Cancer

Question 1

Rx for malignant ascites in palliative care

Answer 1

Furosemide
Spironolactone
Dexamethasone

Question 2

Most common type and place of pancreatic cancer

Answer 2

Adenocarcinoma, Head of the Pancreas (approx. 60-70%)

Question 3

RF for pancreatic cancer

Answer 3

Smoking
Alcohol Overuse
Diabetes
Obesity
Prior Gastrectomy/Cholecystectomy
Family History
BRCA1 Gene
Chronic Pancreatitis
Cystic Fibrosis
Peutz-Jeghers Syndrome
Atypical Multiple Moles or Melanoma Syndrome
Hereditary Nonpolyposis Colon Cancer (Lynch Syndrome)

Question 4

Cancer associated W/ celiac

Answer 4

Lymphoma of small bowel

Question 5

When to do next pap for pt with ASCUS

Answer 5

Repeat in 6mo

Question 6

Lab work up for malignancy

Answer 6

CBC, Cr, lytes, calcium, magnesium, phosphate, LFTs w/ albumin, INR, LDH, SPEP, tumor markers

Question 7

Tumor markers for
1) colon, hepatocellular
2) pancreatic
3) breast
4) ovarian
5) prostate
6) hepatocellular
7) germ cell

Answer 7

CEA = colon, hepatocellular
CA 19.9 = pancreatic
CA 15.3 = breast
CA 125 = ovarian
PSA = prostate
aFP = hepatocellular
beta-HCG = germ cell

Question 8

Ix for breast staging

Answer 8

not needed if asymptomatic, tumor <5cm + <3 nodes. Otherwise, CT chest/ abdo/ pelvis + bone scan

Question 9

Lung staging

Answer 9

CT chest/ abdo/ pelvis, bone scan, MRI brain

Question 10

Colon staging

Answer 10

CT chest/ abdo/ pelvis

Question 11

Prostate staging

Answer 11

not needed if asymptomatic, PSA <10 + Gleason <5. Otherwise, bone scan, CT abdo/ pelvis

Question 12

Lung cancer screening

Answer 12

low dose CT q1yr x 3, pts 55-74 y/o w/ >30 pack yr smoking hx who currently smoke or quit within last 15yrs

Question 13

Colorectal cancer screening, inc high risk, IBD, FAP and HNPCC

Answer 13

avg risk 50-74 FIT q2yr or sigmoid q10yr
High risk (FDR w/ colon Ca) = colonoscopy 40-50 y/o q5 yrs
IBD = q1-2 yrs colonoscopy 10 yrs after pancolitis or 15 yrs after left sided colitis
FAP = genetic counselling, flex sigmoidoscopy annually starting age 10
HNPCC = genetic counselling, colonoscopy q1-2yrs at age 20

Question 14

Most Common bladder cancer

Answer 14

Transitional (Urothelial) Cell Carcinoma

Question 15

Cancer associated with flushing, diarrhoea and bronchospasm

Answer 15

Neuroendocrine Tumor (carcinoid tumors)

Question 16

Types of thyroid cancer

Answer 16

Papillary
Follicular
Medullary
Anaplastic
* from most common to least common
* from least aggressive to most aggressive

Question 17

Ix for bony mets

Answer 17

calcium, alkaline phosphatase, LDH

Question 18

Multiple myeloma features

Answer 18

CRAB
high calcium
renal failure
anemia
bony lesions

Question 19

RF for cervical cancer

Answer 19

Sexual activity <20 y/o
Multiple partners
Smoking
Immunocompromised
Long term OCP

Question 20

Protective factors for cervical cancer

Answer 20

Routine pap
HPV immunizations

Question 21

Screening for cervical cancer

Answer 21

Q3 yrs 25-69 if ever sexually active
>70 y/o = DC if 3 consecutive negative results in 10 years
Annual screening for immunocompromised, SLE
TAHBSO = no screening
Pregnancy = same screening

Question 22

RF for colorectal cancer

Answer 22

Age >50 y/o
Family history
IBD
High fat diet
Obesity
Smoking
Excessive alcohol intake
Sedentary life

Question 23

Sx for colorectal cancer

Answer 23

Blood in stool
Change in BMs
Persistent bloating
Weakness, fatigue, wt loss
Rectal mass on DRE
Anemia

Question 24

Rx + associated complications for colorectal cancer

Answer 24

Surgery (infection, anastomosis breakdown, bleeding, adhesions)
Chemo (premature ovarian failure, dilated cardiomyopathy, secondary cancers, cognitive decline)
Radiation (weakness, paresthesia, CAD, valvular disease)
Immunotherapy (bone pain, fatigue, fever, rash, bleeding)

Question 25

Mets of colorectal cancer

Answer 25

Liver > lung > peritoneum

Question 26

RF for leukemia

Answer 26

Downs
Neurofibromatosis
Ionizing radiation
Exposure to benzene
Household pesticides
Obesity

Question 27

Sx of leukemia

Answer 27

Acute: fever, fatigue, wt loss, anemia, bleeding, hepatosplenomegaly, MSK sx in kids
Chronic: usually asymptomatic, hepatosplenomegaly

Question 28

Ix + results for leukemia

Answer 28

Anemia
Thrombocytopenia
Peripheral smear = increased hematopoietic precursor cells or increased lymphocytes
LFTs, Cr, lytes, coag
Bone marrow aspirate + biopsy
Flow cytometry

Question 29

Rx for leukemia

Answer 29

Chemo
RT
Monoclonal antibodies
Stem cell transplant

Question 30

RF for lung cancer

Answer 30

Smoking
Asbestos
Occupational exposure to dust
Occupations (miners, painters)
Personal or family hx of cancer
Hx of COPD
TB
HIV

Question 31

Sx of lung cancer

Answer 31

Clubbing
Hemoptysis
Wt loss
Anorexia
Dyspnea
Chest pain
Fatigue

Question 32

Ix for lung cancer

Answer 32

CBC, ALP, AST, ALT, Calcium, albumin, lytes, urea, Cr
Staging = CT chest abdo pelvis, bone scan, CT/ MRI brain

Question 33

Mets of lung cancer

Answer 33

Liver
Bone
Lymph
Brain

Question 34

Rx of lung cancer

Answer 34

NSCLC: stage 1 + 2 = surgery, 3 = chemo + RT, 4 = palliative
SCLC: chemo + RT

Question 35

Prevention of upper GI cancer

Answer 35

Stop smoking
Reduce alcohol
Maintain healthy weight
Increase fruit and veg consumption

Question 36

When to screen for pancreatic cancer

Answer 36

screen if high risk:
family history, high risk syndromes like Peutz-Jeghers or BRCA1 w/ affected relative

Question 37

Breast cancer treatment SE

Answer 37

cardiomyopathy, valvular dz, ovarian failure, lymphadenopathy, fatigue, secondary malignancy

Question 38

Management of radiation dermatitis

Answer 38

loose fitting clothing, avoidance of fragrances, weak topical steroids, emollients