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EMS > Theme 5: Neoplasia - Part 1 > Flashcards

Theme 5: Neoplasia - Part 1 Flashcards

1
Q

What is Huntington’s disease?

A

progressive neurogenerative disorder with motor, cognitive and psychiatric disturbance
-mode of inheritance is autosomal dominant

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2
Q

What effect does Huntington’s have on your movement, memory and mood?

A

Movement:

  • chorea (involuntary motor movement)
  • dystonia (prolonged contraction in abnormal position)
  • bradykineasia (slowing of movement)
  • swallowing/choking
  • dysarthria (difficulty speaking)

Mood:

  • depression
  • euphoria
  • apathy
  • anxiety
  • aggression
  • psychotic symptoms

Cognition:

  • loss of executive functioning
  • rigidity of thought
  • memory loss
  • dementia
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3
Q

What is the mean age of onset and the mean survival time?

A

Mean age of onset: 35 to 44 years

Mean survival time: 15 to 20 years after onset

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4
Q

Huntington’s has complete penetrance. What does this mean?

A

all individuals with the disease causing mutation will have clinical symptoms of the disease

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5
Q

Which gene is affected in Huntington’s?

A

HTT gene at 4q16.3

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6
Q

What is the HD mutation?

A

an expansion of CAG repeats with >40 triplet repeats

  • few people will develop HD with 36-39 repeats = reduced penetrance alleles
  • 27-35 repeats = will not develop HD but next generation might
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7
Q

What amino acid does CAG code for?

A

glutamine

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8
Q

what is the relationship between the HD triplet repeat size and age of onset?

A

as the size of the repeat increases, the age of onset gets younger

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9
Q

What is anticipation?

A
  • the onset of a disorder occurs at an earlier age as it is passed from one generation to the next
  • often associated with an increase in severity of symptoms
  • phenomenon associated with triplet repeat disorders
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10
Q

Anticipation is often linked to a specific parental gender. Which parent provides a high anticipation risk with HD?

A

Paternal inheritance

-if HD is passed by the father, there is much higher chance of the triplet expanding than if it were passed on by mother

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11
Q

what are two other examples of triplet repeat disorders?

A
  1. myotonic dystrophy
  2. fragile X syndrome
    high anticipation risk is associated to maternal inheritance (opposite of HD)
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12
Q

What is Juvenile HD?

A
  • onset under 20 years
  • rare
  • usually paternally inherited (and repeats have expanded)
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13
Q

What is predictive testing?

A

The use of a genetic test in an asymptomatic, at risk person to predict the future of a disease

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14
Q

What are the reasons to undertake predictive testing?

A
  • screening to detect early disease - cancer, arrhythmia
  • initiate treatments early
  • take prophylactic measures
  • may offer prenatal testing options
  • inform other relatives
  • plan future care, careers
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15
Q

What are three other conditions where predictive gene testing is possible?

A
  1. BRCA (familial breast cancer genes)
  2. HNPCC (hereditary non-polyposis colon cancer)
  3. Myotonic dystrophy
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16
Q

What are the treatments for HD?

A
  • symptomatic treatment only at present

- no prevention or cure

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17
Q

What is exclusion testing?

A

For parents who do not want predictive testing but want to ensure their children are not at risk - predicts whether the foetus is at risk

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18
Q

What is bioinformatics?

A

A combination of principles from computer science and IT, used to handle and interpret the large datasets generated by genomic analysis

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19
Q

What are the limitations of bioinformatics?

A
  • computers simply follow a set of rules, they are not aware of what they’re doing
  • variants are missed
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20
Q

Stats about rare diseases:

  1. What % of the population will be affected by a rare disease?
  2. What % of rare diseases have a genetic component?
  3. What % of rare diseases affect children?
A
  1. 7%
  2. 80%
  3. 75%
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21
Q

What is Cockayne Syndrome?

A
  • A rare and fatal autosomal recessive neurodegenerative disorder charachterized by growth failure (dwarfism), impaired development of the nervous system, photosensitivity, eye disorders and premature ageing
  • Most children with severe CS do not survive to 7
  • no cure
  • treatment of symptoms: hearing acids, protection of skin and eyes from sun, dental hygiene
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22
Q

What is FTT?

A

Failure to thrive - insufficient weight gain or inappropriate weight loss

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23
Q

Explain the genome analysis pipeline

A
  1. Collect DNA
    - genomic DNA (e.g blood)
    - tissue DNA (e.g tumour)
  2. Capture DNA of interest
    - clinical exome/ exome/ whole genome
  3. Sequence captured DNA
    - short/long read
    - single-end/paired-end
  4. Analyse sequence
    - align data to human genome and call variants, SNVs, CNVs etc
  5. Variant interpretation
    - does the variant cause disease?
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24
Q

In what ways can cells adapt?

A
  • increase in size of cells (hypertrophy)
  • increase in number of cells (hyperplasia)
  • decrease in size and metabolic activity of cells (atrophy)
  • increase in functional activity of cells
  • change in the phenotype of cells (metaplasia)
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25
Q

Can fibroblasts adapt to environmental change?

A

they can survive severe metabolic stress without harm e.g absence of oxygen
-don’t need to adapt

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26
Q

Can epithelial cells adapt to environmental change?

A
  • labile (flexible) cell population
  • active stem cell compartment
  • highly adaptive in number and function
  • adapt easily
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27
Q

What are the 3 types of adaptive response?

A
  1. Increased cellular activity - increased size or number of cells
  2. Decreased cellular activity - decreased size or number of cells
  3. Change in cell function and/or morphology
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28
Q

What does hypertrophy result in? Examples

A
  • increase in size of existing cells - resulting in increase in size of organ
  • increase in function capacity
  • seen in permanent cell populations e.g cardiac and skeletal muscle
  • increased synthesis of structural components (explains why organ gets larger)
  • increased metabolism
  • growth of the uterus in pregnancy results from the hypertrophy of muscle fibres
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29
Q

Why does left ventricular hypertrophy occur?

A
  • systemic hypertension is caused by increased peripheral vascular resistance
  • so will increase the work required of the left ventricle
  • hypertrophy will compensate for some time, but if hypertension is untreated, left ventricle will fail
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30
Q

What is sub cellular hyperplasia and hypertrophy?

A

-increase in size and number of sub cellular organelles

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31
Q

What is an example of hormone-driven hyperplasia?

A

proliferation of the glandular epithelium of the female breast at puberty and during pregnancy

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32
Q

What is compensatory hyperplasia?

A

Increases tissue mass after damage or partial resection

33
Q

How does hyperplasia occur in Graves disease?

A

an autoantibody binds to and switches on the TSH receptor in the thyroid, leading to prolonged, uncontrolled hyperplasia of the thyroid ad hyperthyroidism (thyrotoxicosis)

34
Q

What is the charachteristic sign of Grave’s disease?

A

eye signs (exophthalmos) - bulging of the eye anteriorly out of the orbit

35
Q

What is atrophy?

A

reduction in size of organ or tissue by decrease in cell size and number

36
Q

What are the common causes of atrophy?

A
  • decreased workload (atrophy of disuse)
  • loss of innervation (damage to nerve causing denervation atrophy)
  • diminished blood supply (ischamia)
  • inadequate nutrition e.g cachexia
  • loss of endocrine stimulation
  • pressure
37
Q

What are the mechanisms of atrophy?

A
  1. reduced metabolic activity
  2. decreased protein synthesis
  3. increased protein degradation in cells
  4. reduction in volume of individual cells
38
Q

What is metaplasia?

A
  • transformation of one differentiated cell type into another
  • may form the basis of which neoplasia develops
39
Q

What is dysplasia?

A
  • earliest morphological manifestation of multistage process of neoplasia
  • in-situ disease; non invasive
  • shows cytological features of malignancy
  • recognition of dysplasia gives us the chance to treat a potentially fatal tumour before it arises
  • basis of cervical screening programme
40
Q

What is omeprazole?

A

proton pump inhibitor

medicine to reduce stomach acid

41
Q

What s metformin?

A

drug for type 2 diabetes

42
Q

What is GORD?

A

Gastro-oesophageal reflux disease

43
Q

What is Baretts oesophagus?

A
  • lining of oesophagus is damaged by acid reflux
  • a metaplastic process in which the normal stratified squamous epithelial lining is replaced with columnar epithelium (gastric or intestinal) with goblet cells
  • predisposes to dysplasia and invasive malignancy
44
Q

What does bisoprolol, furosemide, ramipril treat?

A

high blood pressure

45
Q

What is BPH?

A
  • Benign prostatic hyperplasia
  • common condition affecting males > 50 years resulting in enlargement of the prostate
  • characterised by hyperplasia of glandular and stromal tissue
46
Q

What is dyskaryosis?

A

Dyskaryosis means abnormal nucleus and refers to the abnormal epithelial cell which may be found in cervical sample

47
Q

What is CIN?

A

Cervical intraepithelial neoplasia

  • dysplastic condition caused by HPV
  • carcinoma in situ is the presence of dysplastic cells that have not yet breached the basement membrane, but have a high risk of progressing to invasive malignancy
48
Q

What is Beckwith Weidemann syndrome?

A

n overgrowth syndrome due to the dysregulation of IGF2 gene

49
Q

What is a tumour?

A

A swelling or a mass of any kind

50
Q

What is a neoplasia?

A

A new, uncontrolled growth of cells that is not under physiologic control. Usually forms a tumour. Can be benign or malignant

51
Q

what is cancer?

A
  • malignant neoplasia

- growth of abnormal cells that can invade and metastasise

52
Q

What are the 8 hallmarks of cancer?

A
  1. Enabling replicative immortality
  2. Activating invasion and metastasis
  3. Inducing angiogenesis
  4. Resisting cell death
  5. Deregulating cellular energetics
  6. Sustaining proliferative signalling
  7. Evading growth suppressors
  8. Avoiding immune destruction
53
Q

What are lung cells, thyroid cells and digestive cells formed from?

A

undifferentiated endoderm (internal layer)

54
Q

What are cardiac muscle cells, skeletal muscle cells, tubule cells of the kidney, red blood cells, smooth muscle cells?

A

undifferentiated mesoderm (middle layer)

55
Q

What are skin cells of epidermis, neuron on brain and pigment cells?

A

undifferentiated ectoderm (external layer)

56
Q

What cells are carcinomas derived from?

A

Digestive cells

57
Q

What cells are sarcomas derived from?

A

smooth muscle cells

58
Q

What cells are melanomas derived from?

A

Pigment cells

59
Q

What is differentiation?

A

The extent to which a neoplasm resembles its tissue of origin
Well-differentiated - neoplasm closely resembles tissue of origin
Poorly differentiated - neoplasm does not resemble the tissue the tissue of origin/ can’t tell where its come from

60
Q

What does pleomorphic mean?

A

When a large number of cells show lots of variability in cell size and cell shape

61
Q

What is anaplasia?

A

A neoplasm that is poorly differentiated and highly pleomorphic

62
Q

What are the 3 most common types of cancer in females?

A
  1. Breast - 31%
  2. Lung - 13%
  3. Bowel - 10%
63
Q

Which cancer has the highest mortality?

A

lung

64
Q

What are the 3 most common types of cancer in males?

A
  1. Prostate - 26%
  2. Lung - 14%
  3. Bowel - 13%
65
Q

Cancer in which organ has the highest percentage mortality?

A

pancreas (then brain, lung, oesophagus etc)

66
Q

Benign Vs Malignant neoplasm:

  1. Invasion?
  2. Mets?
  3. Rate of growth?
  4. Differentiation?
  5. Prognosis?
A
  1. Benign - neoplasm does NOT invade surrounding tissues
    Malignant - neoplasm DOES invade surrounding tissues
  2. Benign - does NOT metastasise
    Malignant - may metastasise
  3. Benign - slow rate of growth
    Malignant - fast rate of growth
  4. Benign - usually well-differentiated
    Malignant - well –> moderate –> poorly differentiated –> anaplastic
  5. Benign - rarely fatal
    Malignant - often fatal

Malignant tumours grow through the basal lamina/ basement membrane

67
Q

What are the 3 potential routes that malignant neoplasms can metastasise?

A
  • lymphatic
  • haematogenous (blood vessels)
  • direct seeding
68
Q

What is seeding?

A

Malignant neoplasm penetrates into a natural body cavity

69
Q

What complications can arise as effects of the primary tumour?

A
  • invasion into and replacement of normal tissue–> failure of that organ to function
  • pressure on normal tissue
  • invasion into blood vessels –> bleeding
  • pressure on blood vessels —> ischaemia
  • pressure/invasion into nerves –> loss of nerve function /pain
  • grow into lumen –> obstruction
70
Q

What other complications can arise as a result of tumours?

A
  1. Effect of distant metastases (same effect as primary tumour, just in different location)
  2. Paraneoplastic syndromes
71
Q

What are paraneoplastic syndromes and why do they develop?

A

Signs and symptoms that are NOT related to local effects of the primary or metastatic tumours
Develop as a result of:
-proteins/hormones secreted by tumour cells e.g cancer cachexia
-immune cross reactivity between tumour cells and normal tissues e.g Lambert eaton myasthenia syndrome

72
Q

What is cancer cachexia?

A

Proteins affect metabolism causing cancer patients to have muscle wasting and become very thin

73
Q

What is parenchyma?

A

Cells that perform actual function of an organ e.g cells that do gas exchange (pneumocytes) in the lungs, cells that contract the heart (myocytes)

74
Q

What is stroma?

A

Cells that support the parenchyma (all other cells except parenchyma) including:

  • blood vessels
  • fibroblasts
  • immune cells
75
Q

What is an organ made up of?

A

Parenchyma + stroma

76
Q

What is tumour stroma?

A
  • everything around the tumour

- required for a cell to acquire the ‘hallmarks of cancer’ and become malignant

77
Q

What is a common symptom of bladder cancer and why?

A

blood in urine - local effect because all the new blood vessels from the tumour are eroding into existing blood vessels

78
Q

What is a common symptom of bowel cancer?

A

diarrhoea - local effect due to local inflammation and cell turnover which will irritate the lining of the bowel and lead to more water in stool

79
Q

What is Lambert Eaton Mysthenic Syndrome?

A

a rare autoimmune disorder where the immune system mistakenly attacks the body’s own tissues
-paraneoplastic syndrome

EMS (16 decks)

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