M. Testicular cancer + Prostate cancer vs BPH points Flashcards
M. Most common testicular cancer; occurs teenage years and older. Dx?
Seminoma
M. Large, uniform cells with watery cytoplasm. Chemo- and radiosensitive. Dx?
Seminoma
M. Placental ALP can be a tumor marker. Tumor?
Seminoma
M. Seminoma. tumor marker?
Placental ALP can be a tumor marker.
M. Aka endodermal sinus tumor. Dx?
Yolk sac tumor
M. Most common in kids under 3. Dx?
Yolk sac tumor
M. Yolk sac tumor - tumor marker?
AFP is tumor marker.
M. AFP is tumor marker. Tumor?
Yolk sac tumor
M. Immature/anaplastic cells. Dx?
Embryonal carcinoma
M. Embryonal carcinoma. Tumor markers?2
Combined AFP and hCG are tumor markers.
M. Combined AFP and hCG are tumor markers. What tumor?
Embryonal carcinoma
M. Embryonal carcinoma - age?
Usually adult men
M. Secrete androgens. Dx?
Sertoli-Leydig cell tumor
M. Sertoli-Leydig cell tumor. can cause what breast?
Can cause gynecomastia (shows up on NBME). This is because incr. androgens can be aromatized into estrogens.
M. Secrete androgens. Can cause gynecomastia (shows up on NBME). This is because androgens can be aromatized into estrogens. Dx?
Sertoli-Leydig cell tumor.
M. Secretes estrogen. Dx?
Granulosa cell tumor
M. Granulosa cell tumor. secretes what?
Secretes estrogen.
M. Granulosa cell tumor. cause what on breast?
Can also cause gynecomastia.
If NBME gives you Q with Sertoli-Leydig cell tumor causing gynecomastia, they won’t simultaneously list granulosa cell tumor as an answer.
M. Secretes estrogen.
Can also cause gynecomastia. If NBME gives you Q with Sertoli-Leydig cell tumor causing gynecomastia, they won’t simultaneously list granulosa cell tumor as an answer.
M. Granulosa cell tumor.
M. Composed of syncytiotrophoblastic placental cells. Dx?
Choriocarcinoma
M. Choriocarcinoma. age?
Can occur in males, yes. Usually 20s-30s.
M. Choriocarcinoma. tumor marker?
Incr. incr. (2arrows) hCG as tumor marker.
M. Incr. incr. (2arrows) hCG as tumor marker. Dx?
Choriocarcinoma.
M. Adenocarcinoma (i.e., glandular); most common cancer in men.?
Prostate cancer
M. Prostate cancer. Stimulated by ?
DHT
!!!!M. Prostate cancer. what metastases?
Causes osteoBLASTIC metastases (highest yield point on USMLE).
M. Can present as random guy over 50 with no PMHx who just suddenly has neurologic symptoms in the legs and two blastic lesions in his spine picked up on MRI. Dx?
Prostate cancer
M. Prostate cancer. If neuro Sx are present due to spinal mets, give what drug?
Give IV methylprednisolone.
M. Prostate cancer. If no neuro Sx are present and they just say vertebral blastic lesions, answer will be ??? Tx
radiotherapy
M. Prostate cancer.
Radiotherapy for mts without neuro. I’ve seen distractor answers in this case such as “morphine + corticosteroids,” where the student says, “I thought we give steroids though.” Yeah, if the patient has neuro Sx, which he doesn’t here, plus jumping to morphine before trying other pain management first is wrong.
.
M. Prostate cancer. Orchiectomy will decr. what?
Orchiectomy will decr. androgen production -> leads to atrophy and shrinkage of prostatic cancer cells.
M. Prostate cancer. what drugs given? 2
Flutamide blocks androgen receptor. It is given prior to leuprolide, which is a GnRH receptor agonist that, when given continuously, causes desensitization at GnRH receptor.
Since leuprolide can incr. LH and FSH prior to desensitization, the flutamide is given first.
M. Prostate cancer. PSA?
Prostate-specific antigen (PSA) will often be elevated.
Free-PSA (i.e., not bound to protein) is low compared to bound-PSA in prostate cancer.
M. Prostate cancer. what scale used?
Gleason scoring is used to grade prostate cancer.
M. Prostate cancer. ….. are at greatest risk of injury during radical prostatectomy (asked somewhere on NBMEs).
The parasympathetic nerves (for erection) are at greatest risk of injury during radical prostatectomy (asked somewhere on NBMEs).
M. BPH. All old dudes have enlarged prostates due to lifetime exposure to DHT, which causes prostatic enlargement.
.
M. BPH. CP?
Presents as dribbling, hesitancy commencing urination, or interrupted stream in a male over 60 (but usually 70s+).
M. “Old dude + high creatinine = Dx?
BPH till proven otherwise.”
M. BPH. Discontinue anti-cholinergic meds because they cause urinary retention. This concept shows up a lot on NBMEs. Three classes of drugs in particular: ??? 3
1) First-gen H1 blockers (i.e., diphenhydramine, chlorpheniramine);
2) TCAs (i.e., amitriptyline).
3) Anti-psychotics.
M. You’ll get a Q where an older male has high Cr and then the answer is just ?? about drugs
BPH. “discontinue anticholinergic meds,” or “discontinue the diphenhydramine.”
M. BPH. examination?
Can be described as “nodular” on palpation.
M. BPH. PSA?
Prostate-specific antigen (PSA) will often be elevated. Free-PSA is high compared to bound-PSA in BPH.
M. BPH. Tx? drugs
Tx is alpha-1 blocker, such as tamsulosin/terazosin; or the 5-alpha-reductase inhibitor, finasteride.
M. BPH. When surgery?
Transurethral resection of prostate (TURP) for refractory cases.
M. BPH vs cancer PSA?
BPH: PSA will often be elevated. Free-PSA is high compared to bound-PSA in BPH.
Cancer: PSA will often be elevated. Free-PSA (i.e., not bound to protein) is low compared to bound-PSA in prostate cancer.
