(Journal) HRM - Final Exam Review

Question 1

Answer 1

Granuloma w/ multinucleated giant cells

Trying to “wall-off” an infection

Caseous necrosis = caused by infection

Question 2

Diagnosis?

Answer 2

Sertoli - only syndrome

Question 3

A ____ mass is a palpable breast mass that is 3-dimensional, distinct from surrounding tissues, and asymmetrical relative to the other breast

Persists through menstrual cycle

Answer 3

Dominant mass

Question 4

An ____ mass is often described as an area of vague or indiscrete nodularity or thickening that differs from the surrounding tissue and the finding is not matched in a mirror-image location in the opposite breast.

Answer 4

Indeterminate

Question 5

When should breast cancer screening exams ideally be performed?

(what week)

Answer 5

The week after menses

(when breast tissue is engorged)

Question 6

What type of breast cancer is often silent on mammogram?

Answer 6

Infiltrative lobular

Question 7

Do HER2/neu (+) tumors need oncotype testing? Why?

Answer 7

NO

(because they are already high-grade by definition)

Question 8

Which breast cancer do you NOT use chemotherapy in?

Answer 8

DCIS

(ductal carcinoma in situ)

Question 9

Where do direct inguinal hernias go through?

Answer 9

Direct = through weakness in the floor of inguinal canal

Question 10

Where do indirect inguinal hernias go through?

Answer 10

Indirect = through inguinal ring

Question 11

Ethics:

What 2 topics can youth make decisions on?

Answer 11

Pregnancy and STD’s

Question 12

Ethics:

Pregnant mother can make decisions independent of ____ and implications for health of fetus/child

Answer 12

Independent of father

Question 13

Ethics:

If pregnant woman is under <18 and is a dependent, what is required to happen before obtaining an abortion?

What are 3 exeptions to this?

Answer 13

Parental notification

(unless there is sexual abuse, physical abuse, or neglect)

Question 14

With assisted reproduction, when is sex selection appropriate?

Answer 14

Only to avoid sex-linked inheritable diseases

Question 15

Ethics:

Pre-implantation genetic diagnosis/testing to select for disability is ____ (acceptable, prohibited)

What is an example of this?

Answer 15

Morally unacceptable but not prohibited

Deaf parents commonly want to have deaf kids since they do not see it as a disability

Question 16

Ethics:

Surrogate mothers (to host baby)

What are the 3 requirements in MN for a woman to become a pregnancy surrogate for another woman?

Answer 16

Surrogate pregnancy requirements:

• Age > 21
• Mental competence
• Prior pregnancy of their own (b/c surrogacy can lead to infertility)

Question 17

What is the most common male cancer?

Answer 17

Prostate cancer

Question 18

What is the 5-year survival rate for prostate cancer if it is local at the time of diagnosis?

Answer 18

100%

Question 19

What race is more common to have prostate cancer?

Answer 19

African americans

Question 20

Men with a ____ (relative) or ___ (relative) who has prostate cancer are 2.4x as likely to develop prostate cancer themselves

Answer 20

Father or brother

Question 21

Male relatives of patients with ____ (other cancer) have a higher incidence of prostate cancer

Why?

Answer 21

Breast cancer

Increased if BRCA1 and BRCA2 carrier

Question 22

What tumor suppressor gene associated with breast cancer, prostate cancer, and endometrial cancer?

What chromosome?

Answer 22

PTEN (on chromosome 10)

Question 23

~ 70% of men with prostate cancer have lost one copy of what gene at diagnosis?

Answer 23

PTEN (on chromosome 10)

Question 24

sufficient dietary ____ is protective against prostate cancer

Answer 24

folate

Question 25

Men with high plasma levels of what hormone are at increased risk for prostate cancer?

Answer 25

Testosterone (low testosterone may have a protective effect)

Question 26

When prescribing testosterone replacement, what cancer must you increase the screening for?

Answer 26

Prostate cancer

Question 27

What is the primary intra-prostatic androgen for cell growth? Where is it made?

Answer 27

**DHT** testosterone is converted by 5-alpha reductase to DHT in the **prostate**

Question 28

\_\_\_ (agent orange) exposure is associated with an increased risk for prostate cancer

Answer 28

Dioxin

Question 29

In the SELECT study, how does **Selenium** and **Vitamin E** affect risk of prostate cancer?

Answer 29

NO CHANGE in risk

Question 30

What is selenium used as a cofactor for?

Answer 30

Glutathione peroxidase

Question 31

What 2 drugs can reduce the risk of prostate cancer?

Answer 31

Finasteride Dutasteride (5a-reductase inhibitors)

Question 32

What are 4 things that can cause an increase in PSA (protein sensitive antigen)?

Answer 32

Prostate cancer BPH Prostatitis Digital rectal exam (DRE)

Question 33

Which is better at detecting prostate cancer: PSA or DRE? (Protein-Sensitive Antigen or Digital Rectal Exam)

Answer 33

PSA is better (although it’s possible that PSA could miss a prostate cancer that a DRE would have picked up)

Question 34

What is a normal PSA level?

Answer 34

\< 4

Question 35

A lower % of free PSA increases what risk?

Answer 35

A lower % of free PSA = INCREASED cancer risk

Question 36

What part of the prostate does cancer arise?

Answer 36

_Peripheral_ zone ## Footnote ***"Peripheral prostate cancer"***

Question 37

What are 2 drugs for hormonal therapy of prostate cancer? MOA's?

Answer 37

**_Leuprolide_** (GnRH analog) - admistered ***continously*** ***(downregulates*** ↓ ***GnRH receptor*** →↓ ***FSH + LH)*** **_Flutamide_** (androgen receptor antagonist)

Question 38

What best reflects a patient's hormone status? (Free T4 vs total T4)

Answer 38

Free T4

Question 39

In post-partum thyroiditis, what occurs first? (thyrotoxicosis or hypothyroidism)

Answer 39

Thyrotoxicosis

Question 40

What are risk factors for osteoporosis?

Answer 40

* Female gender * petite body frame * White or Asian * Smoking * Alcohol * Sedentary * Nulliparity * Old age * High caffeine intake * Renal disease * Postmenopausal status

Question 41

What age is bone mineral density (BMD) testing recommended in women? Men? What if their is concern given their risk factors?

Answer 41

Women = 65+ Men = 70+ If has risk factors = 50+

Question 42

When to start osteoporosis Tx if there is a hip or vertebral fracture?

Answer 42

Always start right away

Question 43

Which bone mineral density scan score is compared to **young adult**? What levels indicate osteopenia? What levels indicated osteoporosis?

Answer 43

**T-score** *"young adul-**T"*** Between -1 and -2.5 **= *osteopenia*** Less than 2.5 ***= osteoporosis***

Question 44

Which bone mineral density scan score is compared to someone of same age/sex/race?

Answer 44

Z-score ## Footnote ***"Z = zame age"***

Question 45

Which synthetic glucocorticoid also ha very strong mineralocorticoid effects?

Answer 45

Fludrocortisone

Question 46

\_\_\_\_\_ inhibits CYP450scc, used to tx Cushing syndrome (Cushing disease and ectopic ACTH-secreting tumors)

Answer 46

Ketoconazole

Question 47

What is the treatment for Cushing syndrome?

Answer 47

Ketoconazole

Question 48

What are renin levels in primary hyperaldosteronism? How do the adrenal glands change?

Answer 48

High aldosterone (duh) **Low renin** **Bilateral** adrenal **hyperplasia**

Question 49

What syndrome cause a unilaterally enlarged adrenal gland + high aldosterone + low renin?

Answer 49

**Conn Syndrome** (adrenal adenoma) type of primary hyperaldosteronism

Question 50

What type of acute adrenal insufficiency has **hemorrhagic necrosis** of the adrenal glands stemming from infection with ***Neisseria Meningitidis***

Answer 50

Waterhouse-Friderichsen syndrome

Question 51

What type of hyaline change is a sign of ***Cushing disease?***

Answer 51

Crook hyaline change

Question 52

What syndrome has mutation of AIRE gene + IL-17 antibodies?

Answer 52

Autoimmune polyendocrine syndrome 1

Question 53

What is the posterior pituitary derived from? (embryologically)

Answer 53

Neural crest (ectoderm)

Question 54

What is the adrenal medulla derived from? (embryologically)

Answer 54

Neural crest (ectoderm)

Question 55

What is the adrenal cortex derived from? (embryologically)

Answer 55

Mesoderm | (like the rest of the GI tract)

Question 56

Child w/ VMA + HVA in urine + Homer-Wright rosettes + small blue cell tumor Diagnosis?

Answer 56

Neuroblastoma

Question 57

What are the 3 P's of MEN-1?

Answer 57

* Pituitary tumors * Parathyroid adenomas * Pancreas endocrine tumors

Question 58

What are the components of MEN-2A and MEN2B? What mutation is associated with these?

Answer 58

* MEN-2A: (*RET* mutation) = **MPP** * Medullary thyroid carcinoma (parafollicular C cell proliferation -- secrete calcitonin) * _Pheochromocytoma_ * Parathyroid adenomas * MEN-2B: (*RET* mutation) = **_MPG_** * Medullary thyroid carcinoma * _Pheochromocytoma_ * Gangliomas of the oral mucosa