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Step 1 11.17.12
PathologyII/Pharm I
| Question | Answer |
|---|---|
| What is cahecia and what mediates it? | loss of weight and muscle atrophy fatigue occuring in chronic disease like cancer, AIDS, HF, Tb). mediated by TNF-alpha, IFN-gamma, IL-6 |
| What cancers are associated with Down Syndrome? | ALL, AML |
| What cancers are associated with xeroderma pigmentosa, albinism? | melanoma, basal cell carcinoma, esp squamous cell carcinoma of the skin |
| What cancers are associated with chronic atrophic gastritis, pernicious anemia, or post surgical gastric remnants? | gastric adenocarcimnoma |
| What cancers are associated with tuberous sclerosis (facial angiofibroma, seizures, mental retardation)? | astrocytoma, angiomyolipoma, cardiac rhabdomyoma |
| What cancers are associated with actinic keratosis? | squamous cell carcinoma of the skin |
| What cancers are associated with Barrett's esophagus (chronic GI reflux)? | esophageal adenocarcinoma |
| What cancers are associated with Plummer-Vinson syndrome ( atrophic glossitis, esophageal webs, anemia all from Fe deficiency)? | squamous cell carcinoma of esophagus |
| What cancers are associated with Cirrhosis (alcoholic, HepB or C)? | hepatocellular carcinoma |
| What cancers are associated with ulcerative colitis? | colonic adenocarcinoma |
| What cancers are associated with Paget's disease of bone? | secondary osteosarcoma and fibrosarcoma |
| What cancers are associated with immunodeficiency states? | malignant lymphomas |
| What cancers are associated with AIDS? | aggressive NHL and Kaposi's sarcoma |
| What cancers are associated with autoimmune diseases ( Hashimoto's thyroiditis, myasthenia gravis)? | lymphoma |
| What cancers are associated with acanthosis nigricans ( hyperpigmentation and epidermal thickening)? | viceral malignancy ( stomach, lung, brast uterus) |
| What cancers are associated with dysplastic nevus? | malignant melanoma |
| What cancers are associated with radiation exposure? | sarcoma, paipllary thyroid cancer |
| What is the mech of oncogenes? | gain of function. only need damage to one allele? |
| What is the gene type, associated tumor, and gene product of abl? | oncogene, causes CML, makes a tyrosine kinase |
| What is the gene type, associated tumor, and gene product of c-myc? | oncogene, Burkitt's lymphoma, makes a transcription factor |
| What is the gene type, associated tumor, and gene product of bcl-2? | oncogene, follicular and undifferentiated lymphomas (inhibits apoptosis), makes an anti-apoptotic molecule |
| What is the gene type, associated tumor, and gene product of erb-B2? | oncogene, nreast ovarian, gastric carcinomas. makes a tyrosine kinase |
| What is the gene type, associated tumor, and gene product of ras? | oncogene, colon carcinoma, makes a GTPase |
| What is the gene type, associated tumor, and gene product of L-myc? | oncogene, lungtumor, makes a transcription factor |
| What is the gene type, associated tumor, and gene product of N-myc? | oncogene, neuroblastoma, makes a transcription factor |
| What is the gene type, associated tumor, and gene product of ret? | oncogene, multiple endocrine neoplasia (MEN) types IIA and II B, makes a tyrosine kinase |
| What is the gene type, associated tumor, and gene product of c-kit? | oncogene, makes a gastrointestinal stromal tumor (GIST), cytokine receptor |
| What is the mech of tumor surpressor genes? | loss of function leads to cancer, both alleles must be lost for the expression of genes |
| What is the gene type, associated tumor, and gene product of rb? | tumor surpression, retinoblastoma, osteosarcoma, Rb product blocks G1-->S cell cycle |
| What is the gene type, associated tumor, and gene product of p53? | tumor surpressor, most human cancers, Li-Fraumeni syndrome, p53 gene product blocks G1--->S cell cycle |
| What is the gene type, associated tumor, and gene product of BRCA1? | tumor surpressor, breast and ovarian cancer, DNA repair protein |
| What is the gene type, associated tumor, and gene product of BRCA2? | tumor surpressor, breast cancer, DNA repiar protein |
| What is the gene type, associated tumor, and gene product of p16? | tumor surpressor, melanoma, unk product |
| What is the gene type, associated tumor, and gene product of APC ? | tumor surpressor, colorectal cancer (associated with FAP, unk product |
| What is the gene type, associated tumor, and gene product of WT1? | tumor surpressor, Wilm's tumor, ukn product |
| What is the gene type, associated tumor, and gene product of NF1? | tumor surpressor, neurofibromatosis type 1, ukn product |
| What is the gene type, associated tumor, and gene product of NF2? | tumor surpressor, neurofibromatosis type 2, ukn product |
| What is the utility of tumor marker use clinically? | not used to make dx, used to confirm and monitor recurrence and tumor response to therapy |
| What is PSA and what can it be used for? When might it be elevated in a non cancer? | Prostate-specific Ag, used to screen for prostate cancer. also elevated in BPH and prostatitis |
| What is prostatic acid phosphatase a marker for? | prostate carcinoma |
| What is the screening use of CEA? | carcinoembryonic Ag, non specific but produced by 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and thyroid medullary carcinomas |
| What is the screening use of alpha fetoprotein? | normally made by fetus. but also made by hepatocellular carcinomas and nonseminomatous germ cell tumors of the testis (yolk sac tumor) |
| What is the screening use of Beta-hCG? | detects hydatidifrom moles, choriocarcinomas, and gestational trophoblastic tumors |
| What is the screening use of CA-125? | ovarian, malignant epithelial tumors |
| What is the screening use of S-100? | melanoma, neural tumors, astrocytomas |
| What is the screening use of alkaline phosphatase? | metastases to bone, obstructive biliary disease, Paget's disease of bone |
| What is the screening use of bombesin? | neuroblastoma, lung and gastric cancer |
| What is the screening use of TRAP? | tartate resistant acid phosphatase. hairy cell leukemia which is a B cell neoplasm |
| What is the screening use of CA-19-9? | pancreatic adenocarcinoma |
| What is the screening use of calcitonin? | thyroid medullary carcinoma |
| What cancer is associated with HTLV-1? | adult T cell leukemia/lymphoma |
| What cancer is associated with HBV, HBC? | hepatocellular carcinoma |
| What cancer is associated with EBV? | Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma |
| What cancer is associated with HPV? | carvical carcinoma (16,18), penile/anal carcinoma |
| What cancer is associated with HHV-8? | Kaposi's sarcoma, body cavity fluid B cell lymphoma |
| What cancer is associated with HIV? | primary CNS lymphoma |
| What cancer is associated with H. pylori? | gastric adenocarcinoma, lymphoma |
| What cancer is associated with schistosoma haemotobium? | squamous cell carcinoma or transitional epithelium (bladder) |
| What organ is affected by and what cancer is associated with aflatoxins from aspergillus? | liver, hepatocellular carcinoma |
| What organ is affected by and what cancer is associated with vinyl chloride? | liver, angiosarcoma |
| What organ is affected by and what cancer is associated with CCl4? | liver, centrilobular necrosis, fatty change |
| What organ is affected by and what cancer is associated with nitrosamides (smoked foods)? | stomach, gastric cancer |
| What organ is affected by and what cancer is associated with cigarette smoke on larynx? | squamous cell carcinoma |
| What organ is affected by and what cancer is associated with cigarrette smoke in lungs? | squamous cell carcinoma and small cell carcinoma |
| What organ is affected by and what cancer is associated with cigarrette smoke on the kidney? | renal cell carcinoma |
| What organ is affected by and what cancer is associated with cigarrette smoke on bladder? | transitional cell carcinoma |
| What organ is affected by and what cancer is associated with abestos? | lung, mesothilioma, bronchogenic carcinoma |
| What organ is affected by and what cancer is associated with arsenic? | squamous cell carcinoma on skin, angiosarcoma in liver |
| What organ is affected by and what cancer is associated with naphthalene (aniline) dyes? | bladder, transitional cell carcinoma |
| What organ is affected by and what cancer is associated with alkylating agents? | blood, leukemia |
| What is the the effect and associted paraneoplastic effects of ACTH or ACTH-like peptide? | causes Cushing's syndrome, see small cell lung carcinoma |
| What is the the effect and associted paraneoplastic effects of of ADH? | causes SIADH, see small cell lung carcinoma and intracranial neoplasms |
| What is the the effect and associted paraneoplastic effects ofPTH related peptide, TGF-beta, TNF, IL-1? | causes hypercalcemia, see squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma |
| What is the the effect and associted paraneoplastic effects of erythropoetin? | get polycythemia, see renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma |
| What is the the effect and associted paraneoplastic effects of Ab against Ca++ channels at the NMJ? | causes Lmbert-Eaton syndrome, see thymoma, small cell lung carcinoma |
| What is the the effect and associted paraneoplastic effects of hyperuricemia due to excess nucleic acid therapy as in cytotoxic therapy? | causes gout, urate nephropathy. see leukemias and lymphomas |
| What are psammoma bodies? Where are they seen? | laminated, concentric, calcific spherules seen in : 1.papillary adenocarcinoma of thyroid 2. serous papillary cystadenocarcinoma of ovary 3. meningioma 4. malignant mesothelioma (PSMM) |
| What are the most common male cancers by incidence? | prostate (32%), lung (16%), colon/rectum (12%) |
| What are the most common male tumors by mortality? | Lung (33%), Prostate ( 13%) |
| What are the most common female cancers by incidence? | Breast (32%), lung (13%),colon/rectum (13%) |
| What are the most common female tumors by mortality? | Lung (23%), Breast (18%) |
| What has been the pattern of lung cancer for men vs women? | incidence has dropped in men but level in women |
| Is cqancer the #1 cause of death? | no, HD still #1 |
| Which tumors have a predilection for brain metastases? | lung>breast>kidney>skin (melanoma) |
| What do brain metastases look like? | multiple well circumscribed tumors at gray/white matter junction |
| Which tumors have a predilection for liver metastases? | Colon>stomach>pancreas |
| What are the most common sites of metastases after regiona LN? | liver and lungs |
| Which tumors have a predilection for bone metastases? | prostate,breast>lung>thyroid,testes. metastatic bone tumors more common than primary. |
| What are lung, prostate, and breast bone mets called? | lung: lytic prostate:blastic breast: lytic and blastic |
| What does Km for an enzyme reflect? | its affinity for substrate, decr Km= incr affinity |
| What is V max directly proportional to? | enzyme concentration |
| What is Km? | concentration of substrate at 1/2 V max |
| What is the relationship between V max and the y intercept in a 1/s vs 1/v graph? | incr Y intercept= decr V max |
| What is the relationship between the x intercept and Km in a graph of 1/s vs 1/v? | further x intercept is to the right= greater Km = less affinity |
| What are the X and y intercepts in a 1/s vs 1/v graph? What is the slope? | y intercept:1/Vmax x intercept:1/-Km slope: Km/Vmax |
| What is the resemblance to substrate, ability to be overcome with substrate, and binding to active site for a competitive inhibitor? | resembles the substrate, can be overcome with substrate, binds the active site |
| What is the resemblance to substrate, ability to be overcome with substrate, and binding to active site for a noncompetitive inhibitor? | does not resemble the substrate, cannot be overcome by [s], does not bind the active site |
| What is the effect on Vmax, Km, and pharmacodynamics of a competitive inhbitor? | do not change Vmax, incr Km, decr potency |
| What is the effect on Vmax, Km, and pharmacodynamics of a noncompetitive inhbitor? | decr Vmax, does not change Km, decr efficacy |
| What is volume of distrobution? How might it be altered? | relates amount of drug in body to plasma conc. Vd=amt body/plasma conc. Vd of plasma protein bound drugs will incr vd due to decr protein binding in liver and kidney disease |
| What type of drugs have low Vd? | distribute in blood, are large or charged molecules |
| Where do drugs with a medium Vd distribute to, what types of molecules? | distribute to extracellular space or body water. small hydrophillic molecules that do not bind plasma proteins |
| Where do drugs with high Vds distribute to and what types of molecules? | distribute to all tissues, small, lipophilic molecules that bind strongly to extravascular proteins |
| What is drug clearance? | CL=rate of elimination of drug/plasma drug concentration |
| How many half lives does a drug infused at a constant rate take to reach a steady state? | 4-5 half lives |
| How is the T 1/2 calculated? | t1/2= 0.7 x vd/ Cl |
| What is bioavailabilty (F) and what is the diff between the IV and oral? | F= fraction of adminstered drug IV=100% Orally= % that survives first pass in liver or gut |
| How do you calculate the loading dose? | LD=CpxVd/F where Cp is the target conc |
| How do you calculate the maintenance dose? | MD=CpxCL/F |
| What is the effect on maintenance and loading dose by renal or liver disease? | these disease decr the MD but LD is unchanged |
| Which affects the frequency of dosing, T1/2 or time to steady state? | frequency not affected by time to steady state, but is affected by T1/2 |
| What is zero order drug elimination? | rate of elimination is constant regardless of Cp, Cp will decr linearly with time |
| What is the elimination of phenytoin, ethanol, aspirin? | zero order elimination |
| What is first order drug elimination? | rate of elimination is proportional to drug concentration. constant fraction of drug eliminated per unit time. Cp decr exponentially with time |
| Which drugs are trapped in urine and cleared quickly? Which drugs can be reabsrobed? | ionized species trapped in urine and eliminated quickly. neutral forms reabsorbed |
| What types of drugs are phenobarbital, methotrexate, aspirin? When are they trapped and how can OD be Tx? | weak acids. trapped in basic environments. Tx overdose with bicarbonate |
| What types of drugs are amphetamines? When are they trapped and how can OD be Tx? | weak bases. trapped in acidic environments. tx OD with ammonium chloride |
| What is Phase I metabolism and what enzyme does it? What are the products? | PHase I = reduction oxidation, hydrolysis. usually yield slightly polar water soluble metabolites. Done by Cyt P 450 |
| What is Phase II metabolism What are the products? | glucoronidation, acetylation sulfation. yield polar inactive metabolites. conjugation |
| Which phase of metabolism do geriatric patients not have? | often dont have phase I |
| What might be seen in pt who are slow acetylators? | can get more SE because of decr rate of metabolism |
| What is efficacy? What classes of drugs have high efficacy? | maximal effect a drug can produce. highe efficacy drug classes are analgesic, abtx, antihistamines, decongestant |
| What is potency? What classes of drugs have high potency? | amount of drug needed for a given effect. incr potency, incr affinity for receptor. chemotherapeutics, antihypertensive drugs, antilipid drugs |
| What is the effect on an dose max effect scale by a competitive antagonist? | shift curve to right, decr potency, NC in efficacy ex. diltizam + flumazenil on a GABa receptor |
| What is the effect on an dose max effect scale by a noncompetitive antagonist? | shifts curve down= decr efficacy. ex. NE + phenoxybenzamine on alpha receptors |
| What is the effect on an dose max effect scale by a partial agonist? | acts the same as a full agonist but with reduced maximal effect. decr efficacy. ex. morphine and buprenorphine at opioid mu recetor |
| What is the therapeutic index and how is it calculated? how does it relate to drug safety? | LD50/ED50= median lethal dose/median effective dose. safer = higher TI |
Created by:
tjs2123
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