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2018 ABIM Awesome Review > 2018 Medical Oncology 6% > Flashcards

2018 Medical Oncology 6% Flashcards

1
Q

Colon CA

Risk factors

A

Age>50*
long standing UC&Crohns >8yr
1st deg relatives with colon CA
h/o other CA (breast, ovarian, endometrial)
Familial polyposis (gardners, familiar adenomatous polyposis highest risk (5Q- gene abnormality)
Hereditary non polyposis colono CA (HNPCC)
Adenomas –> next colonoscopy in 3 years if > or + 1 cm or 3 or more polyps

<60 1st degree relative–> 40 yrs + every 5 yrs
2 1st degree relatives –> 40 yrs + every 5 yrs
1 1st degree relative –> 40yrs + every 10 yrs

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2
Q

Decrease risk colon CA:

A

ASA >20yrs
Celecoxib & sulindac–> decrease load of polyps in colon
estrogens

colon cancer usually arises from adenomas
hyperplastic polyp has no malignant potential!

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3
Q

Familial Adenomatous polyposis

A

Fhx adenomatous polyposis and CA
Mut of APC gene–> Chr 5q-gene abnormality

[????hundreds polyps before age 16
95% cancer
colectomy indicated before malignancy begins
Sigmoidoscopy age 12-16 then colonoscopy q yearly - if any polyps - colectomy????]

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4
Q

Gardner syndrome

A
  • Subtype of FAP involving adenomatous polyps involving the colon
  • extraintestinal manifestation - osteomas mandible , skull, and long bones, soft tissue tumors, thyroid and adrenal tumors, epidermoid and sebaceous cysts

[????Adenomatous polyps invovling colon
95% cancerColectomy before malignancy begins
Sigmoidoscopy age 12-16 then colonoscopy q yearly - if any polyps - colectomy???]

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5
Q

HNPCC (lynch syndrome)???

A 
3 relatives with Cancer related to HNPCC
one 1st deg
2 generations
1 extracolon CA
FAP excluded
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6
Q

Adenoma Colonoscopy screening????

A

Hyperplastic polyp - q10yr
Adenoma < 1cm x1 - q5-10yr
Adenoma <1cm 3 Q3yr
Villous adenoma - regardless of size q3yr

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7
Q

Colon CA screening ???

A

1st deg relative colon CA age 10
colonoscopy standard time (age 50 then q10yr
Two 1st deg relatives colon CA
colonscopy now then q5yr

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8
Q

Peutz-Jeghar’s syndrome

A

STK 11
Pigmented lesions on skin, lips, mouth
Do colonoscopy

[???hemartomas of small intestine
Juventile polypossi: hyperpalstic polyps in colons - p./w GI bleed or inussusception
Tx: colonoscopy????}

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9
Q

HNPCC (hereditary non-poyposis colon CA) or Lynch syndrome

A

-Autosomal dominant
-Need to have at least 3 relative with colon CA. One must be 1st deg relative of the other two,
2 generations with colon CA May have extracolonic cancer as well.
-At least one relative <50yo with colon CA

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10
Q

50yo F with HNPCC had colon CA done - adenomatous polyps - wtd?

A

TV US

??for uterine CA (extracolonic CA)???

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11
Q

55yo M asx for routine checkup - t neg (FIT) - signmoidoscopy => polyp

A

If bx of polyp= hyperplastic polyp wtd?

  • ->FIT q 1yr, sigmoidoscopy 10 yr OR
  • -> sigmoidoscopy alone q 5 yrs OR
  • ->double contrast barium enema q 5 yrs.

If bx of polyp= adenoma wtd?
–>full colonoscopy

IF bx of polyp–> adenocarcinoa wtd?
–> full colonosopy prior to sx

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12
Q

???55yo asx M routine checkup - sigmoidoscopy - neg - FIT +

A

Full colonoscopy

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13
Q

Elderly male or postmenopausal female with unexplained Iron deficiency anemia - wtd?

A

Colonoscopy

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14
Q

Elderly pt with hematochezia, h/o hemorrohids wtd?

A

Colonoscopy

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15
Q

Pt on routine health maintenance exam FIT 1 out of 6 cards + occult blood - pt takes high doses of vit C, wtd?

A

Colonoscopy

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16
Q

55yo F screening colonoscopy done - 2 polyps removed - both hyperplastic - when next colonoscopy

A

10 years

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17
Q

Pt with 2 adenomas <1cm removed when repeat colonscopy?

A

colonoscopy q5-10yrs

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18
Q

Pt with 1 tubular adenoma 1cm - next colonoscopy?

A

3 years

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19
Q

Pt 1 tubular adenoma 2.5 cm next colonoscopy?

A

3 years

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20
Q

Pt with 3-10 tubular aenoma <1cm next colonoscopy

A

3 years

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21
Q

Pt with 1 villous adenoma <1cm next colonscopy

A

3 years

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22
Q

Pt with obstructive colon CA with colonic resection wtd?

A

Full colonoscopy to r.o other concomitant lesions

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23
Q

Pre-op colonscopy with no other lesions

A

colonoscopy 1 yr then 3 years then q5yrs

measure CEA q3 to 6 mo for 2 years then q 1yr x 5 years

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24
Q

Best dx test r/o colon CA?

A

Colonoscopy with bx. Best risk reduction in left colon.

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25
Q

When do you recommend against routine colonoscopy screening?

A

75yo
(your book only lists this)

[???D/c mammo 75yo
D/C pap smears - 65
Hep C screening 1945 to 1965
LDCT screen for smokers up to age 79???]

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26
Q

12y/o , Familial Adenomatous Polyposis (FAP)

A

Sigmoidoscopy q1-2 yrs starting at age 12

colonoscopy @ 16 y/o

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27
Q

HNPCC

A

start colonoscopy 25yr or 10 years younger than youngest affected relative with HNPCC - then q2yr up to age 40 then q1yr

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28
Q

If 2 first deg relatives or 1 first deg relative with colon CA before age 60 when to screen?

A

40 years or 10 yrs younger than youngest affected relative (whichever younger) then q5 yrs

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29
Q

If two second deg relative with colon CA after age 60 - when to screen?

A

40 years FIT q 1 yr + sigmoidoscopy q 10 yrs or colonoscopy now and q 10 yrs.

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30
Q

General population or distant family hx of colon CA screening

A

50 yo (??AA 45yo???) - FIT q 1 yr + signmoidoscopy q10 yr or colonoscopy at 50 then q10 yrs

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31
Q

Post colonic resection for Colon CA

A

Colonoscopy 1 yr after resection then 3 yrs then q5yrs

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32
Q

UC, Crohns’s dz

A

Colonoscopy 8yrs after dx then q1-2 yr

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33
Q

35yo asx - father with colon CA @ age 45yo

A

Colonoscopy now then q5yrs

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34
Q

40yo asx father colon CA age 60, brother age 52

A

Colonoscopy now then q5yr

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35
Q

35yo asx, father colon CA age 65

A

FIT+Sigmoidoscopy q 10yr or colonoscopy q10yr starting at age 50

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36
Q

25yo asx - family h/o HNPCC

A

Colonoscopy now then q2yr up to age 40 then q1yr

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37
Q

Pt with UC dx recently

A

Colonoscopy 8yrs later and then q2yr

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38
Q

Pt with Colon Ca Duke B underwent resection of colon

A

Colonoscopy in 1 yr then in 3 yrs then q5yr

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39
Q

50yo asx - neg fxhx colon CA

A

FIT + sigmoidoscopy q10 yrs or colonoscopy q10yr starting at age 50

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40
Q

Young pt with h/o familial adenomatous polyposis

A

Colonoscopy age 16yo

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41
Q

40yo asx father colon CA after age 55

A

Colonoscopy now then q5yr

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42
Q

37yo M, father colon CA at age 65, brother colon CA age 50, aunt uterine CA age 48. what is more likely?

A

HNPCC (microsatellite mismatch repair gene MSH)

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43
Q

What does tamsulosin cause?

A

Floppy iris syndrome!

d/c tamsulosin

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44
Q

Acute afib chemical cardioversion

A

ibutelide

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45
Q

Colon Cancer Duke A/ I

A

tx - resection
mucosa layer

[????90% survival - thru submucosa but not past muscularis????]

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46
Q

Colon Cancer Duke IIA

A

tx - resection
submucosa layer

????90% survival thru muscularis but not past serosa (no LN)????

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47
Q

Colon Cancer Duke B IIB

A

tx resection
muscularis layer

????60-80% survival - thru muscularis into serosa not into LN????

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48
Q

Colon Cancer Duke B IIC

A

tx : resection
serosa layer

???60-80% survival - thru serosa and involving LN???

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49
Q

Colon Cancer Duke C/ III

A

Tx: resection +5FU + leucovorin+oxaliplatin (folfox)
Lymph nodes

???7% survival - Widespread metastasis (liver)???

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50
Q

When to resect soitary liver metastasis

A

If have pursued curative intent in past**

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51
Q

Pt with colon CA undergoes hemicolectomy - histopathology with infiltartion of musularis , LN(-), wtd?

A

Observe

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52
Q

Pt with colon CA infiltrating serosa & pericolic structures (visceral peritoneum). After hemicoloectomy, wtd?

A

Chemotx (5FU + leucovorin + Oxaliplatin)

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53
Q

Pt with colon CA not infiltrating sera but 4/10 LN invovled - after hemicolectomy wtd?

A

Chemotx (5FU +leucovorin + oxaliplatin)

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54
Q

Pt with stage B2 rectal CA - local resectio done - wtd?

A

Chemotx + RT

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55
Q

Anal Ca - cancer of anal margin how to treat?

A

Local resection

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56
Q

Cancer of anal canal muscosa wtd?

A

external beam radiation tx + 5FU + leukovorin

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57
Q

Breast lump/ suspicious mass w/u

chart on page 147

A

Re-examine in 6 weeks mid cycle
Mass dissappears - do nothing
Mass persists - mammogram
If young woman straight to US
If older woman
if + mammogram then excision bx/intraop bx
If indeterminant/neg mammogram-> US
If solid on US - FNA with bx*** - if neg then excisional bx
If mixed echo US- FNA + bx if neg **-> excisional bx
If cystic on US then FNA bx

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58
Q

Risk factors for breast CA

A 
Highest risk:
Female >50yo
Personal hx breast CA
strong Fhx pre-menopausal breast CA
Genetic BRCA 1+2

Other risk factors:
personal h/o ovarian CA or endometrial CA
dense breasts
OCPs>15yrs.

Screening:

  • women >50yrs OR <5-10yrs prior to age in 1st deg relative w/ breast Ca and then q 2 yrs
  • 10% of breast Ca found on PE is missed by mammogram
  • BRCA 1: Chrom 17; breast, ovarian cancer in women and prostate cancer in men. High penetrance. Other family members should be aware. (MRI every year)
  • BRCA 2: chrom 13
  • TP53 mutation: breast cancer with other cancers in family at younger age; brain, leukemias, and sarcomas.
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59
Q

Breast CA screening

A
  • women >50yrs OR <5-10yrs prior to age in 1st deg relative w/ breast Ca and then q 2 yrs
  • 10% of breast Ca found on PE is missed by mammogram
  • BRCA 1: Chrom 17; breast, ovarian cancer in women and prostate cancer in men. High penetrance. Other family members should be aware. (MRI every year)
  • BRCA 2: chrom 13
  • TP53 mutation: breast cancer with other cancers in family at younger age; brain, leukemias, and sarcomas.
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60
Q

Local breast diseas in situ (??all w/in basement membrane??)

A

tx - lumopectomy + RT or mastecotmy

tamoxifen (pre-menopause)/aromatoase inh (post-menopausal). if ER receptor +

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61
Q

Lobular CA in situ

A

observation or if ER+ -> tamoxifen (???pre)/aromatase (post menopause???)

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62
Q

Infiltrating ductal CA, LN neg

A

wide exceision of mass w/ free margins + RT
Adjuvant chemo for size >1cm
Tamoxifen/aromatase inh if ER receptor +

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63
Q

Infiltrating ductal CA, LN + pos

A

[wide excisition + RT = modified radical mastectomy] + adjuvant chemo + tamoxifen /aromatase inh if ER receptor +

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64
Q

Locally invasive dz involving skin or chest wall

A

chemotx followed by mastectomy + tamoxifen/aromatose inh if ER receptor+

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65
Q

Most important prognostic factor in breast CA?

A

LN invovlement>tumor size>receptor+>grade

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66
Q

Adjuvant therapy for LN(+) dz

A

-Premenoapuse -
ER+ -> chemo + tamoxfen
ER- -> chemotx
HERR-2 (+)–> + trastuzumab

-Post menopause -
ER+ -> chemotx + aromatase inhibitors
ER - -> Chemotx
HERR-2 + –> trastuzumab

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67
Q

Adjuvant therapy for LN neg dz >0.5 cms

A

premenopausal - ER+ tamoxifen + HERR-2 += trastuzumab

Post menopausal - ER+ aromatase inhib + HERR-2 + trastuzumab

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68
Q

???When to use chemo tx in breast CA

A

????Tumor size>1cm, high grade

if <1cm NO CHEMOtx

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69
Q

Types of breast CA

A

Intraductal 80%
Lobular 10%
Other 10%

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70
Q

Excision of mass with free margin +RT =

A

Modifeid radiacla mastectomy + RT

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71
Q

If sentinel LN bx +

A

Further LN dissection

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72
Q

If sentinel LN bx neg

A

no further LN dissection

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73
Q

If LN +

A

Adjuvant tx : Chemotherapy +/- tamoxifen (pre menopausal), aromatose inh (post menopausal)

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74
Q

tamoxifen/aromatase inhib used also?

A

LN neg pts w/ ER+

  • Anti HERR receptor trastuzumab can be used for ER/PR negative pts if HERR positive.
  • it decreases rate of recurrence of breast CA
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75
Q

37yo F fhx breast CA mother 65yo, sister h/o breast CA 35yo - most important risk factor for pt to get breast CA?

A

Family hx breast CA

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76
Q

65yo F fhx breast CA mother 67yo - most important risk factor for her to acquire breast cancer?

A

Her age

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77
Q

Highest risk fo rbreast CA

A

early menarch, late 1st preg, late menopause, strong fhx no deodorant

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78
Q

Pt with breast CA, 1st deg relative of breast and ovarian CA dx?

A

BRCA 1 mutation

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79
Q

40 y/o female with BRCA 1 mutation, what to do next?

A

Mammogram and MRI scrrening now

Also for BRCA 2 and their 1st degree relative, TP 53, PTEN, CHEK 2, RT to chest **

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80
Q

50yo F regular checkup - best way to screen for breast CA?

A

clinical breast exam and mammogram every 2 yrs

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81
Q

How to screen for breast Ca in woman with breast implants

A

mammogram

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82
Q

Mammogram best in woman who is…

A

post menopausal

side note, for dense breast tissue use digital mammogram

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83
Q

40yo F p/w new onset thickening of LU and outer breast in shower -no fhx breast CA - menstruating - exam diffuse nodulatrity in both breasts and vague thickening in LU and outer quadrant - comes back mid cycle, after 3 wks thickening persists - Mammo no CA or dominant mass wtd?

A

US and FNA bx

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84
Q

Pt US with mixed ECHO - FNAB no malign - wtd?

A

excision bx ***

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85
Q

50yo Dx with breast CA - most important prognostic factor

A

LN (+)

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86
Q

35yo F 1.5cm mass

Excision bx with infiltrating dutcal CA adn margins free of CA - Axillary LN neg, ER+ does not want mastiectomy wtd?

A

RT with adjuv chemo and tamoxifen x 10yrs

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87
Q

55yo F lump in breast - lumpectomy done reveals infiltrating adenoCA with free margins - axillary LN+ ER+ adjuvant chemotherapy followed by RT administered Tamoxifen was given for 5 yrs. She is now menopausal, wtd?

A

switch to aromatase inhibitors for 5 yrs.

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88
Q

59yo F painful breast - R Upper Outer quadrant breast painful, red, thickened area 7cms. no nipple d/c, no LN, warmth+ mammo no mass dx?

A

Inflammatory breast CA

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89
Q

Pt s/p breast CA tx with surgery, RT and chemotherapy p/w lymphedema of R arm, what is best management?

A

progressive resistance training

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90
Q

Tamoxifen

A
  • decreases risk of new breast CA
  • effective for tx metastatic breast CA
  • works only if tumor ER & PR+
  • effective in preventing cancer in high risk women
  • tamoxifen has both estrogenic and anti estrogenic effects

Anti-estrogenic Effect:

  • anti breast tumor effect , hence used in tx
  • Menopausal symptoms (tx with venlafaxine)

Estrogenic effect:

  • inc risk of endometrial CA x 3x–> screen by asking if has gyn symptoms
  • inc bone density
  • inc thromboembolic risk/PE***

If there is contraindication to tamoxifen, then ovarian ablation or suppression an be done.

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91
Q

35yo Pt, sister dx w/ breast CA - pt asks how to dec r/o breast Ca in her?

A

Tamoxifen

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92
Q

???Post menopaual F with breast Ca after surgery RT and adjuvant chemotx ER+ wtd?

A

???aromatoase inhib (letrozole, anastrozole, exemestane)

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93
Q

54yo F dx’d with infiltrating ductal CA LN 3/15+ .pt with breast conserving sx +RT+chemo+tamoifen - likely at risk for…?

A

Endometrial Ca

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94
Q

Pt with h/o breast CA. s/p chemo and started on tamoxifen 6 months ago. p/w polyuria, constipation, fatigue, lethargy, and dry mucus membrane - etio?

A

HyperCa

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95
Q

Pt with breast Ca and tx’ed w/ chemo and started on tamoxifen 6 yrs ago. Pt has schedule of yearly mammogram & pap smear. What else would you recommend for this pt ?

A

Ask for GYN symptoms every visit

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96
Q

Pt started on tamoxifen 20mg po daily. 3 years later presents w/ follow up and c/o one time vaginal bloody d/c which resolved by itself about 6 months ago. no other complaints except occasional hot flashes. no other breast mass - mammo and pap neg wtd?

A

Endometrial bx

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97
Q

Pregant women with breast Ca

A
  • treat like regular pt - surgery in 2nd to 3rd trimester - chemotherapy begin in 2nd trim **
  • Male breast CA treated similar to female breast CA
  • Pt treated for breast cancer. Does getting preg increase risk of breast cancer? NO
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98
Q

Long term complication aromatase inhibitors?

A

osteoporosis

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99
Q

Best managment hot flashes from tamoxifen or aromatase inhibitors?

A

venlafaxine

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100
Q

Pt p/w nipple d/c - eczematous scaly lesion at nipple - preg test neg. prolactin normal dx and tx?

A

Pagets disease of breast
Tx - local wide resection if no mass
Treat as breast Ca if underlying mass

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101
Q

Pt h/o breast Ca s/p lumpectomy and chemotx 5 yrs ago p/w pain in hip and lower back. xray hip 3cm lytic lesion - X ray LS spine normal. wtd?

A

MRI LS spine

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102
Q

What is first sx of epidural compression fracture?

A

Pain (NOT loss of sensation)

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103
Q

60yo F breast CA, s/p resected ER/PR+ chemo and aromatase inhib’s started - current meds ACEi, BB, lasix urinating more frequently - labs normal except Ca 11.2 - next best management?

A

Bone scan

THE LEADING solid tumor causing HyperCa+ is breast CA

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104
Q

65yo F dx with infiltrating ductal CA - lumpectomy with free margins, radiotx and adjuvant chemo - 6 months after RT here for f/u - exam neg for new mass or LN, no complaints - mammo neg, what you recommend for this pt?

A

Mammogram yearly

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105
Q

Pt s/p matectomy fo rbreast Ca with metastasis on increasing opiates for pain control - is lethargic, dec’d responsiveness - pupils non-reactive, diplopia, tongue dev to right , absent gag relex - absent left ankle reflex - urinary retention + dx?

A

Leptomeningeal spread

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106
Q

????Pt with metastatic breast Ca ER neg HERR (Her2neu) rct + best med ?

A

Trastuzumab (herceptin)

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107
Q

34yo with breast lump excised -> fibroadenoma - Grandmother with hx breast CA. How to follow up in this pt?

A

repeat mammo at age 50

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108
Q

65yo M on spironolactone for ascites p/w one sided breast mass. wtd?

A

bx

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109
Q

Endometrial Ca

Risk factors

A 
*****Risk factors:
Obestity
Early menarchy
late menopause
Nulliparity
Tamoxifen use

P/w post menopausal bleeding

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110
Q

Obesity associated cancer

A

Endometrial Ca

(Side note on other cancers:

  • cervical cancer: HPV 16, 18,31
  • ovarian ca- dermatomyositis
  • adenocarcinoma stomach- L supraclavicular LN)
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111
Q

???Bariatric surgery comoplications

A

Opthalmoplegia - thiamind ef
Dark urine - no RBCs rhabdo
Tachycardia low grade fever - suture leak - gastrograffin study
Copper def - anemia, thrombocytopenia, leukopenia

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112
Q

Cervical CA

-paper smear screening

A

Pap Smear:

  • Screening age 21-30 every 3 years
  • For women above 30 - pap smear with HPV DNA neg - pap q5yr
  • Don’t do HPV DNA <30 yrs, UNLESS pap smear is abnormal
  • High risk (multiple sex partners, STDs HIV)–> every year
  • stop pap smear screening at 65 y/o
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113
Q

HPV DNA testing

<30 and >30y/o?

A

<30 yrs:
NO testing for WARTS (low risk HPV usually transient and clears in 2 years in 70%)
–> repeat pap in 1 yr
NO testing unless ASCUS +

> 30yrs:
with primary pap:
If ASC-US + and HPV+ -> colposcopy **
If ASCUS+ and HPV neg -> no colp, repeat pap 1 yr *
If ASCUS neg and HPV + -> no colp, repeat pap and DNA in 6-1 year

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114
Q

???High risk patient pap smears

A

q1yr

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115
Q

Stop PAP at age?

A

65yo

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116
Q

Pt with warts -

A

30yo With primary PAP -
If ASC-US and HPV+ -> colposcopy
If ASCUS+ and HPV neg -> no colp, repeat pap 1 yr
If ASC neg and HPV + > no colp, re;eat pap and DNA in 6-12 months

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117
Q

24yo F vaginal d/c - Pap shows clue cells and some AS-CU - ?

A

bacterial vaginosis

tx: metronidazole

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118
Q

24yo F pap with AS CUS wtd?

A

HPV testing

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119
Q

22yo F with AS-CUS. Infected w/ HPV 16, still give vaccine?

A

Yes
It will help other 3 serotypes prevention

(HVP vaccine: warty 6,11….oncogenic: 16,18)

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120
Q

What pt contraindicated for HPV vacc?

A

preg patient

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121
Q

50yo pt with h/o fibroids - 2yrs ago fibroid size 2cm - repeat size now 3cm. no menorrhagia - best managment?

A

Reassess in 1 year

?????If still there 3 yers later post menopause with bleeding - bx????

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122
Q

Pt hysterectomy for severe fibroids - post hysterectomy do you need PAP?

A

NO

?????If uterus/cerix removed for benign reason - NO
If uterus remove for malignant CA then yes bx?????

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123
Q

Pt with lesion in endocervical canal wtd?

A

bx

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124
Q

PT with pap high grade SIL - colposcopic bx confirms CIN III wtd?

A

cryotherapy–> OR–> cone bx especially if endocervical canal involved –> OR hysterectomy

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125
Q

Pt with invasive cervical CA wtd?

A

hysterectomy or RT with chemotherapy

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126
Q

?????Ovarian CA

A

???????leading cause of GYN CA - most p/w advanced stage
General screening NOT recommended (no pelvic US, CA 125, OCP dec risk of ovarina CA)
Pelvic US of pt with dermatomyostis or strong fhx ovarian + breast Ca
CA125 used in monitoring dz
Tx: surgical staging and debulking of tumor with salpingooophroectomy, hysterectomy omentectomy -> chemo (paclitaxel)

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127
Q

Pt with abdominal distension - US shows serous semi solid 6cm. septate mass in R pelvic area. CEA elevated - wtd?

A

CT scan to localize tumor before laparoscopy

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128
Q

Prostate CA

Risk factors:

A 
African american X2 
family history (father had it x 3, brother had it x 4)

PSA screening has NOT shown reduction in mortality

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129
Q

Pt wants PSA wtd?

A

Discuss with patient

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130
Q

????Gleason score

A

determines prognosis

7 poor prognosis

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131
Q

????Staging of prostate CA

A 
A1 5% of resected tissue
B- found on needle bx after inc PSA
B1 < 1/2 one lobe
B2>1/2 on elobe
B3 both lobes invovled
Elderly - observe no sx
Yound Radiacla prostatectomy=Radiotx

C Capsule infiltrated - locally invasive
tx RT+hormonal (Lupron GnRH agonist)

D1 Pelvic node invovlement
Hormonal tx

D2 Distant mets, localized bone, diffuse bone
Beam RT, hormonal

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132
Q

Anti androgens compete with androgens at receptor level in testes and adrenals

A

Flutamide (eulexin), nilutamide (nilandron), bicaltamide(casodex)
Anti androgens block flare by LHRH agonists

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133
Q

?????60yo P with PSA elevated rectal exam unremarkable wtd?

A

????TRUS - trans rectal US bx

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134
Q

????60yo pt with PSA normal but rectal exam with nodule

A

???TRUS bx

135
Q

?????50yo Pt on routine exam with diffusely enlarged prostate elev PSA wtd?

A

???TRUS bx

136
Q

82yo M prostate CA stage A2, wtd?

A

observe

137
Q

????60yo M elev PSA abnormal rectal exam - B1 on bx wtd?

A

radial prostatectomy OR ext beam RT
3yr later - PSA < 10 asx - wtd? - observe
If >10 then mets visible

138
Q

????Pt comes back after prostatecomy 3 years later with elev PSA and back pain - one met lesion on vertebral spine wtd?

A

Bone scan

139
Q

????Bone scan localized mets to bone wtd?

A

ext beam radiation to lesion

140
Q

????One year later - after ext beam rad to spine back with bone pain bone scan diffuse mets wtd?

A

start GnRH agonist (Leuprolide, Goserelin - can combine with anti-androgens to block GnRH induced flares

141
Q

?????6 months later back pain again after tx wit GnRH/antiandrogens for met prostate CA - pt tx’d with mitoxantrong and fails - continues to have pain wtd?

A

IV strontium 89 for palliation of pain

142
Q

?????62yo with locally invasive prostate Ca stage C wtd?

A

RT + GnRH analog (hormonal)

143
Q

S/E LHRH (leuprolide)

A

Short term - hot flashes
Long term - osteoporosis
Tx - Bisophosphonate - Zolendronate or alendronate

144
Q

S/E Anti-androgens

A

impaired dark adaptation

Breast tenderness

145
Q

Pt with met prostate CA started on leuprolide - mc problem

A

fracture - compression fx

146
Q

???65yo pt with prostate CA B3

A

radical prostatectomy

147
Q

?????65yo pt with prostate CA stage C (capsule)

A

RT+hormonal tx

148
Q

?????65yo pt with prostate CA diffuse mets

A

Hormonal tx

149
Q

?????84yo pt with prostate CA stage B2

A

Observe (elderly)

150
Q

Pt afib on warfarin with hematuria INR 2.2, RBC in urine 10-15/hpf, repeat UA with persistent hematuria - rectal exam enlarged proatste - CT scan, cystoscopy IVP neg - prostate bx with prostate hyperplasia but no CA . wtd to tx hematuria?

A

Add finasteride (proscar)

Finasteride has shown to decrease the risk of prostate cancer, however if they do get prostate cancer, it will be high grade. It is not recommended for prevention of prostate cancer.

151
Q

????Pt fhx + prostate CA - wants to decrease risk wtd?

A

Finasteride

152
Q

65yo chronic smoker - p.w painless intermittent gross hematuria with clots. dx?

A

Bladder CA

(side note:
high volume: PSA >1.8; alpha block + finasteride
low volume: PSA <1.8; alpha block)

153
Q

Lower abd pain, fullness in suprapubic area - foley cath with relief of pain and drainage of urine, PSA elevatged wtd next?

A

repeat PSA in 4-6wks

urinary retention from any etio can cause inc PSA,

154
Q

???Lung CA

A

MCC death men/women

85% dx die w/in 5 years

155
Q

Small cell lung CA (20%)

pg 158

A
  • oat cell carcinoma
  • Assume mets at dx hence . NON-resectable
  • adenocarcinoma w/ increasing incidence in both smokers and non smokers
156
Q

Non-small cell (80%)

A
  • Squamous cell CA
  • Large cell CA
  • AdenoCA
  • Eval for surgical resection at dx!!
  • AdenoCA with inc incidence in both smoker and non-smokers
157
Q

MC presentation of Lung CA

A

peristent or inc’ing cough, hemoptysis, post-obstructive pneumonitis

158
Q

Pt p/w hemoptysis

A

> 1wk
40yr old and chronic tobacoo hx has 40% chance of having CA
So always evaluate pt further with these sx with CT & bronchoscopy

CXR 1st

159
Q

???Hemoptysis in young adult dx?

A

Bronchitis, PNA, bronnchiectasis

160
Q

????Hemoptysis in immigrant from south asia or S america dx?

A

Myobacterium Tuberculosis

161
Q

> 50yo pt successfully tx’d in hosptial for PNA with ceftriaxone and azithromycin - 3 months later cough persists - CXR with persistent density dx?

A

Malignancy

162
Q

Non-small cell CA (can be resectable)

pg 159

A

I: Tumor >2cm from carina, node neg
II: Tumor >2cm from carina node +
treatment: surgery + chemotherapy

IIIa Tumor <2cm from carina or invading resectable structure or ipilateral hilar or mediastinal LN+
Tx: Surgery +chemo+radiotherapy

IIIb: Tumor invading unresectable structure contralateral mediastinal LN+
Tx: Chemo then radiotx, no sx

IV: Metastatic dz - Supraclavicular LN+ or pleural effusion with malignant cells+
EGFR mutations- tx: Erlotinib(Tarceva)/Gefitinib(Iressa)
Alk transloc- tx: Crizotinib (Xalkori)
PDL 1 - tx: Pembrolizumab (Keytruda), Nivolumab (Opdivo)
(Autoimmune disorders dec)

163
Q

Small Cell CA (non-resectable)

A

Limited to one hemithorax: chemo + RT lung+ ***RT Brain (ppx)
Extensive dz - Chemotx + RT brain

Elderly Pt with SCC - shoudl be treated with chemotx**

164
Q

58yo chronic smoker >30pk yr p/w hemoptysis >1wk CXR neg wtd?

A

CT scan + bronchoscopy

165
Q

???42yo p/w streaky hemoptysis x 3 weeks CXR clear wtd?

A

Bronchoscopy

166
Q

70yo chronic smoker >50yo p/w seizure and lethargy - CT head shows single ring enhancing lesion with edema - started on phenytoin wtd?

A

Start dexamethasone to dec cerebral edema

167
Q

60yo (55-70) pt with lung CA in family wants screening - 30 pack years, quit smoking 20 yrs ago, wtd?

A

no screening

168
Q

60yo pt with 30pk year smoking hx quit 5 yr ago here for regular check wtd?

A

low dose CT

  • 55-79y/o
  • 30 PY smoking
  • current smoke or quit in last 15yrs
169
Q

????70yo chornic smoker with CT CT solitary ring enhancing lesion started on phenytoin - CT lung with hilar LAD - next test?

A

Bronchoscopy

170
Q

Prevent emetogenic chemotx (cisplatin)

A

grani (setron s) +DMS+Aprepitant (Emed) +/- olzazpine

171
Q

Piror to aministration of chemo pt is nauseous and receives granisetron or ondansetron - still nauseous prior to chemotherapyk wtd?

A

xanax (alprazolam)

172
Q

MCC Paraneoplastic syndrome

A

Small Cell CA
Squamous cell CA
AdenoCA
Large cell CA

173
Q

Small cell CA **

Paraneoplastic syndrome

A 
hyponatremia 2/2 SIADH
Cushing's 2/2 inc ACTH
Carcinoid: flushing and diarrhea
Eaton lambert - power inc's with repetition
SVC syndrome
174
Q

Squamous cell CA**

Paraneoplastic syndrome

A

-HyperCA 2/2 PTH like substace
PTH level dec Ca inc, PO4 dec
-Horner’s: Ptosis, miosis (compression of sympathetic chain), anhydrosis
-Pancoast tumor - compress 1st and 2nd throacic nerve ——>sholder pain—> pain in ulanr aspect of hand and little finger

(??- CXR pancoast tumor??)

175
Q

AdenoCA**

Paraneoplastic syndrome

A

Pulmonary osteoarthropathy - pain in hands or legs
Xray : periosteal thickening***
Marantic Endocardits w/ adenocarcinoma

176
Q

Large cell CA**

Paraneoplastic syndrome

A

SVC syndrome

Gynecomastia

177
Q

65yo Sq cell CA with pleural effusion which is hemorrhagic. PT 160/100, hyper Ca, FEV1 2.4L Hg 9 what prevents from being surgical candidate

A

hemorrhagic pleural effusion

178
Q

What is most important prognositic factor with advance non-small cell lung CA?

A

Poor performance status

179
Q

45yo post lung cancer s/p surgery and chemotx 5 years ago going for elective surgery - echo EF 35% wtd?

A

ACE inhibitor

the ejection fraction of 35% is chemo induced NICM

180
Q

Pt with pancoast tumore - whic is worst prognosis

A

Chest movement asymmetry (phrenic nerve involvement

181
Q

Least likely paraneoplastic syndrome /w small cell CA

A

HyperCA

182
Q

51 yo lung CA with gynecomastia inc HCG

A

Large cell CA

183
Q

62yo chronic smoker pin in legs CXR with coin lesion in periphery of lungs

A

AdenoCA

184
Q

55yo pt with lung CA and hyperCA

A

Squamous cell CA

185
Q

55yo lung CA with wkness, gets better with repetitive movememnts - eaton lambert

A

Small cell lung CA

186
Q

55yo Manual labororer heavy smoker p/w shoulder arm, medial forearm, ring, little finger pain wtd?

A

CXR

187
Q

MC cancer in smoker and non-smoker

A

AdenoCA

188
Q

MC cancer in non-smoker

A

AdenoCA

189
Q

ACTH producting neoplastic syndrome

A

Small cell CA

190
Q

Assume met at Dx

A

Small cell CA

191
Q

<2% 5 year survival Lung Ca

A

Small cell Ca

192
Q

Hyponatremia with lung CA

A

Small cell Ca

193
Q

Squamous cell CA 2cm win in carina and ipsilar LN +

A

Surgical resection+ chemotherapy+ RT

194
Q

AdenoCA >2cm from carina LN neg

A

Surgery + chemotherapy

195
Q

Large cell Ca at carina nad contralat LN+

A

Chemo tx + RT lung

196
Q

Small cell CA in one hemithorax

A

CHemotx, +RT lung+RT brain

197
Q

Small cell Ca extensive

A

Chemo tx + RT brain (ppx)

198
Q

SVC syndrome

A

Lung CA - NSCLC broncogenic CA most common 65%
lymphoma
thymoma
catheter induced thrombosis
sx - dyspnea (in pt w/ cancer), facial swelling, arm swelling, cyanosis, plethora, dysphagia

199
Q

Next step managment SVC syndrome?

A

elev of head (dec hydrostatic prssure and edema)

Tx definitive - radiation tx (superior to chemo)

200
Q

Pt with metastatic lung CA and skeletal mets and osteopenia wtd?

A

bisophosphonates - zolendronate or pamidronate

Pain not relieved by fentanyl patch and opiods, wtd? - strontium 89

201
Q

Medicare guidlines when pt eligible for hospice care?

A

life expectancy less than 6 months

202
Q

Testicular CA

A

-Seminomas -(???Better cure rate)
-Non-seminoma: embryona CA, teratoma, chorioCA,
yolksac tumor

203
Q

Pt with testicular mass

A
  1. approach solid testicular growth as CA until otherwise proven
  2. Do a B HCG and alpha feto protein level

Testicular Ca:

  • Seminomas: B HCG: increase/ N <100, **alpha feto protein: N
  • Non seminomas: B HCG: very inreased, alpha feto protein: very incrased

(????Bx via high inguinal incision (don’t spread CA)
if Bx + then CT chest abd pelvis to stage dz ????)

204
Q

Hormone levels

A

Seminoma
B HCG inc/N (<100)
AFP normal

Non seminoma
B HCG elevated
AFP elevated

205
Q

Treatment testicular CA

A

For all - first DO radical orchiectomy via high inguinal** incision then…

Stage 1 - confined to testes
Seminoma - RT
Non-seminoma - observe, remove LN

Stage II infradiaphragmeatic Node + <5cm
Seminoma - RT
Non-seminoma - Chemotx

Stage III beyond retroperitoneal LN
Seminoma - chemotx
Non-seminoma - Chemotx (NO role for RT)

206
Q

24yo with non-seminoa tumor - B HCG and AFP elevated CT pelvis with mass - radial orchiectomy via inguinal approach done, wtd?

A

chemotx

if with lung nodule - resect it, same principle for Breast Ca or colon Ca as well

207
Q

BCG and afp elv

A

non-seminoma

208
Q

AFP normal

A

seminoma

209
Q

Inguinal approach for bx/orchiectomy

A

both: seminoma and non seminoma

210
Q

???????Trans-scrotal bx?

A

????neither - never!

211
Q

Respond to RT

A

seminoma

212
Q

Don’t respond to RT

A

Non-seminoma

213
Q

19yo inc’d breast enlargement for 2 years no other complaints - normal external genitalia, +gynecomatia wtd?

A

check testosterone/estradio
- testo 450 (n), LH 0.3, FSH 0.5 and estradiol 304 (elev)

next step:
US testes …… if normal –> CT adrenal

214
Q

?????Young man with testicular mas and dragging sensation - nl AFP, nl HCG) wtd?

A

?????High inguinal orchiectomy

215
Q

Lymphoma

A 
-Hodgkin's lymphoma:
B cells Reed sternberg +
...in order of Best prognosis to worst:
       Lymphoyctic predominance
       Nodular sclerosis
       Mixed cellularity
       Lymphocyte depletion (worse prognosis)

Non-hodgkin’s lymphoma B cells 90%, T cells 10%

216
Q

Lymphoma presentation

A 
lymph node enlargement with contiguous spread +/- paracrine effects:
      Fever,
      peripheral granulocytosis
      eosinophilia with pruritis 
      Personality changes
**** +reed sternerg cells (owl eyes)

Dx: hodgkin’s disease

217
Q

Hodgkin’s dz tx

A

varying cyles of ABVD (doxorubicin, bleomycin, vinblastine dacarazine) +/-RT

If pts Relapse/poor response –> high dose chemo followd by autologous hematopoetic stem cell transplant

218
Q

Complications after hodgkins’ tx

A 
Chemotherapy:
      cardiomyopathy
      AML
      Myelodysplastic syndrome
      infertility, amenorrhea

Radiation tx:
constrictive pericarditis (??sqrt sign??)
accelerated CAD despite age
solid tumores (breast, lung, thyroid)
Hypotheyorid
radiation pneumonitis

*MC cause of secondary malignancies

219
Q

38yo ho hodgkins txed with rad tx 10ya p./w chest pain while shoveling snow x 30 min

A

Accelerated CAD

220
Q

40yo egyptian man h/o hodgkins tx with mantel RT to chest 10 yrs ago with palptiations wt loss JVD+, ascites, pedal edema+ , echo with thickened pericardium

A

constrictive pericarditis

221
Q

42yo s/p hodgkin’s dz tx’d with chemo >7yr ago p/w easy bruising & fatigue, Hb 9, Platelets 50,000. Blood smear with anisocytosis, pelger huet anamoly (hyposegmented PMNs) .BM dysplasia of marrow precursor and hypercellularity

A

myelodysplasia (MDS)

222
Q

35yo with hodgkins 10ya s/p mantle radiation now with fatigue wtd?

A

Check TSH

Prone to Lung, breast, and thyroid CA

223
Q

30yo undergoes chemo for hodgkins 10 ya ago - more likely complication?

A

increased incidence of AML

???r/o AML (topoisomerase inhib)???

224
Q

Non-Hodgkin’s lymphoma

A
  • hematoglogic spread**
  • Dx: excision of LN not aspiration**, Site : supraclavicular
  • If relapse, repeat aggresive chemotx and Stem cell transplant**

??????clonal proliferation of cell features of lymphoid cells
>60K/yr inc’ding indcidence

90% B cells, 10% T cells
40% - diffuse large cell ymphoma (BCL 6)
30% follicular lymphoma (t 14:18)

Stageing by ann arbor and CT/PET chest, abd pelvis
Tx base on staging and presence of poor prognositc factors
Tx: chemo with RCHOP or CVP
Relapse - aggressive chemo and stem cell tx??????

225
Q

Poor prognostic factors NHL

A 
age >60 yrs
serum LDH
performance status <70
Ann arbor staging III or IV
Hb<12
226
Q

NHL grading

A

1)Low grade lymophoma
-Follicular: small lymphocytes
-Tx INdolent->local Rt
aggressive transform–> R-CHOP/CVP

2) Intermediate grade lymphoma
- follicular w/ large or small cell, diffuse, mixed
- tx CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)

3) High grade lymophoma
- large cell immunoblastic small non cleaved cell
- Tx: CHOP +/ -rituximab, NO RT–> stem cell tx

227
Q

Post renal transplant lymphomas

A

EBV associated lymphoma

228
Q

CNS lymphoma/burkitts/nasopharyngeal CA

A

EBV

229
Q

MALT

A

h pylori

230
Q

Kaposi’s sarcoma

A

HHV-8 -

?? danorubicin???

231
Q

Ca Cervix/Anal Ca

A

HPV 16, 18,31

232
Q

T cell leukemia

A

HTLV-1

233
Q

65yo Pt w/ asx cervical LAD - LN bx reveals follicular small cell lymophoma, preserved architecture - Bone marrow findings are postive, wtd?

A

local RT

234
Q

?????Pt with abdominal mass, wt loss, fever, bulky retroperitoneal LN - bx mass shows large cell lymophoma tx??????

A

???????CHOP + rituximab
If failus chemo
Stem cell tx

235
Q

Pt post renal tx - 2 years later with ataxia - CT head shows ring enhancing lesion in cerebellum dx?

A

EBV

??? = cause for lymphoma s/p tx???

236
Q

Pt with well differentiated lymphoma (CLL) p/w fatigue, weakness, cbc hg 9.5, retic 5% smear with spherocytes, polychormasia best tes?

A

Coombs test r/o warm autoimmune hemoytic anema

Tx –> steroids–> Rituximab –> Tx underlying dz

237
Q

Pt with large hilar LAD dx as small cell Ca, p/w SOB - exam with massive pleural eff wtd?

A

tap effusion

If patient comes back couple of months later with recurrent effusion , wtd?
Thoracoscopy w/ talc poudrage

238
Q

Pt with lymphoma dx 2 years ago, but not require tx at the time p/w sob, cxr with effsuion. wtd next and what is the best management?

A

Tap the pleural effusion

best management?
Same for NSCLC or breast cancer

239
Q

What can you expect one month after two infusions of Rituximab? (s/e?)

A

lymphopenia

side note: hypogammaglobulinemia- CLL, CVID

240
Q

Multiple Myeloma

A
  • Lytic lesions, bone pain, hyperCa, serum&urine protein ‘M’ spike
  • Marrow cytosis >10%**
  • Plastma cells
    - ->osteoclasts->punched out bone lesions->hyper Ca
    - ->Immuoglobulin(faulty IgG)->’M’ spike in serum and urine->renal failure
    - >roleaux formation of RBCs
    - >inc’d ESR
    - >platelet dsyfxn
    - >infections

(anion gap low, Kappy> Lambda chains)

Tx:
No end organ daamge (RF, lytic lesion or anemia absent)
-monitor
Evience of damage
->lenalidomide/ Melphalan (Alkeran)/prednisone
Relapse - do not do induction with melphalan
tx with bortezomib (velcade)/hematopoietic stem cell transplant

Prior to bortezombi, what ppx? acyclovir (zovirax) for herpes zoster ppx

241
Q

PPX prior to bortezomib?

A

acyclovi (zovirax) for Herpes zoster ppx

242
Q

MM (multiple myeloma)

A

protien >3.5
Lytice lesions
marrow plasmacytoma >10%
+ hyper Ca+

243
Q

MGUS (monoclonal gammopthy of unknown significance)

A

protein <3.5
no lytic lesions
marrow plasmacytoma <10%
no hyper Ca+

244
Q

????????Smoldering MM???????

A

??????no hyperCa+
>10% plasmacytoma
+lytic lesions???????????

245
Q

T/F Hypercalemia with MM

A

T

246
Q

T/F MM w/ inc’d protein?

A

T

247
Q

T/F MM w/ renal dysfxn?

A

T

248
Q

T/F MM w/ Plt dysfxn?

A

T

249
Q

T/F MM w/ bone pain?

A

T

250
Q

T/F MM- infections?

A

T

251
Q

T/F MM -amyloidosis?

A

T

252
Q

T/F MM -Dilation of retinal veins?

A

T

253
Q

Hypervicosity caused by all of the following

A

Waldenstroms macroglobulinemia-> ??tx plasmphoresis??
PC Vera-> ??tx splenomegaly - phelebotomy/low dose ASA??
Leukemia - ??leukapheresis??

254
Q

65yo Pt with protein 8gm glboulin 3.1 serum protein electrophor with inc’d IgG - best way to diff MM vs MGUS

A

radiographic skeletal survey

+lytic lesions in MM

255
Q

Pt dx with MGUS (plasma cells <10% in bone marrow bx, radiological skeletal survey is normal, ca is normal) - wtd?

A

f/u 6 months r/o MM

256
Q

Pt with plasma cells >10% in BM, skeletal survey normal, Ca normal - no end organ damage (Cr normal, Hb normal, no lytic lesions) - pt dx with smolerding (asymptomatic) MM - wtd?

A

f/u myeloma protein q2 months

257
Q

60yo M h/a blurred vision, LAD fatigue Gh 9, lethargic, dec’d power on one side, total protein 8gm globulin 3, Ca 9 - serum protein electroprhoesis IgM>2g, inc’d ESR dx?

A

Waldenstroms’s macroglobulinemia
-caused by IgM (largest immunoglobulin) ->remains intravascular-> hyperviscosity syndrome
-No lytic lesions
-No hyperCa+
-BM: ‘phlascytoid lymophocytes’
Tx: plasmapheresis, fludarabine (Fludara) based chemotherapy

258
Q

Tumor of pancreas

A

Pancreatic CA
Glucoagonoma
Gastrnoma
VIPoma

259
Q

Elderly man with h/o chronic smoking >40pk yr p/w wt loss, fagigue anorexia painelss jaundice +/- diarrhea . painless palpable gall bladder (courvoisier’s sign) - best dx test?

A

CT Scan pancreas r/o pancreatic CA
–> mainly head of pancreas -> double duct sign+ (??bile and common duct enlarged??)
Tx: Pancreatic Ca with no mets -> surgery (pancreaticduoenectomy)
can invovle minimal invasion (<50%)of protal or mesenteric vein

260
Q

If pt refuses surgery for pancreatic CA wtd?

A

Gemcitabine + nab-paclitaxel chemotherapy

Pancreatic Ca with mets -> palliative tx with stent placement and Gemcitabine (Gemzar) +nab-Pacitaxel

261
Q

Pt with stage IV pancreatic CA and sever itching wtd?

A

Biliary stent

262
Q

46yo F no h/o pancreatitis with 3.8cm mass head of pancreas seen on CT wtd?

A

Surgical excision

- if mass not clearly defined or borderline resctable on CT then the best test is endoscopic US

263
Q

What is more commonly a/w pancreatic CA - tob or etoh?

A

smoking…

264
Q

Diabetics ar prone to what kind of cancer - breast, colon or pancreatic?

A

pancreatic CA

265
Q

Pt with familial adenomatous polyposis prone to what kind of cancer?

A

Ampulla of vater cancer

266
Q

Pt with persistent hyperglycemia, wt loss anemia - exam with scaly necrotizing dermatitis - glucagon injection does not increase glucose level

A

glucagonoma - plasma glucagon >1000

267
Q

Pt with profuse watery diarrhea not responding to fasting, h/o wt loss, serum K 3.3, hypochlorhydria . serum VIP level inc’d. stool osmolar gap low

A

Dx: VIPoma
Tx: octreotide

268
Q

Courvoisier’s sign

A

Pancreatic CA

269
Q

Trousseau’s syndrome( migratory thrombophlebitis)

A

Pancreastic CA
Also seen in adenocarcinoma of stomach- L SC LN +
Renal cell CA- L bag of worms senssation in L testes

270
Q

Double duct sign

A

Pancreatic CA

271
Q

Sentinel loop sign (small bowel ileus)

A

Acute pancreatitis

272
Q

Pt with diarrhea h/o flushing sensation, exam with telangiectasia wtd next, and what is dx?

A

Check 5HIAA

dx? Carcinoid

273
Q

Hepatocellular CA- best survelliance

A

liver US ever 6 months

274
Q

Pt w/ cirrhosis has an US done which shows 0.8 cm lesion, wtd?
….pt 6 months later the size is 1.2 cm…wtd?

A

…0.8 cm lesion: Repeat US in 3 months

…6 months later when size is 1.2 cm: three phase CT scan

275
Q

What agent inc’s survival with hepatocellular CA

A

Sorafenib (Nexavar)

276
Q

Thyroid CA

A

Parafollicular
Medullary carcinoma
-Calitonin increased, RET proto-oncogene (R/O pheo)
-dense calcification in tumor
-assoc with MEN II&III (check fhx)
-Tx: total thyroidectomy (???follow calcitonin levels after surgery????)

277
Q

Follicular

Papillary CA

A

Cervical LN, pitted CAlcification (MC wit best prognosis), BRAF +

278
Q

Follicular CA

A

mass and distant mts. RAS+

279
Q

????Anaplastic CA?????

A

with mass - elderly with worst prognosis

280
Q

Best managment for papillary and follcular CA after surgery

A

Radioiodine ablation; f/u w/ thyroglobulin levels

It will NOT work for medullary CA as radioiodine not take up by C cells

281
Q

Medullary CA recurrence

A

check Calcitonin level

CT scan neck and chest

282
Q

Papillary CA recurrence

A

Check Thyroglobulin level

283
Q

Follicular CA recurrence

A

Check Thyroglobulin level

284
Q

Axillary LN

DIAGRAM on page 176!!!!

A

breast CA

285
Q

Occipital LN

DIAGRAM on page 176!!!!

A

scalp infxn

286
Q 
Supraclavicular LN (R)
DIAGRAM  on page 176!!!!
A

esophaeal lung or mediastinal malignancy

287
Q

L Supraclavicular LN

DIAGRAM on page 176!!!! please look at the diagram there are more nodes

A

Abdominal malignancy

288
Q

Cancer of Unknown Origin

A

MC - adenoCA
then poorly diff
then Others

289
Q

Presentation CA unknown origin

A

40% LN, Cervical supraclavicular>Mediastinal>axillary
30% Liver, lung, bone
20% of pts primary CA will be identified
Expected mean survival time 6 months

290
Q

AdenoCA in females with axillary LN

A

pursue breast CA diagnosis
Do mammogram +- MRI, ER/PR receptors
Tx mastectomy +/- radiation +/- chemo

291
Q

AdenoCA in females with bony invovlement

A

Pursue breast CA diagnosis**

292
Q

AdenoCA in males with bony invovlement

A

Pursue prostate CA**

Ask for urinary sx, do PSA and rectal exam

293
Q

Poorly diff CA in young males

A

Pursue germ cell tumor
DO alpha feto protein & B HCG
Platinum based chemo if +

294
Q

Squamous cell CA

A

presentation with cervial LN +, -> pursue head/neck CA

present w/ lower Cervical LN +, -> pursue Lung CA

295
Q

MCC CA of unknown origin

A

AdenoCA

296
Q

MC place of presentation of CA unknown origin

A

Lymph node

297
Q

Femaile with axillary LN+ most likely CA type

A

AdenoCA

298
Q

Carcinoma of unknown origin in young male

A

Undiff cell CA

299
Q

Head/neck CA

A

Squamous cell CA

300
Q

50yo M smoker, single submandibular LN+ found to be undiff CA - Phy exam head/neck neg, CXR neg wtd?

A

Upper pan endoscopy

301
Q

Which screenings DO NOT decrease mortality

A

PSA

Mmamo, pap, fecal occult, sigmoidoscopy DO decrease mortality

302
Q

Pt with metastatic CA with persisent pain - takes oxycodone with tylenol prn and morphine sulfate twice a day wtd?

A

Extended release oxycodone or morphine q8-12hr continuously

303
Q

S/E Methotrexate (Trexall)

A

Reversible pneumonitis, hepatic fibrosis

304
Q

S/E 5FU (efudex)

A

Myocardial ischemia, myelosuppression

305
Q

S/E Vincristine (oncovin)

A

Neuropathy, SIADH

306
Q

S/E Doxorubici (Doxil), Trastuzumab (herceptin)

A

Cardiomyopathy

307
Q

S/E Bleomycin (Blenoxane)

also w/ Rituximab

A

interstitial fibrosi

308
Q

S/e Mitomycin (Mutamycin)

A

HUS, blue green urine

309
Q

S/e cyclophosphamide (Cytonxan)

A

hemorrhagic cystitis, bladder CA

310
Q

S/e Bicalutamide (Casodex)

A

gynecomastia, pulm fibrosis, impaired dark adaptation

311
Q

s/e paclitaxel (Abraxane)

A

Neuropathy, bradycardia

312
Q

s/e gemcitabine (Gemzar)

A

anal pruritis, HUS, flu rash

313
Q

s/e tamoxifen (Nolvadex)

A

hot flashes, thromboemboli, endometrial CA

314
Q

LHRH agonists (Lupron, Zoladex) s/e

A

impotence, transient cancer flare, osteoporosis

315
Q

s/e hyroxyurea (Hydrea)

A

dec’d wbc, myelosuppression

316
Q

Cisplatin (platinol) s/e

double check this one on page 179!

A

nephrotoxic, ototoxic, neuropathy

317
Q

s/e etoposide (etophophos)

double check this one on page 179!

A

myelosupp, hypotension, weakness, alopecia

318
Q

S/e IL-2

A

capillary leak syndrome, erythema

319
Q

S/E IFN alpha

A

Flu like sx, LFT inc, arthalgias, hypo/hyperthyroidism

320
Q

One 1st deg relative after age 60, when to screen for colon CA?

A

50 y/o, FIT q 1 yr + sigmoidoscopy q 10yrs or colonoscopy at 50y/o and q 10 yrs.

321
Q

colonoscopy negative with improper bowel prep, wtd?

A

repeat w/ proper prep

322
Q

Adjuvant therapy for Node (-) disease >1cms –>

A

chemotx plus endocrine therapy

323
Q

HERR-2 (+) –>

pg 148

A

trastuzumab

324
Q

tamoxifen, aromatase inh. =

Pg 148

A

endocrine therapy

325
Q

Pt had hysterectomy for Ca cervix. Post hysterectomy do you need to do a pap smear?

A

yes

326
Q

Pt discusses about PSA test. You explain that if pt is diagnosed w/ prostate Ca and treated

A

small benefit and significant harm: urinary incontinence, erectile dysfunction and bowel dysfunction

327
Q

Pt post radical prostatectomy followed by decreased PSA levels. 3 yrs later, PSA <10. Pt is asymptomatic. wtd?

A

observe

328
Q

Pt w/ metastatic prostate CA to bone refractory to LHRH agonists and anti androgens. Decrease mortality, decreased pain w/ ?

A

radium 223

329
Q

65 y/o low dose CT scan lung is positive. What will you inform patient?

A

there are more false positives than true positives

330
Q

How to diagnose hepatocellular carcinoma?

A

imaging studies

331
Q

What is 1st line treatment for hepatocellular carcinoma?

A

resection or transplant

332
Q

base of neck, by SCM lymph node

DIAGRAM on page 176!!!! there are moreeeeee

A

TB lymphoma

333
Q

Lemier’s

A

IJV thrombosis

under sternocleidomastoid cord like

334
Q

PD1, PDL 1, CTLA

S.E?

A

Rash, vitiligo, worsening of auto immune diseases

2018 ABIM Awesome Review (14 decks)

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