Awesome review Flashcards
1
Q
BRCA 1 and 2 gene on which chromosomes
A
BRCA 1 on chromo 17
BRCA 2 on chromo 13
2
Q
HERR+ breast mass - what do you treat with?
A
Trastuzumab
3
Q
ER+ breast mass - what do you treat with?
A
If premenopausal - tamoxifen
If postmenopausal - aromatase inhibitor
4
Q
If breast mass is infiltrating ductal carcinoma, how to treat?
A
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+
5
Q
Most important prognostic factor when investigating a breast cancer is?
A
Lymph node status
6
Q
Highest risk factors for breast cancer
A
Lady that with strong family history that wears no deodorant with early menarche, zero pregnancies and late menopause
7
Q
Menstruating woman with persistent lump when examined mid cycle. Mammo negative. Ultrasound mixed echo. Fine needle asp biopsy negative. What is next step?
A
Excisional biopsy
8
Q
Best management of lymphedema
A
Progressive resistance training
9
Q
Best two medications for menopausal symptoms
A
Citalopram
Venlafaxine
10
Q
Name 3 estrogenic Effects of tamoxifen (SERM)
A
3x incr risk of endometrial ca
Incr bone density
Incr VTE
Incr hypercalcemia (if Ca++
11
Q
Treatment for Paget’s disease of the breast without mass
A
Local wide resection
12
Q
Treatment for Paget’s disease of the breast with underlying mass
A
Treat as if breast cancer
13
Q
Leading solid tumor causing hypercalcemia is?
A
Breast cancer
14
Q
Frequency of mammograms in general population
A
Biennial (every other year) in patients age 50-74 per USPTF
15
Q
Frequency of mammograms in patients recently treated for breast cancer
A
Annually
16
Q
> 30 female
Ascus +
HPV +
What to do?
A
Colposcopy!
17
Q
> 30 female
Ascus +
HPV negative
What to do
A
Repeat pap in 1 year only
18
Q
> 30 female
Ascus negative
HPV +
What to do?
A
Repeat pap in 6 months to 1 year with HPV DNA
19
Q
What age to screen for cervical cancer ?
A
Start at age 21
20
Q
Maintenance schedule of cervical cancer screening in females >30
A
Pap smear + HPV DNA testing every 5 years (if negative)
21
Q
Stop Pap smearing women over the age of…?
A
65
22
Q
Pap smear showing ASCUS, what’s next?
A
Reflex HPV testing
23
Q
Cervical cancer screening for high risk Patients that have multiple partners with STDs and HIV
A
Pap smears annually
24
Q
What does ascus stand for
A
Atypical cells of u determined significance
25
Clue cells + treatment with?
Metronidazole 500 BID X 7 days
26
Gardasil protects from which HPV serotypes?
6, 11, 16, 18
27
When is HPV vaccination contraindicated ?
During pregnancy
28
What other vaccines should be avoided in pregnancy?
HPV
MMR
Herpes
Yellow fever
Ok for ...
Hepatitis B
Influenza
Pneumococcal
29
Hysterectomy with cervix removed for benign etiology. When do perform next pap?
No more pap - ever
30
Hysterectomy with cervix removed for cervical cancer. When to perform next Pap smear?
Blind sweep vaginal walls
31
Treatment for invasive cervical cancer
Paclitaxel
Carboplatin
Bevacizumab
32
Who gets screened with pelvic ultrasound for ovarian cancer?
Dermatomyositis
| Ovarian or breast family history
33
Treatment of ovarian cancer
Hysterectomy
Salphingo oophorectomy
Omentectomy
Chemo - paclitaxel
34
Treatment of prostate cancer
```
Anti androgens
Flutamide
Nilutamide
Biclutamide
Help to block flare of prostate cancer when LHRHs used which causes increase in testosterone
```
35
Psa above what level will light up prostate cancer on bone scan?
PDs >10
36
Side effects of LHRH (leuprolide)
Hot flashes
| Osteoporosis treat with bisphosphonates
37
Side effects of anti androgens
Impaired night vision
DONT give vitamin A
Breast tenderness
38
First line therapy for multiple myeloma
Thalidomide or lenolidomide
39
Patient failed first line therapy for multiple myeloma - what to give next? And prophylaxis medication?
Bortezamib
| And acyclovir
40
Family history of prostate cancer add this medication to decrease risk of getting prostate cancer
Finasteride
41
Urinary retention can falsely increase which lab value?
PSA
42
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
43
Which COPD medication causes acute urinary retention in the elderly?
Tiotropium
44
Most common presentation of lung cancer
Persistent or increasing cough
Hemoptysis
Obstructive pneumonitis
ALWAYS IMAGE BEFORE PROCEDURE
45
Metastatic non small cell cancer treatment
Erlotinib/Gefitinib
46
Treatment of small cell lung cancer limited to one hemithorax
Chemo
Radiation lung
Radiation brain (prophylactic)
47
Treatment for extensive small cell lung cancer
Chemo
| Radiation brain
48
Treatment lung adenocarcinoma Exon 21 mutation on EGFR
Afatinib
49
Treatment of advanced adenocarcinoma of lung
Carboplatin + pemetrexel
50
Medication given to patients with brain edema with ring enhancing lesion
Dexamethasone
Also give anti seizure medication to prevent and treat seizures
51
USPTF RECOMMENDATION for low dose CT chest
55-80 year old
30 pack years
Still smoking or quit no more than 15 years ago
52
Cisplatin is the poster boy of emesis. How to prevent?
Granisetron/ondansetron plus dexamethasone plus
Aprepitant
(Substance p / neurokinin antagonist)
53
Refractory nausea and vomiting prior to chemo. What medication to give now?
Alprazolam
54
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
55
Which lung cancer can cause marantic endocarditis like multiple myeloma or lupus?
Adenocarcinoma
56
What prevents a patient with squamous cell cancer from being a surgical candidate?
Hemorrhagic effusion (mets)
57
Most important prognostic factor in a patient with advanced non small cell lung cancer
Poor performance status
58
Pan coast tumor causing chest movement asymmetry is considered worsening prognosis - why
Phrenic nerve now involved
59
```
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
```
60
Which lung cancer is usually found in the periphery as a coin lesion
Adenocarcinoma
61
Treatment for squamous cell 2cm within carina plus ipsilateral hilar adenopathy and lymph node +
Resection
Chemo
RT
62
Treatment for Adenocarcinoma >2cm from carina with lymph node negativity
Resection
| Chemo
63
Treatment for Large cell carcinoma at carina and contralateral lymph node
Chemo
| RT
64
Definitive treatment of SVC syndrome
RT is superior to chemo ESP if no specified cancer identified
65
Lung cancer completely refractory to all pain medications like opiates. What do u use next
Strontium 89
66
Hospice care considered if you have less than ___ months to live
6 months
67
Which group of testicular germ cell cancer is responsive to radiation ?
Seminomas!!!
| Always do RT unless extensive disease beyond RP nodes (then do chemo)
68
Which group of germ cell testicular cancers make high amounts of alphafetoprotein and bHCG?
Non seminomas
69
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
```
70
Best two kinds of Hodgkin's lymphoma and worse two kinds
Best
Lymphocyte predominance and modular sclerosis
Worst
Mixed cellularity and lymphocyte depletion
71
Treatment for Hodgkin's disease
ABVD +/- RT
Doxorubicin
Blew thin
Vinblastine
Dacarbazine
72
Hodgkin's relapse or poor response to first line treatment - now what?
High dose chemo and autologous stem cell transplant
73
Hodgkin's lymphoma failing chemo and stem cell transplant !! Now what ??
Brentuximab
74
Two common Side effects of brentuximab
Neuropathy
| Neutropenia
75
Hodgkin's lymphoma spread of cancer is ...
Contiguously
76
Non Hodgkin lymphoma spread of cancer is ...
Hematogenously
77
Type of non Hodgkin lymphoma is follicular lymphoma with translocation ...
(t 14:18)
78
Type of non Hodgkin lymphoma is diffuse large B cell lymphoma on gene ...
BCL 6
79
Diagnose non Hodgkin lymphoma by ...
Excisional biopsy of lymph nodes (ESP if there is a supraclavicular LN)
80
Primary treatment for non Hodgkin lymphoma
R CHOP or CVP
```
Rituximab
Cyclophosphamide
Hydroxydaunorubicin (doxorubicin)
Oncovin (vincristine)
Prednisone/prednisolone
```
81
Treatment of non Hodgkin lymphoma relapse
Chemo
| Stem cell transplant
82
Name five poor prognostic factors of non Hodgkin lymphoma
Age > 60
Serum LDH increased
Performance status
83
HPV serotypes associated with cervical cancer
HPV 16, 18, 31
84
Treatment of follicular small cell lymphoma found on lymph node with preserved architecture in asx patient.
Local RT
85
Treatment of large cell lymphoma
RCHOP
86
Patient with small cell lung cancer with recurrent pleural effusions - what to do?
Talc instillation
87
Patient with breast cancer, non small cell lung cancer or lymphoma now with recurrent pleural effusions. What to do?
Chemotherapy
88
Treatment of multiple myeloma with end organ damage
Lenolidomide
Melphalan
Prednisone
89
Treatment of multiple myeloma RELAPSE; what kind of prophylaxis do you need?
Bortezomib
| Acyclovir for herpes zoster ppx
90
How to monitor MGUS which can transform into MM
Follow up labs (CBC Chem serum protein electrophoresis serum FLC assay) every 6 months
91
Smoldering asymptomatic multiple myeloma monitoring schedule
Follow up Myeloma protein every 2 months
92
Bone marrow shows plasmacytoid lymphocytes - what is the diagnosis?
Waldenstrom's macroglobulinemia
93
Treatment of waldenstrom's macroglobulinemia
Plasmapheresis for the hyper-viscosity and fludarabine
| purine analog interferes with DNA synthesis
94
Treatment of pancreatic cancer with no mets
Pancreaticduodenectomy and still give chemo with gemcitabine and nab-paclitaxel
95
Treatment of Pancreatic cancer with mets
Palliative stent placement
Gemcitabine
Nab-Paclitaxel
96
Treatment for severe pruritus in end stage pancreatic cancer
Biliary stent
97
Diabetes makes one more prone to which cancer?
Pancreatic cancer !
98
Diagnosis for hyperglycemia with scaly necrotizing dermatitis
Glucagonoma
99
Osmolar gap in patients with diarrhea caused by VIPoma. What is the treatment?
Ocreotide
100
What micronutrient deficiency causes hyperglycemia
Chromium deficiency
101
What micronutrient deficiency causes necrotic rash
Zinc deficiency
102
Sentinel loop sign is found in?
Acute pancreatitis
103
Eponym for migratory thrombophlebitis
Trousseau's syndrome
104
Eponym for palpable gallbladder
Courvoisier's sign
105
Test 5HIAA for which cancer?
Carcinoid cancer
106
Best surveillance for liver cancer ?
Liver ultrasounds NOT AFP
107
Cirrhotic Patient with >1 cm liver lesion - what's next step
3 phase CT scan / MRI with contrast
108
First line treatment of hepatocellular carcinoma
Resection or transplant
109
Which agent has been shown survival benefit in hepatocellular carcinoma
Sorafinib
110
Which thyroid cancer associated with MEN 2 and 3?
Medullary thyroid cancer
RET protooncogene with calcitonin increased
111
Treatment of medullary thyroid cancer
Total thyroidectomy
112
Best management for papillary and follicular thyroid carcinoma after surgical removal
Radioactive iodine ablation
113
Why doesn't radioactive iodine ablation work for medullary thyroid cancer
Because iodine is not taken up by C cells !!!
114
Follow this lab level to look for medullary thyroid cancer recurrence
Calcitonin
115
Lab value to follow to rule out Papillary and follicular cancer recurrence
Thyroglobulin level
116
Diagnostic test needed for aromatase inhibitors?
DXA scan due to osteoporosis risk
117
When do you give Prophylaxis/prevention for breast Cancer?
Premenopausal- Tamoxifen
Postmenopausal- AI
Gail Model Risk > 1.7%
Lobular carcinoma in situ
Atypical hyperplasia
118
Treat anal cancer of anal margin
Surgery
119
Treat anal cancer of anal canal mucosa
External beam radiation and 5FU/Mitomycin
120
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
