TIN

Question 1

nsaids m of a and side effects

Answer 1

inhibit cox enzymes - reduce PG, thromboxanes - mediating pain. cox1 - side effects, cox 2 therapeutic.
adverse - dyspepsia, nausea and vom, CV, renal, nephro, bronchospasm

Question 2

corticosteroids and side effects

Answer 2

glucocorticoid intracellular receptor bind - trigger gene process - inhibit genes for CK, Th, fibroblast, osteoblast, COX2, NO, histamine, IgG.
reduced response to infection, osteoporosis, hyperglycaemia, muscle wasting, CNS efect.

Question 3

osteoarthritis explain

Answer 3

degenerate joint disease - non-inflammatory affecting weight bearing jts, loss of articular cartilage and forming thick subchondral bone, wear and tear factors. factors include pain, jt stiffness, joint deformation, reduced range of motion

Question 4

explain rheumatoid arthritis

Answer 4

autoimmune causing swollen painful joints due to inflammation of synovium and erosion of cartilage and bone.

Question 5

5-aminosalicylates

Answer 5

scavenge toxic oxygen metabolites produced by neutrophils. side effects are gi, malaise, headache

Question 6

TNF alpha antagonists

Answer 6

bind to TNF alpha and inhibit- inhibiting leukocyte migration. adverse - infection, injection reaction, headache, autoantibody, malignancy, lymphoproliferative.

Question 7

Rituximab

Answer 7

Anti CD20 monoclonal antibody.. bind to CD20 on B cell and lyse. adverse is infection, muscle pain, weakness, infusion

Question 8

Abatercept

Answer 8

bind to CD80/86 on APC. Prevent full T cell activation and reduce cytokines. adverse effects - infection, infusion and malignancy.

Question 9

methotrexate - 2 mechanisms explain

Answer 9

for anti-inflammatory, inhibits enzymes in purine metabolis - increasing adenosine thus inhibit T cell, B cell. for RA. teratogenic. for cancer, inhibit dihydrofolate reductase reducing tetrofolate and interfere with DNA synthesis.

Question 10

explain gout

Answer 10

increased plasma urate - painful intermittent arthritis due to accumulation of sodium urate in synovial jts, inflammatory response leads to neutrophils etc. in the joint .- release ros and proteolytic enzymes

Question 11

colchinine

Answer 11

inhibit neutrophil migration, chemotaxis, adhesion and phagocytosis.

Question 12

integrin antagonist

Answer 12

IgG monoclonal antibody - against alpha4beta7 integrin on leukocytes. inhibit T cell adhesion to MADCAM in GI and preventing GI inflammation

Question 13

leukotriene receptor antagonist

Answer 13

leukotriene cysL1 antagonist, blocking leurkotrienes in lung and therefore reducing bronchoconstriction.

Question 14

pyridamine.purine analogue (fluorouracil)

Answer 14

inhibit thymidylate synthetase- false nucleotide inhibiting synthesis

Question 15

alkylating agents and platinum compounds

Answer 15

produce reactive chemical groups forming covalent bonds with DNA, can form cross bridges.

Question 16

vinca alkaloids

Answer 16

bind to B tubulin and prevent polymerisation

Question 17

taxanes

Answer 17

freeze microtubules in non-functional polymerised state

Question 18

topoisomerase 1 inhibitors

Answer 18

inhibit this, accumulation of breaks and cell death (this enzyme enables supercoiled DNA to uncoil, replicate, repair and transcribe)

Question 19

anthracyclines

Answer 19

intercation of DNA, top 2 inhibition 0 accumulation of dna breaks

Question 20

podophyllotoxins

Answer 20

top 2 inhibition

Question 21

antiandrogens

Answer 21

inhibit competitively androgens at receptors - cytoproterone has prostegerone effects reducing testorernce but does cause impotence, flushes, reduced libido

Question 22

gnrh analogue

Answer 22

inhibit this secretion from pituitary long term

Question 23

aromatase inhibitors

Answer 23

aromatase converts androstenedione and testosterone to estriol and estradiol, but this causes hot flush, vaginal dry, weakness, headache. not before menopause.

Question 24

serms (tamoxifen)

Answer 24

compete with oestrogen for receptor. anti-oestrogen can be cardioprotective, can agonise elsewhere

Question 25

TK inhibitors

Answer 25

involved in signalling in proliferation - angiogenesis, invasion, metastasis, small molecules all end in ib

Question 26

mTOR inhibitors

Answer 26

inhibit growth pathways - inhibiting angiogenesis, tumour cell proliferation and growth.

Question 27

``` trastuzumab ipilimumab cetuximab bevacizumab rituximab nivolumab ```

Answer 27

``` HER 2 antibody Bind to CTLA4 - prevent inactivation of T cells. Anti EGFR antibody Anti VEGFR antibody CD20 antidody - lyse abnormal B cells anti PD1 - stop rpogrammed death of CTLs ```

Question 28

risk factors breast cancer

Answer 28

age, female, family, oes exposure, OCP, HRT, obesity and alcohol

Question 29

3 types of breast cancer best to worst

Answer 29

ER+ve, HER2 -ve HER2+ve Triple negative

Question 30

how does breast cancer present

Answer 30

screening, palpable mass, skin tenderness

Question 31

investigations for breast cancer

Answer 31

mammogram, ultrasound, core biopsy, histopathology.

Question 32

Rx for breast cancer

Answer 32

Early - surgery, radiotherapy. can give targeted therapy, chemo usually only if young high grade. locally advanced need neoadjuvant chemo first. metastatic just symptomatic relief.

Question 33

3 types of NSCLC and explain

Answer 33

adenocarcinoma - most common from mucosal cell of bronchial epithelium squamous cell carcinoma - more aggressive large cell - more undifferentiated

Question 34

where do SCLC come from and how present

Answer 34

system disease, from neuroendocrine cells.

Question 35

presentation of lung cancr

Answer 35

dry cough, haemophytis, wheeze, recurrrent pneumonia and dyspnoea.

Question 36

Ix for lung cancer

Answer 36

chest x ray, CT and abdo,

Question 37

Rx lung cancer

Answer 37

sc: limited chemo and radiation nsc: surgery, chemo if sprad to lymph nodes

Question 38

progression of GI cancer

Answer 38

normal -> dysplasia -> polyp -> invasion to submucosa.

Question 39

Cx of bowel cancer

Answer 39

change in bowel habits, anaemia, rectal bleed, bowel obscturction

Question 40

Ix bowel cancer

Answer 40

colonoscopy, biopsy, CT abdomen.

Question 41

Rx bowel cancer

Answer 41

early - surgery, locally advanced - surgery and neoadjuvant chemo, stage 4 is incurable but can do chemo

Question 42

how does radiotherapy work

Answer 42

breaking bonds in DNA - cell chekcpoints then kill

Question 43

adverse effect of radiotherapy

Answer 43

local tissue damage in fast turnover - GI, BM, epidermis, tissue damae to non-proliferating more serious. fibrosis, scarring, telangie.

Question 44

how to pronounce death

Answer 44

1. look and listen to breath for 2 mins, 2, listen to chest for 2 mins, listen to heart for 2 mins, feel for pulse, light in pupils, response to pain, re-check ID.

Question 45

signs of hereditary cancer

Answer 45

successive generations, younger age, multiple cancer, both organs, not usually in that gender.

Question 46

why genetic counselling

Answer 46

guide treatment, inherited cancer risk, can be interpreted

Question 47

explain grading and srtaging

Answer 47

Graded on differentiation GX, G0-G4 | TMN staging Tx,0-4 on size, Nx,0-3 on lymph nodes, Mx,0-1 on metz. can be collated to stage 0-4.

Question 48

side effect of cytotoxic antineoplastics

Answer 48

myelosuppression, reduced wound healing, alopecia, GI damage, sterility, teratogenicity