DIT Part 3 Flashcards Preview

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Flashcards in DIT Part 3 Deck (261):
1

What is the DNA structure of most all of the DNA viruses?

What are the exceptions

Most are double stranded and linear

exceptions include:
Parvovirus B19 is ssDNA
Papillomavirus (circular DNA)
Polyomavirus (circular DNA)
Hepadnavirus (circular DNA)

2

What is the DNA structure of most all of the DNA viruses?

What are the exceptions

Most are double stranded and linear

exceptions include:
Parvovirus B19 is ssDNA
Papillomavirus (circular DNA)
Polyomavirus (circular DNA)
Hepadnavirus (circular DNA)

3

Examples of live atteuated vaccines?

MMR
Sabine polio vaccine (oral)
varicella zoster vaccine
yellow fever vaccine
smallpox vaccine
intranasal influenza vaccine

4

What live virus vaccines should be considered for HIV positive patients?

Rotavirus recommended for all infants with HIV

MMR and varicella for CD4 counts >200

Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts

5

where do most get their envelope?

exception?

usually from plasma membrane but herpes virus gets its envelope from nuclear membrane

6

which families virus do not have an envelope

Naked (non-enveloped)

Adenovirus
Calicivirus
Papilloma
Parvovirus
Picornavirus
Polyomavirus
Reovirus
Hepevirus

7

signet ring cells

gastric adenocarcinoma

8

nutmeg liver

right sided heart failure and budd chiari syndrome

9

maternal elev of AFP

anencephaly, spina bifida, omphalocele, gastroschisis

10

RBC cast in urine

acute glomerulonephritis

11

Currant-Jelly sputum

klebsiella

12

Dog or cat bite

pasteurella multocida

13

Examples of live atteuated vaccines?

MMR
Sabine polio vaccine (oral)
varicella zoster vaccine
yellow fever vaccine
smallpox vaccine
intranasal influenza vaccine

14

What live virus vaccines should be considered for HIV positive patients?

Rotavirus recommended for all infants with HIV

MMR and varicella for CD4 counts >200

Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts

15

EBV associated malignancies

Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma
Diffuse large cell lymphoma
Oral hairy leukoplakia
Lymphoproliferative disorders

16

which families virus do not have an envelope

Naked (non-enveloped)

Adenovirus
Calicivirus
Papilloma
Parvovirus
Picornavirus
Polyomavirus
Reovirus
Hepevirus

17

signet ring cells

gastric adenocarcinoma

18

nutmeg liver

right sided heart failure and budd chiari syndrome

19

benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark

Alkaptonuria

20

RBC cast in urine

acute glomerulonephritis

21

Currant-Jelly sputum

klebsiella

22

Dog or cat bite

pasteurella multocida

23

Retrovirus family members

HIV
Human T cell leukemia (HTLV)

24

MC cause of fatal infantile gastroenteritis

rotavirus

25

HSV-1 causes what

Oral herpes labialis (cold sores)
Gingivostomatitis
Keratoconjunctivitis
Temporal lobe encephalitis
Genital herpes

26

Monospot test

Detects heterophile antibodies
Antigens found in horse, sheep, and beef RBCs
High sensitivity and specificity


(for Epstein Barr Virus)

27

fever, jaundice, black vomit

yellow fever

28

EBV associated malignancies

Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma
Diffuse large cell lymphoma
Oral hairy leukoplakia
Lymphoproliferative disorders

29

where is latency established

HSV-1
HSV-2
VZV
CMV
EBV

HSV1:trigeminal ganglia
HSV2: sacral ganglia
Varicella zoster: DRG or trigeminal ganglia
CMV: Mononuclear cells
EBV: B Cells

30

fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash

measles

31

benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark

Alkaptonuria

32

nephritis, hearing loss, cataracts

alport syndrome

33

Retrovirus

HIV
Human T cell leukemia (HTLV)

34

thyroglossal duct cyst presentation

-asymptomatic mass in the midline neck
-moves with swallowing
-often in pt

35

painful raised lesions on finger pads and fever

osler's nodes (infective endocarditis)

36

Bamboo spine on xray

ankylosing spondylitis

37

fever, jaundice, black vomit

yellow fever

38

diarrhea in children during winter months

rotavirus

39

small irregular blue gray spots on the buccal mucosa surrounded by a base of red

koplik spots in measles

40

fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash

measles

41

Ring enhancing lesions in the brain

Toxoplasmosis
Non-Hodgkin lymphoma (primary CNS lymphoma)

42

toxoplasmosis prophylaxis,

when is it given

TMP-smx
or
dapstone+pentamadine+leucovorin

when CD4 is less than 100

43

nephritis, hearing loss, cataracts

alport syndrome

44

What regulates prolactin secretion

TRH increase

Dopamine inhibits

Prolactin also inhibits by increasing dopamine

45

thyroglossal duct cyst presentation

-asymptomatic mass in the midline neck
-moves with swallowing
-often in pt

46

Protease inhibitors

Saquinavir
Ritonavir
Indinavir
Nelfinavir
Amprenavir
Fosamprenavir
Lopinavir
Tipranavir
Atazanavir
Darunavir

47

NRTI

Zidovudine
Didanosine
Lamivudine
Abacavir
Emtricitabine
Tenofovir

48

NNRTIs

Nevirapine
Delavirdine
Efavirenz
Etravirine
Rilpivirine

49

Protease inhibitor SE

GI intolerance
Hyperlipidemia/hypertriglyceridemia
Lipodystrophy

50

Ritonavir SE
(protease inhibitor)

Inhibits cytochrome P450

Pancreatitis

51

Nephrolithiasis side effect from what drugs

Idinavir
Atazanavir

(protease inhibitors)

52

Increased bilirubin SE from what drug

Atazanavir
(Protease inhibitor)

53

Bone marrow suppression from what drugs for HIV

Zidovudine
(NRTI)

54

Pancreatitis and peripheral neuropathy from what drugs for HIV

Didanosine,
Zalcitabine
Stavudine

(NRTIs)

55

Hepatic steatosis from what drugs for HIV

Didanosine
Stavudine
(NRTIs)

56

Hypersensitivity from what drugs for HIV

Abacavir (NRTI)

57

Side effect of NNRTIs

Rash

58

SE of efavirenz (NNRTI)

Neuropsychiatric
False positive cannabinoid drug test
Teratogenic

59

Enfuvurtide
Mech

SE

Fusion inhibitor by binding gp41, inhibiting viral entry

se:
injection site reaction
increased risk of bacterial pneumoniae

60

Raltegravir Mech

SE

Integrase inhibitor

SE:
nausea
rash
myopathy

61

Maraviroc mech

who can use it?

CCR5 antagonist, inhibiting gp120 conformational change so virus cannot bind host cell effectively.

only patients with all R5 virus

62

Cancers assoc with asbestos

mesothelioma
bronchogenic carcinoma

63

owl's eye inclusions

cmv

64

owl's eye nucleus

reed sterberg cells (hodgkin lymphoma)

65

owl's eye protozoan

Giardia lamblia

66

Howell-Jolly bodies

DNA remnants (asplena)

67

Treatment for PCP

TMP-SMX (bactrim)

or if sulfa allergy:

Pentamidine

or

unofficially Clindamycin and primaquine

68

Treat rhizopus/mucormycosis

Surgery and amphotericin B

69

most common opportunistic infection in HIV patients

PCP

70

treatment for systemic candidasis

Fluconazole for immunocompetent

Amphotericin B or caspofungin for immunocompromised

71

animal urine you should think of

leptospira

hantavirus for rodent urine

72

what hormones arise from anterior pituitary

FSH
LH
TSH
PROLACTIN
GH
ACTH
MSH or melanotropin

73

what effect does adipocyte generated leptin have on the hypothalamus

INHIBITS LATERAL THALAMUS TO STOP HUNGER
STIMULATES VENTROMEDIAL THALAMUS FOR SATIETY

74

treatment for sporothrix schenckii

itraconazole
or
KOH

75

councilman bodies

apoptotic liver cells (viral hepatitis, yellow fever)

76

Anti-dsDNA antibodies

lupus nephritis

77

Dementia and eosinophilic inclusions in neurons

Lewy body dementia

78

Side effects of orlistat

steatorrhea
GI disturbances
Decreased absorption of fat soluble vitamins

79

Enzyme converting glucose to sorbitol

Aldose reductase

80

Amphotericin B Mechanism

Use

SE

How to avoid some SE

Binds ergosterol in cell membrane of fungi, forms pores in membrane, loss of electrolytes and small molecules, fungal death

Can be used intrathecally for fungal meningitis

SE:
Fever/chills
hypotension
nephrotioxicity
Arrhythmias
Anemia
IV phlebitis

Avoid nephrotoxicity by increased hydration
Avoid toxicity by liposomal amphotericin (but expensive)

81

Nystatin Mechanism

Clinical uses

same as amphotericin B. But topical form b/c too toxic for systemic use.

Swish and swallow for oral candidiasis (thrush), topical for diaper rash or vaginal candidiasis

82

Azole mechanism

inhibits fungal sterol (ergosterol) synthesis by inhibiting cytochrome P450 that converts lanosterol to ergosterol

83

Clinical use for Itraconazole

First line therapy
-Blastomyces
-Coccidoides
-Paracoccidoides
-Histoplasma
-Sporothrix

84

Clinical use for Ketoconazole

NOT FIRST LINE
-Blastomyces
-Coccidoides
-Histoplasma
-Candida

85

Clinical use for Fluconazole

-Cryptococcal meningitis (can cross BBB)
-Candidal infections

86

Clinical use for Posaconazole

Active against many fungi refractory to other treatments
-Mucor

87

Clinical use for Clotrimazole and microconazole

Used for topical fungal infections

88

Clinical use for Voriconazole

Aspergillus

89

SE of azoles

-Decrease production of cortisol and testosterone
-Gynecomastia
-Impotence
-Drug Drug interactions
-Increased hepatic enzymes

90

Flucytosine mechanism

Clinical use

SE

converted into 5-FU by cytosine deaminase

Inhibitng DNA and RNA biosynthesis


Use:Used in combo with amphotericin B to treat systemic candidal and cryptococcal infections

SE: BM toxicity and GI symptoms

91

caspofungin mechanism

Use

SE:

inhibits cell wall synthesis by inhibiting synthesis of Beta-1,3-D Glucan leading to cell lysis and death

Use: Invasive aspergillosis, candida infection

SE: GI upset and flushing

92

Terbinafine (lamisil) mechanism

Use

SE

Inhibits fungal enzyme squalene epoxidase leading to decreased ergosterol synthesis

Use:
TOPICAL
-Tinea pedis
-Tinea corporis
ORAL
-Onychomycosis
-Tinea capiti

SE:
GI symptoms
Hepatotoxicity

93

Griseofulvin mechanism

Use

Targets microtubule function inhibiting mitosis

Deposits in keratin-containing tissues

Use:
-Tinea corporis
-Tinea capitis
-Onychomycosis

SE:
-Teratogenic
-Headache
-GI symptoms
Confusion
-Cytochrome P450 inducer

94

Strawberry tongue

Scarlet fever/
Kawasaki disease/
Toxic shocks syndrome

95

Rash on palms and soles

2ndary syphilis
Rocky mountain spotted fever
Coxsackie A virus

96

Name for thyroid hormone secreting teratoma

struma ovarii

97

medx to shrink prolactinomas

Dopamine agonists
-Bromocriptine
-Cabergoline

98

Treatment for Entamoeba histolytica

Kill Trophozoites with
-Metronidazole
or
-Tinidazole

Kill asymptomatic cyst passers with
-Iodoquinol
or
-Paromomycin

99

Uses for metronidazole

GET GAP on the Metro

Giardia
Entamoeba
Trichomonas
Gardnerella vaginalis
Anaerobic bacteria
Pylor (H. pylori)

100

Treatment for Toxoplasma gondii

Sulfadiazine+ Pyrimethamine+Folinic acid

101

treatment for Trypanosoma brucei

Suramin for blood borne disease

Melarsoprol for CNS penetration

102

Treat P. vivax and P. ovale

Primaquine

103

Treat of malaria

Chloroquine

(+primaquine if Pvivax or Povale)

104

Treatment of Chloroquine resistant malari

Quinine + Doxycycline
Atovaquone-proguanil
Artemether-Lumefantrine
Mefloquine

105

Treatment of Babesiosis

Quinine+clindamycin

106

most common protozoal infection in the US

Trichomonas vaginalis

107

Diarrhea with liver abcess?

Not Giardia but Entamoeba histolytica

108

Names for the stages in the malaria life cycle

Sporozoites injected

In liver early schizonts, late schizonts,

Merozoites rupture

Trophozoites resemble diamond ring, in RBC

Early schizont, late schizont in RBC

Merozoites released with lysis

Gametocytes (falicparum is banana shaped)

Taken up by mosquito

109

Smudge cell

CLL

110

Port-wine stain in ophthalmic division of trigeminal ganglion

Sturge-Weber syndrome

111

S3 heart sound

Dilated cardiomyopathy
Post MI
Left ventricular failure
Mitral regurgitation
Left to right shunt (VSD/ASD/PDA)

112

Subepithelial humps on EM

poststreptococcal glomerulonephritis

113

Spike and dome on EM

Membranous glomerulonephritis

114

Adv. rxn from mixing succinylcholine and inhaled anesthetics

Malignant hyperthermia
(tx with dantrolene)

115

Currant jelly stool

Intussusception

116

Ketoconazole inhibits what enzyme of the adrenal steroid synthesis pathway

Desmolase (Cholesterol-->Pregnenolone)

117

Treatment for Pinworm/Enterobius Vermicularis

Ascaris Lumbricoides

Albendazole
Mebendazole
Pyrantel Pamoate

(same for both)

118

Treatment of Trichinella spiralis

Benzimidazoles

119

Treatment of Strongyloides stercoralis

Ivermectin
Mebendazole

120

What are the hookworms

tx?

Necator Americanus
Ancyclostoma duodenale

tx
Albendazole
Mebendazole
Pyrantel Pamoate

121

Tx of taena solium

Praziquantel
Albendazole +
dexamethasone (neurocysticercosis)

122

Treatment of Echinococus granulosus

injection of scolicidal agent (ethanol, hypertonic saline)
followed by surgical removal

-Albendazole in conjuction w the procedure

123

Most common helminthic infection in US

2nd most common helminthis infxn in the US

Enterobius vermicularis is most common in the US

Ascaris lumbricoides is the 2nd most common helminthic infxn in the US

124

1/4 of world infected with it

Ascaris lumbricoides

125

Snail host swimmers itch

Schistosoma species

126

Most common predisposing factor for bladder cancer in 3rd world countries

Schistosoma haematobium

127

Giant roundworm

Ascaris lumbricoides

128

responsible for lymphatic filariasis

Wuchereria bancrofti

129

Adult pt from Mexico with new onset seizures and brain calcifications

Taena solium (neurocystercosis)

130

hematuria in patient form developing country

Schistosoma haematobium

131

Treat giardia, entamoeba, trichomonas

Metronidazole

132

Treat most all flukes and tapeworms

Praziquantel

133

Treat hookworm, pinworm, roundworm

Benzimidazoles (Mebendazole)
Pyrantel Pamoate

134

Treat chagas disease

Benznidazole
Nifurtimox

135

Best guess for roundworms

Benzimidazoles

136

Treat Leishmaniasis

Cutaneous-Sodium stibogluconate
Visceral-Liposomal amphotericin B

137

Contracted by eating undercooked fish and causes an inflammation of the biliary tract

Clonorchis

138

Which 2 agents are usually used in the treatment of peduculosis capitis and pediculosis pubis

Pyrethrin
Permethrin

139

Why is lindane not the preferred agent in the treatment of lice

Neurotoxicity and Resistance

140

Incidences of cancer in men

mortality in men

INCIDENCE
Prostate
Lung
Colon

MORTALITY
Lung
Prostate
Colon
Pancreas

141

Incidences of cancer in women

mortality in women

INCIDENCE
Breast
Lung
Colon
Uterus

MORTALITY
Lung
Breast
Colon
Pancreas

142

DPC mutation also known as
what does DPC mean?

SMAD4
Deleted in pancreatic cancer

143

DCC mutation means

Deleted in colon cancer

144

K-RAS

H-RAS

N-RAS

K-RAS: Colon, lung, pancreatic tumors

H-RAS: Bladder and kidney tumors (Hematuria)

N-RAS: Melanomas and hematologic malignancies

145

Follicular thyroid carcinoma is associated with what mutations?

RAS mutations

146

BCR-ABL

t9;22
philadelpha chromosome
CML

Tyrosine kinase constitutively on

147

ret mechanism

associations

tyrosine kinase always on

MEN2A and 2B
-Pheochromocytoma
-Medullary thyroid cancer
Papillary carcinoma of the thyroid

148

HER2/new (c-erbB2) associations

tx

Breast cancer
Ovarian cancer
Gastric cancer

Tx with trastuzumab

149

L-myc association

lung tumors

150

N-myc association

Neuroblastoma (sounds like a brain tumor but really is one of the adrenal medulla)

151

Most common causes of hypocalcemia

vitamin d deficiency
chronic renal disease
parathyroidectomy
autoimmune destruction of parathyroid glands
digeorge syndrome
pseudohypoparathyroidism
acute pancreatitis

152

cancer assoc with hashimoto thyroiditis

Marginal cell lymphoma

153

What is iron bound to in human cells

myoglobin and ferritin

154

What is iron bound to in blood

hemoglobin and transferrin

155

arsenic risks for cancer

Squamous cell skin cancer
Angiosarcoma of the liver
Lung cancer

156

vinyl chloride risk for cancer

angiosarcoma

157

Naphthalene (moth balls) risk for cancer

Transitional cell bladder cancer

158

smoking increases risk for same cancer type that naphthalene does

Transitional cell bladder cancer

159

Asbestos increases risk for

Bronchogenic carcinoma (MOST COMMON!!_
Malignant mesothelioma

160

In asbestosis what is the most common cancer

BRONCHOGENIC CARCINOMA not malignant mesothelioma

161

Most common cancers assoc with ionizing radiation

Myeloid leukemias
-AML
-CML

Thyroid cancer (all types, papillary is just the most common in general)

162

What cancers are assoc with UV radiation exposure?

Which type of UV is most problematic?

Squamous cell carcinoma
Basal cell carcinoma
Melanoma

UVC is the shortest wavelength and filtered out by ozone layer

UVB causes pyrimidine dimers in DNA. MOST PROBLEMATIC

UVA is the longest wave length, inducing generation of free radicals. contributes only slightly to skin cancer risk.

163

Actinic keratosis is due to what?

Precursor to what?

Tx with what?

Due to sun exposure

Precursors to squamous cell skin cancer

Tx: 5-FU

164

Dysplastic nevi progress to

Melanoma

165

Adenomatous colon polyps progress to

colon cancer

166

Barretts esophagus progresses to

Esophageal adenocarcinoma

167

Tuberous sclerosis presentation

neoplasms?

Facial angiofibromas
-Adenoma sebaceum
Seziures
Intellectual disability
Ash Leaf Spots

Neoplasms include:
-Cardiac rhabdomyoma
-Renal angiomyolipoma
-Astrocytoma

168

HBV and HCV increase risk for

Hepatocellular carcinoma (HBV can without cirrhosis)

169

HCV increases risk for

Papillary thyroid carcinoma

170

HTLV increases risk for

T-cell lymphoma

171

EBV increases risk for

Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma

172

Schistosoma haematobium increases risk for

SCC of bladder (not transitional as in smoking)

173

Clonorchis sinensis increases risk for

Biliary cancer

174

Down syndrome associated with what neoplasm

ALL
AML

175

Ataxia-telangiectasia assoc with what neoplasm

Leukemia
Lymphoma

176

Paget disease of bone assoc with what neoplasm

Osteosarcoma

177

Nitrosamines assoc with what neoplasm

Esophageal cancer
Gastric cancer
Colon cancer

178

HPV cancer risk

Vulvar cancer
Vaginal cancer
Cervical cancer
Anal cancer
Penile cancer
(16 and 18)

179

Most common side effect is hypoglycemia in this oral type 2 diabetes drug

Sulfonylureas

180

Primarily effects postprandial hyperglycemia (oral diabetes type II drug)

alpha-glucosidases

181

MOA: closes K+ channels on beta cells

sulfonylureas

182

MOA: inhibits alpha-glucosidase at intestinal brush border

alpha-glucosidase inhibitors

183

MOA: agonist at PPARgamma receptor

TZD

184

features of anaplasia

High nucleus:cytoplasm ratio
Prominent nucleoli
Clumping of nuclear chromatin
Many mitotic figures

185

Malignant tumor from epithelium

Stain?

adenocarcinoma
papillary carcinoma

stain with cytokeratin

186

Epithelial tumors spread by:

Mesenchymal tumors spread:

Lymphatics for epithelial tumors

Hematogenously for mesenchymal tumors

187

CEA

Colon cancer
Pancreatic cancer

188

CA 19-9

Pancreatic cancer

189

alpha-fetoprotein

Hepatocellular carcinoma and testicular tumors

190

CA-125

Ovarian cancer (but also elevated with anything irritating peritoneum...)

191

S-100

Melanoma
Schwannoma

192

Alkaline phosphatase

Metastasis to bone
Biliary disease
Paget disease of bone

193

Psammoma bodies

Papillary thyroid cancer
Serous papillary cystadenocarcinoma of the ovary
Meningioma
Malignant mesothelioma

194

what hormones use steroid receptors

Estrogens
Progesterone
Testosterone
Aldosterone
Vitamin D
Thyroid hormones
Glucocorticoids

195

What hormones use tyrosine kinase receptors

insulin
insulin like growth factor
fibroblast growth factor
platelet derived growth factor
prolactin
growth hormone

196

RLS in purine synthesis

glutamine PRPP amidotransferase

197

RLS in pyrimidine synthesis

CPS2

198

What are two cofactors involved in the ability to induce angiogenesis in tumors

Basic fibroblast growth factor (bFGF)

Vascular endothelial growth factor (VEGF)

199

Most common liver metastatic cancers

Cancer Sometimes Penetrates Benign Liver

Colon
Stomach
Pancreas
Breast
Lung

200

most common brain metastatic cancers

Lots of Bad Stuff Kills Glia

Lung
Breast
Skin (melanoma)
Kidney (renal cell carcinoma)
GI tract (colon cancer)

201

most common bone metastatic cancers

Permanently Relocated Tumors Like Bones

Prostate
Renal cell carcinoma
Testes/Thyroid
Lung
Breast

202

What is Cachexia and why does it happen?

Profound wt loss
Loss of fat and lean muscle, b/c tumor produces cytokines that raise the BMR

203

Paraneoplastic effects of tumors

Small cell lung cancer (ACTH-->Cushing syndrome)
(ADH-->SIADH)
(Lambert-Eaton syndrome)

Squamous cell lung cancer
(Humoral hypercalcemia of malignancy: PTHrp)

204

Lambert-Eaton syndrome is associated with what?

Mechanism?

Clinical presentation?

Assoc with small cell lung cancer

Antibodies against presynaptic ca2+ channels at the NMJ

Weakness improves with use (c/f with myasthenia gravis)

205

What can release PTHrp

Squamous cell lung cancer

Squamous cell cancers of head and neck

Breast cancer

Renal cell carcinoma

206

How does multiple myeloma cause hypercalcemia?

Secretes local osteolytic factors causing lytic bone lesions and hypercalcemia

207

EPO secreting conditions?

Potentially Really High Hematocrit

Pheochromocytoma
Renal cell carcinoma
Hepatocellular carcinoma
Hemangioblastoma

also Uterine fibroids (leiomyoma)

208

most common cause of hypercalcemia

Primary hyperparathyroidism

209

What malignancies cause hypercalcemi

Squamous cell lung cancer
squamous of head and neck
breast cancer
renal cell carcinoma
multiple myeloma
hodgkin lymphoma
lytic bone metastases

210

RLS for urea cycle

CPS I (carbamoyl phosphate synthetase I)

211

RLS fo fatty acid synth

Acetyl-CoA carboxylase

212

RLS for beta-oxidation of fatty acids

CAT 1 (Carnitine acyltransferase I)

213

RLS for bile acid synthesis

7-alpha hydroxylase

214

RLS for heme synthesis

Amino levulinate synthase

215

5 most important lifestyle factors that impact cancer risk

Smoking
Obesity
Poor diet
Inactivity
Sun exposure

216

Smoking increases risk for what types of cancers

Lung cancer
Laryngeal cancer
Oral cancer
Esophageal cancer
Pancreatic cancer
Renal Cell carcinoma
Bladder cancer

217

What cancers are increased with obesity

in both women and men

In women

In men

Men and women:
Esophageal adenocarcinoma
Renal cell carcinoma
Women:
Endometrial cancer
Gallbladder cancer
Men:
Thyroid cancer
Colon cancer

218

Screening recommendations for the following cancers according to USPSTF

Breast cancer
Cervical cancer
Prostate cancer
Colon cancer
Ovarian cancer
Smoking

Breast: mammogram every 2 years 50-75

Cervical: pap smear every 3 years, 21-65

Prostate: no recommendation 75 do not

Colon: Colonoscopy every 10 years, 50-75. but if family hx then 40 or 10 yrs before that of dx for family member

Ovarian: no recommendation

Smoking:
annual chest CT for age 55-80 with 30 pack year smoking history or current smoker or quit within last 15 years

219

What immune cells are involved in killing cancer cells

CD8+ Cytotoxic T lymphocytes MOST IMPORTANT!

NK cells
Macrophages

220

treatment for homocystinuria?

Decrease methionine
Increase cysteine
Increase B6 and B12
Add folate

221

what irrev enzymes are involved in gluconeogenesis

Pyruvate carboxylase

PEP carboxykinase

Fructose 1,6 bisphosphatase

Glucose 6 phosphatase

222

Rescue agent for 5-FU toxicity

Uridine

223

SE of Methotrexate

SE of 5-FU

Fibrosis of lung for methotrexate

Photosensitivity for 5-FU

224

6-MP can become toxic when given with

allopurinol

225

How to get around the CI of allopurinol with 6mp?

give 6-Thioguanine, b/c not metabolized by xanthine oxidase

226

Cytarabine is what

what does it do

Pyrimidine analog
Inhibiting DNA polymerase

227

Cyclophosphamide mechanism

Use

SE

Any special characteristics?

Alkylates guanine residues on DNA, crosslinking it

Use:
Cancer
Immunosuppresion for
-Lupus nephritis
-Polyarteritis nodosa

SE:
-Hemorrhagic cystitis because metabolite acrolein is toxic
Give mesna to prevent
-Increases risk of TCC of bladder

REQUIRES BIOACTIVATION IN LIVER

228

Ifosfamide

same as cyclophosphamide except used for testicular cancer and not as immunosuppressant

229

Nitrosureas

use

SE

put nitro in your MUSTANG (-MUSTINE)

alkylating agent that crosses BBB, so use for brain tumors

SE: CNS toxicity

230

Busulfan mech

Use

SE

Cross links DNA

Use:
CML, also ablate BM before transplant

SE:
-severe myelosuppression
-pulmonary fibrosis
-hyperpigmentation

231

Doxorubicin and Daunorubicin Mech

Use

SE

Anthracyclines that generate free radicals, intercalate DNA,

Use:
Solid tumors
Leukemias
Lymphomas


SE:
-Cardiotoxic (dilated cardiomyopathy, b/c heart is susceptible to free radical damage due to deficiency in superoxide dismutase)
PREVENT THIS WITH DEXRAZOXANE

232

Dexrazoxane

Prevent cardiotoxicity with Daunorubicin and doxorubicin

233

Dactinomycin mechanism

Use

Intercalates DNA

Use:
Wilms tumor
Ewing Sarcoma
Rhabdomyosarcoma

234

Bleomycin

Use:

Mech

SE

Use: with etoposide and cisplatin, treats testicular cancer

Mechanism: Generates free radicals

SE: Pulmonary fibrosis

235

What oncology drugs cause pulmonary fibrosis and what are their mechanisms?

Bleomycin (generates free radicals)
Busulfan (cross links DNA)
Methotrexate (inhibits dihydrofolate reductase))

236

Uses for methotrexate

Leukemias
Lymphomas
Choriocarcinomas
Sarcomas

Abortion
Ectopic pregnancy
RA
Psoriasis
IBD

237

6-MP uses

prevent organ rejection
RA
Leukemia
IBD

238

5-FU uses

Colon cancer
Pancreatic cancer
Basal cell skin cancer
Actinic keratosis

239

Azathioprine use

SLE

240

folic acid analog

methotrexate

241

pyrimidine analog

5-FU

242

3 most common types of thyroid cancer

Papillary carcinoma
Follicular carcinoma
Medullary carcinoma

243

what cancers are assoc with RET gene mutation

MEN 2A and 2B
Medullary thyroid carcinoma
Papillary thyroid carcinoma

244

Cisplatin, Carboplatin, Oxaliplatin

Uses

SE

Mech: Cross link DNA

Uses:
-Testicular cancer
-Ovarian cancer
-Bladder cancer

SE:
-Nephrotoxicity (prevent with amifostine and chloride diuresis)

-Acoustic nerve damage

245

What drugs are nephrotoxic/ototoxic

Vancomycin
Aminoglycosides
Loop diuretics
Cisplatin and carboplatin

246

Etoposide, Teniposide
Mech:
Use:

Mech: Inhibit Topoisomerase 2--> DNA degradation

Use:
-Small cell lung cancer
-Prostate cancer
-Testicular cancer

247

regimen for treating testicular cancer

Eradicate Ball Cancer

Etoposide+Bleomycin+Cisplatin

or

Etoposide+Ifosfamide+Cisplatin

248

Irinotecan, Topotecan
Mech

Use

Mech: Inhibit topoisomerase I

Use
Irinotecan: Metastatic colon cancer

Topotecan: Small cell lung cancer/Ovarian cancer/Cervical cancer

249

Vincristine
mech
uses
and what are drugs that also treat these same conditions

SE

mech: blocks polymerization of microtubules

use:
-Hodgkin lymphoma
-Wilms tumor
-Ewing sarcoma
(Dactinomycin can also work for these childhood cancers)

-Choriocarcinoma (methotrexate works also)

se:
-Neurotoxicity
-Peripheral neuritis

250

Vinblastine
Mech

se:

Mech: blocks microtubule polymerization

SE: Myelosuppression (vinblastine BLASTS BONE MARROW)

251

Paclitaxel mech

use

SE

mech: stabilizes microtubules

Use:
-Ovarian and breast carcinomas

SE: myelosuppression and hypersensitivity

252

Microtubule drugs

Vincristine
Vinblastine
Paclitaxel
Mebendazole
Albendazole
Griseofulvin
Colchicine

253

Hydroxyurea Mech

use

Mech: Inhibits ribonucleotide reductase, inhibiting DNA synthesis)

use:
-Melanoma
-CML
-increases HbF in sickle cell patients

254

Prednisone mech

Use

SE

Mech: triggers apoptosis

use:
lymphoid tumors
-CLL
-hodgkin lymphoma

SE:
BAM CUSHINGOID
-Buffalo hump
-Amenorrhea
-Moon facies
-Crazy (psychosis/agitation)
-Ulcers
-Skin changes
-HTN
-Infection
-Necrosis of femoral head
-Glaucoma and cataracts
-Osteoporosis
-Immunosuppression
-Diabetes

255

glucocorticoid SE

BAM CUSHINGOID
-Buffalo hump
-Amenorrhea
-Moon facies
-Crazy (psychosis/agitation)
-Ulcers
-Skin changes
-HTN
-Infection
-Necrosis of femoral head
-Glaucoma and cataracts
-Osteoporosis
-Immunosuppression
-Diabetes

256

Tamoxifen mech

Use

SE

Tamoxifen
ER antagonist
-Breast
ER agonist
-Bone
ER partial agonist
-Endometrium

Use:
-ER + Breast cancer
-Prevention in pt with BRCA mutation
-Endometrial cancer (b/c partial agonist)

SE:
-Increase risk of endometrial carcinoma (b/c partial agonist)

257

SERMs

Tamoxifen, Raloxifene

258

Raloxifene mech

USe

ER antagonist
-Breast
-Endometrium
ER agonist
-Bone

Use:
Treat osteoporosis

259

Trastuzumab mech
Use

SE

HER-2 monoclonal antibody

Use: Treat breast cancer that overexpress HER-2

SE:
Cardiotoxic (HERts THE HEART

260

Rituximab
mech

Use

Antibody against CD20

Uses:
-Lymphomas and leukemias
-RA
-Vasculitis
-Pemphigus vulgaris
-ITP

261

Imatinib mech

Use

Enzyme inhibitor targets mutant BCR-ABL tyrosine kinase produced by philadelphia chromosome t(9;22)

Use:
-CML
-ALL
-AML