UWorld REview > Oncology > Flashcards

Oncology Flashcards

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1
Q

hemosiderin-def and patient population (2)

A

accumulation of iron. common in pt with hemolytic anemia or those who undergo frequent blood transfusions

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2
Q

Fas (CD95)-def, family, another family member example, function

A

death receptor. member of tumor necrosis factor family. along with type 1 TNF receptor (TNFR1). Fas cross links with it’s ligand to induce caspase via the extrinsic apoptosis pathway

cytochrome c works through intrinsic pathway

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3
Q

what should be given to pts receiving platinum-based chemotherapy? what is an example of such a chemotherapy agent?

A 
aggressive hydration (cisplatin stays in non-reactive state when in higher chloride concentration) and amifostine (free-radical scavenger) to prevent neurotoxicity
cisplatin-can cause acute tubular injury
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4
Q

filgrastim

A

granulocyte-colony-stimulating factor (G-CSF)

stimulates proliferation and differentiation of granulocytes

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5
Q

purine analog drug of choice for hair cell leukemia. mech of action and resistance

A

cladribine-purine analog that achieves high intracellular concentrations b/c of resistance to degradation by adenosine deaminase

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6
Q

name three families of antimetabolites

A

folate antagonist, purine analogs, pyrimidine analogs

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7
Q

name a folate antagonist

A

methotrexate

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8
Q

name 3 purine analogs

A

6-thiopurines (6-MP, 6-GP), Fludarabine-CLL, and Cladribine-HCL

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9
Q

name 4 pyrimidine analogs

A

5-FU, capecitabine, cytrabine, gemcitabine

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10
Q

metalloproteinases

A

Zn-containing enzymes that degrade components of ECM and basement membrane- active in tissue remodeling, embryogenesis and tumor metastasis

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11
Q

encapsulation

A

when a tumor pushes against but does not invade fibrous tissue- i.e. meningioma

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12
Q

in an Receiver Operating Characteristic (ROC) curve adjusting the cut off line to the right changes SEN and SPE how? moving curve to the left?

A
  • right shift increases SPEC at expense for SEN

- left shift increases SEN at expense of SPEC

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13
Q

name carcinoma associated with: which one is reactivated in HIV

  • EBV
  • H. Pylori
  • HTLV-1 (Human T-lymphtrophic virus)
  • Hepatitis B
  • BK virus
A
  • non-Hodgkin’s diffuse B-cell lymphomas (reactivated in HIV pts)
  • MALToma and gastric adenocarcinoma
  • adult-T cell leukemia
  • hepatocellular carcinoma
  • nephropathy (post-transplant) or hemorrhagic cystitis
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14
Q

two key growth factors that promote angiogenesis in neoplastic and granulation tissue. why not EGF which cytokines? what poses a barrier?

A

FGF and VEGF

  • EGF has mitogenic influence on epithelial cells hepatocytes and fibroblasts but doens’t stimulate angiogenesis
  • IL-1 and INF gamma can stimulate VEGF expression
  • laminin in basement membrane may pose a physical barrier to new blood vessel growth
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15
Q

equation for RRR=

-risk of using relative risk reduction alone

A

absolute risk(control)-absolute risk (treatment)/ absolute risk (control)

note that relative risk reduction may overstate effectiveness of an intervention. use absolute risk reduction instead

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16
Q

topisomerase I vs II. inhibited by which enzymes

A
  • I causes single stranded nicks to relive negative supercoiling. itrinotecan and topotecan
  • II causes double standed nicks to relieve both positive and negative supercoiling. etoposide and podophyllin
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17
Q

what inhibits thymidylate synthase and what inhibits dihydrofolate reductase. enzyme class

A
  • 5-FU
  • MTX
  • antimetabolites
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18
Q

uses for etoposide and podophyllin

A
  • inhibits topoisomerase II
  • treats testicular cancer and small cell lung cancer
  • genital warts
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19
Q

185-kD transmembrane glycoprotein that has intracellular tyrosine kinase activity. define class and cancers associated with it’s mutation.

A
  • HER2/neu oncogene
  • epidermal growth factors
  • breast and ovarian cancer
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20
Q

what is useful in determining prognosis of cancer? not differentiation b/c?

A

-progonsis is better measured by staging. (how far has it spread) vs gradin how much as it differentiated

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21
Q

two cancers of bladder and causes

A
  • mc is transitional cell carcinoma aka urothelial
  • squamous cell caused by schistosoma haematobium
  • pt will complain of painless hematuria
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22
Q

vimentin

A

intermediate filament found in cells of mesenchymal origin

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23
Q

LCA aka

A

leukocyte common antigen. aka CD 45

-diiferentiates malignant lymphomas from poorly differentiated neoplasms of other types

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24
Q

name skull foramen in anterior cranial fossa and structures that transverse them

A

-ciribiform plate- CN I olfactory bundles

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25
name skull foramen in middle cranial fossa and structures that transverse them
- optic canal-CN II, opthalmic artery, central retinal vein - superior orbital fissure, CN III,IV, V, VI, opthalmic vein, sympathetic fibers - foramen rotundum CV V2 (maxillary) - foramen ovale (CN V3) mandibular - foramen spinosum- middle meningeal art and vein
26
name skull foramen in posterior cranial fossa and structures that transverse them
- internal acoustic meatus CN VII, CNVIII - jugular foramen CN IX, X, XI, jugular vein - hypoglossal canal CN XII - foramen magnum spinal roots of CN XI, brain stem, vertebral arteries
27
symptoms of jugular foramen (vernet) syndrome
- CN IX, X, and XI are affected - loss of taste from posterior 1.3 of tongue 9 - reduced parotid gland secretion 9 - loss of gag reflex 9,10 - dysphagia 9,10 - dysphonia/hoarseness 10 - soft palate drop with deviation of the uvula towards the normal side 10 - SCM and trapezius muscle paresis, 11
28
lipid peroxidation- define and then explain using carbon tetrachloride as a n example
- when free radical reaction with lipids to form peroxide which leads to damage - P-450 system breaks down CCL4 into CCL3 a free radical that causes lipid peroxidation leading to hepatocyte necrosis
29
which HY drug causes hemorrhagic cystitis?
-cyclophosphamide
30
chronic MTX use for RA and anti-inflammatory process is associated with what toxicity
-cirrhosis
31
used to mark b lymphocytes and t lymphocytes - myeloid cells - neuroentrocrine tumors
- CD 20/ CD3 - MPO - chromogranin A
32
name diseases associated with: - defect in UV-specific endonuclease (nucleotide excision repair) - 3'-5' exonuclease defect (defect in mismatch repair)
- xeroderma pigmentosum | - hereditary nonpolyposis colorectal cancer (HNPCC)
33
similarity of molecular pathophysiology of non-small cell carcinoma and CML?
- in both cases a chromosomal rearrangement creates a fusion protein gene leading to constitutive tyrosine kinase activity - NSCLC results in EML4 (echinoderm mictotubule-assocaited protein like 4)-ALK (anaplastic lymphoma kinase) - CML results in a BCR-ABL fusion protein
34
how to determine benign lymph node enlargement vs neoplasm?
use PCR to search for poissible gene rearrangments to determine if it's polycolonal or monoclonal growth
35
"waxing and wanning" painless lymphadenopathy. translocation, overexpression molecule
- follicular lymphoma - t(14,18) - results in overexpression of bcl-2
36
presentation of hairy cell leukemia
- splenomegaly and pancytopenia in older men - cells with hair like projection - positive of TRAP (tartrate resistance acid phosphatase)
37
presentation of diffuse large cell lymphoma- define, masses are commonly where?
aggressive non-H lymphomas of B origin - large lymph or extranodal mass - common seen in waldeyer ring (oropharyngeal lymphoid tissue) and GI tract
38
mycosis fundgoidies- define, presentation, differential diag
cutaneous T-celll lymphoma - CD4+ in dermis and epidermis causes Pautrier microabcesses. can result in erythema, scaling, and thickening of skin - confused with eczema or psoriasis
39
secretion of wht from where causes cachexia? presentation? mech
TNF- alpha from mac in response to infection and some tumor cells - anorexia, malaise, anemia, and weight loss - suppresses appetite, inhibits lipoprotein lipase and increases insulin resistance to peripheral tissues
40
IFN alpha vs TNF alpha
- from leukocytes and has antiviral as well as anti-tumor activity - from mac or tumor cells causing cachexia
41
HHV-8 associated with? pt pop. presentation
- kaposi's sarcoma - HIV positive pts - blue violet or brownish skin plaques on extremities and mucous membranes - spindle and endothelial cell proliferation, RBC extravasation*, and inflammation
42
human T-cell leukemia virus type-1. family.pt pop
- retroviridae | - causes T-cell leukemia esp in pts from southern Japan
43
CD 34 and vWF stain for
endothelium
44
what causes chemical carcinogens to become ROS?
cytochrome P-450 mooxygenase
45
benx(o) pyrene
chemical carcinogen
46
how to prevent hemorrhagic cystitis? presentation
- frequent urination, suprapubic pain, dsyruia, and hematuria - aggressive hydration, bladder irrigation, and mensa
47
mensa- define and aka
- a sulfhydryl compound that bind acrolein (toxic substance) in urine - aka 2-mercatopethansulfonate
48
hereditary breast cancer is associated with mutation in which gene? function of gene? associated with which other cancer?
- BRAC-1 and BRAC-2 - tumor supressors that function in gene repair and regulation of cell cycle - ovarian
49
APC gene is responsible for? associated cancers
- cell attachment | - colon
50
why can OCP decrease risk of ovarian cancer? what other things reduce risk of ovarian cancer?
- b/c it reduces the number of times a woman ovulates decreasing the number of time that the ovary has to repair itself - multiparity and breast-feeding (reduced cycles)
51
promotor or suppressor? ras
promoter | bladder, lung, colon, pancreas, kidney
52
promotor or suppressor? N-myc
promoter | neuroblastoma, small cell, carcinoma of lung
53
P or S? Nf-1
supressor | neuroblastoma type 1, sarcomas
54
P or S? BRCA-1, BRAC-2
suppressors | breast and ovarian
55
P or S? APC/beta catenin?
suppressors gastric, colon, pancreatic familial adenomatous polyposis coli
56
P or S? ERB-B1?
promoter | squamous cell carcinoma of lung
57
P or S ERB B2?
promoter | breast and ovarian cancer
58
P or S? DCC
suppressor | colon
59
P53 P or S?
suppressor | majority of cancers Li Fraumeni syndrome
60
P or S? TGF-alpha
promoter | astrocytoma, heptocellular carcinoma
61
P or S? sis
promoter | astrocytoma and osetocarcoma
62
P or S? WT-1?
suppressor | wilms tumor
63
P or S? RB?
suppressor | retinoblastoma and osterosarcoma
64
P or S? abl
promoter | CML, ALL
65
fibronectin-define, secreted from, bind to (3) to mediate (2)?
- large glycoprotein - produced by fibroblasts and some epithelial cells - binds to integrins, matric collagen and glycosaminoglycans to mediate cell adhesion and mirgration
66
hyaluronic acid-contains, role in ECM
glucronic acid containing glycosaminoglycan in ECM | -helps with water retention giving matrix lubricant properties and a viscous, gel like consistency
67
keratin sulfate
galatcose- containing glycoaminoglyca in ECM | -help to maintain type 1 collagen fibril organization in cornea
68
integrin mediated adhesoin of cells to basement membrane involves
-fibronectin, collagen, and laminin
69
heparin sulfate- define and role in ECM
proteoglycan component of ECM | -vascular endothelial cell attachment to BM
70
most common primary brain tumors in adults (3, origin, location, prognosis)
- glioblastoma multiforme- from astrocytes, hemispheres, cross midline highly malignant, poor prognosis - meningiomas-arachnoid cells, brain surfaces, benign and well circumscribed, - acoustic neuromas- from Schwann cells of CN VIII, cerebellopontine angle
71
sequence of epithelial malignancies. reversible step
- low grade dysplasia (doesn't involve entire thickness of epithelium) - high grade aka carcinoma in situ (entire epithelium but doesn't penetrate BM) - invasive carcinoma ( breached BM) - can't be reversed after cells have breached BN
72
pseudopalisading around areas of necrosis
glioblastoma multiforme
73
histological appearance of Burkitt's lymphoma
"starry sky" | -diffuse infiltrate of lymphoid cells with numerous mitotic figures and interspersed mac surrounded by a clear space*
74
what enzymes are responsible for repairing deamination of bases in DNA. not specific endonucleases b/c?
- specific glycosylases | - specific endonucleases repair thymidine dimers
75
caspases cleave where?
Cysteine-ASPartic acid proeASES
76
role of ras in tumor generation
ras protein is a component of MAP-kinase pathway | -if overactive it's makes the cell more sensitive to mitogenic stimuli
77
when is RB active? when is it not?
- active when hypophosphorylated | - inactive can phosphorylated
78
folinic acid vs folic acid. how to cure MTX toxicity?
- aka leuvocorin. folinic (N5-formyl-THF) enters in cycle as methylene THF and is converted to DHF by thymidylate synthetase -folic acid is converted to DHF with DHF reductase. -MTX inhibits DHF reductase so give folinic acid
79
treatment for side effects of chemo - granulocytopenia - vomiting and nausea - cardiotoxicity - nephrotoxicity - tumor lysis syndrome
- filgrastim (G-CSF analog) - ondansteron (block vagus-mediated vomiting and serotonin in chemo trigger zone) - dexrazoxane (antracycline aka doxorubicin) - amifostine (platinum-containing and alkylating chem agents) - allopurinol and hydration (for chemo against tumors with high turnover rate leukemias and lymphomas)
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