Erickson's Rapid Fire Questions

Question 1

What is a PARP Inhibitor (mechanism of action and who gets it)

Answer 1

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

Question 2

What cancers are BRCA+ patients predisposed to?

Answer 2

Breast, Ovarian, Fallopian Tube, Primary peritoneal

ALSO* melanoma, pancreas, prostate, UTERINE SEROUS

**only screen for breast/ovary

Question 3

How should you screen for breast cancer in pts with BRCA+ (or high risk family history)

Answer 3

Annual mammography + MRI + clinical exam

If < 30 yo (MRI only)

**all should be offered a bilateral mastectomy

Question 4

What are recommendations for tubes/ovaries/uterus for BRCA+ patients

Answer 4

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)

Question 5

Which ovarian cancer patients should be referred for genetic counseling?

Answer 5

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!

Question 6

How can you screen for Lynch? How do you diagnose Lynch?

Answer 6

Screen by testing the TUMOR FIRST
- IHC for MMR proteins

If absent expression, then perform germline testing

Question 7

How do you screen if your patient is Lynch Positive?

Answer 7

Annual colonoscopy
Annual EmBx/TVUS
?Ca-125
Eventual TAH/BSO

Risk for ovary, upper GI, renal (no breast)

***Mismatch repair DNA

Question 8

Most common palpable breast mass in young woman

Answer 8

Fibroadenoma

Question 9

Your patient is 60 years old on tamoxifen, she has vaginal bleeding, what do you need to do?

Answer 9

Em Bx

Tamoxifen has increased risk for CAH and EmCa

Question 10

Woman with Hx of Stage IA Grade 1 Endometrial Cancer, what is recommended for surveillance?

Answer 10

Clinical/Pelvic Exam q3-6 months

No routine imaging
No pap

Question 11

Treatment for vulvar Paget’s Disease

Answer 11

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)

Question 12

What are the most common HPV Types?

Answer 12

HPV 16, HPV18 (70%)
-HPV 16 is the worst
Protein E6 – P53
Protein E7 - Rb

Question 13

When do you initiate Pap Testing?

Answer 13

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

Question 14

Your pt is 30. You co-test her because you known the guidelines. Pap is negative. HPV test is positive. What do you do?

Answer 14

3 OPTIONS:

• Colpo
• Test for HPV 16/18 (if positive, colpo)
• Repeat cotesting in 1 year

Question 15

What is the management of an Atypical Glandular Cell pap?

Answer 15

Colpo
ECC
EmBx if >35 or risk factors

Question 16

What is the management of CIN2/HGSIL in patient less than 25?

Answer 16

• Observation w colpo q 6 months (preferred)

- LOOP

Question 17

What is the management of AIS

Answer 17

• CKC and then ultimately definitive Hysterectomy!

- If they want fertility, could do CKC, but need close followup

Question 18

What is the management of Stage 1A1 cervical cancer?

Answer 18

• 1A1: <3x7mm (microinvasive, no visible lesion)
• CKC is definitive
• Simple Hyst also acceptable.

Question 19

What is the management of Stage 1A1 cervical cancer in pregnancy?

Answer 19

• Can do a small LOOP/CKC in pregnancy, but scary
  Postpartum CKC
  *Remember: 1B1 needs a C-Rad Hyst after +FLM

Question 20

Do women who have had hysterectomies need pap smears?

Answer 20

A: NO!!!!

- unless hyst was for persistent CIN3, then they need annual cytology for ~25 years

Question 21

What is the treatment for Early stage vulvar cancer (stage 1 = confined to vulva)?

Answer 21

• 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

Question 22

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?

Answer 22

yes!

Question 23

How do you treat recurrent cervical cancer?

Answer 23

• If isolated central pelvic recurrence= exent
• widely metastatic: palliative chemo vs supportive care
• Carbo/taxol/bevicizumab

Question 24

Are dermoid tumors benign or malignant?

Answer 24

Benign

*Can have SCC differentiation

Question 25

How do you treat vaginal cancer?

Answer 25

Early stage (st 1, epithelium only) SURGERY

Stage 2 or greater: CHEMORADIATION

Question 26

How do you treat complex atypical hyperplasia in a 27 year old P0?

Answer 26

Give progesterone or IUD if they want fertility

Need q 3-6 month endometrial sampling

Question 27

Fallopian tube cancer- what one symptom is pathognomonic

Answer 27

Weird, watery discharge

Question 28

How do you treat neutropenic fever?

Answer 28

-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

Question 29

Numbness in thigh post op, what nerve was injured

Answer 29

Genitofemoral

Question 30

Describe a Maylard and Cherney incision

Answer 30

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.

Question 31

What is the best IVF for septic shock resuscitation?

Answer 31

LR

Question 32

Pt has anaphylaxis to IV contrast dye. What do you give them to prevent a reaction?

Answer 32

Dexamethasone + Benadryl

Mucomyst for renal protection