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Oncology boards > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

LEMS mechanism

A

reduced acetylcholine (ACh) release from the presynaptic nerve terminals

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2
Q

LEMS clinical features

A
  • slowly progressive muscle weakness
  • proximal lower extremity weakness (gait alteration, difficulty arising from a chair)
  • Oculobulbar findings (ptosis, diplopia)
  • Improvement in strength with vigorous muscle activation
  • Respiratory failure in late stages
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3
Q

Effect of finasteride for chemoprevention of prostate cancer

A
  • 25% reduced incidence of prostate cancer
  • small but significant increase in risk of high-grade prostate cancer (likely from detection bias)
  • no effect on OS
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4
Q

Management of G1 pneumonitis from T-Dxd (asymptomatic) per package insert

A
  • steroids
  • Stop enhertu until resolved to G0
  • If resolved in 28 days or less, maintain dose
  • If resolved in greater than 28 days, dose reduce
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5
Q

Clinical features of inflammatory breast cancer

A

rapid-onset breast erythema (No more than 6 month history) + edema + peau d’orange appearance + warm breast

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6
Q

Differential for anterior mediastinal mass

A

small cell lung cancer →
lymphoma (T-ALL, nodular sclerosing HL, primary mediastinal b-cell lymphoma) →
germ cell tumor → carcinoma) (50%) →

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7
Q

Differential for posterior mediastinal mass

A

Neurogenic →
Meningocele →
Thoracic spine lesions →

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8
Q

Differential for middle mediastinal mass

A

Lymphadenopathy (most commonly) →
Benign cystic tumor →
Cardiovascular aneurysm or anomaly →
Esophageal tumor →

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9
Q

Most common symptoms of leptomeningeal disease

A
  • pain
  • seizures
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10
Q

1) Newly approved NTRK inhibitor 2) clinical benefit

A

Repotrectinib
*high ORR in second line + CNS penetraton

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11
Q

NTRK inhibitors target what specifically

A

FUSIONS

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12
Q

GCSF indications

A

1) neutropenic fever risk > 20%
2) ***Maintain dose density

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13
Q

Risk factors to consider GCSF for intermediate risk for neutropenic fever

A
  • prior chemo or radiation
  • age > 65
  • liver dysfunction
  • CrCl <50
  • chronic immunosuppression
  • bone marrow involvement
  • recent surgery or wounds
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14
Q

Risk factors to consider GCSF for intermediate risk for neutropenic fever

A
  • prior chemo or radiation
  • age > 65
  • liver dysfunction
  • CrCl <50
  • chronic immunosuppression
  • bone marrow involvement
  • recent surgery or wounds
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15
Q

Other brand name for pegfilgrastim

A

Udenyca

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16
Q

GCSF toxicity

A
  • ARDS
  • bone pain
  • bleomycin lung toxicity has higher incidence when given with GCSF
  • sickle cell crisis
  • splenic rupture
  • MDS/AML
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17
Q

Management of bone pain from GCSF

A
  • NSAIDs
  • loratadine
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18
Q

GCSF contraindication

A

Within 14 days of CAR-T (exacerbating CRS)

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19
Q

Chemo induced thrombocytopenia management per boards

A

1) plt transfusion as per standard goals
2) dose reduce subsequent cycle
3) consider romiplostim

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20
Q

Chemo induced anemia transfusion goals per boards

A
  • goal hgb 7, 8 if comorbid cardiovascular disease
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21
Q

Chemo induced anemia transfusion goals per boards

A
  • goal hgb 7, 8 if comorbid cardiovascular disease
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22
Q

Use of ESAs for chemo related anemia per boards

A
  • can be considered if CKD + cancer
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23
Q

Use of ESAs for chemo related anemia per boards

A
  • can be considered if CKD + cancer (already receiving)
  • declining and refusing transfusions
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24
Q

Breast cancer screening modality and timing for women with history of chest wall radiation + at what age it is indicated

A
  • MRI + mammogram annually (typically alternated every 6 months)
  • annual breast MRI after age 25
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25
Q

Most common testicular cancer histology in older men

A

Seminoma

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26
Q

HPV vaccination recommendation

A
  • age 11-12 up to age 26
    *can be offered 27-45 to those most likely to benefit
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27
Q

alcohol and BMI and exercise as RF’s for breast cancer

A

*High BMI is only a a risk factor for postmenopausal women, in premenopausal women low BMI is actually a RF
- minimal alcohol intake (even if less than 1 drink per day) has been shown to increase breast cancer risk
*sedentary/lack of physical activity is also a risk factor
*increased breast density is also a RF

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28
Q

In what ALL subtype is CRLF2 gene rearrangement found in?

A

Ph-like ALL

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29
Q

Ethnic + genetic variant RF for Ph-like ALL

A

1) latino
2) GATA3

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30
Q

How to reduce risk of pancreatic cancer

A
  • weight loss, including bariatric surgery
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31
Q

Most common environmental RF for lung cancer

A
  • residential radon exposure
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32
Q

Drug that requires fixed dosing as opposed to actual weight

A

Bleomycin

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33
Q

Blood thinner contraindicated with tamoxifen

A

Warfarin

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34
Q

Mutations seen in prostate cnacer with neuroendocrine differentiation

35
Q

Statistical test that is less sensitive to outliers

A

Wilcoxon rank-sum test

36
Q

Trial design that allows determination of efficicacy and ability to terminate early for futility

A

Simon two-stage design

37
Q

Statistical test best suited to compare populations with small sample sizes

A

Fisher exact test

38
Q

Pemetrexed mechanism

A

Folate antagonist

39
Q

Drug contraindicated with second generation BCR-ABL TKI’s

A

PPI’s (pH dependent absorption)

40
Q

Problems of 3+3 phase I design

A
  • doesn’t minimize sample size
  • can give poor estimate of MTD
41
Q

First line for NETs per boards

42
Q

Point of a Phase 4 trial

A
  • evaluate toxicity and outcomes after a new treatment has been approved under real-life conditions
43
Q

What is the healthy volunteer effect?

A

Volunteers are healthy and not representative

44
Q

Most common mechanism of radiation-induced cell death in solid tumors

A

mitotic castastrophe

45
Q

VHL funtion

A

Tumor suppressor

46
Q

Recurrent metastatic head and neck

A

IF recurrence <6 months (platinum refractory),
IF low-moderate volume of disease AND PD-L1+, pembrolizumab
IF high volume disease, cetuximab + pembro (Phase II, OS, ORR benefit)
IF PD-L1 negative, cetuximab + pembro
IF recurrence >6 months, treat as de novo metastatic

47
Q

Antibody associate with paraneoplastic cerebellar degeneration in SCLC

48
Q

CRC in surveillance imaging indication

A

CT torso q6-12 months

49
Q

Stage IA ovarian cancer management in patient desiring fertility

A
  • unilateral salpingo-oophorectomy with adjuvant carbo/taxol (stage IA is isolated involvement of one ovary, this is the only scenario in ovarian where fertility preservation is possible)
50
Q

What qualifies as low risk PC

A

PSA <10
T2a or lower
Grade group 1

51
Q

Low risk PC options

A

IF life expectancy >10 years
Active surveillance (preferred)
XRT
RP without ADT

52
Q

Very low risk PC options

A

Active surveillance if life expectancy >10 years
IF <10 years, observation (do nothing)

53
Q

Unfavorable intermediate PC

A
  • Grade group 3
  • > 50% positive biopsy cores
  • PSA 10-20
54
Q

favorable vs. unfavorable intermediate risk PC in terms of ADT w/ RT

A
  • ADT only indicated with RT if unfavorable
55
Q

When zytiga is indicated for localized prostate cancer

A

node positive on conventional scan OR 2 of following: T3/T4, grade group 4 to 5 (GS 8-10), PSA ≥40 ng/mL

56
Q

Clinical benefit of cetuximab added to RT vs. RT alone

A
  • OS benefit but still understudied so hasn’t replaced standard of care
57
Q

Stage IIb cervical cancer management

A

Chemoradiation w/ cisplatin then brachytherapy

58
Q

What defines tage IIb cervical cancer

A

parametrial involvement

59
Q

Chemo-induced neuropathy treatment

A
  • duloxetine
  • gabapentine
60
Q

Indications for treatment in WM

A

hyperviscosity
hepatosplenomegaly
cryoglobulinemia
cold agglutinin disease
b symptoms
bulky adenopathy (>5cm)
Cytopenias

61
Q

Metastatic merkel cell - prognosis better w/ known vs. uknown primary

A

Better prognosis if unknown primary

62
Q

First line for MSI-H BRAF V600 E mutant metastatic colon

A

chemoimmunotherapy - mFOLFOX + pembro (Accumulating evidence that sporadic MSI-H has high disease heterogeneity. BRAF mutant needs upfront intensification of therapy but dMMR/BRAF still do better than pMMR/BRAF)

63
Q

Anticipatory nausea management

A

Behavioral therapy per guidelines
Lorazepam 0.5 mg-2mg before pretreatment if no improvement with behavioral therapy

64
Q

Biomarker predictive of improved response from margetuximab vs. trastuzumab

A

CD16A 158F allele

65
Q

management of pulmonary toxicity from chlorambucil in CLL

66
Q

Drugs for lowering potassium in TLS

A

IF available, sodium zirconium cyclosilicate (SZC) 10 g TID for 48h (preferred, since more rapid acting)
IF SZC not available, patiromer 8.4 g daily (repeated daily as needed)
Avoid sodium polystyrene sulfonate (bowel necrosis, toxicity)

67
Q

When to hold and discontinue bev for proteinuria

A

> 2 = hold
3.5 = permanently discontinue

68
Q

Opioid risk tool - score indicating high risk

A

Greater than or equal to 8

69
Q

Biomarker used in CLL IPI

70
Q

most common genetic abnormality in SCLC

A

p53 mutations (nearly all SCLC tumors)

71
Q

First line for papillary thyroid cancer

72
Q

localized NPC treatment

A

definitive XRT

73
Q

locally advanced NPC management

A

induction chemo then CRT

74
Q

Effect of CYP3A inducers on chemo drugs

A

Decrease concentration and efficacy

75
Q

Examples of CYP3A inducers

A
  • seizure drugs
  • TB
  • PPI’s
  • St. John’s wort
76
Q

Effect of CYP3A inhibitors on chemo drugs

A
  • increase serum chemo levels and increase opioid toxicity
77
Q

Examples of CYP3A inhibitors

A
  • grapefruit
  • HIV
  • Fungal drugs
  • macrolides
  • fluoroquinolones
  • anti-depressants
78
Q

Smear findings in cirrhosis

A
  • acanthocytes (spur cells)
    *see photo online
79
Q

Drug in CRC that’s contraindicated with bili >2

A

irinotecan

80
Q

Why does brigatinib require step up dosing?

A

pulmonary toxicity

81
Q

CLL pts for whom chemoimmunotherapy (eg FCR) is contraindicated

A
  • IGHV unmutated
  • p53 mutant
82
Q

Paget’s disease management

A

central breast excision

83
Q

second line for papillary thyroid cancer

A

lenvatinib

84
Q

clinical benefit of sunitinib for RCC

Oncology boards (41 decks)

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