Dermatology and Oncology

Question 1

No primary skin lesions just manifestation of liver disease

Inc SGPT
Bile acid in subcutaneous tissue
Pruritus, icterus/jaundice

Multifetal pregnancy, genetic influence

Answer 1

Intrahepatic cholestasis of pregnancy

Pruritus gravidarum

Question 2

Pruritus gravidarum Tx

Answer 2

Ursodeoxycholic acid

relief of pruritus

Question 3

Autoimmune bullous disease manifesting as plaque or pustule

Initially pruritic and urticarial palaques followed by 1-2 weeks vesicles or bullae

Periumbilical distribution with sparing of mucous membranes, scalp and face

Not related to HSV

Reaction between maternal IgG antibody and collagen 17 in basement membrane of skin and amniotic epithelium

Eosinophilic degranulation damaging dermal-epidermal junction

First pregnancy at 2nd or 3rd tri

Answer 3

Pemphigoid gestationis

Herpes gestationis

Question 4

Associated with adverse perinatal outcomes

Answer 4

Intrahepatic cholestasis of Pregnancy
Pemphigoid gestationis

Resolve following delivery without scarring

Question 5

Gold standard for Dx of Pemphigoid gestationis

Answer 5

Immunoflourescent skin tissue

Skin biopsy

Question 6

Pemphigoid gestationis Tx

Answer 6

Topical high potency corticosteroids
Oral antihistamine
Oral steroid - Prednisone 
Plasmapheresis
IV IG

Question 7

Direct immunoflouresence of peri-lesional skin showing linear deposition of C3 along BM

Answer 7

Pemphigoid gestationis

Question 8

Most common lesion in pregnancy
Cause unknown

Pregnancy-specific dermatosis with intensely pruritic 1-2mm erythematous papules that coalesce to form urticarial plaques

Late in pregnancy
Starts with striae manifesting as elevated hyperemia

Excoriations and secondary fungal infection

Rash affects abdomen and proximal thigh (97%)

Answer 8

Pruritic Urticarial Papules and Plaques of Pregnancy

Question 9

PUPPP Tx

Answer 9

Oral antihistamines
Topical corticosteroids
Emollients.

Resolves within several days of delivery
Leaves no scarring

Question 10

Most common
Dry, thickened scaly red patches

Extremity flexures, nipples, neck, face
Elevated IgE

Answer 10

Eczema

Question 11

5-10 mm itchy erythematous papules and nodules

Extensor surfaces, trunk

Answer 11

Prurigo of pregnancy

Question 12

Rare, small papules and sterile pustules

Trunk

Answer 12

Pruritic folliculitis of Pregnancy

Question 13

Surgery for neoplasm classically performed after

Answer 13

12-14 weeks to minimize abortion in first trimester

Question 14

Radiation SE

Answer 14

Microcephaly
Mental retardation

Late exposure: IUGR and brain damage

Question 15

Chemotherapy is withheld before expected delivery at

Answer 15

3 weeks before

Question 16

Tumors that frequently metastasize to placenta

Answer 16

Malignant melanoma
Leukemia
Lymphoma
Breast cancer

Question 17

In the fetus, metastasis takes place in

Answer 17

Liver
Subcutaneous tissue

80% mort

Question 18

Endocervical polyp asymptomatic in pregnancy tx

Typically (atypical glandular cells of undetermined significance) AGUS

Answer 18

Polypectomy/Excision

Question 19

HPV vaccination on pregnancy

Answer 19

Not recommended

Question 20

CIN 1, 2, 3 and adenocarcinoma in situ in pregnancy Tx

Answer 20

Allowed to delivery vaginally and further eval planned after delivery until 6 weeks postpartum

Question 21

Cervical conizariob or excision of cone shaped cylindrical wedge from cervix that includes transformation zone and all or a portion of endocervical canal may be done with

Answer 21

Loop electrosurgical excisional procedure (LEEP)

Cold knife conization

Question 22

Can develop scars in such a way that cervix will not dilate during labor

Answer 22

Cicatricial cervical stenosis

Question 23

Cervix becomes very thin and opening will be difficult to locate the external os wherein cruciate incision should be done

Avoid in pregnancy due to abortion, membrane rupture, hemorrhage and preterm delivery

Answer 23

Conglutinated cervix

Question 24

Invasive cervical cancer Dx in pregnancy

Answer 24

Cervical punch biopsy
70% stage 1
vaginal bleeding

Question 25

Stage IA1 Cervical CA tx

Answer 25

Definitive therapy until 6 weeks postpartum

Question 26

True invasive cancer more than Stage IA1 Tx

Answer 26

First half of pregnancy: immediate treatment regardless of age of gestation

Radiation: death of fetus
Curettage: labor

Later half: pregnancy safely continued until fetal viability/lung maturity; neoadjuvant chemotherapy

Question 27

Stage IA - Early stage IIA Tx

Answer 27

CS followed by radical hysterectomy with B pelvic lymph node dissection

Before 20 weeks: 12 weeks hysterectomy performed with fetus in situ (double effect)
In later pregnancy, hysterotomy first

Advanced stage: chemoradiation combination

Question 28

Leiomyoma in pregnancy

Answer 28

Asymptomatic
Chronic pain or acute pain (hemorrhagic infarction)

Tx: analgesics

Not removed in CS bec bloody and known to regress

Question 29

Corpus luteum cyst
Endometriomas
Benign cystadenomas
Mature cystic teratomas

Tx

Answer 29

Surgical removal 14-20 weeks

give time for masses that will regress to do so

Question 30

Pregnancy luteoma from luteineized stromal cells

Inc androgen 25% virilized, 50% female fetus with virilization

Tx

Answer 30

Spontaneously regress postpartum

Question 31

Large theca-lutein cyst after first tri
High HCG
More common in GTD, twins and hydrous
Resolve postpartum

Answer 31

Tx surgery not needed

Question 32

Ovarian cancer

Most common:
Germ cell
Sex cord stromal
Low malignant potential 
Epithelial tumors 

Tx

Answer 32

Surgery done at diagnosis regardless of gestation once mass is suspected to be malignant

Question 33

Can be given in diagnosis of ovarian ca while awating pulmonary maturation (after 12 weeks gestation)

Answer 33

Neoadjuvant chemotherapy

Question 34

Most frequent cancer in pregnant women

Answer 34

Breast cancer

Question 35

Protective factors for breast cancer

Answer 35

Multiparity

Breast feeding

Question 36

Most common presenting symptom of breast cancer

Answer 36

Palpable mass 90%

Question 37

Breast ca diagnosis

Answer 37

Triple test (99%)
Clinical exam
Ultrasound and mammography with abdominal shield
Biopsy

CXR with abdominal shield
Liver UTZ
Skeletal MRI without contrast

Question 38

Breast cancer Tx

Answer 38

Chemo and surgery delayed to second trimester of pregnancy

Radiation given after delivery

Question 39

It is recommended that pregnancy be delayed in breast cancer after

Answer 39

2-3 years

Question 40

Most common lymphoma in childbearing age

Painless enlargement of lymph node above diaphragm

Answer 40

Hodgkin disease

Question 41

Hodgkin Early-disease Stage Tx

Answer 41

Chemotherapy delayed and done after first trimester

After first tri, give single-agent chemotherapy (Vinblastine)

Question 42

Multi-agent tx in Hodgkin is only given

Answer 42

upon termination of pregnancy 34 weeks

Question 43

Hodgkin Advanced stage Tx

Answer 43

Full chemotherapy given regardless of AOG

Before 20 weeks, therapeutic abortion

Question 44

From B cells, T cells or NK cells

5-10% have HIV

EBV, HHVS 8, Hep C

Answer 44

Non-hodgkin disease

Tx: full tx at second trimester
Chemotherapy and immunotherapy (Rituximab)

Question 45

Leukemia Mx

Answer 45

Induction therapy during pregnancy
Post remission maintenance after pregnancy and stem-cell

Complications:
Infection and hemorrhage
Inc incidence of preterm delivery and stillbirths

Question 46

Malignant melanoma tx

Answer 46

Resection of primary tumor 
LN dissection (sentinel)

Question 47

Strongest determinant of maternal survival in malignant melanoma

Answer 47

Clinical stage

Worst prognosis: deep cutaneous invasion or regional involvement have the worst prognosis

Pregnancy avoided for 3-5 years after surgical resection

Question 48

Colon CA in pregnant Tx

Answer 48

In later pregnancy after first tri, therapy can be delayed until fetal maturation

Surgery is avoided bec lower rectal lesion ay cause dystocia or delivery may cause tumor hemorrhage

CS