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Oncology > IPAP Senior Onc > Flashcards

IPAP Senior Onc Flashcards

1
Q

What are examples of cancers that are hematologically spread

A

Sarcomas of the Liver and Lungs

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2
Q

Define a benign tumor

A

Remains in the pr ray location; well defined; well differentiated; abnormal growth without Mets.

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3
Q

What are the two reasons for cancer

A

Sporadic and hereditary

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4
Q

What is a proto onco gene

A

Gene proliferation growth factor

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5
Q

What is the #1 modifiable risk factor that predisposes someone to cancer

A

Cigarette smoke

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6
Q

Where do cancers often manifest in alcoholics

A

Liver
Head
Neck
Esophagus

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7
Q

What is screening grade levels ABCDI

A

A;B = recommend
C= clinical judgement
D = not recommended
I = No evidence

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8
Q

What are the 5 common cancers

A

Breast
Colon
Cervical
Lung
Prostate

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9
Q

What is the best primary prevention for cancer

A

Screening!

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10
Q

What kind of cancers are associated with EBV

A

Nasopharyngeal

B-cell

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11
Q

What is the recommendation for breast cancer screening

A

Mammography ever 2 years b/w the age of 50-74

WITHOUT CBE / SBE

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12
Q

What is the recommendation for colorectal screen

A

Colonoscopy Screen @
A) 50 yrs
B) 45 yrs

OR

High Risk at 40 years or 10 years before family member with a 5 year repeat

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13
Q

What is the cervical cancer screen criteria

A

21-29 yrs every 5 years w/ HPV test combo STOP: @ 65 yrs or hysterectomy

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14
Q

Prostate screen recommendation

A

DRE + PSA = best test
C- recommendation between age of 55-69 years old

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15
Q

Lung cancer screen recommendation

A

50-80 yrs
CT w/ 20 pack yr Hx or if they stopped smoking within the last 15 yrs

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16
Q

Tumor markers :

AFP
CA125
CA19-9
CEA

A

Liver
Ovarian
Pancreatic
Colon pancreatic breast

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17
Q

What is the best staging system

A

TNM

T= size and extension

N= absent or present NODES

M= absent or present METS

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18
Q

Define polycythemia

A

Increase in all blood cells (RBC’s most)
60 yrs old common
+/- plethora / PUD
Splenomegaly

“Aquagenic Pruritis”

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19
Q

Labs for polycythemia (4)

A

Increased Hct / WBC increased
Peripheral = NML Smear
EPO = LOW
Serum Irone Low

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20
Q

What is the confirmatory test for polycythemia

A

JAK2 mutation

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21
Q

What painful dz process is also associated with polycythemia

A

Gout ;
From : increased Uric acid and B12

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22
Q

What is good txm for polycythemia

A

Phlebotomy
+/- low dose ASA
Allopurinol for GOUT
Antihistamines for PRURITIS

Hydroxyurea : refractory txm

Roxolitinib : JAK2 Inhibitor

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23
Q

What progression of polycythemia is lethal

A

AML

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24
Q

What is the goal platelet and neutro’s for polycythemia

A

Platelets below 500 K
Neutro’s above 2 K

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25
Essential thrombocytopenia dz characteristics
NML life expectancy 50 -60 yrs BM = megakarocytes Erythromyalgia (Burning Hands) Levied o Reticularis Mucosal Bleeding Splenomegaly +/- HA/ Vision changes Increase in PLATELETS on CBC (over 2mil)
26
When should you suspect essential thrombocytopenia
Thrombos: Mesenteric Hepatic Portal vein
27
What are labs for essential thrombocytopenia
CBC = Hct NML Platelets over 2 mil BM= megakarocytes
28
What is good txm for Essential thrombocytopenia
Hydroxyurea (Cytotoxic to platelets) ASA(dec thrombi events)
29
CML dz process
Multipluripotent stem cell dz w/ BCR/ABL gene Oncogenes with increased leukocytosis +Philly chromosome TRIPHASIC = Chronic/Accelerated/Blast
30
Define the triphasic process of CML
Chronic = Anemic WBC avg 150K peripheral smear = NML RBC Morphology Blasts = less than 10% avg = 5% Fever Chills Bone Pain. Accelerated = progresses to anemia 10-20% blasts; TTP increased myeloid blasts Blast Crisis = marrow overdrive EOD more than 20% blasts
31
Clinical presentation of CML
Bravo + with ABD FULLNESS Sternal tenderness due to marrow overload LEUKOCYTOSIS over 100K Later = blurred vision resp. Distress priapism
32
TXM for CML
Chronic = stay here! TKI = Imatinib/Nilotinib Splenomeg. = better @ 3 months Hydroxyurea = for the leukocytosis Stem cell transplant to suppress the cell division
33
What is the dz process of myelofibrosis
BM replaced with fibrotic tissue by : megakarocytes +DACROCYTES TOO MUCH COLLAGEN = NO NORMAL CELL TISSUE First = Fatigued Spenomeg then Hepatomeg w/ mild wt loss Late = cache is satiety portal HTN cirrhosis
34
Labs for myelofibrosis
CBC = anemia POIKOLOCYTOSIS + Dacrocytes
35
What are four cardinal bravo sxs
Fever Chills Night sweats Wt loss
36
TXM for myelofibrosis
+/- androgens 1st Line = Hydroxyurea for splenomeg. 2nd Line = Roxukitinib = high risk TXM JAK2 inhibitor 3rd Line= Allogenic stem cell
37
Acute leukemia dz process AML vs ALL
AML = + Auer Rods ; Gingival Hypertrophy MYELOID cells DOE ALL = Kids; LYMPHOID cells + CNS sxs
38
Labs for AML
CBC = anemia Reticular count low TTP Abnormal WBC’s Neutropenia
39
Labs for ALL
TTP Anemia Abnormal high WBC release
40
CLL dz process
Uncontrolled prol of maturing lymphocytes +/- immune hemolytic anemia w/ +COOMBS test
41
Labs for CLL
CBC = peripheral smear wiht increaed lymphocytes BM Biopsy confirm
42
What is the richter transformation
Increased LDH with worse prognosis Rapid progressive lymphadenopathy with TTP and Anemia ISO B-celll lymphadenopathy
43
TXM for CLL
Observe 1st; no cure Active Dz (BM dysfn/Splenomeg/Lymphocytosis) = CHEMO
44
What CLIN presentation best describes CLL
ASX + Lymphadenoapthy Splendor/Hepatomeg Bravo + = worse dz
45
NON HODKINS dz process
Heterogenous enlarged lymph nodes with varied presentation B cell d/o primarily Low grade and High grade
46
Describe indolent NON HODGKINS
Hepatosplenomeg. with slow lymphadenopathy w/ MALT From Acute(h.pylori) or Chronic(Sjorgens)
47
Describe aggressive NONHODKINS
Fever chills TUMOR LYSIS SYNDROME Burkitts = quick high grade swelling EBV infection
48
What is stage 3 non hodgkins
Bravo sxs with significant NHL Nodes below diaphragm Bulk over 10 cm
49
What predisposes poor prognosis for Non-HODKINS (5)
Age over 60 years LDH high Stages 3-4 2+ Extranodal spread Poor response to txm
50
Dz process of Hodgkin’s lymphoma
PAINLESS neck mass with hilar lymphad. Central and supraclavicular nodal spread BIMODAL age distro Nodular Mixed Rich Depleted
51
HODGKINS can be due to what kind of infection
EBV / HIV
52
Presentation of hodgkins
Painless singularly node [cerv/Supra/axilla] Pruritis and excoriations after ETOH Asx cough retracted chest pain
53
Labs for hodgkins
R/o infxn Smear = +REED STERNBERG cells
54
Stage differences for Lugano hodgkins
2a = absent 2b = bravo sxs Stage 3 = below the diaphragm
55
What 5 things are poor prognostics for hodgkins
Liver Mets Severe anemia HGB low w/ albuminemia WBC greater than 15K Stage 4
56
TXM hodgkins
Stage based. Chemo : ABVD full course = stage 3/4 Stage 1/2 = chemo + rads
57
What is plasma cell dyscrasia
Clonal disorder of plasma cells with MM as the end result
58
What does plasma cell crisis define
Stage of severity
59
What are on the light chains and heavy chains
Light = kappa and lambda Heavy = class determinate
60
What is the def of monoclonal
Proliferation of single type of Ig
61
What assay is abnormal and defines dz in plasma cell dyscrasia
FLC-Assay
62
Dz process of MGUS
Monoclonal gammon. Of undefined sign. Less than 10% mc abs in the BM NO EOD Elderly with unexplained HyperCa+ Vague sxs
63
What is positive in MGUS
Bence jones proteins on SPEP or UPEP
64
6 red flags of progression in MGUS
General weakness Bleeding Neuro sxs Lymph. Bravo+ Lymphadenopathy
65
MGUS mgmt :
@ 6 months post dx and then annually SPEP/UPEP Ca2+ Renal with imaging as needed
66
Dx for MGUS
FLC-Assay Skeletal survey CBC/CMP SPEP/UPEP
67
Smoldering Myeloma dz process
Low level indolent 10-60% mc cells NO EOD M protein greater than 3g/dL or equal.
68
How often do you monitor smoldering myeloma
3-4 months
69
Plasma cell myeloma dz process
MM Medullary bone cavity cancer Bone Pain Anemia Renal Insuff. Pelvis Ribs Spine (Cord compression)
70
What mc cell quantity defines MM
Greater than 60% clonal plasma cells OR plasma cytoma w/ CRAB SLiM
71
What is CRAB SLiM
Ca2+ greater than 11 Renal insuff. (CrCl over 2; GFR under 40) Anemia less than 10 Bone Lesions greater than 5 Sixty Clonal cells Light chains MRI shows more than 1 lesion
72
Lytic lesion with EOD clonal exp of plasma cell
MM
73
What toxin can predispose you to plasma cell myeloma
Agent Orange Vietnam
74
What defines sup vena cava syndrome
Obstructed BF by Tumor invasion venous blood to the rat atrium dilated over weeks = Upper body edema Plethora and facial swelling
75
What is the MC syndrome assoc with lung cancer
Sup vena cava syndrome
76
What are 3 outcomes from sup vena cava syndrome
Cerebral edema Laryngeal involvement Pain increases with bending over or laying down
77
What is the def dx of sup vena cava syndrome
Contrast venography
78
What is 1st and 2nd line txm for sup vena cava syndrome
Endogenous recontstruciton with a stent Thrombolysis
79
What is evaluated in the arm in sup vena cava syndrome
Venous pressure over 20cm in the arm
80
What is seen on peripheral smear for MM
Rouleaux (stacking RBC’s)
81
What is spinal cord compression
Neoplastic epidural cord compression HIGH neuro complications INSIDIOUS radicular back pain-Elderly URGENT +/- damage to myelin sheath w/ neuro imp. WORSE if you lay down +/- bowel bladder sxs (later)
82
What can spinal cord compression progress to
Cauda equina
83
What type of reflexes happen in cauda equina
Hyporeflexia
84
Where should you get the MRI for spinal cord compression
Lumbar Thoracic Cervical
85
Txt for unknown cancer spinal cord compression
IV/PO Dexamethasone Taper Def: surgery/rads/chemo
86
TXT fro known cancer spinal cord compression
Surgery w Neuro consult ASAP
87
Febrile neutropenia dz process
Iatrogenic from CHEMO Fever over 100.4F or 38C for longer than 1 hour with cancer + decreased neutrophils
88
Mild mod severe febrile neutro count
Mild =1500-1000 Mod = 500-1000 Severe= less than 500
89
Txt for febrile neutropenia
Broad spectrum Cefeoime Carbamazepine Pipercillin Tazo
90
When does febrile neutro get anti fungals
Condition consists for longer than 4-7 days
91
3 anti fungals for febrile neutro
AMPHOTERICIN B Itraconazole Capsfungin
92
Sxs for hyperca+ are what?
BONES MOANS GROANS OVERTONES
93
What us high in hyperca2+ with low normal PTH
PTHrp and potentially Vit D
94
TXM for hyperca2+ assoc. with cancer
IV Fluids IV Furosemide IV Bisphosphonates Calcitonin THEN -CANCER TXM
95
2 types of hyper ca 2+
Cancer (PTHrP) Local(osteopathic w/ clastic activity)
96
Abundant electrolytes in blood stream with chemo therapy can lead to what
Tumor lysis syndrome
97
What dz process can lead to tumor lysis syndrome
Non hodkins burkitts lymphoma (indolent)
98
What is released in TLS
Nucleic acids Proteins Phosphate Potassium
99
What can result from TLS
HyperKa+ Hyperuricemia Hyperphosph.
100
TXM for TLS
Aggressive hydration Allopurinol before chemo (for hyperuricemia) Rasburicase (for Hugh grade lymphomas with increased WBCs and refractory to allopurinol
101
What are contras to rasburicase
Pregnant Lactating G6PD
102
When are opiods given for pain mgmt of cancer
Short acting fro 24-48 hours or break through sxs control to block transmission of pain

Oncology (1 decks)

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