Gyn-Onc

Question 1

What is the preferred route of hysterectomy for benign conditions when patient factors and surgeon experience permit

Answer 1

Vaginal Hysterectomy.
Ex: 57 yo P3 with 11wk uterus and single 7 cm fundal fibroid.

Question 2

Management of AGC (Atypical Glandular Cells) on pap

Answer 2

-AGC: represent < 1% of pap tests , previously known as AGUS
-4 Categories when result is AGC
1. AGC: endocervical, endometrial or not specified
2. AGC: Favor neoplastic-endocervical or not specified
3. Endocervical adenocarcinoma in situ
4. Adenocarcinoma

-Evaluation:
1. ALL receive colposcopy
2. Endocervical sampling EXCEPT atypical endometrial cells
3. EMB IF
-35 years and older
-Less than 35 IF increased risk of endometrial neoplasia (AUB/Annovulation)

Question 3

Statistics: Sensitivity

Answer 3

Proportion of subjects with the disease who are correctly identified by a positive test

Calculation: (subjects with disease and a positive test) / (total with the disease)
or a/(a+c)

Question 4

Statistics: Specificity

Answer 4

Proportion of subjects withOUT the disease who are correctly identified by a negative test

Calculation: (subjects without disease and negative test) / (total without disease)
or d (b+d)

Question 5

Statistics: PPV or Positive Predictive Value

Answer 5

Proportion of subjects with positive result who actually have the disease

Calculation: True positive (disease pos and test pos) / total positive results

a / (a+b)

*Varies by prevalence of disease. PPV decreases with low prevalence as false positive results increase. Difficult to develop accurate screening tests for diseases with low prevalence

Question 6

Statistics: NPV Negative Predictive Value

Answer 6

Proportion of subjects with negative test who do not have the disease

Calculation: True negative / total negative results

d/ (d+c)

Question 7

Treatment of uterine carcinosarcoma

Answer 7

In patients with advanced stage chemotherapy is indicated

Question 8

Side Effects of Cytotoxic Chemotherapy

Answer 8

-Bone marrow toxicity
-Therapy parameters. If no delay therapy until recovery
1. Granulocytes (day of therapy) < 1500
2. Plts (day of therapy) < 75K
3. Granulocytes (cycle nadir) < 1000
4. Plts (cycle nadir) < 50K

Question 9

Pseudomyxoma Peritonei. What is the primary tumor site

Answer 9

-Abundant collection of gelatinous material in abdomen
-Primary site: GI. Specifically Appendix
-Mucinous tumor of ovary seconday

Question 10

Management of IDA in patient undergoing chemotherapy

Answer 10

Defined as Ferritin < 30
-Replace Iron stores.
-Avoid Erythropoietin stimulating agents as may progress disease

Question 11

What tumor site are CEA and CDX2 associated with

Answer 11

GI Tumors

Question 12

Goals of Hospice Care

Answer 12

Providing palliative care, symptom management and quality of life improvement

Qualify if ~ last 6 mo of life

Question 13

Management of Immature Teratoma

Answer 13

-Ovarian germ cell tumors account for 2-3% of all cases of ovarian cancer in Western countries
-Typically in women in 20s
-No Chemo indicated for immature teratomas that are Stage 1/Grade 1 vs. could consider in Grade 2/3 (more nueral elements)

-MOST Germ Cell Tumors: Chemo with Bleomycin, Etoposide and Cisplatin

Toxicities:
1. Bleomycin: Pulmonary Fibrosis
2. Etoposide: Secondary Heme Malignancy
3. Cisplatin: Neuropathy

Question 14

Management of Hyperkalemia

Answer 14

-Diagnosis: K > 6.0 or Less with EKG changes (peaked T waves)
-Treatment
1. IV Calcium: Stabilizes the myocardium
2. Insulin and Glucose: Drives K into cells
3. Diuretics: Remove K