Exam 2 General

Question 1

What happens to TH if binding proteins increase?

Answer 1

concentration of free TH falls and TSH is stimulated to correct free TH levels and a new equilibrium will be established

Question 2

High free T4 low TSH

Answer 2

hyperthyroidism

Question 3

Low free T4 high TSH

Answer 3

hypothyroidism

Question 4

If you decrease binding proteins what happens to free TH levels?

Answer 4

increase

Question 5

L isomers vs D isomers

Answer 5

L are the naturally occurring isomers and D have a small fraction of the activity that L has

Question 6

Where is T4 best absorbed?

Answer 6

from duodenum and ileum

Question 7

Is absorption slowed by mild hypothyroidism?

Answer 7

no

Question 8

What can absorption be impaired by?

Answer 8

severe hypothyroidism with ileus

Question 9

What is the MC form of adult hypothyroidism?

Answer 9

hashimoto’s thydoiditis

Question 10

What is cretinism?

Answer 10

infatile hypothyroidism

neuro impaitment, deaf mutism, develop failures, iodine deficient areas

Question 11

What can hasten regression of goiter?

Answer 11

full replacement dose of TH to suppress TSH

Question 12

What is the treatment for subtotal thyroidectomy?

Answer 12

Thioamide drug till euthyroid (~ 6 wk)

KI 10 days prior to surgery to reduce size and vascularity

β-blocker to antagonize catecholamines

Question 13

What is the dawn effect?

Answer 13

(morning glucose increase) → overnight dosing important

Question 14

In a patient with severe hypoglycemia, the differential diagnosis between self-administered insulin overdose and a tumor that produces excess insulin can be made by determining plasma levels of what?

Answer 14

c peptide

Question 15

What is the window of peak fertility?

Answer 15

day 9-15 of menstrual cycle

Question 16

7 main categories of contraception

Answer 16

Surgical sterilization
Intrauterine devices (IUDs)
Combination Estrogen/Progestin methods
Progestin-only methods
Barrier methods
Natural Family Planning 
Emergency contraception

Question 17

Secondary benefits of combo E/P

Answer 17

Improved acne
Regulation/control of menstrual cycle
Lighter and shorter periods (anemia)
Improved cramps (dysmenorrhea)
Bone protection if at risk for osteopenia (anorexics)
Decreased risk of ovarian and endometrial cancers

Question 18

What are the brands of levonorgestrel- IUDs and for each what is their approved duration of use?

Answer 18

Mirena (5 yrs)

Liletta (3 yrs)

Skyla (3 yrs)

Question 19

MC type of breast ca

Answer 19

Estrogen receptor positive (ER+)

Question 20

If Estrogen receptor positive (ER+) if progesterone receptor likely positive or negative

Answer 20

positive

Question 21

1st line Estrogen receptor positive (ER+)

Answer 21

Surgical and/or radiation therapy, plus tamoxifen

Question 22

What breast ca responds best to tamoxifen

Answer 22

ER+/PR+/HER2-

Question 23

First line for HER2 positive

Answer 23

Surgical and/or radiation therapy, plus trastuzumab

Question 24

What mutation is triple negative breast ca associated with

Answer 24

BRCA1

Question 25

Triple negative (ER negative, PR negative and HER2 not amplified) treatment

Answer 25

Surgical and/or radiation therapy, plus cytotoxic chemo

Question 26

What are the 6 ca tx modalities

Answer 26

Surgery Radiotherapy Chemotherapy Endocrine therapy Monoclonal Ab/Biologics Small molecule inhibitors

Question 27

Primary induction chemotherapy

Answer 27

1' tx in patients presenting with adv solid ca or mets for which no alt tx exists→ palliative measure to improve overall QOL, and to ↑ survival by delaying tumor progression (not a cure) 1' tx for disseminated cancer such as leukemia (meant to be curative)

Question 28

Neoadjuvant chemotherapy

Answer 28

irst step to shrink tumor burden prior to local therapy (surg/rad)

Question 29

Adjuvant chemotherapy

Answer 29

additional treatment after primary local therapy to ↓ risk of ca recurrence

Question 30

What does a chievement of a therapeutic effect in tumor cells & minimization of adverse effects in non-tumor cells typically require?

Answer 30

combo of drugs w/ diff: MOA dose limiting tox mech of susceptibility to resistance

Question 31

What drugs are rapidly growing tumors most sensitive?

Answer 31

cell-cycle specific chemo drugs (CCS)

Question 32

What ca have high growth fraction?

Answer 32

acute leukemias, aggressive high-grade lymphomas (hodgkin's)

Question 33

Define Cell Cycle-Nonspecific (CCNS) Drugs

Answer 33

Anticancer drugs capable of exerting their actions on cancer cells that are cycling or in the resting state (Go compartment)

Question 34

What is the purpose of the treatment-free period?

Answer 34

want the shortest possible treatment free period to allow for: recovery of the most sensitive normal tissues (usually bone marrow, gastrointestinal tract), but not enough time for recovery of cancer cells

Question 35

How do disseminated ca grow?

Answer 35

exponentially

Question 36

What is the log-kill hypothesis?

Answer 36

killing action of CCS drugs follows 1st order kinetics in which a given dose kills a PROPORTION of ca pop not a constant number

Question 37

How do solid tumors frow?

Answer 37

Gompertzian growth pattern in which first exponentially grows then growth rates DECLINE as tumor expands

Question 38

Best therapy for solid tumors

Answer 38

adjuvant chemo to dec burden before surg/rad

Question 39

Best therapy for disseminated ca

Answer 39

induction chemo consolidation maintenance chemo for mo-yrs until disappeared

Question 40

Why are common sites for anti-ca drug toxicity normal tissues that have a high growth factor?

Answer 40

anti- ca drugs target proliferating cells

Question 41

Why do high tumor burdens have greater change of MDR?

Answer 41

accumulate more mutations