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Gyn Onc Flashcards

1
Q

GTN stage I or low risk (score <7) stage II and III treatment

A

Single agent chemo with either methotrexate or actinomycin D

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2
Q

GTN high risk stage II/III (score 7 or more) or stage IV treatment

A

Multiagent chemo +/- surgery/radiotherapy

Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine

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3
Q

Scores 4 points on GTN staging (WHO)

A

13 or more months from antecedent pregnancy
Pretreatment serum hCG 1,000,000 or more
Liver, brain mets
>8 metastases
Previously failed two or more chemo drugs

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4
Q

Recommended criteria for decision-making capacity

A
  1. Communicates choice between treatment options
  2. Understands treatment options
  3. Understands the information leading to the decision
  4. Understands consequences of treatment
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5
Q

Should a patient with PMB on tamoxifen get a biopsy?

A

Yes, regardless of endometrial thickness

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6
Q

Palliative option for treatment of large bowel obstruction in cancer patients

A

Colonic stent

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7
Q

Breast cancer screening in BRCA1 and BRCA2

A

Annual MRI alternating with semiannual digital mammography starting at 25-30 years

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8
Q

What do you do with a perimenopausal woman with low positive hCG?

A

1 week of OCPs and recheck hCG

If OCPs aren’t successful, do a CT chest/abd/pelvis

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9
Q

Ovarian cancer debulking should…

A

remove all visible disease, including bowel resection, as safely as possible.

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10
Q

Standard evaluation of all categories of AGC/AIS

A

ECC

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11
Q

If AGC and +HPV, likely…

A

cervical disease

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12
Q

AGC/AIS in women >35 (or younger with AUB or e/o chronic anovulation)

A

colposcopy + ECC + EMB

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13
Q

Table for statistics

A 
DISEASE +      DISEASE -
T      +        a                      b
E
S     -          c                      d
T
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14
Q

Next step after surgery of stage IIIC1 uterine carcinosarcoma

A

Adjuvant chemotherapy

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15
Q

Neutropenia < 1,500/mm3 on day of therapy

A

Delay until recovered
(if delay >7 days, reduce doses by 1 or add GCSF)
(if delay >14 days, reduce doses by 1 AND add GCSF)

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16
Q

Platelets 75,000-150,000 on day of chemotherapy

A

Delay until recovered

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17
Q

Platelets <75,000 on day of chemotherapy

A

Delay until recovered

If delay is >7 days, reduce doses by 1 level

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18
Q

Immature teratoma, surgically resected, stage IA, grade 1 management

A

Surveillance

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19
Q

Immature teratoma, surgically resected, stage IA, grade 2 or 3 management

A

Chemotherapy - bleomycin, etoposide, cisplatin

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20
Q

First line treatment of hyperkalemia to stabilize myocardium

A

IV calcium

can also use insulin with glucose

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21
Q

Greatest risk with oral conjugated equine estrogen use

A

Stroke

then DVT

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22
Q

Ovarian luteoma

A

Causes gestational hyperandrogenism
Benign
Usually regress and disappear 2-3 weeks after delivery

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23
Q

Risk of Ovarian Malignancy Algorithm

A

CA125
Human epididymis secretory protein 4
(In a woman with a pelvic mass)

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24
Q

International Ovarian Tumor Analysis

A

Classification of adnexal masses

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25
Q

Risk of Malignancy Index

A

CA125
Menopausal status
Ultrasound findings
(factors are multiplied together)

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26
Q

Risk of Ovarian Cancer Algorithm

A

Uses longitudinal increase in CA125 to determine risk

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27
Q

Ultrasound findings of pelvic mass consistent with malignancy

A

Irregular solid tumor
Ascites
At least four papillary structures
Irregular multilocular tumor with largest diameter 100mm
Very high color content on Doppler ultrasonography

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28
Q

After surgery for endometrial or colorectal cancer, first step to test for Lynch

A

Immunohistochemical TUMOR testing for MLH1, MSH2, MSH6, and PMS2 proteins

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29
Q

Ovarian cancer screening in BRCA1 or BRCA2

A

Periodic CA125 and transvaginal ultrasound starting at 30-35 or 5-10 years prior to earliest ovarian cancer diagnosis in the family

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30
Q

Prophylactic BSO in BRCA1 and BRCA2

A

Immediately after childbearing is complete or by 40

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31
Q

Managemnet of smooth muscle tumor of uncertain malignant potential

A

Surveillance for women desiring fertility

Hysterectomy for women not desiring fertility

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32
Q

Common prognostic prediction models use

A

Age
Comorbidities
Nodal status
Tumor size

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33
Q

Factors associated with abnormal anal cytology in HIV individuals

A

CD4 count of less than 200cell/mm3
History of STD other than HPV
Cervical cytology abnormality

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34
Q

Risk with St. John’s wort

A

Induces cytochrome P450 activity (doubles its metabolic activity)
(stop at least 5 days before surgery)

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35
Q

High risk patients with neutropenic fever

A

Neutropenia <100 cells/mm3
Anticipated duration of neutropenia >7 days
Significant comorbid conditions (hypotension, pneumonia, new abd pain, neuro changes)

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36
Q

Broad spectrum antibiotics for neutropenic fever

A

Cipro and augmentin

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37
Q

Mutation associated with uterine papillary serous carcinoma

A

TP53 mutations

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38
Q

Side effect associated with switching from tamoxifen to aromatase inhibitor

A

Joint aches

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39
Q

Recommended treatment for advanced ovarian cancer that has been suboptimally cytoreduced

A

IV carboplatin and paclitaxel

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40
Q

RIsk factors for ovarian cancer

A 
Increasing age
Endometriosis
Family history of breast or ovarian cancer
Nulligravidity
Infertility
Early menarche
Late menopause
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41
Q

Benefit of mechanical bowel prep

A

None

42
Q

Treatment of IB1 cervical cancer in patient desiring fertility

A

Radical trachelectomy with pelvic lymphadenectomy

43
Q

Contraindication to salvage products

A

Any solution mixed with blood that results in red cell lysis:
Sterile water
Hydrogen peroxide
Alcohol

44
Q

Indication for radical vulvectomy over wide local excision

A

Invasive carcinoma

45
Q

Treatment of preinvasive lesions of the vulva

A

Wide local excision

46
Q

Breast cancer risk reduction after 5 years of chemoprophylaxis with tamoxifen

A

50%

47
Q

MLH1 immunohistochemical staining is absent, next test

A

Test sample for MLH1 methylation

20-30% of cases of endometrial cancer with absence of MLH1 are due to methylation

48
Q

Best surveillance for ovarian cancer with previous complete response to treatment

A

Physical exam

49
Q

Nulligravid with microinvasive cervical cancer on biopsy (not excision)

A

Do cone or LEEP for further diagnostic evaluation

50
Q

Treatment for HIT

A

Stop heparin/LMWH

Start another anticoagulant to treat VTE (argatroban or danaparoid)

51
Q

ARDS clinical criteria

A

Respiratory symptoms within 1 week of inciting event
Bilateral opacities on x-ray or CT that can’t fully be explained by other cause
Respiratory failure not explained by cardiac failure or fluid overload
Impairment of oxygenation (PaO2/FiO2)

52
Q

Ovarian cancer associated with endometriosis

A

Endometrioid or clear cell

53
Q

Most common transfusion-associated infection in the US

A

Staphylococcus (gram + cocci)

54
Q

Less than 25 years old with HSIL –> CIN2 –> ?

A

Repeat colposcopy and cytology at 6 months

55
Q

Okay to use estrogen postoperatively in patients with endometrial cancer?

A

Controversial but yes, estrogen not shown to increase recurrence

56
Q

Prognostic factors for success of exenteration

A

Time to recurrence
Tobacco use
Age >70
Primary site of disease

57
Q

LEEP with AIS extending to margin?

A

Re-excise with cone

58
Q

Most effective method to prevent gynecologic cancer risk in Lynch syndrome

A

Hysterectomy and bilateral salpingoophorectomy

59
Q

Vulvar biopsy with large cells with prominent nuclei and coarse chromatin

A

Paget’s disease

60
Q

Management of vulvar Paget’s

A

Cervical cancer screen, colonoscopy, and mammography

61
Q

Cervical cancer stage if tumor is limited to cervix >4cm

A

IB2

62
Q

Cervical cancer stage if involvement of upper third of vagina

A

IIA2

63
Q

Cervical cancer stage if tumor involves lower third of vagina

A

IIIA

64
Q

Are lymph nodes included in cervical cancer staging?

A

No

65
Q

Highest risk factor for long-term sexual dysfunction after vulvectomy

A

Age

66
Q

Treatment for vulvar basal cell carcinoma

A

Wide local excision (without lymphadenectomy)

67
Q

Postoperative treatment for small cell cervical cancer (neuroendocrine)

A

Chemotherapy

68
Q

Most compelling reason to convert to laparotomy for adnexal mass removal

A

Mural nodule
Papillary projections
Size greater than 10

69
Q

Best method for contraception during molar pregnancy postoperative surveillance

A

OCPs

IUDs haven’t been studied with regards to recurrences

70
Q

Surveillance for first 2 years after IIIC high grade serous ovarian cancer surgery with no residual disease

A

History and physical
CA-125
(not CT)

71
Q

Risk factors for intraperitoneal catheter related complications

A 
Timing of catheter insertion
Hysterectomy
Appendectomy
Small bowel resection
Ileocecal resection
Left colon-rectosigmoid resection
72
Q

Precludes candidacy for sentinel lymph node dissection in patients with vulvar cancer

A

Palpable lymph node

73
Q

DCIS treatment

A

Breast sparing surgery + radiation

74
Q

Best imaging modality for dense breast tissue

A

Digital mammography

75
Q

Risk of laparoscopic resection of ovarian tumor

A

Port site metastasis

76
Q

Prophylaxis for patients that are at high risk for VTE (age, cancer, extent of surgery)

A

LMWH for 4 weeks

77
Q

General prerequisites for weaning from intubation

A

Secretions <2.5mL/hr
Strong cough
FiO2 <50%, PaOw/FiO2 of at least 150-200mmHg
Manageable minute ventilation
Acceptable pulmonary mechanics
Alert
No CHF, sepsis, acid-base abnormalities, severe electrolyte imbalances, vasopressor requirements, need for ongoing plasma expansion, no planned general anesthesia the same day, etc

78
Q

What is the minimum ovarian pelvic radiation dosage that has no effect on the ovaries in females younger than 40

A

1.5 Gy

79
Q

Immunohistochemical markers indicative of ovarian cancer

A

PAX8
CA125
WT1
KRT7

80
Q

Treatment of choice for VAIN III

A

CO2 laser

81
Q

LEEP showing CIN III with positive margins

A

Repeat cytology/ECC and colposcopy in 4-6 months

82
Q

ASCUS in a 16 year old?

A

Repeat cytology 1 year

83
Q

Least important intraoperative step for stage 1 ovarian cancer

A

Biopsy of the diaphragm

84
Q

Best to determine prognosis of breast cancer

A

Stage

85
Q

Tumor marker that’s most reliable in pregnancy

A

LDH

86
Q

What to do for concern of increased intraabdominal pressure

A

Monitor intraabdominal pressures

87
Q

Treatment for stage II invasive carcinoma of the vagina

A

Radiation

88
Q

Pseudomyxoma peritonei can be fatal if left untreated due to what

A

Bowel obstruction

89
Q

NOT a treatment for EIN

A

Nexplanon

90
Q

What part of the cell does ionization radiation effect

A

Nucleus

91
Q

If upper ur

A
92
Q

Placenta site trophoblastic tumors most commonly develop following

A

Term pregnancies

93
Q

What tumor marker is most elevated in endometrial cancer

A

Ça 125

94
Q

Serum levels of which hormone can support a clinical impression of ectopic but can’t distinguish ectopic from IUP

A

Progesterone

95
Q

Does prophylactic BSO reduce the risk of breast cancer in BRCA1?

A

No

96
Q

Paget disease of the breast is what type of carcinoma

A

Ductal carcinoma

97
Q

BRCA 1

A

Pancreatic
Melanoma
Breast
Ovarian

98
Q

Percentage of fibromas in miegs syndrome undergo malignant transformation

A

1%

99
Q

Late effects of radiation in women with gynecologic cancer

A

Fistulas
Fibrosis stenosis of vaginal canal
Intestinal obstructions
Bladder stenosis

100
Q

What can’t be treated with topical imiquimod?

A

VIN differentiated

101
Q

Chemo that causes extravasation leading to skin necrosis and ulceration

A

Doxorubicin

102
Q

Most favorable vulvar cancer

A

Basal cell

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