Dit Set #7: Lectures 79 - 91

Front 1

Lecture 79: Micro 3

Back 1

Enterobacteriaceae, Diarrhea, and Food poisoning

Front 2

What diseases might be found immediately proximal to the pectinate line vs. immediately distal to the pectinate line?

Back 2

•Proximal to the pectinate line: Adenocarcinoma, Internal hemorrhoids

•Distal to the pectinate line: Squamous cell carcinoma, External hemorrhoids

Front 3

How many ATP are generated during aerobic metabolism? During anaerobic metabolism?

Back 3

• Aerobic metabolism
o Malate shuttle: 32 ATP
o G-3-P shuttle: 30 ATP

• Anaerobic metabolism
o 2 ATP

Front 4

What enzyme is inhibited by the drug fomepizole?

Back 4

• Alcohol dehydrogenase

Front 5

Shigella flexneri

Back 5

• Associated with Reiter syndrome

Front 6

Salmonella

Back 6

• Osteomyelitis in sickle cell patient

Front 7

Salmonella typhi

Back 7

• Typhoid fever
• Rose color spots (abdomen) * remember*

Front 8

Campylobacter jejuni

Back 8

• Guillain-Barre syndrome (important fact to remember)

Front 9

Vibrio cholera

Back 9

Rice- water diarrhea due to a toxin that permanently activates cAMP (KNOW)

Heat- labile toxin

Associated with eating raw oysters

Front 10

Clostridium difficile

Back 10

•Makes a cytotoxin that kills enterocytes causing a pseudomembranous colitis *Very important to remember*

•Tend to occur after antibiotics
o Clindamycin
o Ampicillin

•Diagnosis
o C. diff toxin in stool (KNOW)

•Treatment
o Metronidazole
o Vancomycin (oral)

Front 11

Yersinia entercolitica

Back 11

• Bloody diarrhea
• Pet feces
• Contaminated food

Front 12

ETEC

Back 12

•Heat-labile enterotoxin-- IncreasedcAMP
o Increase in electrolyte excretion
o Increase in water excretion

•Heat-stable enterotoxin-- Increased cGMP
o Increased fluid excretion

Front 13

EHEC

Back 13

E. coli (O157:H7) (KNOW)

Infected hamburger mean

Hemolytic uremic syndrome (HUS) (KNOW)
-Causes: Anemia, Thrombocytopenia, Acute renal failure
-Endothelium swells and narrows lumen, Mechanical hemolysis
-Reduction of renal blood flow: Anemia, Acute renal failure
-Damaged endothelium consumes platelets: Thrombocytopenia

Front 14

What is the most common cause of gram negative sepsis?

Back 14

• E. coli
• Klebsiella (2nd most common)

Front 15

• Shigella

Back 15

o Bloody
o Non-motile
o Associated with Reiter’s

Front 16

• Salmonella

Back 16

o Egg salad
o Turtles

Front 17

• S. typhi

Back 17

o Rose spots on abdomen

Front 18

• Campylobactero

Back 18

o Associated with Guillain Barre

Front 19

• Vibro cholera

Back 19

o Rice-water diarrhea
o Raw oysters

Front 20

• C. difficile

Back 20

o Diagnosis with toxin
o Pseudomembranous colitis

Front 21

• Yersinina

Back 21

o Pet feces

Front 22

• Enterotoxigenic E. coli

Back 22

o Traveler’s diarrhea

Front 23

• Enterohemorrhagic E. coli

Back 23

o HUS

Front 24

Klebsiella pneumoniae

Back 24

•Red currant jelly sputum
•Major cause of UTIs
•4 A’s of klebsiella
o Aspiration pneumonia
o Abscess in the lung
o Alcoholics
o di A betics

Front 25

Which form of E. coli causes hemolytic-uremic syndrome (HUS)?

Back 25

• E. coli O157:H7

Front 26

What medications are commonly used to treat C. diff colitis?

Back 26

• Metronidazole
• Oral vancomycin

Front 27

Food poisoning as a result of mayonnaise sitting out too long

Back 27

o Staph aureus (preformed enterotoxin)

Front 28

Diarrhea caused by Gram (-) nonmotile organism that does not ferment lactose

Back 28

o Shigella

Front 29

• Rice-water stools

Back 29

o Vibrio cholera
o ETEC

Front 30

• Diarrhea caused by an S-shaped organism

Back 30

o Campylobacter

Front 31

• Diarrhea transmitted from pet feces

Back 31

o Yersinia enterocolitica

Front 32

• Food poisoning resulting from reheated rice (Chinese food)

Back 32

o Bacillus cereus

Front 33

• Diarrhea caused by Gram (-) motile organism that doesn’t ferment lactose

Back 33

o Salmonella

Front 34

• Most common cause of “travelers’ diarrhea”

Back 34

o ETEC

Front 35

• Diarrhea after a curse of antibiotics

Back 35

o Clostridium difficile

Front 36

• Diarrhea caused by Gram (-) lactose fermenting bacteria, no fever

Back 36

o E. coli

Front 37

• Diarrhea caused by Gram (-) comma-shaped organism, no fever

Back 37

o Vibrio cholerae

Front 38

• Diarrhea + recent ingestion of water from a stream

Back 38

o Giardia lamblia
o Entamoeba histolytica

Front 39

• Food poisoning from undercooked hamburger meat

Back 39

o E. coli O157:H7

Front 40

Food poisoning due to exotoxin

Back 40

Staph aureus
Bacillus cereus

Front 41

Osteomyelitis in sickle cell disease

Back 41

Salmonella

Front 42

Lecture 80: Micro 4

Back 42

Protozoa

Front 43

What is the difference between kwashiorkor and marasmus?

Back 43

•Kwashiorkor
o Protein malnutrition
o Skin lesions, edema, and liver malfunction
o Small child with a swollen belly

•Marasmus
o Energy malnutrition
o Complete nutrient deficiency
o Tissue and muscle wasting
o Loss of subcutaneous fat

Front 44

What vitamins should vegetarians supplement in their diet?

Back 44

• Vitamin B12

Front 45

What patient groups must avoid fluoroquinolones?

Back 45

• Children
• Pregnant women

Front 46

Metronidazole

Back 46

“GET GAP on the Metro”
o Giardia
o Entamoeba
o Trichomonas
o Gardnerella vaginalis
o Anaerobic bacteria
o Pylori (H. pylori)

•Tetrogenic

•Can cause a disulfarim like reaction

Front 47

Toxoplasmosis

Back 47

Brain abscesses: Ring enhancing lesions in AIDS patients on MRI (definitely remember)

One of the TORCH infections

Causes Cororetinis, hydrocephalis, intercranial calcifications in the fetus (definitely remember)

Front 48

Leishmania donovani (KNOW)

Back 48

Transmitted via sand fly

Front 49

Malaria (HIGH YIELD)

Back 49

• Know: banana shaped= Plasmodium falciparum

• Treatment
o Chloroquine-sensitive: chloroquine
o P. vivax or P. ovale: chloroquine + primaquine
o Chloroquine-resistant (most P. falciparum in Africa)
-Quinine + doxycycline
-Atovaquone + proguanil
-Artemether + lumefantrine
-Mefloquine

Front 50

Babesia nicroti key points

Back 50

o Trophozoite ring form on blood smear
o Tetrad morphology of merozoites = Maltese Cross
-Seen inside RBC on blood smear
o Occurs predominantly in NE US
o Same transmitter as lyme disease, tick

Front 51

• Cause of malaria

Back 51

o Plasmodium species

Front 52

• Most common protozoal infection in US

Back 52

o Toxoplasma gondii

Front 53

• Cause of Chagas disease

Back 53

o Trypanosome cruzi

Front 54

• Amoebic dysentery

Back 54

o Entamoeba histolytica

Front 55

• African sleeping sickness

Back 55

o Trypanosome brucei rhodesiense
o Trypanosome brucei gambiense

Front 56

• Diarrhea in campers and hikers

Back 56

o Giardia lamblia

Front 57

• Transmitted in raw meat or infected cat feces

Back 57

o Toxoplasma

Front 58

• Transmitted by sandflies

Back 58

o Leishmania

Front 59

• Causes vaginits

Back 59

o Trichomonas vaginalis

Front 60

A patient who visited Mexico presents with bloody diarrhea. What infectious form is found in the stool?

Back 60

Cysts of Entamoeba histolytica

Front 61

A 32 year old man went camping in northern California 2 weeks ago, had a 2-day stint of diarrhea, and now presents with symptoms of liver damage and jaundice. What is the infecting organism?

Back 61

• Entamoeba histolytica

Front 62

What are the names of the following stages in the malaria life-cycle?
• Looks like a diamond ring
• Ruptures the cell host
• Replicating intracellularly
• Form injected from the Anopheles mosquito
• Banana-shaped

Back 62

•Looks like a diamond ring
o Trophozoite

•Ruptures the cell host
o Merozoite

•Replicating intracellularly
o Schizont

•Form injected from the Anopheles mosquito
o Sporozoite

•Banana-shaped
o Gametocyte of Plasmodium falciparum

Front 63

A patient returning from a 2-week vacation in West Africa presents with typical malaria presentation and recurrent fever. What is the mechanism responsible for this patient’s fever?

Back 63

• Hemolysis

Front 64

Ring-enhancing brain lesion in an HIV patient

Back 64

Toxoplasma gondii

Front 65

Treatment for Trichomonas vaginalis

Back 65

Metronidazole

Front 66

Most common protozoal diarrhea

Back 66

Giardia lamblia

Front 67

Lecture 81: Micro 5

Back 67

Helminths and Ectoparasites

Front 68

Which coagulation factors are dependent on vitamin K for synthesis?

Back 68

• Factors 2, 7, 9, and 10
• Anti-coagulants= Protein C & S

Front 69

What are some of the effects of bradykinin on the body?

Back 69

• Increase vascular permeability
• Vasodilation
• Increased pain

Front 70

What enzyme converts glucose to sorbitol?

Back 70

• Aldose reductase

Front 71

Enterobius vermicularis= pin worm

Back 71

• Most common helminth infection in the US
• Remember: Scotch tape test
• Tx: mebendazole or albendazole

Front 72

Ascaris lumbricoides

Back 72

• Loeffler eosinophilic pneumonitis

Front 73

Trichinella spiralis

Back 73

• Remember it causes: Myocytis & Periorbital edema

Front 74

Route of infection via ingestion

Back 74

Enterobius, Ascaris, and Trichinella spells “E-A-T”

Front 75

Route of infection via the skin

Back 75

•“SANd” – Strongyloides, Ancylostoma, and Necator
o Invade skin through the soil

Front 76

Taenia solium

Back 76

•Undercooked pork
o Adult tape worm infects the GI tract

•Fecal contaminated food/water
oLead to Neurocysticercosis
-Suspect if immigrant presents with new CNS symptoms esp. seizures
-Immigrant with new CNS symptoms

-Treatment : Albendazole + Dexamethasone

Front 77

Diphylobothrium latum

Back 77

Can cause B12 deficiency that will presnt as megaloblastic anemia

Front 78

• Most common helminthic infection in the US

Back 78

o Enterobius vermicularis

Front 79

• One-quarter of the world infected with it

Back 79

o Ascaris lumbricoides

Front 80

• Snail host, “swimmer’s itch”

Back 80

o Schistosoma

Front 81

• Most common predisposing factor for bladder cancer in 3rd world countries

Back 81

o Schistosoma haematobium

Front 82

• Contracted by eating undercooked fish and causes an inflammation of the biliary tract

Back 82

o Clonorchis

Front 83

• Soil enters through skin enters venous blood supply and enters lungs-- coughed into pharyns-- swallowed into the intestines where they reside

Back 83

o Strongyloides

Front 84

• Hookworm

Back 84

o Ancylostoma

Front 85

• Giant roundworm

Back 85

o Ascaris lumbricoides

Front 86

• Contract by eating undercooked crabmeat and causes inflammation of the lung

Back 86

o Paragonimus westermani

Front 87

• Pork tapeworm

Back 87

o Taenia solium

Front 88

• Responsible for lymphatic filariasis

Back 88

o Wuchereria bancrofti

Front 89

• Adult patient from Mexico with new onset seizures and brain calcifications

Back 89

o Taenia solium

Front 90

• Hematuria in patient from 3rd world country

Back 90

o Schistosoma haematobium

Front 91

What medication is used to treat each of the following parasitic infections?
• Giardia, Entamoeba, Trichomonas

Back 91

o Metronidazole

Front 92

• Most malarias

Back 92

o Chloroquine

Front 93

• Plasmodium vivax or ovalee

Back 93

o Chloroquine + primaquine

Front 94

• Resistant malarias

Back 94

o Quinine + doxycyclin
o Mefloquine
o Atovaquone-proguanil
o Artemether-lumefantrine

Front 95

• Most all flukes and tapeworms

Back 95

o Praziquantel

Front 96

• Hookworms, pinworm, roundworm

Back 96

o Benzamidazoles (mebendazole)
o Pyrantel pamoate

Front 97

• Chagas disease

Back 97

o Nifurtimox

Front 98

• Best guess for roundworms

Back 98

o Benzamidazoles

Front 99

• Leishmaniasis

Back 99

o Cutaneous: sodium stibogluconate
o Visceral: liposomal amphotericin B

Front 100

Which two agents are usually used in the treatment of pediculosis capitis and pediculosis pubis?

Back 100

• Permethrin (1st line) or pyrethrin

Front 101

Why is lindane not the preferred agent in the treatment of lice?

Back 101

• Lindane is neurotoxic
• Lice are resistant

Front 102

Most common helminth infection in the US

Back 102

Enterobius vermicularis

Front 103

Second most common helminth infection in the US

Back 103

Ascaris lumbricoides

Front 104

Lecture 82: Oncology 1

Back 104

Genetics of cancer

Front 105

Which protozoa are responsible for each of the following diseases?
• Chagas disease

Back 105

o Trypanosoma cruzi

Front 106

• Protozoal vaginitis

Back 106

o Trichomonas

Front 107

• Malaria

Back 107

o Plasmodium species

Front 108

• Birth defects

Back 108

o Toxoplasma

Front 109

• Bloody diarrhea

Back 109

o Entamoeba histolytica

Front 110

• Foul-smelling diarrhea, flatulence, bloating

Back 110

o Giardia lamblia

Front 111

After bone marrow transplantation, a patient suffers from dermatitis, enteritis, and hepatitis. What disease process is occurring?

Back 111

• Graft-Versus –Host Disease

Front 112

Which regions of the brain are included in the limbic system?

Back 112

• Septal nucleus
• Mammillary bodies
• Fornix
• Hippocampus
• Cingulate gyrus

Front 113

Cancer Epidemiology for Men (KNOW)

Back 113

o Most common
-Prostate
-Lung
-Colorectal

o Mortality
-Lung
-Prostate
-Colorectal
-Pancreas

Front 114

Cancer Epidemiology for women (KNOW)

Back 114

o Most common
-Breast
- Lung
- Colorectal
- Uterus

o Mortality
- Lung
- Breast
- Colorectal
- Pancreas

Front 115

What type of cancer is associated with the following tumor suppressor genes?
• Rb

Back 115

o Retinoblastoma
o Osteosarcoma

Front 116

• DPC

Back 116

o Pancreatic cancer

Front 117

• P53

Back 117

o Most cancers

Front 118

• APC

Back 118

o Colorectal cancer

Front 119

• WTI

Back 119

o Wilm’s tumor

Front 120

• BRCA1 and BRCA2

Back 120

o Breast cancer and ovarian cancer
o Only 3% of breast cancer cases are assoc with BRAC mutation

Front 121

What cancers are associated with a mutation of the K-RAS oncogene?

Back 121

• Colon
• Lung
• Pancreas

Front 122

Lecture 83: Oncology 2

Back 122

Cancer Risk Factors

Front 123

A 20-year-old man contracts influenza then presents with an idiopathic hyperbilirubinemia. What is the most likely cause?

Back 123

• Gilbert syndrome

Front 124

What is the equation for half-life?

Back 124

• Clearance (CL) = (0.7 x Vd)/(t ½)
• T ½ = (0.7 x Vd)/(CL)

Front 125

What are some medications that are known for having a low therapeutic index?

Back 125

• Lithium
• Digoxin
• Warfarin
• Phenobarbital

Front 126

What are the most common cancers associated with ionizing radiation?

Back 126

• Myeloid leukemias: AML, CML

• Thyroid cancer

Front 127

Which cancers are associated with UV radiation exposure? Which type of UV radiation is most problematic?

Back 127

• Cancers
o Squamous cell carcinoma of the skin
o Basal cell carcinoma of the skin
o Melanoma

• UVB radiation
o Causes thymine dimers that prevent DNA replication

Front 128

What diseases are associated with DNA-repair defects?

Back 128

• HNPCC
• Xeroderma pigmentosum
• Ataxia-telangiectasia

Front 129

Oncogenic Bacteria and Helminths

Back 129

• Strep. bovis: Colon cancer
• H. pylori: Gastric cancer
• Schistosoma haematobium: SCC bladder
• Clonorchis sinensis: Biliary cancer

Front 130

What neoplasms are associated with each of the following conditions?

• Hashimoto thyroiditis

Back 130

o Lymphoma

Front 131

• Down syndrome

Back 131

o ALL
o AML

Front 132

• Tuberous sclerosis

Back 132

o Cardiac rhabdomyoma
o Astrocytoma
o Angiomyolipoma

Front 133

• Ataxia-telangiectasia

Back 133

o Leukemias
o Lymphoma

Front 134

• Paget disease of bone

Back 134

o Osteosarcoma
o Fibrosarcoma

Front 135

Which neoplasm is associated with each of the following?
• Nitrosamines

Back 135

o Esophageal cancer
o Stomach cancer
o Colon cancer

Front 136

• Asbestos

Back 136

o Bronchogenic carcinoma
o Mesothelioma

Front 137

• Naphthalene

Back 137

o Transitional cell bladder cancer

Front 138

• Arsenic

Back 138

o Squamous cell skin cancer
o Angiosarcoma of the liver

Front 139

• EBV

Back 139

o Burkitt lymphoma
o Nasopharyngeal carcinoma
o Hodgkin lymphoma

Front 140

• HPV

Back 140

o Cervical cancer
o Vulvar cancer
o Penile cancer
o Anal cancer

Front 141

• Schistosoma haematobium

Back 141

o Squamous cell cancer of the bladder

Front 142

Lecture 84: Oncology 3

Back 142

Neoplastic progression

Front 143

Which hypothalamic nuclei fit each of the following descriptions?
• Considered the “master clock” for most of our circadian rhythms

Back 143

o Suprachiasmatic nucleus

Front 144

• Regulates the parasympathetic NS

Back 144

o Anterior nucleus
o Preoptic nucleus

Front 145

• Regulates the sympathetic NS

Back 145

o Posterior nucleus
o Lateral nucleus

Front 146

• Produces antidiuretic hormone (ADH) to regulate water balance

Back 146

o Supraoptic nucleus

Front 147

• Mediates oxytocin production

Back 147

o Paraventricular nuclei

Front 148

• Regulates the release of gonadotropic hormones (i.e., LH and FSH)

Back 148

o Preoptic nucleus

Front 149

What organisms are transmitted by each of the following vectors?
• Freshwater snail

Back 149

o Schistosoma

Front 150

• Ixodes tick

Back 150

o Babesia

Front 151

• Reduviid bug

Back 151

o Trypansoma cruzi

Front 152

• Anopheles mosquito

Back 152

o Plasmodium

Front 153

• Sandfly

Back 153

o Leishmania donovani

Front 154

• Tsetse fly

Back 154

o Trypanosome brucei

Front 155

What drugs should not be given to sulfa allergic patients?

Back 155

• Celecoxib
• Loop diuretics
• Thiazide diuretics
• Acetazolamide
• Probenecid
• Sulfonamides

Front 156

What growth factors induce angiogenesis?

Back 156

o bFGF
o VEGF

Front 157

How do epithelial tumors metastasize?

Back 157

o Epithelial tumors tend to spread lymphatically

Front 158

How to mesenchymal tumors metastasize?

Back 158

o Mesenchymal tumors tend to spread hematogically

Front 159

Metastasizes to liver

Back 159

“Cancer Sometimes Penetrates Benign Liver”
o Colon
o Stomach
o Pancreas
o Breast
o Lung

Clinical manifestations of liver METs
o Elevated LFTs (Alk phos)
o Liver tenderness or abdominal pain
o Hepatomegaly
o Ascites or jaundice

Front 160

Metastasizes to the brain

Back 160

“Lots of Bad Stuff Kills Glia”
o Lung
o Breast
o Skin (melanoma)
o Kidney (renal cell carcinoma)
o GI tract (colorectal cancer)

Clinical manifestations of brain METs
o Headache
o Focal neurologic deficits
o Cognitive dysfunction
o Seizures

Front 161

Metastasizes to bone

Back 161

“Permanently Relocated Tumors Like Long Bones”
o Prostate -- blastic
o Renal cell carcinoma
o Thyroid/Testes
o Lung -- Lytic lesions
o Lymphoma
o Breast-- lytic or blastic

• Important to know that some metastases are lytic and other are blastic/ building new bones

•Clinical manifestations of bone METs
o Bone pain
o Epidural spinal cord compression (Pain, Motor or sensory deficits, Bladder or bowel dysfunction)
o Hypercalcemia

Front 162

Paraneoplastic Effects of Tumors (HIGH YIELD – 3 star/ 4 star topic)

Back 162

• FA13 p 223
• Tumors Secreting Erythorpoietin
o Renal cell carcinoma
o Hemangioblastoma
o Hepatocellular carcinoma
o Pheochromocytoma

Front 163

Serum Tumor Markers (HIGH YIELD – 4 star topic)
• PSA

Back 163

o Prostate cancer

Front 164

• Carcinoembryonic antigen (CEA)

Back 164

o Colon cancer
o Pancreatic cancer

Front 165

• a- fetoprotein (AFP)

Back 165

o Hepatocellular carcinoma
o Yolk sac (endodermal sinus) tumor

Front 166

• CA-125

Back 166

o Ovarian cancer

Front 167

• S-100

Back 167

o Melanoma
o Schwanomma
o Glial tumor (astrocytoma)

Front 168

• Alk phos

Back 168

o Bone METs
o Paget’s disease of bone

Front 169

• Bombesin

Back 169

o Adrenal neuroblastoma
o Lung cancer
o Gastric cancer

Front 170

• Tartrate resistant acid phosphatease (TRAP)

Back 170

o Hairy cell leukemia

Front 171

• CA 19-9

Back 171

o Pancreatic adenocarcinoma

Front 172

Psammoma bodies
KNOW

Back 172

• Laminated concentric calcific spherules
• Concentric calcium laid down in sheets
• 4 cancer where you see these:
o Papillary thyroid cancer
o Serous ____ carcinoma of ovary
o Meningoma
o Malignant methioloma

Front 173

What type of tumor matches each of the following descriptions?
• Benign tumor of epithelium

Back 173

o Adenoma or papilloma

Front 174

• Malignant tumor of blood vessels

Back 174

o Angiosarcoma

Front 175

• Benign tumor of bone

Back 175

o Osteoma

Front 176

• Malignant tumor of smooth muscle

Back 176

o Leiomyosarcoma

Front 177

What unique enzyme is normally absent in somatic cells, but is active in stem cells and cancer cells?

Back 177

• Telomerase

Front 178

Which tumor marker would you use to follow each of the following cancers?
• Hepatocellular carcinoma (Hep B and C patients)

Back 178

o a- fetoprotein

Front 179

• Ovarian cancer

Back 179

o CA 125

Front 180

• Pancreatic cancer

Back 180

o CA 19-9
o CEA

Front 181

• Melanoma

Back 181

o S-100

Front 182

• Colon cancer

Back 182

o CEA

Front 183

• Astrocytoma

Back 183

o S-100

Front 184

What is the most common cause of hypercalcemia? What cancers may cause hypercalcemia?

Back 184

• Most common cause
o Primary hyperparathyroidism

•Cancers that may cause
o Squamous cell lung cancer
o Squamous cell cancers of the head/neck
o Breast cancer
o Renal cell carcinoma
o Multiple myeloma
o Metastatic myeloma
o Metastatic disease to the bones

Front 185

What neoplasm is most commonly responsible for each of the following paraneoplastic syndrome?

Back 185

• ACTH -- Cushing syndrome
o Small cell lung cancer

• Erythropoietin -- polycythemia
o Renal cell carcinoma
o Hemangioblastoma
o Hepatocellular carcinoma
o Pheochromocytoma

•ADH -- SIADH
o Small cell lung cancer
o Any intracranial lesion

Front 186

Mets to Bone

Back 186

“Permanently Relocated Tumors Like Long Bones”
o Prostate
o Renal cell carcinoma
o Thyroid/Testes
o Lung
o Lymphoma
o Breast

Front 187

Mets to Liver

Back 187

“Cancer Sometimes Penetrates Benign Liver”
o Colon
o Stomach
o Pancreas
o Breast
o Lung

Front 188

Mets to Brain

Back 188

“Lots of Bad Stuff Kills Glia”
o Lung
o Breast
o Skin (melanoma)
o Kidney (renal cell carcinoma)
o GI tract (colorectal cancer)

Front 189

Lecture 85: Oncology 4

Back 189

Cancer prevention and host defense

Front 190

Which cranial nerve is responsible for each of the following actions?
• Eyelid opening

Back 190

o Oculomotor nerve

Front 191

• Taste from anterior 2/3 of tongue

Back 191

o Facial nerve

Front 192

• Head turning

Back 192

o Spinal accessory nerve

Front 193

• Tonge movement

Back 193

o Hypoglossal nerve

Front 194

• Muscles of mastication

Back 194

o Trigeminal nerve

Front 195

• Balance

Back 195

o Vestibulocochlear nerve

Front 196

Monitoring carotid body and sinus chemo- and baroreceptors

Back 196

o Glossopharyngeal nerve

Front 197

What CD surface marker fits each of the following statements?
• Displayed only by helper T cells

Back 197

o CD4

Front 198

Displayed only by cytotoxic T cells (and suppressor T cell)

Back 198

o CD8

Front 199

• Found on all T cells (except NK cells)

Back 199

o CD3**
o CD2

Front 200

• Used to ID B cells

Back 200

o CD19
o CD20
o CD21

Front 201

• Found on all NK cells and binds the constant region of IgG

Back 201

o CD16

Front 202

• Inhibits complement C9 binding

Back 202

o CD55
o CD59

Front 203

• Endotoxin receptor found on macrophages

Back 203

o CD14

Front 204

What surface molecule on platelets binds fibrinogen? What surface molecule binds von Willebrand factor?

Back 204

• Binds fibrinogen: Glycoprotein IIb/IIIa
• Binds von Willebrand factor: Glycoprotein Ib

Front 205

What are the four most important lifestyle factors that impact cancer risk?

Back 205

• Smoking
• Obesity
• Poor diet
• Inactivity

Front 206

Mammograms
*High Yield*

Back 206

o Age 40: Case-by-case basis
o Age 50: Every 2 years from 50-74
o Age 75 and up: Insufficient evidence to whether beneficial

Front 207

Pap Smears
*High Yield*

Back 207

o Start screening: Age 21, 3y after women 1st had intercourse
o Under 65: Every 3 years
o Age 65: Recommend against Pap, in normal PAPs
o Total hysterectomy for benign condition: Recommend against

Front 208

Prostate cancer screening
*HY*

Back 208

o PSA: Insufficient evidence for or against in men under 75, Recommend against in men over 75
o DRE: No recommendation for or against

Front 209

Colon cancer screening
*HY*

Back 209

o Colonoscopy: Age 50, Every 10 years
o Flexible sigmoidoscopy: Age 50, Every 5 years
o Annual fecal occult blood test
o Age over 75: No recommendation for or against
o Age over 85: Recommend against screening
o Family history: Begin 10 years younger than the age the family member was diagnosed

Front 210

What are the screening recommendations for the following cancers?
-Breast cancer
-Cervical cancer
-Prostate cancer
-Colon cancer

Back 210

Breast cancer: Mammogram every 2 yrs, 50-75 yo

Cervical cancer: Pap smear every 3 yrs, 21 yo or 3 years after intercourse. End at 65 yo

Prostate cancer: No recommend <75yo. Against >75yo

Colon cancer: Colonoscopy every 10 yrs, 50-75yo

Front 211

What is currently the most effective intervention in the prevention of the following cancer?
-Lung cancer
-Cervical cancer
-Renal call carcinoma
-Breast cancer
-Colon cancer

Back 211

Lung cancer: Stop smoking

Cervical cancer: Pap smears/HPV vaccine

Renal cell carcinoma: Stop smoking

Breast cancer: Screening mammograms

Colon cancer: Colonoscopy

Front 212

What is the only definitive way to prevent ovarian cancer?

Back 212

• Bilateral oophorectomy

Front 213

Which male patients should be screened for prostate cancer with a serum PSA?

Back 213

• Any male between age 50-70
• 10-year life expectancy

Front 214

What is the primary immune system cell type involved in host tumor immune surveillance?

Back 214

• Cytotoxic T cells (CD8 cells)

Front 215

What enzyme present in melanoma generates peptides that are targets for host T cells?

Back 215

• Tyrosinase

Front 216

How can tumor cells evade attack from cytotoxic T cells?

Back 216

• Developing the loss of expression of MHC class I

Front 217

How might tumor cells induce apoptosis of T cells that would antagonize them?

Back 217

• Expressing FasL

Front 218

Lecture 86: Oncology 5

Back 218

Cancer drugs

Front 219

What are the symptoms of inhibiting parasympathetic activity?

Back 219

• Decreased secretions/salivation
• Increased temperature
• Peripheral vasodilation
• Mydriasis/Cycloplegia
• Agitation and delirium
• Constipation/urinary retention

Front 220

Which cancers are associated with each of the following tumor markers?
• PSA

Back 220

o Prostate cancer

Front 221

• AFP

Back 221

o Hepatocellular carcinoma
o Yolk sac tumors

Front 222

• CA 125

Back 222

o Ovarian cancer

Front 223

• Elevated alk phos

Back 223

o Mets to bone

Front 224

• CEA

Back 224

o Colorectal cancer
o Pancreatic cancer
o Stomach cancer
o Breast cancer

Front 225

• B-hCG

Back 225

o Choriocarcinoma/ hydatiform mole

Front 226

• S-100

Back 226

o Astrocytoma
o Melanoma
o Some neural tumors

Front 227

What medication is used to treat each of the following parasitic infections?
• Giardia, Entamoeba, Trichomonas

Back 227

o Metronidazole

Front 228

• Plasmodium vivax or ovale

Back 228

o Chloroquine + primaquine

Front 229

• Most flukes and tapeworms

Back 229

o Praziquantel

Front 230

• Hookworm, pinworm, roundworm

Back 230

o Bendazoles
o Pyrantel pamoate

Front 231

Myelosuppression by methotrexate is reversed with...

KNOW!

Back 231

Leucovorin

Front 232

Cyclophosphamide

Back 232

• Side effects:
Hemorrhagic cystitis (KNOW)
- Prevented with Mesna
- Due to acrolein

Increases risk of transitional cell cancer of the bladder

Requires bioactivation in the liver

Front 233

Cisplatin, carboplatin, oxaliplatin

Back 233

“Eradicate Ball Cancer”
o Etoposide
o Bleomycin
o Cisplatin

Front 234

Nephrotoxic/Ototoxic Drugs

Back 234

• Vancomycin
• Aminoglycosides
• Loop diuretics
• Cisplatin

Front 235

Busulfan

Back 235

• Can cause pulmonary fibrosis

Front 236

Doxorubicin, daunorubicin

SE is Very HY***

Back 236

• MOA: Generate free radicals, Intercalate DNA

•Side Effects: Cardiotoxic (Very High yield), Dexrazoxane (use to prevent)

Front 237

Bleomycin

Back 237

• Causes pulmonary fibrosis
• Tx: testicular cancer

Front 238

Prednisone Side effects (HIGH YIELD) KNOW THEM ALL

Back 238

o Osteoporosis
o Cushingoid reaction
o Psychosis
o Psychomotor hyperactivity
o Insomnia
o Hyperglycemia/ DM
o Immunosuppression
o Infections
o Hypertension
o Cataracts
o Acne
o Peptic ulcer

Front 239

Vincristine

Back 239

• Interferes with microtubules

•Clinical uses
o Hodgkin lymphoma
o Wilms tumor
o Ewing sarcoma
o Rhabdomyosarcoma
o Choriocarcinoma

Front 240

Vinblastine

Back 240

• “VinBLASTine BLASTS bone marrow”

Front 241

Paclitaxel

Back 241

o Hyperstabilize the microtubules
o “Taxes stabilize society “
o Clinical uses
-Ovarian cancer
-Breast cancer

Front 242

Other Drugs that Interfere with Microtubules (KNOW)

Back 242

• Vinca drugs (vincristine, vinblastine)
• Taxanes (paclitaxel)
• Anti-helminthic drugs
- Mebendazole
- Thiabendazole
- Albendazole
• Griseofulvin
• Colchicine

Front 243

How does the mechanism of action of methotrexate differ from 5-fluorouracil?

Back 243

• Methotrexate
o Folic acid analong
o Inhibits dihydrofolate reductase

•5-FU
o Pyrimidine analong
o Inhibits thymidylate synthase

Front 244

How does the body metabolize 6-mercaptopurine?

Back 244

• Metabolized by xanthine oxidase

Front 245

Which anticancer drug is also often used in rheumatoid diseases as well as ectopic pregnancies?

Back 245

• Methotrexate

Front 246

Which anticancer drug fits each of the following descriptions?
• Forms a complex between topoisomerase II and DNA

Back 246

o Etoposide

Front 247

Alkylates DNA, toxicity
SE: pulmonary fibrosis

Back 247

o Busulfan

Front 248

Fragments DNA, toxicity
SE: pulmonary fibrosis

Back 248

o Bleomycin

Front 249

• Blocks purine synthesis, metabolized by xanthine oxidase

Back 249

o 6-mercaptopurine

Front 250

• Cross-links DNA, nephrotoxic, ototoxic

Back 250

o Cisplatin
o Carboplatin

Front 251

• Nitrogen mustard, alkylates DNA (electrophile that binds DNA)

Back 251

o Cyclophosphamide

Front 252

• Folic acid analog that inhibits dihydrofolate reductase

Back 252

o methotrexate

Front 253

• Prevents tubulin disassembly

Back 253

o Paclitaxel

Front 254

• Intercalates DNA, produces oxygen free radicals, cardiotoxic

Back 254

o Doxorubicin
o Daunorubicin

Front 255

• DNA alkylating agents used in brain cancer

Back 255

o Nitrosoureas

Front 256

• Applied topically for AKs and basal cell cancers

Back 256

o 5-fluorouracil

Front 257

• Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, rhabdomyosarcoma)

Back 257

o Dactinomycin

Front 258

• Inhibits ribonucleotide reductase

Back 258

o Hydroxyurea

Front 259

• SE of hemorrhagic cystitis

Back 259

o cyclophosphamide

Front 260

• Inhibitor of the mutated tyrosine kinase produced by the Philadelphia Chromosome

Back 260

o Imatinib

Front 261

Lecture 87: Med in Society 1

Back 261

Studies and Diagnostic tests

Front 262

What G protein classes do each of the following receptors stimulate?

Back 262

• α 1—Gq
• α2—Gi
• β1—Gs
• β2—Gs
• M1—Gq
• M2—Gi
• M3—Gq
• D2—Gi

Front 263

Which anticancer drug fits each of the following descriptions?

Back 263

•Treatment for choriocarcinoma
o Methotrexate
o Vincristine
o Vinblastine

• Treatment for AML
o Cytarabine

•Treatment for CML
o Imatinib

• Prevents breast cancer
o Tamoxifen

•Treatment for testicular cancer
o Etoposide
o Bleomycin
o Cisplatin
o Ifosfamide

Front 264

What is the rate- limiting enzyme in purine synthesis? In pyrimidine synthesis?

Back 264

• Purine: Glutamine PRPP aminotransferase
• Pyrimidine: Carbamoyl phosphate synthetase 2

Front 265

Drug development phases

Back 265

• Phase I—Is the drug safe?
• Phase II—Does the drug work?
• Phase III—Does the drug work better?
• Phase IV—Postmarketing surveillance

Front 266

Sensitivity
5 stars*****

Back 266

Proportion of people with the disease that get a positive test result
= A/ (A + C)

Front 267

Specificity
5 stars*****

Back 267

Proportion of people without the disease that get a negative test result
=D/ (D + B)

Front 268

Positive Predictive Value
5 stars*****

Back 268

PPV—proportion of test results that are true positive
= A / (A + B)

Front 269

Negative predictive value
5 stars*****

Back 269

(NPV)—proportion of negative test results that are true negative
= D/ (C + D)

Front 270

A certain screening test has a 1% false-negative rate. What is the sensitivity of the test?

Back 270

Sensitivity= 1 – false negative rate
= 1- 1%= 99%

Front 271

Lecture 88: Med in Society

Back 271

Application of test data

Front 272

What clinical presentation might lead you to suspect a patient may have lymphoma?

Back 272

• Painless lymphadenopathy
• B symptoms
o Fever
o Weight loss
o Night sweats

Front 273

How many ATP are yielded from aerobic metabolism? How many are yielded form anaerobic metabolism?

Back 273

• Aerobic metabolism—32 ATP
• G3P shuttle—30 ATP
• Anaerobic metabolism—2 ATPs + lactate molecule

Front 274

An 80yo woman comes to your clinic because her family is concerned about yellowing skin. Exam reveals yellowing of the skin including palms and soles but no scleral icterus. What question could you ask the patient that would most likely identify the cause of the yellowing?

Back 274

•Carotemia
o Excess beta- carotene in the body
o Due to taking in too many carrots

Front 275

Incidence
*HY*

Back 275

Incidence = (total # of new cases of diagnosis in a period of time) / (total # of individuals at risk of diagnosis in a period of time)

Front 276

Prevalence
*HY*

Back 276

Prevalence= Incidence x Disease duration

Front 277

Relative Risk and Odds Ratio ***** (5 star topic)

Back 277

Relative risk= A / (A + B) ÷ C / (C + D)

Odds ratio= (A/B) ÷ (C/D)

Front 278

Absolute risk reduction
5 stars*****

Back 278

•Absolute risk reduction= C / (C + D) - A / (A + B) *****

Front 279

Attributable risk
5 stars*****

Back 279

AR= incidence of disease in the exposed group - incidence of disease in the unexposed group

Front 280

Number needed to Treat
5 stars *****

Back 280

NNT= 1/ absolute risk ratio

Front 281

What can you say about the precision and accuracy of your new glucose test?

Back 281

• Very precise
• Not accurate

Front 282

Lecture 89: Med in Society 3

Back 282

Bias & Error

Front 283

Which hormones share a common alpha subunit?

Back 283

• TSH
• LH
• FSH
• hCG

Front 284

What is the difference between a case- control study, a cohort study, and a clinical trial? Which studies use OR, and which use RR?

Back 284

• Case- control study
o Retrospective observational study
o OR

• Cohort study
o Prospective or retrospective observational study
o RR

• Clinical trial
o Prospective experimental study

Front 285

Which neoplasm is most commonly responsible for each of the following hormone paraneoplastic syndromes?

Back 285

• ACTH: Cushing syndrome
o Small cell lung cancer

• PTH- related peptide: hypercalcemia
o Squamous cell cancers
o Renal cell carcinoma
o Breast cancer

• Erythropoietin: Polycythemia
o Renal cell carcinoma
o Hemangioblastoma
o Hepatocellular carcinoma
o Pheochromocytoma

•ADH: SIADH
o Small cell lung cancer

Front 286

Statistical distribution KNOW

Back 286

• Mean is the average
• Median is the middle
• Mode is the most frequent value
• In a normal, perfect bell shaped curve mean= median= mode
• Skews:
o Positive skew: Mean > median > mode
o Negative skew: Mean < median <mode
o Bimodal distribution

Front 287

Type I error (α)
5 stars*****

Back 287

o Rejects the null hypothesis
o Reality—no association between exposure and outcome
o “False positive error”

Front 288

Type II error (β)
5 stars*****

Back 288

o Accepts null hypothesis
o Reality—association between exposure and outcome
o “False negative error”

Front 289

Lecture 90: Med in Society 4

Back 289

Confidence Interval

Front 290

What is Reynold’s pentad for cholangitis?

Back 290

•Charchot’s traid
o Fever
o Jaundice
o RUQ pain

• Hypotension

• Altered mental status

Front 291

What are some of the inducers of cytochrome P450?

Back 291

“Kenytoin Rides Shotgun in Barbie’s Girl Car”

• Phenytoin
• Rifampin
• St. John’s wort
• Barbiturates
• Griseofulvin
• Carbamazepine

Front 292

Standard Deviation and SEM KNOW *****

Back 292

• Standard deviation
o ± 1 σ = 68%
o ± 2 σ= 95%
o ±3 σ= 99.7%

• Standard Error of the Mean
o SEM = σ / √n
o n= sample size
o σ= standard deviation

Front 293

Confidence Interval *****

Back 293

CI= range from [mean- Z(SEM)] to [mean + Z(SEM)]
CI= mean ± Z (SEM)
• 95% CI is often used
• For 90% CI, Z= 1.645
• For 95% CI, Z = 1.96
• For 99% CI, Z= 2.57

Front 294

Correlation coefficient

Back 294

• r=1—perfect correlation between the 2 variables
• r=0—no relationship between the 2 variables
• r> 0—positive correlation
• r<0—negative correlation

Front 295

In a normal Gaussian curve, what percentage of the sample population falls, I standard deviation, 2 standard deviation, and 3 standard deviations?

Back 295

• 1 SD= 68%
• 2 SD= 95%
• 3 SD= 99.7%

Front 296

Lecture 91: Med in Society

Back 296

Public health

Front 297

What are the clinical manifestations of Addison disease? What is the cause of Addison disease?

Back 297

• Increased skin pigmentation
• Hypotension
• Weakness
• Malaise
• Anorexia
• Weight loss
• Autoimmune disease
• Adrenal atrophy
• Decreased aldosterone and cortisol

Front 298

A heart failure patient is newly diagnosed with cancer and is being evaluated for chemotherapy. Which chemotherapeutic agent should be avoided in this patient?

Back 298

• Doxorubicin
• Daunorubicin

Front 299

Assuming a normal Gaussian distribution… what percentage of people will be in the interval between 31 & 43?

Back 299

• 31- 25= 34%
• 35-43= 47.5%
• 31-43= 81.5%

Front 300

What is the current recommendation on receiving a meningitis vaccine?

Back 300

• All children 11-12 yo
• Booster at 16
• For certain high-risk conditions, we vaccinate kids as young as 2 months old

Front 301

When is it important for a patient with a tetanus prone wound to receive a tetanus vaccine?

Back 301

• Minor wound: Vaccinate if > 10 years since last booster

• High risk wound: Vaccinate if last booster >5 years ago

• If the vaccine status is unknown: Vaccinate

Front 302

Which adult patient populations should receive a pneumococcal vaccine?

Back 302

• ≥ 65 yo
• Long-term care facility residents
• COPD and asthma
• Smokers
• CVD
• Diabetes
• Liver disease
• Asplenia
• HIV
• CSF leaks

Front 303

What are the current indications for the herpes zoster vaccine?

Back 303

• 1 dose after age 60

Front 304

At minimum, what four medications should a patient with a prior MI due to atherosclerosis be taking?

Back 304

• Aspirin
• B-blocker
• ACE inhibitor
• Statin