MKSAP Flashcards
- A 52-year-old man is seen following an axillary lymph node
biopsy confirming a diagnosis of large B-cell lymphoma. - Complete blood count, liver chemistry tests, and electrolyte, blood urea
nitrogen, and creatinine levels are normal. - PET/CT shows uptake in left axillary, mediastinal, hilar, and retroperitoneal
nodes, as well as multiple foci in the ileum, ribs, and vertebral bodies.
A) Biospie de moelle
* B) IRM cérébrale
* C) Biopsie d’une ADP RP
* D) LDH
LDH
A 78-year-old man undergoes preoperative evaluation for left
knee arthroplasty. Other than knee pain, he has no other
symptoms. Medical history is otherwise unremarkable. His only
medication is ibuprofen, which he has recently discontinued.
* On physical examination, vital signs are normal. Diffuse adenopathy with
nodes 1.5 to 2 cm is present in cervical, axillary, and inguinal areas. The
spleen is enlarged 2 cm below the left costal margin.
* Results of laboratory studies show a leukocyte count of 62,000/µL (62 ×
10 9
/L) with 90% lymphocytes, hemoglobin level of 12.8 g/dL (128 g/L),
and platelet count 152,000/µL (152 × 10 9
/L). Flow cytometry shows a
predominance of CD5, CD19, and CD20 cells expressing only κ light chains
consistent with chronic lymphocytic leukemia.
1) BMO
* 2) Ibrutinib
* 3) Bendamustine-rituximab
* 4) Chirurgie comme prévu
- 4) Chirurgie comme prévu
A 79-year-old man is evaluated in the office following a recent hospitalization for pneumonia. This is his second episode of pneumonia in the past year. Medical history is notable for chronic lymphocytic leukemia. His disease course has been followed without treatment for the past 9 years.
- Leukocyte count 46,000/µL (46 × 109/L) with 92% lymphocytes, 6% neutrophils, 1% bands, and 1% monocytes
- IgG 320 mg/dL (3.2 g/L)
- IgA 20 mg/dL (0.2 g/L)
- IgM 34 mg/dL (0.34 g/L)
choix :
- Splénectomie
* Ibrutinib
* Immunoglobulines IV
* G-CSF
ivig
- A 56-year-old man is evaluated for an enlarging, painful inguinal lymph node he first noticed 1 month ago. He has a history of follicular lymphoma of 8 years’ duration. The patient was treated in the past with two courses of rituximab 8 and 3 years ago with durable partial responses. For the past 3 years, he had stable diffuse adenopathy managed with observation. He has no other symptoms.
- On physical examination, vital signs are normal. The patient has diffuse adenopathy in the neck, axillae, and right inguinal area and a new left inguinal conglomerate nodal mass measuring 5 × 7 cm.
- Complete blood count and metabolic profile are normal.
- PET/CT scan shows diffuse uptake in axillary, mediastinal, hilar, and mesenteric nodes with elevated standardized uptake values in the 4 to 12
range, but 28 in the left inguinal area. - Bendamustine-rituximab
- Rituximab
- Biopsie inguinale
- RT inguinale
Bx inguinale
A 68-year-old man is evaluated for early satiety and right upper quadrant discomfort. He is otherwise well. He reports that he is still working full time and walks about a half mile to and from work each day.
* On physical examination, vital signs are normal. Examination is notable for hepatomegaly.
* Complete blood count is normal. On serum chemistry testing, alkaline phosphatase and aminotransferase levels are elevated; bilirubin and creatinine levels are normal.
* CT scan of the chest, abdomen, and pelvis shows hepatomegaly with multiple metastatic lesions and abdominal carcinomatosis with a small amount of ascites. No other abnormalities are noted. Liver biopsy reveals adenocarcinoma.
* The patient is diagnosed with metastatic cancer from an unknown primary.
* 1) Marqueurs tumoraux
* 2) Pannel génétique
* 3) TEP
* 4) Endoscopies
* 5) Commencer la chimiothérapie
5
A 54-year-old woman is evaluated for a several-month history of increasing abdominal girth. Medical history is otherwise unremarkable, and she takes no medications.
* On physical examination, vital signs are normal. Abdominal examination reveals ascites. Pelvic examination and the remainder of the physical examination are normal.
* Complete blood count and comprehensive metabolic profile are normal.
* Contrast-enhanced CT scan of the chest, abdomen, and pelvis reveals ascites with areas of peritoneal and omental thickening consistent with metastatic cancer. No abnormalities of the liver are noted, and the adnexa appear normal.
* Paracentesis is performed, and cytology reveals adenocarcinoma.
* Surgical debulking of the peritoneal tumor is planned.
- Régime de chimio pour tumeur GI
- Régime de chimio pour tumeur ovarienne
- Anti-PD1
- RT pan-abdominale
- Régime de chimio pour tumeur GI
45 ans No/Vo, céphalé, pire en am
hx medical: cancer sein métastatique
fond oeil: papilloedeme
IRM lésion réhaussante de 4 cm avec de l’oedème vasogénique ( pas d’herniation, pas de midline shift)
PROCHAINE étape?
* Décadron
* Chirurgie cérébrale
* SBRT
* WBRT
décadron
* Bien que ce soit la meilleure première étape pour diminuer l’œdème
et améliorer symtômes, urgence de faire plus:
* À discuter avec neurochx et RT: SBRT vs Chirurgie.
- A 55-year-old woman is admitted to the hospital for chemotherapy following a diagnosis of Burkitt lymphoma.
She is considered to be at high risk for tumor lysis syndrome. - On physical examination, blood pressure is 110/60 mm Hg and
pulse rate is 110/min; the remainder of her vital signs are normal. The patient has large, palpable, bilateral, cervical, supraclavicular, and axillary lymphadenopathy. Cardiopulmonary examination is
normal. - CT imaging of the chest, abdomen, and pelvis at the time of diagnosis revealed bulky mediastinal and periaortic lymphadenopathy.
- Intravenous isotonic saline is administered at 200 mL/hour.
Quelle mesure additionnelle?
* Acetazolamide
* Allopurinol
* Furosemide
* Rasburicase
- Rasburicase
- 1) La rasburicase est clairement indiquée pour les situations à haut risque de lyse
tumorale - 2) La diurèse forcée (furosemide) ou l’alacalinisation des urines (acetazolamide)
ne sont pas recommandés car comportent des risques: - Contraction volémique (lasix)
- Accroissement dépots phospho-calciques (alcalinisation)
- 3) l’allopurinol n’est pas suffisant dans ce cas
- A 66-year-old man is evaluated for increased confusion and lethargy over the past 2 days, as well as nausea and vomiting. He has also had diffuse bone pain that began 6 weeks ago and has worsened over the past month. His medical history is otherwise unremarkable, and he takes no medications.
- On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 110/60 mm Hg, pulse rate is 110/min, and respiration rate is 16/min. He is somnolent but can be aroused. Mucous membranes are dry, and he has decreased skin turgor. Cardiopulmonary examination is normal.
- Results of laboratory studies show an albumin level of 3.8 g/dL (38 g/L), calcium level of 14.8 mg/dL (3.7 mmol/L), and creatinine level of 2.5 mg/dL (221 µmol/L).
Choix: Meilleur premier choix? - Denosumab
- NaCl 0,9 et calcitonine
- NaCl 0,9 et furosemide
- Acide zolendronique
- NaCl 0,9 et calcitonine
Justification: - 1 re étape pour diminuer rapidement calcémie = hydratation
- Calcitonine peut aussi faire baisser rapidement la calcémie dans un cas aussi malade que celui-ci
(mais tachyphylaxie rapide en 48h) - Acide zolendronique est AUSSI indiqué pour faire diminuer calcémie (mais onset plus lent et pic
d’action 3-7 jours) (vs heures pour soluté et calcitonine) - X-geva = cas réfractaires aux bisphosphonates
- Furosemide = contre-indiqué re: risque de contraction volémique et de diminuer calciurie
- A 68-year-old man is evaluated for shortness of breath, headache, and swelling of the neck. He first noticed symptoms 3 weeks ago, which have worsened over the past 2 days.
- Medical history is significant for a 25-pack-year history of smoking.
- On physical examination, temperature is 36.5 °C (97.8 °F), blood pressure is 110/65 mm Hg, pulse rate is 112/min, and respiration rate is 18/min.Oxygen saturation is 92% breathing ambient air. The patient is cachectic but appears comfortable. His face is plethoric, and there are distended cutaneous vessels over the anterior thorax. An enlarged right supraclavicular lymph node is palpable. Pulmonary examination is normal.
- CT scan of the chest reveals bulky mediastinal adenopathy compressing the superior vena cava, right supraclavicular adenopathy, and a small
right-sided pleural effusion.
choisi - Biospsie du gg sus-clav
- Stéroïdes
- Radiothérapie
- Résection chirurgicale du gg sus claviculaire
- Biospsie du gg sus-clav
A 55-year-old woman is evaluated in the office following a recent diagnosis of metastatic adenocarcinoma of the lung.
She has excellent performance status. Medical history isotherwise unremarkable, and she takes no medications.
* There are no molecular alterations (epidermal growth factor receptor, ALK, ROS1). Programmed death ligand-1 expression is negative.
- Chimiothérapie + pembro
- A 61-year-old man is evaluated in the emergency
department for chronic low back pain, which has worsened rapidly over the past week and is now associated with newonset weakness in his legs. Medical history includes metastatic non–small cell carcinoma of the lung. Previous to this event, the patient had good functional status. - On physical examination, vital signs are normal. He has 4/5 muscle strength with flexion at the bilateral hips and knees.
- MRI of the entire spine reveals a 5-cm mass centered in the posterior elements of L1 and L2 with extension into the epidural space and spinal cord compression.
Meilleur choix? - Décadron
- Décadron, chirurgie, RT complémentaire
- RT
- Chirurgie
- Décadron, chirurgie, RT complémentaire
A 77-year-old woman undergoes follow-up evaluation for recently diagnosed stage I adenocarcinoma of the lung. Medical history is notable for very severe COPD that limits her ability to dress unaided. Her medications are an inhaled corticosteroid, salmeterol, tiotropium, roflumilast, and an albuterol inhaler as needed.
* On physical examination, respiration rate is 25/min; other vital signs are normal. Oxygen saturation is 91% breathing 3 L/min of oxygen by nasal cannula. BMI is 20, and she is thin with significant muscle wasting. She has a prolonged expiratory phase of respiration and decreased breath sounds bilaterally.
* Surgical and pulmonary consults concur that the patient is too chronically disabled to safely undergo elective thoracic surgery
Choix:
* Chimio
* Chimio-radio
* Immunothérapie
* SBRT thoracique
- SBRT thoracique
