Awesome review Flashcards
BRCA 1 and 2 gene on which chromosomes
BRCA 1 on chromo 17
BRCA 2 on chromo 13
HERR+ breast mass - what do you treat with?
Trastuzumab
ER+ breast mass - what do you treat with?
If premenopausal - tamoxifen
If postmenopausal - aromatase inhibitor
If breast mass is infiltrating ductal carcinoma, how to treat?
Wide excision w/clean margins + RT IF: LN neg, no adjuvant chemo if 1cm OR pos, yes adjuvant chemo Tamoxifen/AI if ER+ Trastuzumab if HERR+
Most important prognostic factor when investigating a breast cancer is?
Lymph node status
Highest risk factors for breast cancer
Lady that with strong family history that wears no deodorant with early menarche, zero pregnancies and late menopause
Menstruating woman with persistent lump when examined mid cycle. Mammo negative. Ultrasound mixed echo. Fine needle asp biopsy negative. What is next step?
Excisional biopsy
Best management of lymphedema
Progressive resistance training
Best two medications for menopausal symptoms
Citalopram
Venlafaxine
Name 3 estrogenic Effects of tamoxifen (SERM)
3x incr risk of endometrial ca
Incr bone density
Incr VTE
Incr hypercalcemia (if Ca++
Treatment for Paget’s disease of the breast without mass
Local wide resection
Treatment for Paget’s disease of the breast with underlying mass
Treat as if breast cancer
Leading solid tumor causing hypercalcemia is?
Breast cancer
Frequency of mammograms in general population
Biennial (every other year) in patients age 50-74 per USPTF
Frequency of mammograms in patients recently treated for breast cancer
Annually
> 30 female
Ascus +
HPV +
What to do?
Colposcopy!
> 30 female
Ascus +
HPV negative
What to do
Repeat pap in 1 year only
> 30 female
Ascus negative
HPV +
What to do?
Repeat pap in 6 months to 1 year with HPV DNA
What age to screen for cervical cancer ?
Start at age 21
Maintenance schedule of cervical cancer screening in females >30
Pap smear + HPV DNA testing every 5 years (if negative)
Stop Pap smearing women over the age of…?
65
Pap smear showing ASCUS, what’s next?
Reflex HPV testing
Cervical cancer screening for high risk Patients that have multiple partners with STDs and HIV
Pap smears annually
What does ascus stand for
Atypical cells of u determined significance
Clue cells + treatment with?
Metronidazole 500 BID X 7 days
Gardasil protects from which HPV serotypes?
6, 11, 16, 18
When is HPV vaccination contraindicated ?
During pregnancy
What other vaccines should be avoided in pregnancy?
HPV
MMR
Herpes
Yellow fever
Ok for …
Hepatitis B
Influenza
Pneumococcal
Hysterectomy with cervix removed for benign etiology. When do perform next pap?
No more pap - ever
Hysterectomy with cervix removed for cervical cancer. When to perform next Pap smear?
Blind sweep vaginal walls
Treatment for invasive cervical cancer
Paclitaxel
Carboplatin
Bevacizumab
Who gets screened with pelvic ultrasound for ovarian cancer?
Dermatomyositis
Ovarian or breast family history
Treatment of ovarian cancer
Hysterectomy
Salphingo oophorectomy
Omentectomy
Chemo - paclitaxel
Treatment of prostate cancer
Anti androgens Flutamide Nilutamide Biclutamide Help to block flare of prostate cancer when LHRHs used which causes increase in testosterone
Psa above what level will light up prostate cancer on bone scan?
PDs >10
Side effects of LHRH (leuprolide)
Hot flashes
Osteoporosis treat with bisphosphonates
Side effects of anti androgens
Impaired night vision
DONT give vitamin A
Breast tenderness
First line therapy for multiple myeloma
Thalidomide or lenolidomide
Patient failed first line therapy for multiple myeloma - what to give next? And prophylaxis medication?
Bortezamib
And acyclovir
Family history of prostate cancer add this medication to decrease risk of getting prostate cancer
Finasteride
Urinary retention can falsely increase which lab value?
PSA
Treatment for metastatic prostate cancer refractory to LHRH agonists and anti androgens ?
Radium 223 (decreases pain and mortality)
The following only decreased mortality:
Abiraterone-prednisone
Enzalutamide
Docetaxel + prednisone
Which COPD medication causes acute urinary retention in the elderly?
Tiotropium
Most common presentation of lung cancer
Persistent or increasing cough
Hemoptysis
Obstructive pneumonitis
ALWAYS IMAGE BEFORE PROCEDURE
Metastatic non small cell cancer treatment
Erlotinib/Gefitinib
Treatment of small cell lung cancer limited to one hemithorax
Chemo
Radiation lung
Radiation brain (prophylactic)
Treatment for extensive small cell lung cancer
Chemo
Radiation brain
Treatment lung adenocarcinoma Exon 21 mutation on EGFR
Afatinib
Treatment of advanced adenocarcinoma of lung
Carboplatin + pemetrexel
Medication given to patients with brain edema with ring enhancing lesion
Dexamethasone
Also give anti seizure medication to prevent and treat seizures
USPTF RECOMMENDATION for low dose CT chest
55-80 year old
30 pack years
Still smoking or quit no more than 15 years ago
Cisplatin is the poster boy of emesis. How to prevent?
Granisetron/ondansetron plus dexamethasone plus
Aprepitant
(Substance p / neurokinin antagonist)
Refractory nausea and vomiting prior to chemo. What medication to give now?
Alprazolam
Pain in shoulder with radiation of ulnar aspect of hand and little finger. What do you suspect and how to detect it?
Pancoast tumor
Diagnose with CXR
Which lung cancer can cause marantic endocarditis like multiple myeloma or lupus?
Adenocarcinoma
What prevents a patient with squamous cell cancer from being a surgical candidate?
Hemorrhagic effusion (mets)
Most important prognostic factor in a patient with advanced non small cell lung cancer
Poor performance status
Pan coast tumor causing chest movement asymmetry is considered worsening prognosis - why
Phrenic nerve now involved
Which lung cancers are associated with these paraneoplastic syndromes? Gynecomastia Hypercalcemia Eaton Lambert ACTH producing SIADH
Large cell Squamous cell Small cell Small cell Small cell
Which lung cancer is usually found in the periphery as a coin lesion
Adenocarcinoma
Treatment for squamous cell 2cm within carina plus ipsilateral hilar adenopathy and lymph node +
Resection
Chemo
RT
Treatment for Adenocarcinoma >2cm from carina with lymph node negativity
Resection
Chemo
Treatment for Large cell carcinoma at carina and contralateral lymph node
Chemo
RT
Definitive treatment of SVC syndrome
RT is superior to chemo ESP if no specified cancer identified
Lung cancer completely refractory to all pain medications like opiates. What do u use next
Strontium 89
Hospice care considered if you have less than ___ months to live
6 months
Which group of testicular germ cell cancer is responsive to radiation ?
Seminomas!!!
Always do RT unless extensive disease beyond RP nodes (then do chemo)
Which group of germ cell testicular cancers make high amounts of alphafetoprotein and bHCG?
Non seminomas
Steps for male symmetrical gynecomastia
Check testosterone and estradiol levels If estradiol elevated Check ultrasound testes If normal CT adrenals r/o germ cell Tumor
Best two kinds of Hodgkin’s lymphoma and worse two kinds
Best
Lymphocyte predominance and modular sclerosis
Worst
Mixed cellularity and lymphocyte depletion
Treatment for Hodgkin’s disease
ABVD +/- RT
Doxorubicin
Blew thin
Vinblastine
Dacarbazine
Hodgkin’s relapse or poor response to first line treatment - now what?
High dose chemo and autologous stem cell transplant
Hodgkin’s lymphoma failing chemo and stem cell transplant !! Now what ??
Brentuximab
Two common Side effects of brentuximab
Neuropathy
Neutropenia
Hodgkin’s lymphoma spread of cancer is …
Contiguously
Non Hodgkin lymphoma spread of cancer is …
Hematogenously
Type of non Hodgkin lymphoma is follicular lymphoma with translocation …
(t 14:18)
Type of non Hodgkin lymphoma is diffuse large B cell lymphoma on gene …
BCL 6
Diagnose non Hodgkin lymphoma by …
Excisional biopsy of lymph nodes (ESP if there is a supraclavicular LN)
Primary treatment for non Hodgkin lymphoma
R CHOP or CVP
Rituximab Cyclophosphamide Hydroxydaunorubicin (doxorubicin) Oncovin (vincristine) Prednisone/prednisolone
Treatment of non Hodgkin lymphoma relapse
Chemo
Stem cell transplant
Name five poor prognostic factors of non Hodgkin lymphoma
Age > 60
Serum LDH increased
Performance status
HPV serotypes associated with cervical cancer
HPV 16, 18, 31
Treatment of follicular small cell lymphoma found on lymph node with preserved architecture in asx patient.
Local RT
Treatment of large cell lymphoma
RCHOP
Patient with small cell lung cancer with recurrent pleural effusions - what to do?
Talc instillation
Patient with breast cancer, non small cell lung cancer or lymphoma now with recurrent pleural effusions. What to do?
Chemotherapy
Treatment of multiple myeloma with end organ damage
Lenolidomide
Melphalan
Prednisone
Treatment of multiple myeloma RELAPSE; what kind of prophylaxis do you need?
Bortezomib
Acyclovir for herpes zoster ppx
How to monitor MGUS which can transform into MM
Follow up labs (CBC Chem serum protein electrophoresis serum FLC assay) every 6 months
Smoldering asymptomatic multiple myeloma monitoring schedule
Follow up Myeloma protein every 2 months
Bone marrow shows plasmacytoid lymphocytes - what is the diagnosis?
Waldenstrom’s macroglobulinemia
Treatment of waldenstrom’s macroglobulinemia
Plasmapheresis for the hyper-viscosity and fludarabine
purine analog interferes with DNA synthesis
Treatment of pancreatic cancer with no mets
Pancreaticduodenectomy and still give chemo with gemcitabine and nab-paclitaxel
Treatment of Pancreatic cancer with mets
Palliative stent placement
Gemcitabine
Nab-Paclitaxel
Treatment for severe pruritus in end stage pancreatic cancer
Biliary stent
Diabetes makes one more prone to which cancer?
Pancreatic cancer !
Diagnosis for hyperglycemia with scaly necrotizing dermatitis
Glucagonoma
Osmolar gap in patients with diarrhea caused by VIPoma. What is the treatment?
Ocreotide
What micronutrient deficiency causes hyperglycemia
Chromium deficiency
What micronutrient deficiency causes necrotic rash
Zinc deficiency
Sentinel loop sign is found in?
Acute pancreatitis
Eponym for migratory thrombophlebitis
Trousseau’s syndrome
Eponym for palpable gallbladder
Courvoisier’s sign
Test 5HIAA for which cancer?
Carcinoid cancer
Best surveillance for liver cancer ?
Liver ultrasounds NOT AFP
Cirrhotic Patient with >1 cm liver lesion - what’s next step
3 phase CT scan / MRI with contrast
First line treatment of hepatocellular carcinoma
Resection or transplant
Which agent has been shown survival benefit in hepatocellular carcinoma
Sorafinib
Which thyroid cancer associated with MEN 2 and 3?
Medullary thyroid cancer
RET protooncogene with calcitonin increased
Treatment of medullary thyroid cancer
Total thyroidectomy
Best management for papillary and follicular thyroid carcinoma after surgical removal
Radioactive iodine ablation
Why doesn’t radioactive iodine ablation work for medullary thyroid cancer
Because iodine is not taken up by C cells !!!
Follow this lab level to look for medullary thyroid cancer recurrence
Calcitonin
Lab value to follow to rule out Papillary and follicular cancer recurrence
Thyroglobulin level
Diagnostic test needed for aromatase inhibitors?
DXA scan due to osteoporosis risk
When do you give Prophylaxis/prevention for breast Cancer?
Premenopausal- Tamoxifen
Postmenopausal- AI
Gail Model Risk > 1.7%
Lobular carcinoma in situ
Atypical hyperplasia
Treat anal cancer of anal margin
Surgery
Treat anal cancer of anal canal mucosa
External beam radiation and 5FU/Mitomycin
In addition to colonoscopies, what other postoperative surveillance needed for colorectal cancer stage 3?
Physical examination
CEA every 3-6 months
CT scans chest and abdomen annually for 3-5 years