Erickson's Rapid Fire Questions Flashcards
What is a PARP Inhibitor (mechanism of action and who gets it)
MOA: PARP is a protein important for repair of single strand DNA breaks. If inhibited, cells are too damaged, and can’t replicate
**Note BRCA are proteins important for repair of DOUBLE strand DNA breaks via homologous recombination
Given for 3rd/4th line treatment and for maintenance after first recurrence
What cancers are BRCA+ patients predisposed to?
Breast, Ovarian, Fallopian Tube, Primary peritoneal
ALSO* melanoma, pancreas, prostate, UTERINE SEROUS
**only screen for breast/ovary
How should you screen for breast cancer in pts with BRCA+ (or high risk family history)
Annual mammography + MRI + clinical exam
If < 30 yo (MRI only)
**all should be offered a bilateral mastectomy
What are recommendations for tubes/ovaries/uterus for BRCA+ patients
BRCA1 - BSO by age 35-40
BRCA2- BSO by age 40-45
Screening with Ca-125 and TVUS is NOT recommended!
Breast cancer risk up to 80%
Ovarian cancer risk 40-50% for BRCA 1 (younger)
Ovarian cancer risk 10-30% for BRCA2 (older)
Which ovarian cancer patients should be referred for genetic counseling?
ALL EPITHELIAL OVARIAN CANCER
also all breast cancer patients
if your patients mom had ovarian cancer and she did not get tested (and is deceased) then send your patient for genetic counseling!
How can you screen for Lynch? How do you diagnose Lynch?
Screen by testing the TUMOR FIRST
- IHC for MMR proteins
If absent expression, then perform germline testing
How do you screen if your patient is Lynch Positive?
Annual colonoscopy
Annual EmBx/TVUS
?Ca-125
Eventual TAH/BSO
Risk for ovary, upper GI, renal (no breast)
***Mismatch repair DNA
Most common palpable breast mass in young woman
Fibroadenoma
Your patient is 60 years old on tamoxifen, she has vaginal bleeding, what do you need to do?
Em Bx
Tamoxifen has increased risk for CAH and EmCa
Woman with Hx of Stage IA Grade 1 Endometrial Cancer, what is recommended for surveillance?
Clinical/Pelvic Exam q3-6 months
No routine imaging
No pap
Treatment for vulvar Paget’s Disease
Wide Local Excision
- Remember: Risk of underlying adenocarcinoma
- Remember: Foamy cells
- Remember: Bartholins gland carcinoma (always worry about cancer if postmenopausal issues with bartholin’s gland)
What are the most common HPV Types?
HPV 16, HPV18 (70%)
-HPV 16 is the worst
Protein E6 – P53
Protein E7 - Rb
When do you initiate Pap Testing?
21!!!!! No sooner!!!!!
Every 3 years in the 20s
At 30 DO COTESTING! REGARDLESS!
HIV/Immunocompromised= annual cytology
Female partner= routine pap screening (many have had a male partner)
Pregnant patients= routine pap screening
Your pt is 30. You co-test her because you known the guidelines. Pap is negative. HPV test is positive. What do you do?
3 OPTIONS:
- Colpo
- Test for HPV 16/18 (if positive, colpo)
- Repeat cotesting in 1 year
What is the management of an Atypical Glandular Cell pap?
Colpo
ECC
EmBx if >35 or risk factors
What is the management of CIN2/HGSIL in patient less than 25?
- Observation w colpo q 6 months (preferred)
- LOOP
What is the management of AIS
- CKC and then ultimately definitive Hysterectomy!
- If they want fertility, could do CKC, but need close followup
What is the management of Stage 1A1 cervical cancer?
- 1A1: <3x7mm (microinvasive, no visible lesion)
- CKC is definitive
- Simple Hyst also acceptable.
What is the management of Stage 1A1 cervical cancer in pregnancy?
- Can do a small LOOP/CKC in pregnancy, but scary
Postpartum CKC
*Remember: 1B1 needs a C-Rad Hyst after +FLM
Do women who have had hysterectomies need pap smears?
A: NO!!!!
- unless hyst was for persistent CIN3, then they need annual cytology for ~25 years
What is the treatment for Early stage vulvar cancer (stage 1 = confined to vulva)?
- Radical vulvectomy.
- LND (bilateral if midline or within 2 cm of midline)
- Sentinel nodes now sexy if small lesion
*1A1 = Depth of invasion <1mm and tumor <2cm = WLE only, no nodes
What if LN+ after vulvectomy and LND?
- pelvic and groin chemoradiation
You have a 21 year old patients with an LSIL pap. She asks you if she can still get the “cervical cancer vaccine”. Can she?
yes!
How do you treat recurrent cervical cancer?
- If isolated central pelvic recurrence= exent
- widely metastatic: palliative chemo vs supportive care
- Carbo/taxol/bevicizumab
Are dermoid tumors benign or malignant?
Benign
*Can have SCC differentiation
How do you treat vaginal cancer?
Early stage (st 1, epithelium only) SURGERY
Stage 2 or greater: CHEMORADIATION
How do you treat complex atypical hyperplasia in a 27 year old P0?
Give progesterone or IUD if they want fertility
Need q 3-6 month endometrial sampling
Fallopian tube cancer- what one symptom is pathognomonic
Weird, watery discharge
How do you treat neutropenic fever?
-Culture
Antibiotics (3rd gen ceph, Zosyn)
IVF
No GCSF if febrile
*remember: ppx antibiotics do not prevent neutropenic fevers
*remember: most of the time, no source identified
Numbness in thigh post op, what nerve was injured
Genitofemoral
Describe a Maylard and Cherney incision
Maylard: Cut the rectus. Sacrifice the superior hypogastrics
Cherney: detach the rectus from the pubic symphasis then reattach before you close (ask Dr Varner to show you)
*Use for radicals or if you need more room.
What is the best IVF for septic shock resuscitation?
LR
Pt has anaphylaxis to IV contrast dye. What do you give them to prevent a reaction?
Dexamethasone + Benadryl
Mucomyst for renal protection
