Board Vitals Oncology Flashcards
What cancer most commonly metastasizes to the heart?
Melanoma
Which malignancy is the most common cause of pericardial effusion?
Lung cancer
Which malignancy is the most common cause of pericardial metastasis?
Lung cancer
Are malignant pericardial effusions likely to recur after drainage?
Yes
What is the treatment of a recurrent pericardial effusion due to malignancy in a patient who has adequate life expectancy and wishes to manage the condition?
Pericardial window
Other than lung carcinoma, which most commonly causes malignant pericardial effusions, which other (two) cancers account for about 40% of malignant pericardial effusions?
Lymphoma
Breast cancer
Will patients with platinum-sensitive ovarian cancer who relapse more than 6 months following treatment, respond to platinum-based therapy again?
Yes
What happens to the calcium level in tumor lysis syndrome?
Hypocalcemia
Hemorrhagic cystitis is caused by which chemotherapy drug?
Cyclophosphamide
What is the next step after diagnosing Hodgkin’s lymphoma on biopsy?
FDG-PET/CT scan
Is flow cytometry immunotyping used in Hodgkin’s lymphoma?
No (limited Reed Sternberg cells)
What does the presence of Reed Sternberg cell on biopsy indicate?
Hodgkin’s lymphoma
Is fluorescent in-situ hybridization (FISH) used in Hodgkin’s lymphoma?
No
What hematologic condition is associated with t(15;17) fusion?
Acute promyelocytic leukemia
What is the treatment of acute promyelocytic leukemia?
All-trans retinoic acid + another agent such as arsenic trioxide
What is the treatment of non-promyelocytic acute myeloid leukemia?
Cytarabine + daunorubincin (7 + 3)
Why is acute promyelocytic leukemia not treated with just all-trans retinoic acid?
Monotherapy results in short term remissions
Patient with history of malignancy has abrupt appearance of tender or painful erythematous papules and plaques, along with fevers, myalgias, arthralgias, and leukocytosis.
Diagnosis?
Sweet syndrome
Is CEA useful in diagnosing testicular cancer?
No
What is the initial study in a patient with a testicular mass?
Testicular ultrasound
What is the next step after flow cytometry and immunophenotype is consistent with chronic lymphocytic leukemia, in a patient with symptomatic anemia?
Direct antiglobulin test (DAT)
CLL is associated with various autoimmune disorders processes.
What kind of abnormalities does FISH detect?
Cytogenetic abnormalities
Which virus is associated with nasopharyngeal carcinoma (squamous cell)?
Epstein-Barr Virus
What virus is associated with primary central nervous system lymphoma in immunocompromised patients?
Epstein-Barr Virus
Which virus is associated with oropharyngeal squamous cell carcinoma?
Human papillomavirus
Which virus is associated with mucoepidermoid carcinoma?
Cytomegalovirus
Which virus is associated with T-cell leukemia or lymphoma?
Human T-cell leukemia retrovirus 1 (HTLV-1)
Which virus is associated with Kaposi sarcoma?
Human herpesvirus 8 (HHV-8)
What is the greatest preventable risk factor for bladder cancer (urothelial carcinoma) in the general population?
Smoking
Is urothelial cancer more common in males or females?
Males
Is excess alcohol a risk factor for urothelial carcinoma?
Maybe - it has not been proven
Is excess alcohol a risk factor for hepatocellular carcinoma?
Yes
What should you do for breast papillomas with atypical cells?
Excision
What should you do for breast papillomas without atypical cells?
Observation
Do breast papillomas increase the high of developing breast cancer?
Yes
In what age range does intraductal papilloma occur?
35 - 55 years
What age group gets Hodgkin’s lymphoma?
15 - 35 years
Reed-Sternberg cells.
Diagnosis?
Hodgkin’s lymphoma
Should leukapheresis be used in patients with acute promyelocytic leukemia?
No (survival benefit unclear and worsens intrinsic coagulopathy)
Can you start induction chemotherapy on a patient with acute promyelocytic leukemia who is intubated and on mechanical ventilation?
Yes
When is ovarian function suppression used in hormone receptor positive breast cancer patients?
When there is high risk of recurrence
Are aromatase inhibitors such as anastrozole effective as monotherapy in post-menopausal women with receptor positive breast cancer?
Yes
Are aromatase inhibitors such as anastrozole effective as monotherapy in pre-menopausal women with receptor positive breast cancer?
No - need to be used with ovarian function suppression.
What medication can be used as ovarian function suppression in hormone receptor positive breast cancer?
Leuprolide
Which hormone therapy is recommended for premenopausal women with low-risk, early stage, resected breast cancer?
Tamoxifen
Which chemotherapy drug is associated with the most nephrotoxicity?
Cisplatin
What is the most common type of carcinoma in the duodenum?
Adenocarcinoma
What is the most common type of carcinoma in the ileum?
Carcinoid
What are atypical B lymphocytes with bilobed nuclei called?
Reed-Sternberg cells
Reed-Sternberg cells are seen in which disease?
Hodgkin’s lymphoma
Do Reed-Sternberg cells in Hodgkin’s lymphoma express CD20?
No
Do Reed-Sternberg cells in Hodgkin’s lymphoma express CD30?
Yes
Do Reed-Sternberg cells in Hodgkin’s lymphoma express CD15?
Yes
What is the renal insufficiency typically from in tumor lysis syndrome?
Uric acid nephropathy (accumulation of uric acid crystals in the tubules)
Does obstructive nephropathy in tumor lysis syndrome result from uric acid stone formation or crystal deposition?
Crystal deposition
What is the treatment of small cell lung cancer with mediastinal lymph node involvement?
Etoposide + cisplatin (EP) followed by radiotherapy
What percentage of primary lymphomas of the gastrointestinal tract occur in the stomach?
75%
What percentage of small bowel neoplasms are sarcomas?
10%
What the most cardiotoxic chemotherapy drug?
Doxorubicin
Chromosomal arrangement: T(12,21)
Diagnosis?
Acute lymphocytic leukemia (ALL)
Chromosomal arrangement: T(14,18)
Diagnosis?
Follicular lymphoma
Chromosomal arrangement: T(8,14)
Diagnosis?
Acute lymphocytic leukemia (ALL)
Chromosomal arrangement: T(9,22)
Diagnosis?
Chronic myelogenous leukemia (CML)
Chromosomal arrangement: T(15,17)
Diagnosis?
Acute promyelocytic leukemia (AML)
What’s the next step when a mediastinal mass is found to be causing superior vena cava syndrome?
Biopsy and tissue diagnosis
What is the name of recurrent or migratory thrombophlebitis associated with visceral carcinoma?
Trousseau’s syndrome
What is the clonal population of bone marrow plasma cells in monoclonal gammopathy of undetermined significance (MGUS)?
Less than 10%
When are TKIs used to treat CML safe to discontinue?
Duration of 3 or more years
Complete molecular response for 2 or more years
What is the most likely source of a HPV-related squamous cell carcinoma of the head and neck?
Lingual and palatine tonsils
What the P16 positivity in squamous cell carcinoma indicate?
Tumorigenesis is in some way mediated by HPV
What is the treatment of BRAF negative metastatic malignant melanoma?
Ipilimumab plus nivolumab
Is dacabazine used as first line therapy in metastatic melanoma?
No
What does the presence of anti-N-methyl-D-aspartate receptor (NMDAR) antibodies indicate in a patient with neurologic symptoms?
Paraneoplastic neurologic syndrome
What are the most common tumors associated with anti-NMDA receptor encephalitis?
Ovarian teratomas
What is the next step in a patient with known follicular lymphoma now with new constitutional symptoms and a rapidly growing lymph node?
Biopsy (can have histologic transformation)
What is the treatment for progressive follicular lymphoma?
Rituximab
How is staging done in non-Hodgkin’s lymphoma?
- PET/CT
- Bone marrow biopsy of FDG-avid nodal lymphomas
Which histologic types (3) of colon cancer are associated with a poor prognosis?
- Signet cell adenocarcinoma
- Poorly differentiated adenocarcinoma
- Undifferentiated adenocarcinoma
Does the location of the colon matter - which side has a more favorable prognosis?
Yes - Left sided colon cancers have a more favorable prognosis than right sided colon cancers.
Does colon cancer with a KRAS mutation have a better or worse prognosis compared to colon cancer with the mutation?
Worse prognosis
Are higher pre-operative CEA levels associated with better or worse prognosis in colon cancer?
Worse prognosis
Patient’s on chronic opioid therapy need to be screen with the 4 A’s - what are they?
- Analgesia
- Adverse effects
- Aberrant behaviors
- Activity
Patient has multiple trichilemmomas, hamartomatous polyps throughout the gastrointestinal (GI) tract, fibrocystic breast disease, and an increased risk of breast and thyroid cancer.
Diagnosis?
Cowden syndrome
Patient has mucosal lentingines and hamartomatous polyps throughout the GI tract; there is an increased risk of breast, ovarian, and GI cancer.
Diagnosis?
Peutz-Jehgers syndrome
What syndrome is caused by a STK11 mutation?
Peutz-Jehgers syndrome
A mutation in which gene causes Cowden syndrome?
PTEN
What is the initial step in tumor lysis syndrome management?
Hydration
The negative predicative value is the probability that the person does not have the disease when the test results are negative.
True or false?
True
Which virus is associated with nasopharyngeal squamous cell carcinoma?
Epstein-Barr virus
Can neutropenic fever be treated outpatient?
Yes - if considered low risk for complications based on MASCC Risk-Index and CISNE scores
What is the outpatient treatment of neutropenic fever?
Ciprofloxacin plus amoxicillin-clavulanate
What should you do in a patient presenting with back pain and lower extremity weakness who has cancer?
- Glucocorticoids
- Urgent spine imaging
(Concern for spinal cord compression)
Which tumor marker is associated with pancreatic cancer?
CA19-9
