Quiz 6 (test 3) Flashcards
(207 cards)
1
Q
What is a sty?
A
Skin infection like a pimple on the edge of the eyelid. Associated with hair follicle
2
Q
True or false… cancers of the eyelid such as ___ and ___ destroy lashes.
A
True
Basal cell
Squamous cell
3
Q
What is glaucoma?
A
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
4
Q
True or false… glaucoma can cause optic nerve damage and cause blindness
A
True
5
Q
What is closed-angle glaucoma?
A
Iris fused to cornea
Often painful
Fast developing
Requires immediate attention to avoid blindness
6
Q
What is open angle glaucoma?
A
Wide space between iris and cornea
Reduction in drainage
Slow developing
7
Q
What is the most common form of glaucoma (90%)?
A
Open angle glaucoma
8
Q
What are four risk factors for open angle glaucoma?
A
Age
African American
Diabetes
Hypertension
9
Q
_____ measures intraocular pressure
A
Tonometry
10
Q
Name three drugs that can be used to treat glaucoma
A
Pilocarpine
Timolol
Lantanoprost
11
Q
What is the mechanism of pilocarpine in the treatment of glaucoma?
A
Cholinomimetic
Contract ciliary muscle and increases outflow of aqueous humor
12
Q
What is the mechanism of timolol in the treatment of glaucoma?
A
Beta blocker
Decreases aqueous humor secretion
13
Q
What is the mechanism of lantanoprost in the treatment of glaucoma?
A
Prostaglandin
Increase outflow of aqueous humor
14
Q
What drugs should you avoid in a patient with glaucoma? Why?
A
Anticholinergics
Stimulants (amphetamines)
These drugs worsen glaucoma
15
Q
What is the #1 cause of blindness worldwide? What is the #2 cause of blindness?
A
1 = cataracts
16
Q
What are cataracts? What causes it?
A
Opaque lens due to…
Age
UV exposure
Diabetes
Steroid use
17
Q
What has micro-aneurysms of retina and cotton wool spots from ischemia?
A
Diabetic retinopathy
18
Q
What does hypertensive retinopathy look like?
A
Diabetic retinopathy
19
Q
> ___% of pts >___ years of age have age-related macular degeneration
A
10%
80 years old
20
Q
Age related macular degeneration is a loss of ___ vision which widens ___. It is associated with ___, ___, and ___.
A
Central vision
Widens laterally
Gene polymorphisms
Smoking
Cardiovascular disease
21
Q
Age-related macular degeneration progresses faster in ___(which is?..) than ___ (which is?…)
A
Wet (hemorrhage and fluid present behind retina
Dry (large majority)
22
Q
True or false… smoking is a risk factor for age-related macular degeneration
A
True
23
Q
What are the pharmacological options for age-related macular degeneration?
A
Minimal options
Some evidence that antioxidants such as vitamin C or zinc oxide may help reduce development, but benefit is minimal
24
Q
What is the most common cause of retinal detachment?
A
Usually a retinal tear resulting from trauma
25
What is the most common tumor in children?
Retinoblastoma
26
What is meniere disease?
Excess of endolymphatic fluid in inner ear
27
What are the symptoms of meniere disease?
Vertigo
Healing loss
Nausea
Sometimes migraine
Headaches
Swimming feeling
Tinnitus
28
What are fours risks for developing meniere disease?
Abnormal immune response
Allergies
Head trauma
Migraines
29
What are 5 drugs that can be used to treat meniere disease?
Meclizine
Diazepam
Promethazine
Long acting steroids
Hydrochlorothiazide
30
What is meclizine?
H1 blocker and anticholinergic used to treat...
meniere disease
CNS depressant
Motion sickness
Xerostomia
31
What is promethazine?
H1 blocker and anticholinergic used to treat..
Meniere disease
Nausea
Motion sickness
Xerostomia
32
What is hydrochlorothiazide?
Diuretic
Regulates fluid volume and pressure in inner ear
33
What are the symptoms of otitis media?
Pain (can be mistaken for dental or sinus pain)
Ear discharge
Headache
Hearing loss
Tinnitus
Vertigo
Immobile
Bulging eardrum
34
What drugs can you use to treat otitis media?
Amoxicillin
Or
Amoxicillin + clavalunate
or
ceftriaxone (rocephin 3rd generation cephalosporin) for acute OM
Drain for chronic with effusion if necessary
35
What is the cause of otitis media?
It is middle ear inflammation due to blockage of Eustachian tube
36
Most cancers arise ___, but some come from benign tumors
De novo (starting from the beginning)
37
What is the second leading cause of death in the US after cardiovascular?
Cancers/tumors
38
What is cancer caused by?
Accumulation of DNA mutations in cells acquired spontaneously or induced (environment)
39
What are 5 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
40
What is a neoplasm?
Uncontrolled growth of cells
Progeny of a single cell
Name usually ends in -oma
41
A benign epithelial tumor of glandular origin is called an _____. What if it is projected?
Adenoma
Papilloma
42
What is a malignant tumor?
One that metastasizes
43
In regards to malignant tumors...
Epithelial = ____
Mesenchymal = _____
Lymphoid = ______
Hematopoietic = ______
Carcinoma
Sarcoma
Lymphoma
Leukemia
44
What is an adenocarcinoma?
Malignancy of glandular epithelial cells
45
What is a lipoma?
Benign tumor of fat cells
46
What is an osteosarcoma?
Malignancy of bone cells
47
What is a leiomyoma?
Benign tumor of smooth muscle
48
What are granulomas?
Inflammatory mass of immune cells
*not a neoplasm
49
True or false... skin tags are considered neoplasms
False
50
What is a hamartoma?
Not a malignancy
Mal-developed tissue in proper tissue
51
What is a choristoma?
Normal tissue in another organ
52
What is a myxoma?
Benign tumor usually of fibroblast frequently in the heart
53
What is a teratoma?
Germ cell tumor that can contain tissue or tissues not associated with surrounding organ (tooth bud in an ovary)
54
True or false... sarcomas are the most common form of malignancy.
False. Carcinomas are the most common.
55
Where do carcinomas most often metastasize to?
Regional lymph nodes, but can spread through blood... dependent on type
56
Carcinomas are [high/low] nuclear: cytoplasmic ratio. What does that mean?
High nuclear: cytoplasmic ratio, which underscores the abnormality of nuclear regulation
57
Carcinoma [is/is not] invasive, and its pattern of spread is usually [unpredictable/predictable].
Is invasive
Predictable
58
What is carcinoma in situ?
Not invasive and doesn't metastasize
59
What are two forms of carcinoma in situ?
Squamous cell carcinoma
Adenocarcinoma
60
Squamous cell carcinoma has a similar ___ regardless of primary site. Its prognosis depends on ___.
Appearance
Site
61
What sites of squamous cell carcinoma has a good prognosis? What has a bad prognosis?
Skin is less dangerous
Lip, oral cavity, lung is dangerous
62
What type of carcinoma forms glands and cells and often makes protein mucin?
Adenocarcinoma
63
Name two neuroendocrine tumors
Carcinoid tumors
Small cell
64
What are carcinoid tumors?
Usually show up in GI tract or lungs (typically low grade)
If well-developed, usually do better. If not well differentiated, they do not do as well
65
True or false... small cell lung carcinomas are highly malignant
True
66
Carcinoid tumors of the GI or lung are typically [high/low] grade
Low
67
Sarcomas are a malignant ___ tumor. It has ___ rather than invasive border. It is [more/less] likely to metastasize - when it does, it is by ____ (not ___).
Mesenchymal
Pushing
Less
Blood, not lymph nodes
68
What is a smooth muscle malignancy most often in the uterus?
Leiomyosarcoma
69
What is the most common form of bone cancer?
Osteosarcoma
70
What is a hepatoma?
Malignancy of hepatocytes in liver
71
What is rhabdomyosarcoma?
Malignancy of skeletal muscle
72
Describe the progression of malignancies
Normal - hyperplasia (grows) - dysplasia (grows and cell nuclei charge) - cancer (grows and invades)
73
What are the cytological features of carcinomas?
Nuclear enlargement
Abundant mitotic figures
Pleomorphic (can exist as multiple cell types and morphologies)
74
Lipomas are benign, small, and very common. The cells look ___ and usually ___
Normal
Subcutaneous
75
Ewing sarcoma is most frequently seen in ___
Children
76
Chondrosarcoma develops from ___
Cartilage
77
Lymphomas are cancers of ___ and ___.
Blood cells
Bone marrow
78
___ lymphoma has the presence of reed sternberg cells and [rarely/usually] responds to treatment
Hodgkin
Usually responds to treatment
(Less common than non-hodgkins)
79
____ lymphoma tends to be more variable and more difficult to treat and lacks reed sternberg cells
Non hodgkins
80
What is burkitts lymphoma?
A very fast growing cancer which starts with B cells. Typically associated with impaired immunity and rapidly fatal if not treated quickly. A form of non-hodgkins lymphoma and linked to EBV infection
81
Burkitts lymphoma starts with __ cells. It is a form of ___ lymphoma and is linked to ___
B cells
Non-hodgkins
EBV infection
82
# Define the following...
Incidence:
Mortality:
Prevalence:
Survival:
Incidence: newly diagnosed cases/time
Mortality: deaths/time
Prevalence: new and preexisting cases at one time
Survival: proportion of pts alive at a given time after diagnosis
83
How many cancer cases were there in 2011?
1.5 million
84
How many cancer deaths were there in the US in 2011?
570,000
85
What is the leading cause of most sporadic cancers?
Environment
86
True or false... cancer is often caused by AD gene
True
87
___ cancer is the leading cause of cancer death in the US followed by...
Lung cancer
Prostate cancer in men and breast cancer in females
88
___ genes lead to breast cancers
BRCA 1 and 2
89
___ gene increases intestinal/colon cancer when mutated
Familial adenomatous polyposis coli (APC)
90
T or F... Cancer subtype risks ween in those moving to different areas of the world, usually begins to reflect that of the native population in subsequent generations.
True
91
Japanese risk of gastric cancer is ___ than in the US
7x greater
92
Breast cancer is more common in ___ than in __
Europe
US
93
Environmental factors cause mor cancer than genetic factors, especially in the ___
Elderly
94
___ are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses. Sometimes can predict prognosis
Solid tumor mutation panels
95
____ are used to grow tumor cells and examine cellular histology and abnormalities
Cytogenetics
96
True or false.. common for success response not to kill "all" of the cells (99.9% kill) may lead to recurrence months to years later.
True
97
Chromosomal changes associated with cancers include what 5 things?
Deletions
Translocations
Duplications
Amplification
Abnormal number of chromosomes
98
Genetic targets for tumors include what 6 things?
Oncogenes
Nuclear regulating genes
Tumor suppressor genes
Apoptosis regulating genes
DNA repair genes
Angio-neogenesis
99
What are oncogenes?
They promote proliferation
Growth factors or corresponding receptors.
100
What drug works by inhibits oncogenes?
Gleevac
101
What are tumor suppressor genes?
Inhibit tumor growth
BRCA 1 and 2
Effect is often recessive and both gene copies need to be inactivated with treatment
P53 genes
APC
102
What genes are considered the guardians of the genome and suppressive proliferative genes?
P53 genes
103
What does the APC gene do (adenomatous polyposis coli gene)?
Helps control apoptosis
104
Most chemotherapy targets ____ cells. Most interfere with ___. Consequently, good for killing ___ tumors but not so good for __ tumors
Proliferating
DNA replication
Fast growing
Slow or non-growing tumors
105
True or false.. most chemotherapy injures rapidly proliferating normal cells such as bone marrow, intestinal mucosa, and hair
True
106
___ pattern varies between tumors (due to varying growth factors)
Metastatic
107
True or false... complete response to cancer treatment (~99.9% cancer cell kill) leaves thousands of malignant cells, but while it may cause remission, it does not mean that the cancer is cured.
True
108
Malignant tumors usually requires at least __-___ types of mutations to survive
5-6
109
Roughly ___ of cell doublings occur before tumor detection
3/4
110
What are some causes of cancer?
```
Mutation
Tumor viruses
Bacteria and inflammation
Hormonal activation
Lack of immune responses
Genetic predisposition
Chemical carcinogens
Radiation
Viruses
```
111
What are three metal ions that can cause mutation leading to cancer?
Nickel
Arsenic
Chromium
112
What is the Ames test?
It measures if a chemical alters genetic changes in bacteria and would be a carcinogen
113
Name one example of a tumor virus
HPV cause carcinoma of cervix
114
Name one species of bacteria that can lead to cancer
H. Pylori
Asbestosis is a chemical that can cause inflammation and thus cancer
115
What hormones may stimulate cancer?
Sex hormones
Androgens stimulate prostate cancers
Estrogens stimulate breast cancers
116
Lack of immune responses may lead to cancer. ___ pts have an increased chance to get lymphomas. ___ infections induces kaposi's sarcoma in AIDS.
Transplant pts/AIDS
HHV
117
Immunodeficient children are __ times more likely to develop cancer
200
118
Reactive chemicals alter DNA especially in ___ cells
Rapidly dividing
119
True or false... acidifying agents (including some chemotherapeutic agents) are chemical carcinogens
False. Alkylating agents
120
What is an example of a polycyclic aromatic compound?
Benzopyrene
121
What is alfaztoxin?
Fungus on peanuts or other foods (associated with old moldy food). - chemical carcinogen
122
X rays and gamma rays can cause cancer. What kinds of cancer are they most likely to cause?
Leukemias
Breast
Lung
Salivary gland
123
___ virus is a herpes virus associated with B cell lymphomas (burkitts lymphoma)
Epstein Barr
124
What virus causes damage that can lead to hepatocellular carcinoma?
Hepatitis B and C
125
What virus causes kaposi's sarcoma
HHV8
126
What bacteria can cause gastric adenocarcinoma?
H. Pylori
127
Chronic inflammation by asbestos leads to ___ and ___
Mesothelioma
Lung cancers
128
What are four ways in which cancers kill?
Growth and metastasis
Involve vital organ functions
Cachexia (progressive loss of body fat and muscles leading to wasting)
Cancers release secretions of the tissue of origin (Cushing syndrome - hypercortisol)
Paraneoplastic syndrome
129
Paraneoplastic syndrome develops in __% of malignancies and can have a variety of expressions due to the type of tissue involved. Such as...
Hypercortisolism
Hypercalcemia - PTHRP (parathyroid hormone related protein in squamous lung cancer, breast cancer, etc.)
Carcinoid syndrome
Polycythemia (too many RBCs)
Many rare syndromes
130
What are 3 things involved with carcinoid syndrome?
Flushing
Diarrhea
Asthma
131
What are some things that tumors must do to survive?
Develop signal to proliferate
Avoid apoptosis
Invade
Metastasize
Include angiogenesis
Mutation of antitumor factors
132
In order to induce angiogenesis, the tumor must secrete angiogenic factros such as...
VEGF (vascular endothelial growth factor)
bFGF (basic fibroblast growth factors - causes a fibrotic structure in tumor)
133
P53 (an antitumor factor called the gaurdian of the genome) is the [least/most] common tumor suppressor gene mutation. Lost or mutated in __% of malignancies. P53 is supposed to sense sick cell or abnormal DNA and induce ___ if beyond repair. It is related to _____ syndrome which is defined as...
Most common
50%
Apoptosis
Li-Fraumeni syndrome - rare inherited genetic cancer disorder that greatly increases risk of developing multiple cancers/tumors often in childhood or young adults
134
____, if mutated, can stimulate precancerous colon polyps that mutate into colon cancers
APC
135
What are the three factors in tumor staging?
T - size and extent of the primary tumor
N - presence of number of lymph node metastases
M - presence of distant metastases
136
What are the three stages of breast cancer?
Stage 1 - small primary tumors
Stage 2 - positive node
Stage 3/4 - major threat
137
What is therapeutic classification?
Classification methods specific for certain types of cancers ?
Examples include..
Presence of hormone receptors such as estrogen or progesterone
Her-2/Ne4 (human epidermal growth factor receptor protein for breast cancer)
138
In regards to biopsy methods, less invasive techniques are often used and are usually accurate. Two examples are...
Needle biopsy
Fine needle aspirates
139
What are 3 different treatment options for cancer?
Surgical removal
Radiation therapy - maximize exposure to tumor and minimize exposure to normal tissue
Chemotherapy
140
Chemotherapy will most of the time interfere with ___. It kills __ cells. It treats the ___ body. Tumor can develop ____.
DNA replication or function which is necessary for cell proliferation
Fast growing cells. Most damage to rapidly proliferating cells
Treats whole body
Resistance
*remember that treatments can kill >99% of tumor cells, but will still leave thousands or millions of living cancerous cells that can cause recurrence in months or years
141
1/__ patients are cured with local treatment such as surgery or radiotherapy.
3
142
T or F... chemotherapy is typically used for advanced disease or as an adjuvant
True
143
T or F... anticancer drugs usually exert action on cells in cell metabolism
False. Cell cycle
144
Treating cancer typically requires combination of drugs or in combination with ___ or ___. Usually a single drug at clinically tolerable doses do not cure the cancer by itself.
Radiation and/or surgery
145
T or F, it is necessary to have maximal cell kill within the range of toxicity tolerated by host. Adjust scheduling and overlapping toxicities to protect the patient
True
146
What are the three principles of use of chemotherapy?
Primary induction for advanced disease or cancers without other treatment alternatives.
Neoadjuvant - localized disease where surgery/radiation alone are inadequate
Adjuvant - use in addition to local methods such as radiation/surgery to prevent metastasis
147
In regards to drug combination principles to treat cancer.. usually single drugs at clinically tolerable doses [does/does not] cure cancers. Try to find a dose that provides maximum cancer-cell kill while within the range of toxicity tolerated by the host. Provide [broad/narrow] range of interactions between drug and tumor cells with different genetic abnormalities in heterogenous populations.
Does not
Broad
148
In regards to drug combinations to treat cancer, try to optimize what 5 things?
Efficacy
Reduced toxicity
Optimum scheduling
Mechanism of interaction (if possible have synergism)
Optimal dosing
149
P53 is mutated in 50% of all human tumors which leads to...
Resistance to radiation therapy and anticancer agents
Normally, P53 senses sick or abnormal DNA and regulates apoptosis
150
Alkylating agents such as ____ is used to treat what four things?
Cyclophosphamide
Hodgkin's/nonhodgkins lymphoma
Leukemia
Breast cancer
Multiple myeloma
151
How do alkylating agents work?
Transfer their alkyl groups to various cell constituents such as DNA (causing miscoding)
152
What are three adverse effects of alkylating agents?
Nausea/vomiting
Damage to rapidly growing tissues (bone marrow, GI tract, oral mucosa)
Carcinogenic in nature
153
In regards to alkylating agents, resistance can be caused by increased ability of cancer cells to...
Repair damaged DNA
154
Name two examples of nitrosoureas. What are they used for?
Procarbazine
Decarbazine
-used for combination regimens for Hodgkin's lymphoma
155
Nitrosoureas require __ to be effective. They are highly ___, so they are used to treat brain tumors
Biotransformation
Lipophillic
156
Platinum analogs such as ___ are used on [broad/narrow] range of solid tumors.
Cisplatin
Broad
157
antimetabolites act on ___ ___ of proliferating cells
Intermediary metabolism
158
Methyltrexate-folic analog is an antimetabolite that is also commonly used to treat ___. It interferes with formation of ___ and ___ and inhibits ___. Its used to treat ___. It causes ___.
Rheumatoid arthritis
DNA and key proteins
Inhibits tetrahydrofolate
Treats head and neck cancers, and breast cancer
It causes mucositis and diarrhea
159
5-fluorouracil is an antimetabolite used to inhibit ___ synthesis
Thymidine
160
Natural product cancer (chemotherapy drugs) such as ___ or ____ inhibits ____. Toxicities include ___. ____ is a drug that is semisynthetic from mandrake, it inhibits topoisomerase 2.
Vinblastine or vincristine (vinca alkaloids)
Inhibits tubulin polymerzation (cytoskeleton component)
Mucositis
Etoposide
161
What is etoposide?
A chemotherapy drug that is semisynthetic from mandrake plant
It inhibits topoisomerase 2 (interferes with DNA structuring/replication)
162
What are anthracyclines?
Antitumor antibiotics
Doxorubicin and bleomycin treat breast cancer
163
What is erlotineb?
A chemotherapeutic drug used to antagonize epidermal growth factor receptors
164
True of false... non-hodgkins lymphoma is better controlled/treated than hodgkins lympohma
False. Hodgkin's lymphoma is much better controlled
165
Why is breast cancer treated more effectively today?
More effective due to early treatments
166
1 in __ men will develop prostate cancer. It is treated by eliminating ____ production through ___.
1 in 8
Testosterone
Surgery castration
167
What does methyotrexate bind to? What does it inhibit?
Dihydrofolate reductase. And inhibits tetrahydrofolate.
168
What is a new treatment for actinic keratosis or basal cell carcinoma?
5-fluorouracil
169
What drug inhibits thymidine synthase?
5-fluorouracil
170
Where is vinblastine derived from?
Periwinkle plant
171
What drug inhibits tubulin polymerization?
Vinblastine
172
What drug is combined with prednisone to treat acute lymphoblastic leukemia in children?
Vincristine
173
What drug inhibits topoisomerase 1 and is derived from the camptotheca acuminat tree in china?
Camptothecins
174
What drug causes red urine (not hematuria) from cardio toxicity? What is its method of action?
Doxorubicin (anti-tumor antibiotic). MOA: free radicals
175
What is the main form of leukemia in childhood?
ALL
176
What is the most common leukemia in adults?
AML
177
What leukemia has the Philadelphia chromosome (9,22)?
CML
178
How do you treat Hodgkin's lymphoma?
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
179
What is the treatment for multiple myeloma?
Combination of alkylating agent (melphalan) and prednisone
180
Stage 2 breast cancer is treated by...
The CMF protocol
181
What is the most common type of GI malignancy?
Colorectal cancer
182
What is pinguecula?
UV-damaged collagen in the sclera causing discoloration
183
In glaucoma, intraocular pressure > ___
21 mmHg
184
In closed angle glaucoma, the angle of iris to cornea is < ___ degrees
10
185
In open angle glaucoma, the angle is ~ ___ degrees
45
186
True or false... family history of glaucoma is a risk for getting glaucoma
True
187
What drug is a carbonic anhydrase inhibitor used to treat glaucoma by reducing secretion of AH.
Acetazolamide
188
True or false... diabetic retinopathy involves micro-aneurisms on retina; leaves lipid rich yellow exudate
True
189
Acute infections of otitis media are usually caused by ___.
Streptococcus pneumoniae
190
How do you diagnose prostate cancer?
PSA (prostate specific antigen)
191
How do you diagnose recurrent thyroid cancer?
Thyroglobulin protein
192
How do you diagnose leukemias and lymphomas?
Flow cytometry
193
If squamous cell carcinoma is in the ___ and ___ it is more likely to metastasize
Lip and hand
194
True or false... if squamous cell is in skin it rarely metastasizes
True
195
Adenocarcinomas, tumor is __ or ___ in shape
Cuboidal or columnar
196
In the mouth, adenocarcinomas are likely associated with ___. T or F... most organs form adenocarcinomas
Salivary glands
True
197
Why do breast and prostatic carcinoma look similar?
Their ducatal histology is similar
198
True or false... small cell lung carcinoma has lots of cytoplasm
False, barely any cytoplasm
199
Which are more aggressive, carcinomas or sarcomas?
Carcinomas
sarcomas tend to grow and displace rather than invade
200
True or false... angiosarcoma is very likely in oral cavity
False it is not likely
201
Where can chondrosarcoma occur?
Larynx
202
What is brachytherapy?
Includes radioactive implants into the tumor
203
What things does head and neck radiotherapy cause?
Damage vocal cords
Dysphagia
Osteonecrosis in the jaw
204
What is the most common secondary malignancy after chemo?
AML
205
What is decarbazine used to treat?
Hodgkin's lymphoma
Melanomas
Soft tissue sarcomas
206
Imatinib (gleevac) is affective against ___. It blocks a form of ____.
Chronic myelogenous leukemia
Tyrosine kinase
207
True or false... EBV can lead to nasopharyngeal carcinoma
True
