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Flashcards in Quiz 6 Deck (99):
1

What is the most common type of carcinoma in Africa?

Liver cell carcinoma most common in Africa due to link with viral hepatitis.

2

What are the principles of optimal scheduling with anti-cancer drugs?

• Design optimal scheduling-e.g., maintain constant intervals with treatment free interval as short as possible, while allowing most sensitive tissue adequate time to recover (e.g., bone marrow).

3

Hydrochlorothiazide

Treats Meniere disease. Diuretic-regulate fluid volume and pressure in inner ear.

4

What are the characteristics of neoplasms and what are the main ones?

1. Uncontrolled growth of cells, progeny of a single cell

2. Names usually end in –oma

3. Benign epithelial tumor is adenoma (if glandular), a papilloma (if papillary)

4. Malignant tumor (metastasizes)

• Epithelial= carcinoma

• Mesenchymal= sarcoma

• Lymphoid= lymphoma

• Melanocytic tumor=melanoma

• Hematopoietic= leukemia

 

• Squamous cell carcinomas

• Adenosarcomas-grandular epithelium

• Lipoma-benign

• Liposarcoma-malignant

• Osteosarcoma-malignant bone cancer

• Rhabdomyosarcoma-malignant skeletal muscles, usually kids

• Rhabdomyoma-benign

• Leiomyosarcoma-malignant tumor of smooth muscle

• Leiomyoma- benign tumor

5

What are the characteristics of prostate cancer?

• 1 in 8 men, Elevates PSA and acid phosphatase

• Treat by eliminating testosterone production through surgical castration

• LH-releasing hormone agonists

6

Diazepam

Treats Meniere disease. It is an anxiolytic.

7

Metastatic patterns are almost identical between tumors. True or False?

False. They vary due to varying growth factors.

8

What are the stages of breast cancer?

• Stage I: small, primary tumor --surgery alone is an 80% cure

• Stage II: positive node; post-operative use of chemo (e.g., 6 cycles of cyclophosphamide, methotrexate and fluorouracil).

• Stage III-IV: a major challenge

• Breast cancer-much more effective resolution due to early treatments

9

Cisplatin

Treats cancer, is a platinum analog. Used for broad range of solid tumors. Is nephrotoxic.

10

What are the three main types of treatment for cancer?

a. Surgical removal

b. Radiation therapy-maximize exposure of tumor and minimize exposure of normal tissue

c. Chemotherapy

  • • most damage to rapidly proliferating cells
  • • treats whole body
  • • tumor can develop resistance
  • • often multiple drugs required
  • • can cause cancer later

11

Dexamethasone

Treats Meniere disease. Long-acting steroid/inject into the ear—it reduces fluid.

12

Epinephrine

Alpha-agonist non-selective that can help treat glaucoma.

13

What is open-angle glaucoma?

Open-angle glaucoma: wide space between iris and cornea

• most common-90%

• slow clogging of drainage canals

• symptoms subtle and often undetected

• 3 million cases in US

• African Americans especially vulnerable

• Increased risk with diabetes and HP

14

What is the definition of mortality when referring to cancer terms?

• Mortality: death/time period

15

What causes self-limiting colitis?

• Caused by microorganisms such as salmonella, E. coli, shigella, clostridium

16

Erlotinib

Cancer treatment strategy. Blocks ECGR (epidermal growth factor receptor): treatment, non-small cell lung and pancreatic cancer.

17

Procarbazine

Treats cancer, is a nitrosourea. Used for combination regimens for Hodgkin's Lymphoma. Passes blood brain barrier and used to treat brain tumors.

18

How does grading of tumors work and what are the four main serological tests and when are they used?

• TNM grading -T, size and extent of primary tumor -N, presence and number of lymph node metastases -M, presence of distant mestatses

• Serological tests- most useful for assessing cancer recurrence after treatment -PSA: prostate specific antigen -CBA: carcinoembryonic antigen-colon carcinoma -CA-125: serous ovarian carcinoma -HCG: choriocarcinoma

19

Pilocarpine

Treats glaucoma. Cholinomimetic-contract ciliary muscle and increases outflow of aqueous humor. ACh1 agonist.

20

Meclizine

Treats Meniere disease. H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, causes xerostomia.

21

Which type of cells do most chemotherapies target?

Proliferating cells. Consequently, good for killing fast growing tumors, not so good for slow or non-growing tumor cells. Injure rapidly proliferating normal cells such as bone marrow, intestinal mucosa, hair.

22

What is a retinoblastoma?

It is the most common tumor in children

23

What are the two main causes of intestinal obstruction of the small bowel, colon?

a. Usually mechanical (80%)

b. Neoplasm and infarction (20%)

24

What is Hirschsprung disease, and what part of the GI does it involve?

Hirschsprung disease

• Congenital defect in colonic innervation

• Failure to pass meconium The small bowel, colon.

25

What are the characteristics of Otitis Media?

• Typically associated with blockage of the Eustachian tube

• Often associated with infections by strep. Pneum. Or Haemophilus influe.

a. Symptoms: pain, ear discharge, headache, hearing loss, tinnitus, vertigo, immobile eardrum (swollen and inflamed), fever

26

What are the characteristics of reflux esophagitis?

a. Relaxation of gastroesophageal sphincter

b. Symptoms: Burning, Excessive salivation, Choking

c. Aggravating factors: obesity, pregnancy, (decrease esophageal pressure: alcohol/tobacco, narcotics, nicotine patch) use

d. Medical treatment: antacids, H2 blockers, PPI -lose weight, stop smoking/drinking

e. lifestyle treatment: lose weight, stop smoking and drinking

f. Complications: ulceration, stricture, Barrett esophagus (long tongues of extended columns of epithelium cells into esophagus

27

What are the main causes of cancer?

• Mutation (e.g., chemical carcinogens-alkylating agents or nitrosamines in food, UV light-skin cancers, radiation)-

• Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen

• Tumor viruses • HPV-human papilloma virus-carcinoma of cervix and oropharyngeal

• Epstein-Barr: mononucleosis

• Hep B & C viruses: hepatocellular carcinoma

• HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS)

• Bacteria and inflammation (H. pylori [gastric adenocarcinoma], and asbestosis)

• Chemical carcinogens

• Reactive chemical (e.g., free radicals) alter DNA

• Alkylating agents—some of which are used to tx cancer

• Polycarbon aromatics: e.g., benzopyrene in smoke and cooked meat

• Aflatoxin- fungus on peanuts and other foods- not so much in US

• Nitrosamine/nitates in foods

• Metal ions: nickel, arsenic

• Hormonal activation (sex hormones)

• Lack of immune responses (i.e., immunocompromised) - altered host response to tumor can interfere with natural defense mechanisms -immunosuppressed children have 200X increased risk for cancer

• Genetic predisposition

• Variation in hepatic susceptibility of CYP1A1 and glutathione activity

• Radiation: -skin cancer caused by UV rays

• X-rays/gamma radiation -leukemias -papillary thyroid and breast cancers

28

What are the characteristics of Multiple Myeloma?

1. Plasma cell malignancy, primarily in bone marrow

2. Symptoms: • Bone pain • Fractures • Anemia

• Tx: alkylating agent; prednisone

29

Imatinib

Cancer treatment strategy. Tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia.

30

What are the main genetic targets for tumors?

• Oncogenes (promote proliferation)-e.g. growth factors or corresponding receptors

• Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary)

• P53 gene is most common suppressor gene mutation (lost in 50% of malignancies)

• WT-1 gene- regulates apoptosis such as in Wilms tumor

• APC-adenomatous polyposis coli-tumors in bowel and pancreas

• Apoptosis regulating genes (P53 gene also affects apoptosis)

• DNA repair genes

• Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer)

• Angioneogenesis (tumors release vascular endothelial growth factor)

• Develop properties for invasiveness

31

Promethazine

Treats Meniere disease. H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia.

32

Methyltrexate

Treats cancer, is an antimetabolite, anti-inflammatory.

1. Acts on intermediary metabolism of proliferating cells

2. E.g., methyltrexate-folic acid analog

• Inhibits tetrahydrofolate--Interferes with formation of DNA, key proteins

• Treats head and neck cancers, breast cancer

• Toxicity: mucositis, diarrhea

33

What is the leading cause of cancer death in the US?

Lung cancer, followed by prostate in men and breast in females.

34

What is pseudomembranous colitis?

• Cells Slough Off

  • Usually caused by clostridium difficile

• Spread via person to person

• Often follows antibiotic therapy

• Most common nosocomial infection in older adults

35

What causes cancers?

• Caused by accumulation of DNA mutations in cells acquired spontaneously or induced-usually multiple mutations

36

What is the most common cancer in children?

Acute Lymphoblast Leukemia (ALL)

37

What are the characteristics of gastrointestinal cancer?

• Colorectal cancer most common GI malignancy

• Tx: 5-fluorouracil (40-50% response rates)

38

What percentage of patients are usually cured with local treatment like surgery or radiotherapy? When are chemotherapy and anticancer drugs used?

1. 1/3 patients cured with local treatment (surgery, radiotherapy)

2. Chemotherapy used for advanced disease or as an adjuvant (administered after primary treatment (e.g., surgery or radiation) to prevent secondary tumor development or spread)

3. Anticancer drugs usually exert action on cells in cell cycle

4. Typically requires combination of drugs: Combine chemo/radiation tx in locally advanced disease

5. Need maximal cell kill within the range of toxicity tolerated by host

6. Adjust scheduling and overlapping toxicities to protect the patient.

39

Acetazolamide

Helps treat glaucoma. Carbonic anhydrase inhibitor. Reduces aqueous humor secretion.

40

What are the chromosomal changes associated with cancers?

• Deletions

• Translocations

• Duplications

• Amplifications

• Abnormal number of chromosomes

41

What are the characteristics of age-related macular degeneration?

• >10% of patients > 80 years old

• Most common cause of severe loss of sight in 60+ pts.

• Almost never occurs in individuals > 50 years of age

  • Smoking is a risk factor
  • Associated with gene polymorphisms, smoking, cardiovascular disease
  • Loss of central vision
  • Progress of disease faster in wet (hemorrhage and fluid present) than dry (large majority) macular degeneration
  • Pharmacological options minimal; some evidence that antioxidants (e.g., vit. C or zinc oxide may help reduce development, but benefit is minimal) for wet AMD. No treatment for dry AMD.
  • Treatment: monoclonal Ab (anti-angiogenic Ab)- e.g., bevacizumab (Avestatin)

-inject into vitreous humor; 1-2x/ month, for wet AMD

42

What are the characteristics of secondary malignancies?

• Late complication of alkylating agents

• Most frequent is acute myelogenous leukemia—observed as early as 2-4 years after; also see Non-Hodgkin’s lymphoma and bladder cancer

43

What does tonometry measure?

It measures intraocular pressure

44

What is closed-angle glaucoma?

Closed-angle glaucoma: iris fused to cornea

  • <10%
  • Rapid closure of drainage canals
  • Symptoms typically noticeable
  • Surgery usually necessary

45

What is irritable bowel syndrome?

• Relapsing pain, bloating, constipation/diarrhea

• Diet, abnormal motility and stress are factors

• No gross microscopic abnormalities

46

What does a gonioscopy do?

It measures the anterior chamber angle in the eye

47

What is the ames test?

• Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen

48

What are the main cancers of the eye and ear?

• basal and squamous cell carcinomas of eyelid—usually slow growing

• melanoma-varying colors and potentially aggressive—usually occurs in older people

49

What are the main causes and treatment of cataracts?

• Causes include: -diabetes -UV exposure -aging

• Treatment is typically surgical removal

50

What is the most common acute form of leukemia in adults?

Acute Myelogenous Leukemia (AML). Cytarabine is the most single active agent.

51

How does CMV affect the GI tract?

Cytomegalovirus (CMV) affects entire GI tract-elderly or immunocompromised-multiple discrete, well-circumscribed superficial ulcers.

52

What is retinal detachment?

• Usually a retinal tear resulting from trauma

53

Timolol

Treats glaucoma. Beta blocker-decreases aqueous humor secretion (popular for open angle glaucoma).

54

What are solid tumor mutation panels used for?

They are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses, can sometimes predict prognosis.

55

What are the characteristics of mesenchymal (sarcomas) tumors?

➢ sarcomas-Kaposi’s sarcoma [linked with AIDS],

➢ angiosarcoma, malignant tumor of endothelial tissue (vessels); can result from radiation therapy

➢ chondrosarcoma-malignant tumor of cartilage (chondrocytes).

➢ osteosarcoma,

➢ leiomyosarcoma (vs. benign leiomyoma) - malignant tumor of smooth muscle

➢ liposarcoma

• Pushing, rather than an invasive cancer

56

What is the 2nd leading cause of death in the US?

Cancers

57

Cyclophosphamide

Treats cancer, is an alkylating agent.

1. E.g, Cyclophosphamide • Hodgkin’s lymphoma • Multiple myeloma • Leukemia • Breast cancer

2. Mechanism: Transfer their alkyl groups to various cell constituents such as DNA, alkylation of DNA in nucleus—cause miscoding—can break DNA strands

3. Resistance: increased capacity to repair damaged DNA

4. Adverse effects: • Nausea, vomiting • Damage to rapidly growing tissues (bone marrow, G.I. tract, reproductive tissue) • Carcinogenic in nature (increases risk of secondary cancer)

58

What is the definition of prevalence when referring to cancer terms?

• Prevalence: # new and pre-existing cases at one moment

59

What is a sty?

It is a skin infection like a pimple on eyelid-mostly external

60

What is chemical esophagitis, and what are some examples?

Irritants to squamous mucosa.

• corrosives, smoking, alcohol, chemotherapy. Acute inflammation and possible ulceration.

61

What are the characteristics of carcinoid syndrome?

• Metastasis of intestinal carcinoid

• Flushing and diarrhea

• Right heart fibrosis

62

Why is the ear often involved in referred pain associated with the mouth and dental structures?

Because both are innervated by the trigeminal complex

63

What are the characteristics of Meniere disease?

a. Symptoms: vertigo, hearing loss, nausea, sometimes migraine headaches, hearing loss, swimming feeling, tinnitus, balance problems

b. Pathology: endolymphatic hydrops—swelling/excess fluid in labyrinth • Risks- • Improper inner ear fluid drainage • Allergies • Viral infections • Head trauma • Migraines

c. Diagnostic tests: • Hearing and balance assessments

d. Some surgical interventions, but extreme

64

What are the characteristics of diabetic retinopathy?

-associated with hemorrhaging and ischemic spots (expressed as cottonwool spots)

-hypertension causes similar retinopathies as diabetes

65

What are the three main non-neoplastic tumors?

• Granulomas are an inflammatory mass-not a neoplasm

• Hemartoma: mal-developed tissue native to site (e.g., nodular tongue)

• Choristoma: mal-developed tissue in other organs

66

Usually single drugs at clinically tolerable doses are able to cure cancer alone. True or False?

False. Need a combination.

67

What are the characteristics of colonic polyps?

Colonic polyps

• Hyperplastic polyps- no malignant potential

• Adenoma- precursor to adenocarcinoma

68

What are the characteristics of invasive colonic adenocarcinoma?

Invasive colonic adenocarcinoma

• Responsible for 15% of all cancer related deaths in USA

• Dietary features: increased risk with low fiber, high intake carbohydrates/fats Affects small bowel/colon

69

What is the mutation that occurs in up to 50% of all human tumors?

• P53 is a mutation that occurs in up to 50% of all human tumors-leads to resistance to radiation therapy and anticancer agents

70

What strategies are used to detect chromosomal abnormalities?

PCR, microarrays, really just cytogenetics is used to look for these abnormalities. For example, there is a 9:22 translocation on chromosome 22, called the Philadelphia chromosome, that leads to chronic myelocytic leukemia.

71

What gene is linked to familial adenomatous polyposis/colon cancer?

APC gene

72

What does retinoic acid sometimes help out with?

• Retinoic acid-induced differentiation of some leukemias (e.g., promyelocytic leukemia)

73

What are the characteristics of Hodgkin's Lymphoma?

• Hodgkin’s lymphoma much better controlled today

• B-cell neoplasm (Reed-Sternberg cell)

• EBV virus found in ~80%

• Tx: anthracycline, doxorubicin, bleomycin, vinblastine

74

What genes are linked to some breast and ovarian cancers?

BRCA 1 & 2 genes

75

For which types of cancers are hormones commonly used to treat?

Hormones for breast and prostate cancers

76

Where in the world is breast cancer most common?

Breast cancer more common in US and Europe than in other countries

77

Fluorouracil

Treats cancer.

1.Inhibits thymidine synthase, decreases NDA synthase and decreases DNA synthesis and function

2. treats: colorectal, anal, breast, head  neck, and hepatocellular cancers

78

What are the characteristics of the two main inflammatory bowel diseases?

a. Crohn disease: • Similar to ulcerative colitis • It skips lesion and has intermediate constrictures • Granulomas • Fistulas and perianal disease • Also affects upper GI tract • Transmural inflammation • Fistulas, perianal

• Oral manifestation: ➢ 0.5% have oral lesions ➢ Usually males ➢ Linear and deep ulcerations

b. Ulcerative colitis • More continuous especially in the colon • No transmural inflammation • No fistulas and not perianal

• Oral manifestation: ➢ Less common than in CD ➢ Usually males ➢ Edematous oral submucosa

79

What are the five main selected diarrheal diseases?

a. Celiac sprue • Immune mediated—triggered by ingestion of gluten • Malnutrition: • Fe, B12 malabsorption • Atrophic glossitis • Dental effects: enamel defects, delayed tooth eruption, recurrent aphthous ulcers, cheilosis,

b. Lymphocytic colitis • Increased intraepithelial lymphocytes

c. Irritable bowel syndrome • Relapsing pain, bloating, relapsing and alternating constipation/diarrhea • Diet, abnormal motility and stress are factors • No gross microscopic abnormalities

d. Infectious self-limiting colitis • Caused by microorganisms such as salmonella, E. coli, shigella, clostridium

e. Pseudomembranous colitis, cells slough off • Usually caused by clostridium difficile • Spread via person to person • Often follows broad spectrum antibiotic therapy • Most common nosocomial infection in older adults

80

What is glaucoma?

It is high intraocular pressure in anterior chamber: Increased pressure within eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hours; supplies nutrients and removes waste). Can damage optic nerve and cause blindness.

81

Bleomycin

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer.

• Mechanism: formation of free radicals that bind to DNA, causing breaks

• Treat: lymphomas, breast cancer and thyroid cancer

• Toxicity: nausea and red (not blood) urine

82

Lantanoprost

Treats glaucoma. Prostaglandin-increase outflow of aqueous humor (popular for Open angle glaucoma).

83

What are the seven main diseases associated with the stomach?

1. Reactive (erosive gastritis) gastropathy a. Induced by: alcohol, NSAIDS, iron, Stress, bile reflux

2. Acute injury a. Acute gastritis—asymptomatic with possible significant blood loss

3. Acute peptic ulceration a. Nausea, vomiting, NSAIDs, stress

4. Chronic gastritis a. H. pylori gastritis-duodenal and pyloric ulcers; may lead to cancer b. Autoimmune gastritis

5. Peptic Ulcer Disease a. H. pylori and NSAIDs causative b. Increased acid c. Punched our ulcers-potential for perforation and hemorrhage d. Likely also involved in adenocarcinoma development

6. Polyps a. Hyperplastic, sporadic • Response to gastric injury, around ulcers

7. Gastric carcinoma • Looks like intestinal tissue, and diffuse • Some have hereditary connection

8. Autoimmune atrophic gastritis • Genetic factors • No ulcers • Decreased gastric acid • Intestinal metaplasia • Long-term effects relate to malabsorption of B12 (pernicious anemia)

84

What is infectious esophagitis?

Usually immunosuppressed (often Herpes, Candida, and cytomegalovirus [CMV])

• Often ulcers

• CMV:

  • • Affects entire GI tract
  • • Neonates acquire thru birth canal or infected breast milk
  • • Adults acquire through sexual transmission or needles
  • • Multiple discrete, well-circumscribed superficial ulcers.

85

What are the four main ways that cancers actually kill?

a. Growth and metastasis

b. Involve vital organs

c. Get a flood of cytokines that shut down organ functions

d. Cachexia

86

Which country has a 7X increase of gastric cancer compared to US?

Japanese

87

What is the definition of incidence when referring to cancer terms?

• Incidence: newly diagnosed cases/time

88

What are the characteristics of carcinoma, and what are its subsets?

Carcinoma—epithelium/endothelium • Most common type of malignancy

a. Most often metastasizes to regional lymph nodes, but can spread through blood-dependent on type

b. Squamous cell Carcinoma • similar appearance regardless of primary site • usually slow growing in the skin • associated with lips or lung more dangerous • can form keratin whirls

c. Adenocarcinoma (eg, colon or breast adenocarcinoma) • forms glands • tumors of cuboidal or columnar cells • types include: ➢ colon ➢ prostate-fairly innocuous looking ➢ breast-many positive for estrogen receptors ➢ lung-small cell carcinomas are aggressive with poor prognosis -large cell carcinomas are slower with better prognosis

d. neuroendocrine tumors-carcinoids of GI tract and lung

89

What is the most common cause of sporadic cancers?

Environment. Just a subset are hereditary.

90

Which type of cancer often exhibits resistance on initial exposure?

• Melanoma: exhibits primary resistance on initial exposure (lack of tumor response)-need multiple exposures to treatment to get response of tumor

• Sometimes tumor acquires resistance during treatment

91

What is a cataract?

Opacification of the lens

92

What must a malignant tumor do to grow?

• Develop a signal to proliferate

• Avoid apoptosis

• Invade stroma (if carcinoma)

• Metastasize

• Induce angiogenesis

• Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling)

• Develop telomerase to prevent cellular senescence

93

Doxorubicin

Is an antitumor antibiotic, in the class of anthracyclines, that treat breast cancer.

• Mechanism: formation of free radicals that bind to DNA, causing breaks

• Treat: lymphomas, breast cancer and thyroid cancer

• Toxicity: nausea and red (not blood) urine

94

Vinblastine or Vincristine

Is a natural product cancer, chemotherapy drug.

2. Inhibits tubulin polymerization-cytoskeleton component—arrests in cell division and causes cell death

3. Toxicity: mucositis, myelosuppression

4. Treat: breast cancer and Kaposi’s lymphoma

95

What are the characteristics of lymphomas?

➢ Hodgkins lymphoma -younger patients -usually good prognosis -sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes)

➢ Non-Hodgkin’s lymphoma -various levels of aggressiveness/sometimes poor prognosis - Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma; very aggressive from B lymphocytes. Prognosis can be poor.

96

What are the five main properties of cancer?

• Non-responsive to normal physiologic cues

• Lack of response to growth inhibitory signals

• Avoid normal cell cycle mediated death

• Develops own angiogenesis

• Evades immune detection

97

Which types of drugs or stimulants worsen glaucoma?

Anticholinergics and stimulants (amphetamines)

98

Amoxicillin or Amoxicillin + Clavulanate or Cefaclor

Antibiotics used to treat acute otitis media. Second level drugs include Trimethoprim or macrolides.

99

How amazing are you?

So amazing