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GI/ Heme/ Oncology Review Flashcards

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1
Q

Midgut development

  • 6th week
  • 10th week
A

6th week
- midgut herniates through umbilical ring

10th week

  • returns to abdominal cavity
  • rotates around superior mesenteric artery (270 degrees)
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2
Q

Pyloric stenosis associated with exposure to

A

Macrolides

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3
Q

Posterior duodenal ulcers penetrate the

A

gastroduodenal artery

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4
Q

Anterior duodenal ulcer perforate into

A

the anterior abdominal cavity

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5
Q

Stomach ulcer along lesser curve penetrates the

A

left gastric

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6
Q

Sites of anastomosis and what vessels involved (3)

A

1) Esophagus
- Esophageal varices
- L gastric and azygos

2) Umbilicus
- Caput medusae
- Paraumbilical and small epigastric veins of anterior abdominal wall

3) Rectum
- Anorectal varices
- Superior rectal with middle and inferior rectal

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7
Q

Above the pectinate line

  • arterial supply
  • venous drainage
  • innervation
  • lymphatic drainage
A

Above pectinate line

Arterial supply
- superior rectal artery (branch IMA)

Venous drainage
- superior rectal vein –> inferior mesenteric vein –> splenic vein –> portal vein

Innervation
- visceral innervation, not painful

Lymphatic drainage
- Internal iliac lymph nodes

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8
Q

Below Pectinate Line

  • Arterial supply
  • Venous drainage
  • Innervation
  • Lymphatic drainage
A

Below pectinate line

Arterial supply
- Inferior rectal artery (branch of internal pudendal artery)

Venous drainage
- Inferior rectal vein –> internal pudendal vein –> internal iliac vein –> common iliac vein –> IVC

Innervation

  • Somatic innervation
  • Inferior rectal branch of pudendal n.
  • Painful

Lymphatic drainage
- superficial inguinal nodes

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9
Q

Yellow fever affects what zone of liver architecture

A

Zone II: intermediate zone

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10
Q

Zone affected of liver by viral hepatitis

A

Zone I: periportal zone

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11
Q

Diaphragmatic hernia

  • what side
  • due to
A

Left side due to relative protection of right hemidiaphragm by liver

Congenital defect of pleuroperitoneal membrane

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12
Q

Indirect inguinal hernia

  • goes through
  • in reference to inferior epigastric vessels
  • due to
  • covered by
A

Goes through the internal (deep) inguinal ring, external (superfical) inguinal ring and into the scrotum

Lateral to inferior epigastric vessels

Due to failure of processus vaginalis to close

Can form hydrocele

Covered by all 3 layers of spermatic fascia

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13
Q

Direct inguinal hernia

  • goes through
  • in reference to inferior epigastric vessels
  • due to
  • covered by
A

Protrudes through the inguinal (Hesselbach) triangle. Bulges directly through the parietal peritoneum. Goes through external (superficial) inguinal ring only

Medial to inferior epigastric vessels
(lateral to rectus abdominis)

Due to acquired weakness in the transversalis fascia

Covered by external spermatic fascia

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14
Q

Secreted by duodenum and function

A

Cholecystokinin

  • I cells
  • increase pancreatic secretion
  • Increase gallbladder contraction
  • Decrease gastric emptying
  • Increase sphincter of Oddi relaxation

Secretin

  • S cells
  • Increase pancreatic HCO3 secretion
  • Decrease gastric acid secretion
  • increase bile secretion

GIP (Glucose-dependent insulinotropic peptide)

  • K cells
  • Decrease Gastric H secretion
  • increase insulin release
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15
Q

Iron, Folate and B12 absorbed where

A

Iron: duodenum

Folate: Small bowel

B12: terminal ileum

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16
Q

Bile acids conjugated to ____ (2) to make them _____

What catalyzes teh RL step of bile acid synthesis

A

Conjugated to glycine or taurine to make bile acids water soluble

Cholesterol 7alpha-hydroxylase

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17
Q

Mass in parotid gland, biopsy shows cystic with central mass of pale staining B cells

A

Papillary cystadenoma lymphomatosum
(Warthin tumor)

Benign cystic tumor with germinal center

Smokers

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18
Q

Birds beak appear on CT

A

volvulus

Bird beak on barium= achalasia

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19
Q

Esophageal varices located where

A

Lower 1/3 of esophagus

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20
Q

Plummer-Vinson syndrome

A

Plumbers DIE

Dysphagia
Iron deficiency anemia
Esophageal webs

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21
Q

Globus sensation

A

“something is stuck in throat”

Worse w/ swallowing saliva

Alleviated with food and liquid

Associated with anxiety

Functional disorder

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22
Q

Hypertrophied rugae

  • disease
  • pathogenesis
  • results in
A

Looks like brain gyri

Menetrier disease

Hyperplasia of gastric mucosa –> hypertrophied rugae, excess mucus production

With resultant loss of protein and parietal cell atrophy –> decrease gastric acid production

Enteric protein loss –> hypoalbuminemia –> edema

Precancerous

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23
Q

Gastric cancer

- Intestinal vs Diffuse

A

Intestinal

  • Due to H pylori
  • or smoked foods, tobacco smoking, chronic gastritis
  • On Lesser curvature
  • Looks like ulcer with raised margins

Diffuse
- Signet ring cells
- stomach wall grossly thickened and leathery
(linitis plastica)

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24
Q

Signet ring cells in ovaries

A

Krukenberg tumor

Gastric cancer spread to ovaries

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25
Zollinger-Ellison syndrome causes what type of ulcers Tx
Duodenal ulcers PPI (omeprazole) +/- Octeotide (if hemorrhage)
26
Common feature of duodenal ulcers (2)
Pain decreases with eating Hypertrophy of Brunner glands
27
Test for malabsorption syndromes | - test for fecal fat
Sudan stain
28
Celiac disease - intolerance of what protein - Associated with what HLA - Assoc w/ condition - Ab to - Histology of intestine - location
Intolerance of gliadin (gluten protein in wheat) HLA-DQ2 and HLA-DQ8 Dermatitis herpetiformis, decreased bone density IgA anti-tissue transglutaminase (IgA tTG) Villous atrophy, blunting Crypt hyperplasia Distal duodenum and/or proximal jejunum
29
Foamy macrophages (distended) in intestinal lamina propria ``` Confusion Inflamed joints Trouble walking Diarrhea Chest pain WL LAD Hyperpigmentation ``` Tx
Whipple Disease Tropheryma whipplei ``` Tx - Penicillin - Ampicillin - Tetracycline (Takes 1-2 yrs) ```
30
Zenker diverticulum location
Between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
31
Congenital megacolon - disease - Lack of - due to - Mutation - Symptoms
Hirschsprung disease Lack of ganglion cells/ enteric nervous plexuses (Auerbach and Meissner plexuses) in distal segment of colon Due to failure of neural crest cell migration RET mutation Bilious emesis, abdominal distention and failure to pass meconium within 48 hrs Similar to appendicitis but longer than 1 month
32
Volvulus - Children - Elderly - pattern
Twisting of bowel around mesentery Midgut: infants and children Sigmoid: elderly (coffee bean on xray) Whirl pattern on CT Distended loops proximal to volvulus
33
Abdominal pain Currant jelly stools Telescoping Coiled spring - Location - Lead point - May be associated with
Intussusception Ileocecal junction Meckel diverticulum May be associated with recent viral infection (adenovirus) --> peyer patch hyperplasia --> lead point
34
Infant | Swollen bowel full of air
Necrotizing enterocolitis Formula fed infants with immature immune system - received oral food too soon Necrosis of intestinal mucosa
35
Hyperpigmented mouth, lips, hands and genitalia Numberous hamartomas throught out GI
Peutz-Jeghers syndrome | AD
36
Man brought into ER after seizure. Has never had one before. Has had intermittent bloody stools for past 4 months. Head CT reveals irregular masses extending from right to left hemisphere. CT of abdomen shows multiple polyploid masses in sigmoid colon ``` (A) Familial adenomatous polyposis (B) Gardner syndrome (C) Hereditary nonpolyposis colorectal carcinoma (D) Tuberous sclerosis (E) Turcot syndrome ```
E. Turcot syndrome FAP/Lynch + Malignant CNS tumors (medulloblastoma, glioma)
37
Lynch syndrome - disease - symptoms - inheritence - mutation - progression - Location - Associated with
Hereditary nonpolyposis colorectal cancer (HNPCC) 15-20 polyps, family history of colorectal cancer AD Mutation of DNA mismatch repair with microsatellite instability (Mutation or methylation of mismatch repair genes MLH1) Progress to colorectal cancer Proximal colon always involved Associated with endometrial, ovarian and skin cancers
38
Apple core lesions on barium enema xray
Colorectal cancer
39
Main liver cancer | - assoc with
Hepatocellular carcinoma HCV, alcoholic and nonalcoholic fatty liver disease, alpha 1 antitripsin)
40
Budd-Chiari - is what - due to - absence - assoc with - appearance
Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis Congestive liver disease Absence of JVD Hypercoagulable states (polycythemia vera, postpartum, HCC) ``` Nutmeg liver (mottled appearance) - Right sided heart failure ```
41
Wilson's disease - Mutation - chromosome - decreased - symptoms - Degeneration of - Tx
ATP7B Chromosome 13 Decreased ceruloplasmin ``` Copper accumulates Hepatitis Dysarthria, tremor Moody Yellow eyes (green rings) ``` Hepatolenticular degeneration - lenticular nucleus: putamen and globus pallidus Tx: Penicillamine
42
Hemochromatosis - Inheritence - Mutation - Chromsome - HLA - defect - Labs - clinical - Death due to Tx
Recessive mutation in HFE gene on Chr 6 Assoc with HLA-A3 Increased iron sensing and intestinal absorption Increased ferritin, iron, transferrin Decreased TIBC Bronze diabetes Cirrhosis DM Hypogonadism HCC common cause of death Deferoxamine, Phlebotomy
43
Acute pancreatitis causes
I GET SMASHED ``` Idiopathic Gall stones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hypercalcemia/ Hyertriglyceridemia ERCP Drugs (sulfa, NRTIs, protease inhibitors) ```
44
Abdominal pain radiating to back Migratory thrombophlebitis Obstructive jaundice with palpable non tender gallbladder
Pancreatic adenocarcinoma Head to pancreas
45
H2 blockers - example - use - adverse effects
-dine (cimetidine, ranitidine, famotidine, nizatidine) Reversible block H2 receptor Peptic ulcer, gastritis, mild esophageal reflux Cimetidine - P-450 inhibitor - Gynecomastic - impotence - Cross BBB (confusion, dizziness) - Cross placenta - Decrease methomoglobin levels
46
Proton pump inhibitors - example - MOA - Uses
-prazole (Omeprazole, lansoprazole, pantoprazole...) Irreversibly inhibit H/K ATPase in stomach parietal cells Peptic ulcer, gastritis, reflux, zollinger ellison, Stress ulcer prophylaxis
47
Aluminum hydroxide
Alter gastric and urinary pH Hypokalemia Constipation Hypophospahtemia Proximal muscle weakness Seizures
48
Calcium carbonate
Alter gastric and urinary pH Hypokalemia Hypercalcemia Rebound acid increase
49
Magnesium hydroxide
Alter gastric and urinary pH Hypokalemia Diarrhea Hyporeflexia Hypotension Cardiac arrest
50
Bind to ulcer base, provide physical protein and allowing HCO3 secretion to reestablish pH gradient - requires
Bismuth (peptobismal) Sucralfate Requires acidic environment (Sucralfate)
51
PGE1 analog - MOA - Use - adverse effect
Misoprostol Increase production and secretion of gastric mucous barrier Decrease acid production Prevention of NSAID induced peptic ulcers Off label use for induction of labor (ripens cervix) Diarrhea
52
Octreotide - MOA - uses - Adverse effects
Long acting somatostatin analog Inhibits various splanchnic vasodilatory hormones Acute variceal bleeds Acromegaly VIPoma Carcinoid tumors Nausea, cramps Steatorrhea Increase risk cholithiasis due to CCK inhibition **
53
Sulfasalazine - MOA - Use - Adverse
Combo of sulfapyridine (antibacterial) and 5- aminosalicylic acid (anti-inflammatory) Activated by colonic bacteria UC and chrons Nausea, sulfa toxicity Oligospermia** (reversible)
54
Loperamide - MOA - Use - Adverse effects
Agonist at mu opoid receptor Slows gut motility Poor CNS penetration Used for diarrhea AE: constipation, nausea
55
Ondansetron - MOA - Use - Adverse effects
5-HT3 antagonist (serotonin) Decrease vagal stimulation Central- acting aniemetic Control vomiting post-op and in chemo Adverse - Headache ** - Constipation - QT prolongation ** - Serotonin syndrome
56
Metoclopramide - MOA - Use - Adverse effects
D2 receptor antagonist ( Stimulates 5-HT, inhibits D2) Increase resting tone, contractility, LES tone, motility, promotes gastric emptying. Use: DM and post surgery gastroparesis, antiemetic, persistent GERD Adverse - Parkinson effect ** - Tardive dyskinesia - Seizures ** - Restlessness - Depression
57
Orlistat - MOA - Use - Adverse effects
Inhibits gastric and pancreatic lipase Decrease breakdown and absorption of dietary fats Use: Weight loss Adverse - Steatorrhea - Decrease absorption of fat soluble vitamins
58
Laxatives - Psyllium, methylcellulose - Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose - Senna - Docusate
Psyllium, methylcellulose - Bulk forming - soluble fibers draw water into lumen - AE: bloating Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose - Osmotic laxatives - Provide osmotic load to draw water into GI lumen - AE: diarrhea, dehydration Senna - Stimulants - Enteric nerve stimulation --> colonic contraction - Diarrhea - Melanosis coli: lumen of gut is pigmented with brown color Docusate - Emollient - Osmotic draw into lumen, increase water absorption by stool - AE: diarrhea
59
Aprepitant - Type - MOA - Use
Substance P antagonist Blocks NK1 receptors in brain Antiemetic for chemotherapy induced nausea and vomiting
60
Thrombocyte contains what 2 things
Dense granules - ADP, Ca Alpha granules - vWF, fibrinogen, fibronectin
61
vWF receptor
GpIb
62
Fibrinogen receptor
GpIIb/IIIa
63
Neutrophil chemotactic agents
``` C5a IL-8 LTB4 kallikrein Platelet activating factor ```
64
Target cell seen in
HALT HbC disease Asplenia Liver Thalassemia
65
Drugs that target P2Y12 receptor
Inhibit ADP induced expression of GpIIb/IIIa via P2Y12 receptor Clopidogrel Prasugrel Ticlopidine
66
Drugs that target GpIIb/IIIA
Inhibit directly Abciximab Eptifibatide Tirofiban
67
Microcytic hypochromic anemia
MCV < 80 Hypochromic (central pallor) LIST Lead poisoning Iron deficiency Sideroblastic anemia Thalassemia (Alpha, Beta)
68
Macrocytic anemia
MCV > 100 ``` Megaloblastic anemia Folate deficiency Vit B 12 deficiency (neurologic symptoms) Orotic aciduria (no hyperammonia) ```
69
Non hemolytic, normocytic anemia
Anemia of chronic disease | Aplastic anemia
70
Pyruvate kinase deficiency
AR Pyruvate kinase defect Decreased ATP Rigid RBCs Extravascular hemolysis Increased levels of 2,3 BPG Decreased hemoglobin affinity for O2
71
Crystals inside RBCs | Target cells
HbC disease Glutamic acid --> lyCine (lysine) mutation in beta globin Causes extravascular hemolysis
72
Sickle cell vasoocculsion due to
abnormal hemoglobin polymerization
73
Lead poisoning - affected enzyme - accumulated substance - symptoms
Affected - ferrochelatase - ALA dehydratase Accumulated (blood) - Protoporphyrin - ALA Mental deterioration HA Memory loss
74
Acute intermittent porphyria - inheritence - affected enzyme - Accumulation - symptoms - tx
AD Affected - porphobilinogen deaminase (previously known as uroporphyrinogen I synthase) Accumulation - Porphobilinogen - ALA 5 P's - Painful abdomen - Port wine colored urine (reddish urine darkens on exposure to light and air) - Polyneuropathy - Psychological disturbances - Precipitated by drugs (barbiturates, seizure drugs, rifampin, metoclopramide) Tx Glucose and heme (dextrose)
75
Porphyria cutanea tarda - Inheritence - Affected enzyme - Accumulation - symptoms
Affected enzyme - AD - Uroporphyrinogen decarboxylase Accumulation - Uroporphyrin Symptoms - Tea colored Urine - Blistering to sun - Hyperpigmentation to sun exposure
76
Bernard-Soulier - platelet count - bleeding time - defect
Normal or decreased platelets Increased bleeding time Defect in platelet plug formation - Large platelets - Decreased GpIb - defect platelet to vWF adhesion
77
Glanzmann thrombasthenia - platelet count - bleeding time - defect - blood smear
Normal platelet count Increased bleeding time Defect in platelet integrin (GpIIb/IIIa) - defect in aggreagation Blood smear shows no clumping
78
HUS - platelet count - bleeding time - defect - features
Decreased platelets Increased bleeding time Acute renal failure Children Diarrhea and E.coli
79
Immune thrombocytopenia - platelet count - bleeding time - defect - bone marrow biopsy
Decreased platelets Increased bleeding time Anti-GpIIb/IIIa antibodies Increased megakaryocytes on bone marrow biopsy
80
Thrombotic thrombocytopenic purpura - platelet count - bleeding time - defect - increased - labs
Decreased platelets Increased bleeding time Inhibition or deficiency of ADAMTS 13 (vWF metalloprotease) --> decreased degradation of vWF multimers Increased platelet adhesion, aggregation and thrombosis Schistocytes, increased lactate dehydrogenase, thrombocytopenia
81
Owl eyes | - surface marker for this cell type
Reed Sternberg cells - Hodgkin lymphoma CD15 and CD 30 B cell
82
Mandible Mass Night sweats Sheets of lymphocytes with interspersed "tingible body" macrophages - Translocation - gene - assoc with
Burkitt lymphoma t(8;14) c-myc EBV
83
t(8;14)
Burkitt lymphoma
84
t(14;18)
Follicular lymphoma BCL-2
85
t(11;14)
Mantle cell lymphoma Tranlocation of cyclin D1 (11) and heavy chain Ig (14), CD5+
86
t(11;18)
Marginal zone lymphoma
87
Older adult | Rapidly growing mass
Diffuse large B cell lymphoma
88
Waxing and waning lymphadenopathy
Follicular lymphoma
89
Cutaneous lesions Lytic bone lesions Hypercalcemia
Adult T cell lymphoma HTLV mutation
90
Skin patches/ plaques characterized by typical CD4 + cells with cerebriform nuclei and intraepidermal neoplastic ell aggregates
Mycosis fungoides/ Sezary syndrome
91
Tx multiple myeloma
Proteasome inhibitor Borteozomib - boronic acid containing dipeptidase
92
Rouleaux formation
Multiple myeloma
93
Multiple myeloma symptoms/ features
CRAB ``` hyperCalcemia Renal involvement Anemia Bone lytic lesions/ Back pain Monoclonal M protein spike ```
94
t(12;21)
ALL
95
Splenomegaly Pancytopenia Marrow fibrosis "Dry tap" Positive TRAP (tartrate resistant acid phosphatase) TX
Hairy cell leukemia - mature B cellt umor Hair like projections on LM Treatment - Cladribine - Pentostatin
96
Cell with small amount of purplish clear cytoplasm, large purple nucleus. Small purple particle/ spinter on periphery - disease - cell type - positive for - translocation - tx
AML Auer rods Myeloperoxidase positive t(15;17) TX - all-trans retinoic acid (vit A)
97
t (15;17)
AML
98
t(9;22) - disease - lab - tx
BCL-ABL Philiadelphia chromosome CML Very low LAP Bcl-abl tyrosine kinase inhibitors - Imatinib
99
Myeloproliferative disorders - examples - mutation
Polycythemia vera Essential thrombocythemia Myelofibrosis CML JAK2 mutation
100
Intense itching after hot shower - Due to - Lab - Tx
Polycythemia vera Due to episodic blood clots in vessels of the extremities Decreased EPO Increased RBC, WBC, Platelets TX - Phlebotomy - Hydroxyurea - Ruxolitinib (JAK1/2 inhibitor)
101
Massive splenomegaly Tear drop RBCs - Disease - Due to - Lab
Myelofibrosis Obliteration of bone marrow with fibrosis due to increased fibroblast activity Decreased RBC Dry tap
102
Lytic bone lesions Skin rash Recurrent otitis media EM: Tennis racket - What do cells express
Langerhans cell histicytosis S-100 CD1a
103
Heparin - MOA - Adverse effects - Reversal - Administered - Site of action
Binds antithrombin III which then inhibits Factor Xa and neutralize thrombin AE - Bleeding - Thrombocytopenia - Osteoporosis Protamine sulfate (binds to heparin) IV or SQ Blood
104
Low molecular weight heparins
Enoxaparin Dalteparin Act predominantly on factor Xa
105
Fondaparinux - type - MOA - 4 features
Low molecular weight heparin Acts only on Factor Xa Better bioavailability Longer half life Adminstered SQ Not easily reversible
106
Heparin induced thrombocytopenia (HIT)
development of IgG antibodies against heparin bound platelet factor 4 (PF4) Antibody-heparin-PF4 complex activates platelets --> thrombosis and thrombocytopenia
107
Similar to anticoagulant used by leeches, hirudin
Bivalirudin Direct thrombin inhibitor Directly inhibits activity of free and clot associated thrombin
108
Direct thrombin inhibitors - examples - oral one - MOA - use - reversal
Bivalirudin Argatroban Dabigatran (only oral) Directly inhibits activity of free and clot associated thrombin Use - venous thromboembolism - Afib Dabigatran can be reversed with idarucizumab
109
Warfarin - MOA - Lab - Adverse effects - Route of admission - Site of action
Interferes with gamma-carboxylation of vit K- dependent clotting factors II, VII, IX, X and protein C and S Inhibits epoxide reductase Extrinsic pathway Increase PT Adverse effects - Bleeding - Teratogenic - Skin/ tissue necrosis ** (due to small vessel microthrombosis) - Transient hypercoagulability when first use due to Protein C and S Oral LIver
110
Apixaban - type - other - MOA - Use
Direct Factor Xa inhibitors -Xaban Apixaban Rivaroxaban Bind to and directly inhibit factor Xa TX for DVT and PE, stroke prophylaxis in patients w/ Afib
111
Thrombolytics - examples - MOA - Lab - Use
Alteplase (tPA), reteplase (rPA), streptokinase, tenecteplase (TNK-tPA) Directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots Increase PT, PTT, no change in platelet Early MI, direct thrombolysis of severe PE Dont use in patient with active bleeding or history of bleeding issues
112
Antifibrinolytics
Aminocaproic acid | Tranexamic acid
113
Clopidogrel - type - examples - MOA - Prevents - Use - Adverse effect
ADP receptor inhibitors Clopidogrel Prasugrel Ticagreolar (reversible) Ticlopidine Inhibit platelet aggregation by IRREVERSIBLY block ADP (P2Y12) receptor. Prevent expression of glycoproteins IIb/IIIa) on platelet surface Use: Coronary stenting Adverse effect - Neutropenia (ticlopidine) - TTP
114
Cilostazol - type - other example - MOA - Use - Adverse effect
Phosphodiesterase inhibitors Dipyridamole Increase cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators Use - Intermittent claudication - coronary vasodilation Adverse effects - Nausea, HA - Facial Flushing - Hypotension - Abdominal pain
115
Abciximab - Type - Other examples - MOA - Use - Adverse
Glycoprotein IIb/IIIa inhibitors Abciximab Eptifibatide Tirofiban Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation. Use - Unstable angina Adverse - bleeding - thrombocytopenia
116
Dipyridamole - type - other example - MOA - Use - Adverse effect
Phosphodiesterase inhibitors Cilostazol Increase cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators Use - Intermittent claudication - coronary vasodilation Adverse effects - Nausea, HA - Facial Flushing - Hypotension - Abdominal pain
117
Eptifibatide - Type - Other examples - MOA - Use - Adverse
Glycoprotein IIb/IIIa inhibitors Abciximab Eptifibatide Tirofiban Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation. Use - Unstable angina Adverse - bleeding - thrombocytopenia
118
Cancer drugs that affect S phase of cell cycle
Antimetabolites ``` Azathioprine Cladribine Cytarabine 5-fluorouracil Hydroxyurea Methotrexate 6-mercaptopurine ``` Topoisomerase inhibitors (S and G2) - Etoposide - Teniposide - Irinotecan - Topotecan
119
Cancer drugs that affect both S phase and G2 phase
Topoisomerase inhibitors - Etoposide - Teniposide - Irinotecan - Topotecan
120
Tirofiban - Type - Other examples - MOA - Use - Adverse
Glycoprotein IIb/IIIa inhibitors Abciximab Eptifibatide Tirofiban Bind to the glycopreotin receptor IIb/IIIa on activated platelets, preventing aggregation. Use - Unstable angina Adverse - bleeding - thrombocytopenia
121
Cancer drugs that affect G2 phase of cell cycle
G2 only - Bleomycin Topoisomerase inhibitors (S and G2) - Etoposide - Teniposide - Irinotecan - Topotecan
122
Cancer drugs that inhibit M phase of cell cycle
Microtubule inhibitors - Paclitaxel - Vinblastine - Vincristine
123
Cancer drugs that are independent of cell cycle
Platinum agents (cisplatin) Alkylating agents - Busulfan - Cyclophosphamide - Ifosfamide - Nitrosoureas (carmustine)
124
Cancer drugs that target nucleotide synthesis (4)
MTX, 5-FU - decrease thymidine synthesis 6-MP - decrease de novo purine synthesis Hydroxyurea - inhibit ribonucleotide reductase
125
Cancer drugs that target DNA (9)
Alkylating agents, platinum agents - Cross link DNA Bleomycin - DNA strand breakage Dactinomycin, Doxorubicin - DNA intercalators Etoposide/ teniposide - Inhibit topoisomerase II Irinotecan/ topotecan - inhibit topoisomerase I
126
Use to prevent organ rejection, RA, IBD, SLE - MOA - Adverse effects
Azathioprine 6-mercaptopurine Adverse effects - myelosuppresion
127
Use to tx hairy cell leukemia - MOA - Adverse effect
Cladribine Purine analog --> multiple mechanism - Inhibition of DNA polymerase - DNA strand breaks Myelosuppression Nephrotoxicty Neurotoxicity
128
Tx Leukemia (AML) and lymphomas - MOA - Adverse effect
Cytarabine (arbinofuranosyl cytidine) Pyrimidine analog Inhibition of DNA polymerase Myelosuppresion with megaloblastic anemia CYTarabine causes panCYTopenia
129
Cancer drug can result in hand foot syndrome (palmar-plantar erythrodysesthesia) - MOA - Use
5-fluorouracil Pyrimidine analog Inhibits thymidylate syntehase Decrease DNA synthesis Colon cancer Pancreatic caner Basal cell carcinoma
130
Myelosuppression reversible with
Leucovorin
131
What drug's effects are enhanced by leucovorin
5-fluorouracil
132
Mouth ulcers Hepatotoxicity Pulmonary fibrosis From what drug
Methotrexate
133
Testicular cancer tx (non-alkylating ) - Drug - MOA - Other use - Adverse effect
Bleomycin Induces free radical formation --> breaks in DNA strands Testicular cancer Hodgkin lymphoma Pulmonary fibrosis Hyperpigmentation
134
Cancer drug causes 1) Pulmonary fibrosis 2) Hyperpigmentation 3) Nephrotoxicity, Neurotoxicity 4) Megaloblastic anemia, myelosuppression 5) Redness, swelling and pain on palms or soles 6) Hepatotoxicty 7) Cardiotoxicity 8) Convulsions, dizziness, ataxia 9) Mouth ulcers 10) Alopecia 11) Neuropathy and hypersensitivity 12) Areflexia, peripheral neuritis, constipation 13) Nephrotoxicity, peripheral neuropathy, ototoxicity 14) Diarrhea and myelosuppression 15) Hemorrhagic cystitis 16) Hemorrhage, blood clots, impaired wound healing 17) Rash only 18) Rash, Elevated LFTs, diarrhea 19) Fluid retention 20) Increased risk of thromboembolic events
1) Methotrexate, Bleomycin, Busulfan 2) Bleomycin, Busulfan 3) Cladribine 4) Cytarabine 5) 5-fluorouracil 6) Methotrexate 7) Doxorubicin, Daunorubicin , Trastuzumab (Herceptin) 8) Nitrosoureas 9) Methotrexate 10) Doxorubicin, Daunorubicin, Etoposide, teniposide 11) Paclitaxel 12) Vincristine, Vinblastine 13) Cisplatin, carboplatin 14) Irinotecan, topotecan 15) Cyclophosphamide, ifosfamide 16) Bevacizumab 17) Erlotinib 18) Cetuximab 19) Imatinib 20) Tamoxifen, Raloxifene
135
Used to childhood tumors - Wilms tumor - Ewing sarcoma - Rhabdomyosarcoma MOA
Dactinomycin (actinomycin D) Intercalates DNA
136
Doxorubicin Daunorubicin MOA Use Adverse - Tx adverse
Anthrocyclines Generates free radicals Intercalate in DNA --> breaks DNA --> decrease replication (Wedge into DNA between base pairs, forms tight bond, DNA cant unwind to replicate) Solid tumors Leukemia, lymphomas Cardiotoxicity (dilated cardiomyopathy) Alopecia Dextrazoxane - iron chelating agent - prevent cardiotoxicity
137
Use to prevent cardiotoxicity in patients taking doxorubicin or daunorubicin
Dextrazoxane
138
Tx CML MOA Adverse Other use Adverse effects
Busulfan Cross links DNA Also used to ablate patient's bone marrow before bone marrow transplantation Pulmonary fibrosis Hyperpigmentation
139
Alkylating agent that can cross BBB - Needs - MOA - Use - Adverse effect
Nitrosoureas - mustine (carmustine, lomustine, semustine) Requires bioactivation Cross BBB Cross link DNA Use - Brain tumors (glioblastoma) Adverse - CNS toxicity (convulsions, dizziness, ataxia)
140
Cisplatin, carboplatin - MOA - Use - Adverse effect - Prevent adverse with
Cross link DNA Testicular Bladder Ovary Lung carcinoma Nephrotoxicity Peripheral neuropathy Ototoxicity Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis
141
Prevent nephrotoxicity with
Amifostine Free radical scavenger
142
Aminocapric acid | Tranexamic acid use to reverse
Thrombolytics Alteplase Reteplase Streptokinse Tenecteplase
143
Dexarazoxane
Iron chelating agent Used to prevent cardiotoxity in Doxorubicin, and daunorubicin
144
Amifostine
Free radical scavenger Prevent nephrotoxicity in platins
145
Cyclophosphamide - MOA - Other drug - Uses - Adverse effect
Cross- link DNA at guanine N-7 Requires bioactivation by liver Nitrogen mustard Solid tumors, leukemia, lymphoma Immunosuppressant (SLE, Polyarteritis nodosa) Hemorrhagic cystitis (Prevented by mesna- thio group of mesna binds toxic metabolites or N-acetylcysteine)
146
Mesna
Binds toxic metabolites Prevents Hemorrhagic cystitis Cyclophosphamide
147
Hydroxyurea - MOA - Use
Inhibits ribonucleotide reductase Inhibit DNA synthesis in S phase ``` Myeloproliferative disorders - CML - Polycythemia vera Sickle cells Melanoma ```
148
Monoclonal Ab 1) VEGF - Use - adverse 2) EGFR - Use - Adverse 3) CD20 - Use - Adverse 4) HER-2 - use - adverse
1) VEGF monoclonal Ab= Bevacizumab - Inhibits angiogenesis (blood vessel formation) - Solid tumors (colorectal cancer, renal cell carcinoma) - Hemorrhage, blood clots, impaired wound healing 2) EGFR monoclonal Ab= Cetuximab - Stage IV colorectal cancer (wild type KRAS) - Head and neck cancer - Rash, elevated LFTS, diarreha 3) CD20 monoclonal AB= Rituximab - CD20 on most B cell neoplasma - Non-hodgkin lymphoma, CLL, ITP, RA - Increased risk of progressive multifocal leukoencphalopathy 4) Trastuzumab (Herceptin) - HER2 breast cancer and gastric cancer - Cardiotoxicity. "Heartceptin" damages the heart
149
Erlotinib - Type - Use - Adverse
EGFR tyrosine kinase inhibitor Non-small cell lung carcinoma Rash
150
Imatinib - Type - Use - Adverse
Tyrosine kinase inhibitor of BCR-ABL and c-kt CML, GI stromal tumors (GIST) Fluid retention
151
Borteozomib - type - MOA - Other example - Use - Adverse
Proteasome inhibitor Induce arrest at G2-M phase and apoptosis - Results in accumulation of toxic intracellular proteins excess pro-apoptotic proteins --> induce apoptosis Boronic acid containing dipeptide Multiple myeloma Mantle cell lymphoma Adverse - Peripheral neuropathy - herpes zoster reactivation (shingles)
152
Carfilzomib - type - MOA - Other example - Use - Adverse
Proteasome inhibitor Induce arrest at G2-M phase and apoptosis - Results in accumulation of toxic intracellular proteins excess pro-apoptotic proteins --> induce apoptosis Multiple myeloma Mantle cell lymphoma Adverse - Peripheral neuropathy - herpes zoster reactivation
153
Raloxifene - MOA - Use - Adverse effect
Selective estrogen receptor modulators (SERMs) - antagonist in breast - agonist in bone - blocks binding of estrogen to ER + cells Prevent osteoporosis (Not direct tx for breast cancer but helps) Antagonist in endometrial tissue Increased risk of thromboembolic events
154
Tamoxifen - MOA - Use - Adverse effect
Selective estrogen receptor modulators (SERMs) - antagonist in breast - agonist in bone - blocks binding of estrogen to ER + cells Breast cancer treatment and prevention Partial agonist in endometrium - increase risk of endometrial cancer " hot flashes" Increased risk of thromboembolic events
155
Vemurafenib
Small molecule inhibitor of BRAF oncogene + melanoma V600E-mutated BRAF inhibition VE-MU- RAF-enib is for V600E-MUtated bRAF inhibition Serine/ threonine kinase Metastatic melanoma
156
Tx of cancer Hyperkalemia Hyperphosphatemia Hypocalcemia Hyperuricemia Treatment
Tumor lysis syndrome Agressive hydration Allopurinol Rasburicase
157
Rasburicase
Recombinant uricase that catalyzes metabolism of uric acid to allantoin Prevention and tx of tumor lysis syndrome
158
What can trigger toxic megaclon
Antibiotics --> clostridum difficile
159
Sensation of anterior 2/3 on tongue Taste Motor
Sensation: Mandibular branch of trigeminal n. (CN V3) Taste: facial Motor: hypoglossal n.
160
Salivary gland stimulated secretions
Sympathetic - Thick secretions - Superior cervical ganglion Parasympathetic - Watery - CN VII and CN IX
161
What nerve runs through parotid gland and can be damaged with parotid gland surgery
CN VII
162
Infection common of tonsils and adenoids
S. pyogenes
163
Infection most common of salivary gland
S. aureus | Viridans group strep
164
Pleomorphic adenoma | - composed of
Most common salivary gland tumor Epithelial and mesenchymal cells
165
Tumor of salivary gland Double layer of columnar epithelium around cyst. Stroma is lymphoid. - Can form
Warthin tumor - Benign cystic tumor Can form germinal center
166
Child with immune disorder has recurrent staphylococcal abscess. Found that neutrophils fail to respond because the chemotactic stimuli are deficient. Most likely?
Hyperimmunoglobulin E syndrome (Job syndrome) - IFN-gamma low Leukocyte adhesion deficiency
167
Esophagitis 1) Esophagitis reveals large, pink intranuclear inclusions and host cell chromatin that is pushed to the edge of nucleus 2) Esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions and a clear perinuclear halo 3) Biopsy reveals a lack of ganglion cells between the inner and outer muscosal layers 4) Protrusion of mucosa in the upper esophagus
1) HSV esophagitis 2) CMV esophagitis 3) Achalasia 4) Plummer-vinson syndrome
168
Dark urine Clay colored stools Jaundice
Extrahepatic biliary atresia Incomplete recanalization
169
Tx Esophageal variceal bleed
Vasopressin Octreotide Propranolol or nadolol (beta blocker)
170
Vagus nerve directly stimulates what in GI - receptors - inhibited by Vagus indirectly stimulates what - This secretes what - Inhibited by
Parietal cells to secrete gastric acid - M3 ACh receptors - Can be inhibited by atropine Indirectly stimulates G cells to release Gastrin via Gastrin-releasing peptide - Gastrin stimulates enterochromaffin like (ECL) cells to secrete histamine - Stimulates parietal cells to make gastric acid - Atropine has no effect - H2 blockers (Cimetidine, Ranitidine)
171
Upper GI problem 1) Stomach biopsy reveals neutrophils above the basement membrane loss of surface epithelium and fibrin containing purulent exudate 2) Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells and atrophy of glandular structures 3) Diffuse thickening of gastric folds, elevates serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia
1) Acute gastritis 2) Chronic gastritis 3) Zollinger-Ellison syndrome
172
Peptic ulcer treatment Additional tx if hemorrhage
Triple therapy- H. pylori - PPI + clarithromycin + amoxicillin - PPI + clarithromycin + metronidazole Quadruple therapy - PPI + Bismuth + metronidazole + tetracycline Hemorrhage= Octreotide (somatostatin) - decrease splanchnic blood flow
173
Vasoactive intestinal peptide (VIP)
Smooth muscle cells Parasympathetic ganglia Enteric nervous system Relaxes smooth muscle and sphincters in GI tract Increase secretion of electrolytes and water Copious watery diarrhea
174
Brunner glands - job - location
Secretes alkaline mucus Neutralize gastric acid Duodenal submucosa
175
Ligaments that have to be cut to remove spleen
Gastrosplenic lig | Splenorenal lig
176
Macrolides fxn in GI
Stimulate smooth muscle motilin receptors
177
Pain out of proportion to physical exam
Ischemic colitis
178
Downs syndrome GI problems
Dont Have A Clue Duodenal atresia Hirschsprung Disease Annular pancreas Celiac disease
179
Preop Tx for appendicitis
Hydration Cefoxitin Ampicillin + sulbactam
180
Stops in Chromosomal instability APC pathway
1) Loss of APC gene 2) KRAS mutation (increased growth stimulus) 3) Loss of tumor suppressor genes - p53 - DCC (chr 18 q)
181
Familial adenomatous polyposis
FAP AD Lots of polyps
182
Fatty bulge under skin (fatty tumor)- Lipoma Bone soft tissue tumors (osteomas) - Extra bone growth (spur) Lots of polyps in colon Retinal hyperplasia (dark black spot in eye)
Gardner syndrome
183
Tx Crohns
Initial for mild - 5-ASA agents (5-aminosalicylic) (Mesalamine, sulfasalazine) Azathioprine or mercaptopurine Anti-TNF if arthrtic component (infliximab, adalimumab)
184
Diverticulitis tx
Metronidazole (anaerobic bacteria) | TMP-SMX or fluoroquinolone
185
Pancreas derived from
Endocerm
186
``` Diabetes Depression Dermatitis DVT Wt loss ```
Glucoagonoma Tumor of pancreatic alpha cells TX: octreotide
187
Diabetes Steatorrhea Gallstones Achlorhydrdia
Somatostatinoma
188
Hormones stimulate pancreatic secretion
CCK (pancreas and GB) Secretin (stimulate bicarb secretion) Acetylcholine (CN X)
189
Liver from what germ layer
Endoderm
190
Metabolic Liver failure can cause an increase in
Increased estradiol levels - Testicular atrophy - Gynecomastia - Spider angioma (telangiectasia) - Palmar erythema (red palms)
191
Medications for cirrhosis - Tx ascites and edema - Tx varices - Tx Hepatic encephalopathy
Diuretic (tx ascites and edema) - Spironolactone - Furosemide Beta blockers (varices) - Propranolol - Nadolol Vit K Lactulose (tx hepatic encephalopathy) - Trap ammonium in gut so gets excreted in stool Rifamacin (refractory hepatic encephalopathy)
192
Tx Hep B
``` Tenofovir Entacavir Telbivudine Lamivudine Adefovir ``` Pregnant - Lamivudinie
193
Tx Hep D
Pegylated IFN-alpha
194
Tx Hep C
Ledipasvir-Sofosbuvir | Ombitasvir-paritaprevir-ritonavir + dasabuvir
195
Anti-smooth muscle ab
Autoimmune hepatitis
196
Genus and family 1) Hep A 2) Hep B 3) Hep C 4) Hep D 5) Hep E
1) Hep A - ssRNA - hepatovirus - picronavirus 2) Hep B - dsDNA - orthohepadnavirus - Hepadnaviridae 3) Hep C - ssRNA - hepacivirus - Flavivirdae 4) Hep D - ssRNA - deltavirdae 5) Hep E - ssRNA -
197
Primary Biliary cholangitis (PBC) - MOA - Identifies - Tx
Autoimmune T cells attack bile ductules within the liver parenchyma Granulomas Cirrhosis Antimitochondrial antibody (AMA) Tx: Ursodiol (ursodeoxycholic acid) - bile acid that decreases the synthesis of cholesterol in the liver
198
Primary Sclerosing Cholangitis (PSC) - MOA - Causes - Identifier - Associated with - Tx
Concentric fibrosis of bile ducts Irregular ares of stricturing and areas of dilation "Beads on a string" (+) p-anca Associated with UC and cholangiocarcinoma Tx: liver transplant
199
RL of coagualtion pathway
Factor X
200
Factor V Leiden
Makes Factor Va resistant to inactivation by protein C More coagulation
201
Hypercoagulable | Resistant to Heparin
Antithrombin deficiency Unable to inactivate thrombin
202
Protein C deficiency
Unable to inactivate factor V and VIII
203
PT
Extrinsic Starts with VII Monitor Warfarin
204
PTT
Intrinic start w/ XII Monitor heparin
205
RL step in heme synthesis
delta-ALA synthase
206
Chipmunk facies Hair on end appearance X ray Target cells Microcytic anemia
Beta thalassemia Increase Hemoglobin F (2 alpha 2 gamma)
207
Orotic acid in urine megaloblastic anemia No hyperammonemia
Orotic aciduria Def: UMP synthase
208
Cold agluttings
Ab against RBC that interact more strongly at low temps IgM EBV or mycoplasma
209
Warm agglutins
Ab react against RBC at body temp IgG EBV, HIV Lupus Malignancies (CLL, non-hodgkin) Congenital immune abnormalities
210
Hereditary spheocytosis defects in
Ankyrin Spectrin Band 3 Protein 4.2
211
Tx Sickle cell
Hydroxyurea (increase HbF)
212
Order of bands on hemoglobin electrophoresis
A F S C
213
Ham's test
Paroxysmal nocturnal hemoglobinuria Red urine in morning RBC missing surface markers -CD55 adn CD59
214
Increase in PTT and bleeding time
Von Willebrand factor (vWF) deficiency
215
Von willebrand disease test
Ristsocetin cofactor assay Causes platelets to aggregate if vWF present
216
Tx vWF disease
DDAVP - desmopressin (synthetic ADH) Increases vWF release from storage sites
217
``` Painless non-tender lympadenopathy Low grade fever Night sweats weight loss Pruritis ```
Hodgkin lymphoma B cell symptoms
218
Neutrophils iwth two lobed nucleus connected by thin strand Neutrophil: lots of light blue/ purple cytoplasm
Pelger-Huet Anomaly Myelodysplastic syndromes
219
Small cell lung cancer paraneoplastic syndromes (3)
ACTH --> cushing syndrome ADH --> SIADH - Hyponatremia Lambert-Eaton syndrome - Ab against presynaptic Ca channels at NMJ
220
Cancer that secretes PTHrP
Squamous cell lung cancer | Any squamous cell cancer
221
Tx Actinic keratosis
5-fluorouracil
222
CA-125 screening
Ovarian cancer
223
Alpha feto protein screening
hepatocellular carcinoma | Testicular tumors
224
CA 19-9 screening
Pancreatic cancer
225
S-100
Melanoma | Schwannoma
226
Tartrate resistant acid phosphatase (TRAP)
Hairy cell leukemia
227
Tx testicular cancer (3)
Eradicate Ball Cancer Etoposide + Bleomycin + Cisplatin Etoposide + ifosfamide + Cisplatin
228
Tx choricocarcinoma
Methotrexate | Vincristine
229
Tx Childhood tumors - Wilms - Ewing
VIncristine | Dactinomycin
230
Tx for philadelphia chromosome
Imantinib Targets mutant BCR-ABL`
231
Elevated Liver aminotransferases. Hx of drug use. Panlobular mononuclear cell infiltration taht crooss into adjacent lobules. Occasionally see a intensely Eosinophilic round bodies that are seen scattered amongst the hepatic parenchyma. What could cause this?
Acute viral hepatitis due to drug use Hepatocytes may undergo cytotoxic T cell mediated apoptosis due to presence of viral antigens on the hepatocyte surface These apoptotic cells appear as round acidophilic (pink) bodies known as councilman bodies
232
Epigastric pain, nausea and bloating. Diffuse erythema of antral mucosa. Infiltrate involving the superficial mucosal layers. The underlying cause will lead to
H. pyrloi induced chronic gastritis -->Gastric lymphoma
233
Develop resistance to chemotherapy via
P-glycoprotein, a transmembrane protein taht functions as a ATP dependent efflux pump. Pumps out chemotherapeutic agents
234
Shrunken liver on autopsy
Drug induced liver injury - Inhaled anesthetic (halothane) widespread centrilobular necrosis and inflammation of portal tracts and parenchymas are observed Elevated AST ALT Prolonged PT Leukocytosis and eosinophilia
235
Gallbladder hypomotility causes waht with bile
Biliary sludge
236
Hirschsprung disease
Constipation and abdominal distention Narrow rectum and rectosigmoid area. Rest of colon is dilated. Failure to pass meconium Bilious vomiting Failure of neural crest cells to migrate to intestinal wall or submucosa (meissner) and myenter (auerbach) plexi. Submucosa of rectum (narrowed segment) should be biopsied

AM- STEP1 (20 decks)

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