GynOnc

Question 1

Markers for Lynch Syndrome

Answer 1

MLH1, MSH2 and 6, PMS2, EPCAM

Question 2

Rare paraneoplastic syndrome associated with diplopia, vertigo, loss of dexterity, dysarthria, nystagmus. Most commonly associated with breast and ovarian carcinoma.

Answer 2

Anti-yo progressive cerebellar degeneration

Question 3

Tx of GTN:

1. Stage 1 and low risk stage II/III
2. Stage Iv or high risk stage II/III

Answer 3

1. MTX and actinomycin D
2. MTX/actD/cyclophosphamide (MAC)

OR

for resident ca- etoposide/MTX/actD/Cycloph/vincristine (EMACO)

Question 4

A women with AUB taking tamoxifen has an endometrial thickness of 3mm. Should she have an EMB?

Answer 4

Yes, any woman with AUB on tamoxifen should have an EMB regardless of endometrial thickness.

Question 5

Palpable form, no tender, fixed 1cm mass in right breast of 52yo woman. Best first imaging study?

Answer 5

Diagnostic mammogram of right breast. For women older than 30.

For women younger than 30, start with ultrasound.

Question 6

Patient has decreased end-tidal CO2 and a millwheel murmur during robotic surgery, what should the management be?

Answer 6

Steep trendelenburg, turn to left side to encourage gas to flow to lung, 100% fraction of inspired O2, hyperventilation

Question 7

Whereas SBO can be managed expectantly before surgery is considered, what is necessary for large-bowel obstruction and why?

Answer 7

“Closed loop” effect- gas and contents can’t flow back through ileocecal valve so direct decompression is necessary: colostomy vs cecostomy tube vs colonic stenting (esp if in palliative care)

Question 8

For malignancy associated VTE, what does the American college of chest physicians recommend as best practice?

Answer 8

LMWH> vit k antagonists

Question 9

Organism commonly isolated in necrotizing fasciitis associated with GyN surgery.

Answer 9

Clostridium sordelli

GAS and staph aureus 25%- more rapidly developing

Mostly polymicrobial

Question 10

Proliferative breast lesson with atypical- management

Answer 10

Semi-annual exam and yearly mammo. Consider primary chemo prevention (tamoxifen, etc)

Question 11

What increases risk for uterine sarcoma? (2)

Answer 11

Tamoxifen and prior pelvic radiotherapy

Most sarcomas will occur without these risks present

Question 12

Compare complete, optimal, and suboptimal debunking.

Answer 12

Complete- no visible disease
Optimal- <1cm
Suboptimal - >1cm

Question 13

When do you do EMB with AGC pap?

Answer 13

Always if >35yo

If <35yo, perform if at increased risk

Question 14

Most common components of uterine carcinosarcoma?

Best treatment

Answer 14

Serous carcinoma and strongly sarcoma

Chemotherapy (less abdominal recurrence and distant Mets than radiation)

Question 15

What tumors match the following markers:

1. PAX8, KRT7, CK7, Ca125, WT1
2. KR20, CK20, CEA, CDX2

Answer 15

1. Serous ovarian

2. GI

Question 16

Recommended tx for grade 1, stage 1a immature teratoma after removal vs grade 2/3 or mosy other germ cell tumors

Answer 16

Observation after staging procedure

Vs

BEP Chemo (bleomycin, etoposide, platinum base)

Question 17

What is someone with impaired renal function on an ACE inhibitor at risk for?

Answer 17

Hyperkalemia

Question 18

First line management in hyperkalemic patient with EKG changes?

Answer 18

Calcium to stabilize cardiac myocytes

Then administer insulin (with glucose) or beta-2 adrenergjc agonist to drive k into cells

Then diuretics to increase urinary excretion

Question 19

Surveillance after early stage endometrial cancer

Answer 19

Pelvic exam and sx review every 3-6mo for 2yrs then every 6-12mo

Low risk recurrence, will most likely recur at the vaginal cuff with bleeding

Question 20

What is included in most breast cancer risk-prediction models?

Answer 20

Age, comorbidities, nodal status, tumor size

Question 21

Patients with GTN with low levels of hCG plateau… next best test

Answer 21

Hyperglycosylated hCG- necessary for trophoblastic invasion, primarily produced by cytotrophpblasts not syncytio

If negative, should continue to monitor patient

Question 22

Differeance between ER/PR, TP53, and PTEN alterations in type 1 vs type 2 endometrial cancer?

Answer 22

Type “1”- P”1”0 80% and ER/PR positive

Type 2- TP53 (5-3=2) 90%, ER/PR negative

Question 23

In addition to menopausal symptoms, what other sx do women taking aromatase inhibitors experience compared to tamoxifen?

Answer 23

Joint and muscle aches

Question 24

What products are saved by “Cell Saver” or cell salvage?

When can you not use salvaged products?

Answer 24

Salvaged product is devoid of plasma, thrombocytes, leukocytes… only RBCs are infused back

Cannot be used if any solution is mixed with blood (sterile water, hydrogen peroxide, alcohol, etc) because it leads to red cell lysis

Question 25

Management of unilateral germ cell tumors?

3 Most common malignant germ cell tumors

Answer 25

Unilateral salpingostomy-oophorectomy, staging, washing, omentectomy, lymphadenectomy, biopsies (fertility sparing)

Adjuvant chemo(MC): BEP

Dysgerminoma, endodermal sinus, immature teratoma

Question 26

Dx and Management of HIT

Answer 26

HIT type 2 is clinically significant- 4-14d after exposer, >50% decrease in plts, clotting, skin necrosis, systemic reaction

DC heparin immediately, switch to argatroban (best for renal impairment, direct thrombin inhibitor) or danaparoid (best for hepatic impairment, pregnancy

Question 27

Risk factor for low grade serous carcinoma

Mngmnt

Answer 27

Serous tumor of low malignant potential and ovulation induction

Not associated with BRCA

Cytoreduction followed by platinum/taxol chemo