Gyno Flashcards
1
Q
Biggest risk factor for GTN
A
Complete molar pregnancy
2
Q
Genetic make up for complete mole most commonly is
A
46 XX
3
Q
Describe a complete mole pathologically
A
Trophoblastic Proliferation of cytoplasms and syncytiotrophoblast with coincident findings of diffuse hydronic villi
4
Q
Most common histologic type of endometrial cancer
A
Adnocarcinoma
5
Q
Adenocarcinoma of the cervix most commonly associated with which hpv
A
Hpv 16 (57%)
6
Q
High risk gestational trophoblast neoplasia treatment
A
EMA – CO
Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine
7
Q
Low risk, gestational, trophoblastic neoplasm treatment
A
Methotrexate with Leucovorin rescue
8
Q
Common side effects of EMA - CO
A
Alopecia
Nausea,
Vomiting.
Bone marrow suppression (anemia neutropenia thrombocytopenia) parentheses
Stomatitis
9
Q
95% of primary vulvar cancer diagnosed are of what type
A
Squamous cell
10
Q
The second most common type of vulvar cancer is
A
Melanoma
11
Q
Five predictive factors for low likelihood of chemotherapy response in recurrent cervical cancer
A
Performance status
We current cancer in the pelvis
African-American.
Recurrent cancer within one year of treatment.
Prior platinum exposure
12
Q
Common mutation found in serious borderline ovarian tumors (2 answer)
A
KRAS mutation and BRAF mutation
13
Q
Medical treatments for radiation proctitis
A
Free, radical scavengers: sulfasalazine, balsalazide, mesalazine
14
Q
Histological description of paget disease
A
large oval cells with pale cytoplasm enlarged nuclei with predominant nucleoli
15
Q
What is the recurrence risk of all pageants disease?
With negative margins
With positive margins
A
If negative margins 30%
If positive margins 50%
16
Q
Treatment for vulvar paget disease
A
Wide local excision. Not recommended to use frozen section at time of resection for margins as it has a false negative rate of 10 to 13%.
17
Q
Optimal surveillance strategy for primary epithelia ovarian cancer
A
Cereal CA 125 measurements
18
Q
Risk of new persistent, opioid dependence in naïve users after opioid prescribed for postoperative pain
A
6%
19
Q
Risk developing opioid use disorder
A
Opioid use preoperatively.
Discharged home with opioid
20
Q
Serum albumin estimates protein status over what course of time
A
2 to 3 months with a half-life of 18 to 20 days
21
Q
Serum transferrin reflects protein status over what period of time
A
Past 2 to 4 weeks with a half-life of eight days
22
Q
Serum pre-albumin reflects protein status over what course
A
Few days to one week
23
Q
Indications for TPN
A
Multiple organ failure and not expected to have PO intake for 7 to 10 days
24
Q
Most important prognostic factor for a patient with vulvar cancer
A
Status and number of inguinofemoral lymph node metastasis
25
Risk of lymph node metastasis when depth of Vulvar tumor invasion is 3 mm
25%
26
Pet CT has what percent sensitivity and positive protective value for detecting lymph nodes in Vulvar cancer
95% sensitivity with 100% positive predictive value
27
Pet CT are most helpful with which two types of cancer prognosis
Vulvar and vaginal
28
What type of imaging modality is preferred if vulvar Cancer stage II through IVA, locally advance cancer, is concerned
MRI can help with soft tissue invasions
29
Complication rate from microscopic surgery
0.2% to 10.3%
30
Describe six times that an MRI is preferred imaging modality for breast cancer
1. Breast conserving surgery.
2. Personal history for him new disease must be ruled out.
3. An axle messed with no identifiable primary tumor.
4. Extensive postoperative scarring.
5. Extremely dense breasted.
6. Brac 1
31
Define BI – RADS 0
Incomplete or inconclusive findings
Additional imaging or follow up recommended
32
Define BI -RADS 1
Negative for cancer
Routine screening
33
Define BI - RADS 2
Benign findings
Follow up imaging may be recommended
34
Define BIRADS 3
Probably benign
Additional imaging or short-term follow up
35
Define BIRADS 4
Suspicious for cancer
Recommend biopsy
36
Define BIRADS 5
Highly suggestive of cancer
Biopsy strongly recommended
37
Define BIRADS 6
Known cancer
Likely completed to monitor treatment response
38
39
Most, 70%, of epithelial ovarian cancers are found at what stage
Stage three or four
40
Elevated CA 125 may be caused by (5)
Epithelial ovarian cancer
Infection
Uterine fibroid
Endometriosis
Pregnancy
41
human epididymis protein 4/HE4 is elevated in what type of ovarian cancer and not elevated in what type of ovarian cancer
Elevated in nearly all serious and endometriosis ovarian cancer
Elevated about 50% at the time of clear cell
Not elevated in mucinoid
42
For a patient of Jewish descent with breast ovarian cancer, what type of genetic testing should be recommended
Multigene panel testing
43
Screening for patient with cervical cancer status post chemo radiation
Speculum by manual and rectovaginal exam every 3 to 6 months for the first two years than every six months for the subsequent three years
44
With ventilator settings, what should be adjusted to directly affect CO2
Ventilator rate
45
On a ventilator, adjusting, blank, and blank affects oxygenation
Peep and FI02
46
C diff testing test for what in the stool
Toxin A or toxin B
47
C diff treatment
Oral vanc
48
Sex cord-strong tumors include:
Granules cell
Sertoli
Sertoli-let dog
Steroid cell
Fibromya
Thecoma
49
FOXL2 mutation has been identified in 97% of adult type of what kind of cancer
Granulosa cell tumors
50
What market do follower for granulous cell tumors?
Inhibin A and inhibin B
Inhibin B is preferred for diagnostic and monitoring
51
What enzyme is elevated with ovarian dysgerminoma
LDH
Found in metabolically active tissues and indicates tissue damage
52
Example of endometrial cancer type one
Endometroid adenocarcinoma
53
Example of endometrial type two cancer
Serious
Clear cell
Undifferentiated adenocarcinoma
Grade 3 endometrial adenocarcinoma
54
Which type, type owner or type two, endometrial cancer is more aggressive?
Type two
55
Which type, type one or type two endometrial cancer is estrogen driven?
Type one
56
Common place of recurrence for early stage type one endometrial carcinoma
In the vagina or pelvis
57
Common place of recurrence for early stage type one endometrial carcinoma
Outside of pelvis
58
Primary treatment for widely metastatic cervical cancer
Systemic chemotherapy of cisplatin and taxol
59
BRCA1 or BRCA2 have a lifetime risk of developing breast cancer
75%
60
Lifetime risk of ovarian cancer for BRCA1 patient
40%
61
Lifetime risk of ovarian cancer for BRCA2 patient
20%
62
Most common histologic subtype of epithelial ovarian cancer
Serious, approximately 70% of cases
63
Second, most common histological sub type of epithelial ovarian cancer
Clear cell, approximately 12% of cases
64
Endometriosis can be associated with what type of ovarian cancer
Clear cell
65
Treatment for hypercalcemia
Avoid thigh, diuretic, dehydration, and activity.
Volume expansion with IV, fluids, and administration of calcitonin
66
Follow up testing for molar pregnancy
Sierra Badia hCG concentrations weekly until negative for three consecutive weeks then monthly for 3 to 6 months
67
Atypical glandular sales on Pap smear need what type of follow up?
Call Paul, in the cervical biopsy, endometrial biopsy
68
Low-grade serous ovarian cancer likely to have what mutations
KRAS and BRAF mutation or over expression of insulin like growth, factor one and increase expression of estrogen, progesterone receptors
69
High Grade serious ovarian cancer most common to have what mutation
P53
70
Maintenance therapy for low-grade serous ovarian cancer
Aromatase inhibitor
71
Initial diet for patients with lower gastrointestinal surgery
Regular diet
72
Acceptable alternative for chemotherapy regimen of TAXOL/platinum
Carboplatin and pegylated liposomal doxorubicin
73
Fraction of screened individuals who have the disease who screening test is positive defines what
Sensitivity
A/(A+ C)
74
Fraction of screen individuals who do not have the disease who screen negative defines what
Specificity
D/(B plus D)
75
Cervical screening inpatient population where follow up or not reliable
Visual inspection with 5% acetic acid colpo
76
Define complete cytoreduction
No residual visible disease present
77
Define optimal cytoreduction
1 cm or less of residual disease
78
If a tumor is present here, it will likely lead to an inability to complete a primary cytoreduction surgery
Mesentary
79
Best method of surveillance for diagnosis of endometrial cancer
Public exam
80
Radical hysterectomy can be performed for what type of cervical cancer specific staging
1A1
1A2
Some 1B1
81
82
Most common cause of nosocomial pneumonia
E. coli, Klebsiella pneumonia, acinetobacter, staff aureus, and MRSA, pseudomonas
83
Treatment for dermatomyositis in the setting of upcoming surgery
Corticosteroids
84
Dermatomyositis is commonly associated with malignancy. And women common sites are. 2 answers
Ovary 13–26%
Breast 13%
85
Name, for example, gestational trophoblastic neoplasm
Invasive mole
Choriocarcinoma
Placenta site trophoblastic tumor
Epithelioid trophoblastic tumor
86
Choriocarcinoma is derived from what?
Villa trophoblast
87
Epithelia Lloyd trophoblastic tumor originates from what
Chorionic type extravillous trophoblast
88
Placenta site trophoblast tumors developed from what
Intermediate trophoblast. Villi are not present.
89
Cervical cancer 1A1 with desired future fertility treatment
CKC with cervical cytology follow up
90
Standard treatment for ovarian cancer suboptimally cytoreduced is what
IV carboplatin and paclitaxol
91
Can patient who were suboptimally cytoreduced undergo intraperitoneal, platinum and Taxol chemo?
No, because in prepared to Neil, chemotherapy cannot penetrate large tumors, greater than 1 cm
92
Contraindication for bevacizumab
Poorly controlled hypertension
93
Appropriate broad spectrum anabiotic choice for neutropenic fever (4 answers)
Cefepime
Imipenem/cilastatin
Meropenem
Piperacillin/tazobactam
94
Immunohistochemistry studies that are positive in Sarah ovarian cancer
Cytokeratin 7 - KRT7/CK7, Ca 125, PAX8 WT1
95
Immunohistochemistry positive and gastrointestinal tumors
Cytokeratin 20 -KRT20/CK20, CEA CDX2
96
Before pelvic exoneration, what test must be complete completed
PET scan to ensure no disease burden outside of the pelvis
97
Most common ovarian malignancy in Pregnancy
Dysgerminoma
98
Most common benign ovarian tumor in pregnancy
Mature teratoma
99
Benefit of intraperitoneal chemotherapy over IV route
Higher local drug concentration
100
Intraperitoneal chemotherapy is associated with what negative side effects
Increase toxicity, pain, fatigue, anemia, neutropenia, thrombocytopenia,adverse neurologic events, G.I. toxicity
101
Define negative predictive value
Number of patients within a negative test who do not have the disease
102
Define positive productive value
The number of patients with a positive test who do have the disease
103
Hpv E6 oncoprotein affects what gene
P53
104
Hpv E7 oncoprotein affects what gene
Rb
105
Most sensitive imaging modality for diagnosing brain meds
MRI
106
Another name for endodermal sinus tumor
Yolk, sack tumor
107
Germ cell tumors that do not require adjuvant chemotherapy
1A and 1B dysgerminoma
1A immature teratomas
108
Endodermal sinus tumor, adjuvant chemotherapy
BEP - bleomycin, etoposide, cisplatin
109
Bleomycin side effect
Lung damage, interstitial, pneumonitis, and later fibrosis
110
Etoposide side effect
Development of AML
111
Cystplatin side effects
Naja, vomiting, myelosuppression, nephrotoxicity, ototoxicity
112
Patient with ovarian cancer presenting with symptoms of SBO needs what imaging modality
CT SBO most common with small bowel than large bowel
113
Treatment of one B1 cervical cancer
Radical hysterectomy with pelvic lymph node assessment
114
Treatment for patient with 1A1 cervical cancer disease
Simple hysterectomy
115
BRAF gene relates to which pathways
Mitogen activated protein kinase/MAPK
Extra cellular, signaling regulated kinases/ERP and MEK inhibitors
116
BRCA one or BRCA2 artificial in homologous repair and therefore sensitive to
Poly ADP ribose polymerase (PARK) inhibitors
117
What imaging modality is the most appropriate to evaluate local disease extension outside of the cervix, including the parametrium, lower uterine segment and vagina
MRI
118
Define moderate calcium and treatment
12.0–13.9 mg/dL
Normal saline (even with cardiac changes)
119
Define severe hypercalcemia treatment
Greater than 14.0
IV hydration first, consider Iv calcitonin. Hemodialysis is last resort
120
Hypercalcemia most commonly associated with which cancers (5)
Lung
Multiple myeloma
Renal cell
Neuro endocrine of uterus and cervix
Ovarian small cell
121
follow up screening for VAIN one
Cytology with HPV normal at one year no further testing
Cytology with HPV abnormal than every three years screening
122
Chemo choice for ovarian clear, cell carcinoma
Carbo and Taxel
123
Screening for Figo stage IA, grade one endometrial carcinoma with less than 50% myometrial invasion
No additional follow up screening indicated
124
Most common organisms, causing necrotizing fasciitis
Poly microbial. Clostridium, Bacteroides, E. coli, and enterobacter, klebsiella
125
Vulvar cancer stage IA surgery recommended
WLE without lymph nodes sampling
126
Definition of well lateralized vulvar tumor
Greater than 1–2 cm from the midline
127
Surgery recommended for vulvar tumor that are less than 4 cm
Excision with vulvectomy, depending on the depth of invasion with sentinel lymph node biopsy
128
Surgery recommended for vulvar tumors that are greater than 4 cm or palpable LD
Vulvectomy with full lymphectomy
129
True or false.
If a Vulvar lesion is not considered well lateralized (greater than one to 2 cm for midline) you should look at bilateral lymph nodes.
True
130
Outcome based research would use which national system for data
Center for Medicare Medicaid
131
In young BRCA1 patients that are status post risk reducing bilateral ooopherectomy, best medication choice for menopausal symptoms
Transdermal estrogen
132
If concern for molar pregnancy with risk factors for post molar GTN and done with childbearing, what is the preferred treatment?
Hyst
133
Stage IIB cervical disease would need what treatment
Radiation with concurrent chemotherapy
134
Treatment for biopsy confirmed CIN2 or CIN3 in pregnancy (2 options)
1. Re-Eval at six weeks postpartum.
2. Repeat cytology with colpo during pregnancy.
135
Duration between cytology in pregnancy
At least 12 weeks
136
Indications for bowel prep preoperatively
High concern for bowel involvement with surgery like colostomy
137
Classic EKG findings of hyperkalemia
Short QT interval, wide WRS complex, peaked T waves
138
Patient using aromatase inhibitors should undergo what screening
Bone density testing
139
Is differentiated VIN associated with HPV?
No
140
Is usual type VIN associated with HPV?
Yes
141
Is VAIN associated with HPV?
Yes
142
Broad term for the recommended screening test for lynch syndrome
Tumor immunohistochemistry. Looking for four mismatch repair genes MLH1, MAH2, MAH6, PMS2
143
144
Name the cancers associated with lynch syndrome (7)
Colorectal
Endometrial
Gastric
Pancreatic
Bile duct
Renal pelvis/ureter
Small bowel
145
What parameters ( NPV, PPV, sensitivity, specificity) are independent of disease prevalence
Specificity and sensitivity
146
If the prevalence of a disease in a population increases, describe the effects on PPV and NPV
PPV will increase, and NPV will decrease
147
First line agent, in patient with advanced cancer with nausea, vomiting, without identifiable, cause and bowel obstruction has been rolled out
Metoclopramide
Shows more effectiveness after eight consecutive days of therapy
Prolong treatment greater than 12 weeks may increase risk for tardive dyskinesia
148
If AKI is identified what is next best step
Urine studies to determine pre-renal, intrarenal, post renal
149
Criteria for bariatric surgery
-BMI 40 or greater with coexisting medical condition
-BMI 35 or greater with one or more severe obesity related to morbidities
-BMI 30 to 35 with type two diabetes or metabolic syndrome
150
BRCA1 and BRCA2 mutations have deficiencies in what
Homologous combination, repair pathway
151
If granulosa cell tumor, identified in the ovary with additional surgery should be completed
Endometrial sampling
Because 25–50% of patients will have endometrial hyperplasia and 5–10% will have endometrial cancer
152
ERAS recommendation for postop pain with laparotomy
Incisional infiltration of bupivacaine
153
What is the risk for a postoperative wound infection and a patient with a hemoglobin A1c of 7% or higher?
20% risk
154
Describe pathophys of malignant ascites
Increase vascularity permeability, and blockage of draining lymphatics in the peritoneal cavity
155
First line agent for depression and advanced stage cancer patient
SSRI
156
When radiation induced hemorrhagic cystitis is mild and hemodynamically stable, what is the treatment?
udip, UA, continuous bladder irrigation
157
When radiation induced hemorrhagic cystitis is noted in a non-hemodynamically stable patient. What should the next steps be?
Udip, UA, cysto
158
Describe uterine liomyosarcoma histology
Smooth muscle with spindle shaped cells that have significant variations in shape size and nuclear staining
159
Most common stage of leiomyosarcoma
Stage one
160
If Leiomyosarcoma is identified intraop what all organs need to be removed?
Whatever was planned preop.
Low risk of metastasis so no additional biopsies need to be taken
161
If using penbrolizumab need to determine status of what first
PD-L1
162
True or false
Trials consistently show the screening for ovarian cancer does not decrease disease specific mortality
True
163
What imaging findings are consistent with bowel obstruction?
Air fluid levels within the bowel with distention of the bowel proximal to the side of obstruction and decompression of the bow distal to the side of obstruction
164
Which lymph nodes will drain the upper 2/3 of the vagina
Pelvic
165
Which lymph nodes will drain the lower 1/3 of the vagina
Superficial inguinal nodes
