Term
| Breats cancer increases with age, family history. From age 20-40 they should inspect 2-3 years. What imaging modality? |
|
Definition
| Mammography, then ultrasound, then mri |
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Term
| What is diff btw benign and malign breast cancer on ultrasound? |
|
Definition
| Beingn ovla, clear borders, parallel to skin; malign is irreg shape, taller, bad margins |
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Term
| T or f, Swelling of breasts with tenderness may not be equal and varies with cycles and does not require treatment. |
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Definition
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Term
| Nodularity in boobs is general pattern of lumpiness. |
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Definition
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Term
| Mastalgia is usually unilateral, frequent before menopause, what is treat for mild and severe? |
|
Definition
| NSAID, estrogen blockade with danazol |
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Term
| Bilateral nipple discharge is almost always benign, if unilateral and bloody what are two causes? |
|
Definition
| Intraductal papilloma(can turn malign) or ductal ectasia |
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Term
| The most common cause of unliateratal bloody nipple discharge is intradutal papilloma, rarely palpable in age 40 to 50, what is treat? |
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Definition
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Term
| Mastitis is uncommon in non-lac women and rarely becomes abcess. What is treatment for abcess? |
|
Definition
| Surgical or aspiration with preop antibiotics |
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Term
| A benign dominant mass in breast is unchanging lesion thru 2-3 cycles. What is diff btw 3 types - gross cyst, galactocele, fibroadenoma. |
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Definition
| GROSS CYST si fluid filled epithelial lined, well circumscribed, non classic symptoms; milk filled cyst caused by duct blockage; small, mobile, solid mass, mildly hormone sensitive, painless. None can be differentiated from gross cyst on palap, and treat is usually aspiration or excision |
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Term
| Which of the following have an increase in cancer risk - CYST, DUCTAL ECTASIA, FIRBOADENOMA, MILD EPITHELIAL HYPERPLASIA, FIBROSIS, MASTITIS, MILD SCLEROSING ADENOSIS, METAPLASIA (SQUAMOUS OR APOCRINE). |
|
Definition
| None. Anythings else increases risk |
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Term
| What is more common type of breast cancer - sporadic, fmaillial, hereditary. |
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Definition
|
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Term
| Which ehtnicty has highest prob of breast cancer and what are secondary risk factors other than BRCA1/2? |
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Definition
| Whites, early menacrh, nullparous, HRT, late menopause, late preggers, |
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Term
| Which is a true pre-malignant lesion ductal (comedo or non-comedo) of lobular breast carcinoma in situ? |
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Definition
|
|
Term
| What are the treat for ductal carcinoma in situ? |
|
Definition
| Local surgery, rads, node biopsy if large |
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Term
| HER2/neu is a growth factor receptor causing breast cancer, when does it become oncogene? |
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Definition
| When it loses its extracellular ligand binding domain; treated with herceptin aka transtuzamab |
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Term
| SERMs is for treatment and prophylazis of breast cancer and anastrazole is only for treatment in postmenpasual women, what is mech? |
|
Definition
| Competitive estrogen receptor inhib, aromatase inhi8hnb |
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Term
| T or f, Cronic inflammation can lead to cancer such as UC, Crohns, h. pylori gastris, viral hep, chronic panc. |
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Definition
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Term
| Barrets esophagus puts you at higher risk for what type of cancer? |
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Definition
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Term
| ID which type of gastric carcinoma in the groups. 1. gland forming that resmbles colon, precursor lesions. 2. sheets of cells have mucin vacuole, no precursor. |
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Definition
| 1 is intestinal 2 is diffuse or signet type |
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Term
| The stomach normally has no MALT. But H. pylori can cause B-cell lymphoma of MALT because it is most common site for extranodal lymphoma. Can you treat the H. pylori? |
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Definition
| Yes 50% respond to antibiotics |
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Term
| Endocrine tumors microscopically have sheets of monotonous cells in islands and trabeculae, round nucles with salt and pepper chromatin, and scant eosinophilic cytoplasm. Name a well and poor differentiated tumor. |
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Definition
| Well is carcinoid, poor is small cell |
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Term
| Most common site of carcinoid tumors are in small intestine. What is the carcinoid syndrome? |
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Definition
| Tumors secrete 5-HT. if in bowel no prob cause of liver. If mets, then right heart fibrosis, flushing, palpitations, asthma, HTN |
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Term
| GI stromal tumors are difficult to predict malign behavior but are known mesenchymal sarcomas. What gene is positive in this disease? |
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Definition
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|
Term
| Which is a risk for CRC, high fat diet or low fiber? |
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Definition
|
|
Term
| Prevention of CRC involves calcium, cox-s inhibs, hormonal therapy. When should detection begin for regular and high risk fuckers? |
|
Definition
| 50 yrs, 40 repeat every ten |
|
|
Term
| This gene is in 85% of polyps, 5q21, adhesion molecule, interacts with beta catenin, seen in familial adenomatous polyposis. |
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Definition
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|
Term
| This genetic syndrome has APC muatation, thousand sof polyps, 100% chance of cancer, auto dom, pancolonic. |
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Definition
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|
Term
| Which of the following gene mutations are involve in the pathway for CRC that starts with normal tissue>adenoma>cancer - 5q deletion, Kras, 18q deletion (DCC, SMAD2/4), p53, MMR mutator pathway causing microsatellite instability. |
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Definition
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|
Term
| Most colonic adenomas are asymptomatic, but can have bleeding, anemia-microcytic, obstruction, and changes in bowel movements. What are poor prognostic indicatiors? |
|
Definition
| Obstruction or perforation; microsatellite instable is good prog |
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|
Term
| Stage 1-3 CRC treatment is surgery with 5-FU/LV or rads for rectal cancer. What about stage 4? |
|
Definition
| Chemo and biologics, sugery only if symptomatic |
|
|
Term
| What are the two types of bioligcs used in CRC? |
|
Definition
| Angiogenesis inhibs and VEGF/EGFR antags like rhumab VEGF and cetuximab |
|
|
Term
| What is the first biomarker in colon cancer? |
|
Definition
|
|
Term
| Esophageal squamous cell carcinoma is greater in men, blacks, tobacco, alcohol, celiac, HPV. Another etiology involves failure of LES via loss of myentreric plexus and a syndrome with dysphagia, glossitis, and Fe def anemia. What are they? |
|
Definition
| Achlasia, Plummer-Vinson Syndrome |
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|
Term
| For early gastric and esophageal cancer what is treatment? |
|
Definition
|
|
Term
| Gastric cancer occurs highly in san marino, costa rica, and japan. What dietary risks? |
|
Definition
| Carbs, nitrates liks veges and preserve, high salt intake |
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|
Term
| T or f, Fecal occult blood and hepatomegaly are signs for both esophageal and gatrisc cancer. |
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Definition
|
|
Term
| Which of the hereditary factors can cause pancreatic cancer? familial atypical multiple mole melanoma syndrome, familial breast cancer (BRCA2), Peutz-Jeghers syndrome, and hereditary pancreatitis. |
|
Definition
|
|
Term
| Esopho/GI/Colon cancers are predominatly male. |
|
Definition
| True; COX2 is overexpressed in maligs and can confer resistance to apop, stim cell prolifer and invasion, and angiogenesis |
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|
Term
| When doing helical ct for pancreatic cancer why is contrast timed to arterial phase? |
|
Definition
| Because the cancer is poorly perfused with blood and this helps to image it |
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Term
| A pancreatic cancer patient can have surgery if the disease is local. What is the procedure called and what eventually kills people? |
|
Definition
| Whipple, recurrent systemic disease |
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|
Term
| Chemo for pancreatic cancer is 5-FU and leucovroin and dipyridamole, but what performed better than 5-FU? |
|
Definition
|
|
Term
| The non-endocrine mechanisms of H. pylori in clued enzymes, bacterial adherence, urease/ammonium choloride release. What are its endocrine pathogenicities? |
|
Definition
| Increased gastrin release associated with cytokines, ammonia production downs somato by D cells |
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|
Term
| In addition to somato inhibiting gastrin, CCK, and enzyme secretion it also does what to help with variceal, fistula, neuroendocrine tumors of GI? |
|
Definition
| Decreases bloodflow to GI and thus activity; so drugs that mimic it like octreotide are used cause of longer half life |
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|
Term
| What is the function of glucagons from alpha cells? |
|
Definition
| Secretion is stimulated by low blood glucose, downs peristalsis, ups hepatic glucose release, ketogenesis, glycogenolysis |
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|
Term
| What gut hormone inhibits motility and promotes satiety? |
|
Definition
|
|
Term
| What g-protein coupled receptors does gastrin activate versus CCK? |
|
Definition
| Gastrin CCK2>>CCK1, CCK does CCK1=CCK2 |
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|
Term
| What is the effect of secretin stimulation ttest on gastrinomas? |
|
Definition
| Causes increase, which opposite of expected in normal tissue; however, they do express somato receptors allowing them to be imaged |
|
|
Term
| Describe this syndrome - pancreatic or duodenal neuroendocrine tumor, 50% malign, some MEN-1 inheritance. |
|
Definition
| Gatrinoma, Zollinger-Ellsion (peptic ulcer, hyperacid, pancreatic tumore) |
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|
Term
| What is the treat for gastrinoma when found via secretin stim test, fasting gastrin, and octreotide scan? |
|
Definition
| Ppi, h2, octreotide, and sugery |
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|
Term
| Name this - symp of watery diarrhea, hypokalemia, acholridia, tumor of panc that is 60-80%malig, mostly in the tail. |
|
Definition
| Pancreatic VIPoma, non-a non-b cell tumor that releases VIP and thus water and electrolytes. |
|
|
Term
| Carcinoid tumors of neuroendocrine origin. What type of cells and where in GI? |
|
Definition
| EC or kulchinsky cells, all GI but mostly small intest and lung |
|
|
Term
| Biochemical diagnosis of carcinoids in chromogranin A. what is treat? |
|
Definition
| Chemo, octreotide, surgery |
|
|
Term
| Adenomas and carcinomas can be functioning and non-func and clonal, what is diff tbw? |
|
Definition
| Adenoma does not spread outside the margin of gland event hough it can grow and impinge structre, whil carcinoma is defined by spread outside of glands |
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|
Term
| Since detecting test and synthetic test is difficult what test is used? |
|
Definition
| carbon isotope. Syn hormones made from yams with low C13 |
|
|
Term
| What is the testosterone to estrogen ratio reported in comps? |
|
Definition
| >4:1; note detecting hGH no test yet |
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|
Term
|
Definition
|
|
Term
| What is a natural cholesterol fighter in foods and why? |
|
Definition
| Stanols block cholesterol absorption in micelles but are not absorpbed |
|
|
Term
| Soy is limiting but not lacking in sulfur amino acids. |
|
Definition
|
|
Term
| What is malnutrition defined as? |
|
Definition
| Greater than 10% weight loss and depressed albumin |
|
|
Term
| What is the biff btw marasmus and kwashiorkor in food intake and time to progression? |
|
Definition
| Decreased energy intake vs protein intake in stress state; months or years versus weeks |
|
|
Term
| What is the BMI for over weight vesus obese? |
|
Definition
|
|
Term
| Low birth weight has a correlation to obesity due to ______ gene activation. |
|
Definition
|
|
Term
| What is metabolic syndrome? |
|
Definition
| Metabolic risk factors including - waist size, dyslipidemia, glucose intolerance, HTN |
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|
Term
| T or f, Abdominal and omental visceral fat correlates better with with co morbidities of obesity. |
|
Definition
|
|
Term
| Adipose tissue is seen as an endocrine organ, why? |
|
Definition
| Secretion of adipokines regulate metab, immune response, blood press, reproduction such as - leptin, tissue factor, LPL as well as many endocrine receptors |
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|
Term
| Adipocytes have a correlation between what immuno cell and how? |
|
Definition
| Macros are based on inflammatory respone while adipos have metabolic functions and have similar hormone receptors, so it modifies inflammatory response and might be unlerying affector causing metabolic syndrome |
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|
Term
| What is the abdominal waist size that is high risk in men and women? |
|
Definition
|
|
Term
| Adipocytes have adverse effects related to these up hormones, list what the effects are - tnf-a, angiotensinogen, insulin, leptin, plasminogen actiator inhibitor, down adiponectin. |
|
Definition
| Inflammation, HTN, dyslipids, t2dm, thrombosis, atherosclerosis |
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|
Term
| Leptin is secreted by adipocytes and directly correlates to what physio response? |
|
Definition
| Leptin inhibits NPY/AgRP and stimulates POMC in hypothalamus which inhibs food intake. However, obese are leptin resistant |
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|
Term
| Adiponectin is only excerted by fat cells, what is relationship to obesity, inflammation and insuln resistance? |
|
Definition
| Inverse, as weight goes up adiponectin goes down, inflammation and insulin resistance go up. |
|
|
Term
| Orlistat is a gastic and pancreatic lipase inhib that prevents dietary fat absorption via what mech? |
|
Definition
| It binds intestinal lipase |
|
|
Term
| Sibutramine increases satiety in fat people. How? |
|
Definition
| Norepi and serotonin reup inhib; that is also why serotenergic ags and CB antags work |
|
|
Term
| Gastric bypass, sleeve gastrectomy, and biliopancreatic diversion all cause an increase in PYY and drop in grehlin. But what nutrional deficiencies result? |
|
Definition
| B vitamins, folte, iron, zinc, VIt A/D |
|
|
Term
| Post-surgical dumping syndrome is where body increases satiety and causes GI and hypoglycemia probs. What is instigator? |
|
Definition
| Dumping of undigested food into small bowel; can also nesidioblastosis which is hyperinsulinemia |
|
|
Term
| Of the lap band, gastic bypass, and biliary bypass which losses most weight. |
|
Definition
| Biliary, but major malabsoprtion. Lap band least weight, safest. |
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