Neoplasia & Addiction Flashcards

Question

What are the current screening recommendations for skin cancer?

Answer 1

- A 'skin check' can be defined as a comprehensive assessment and examination of an asymptomatic patient for any evidence of skin cancer. - Current Australian guidelines advise against general population screening for skin cancer, citing the lack of evidence for the feasibility of organised screening and the effectiveness of screening in reducing mortality. Patient self examination with opportunistic screening is the current standard. - Cancer Council Australia argues against patients having regular or annual skin checks on three grounds: nonmelanoma skin cancer has a low mortality, melanoma frequency does not justify a mass population screening program on economic grounds, and the instrument that would be used for mass screening (GP assessment) is not sufficiently accurate.

Answer 2

The top 10 benign lesions are: 1. Solar keratosis 2. Diffuse superficial actini 3. Porokeratosis 4. Seborrhoeic keratosis (and the benign lichenoid keratosis variant) 5. Benign melanocytic naevus (junctional, compound or intradermal) 6. Chondrodermatitis nodularis helices chronicus 7. Blue naevus 8. Benign fibrous papule 9. Sebaceous hyperplasia 10. Capillary haemangioma 11. Dermatofibroma

Answer 3

The recommended strategy for population screening in Australia remains the immunochemical faecal occult blood test, commencing at age 50 years in asymptomatic individuals with no family history of colorectal cancer. This test is to be performed every two years to age 74 years. Individuals with a family history of colorectal cancer will need appropriate risk stratification. Aspirin should now be considered for all patients aged 50–70 years in the prevention of colorectal cancer.

Answer 4

Patients who have adenomatous polyps removed at colonoscopy are then classified as having aboveaverage risk for the development of metachronous adenomatous polyps and CRC.

Answer 5

Neither low-dose CT scanning nor chest X-ray are currently recommended for population-based screening for lung cancer in Australia. *- See Position Statement: Lung Cancer Screening using Low-Dose Computed Tomography*

Answer 6

Mammographic screening for women at average or slightly above average risk is currently recommended for women aged 50–74 years, and is available but not routinely recommended for women at average risk aged 40–49 years due to a much smaller benefit than for older women. Routine mammographic screening is not recommended for women aged <40 years as there is no evidence of effectiveness and screening results in many false positive mammograms.

Answer 7

**How often:** - At least every two years from 50-74 years of age - Annual mammograms from 40 may be recommended if the woman has a first degree relative <50yrs diagnosed with breast cancer.

Answer 8

**How often:** - At least every two years from 50-74 years of age - Annual mammograms from 40 may be recommended if the woman has a first degree relative <50yrs diagnosed with breast cancer.

Answer 9

Women and people with a cervix aged 25 to 74 years of age are invited to have a Cervical Screening Test every 5 years through their healthcare provider.

Answer 10

Screening of asymptomatic (low-risk) men for prostate cancer by prostate specific antigen (PSA) testing is not recommended because the benefits have not clearly been shown to outweigh the harms. Therefore, GPs have no obligation to offer prostate cancer screening to asymptomatic men.

Answer 11

**Top: Chromosomal instability pathway (adenoma-carcinoma sequence)** - Loss of the tumor suppressor gene, APC, results in hyperproliferative epithelium due to a loss of cellular adhesion and increased cellular proliferation. A mutation in KRAS results in unregulated cellular signaling and cellular proliferation, leading to the formation of an adenoma. Loss of the tumor suppressor genes TP53 and DCC results in the malignant transformation of an adenoma to carcinoma. The chromosomal instability pathway is responsible for carcinomas in FAP (loss of APC) as well as in most cases of sporadic colorectal carcinoma. **Bottom: Microsatellite instability pathway** - Acquired or inherited mutations in the mismatch repair genes (esp. MLH1 and MSH2) result in abnormal proliferation and the formation of adenoma and carcinoma. The microsatellite instability pathway is responsible for carcinomas in Lynch syndrome (HNPCC) and a few cases of sporadic colorectal carcinoma.

Answer 12

1. Long-term use of aspirin and other NSAIDs 2. Physical activity 3. Diet rich in fiber and vegetables and lower in meat

Answer 13

**Constitutional symptoms: ** 1. Weight loss 2. Fever 3. Night sweats 4. Fatigue 5. Abdominal discomfort (symptoms similar to diverticulitis, especially in carcinoma of the rectosigmoid or descending colon)

Answer 14

All patients with suspected CRC should undergo a complete colonoscopy with biopsy of suspicious lesions. Once the diagnosis is confirmed, additional tests to stage the cancer are required to guide management.

Answer 15

For the characteristics of Li-Fraumeni syndrome, think BLAST53: Breast cancer/Brain tumors, Leukemia/Lymphoma, Adrenocortical carcinoma, Sarcoma, and Tp53.

Answer 16

1. Ductal carcinoma in situ (DCIS) - eg. Comedocarcinoma 2. Invasive ductal carcinoma (IDC) - eg. Medullary breast cancer 3. Invasive lobular carcinoma (ILC) -

Answer 17

**Early Stages** In early stages, affected individuals may notice a palpable mass with the following characteristics: * Typically single, nontender, and firm * Poorly defined margins * Most commonly located in the upper outer quadrant (∼ 55%) **Progressive disease** 1. Ulcerations 2. Edema of the arm 3. Paget disease of the nipple

Answer 18

**Lymphatic spread** 1. Lymphadenopathy 2. Nontender, firm, enlarged lymph nodes (> 1 cm in size), that are fixed to the skin or surrounding tissue 3. Most commonly the axillary nodes and, in later stages, the supraclavicular and/or infraclavicular nodes

Answer 19

Inflammatory breast cancer is always classified as T4 because it involves the skin.

Answer 20

Even though some sources still refer to H. pylori infection as a risk factor for only the intestinal type of gastric cancer, it has been proven to be associated with both intestinal and diffuse types. It is believed that H. pylori contributes to gastric cancer development by direct action of its virulence factors and indirectly by initiation and maintenance of a chronic inflammation in the gastric mucosa.

Answer 21

H. pylori alone is not likely responsible for gastric cancer. Rather, it may provide a suitable environment, including chronic gastritis and intestinal metaplasia, for neoplastic change.

Answer 22

- EBV is linked to Hodgkin lymphoma , Burkitt lymphoma (a rare type of non-Hodgkin lymphoma) and nasopharyngeal cancers. - EBV could either play a direct or indirect role in the pathogenesis of Hodgkin's disease, possibly by triggering the pathogenic mechanism(s), or it could reflect the presence of an inherited or acquired depression of immunoregulation that is a prelude both to the malignancy and to the reactivation of EBV. - Immunosuppressed patients show rises in all herpesvirus antibodies, rather than a selective rise in EBV antibodies, which suggests that depression of immunoregulation, rather than a specific disease phenomenon, might be responsible for these raised values.

Answer 23

Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you.

Answer 24

A chronic condition in which an uncontrolled pattern of substance use leads to significant physical, psychological, and social impairment or distress, with continued use despite substance-related problems.

Answer 25

- Sex: ♂ > ♀ - Alcohol and nicotine use are most common.

Answer 26

1. Impaired control 2. Social impairment 3. Risky use 4. Pharmacologic indicators

Answer 27

1. Autonomic symptoms (e.g., palpitations, sweating, ↑ blood pressure) 2. Anxiety, insomnia 3. Nausea, vomiting 4. Alcohol withdrawal seizures 5. Alcohol withdrawal delirium

Answer 28

1. Flu-like symptoms (e.g., chills, myalgia, piloerection) 2. Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) 3. Sympathetic hyperactivity (e.g., mydriasis, tachycardia) 4. CNS stimulation (e.g., insomnia, anxiety, agitation)

Answer 29

1. Delirium 2. Severe hypotension, possibly cardiovascular collapse

Answer 30

1. Autonomic symptoms (e.g., sweating, hypertension) 2. Gastrointestinal symptoms (e.g., nausea, vomiting) 3. Neurological symptoms (e.g., seizures, tremors) 4. Psychiatric symptoms (e.g., depressive moods, insomnia)

Answer 31

Physiologic crash after use due to receptor downregulation characterized by: 1. Dysphoria 2. Anhedonia 3. Anxiety 4. ↓ Energy 5. Depression with suicidal thoughts 6. ↑ Appetite 7. Sleep disturbance 8. Agitation

Answer 32

1. Depressed mood, irritability 2. Drowsiness, fatigue 3. Difficulty concentrating 4. Flu-like symptoms, muscle pain

Answer 33

1. Frustration, anger 2. Restlessness, anxiety, insomnia 3. Dysphoria, depressed mood 4. Impaired concentration 5. ↑ Appetite, weight gain

Answer 34

1. Diaphoresis, agitation 2. CNS stimulation (e.g., irritability, insomnia, psychosis) 3. Autonomic instability: tachycardia, hypertension 4. Tremor, ↑ muscle tone 5. Death

Answer 35

- Immunoassay testing is the most frequently used method for urine drug testing. - Mass spectrometry/gas chromatography is used to confirm immunoassay results. - Example situations for the use of a urine drug test include workup of altered mental status and monitoring during SUD treatment or chronic opioid therapy.

Answer 36

**Overdose**: supportive therapy (e.g., beta-blockers for tachyarrhythmia) **Withdrawal**: Symptoms typically manifest within 24 hours after the last intake and resolve spontaneously within 10 days.

Answer 37

**Intoxication**: symptomatic treatment **Withdrawal**: psychosocial support and interventions

Answer 38

Long-term effects include pulmonary problems (e.g., wheezing, shortness of breath), immunosuppression, and sex hormone imbalance.

Answer 39

1. Signs of injury, e.g., due to fights, accidents 2. Memory and speech deficits 3. Cognitive impairment

Answer 40

1. Reduction of environmental stimuli 2. Gastric lavage to increase drug elimination 3. Supportive care 4. Sedation with benzodiazepines (for severe agitation) or haloperidol (if psychotic symptoms are present)

Answer 41

1. Trauma (commonly accompanied by intracranial hemorrhage) 2. Seizures 3. Rhabdomyolysis 4. Reabsorption of the drug in the gastrointestinal tract may lead recurrence of symptoms.

Answer 42

- **Substances**: MDMA, mescaline - MDMA: ecstasy, XTC - Mescaline: mesc, buttons - Mechanism of action: 5HT2A-serotonin-receptor and D2-receptor agonists and serotonin and dopamine reuptake inhibitors: increases serotonin and dopamine concentrations in the synaptic cleft → hallucinations. - MDMA increases secretion of antidiuretic hormone → thirst → increased water intake without electrolyte repletion → hyponatremia

Answer 43

**Definition**: stimulant-related disorders encompass conditions caused by cocaine, amphetamines, amphetamine substituted substances, and synthetic cathinones.

Answer 44

- **Substance**: nicotine from the tobacco plant (consumed in cigarettes, cigars, pipes, e-cigarettes) - **Mechanism of action**: stimulates nicotinic receptors in autonomic ganglia → sympathetic and parasympathetic stimulation - **Epidemiology**: Approx. 13% of adults in the US smoke cigarettes, Most prevalent cause of preventable morbidity and mortality in the US.

Answer 45

- **Definition**: Gambling disorder is a disorder in which the affected individual feels the compulsion to gamble despite negative consequences and/or multiple attempts to stop. Also, the gambling behavior cannot be better explained by a manic episode. - **Epidemiology**: Sex: ♂ > ♀, No specific age group - **Etiology**: combination of factors (genetic, environmental, neurochemical abnormalities)

Answer 46

**Substances**: gamma-hydroxybutyric acid (GHB) **Street names**: liquid ecstasy (unrelated to MDMA), liquid X, invigorate **Mechanism of action**: direct agonist of GABA receptors (similar to benzodiazepines)

Answer 47

A transient excitatory state caused by a sudden cessation of or reduction in alcohol consumption after a prolonged period of heavy drinking

Answer 48

1. Classification by syndrome 2. Classification by severity - Clinical Institute Withdrawal Assessment for Alcohol

Answer 49

Neonatal abstinence syndrome is caused by maternal drug use during pregnancy (typically opioids) that subsequently leads to a withdrawal reaction in the infant.

Answer 50

According to the National Health and Medical Research Council (NHMRC) guidelines, average daily consumption of alcohol in excess of 2 standard drinks is a health risk for men and women. In addition, they state that on any given day consumption should not exceed 4 standard drinks, a lower maximum alcohol consumption than previously. A standard drink contains 10 g of alcohol, the amount in 285 mL of full-strength beer, 100 mL of wine, 60 mL of fortified wine and 30 mL of spirits. Significant dependence associated with a withdrawal syndrome on cessation is more likely in those whose regular consumption is >8 standard drinks per day, and is increased if they also use other sedatives.

Neoplasia & Addiction Flashcards

(172 cards)