Prevalence: new and preexisting cases at one time
Survival: proportion of pts alive at a given time after diagnosis
How many cancer cases were there in 2011?
1.5 million
How many cancer deaths were there in the US in 2011?
570,000
What is the leading cause of most sporadic cancers?
Environment
True or false… cancer is often caused by AD gene
True
___ cancer is the leading cause of cancer death in the US followed by…
Lung cancer
Prostate cancer in men and breast cancer in females
___ genes lead to breast cancers
BRCA 1 and 2
___ gene increases intestinal/colon cancer when mutated
Familial adenomatous polyposis coli (APC)
T or F… Cancer subtype risks ween in those moving to different areas of the world, usually begins to reflect that of the native population in subsequent generations.
True
Japanese risk of gastric cancer is ___ than in the US
7x greater
Breast cancer is more common in ___ than in __
Europe
US
Environmental factors cause mor cancer than genetic factors, especially in the ___
Elderly
___ are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses. Sometimes can predict prognosis
Solid tumor mutation panels
____ are used to grow tumor cells and examine cellular histology and abnormalities
Cytogenetics
True or false.. common for success response not to kill “all” of the cells (99.9% kill) may lead to recurrence months to years later.
True
Chromosomal changes associated with cancers include what 5 things?
Deletions
Translocations
Duplications
Amplification
Abnormal number of chromosomes
Genetic targets for tumors include what 6 things?
Oncogenes
Nuclear regulating genes
Tumor suppressor genes
Apoptosis regulating genes
DNA repair genes
Angio-neogenesis
What are oncogenes?
They promote proliferation
Growth factors or corresponding receptors.
What drug works by inhibits oncogenes?
Gleevac
What are tumor suppressor genes?
Inhibit tumor growth
BRCA 1 and 2
Effect is often recessive and both gene copies need to be inactivated with treatment
P53 genes
APC
What genes are considered the guardians of the genome and suppressive proliferative genes?
P53 genes
What does the APC gene do (adenomatous polyposis coli gene)?
Helps control apoptosis
Most chemotherapy targets ____ cells. Most interfere with ___. Consequently, good for killing ___ tumors but not so good for __ tumors
Proliferating
DNA replication
Fast growing
Slow or non-growing tumors
True or false.. most chemotherapy injures rapidly proliferating normal cells such as bone marrow, intestinal mucosa, and hair
True
___ pattern varies between tumors (due to varying growth factors)
Metastatic
True or false… complete response to cancer treatment (~99.9% cancer cell kill) leaves thousands of malignant cells, but while it may cause remission, it does not mean that the cancer is cured.
True
Malignant tumors usually requires at least __-___ types of mutations to survive
5-6
Roughly ___ of cell doublings occur before tumor detection
3/4
What are some causes of cancer?
Mutation Tumor viruses Bacteria and inflammation Hormonal activation Lack of immune responses Genetic predisposition Chemical carcinogens Radiation Viruses
What are three metal ions that can cause mutation leading to cancer?
Nickel
Arsenic
Chromium
What is the Ames test?
It measures if a chemical alters genetic changes in bacteria and would be a carcinogen
Name one example of a tumor virus
HPV cause carcinoma of cervix
Name one species of bacteria that can lead to cancer
H. Pylori
Asbestosis is a chemical that can cause inflammation and thus cancer
What hormones may stimulate cancer?
Sex hormones
Androgens stimulate prostate cancers
Estrogens stimulate breast cancers
Lack of immune responses may lead to cancer. ___ pts have an increased chance to get lymphomas. ___ infections induces kaposi’s sarcoma in AIDS.
Transplant pts/AIDS
HHV
Immunodeficient children are __ times more likely to develop cancer
200
Reactive chemicals alter DNA especially in ___ cells
Rapidly dividing
True or false… acidifying agents (including some chemotherapeutic agents) are chemical carcinogens
False. Alkylating agents
What is an example of a polycyclic aromatic compound?
Benzopyrene
What is alfaztoxin?
Fungus on peanuts or other foods (associated with old moldy food). - chemical carcinogen
X rays and gamma rays can cause cancer. What kinds of cancer are they most likely to cause?
Leukemias
Breast
Lung
Salivary gland
___ virus is a herpes virus associated with B cell lymphomas (burkitts lymphoma)
Epstein Barr
What virus causes damage that can lead to hepatocellular carcinoma?
Hepatitis B and C
What virus causes kaposi’s sarcoma
HHV8
What bacteria can cause gastric adenocarcinoma?
H. Pylori
Chronic inflammation by asbestos leads to ___ and ___
Mesothelioma
Lung cancers
What are four ways in which cancers kill?
Growth and metastasis
Involve vital organ functions
Cachexia (progressive loss of body fat and muscles leading to wasting)
Cancers release secretions of the tissue of origin (Cushing syndrome - hypercortisol)
Paraneoplastic syndrome
Paraneoplastic syndrome develops in __% of malignancies and can have a variety of expressions due to the type of tissue involved. Such as…
Hypercortisolism
Hypercalcemia - PTHRP (parathyroid hormone related protein in squamous lung cancer, breast cancer, etc.)
Carcinoid syndrome
Polycythemia (too many RBCs)
Many rare syndromes
What are 3 things involved with carcinoid syndrome?
Flushing
Diarrhea
Asthma
What are some things that tumors must do to survive?
Develop signal to proliferate
Avoid apoptosis
Invade
Metastasize
Include angiogenesis
Mutation of antitumor factors
In order to induce angiogenesis, the tumor must secrete angiogenic factros such as…
VEGF (vascular endothelial growth factor)
bFGF (basic fibroblast growth factors - causes a fibrotic structure in tumor)
P53 (an antitumor factor called the gaurdian of the genome) is the [least/most] common tumor suppressor gene mutation. Lost or mutated in __% of malignancies. P53 is supposed to sense sick cell or abnormal DNA and induce ___ if beyond repair. It is related to _____ syndrome which is defined as…
Most common
50%
Apoptosis
Li-Fraumeni syndrome - rare inherited genetic cancer disorder that greatly increases risk of developing multiple cancers/tumors often in childhood or young adults
____, if mutated, can stimulate precancerous colon polyps that mutate into colon cancers
APC
What are the three factors in tumor staging?
T - size and extent of the primary tumor
N - presence of number of lymph node metastases
M - presence of distant metastases
What are the three stages of breast cancer?
Stage 1 - small primary tumors
Stage 2 - positive node
Stage 3/4 - major threat
What is therapeutic classification?
Classification methods specific for certain types of cancers ?
Examples include..
Presence of hormone receptors such as estrogen or progesterone
Her-2/Ne4 (human epidermal growth factor receptor protein for breast cancer)
In regards to biopsy methods, less invasive techniques are often used and are usually accurate. Two examples are…
Needle biopsy
Fine needle aspirates
What are 3 different treatment options for cancer?
Surgical removal
Radiation therapy - maximize exposure to tumor and minimize exposure to normal tissue
Chemotherapy
Chemotherapy will most of the time interfere with ___. It kills __ cells. It treats the ___ body. Tumor can develop ____.
DNA replication or function which is necessary for cell proliferation
Fast growing cells. Most damage to rapidly proliferating cells
Treats whole body
Resistance
*remember that treatments can kill >99% of tumor cells, but will still leave thousands or millions of living cancerous cells that can cause recurrence in months or years
1/__ patients are cured with local treatment such as surgery or radiotherapy.
3
T or F… chemotherapy is typically used for advanced disease or as an adjuvant
True
T or F… anticancer drugs usually exert action on cells in cell metabolism
False. Cell cycle
Treating cancer typically requires combination of drugs or in combination with ___ or ___. Usually a single drug at clinically tolerable doses do not cure the cancer by itself.
Radiation and/or surgery
T or F, it is necessary to have maximal cell kill within the range of toxicity tolerated by host. Adjust scheduling and overlapping toxicities to protect the patient
True
What are the three principles of use of chemotherapy?
Primary induction for advanced disease or cancers without other treatment alternatives.
Neoadjuvant - localized disease where surgery/radiation alone are inadequate
Adjuvant - use in addition to local methods such as radiation/surgery to prevent metastasis
In regards to drug combination principles to treat cancer.. usually single drugs at clinically tolerable doses [does/does not] cure cancers. Try to find a dose that provides maximum cancer-cell kill while within the range of toxicity tolerated by the host. Provide [broad/narrow] range of interactions between drug and tumor cells with different genetic abnormalities in heterogenous populations.
Does not
Broad
In regards to drug combinations to treat cancer, try to optimize what 5 things?
Efficacy
Reduced toxicity
Optimum scheduling
Mechanism of interaction (if possible have synergism)
Optimal dosing
P53 is mutated in 50% of all human tumors which leads to…
Resistance to radiation therapy and anticancer agents
Normally, P53 senses sick or abnormal DNA and regulates apoptosis
Alkylating agents such as ____ is used to treat what four things?
Cyclophosphamide
Hodgkin’s/nonhodgkins lymphoma
Leukemia
Breast cancer
Multiple myeloma
How do alkylating agents work?
Transfer their alkyl groups to various cell constituents such as DNA (causing miscoding)
What are three adverse effects of alkylating agents?
Nausea/vomiting
Damage to rapidly growing tissues (bone marrow, GI tract, oral mucosa)
Carcinogenic in nature
In regards to alkylating agents, resistance can be caused by increased ability of cancer cells to…
Repair damaged DNA
Name two examples of nitrosoureas. What are they used for?
Procarbazine
Decarbazine
-used for combination regimens for Hodgkin’s lymphoma
Nitrosoureas require __ to be effective. They are highly ___, so they are used to treat brain tumors
Biotransformation
Lipophillic
Platinum analogs such as ___ are used on [broad/narrow] range of solid tumors.
Cisplatin
Broad
antimetabolites act on ___ ___ of proliferating cells
Intermediary metabolism
Methyltrexate-folic analog is an antimetabolite that is also commonly used to treat ___. It interferes with formation of ___ and ___ and inhibits ___. Its used to treat ___. It causes ___.
Rheumatoid arthritis
DNA and key proteins
Inhibits tetrahydrofolate
Treats head and neck cancers, and breast cancer
It causes mucositis and diarrhea
5-fluorouracil is an antimetabolite used to inhibit ___ synthesis
Thymidine
Natural product cancer (chemotherapy drugs) such as ___ or ____ inhibits ____. Toxicities include ___. ____ is a drug that is semisynthetic from mandrake, it inhibits topoisomerase 2.
Vinblastine or vincristine (vinca alkaloids)
Inhibits tubulin polymerzation (cytoskeleton component)
Mucositis
Etoposide
What is etoposide?
A chemotherapy drug that is semisynthetic from mandrake plant
It inhibits topoisomerase 2 (interferes with DNA structuring/replication)
What are anthracyclines?
Antitumor antibiotics
Doxorubicin and bleomycin treat breast cancer
What is erlotineb?
A chemotherapeutic drug used to antagonize epidermal growth factor receptors
True of false… non-hodgkins lymphoma is better controlled/treated than hodgkins lympohma
False. Hodgkin’s lymphoma is much better controlled
Why is breast cancer treated more effectively today?
More effective due to early treatments
1 in __ men will develop prostate cancer. It is treated by eliminating ____ production through ___.
1 in 8
Testosterone
Surgery castration
What does methyotrexate bind to? What does it inhibit?
Dihydrofolate reductase. And inhibits tetrahydrofolate.
What is a new treatment for actinic keratosis or basal cell carcinoma?
5-fluorouracil
What drug inhibits thymidine synthase?
5-fluorouracil
Where is vinblastine derived from?
Periwinkle plant
What drug inhibits tubulin polymerization?
Vinblastine
What drug is combined with prednisone to treat acute lymphoblastic leukemia in children?
Vincristine
What drug inhibits topoisomerase 1 and is derived from the camptotheca acuminat tree in china?
Camptothecins
What drug causes red urine (not hematuria) from cardio toxicity? What is its method of action?
Doxorubicin (anti-tumor antibiotic). MOA: free radicals
What is the main form of leukemia in childhood?
ALL
What is the most common leukemia in adults?
AML
What leukemia has the Philadelphia chromosome (9,22)?
CML
How do you treat Hodgkin’s lymphoma?
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
What is the treatment for multiple myeloma?
Combination of alkylating agent (melphalan) and prednisone
Stage 2 breast cancer is treated by…
The CMF protocol
What is the most common type of GI malignancy?
Colorectal cancer
What is pinguecula?
UV-damaged collagen in the sclera causing discoloration
In glaucoma, intraocular pressure > ___
21 mmHg
In closed angle glaucoma, the angle of iris to cornea is < ___ degrees
10
In open angle glaucoma, the angle is ~ ___ degrees
45
True or false… family history of glaucoma is a risk for getting glaucoma
True
What drug is a carbonic anhydrase inhibitor used to treat glaucoma by reducing secretion of AH.
Acetazolamide
True or false… diabetic retinopathy involves micro-aneurisms on retina; leaves lipid rich yellow exudate
True
Acute infections of otitis media are usually caused by ___.
Streptococcus pneumoniae
How do you diagnose prostate cancer?
PSA (prostate specific antigen)
How do you diagnose recurrent thyroid cancer?
Thyroglobulin protein
How do you diagnose leukemias and lymphomas?
Flow cytometry
If squamous cell carcinoma is in the ___ and ___ it is more likely to metastasize
Lip and hand
True or false… if squamous cell is in skin it rarely metastasizes
True
Adenocarcinomas, tumor is __ or ___ in shape
Cuboidal or columnar
In the mouth, adenocarcinomas are likely associated with ___. T or F… most organs form adenocarcinomas
Salivary glands
True
Why do breast and prostatic carcinoma look similar?
Their ducatal histology is similar
True or false… small cell lung carcinoma has lots of cytoplasm
False, barely any cytoplasm
Which are more aggressive, carcinomas or sarcomas?
Carcinomas
sarcomas tend to grow and displace rather than invade
True or false… angiosarcoma is very likely in oral cavity
False it is not likely
Where can chondrosarcoma occur?
Larynx
What is brachytherapy?
Includes radioactive implants into the tumor
What things does head and neck radiotherapy cause?
Damage vocal cords
Dysphagia
Osteonecrosis in the jaw
What is the most common secondary malignancy after chemo?
AML
What is decarbazine used to treat?
Hodgkin’s lymphoma
Melanomas
Soft tissue sarcomas
Imatinib (gleevac) is affective against ___. It blocks a form of ____.
Chronic myelogenous leukemia
Tyrosine kinase
True or false… EBV can lead to nasopharyngeal carcinoma
True
