15 (2) - 19 AUG 2022 (studied 01 JAN)

Question 1

high risk features of a branch duct IPMN

Answer 1

• obstructive jaundice
• enhancing solid component
• main duct > 1 cm

Question 2

worrisome features of IPMNs

Answer 2

• greater than 3 cm
• thickened enhancing cyst walls
• main duct size 5 to 9 mm
• nonenhancing mural nodules
• abrupt caliber change
• lymphadenopath
• pancreatitis

Question 3

the major downside to transanal resection is:

Answer 3

inability to remove and assess the mesorectal lymph nodes

Question 4

after reaching the stomach/gastric body, a foreign body has a __% chance of passage

Answer 4

90%

Question 5

hurley stages of hidradenitis suppurativa

Answer 5

Hurley stage 1:
- localized abscess (painful lump or inflammatory nodule)
- no sinus tract involvement or scarring

Hurley stage 2:
- recurrent abscesses
- sinus tract involvement and scarring
- separation of areas by skin that appear normal/healthy

Hurley stage 3:
- diffuse disease
- multiple interconnected sinus tracts
- abscesses involving an entire area with scarring
- purulent drainage and foul smell

Question 6

most common cause of gastrointestinal bleeding from a Meckel diverticulum

Answer 6

gastric mucosa produces gastrin, an ulcer on the opposite side of the diverticulum (mesenteric side) is likely to form

Question 7

what is the tumor marker for papillary thyroid cancer?

Answer 7

thyroglobulin

Question 8

what is the tumor marker for medullary thyroid cancer?

Answer 8

calcitonin

Question 9

• low amylase
• elevated CEA
• macrocystic on imaging

Answer 9

mucinous cystic neoplasm

Question 10

what is the current standard for adequate margins in invasive breast cancer in the setting of multimodality treatment?

Answer 10

no ink on tumor

Question 11

margins of __ mm are recommended for ductal carcinoma in situ

Answer 11

2

Question 12

invasive cancer is found on the final surgical pathology report in __% of DCIS cases

Answer 12

20%

Question 13

what does the B-24 trial show?

Answer 13

• patients undergoing breast conservation therapy followed by radiation therapy had a 40% reduction in recurrence in the ipsilateral breast if they received tamoxifen for 5 years after surgery and radiation therapy
• it is now recommended that patients with hormonal receptor–positive DCIS undergoing breast conservation therapy should consider tamoxifen (if there are no contraindications)

Question 14

more than __% of patients with Paget disease of the breast also have a separate focus of cancer—either ductal carcinoma in situ or invasive cancer—elsewhere in the breast

Answer 14

97%

Question 15

what does the B-17 trial show?

Answer 15

the standard of care for DCIS is lumpectomy and radiation, which decreased local recurrence

Question 16

sentinel lymph node is not recommended for DCIS unless which criteria apply?

Answer 16

• lesion greater than 4 cm
• palpable mass
• mastectomy
• microinvasion

Question 17

what does the Z-11 trial show?

Answer 17

no survival difference between sentinel lymph node biopsy alone versus axillary dissection for patients with T1 or T2 breast cancer with:
- no clinical evidence of lymph node involvement
- breast-conservation surgery, and
- fewer than three positive sentinel lymph nodes

Question 18

which endocrine therapy medication is given to both pre- and post-menopausal women, and which can only be given to post-menopausal women?

Answer 18

• tamoxifen is approved in both pre- and post-menopausal women
• raloxifene is only given in post-menopausal women

Question 19

what are reasons to prefer mastectomy in DCIS?

Answer 19

• diffuse suspicious mammographic calcifications
• inability to obtain clear margins in lumpectomy
• patient preference
• contraindication to radiation therapy (previous radiation to chest wall, collagen vascular disease, and 1st or 2nd trimester pregnancy)

Question 20

the best way to biopsy calcifications seen on a mammogram is with:

Answer 20

stereotactic biopsy