Most commons in Respiratory System

 In lung cancer, partial deletion of the short arm of chromosome
3 (3p) has been one of the earliest and most common
genetic changes. Chromosome 3p deletion occurs in
almost 100% of SCLC and 90% of NSCLC.
Mutation and more commonly amplification of PIK3CA , which encodes the catalytic
subunit of phosphatidylinositol 3-kinase (PI3K), occur
most commonly in squamous cell carcinomas.


 p53 inactivating mutations are the most common
alterations in cancer, especially lung cancer, where 17p13 frequently demonstrates hemizygous deletion and mutational inactivation in the remaining allele.


 Lung cancer is the most common
cause of brain metastases.


 Patients with persistent
headaches without any structural abnormalities on brain imaging
should undergo spinal fluid evaluation for leptomeningeal
carcinomatosis. A positive cytology is found on an initial lumbar
puncture in 50% to 70% of the patients. In patients with
clinical signs and symptoms suggestive of leptomeningeal metastases,
repeat lumbar puncture is required if the first cytology
evaluation is negative.


 Today, breast cancer is the second most common cause of BM among all solid malignancies, second only to lung cancer; furthermore, it is the most common cause of leptomeningeal carcinomatosis.


 Lung cancer can metastasize to almost
any bone, although the axial skeleton and proximal long bones
are most commonly involved. Bone pain is present in up to
25% of all lung cancer patients at presentation.


 Dermatomyositis and polymyositis are inflammatory conditions characterized by muscle weakness and tenderness, and skin changes, in the case of dermatomyositis.


 Breast and lung cancers are the most common associated malignancies. Most
cases are idiopathic in nature and unrelated to cancer.

Pulsus alternans

Pulsus alternans, in contrast, is defined by beat-to-beat variability of pulse amplitude. It is present only when every other phase I Korotkoff sound is audible as the cuff pressure is lowered slowly, typically in a patient with a regular heart rhythm and independent of the respiratory cycle. In patients with normal heart rates, the finding of pulsus alternans indicates severe left ventricular dysfunction, caused by ischemic or valvular heart disease, long-standing hypertension, or idiopathic dilated cardiomyopathy. In patients with rapid heart rates, Pulsus alternans is of less significance as people with normal heart can develop the finding during paroxysmal tachycardia.

Brain tumors and anticonvulsant drug therapy:

Patients with brain tumors who present with seizures, require anticonvulsant drug therapy. There is no role for prophylactic anticonvulsant drugs in patients who have not had a seizure, thus their use should be restricted to those who have had a convincing ictal event. The agents of choice are those drugs that do not induce the hepatic microsomal enzyme system. These include levetiracetam, topiramate, lamotrigine, valproic acid, or lacosamide. Other drugs such as phenytoin and carbamazepine are used less frequently because they are potent enzyme inducers that can interfere with both glucocorticoid metabolism and the metabolism of chemotherapeutic agents needed to treat the underlying systemic malignancy or the primary brain tumor.

Drug of choices for flukes and roundworms infestations

********Flukes (trematodes)--> Drug of choice*************

Schistosoma haematobium(bilharziasis)
Schistosoma mansoni
Schistosoma japonicum
Clonorchis sinensis (liver fluke);opisthorchis species
Paragonimus westermani (lung fluke)
Fasciolopsis buski (large intestinal fluke)
Heterophyes heterophyes; Metagonimus yokogawai (small intestinal flukes)--- For all DOC is Praziquantel

****************************************************

********Roundworms (nematodes)--> Drug of choice********

Taenia solium,Taenia saginata--> Praziquantel

Ascaris lumbricoides (roundworm)--> Albendazole or pyrantel
pamoate or mebendazole

Trichuris trichiura (whipworm)-->Mebendazole or albendazole

Necator americanus (hookworm);
Ancylostoma duodenale (hookworm); Trichostrongylus species--->Pyrantel pamoate

Strongyloides stercoralis (threadworm);Onchocerca volvulus (onchocerciasis)--> Ivermectin

Enterobius vermicularis (pinworm)--> Mebendazole or pyrantel
pamoate

Trichinella spiralis (trichinosis)--> Mebendazole

Cutaneous larva migrans (creeping eruption)-->Albendazole or ivermectin

Visceral larva migrans; Capillaria philippinensis (intestinal
capillariasis)-->Albendazole

Angiostrongylus cantonensis -->Thiabendazole

Wuchereria bancrofti (filariasis);
Brugia malayi (filariasis); tropical
eosinophilia; Loa loa (loiasis)--->Diethylcarbamazine

Dracunculus medinensis (guinea worm)-->Metronidazole

Selected Examples of Human Chemical Carcinogenesis

BCME = Bis chloromethyl ether; HBV = hepatitis B virus; 4-ABP = 4-aminobiphenyl; ALL = acute lymphoblatic leukemia.

Best mnemonic for Biological transmission

"P"ropagative--> the agent merely "P"ropogates(multiplies) in vector, but no change in form eg: "P"lague

"C"yclo"P"ropagative--> the agent "C"hanges in form and "P"ropagates (e.g Malaria parasite in mosquito) "CPM"

"C"yclo-"D"evelopmental--> Agent undergoes only "D"evelopment but no multiplication eg. "D"racunculiasis, microfilariasis

Caroli's Syndrome:

Abnormal saccular dilatation of the intrahepatic biliary tree,usually affecting the whole liver. Extrahepatic biliary tree is affected in one quarter of the patients.

Signs include recurrent cholangitis {fever,chills,pain(if gallstone present)}. Hepatic abcess may b also there.

Complications include hepatic stone and cholangiocarcinoma.

Cholangitis may b treated with Antibiotics. Partial ressection and hepatic transplantation may b required.