MKSAP STOCK2 Flashcards
A treament regimen for adenocarcinoma of unknown primary below the diaphragm should target this type of cancer
Gastrointestinal primary
What is the appropriate post-operative surveillance colonoscopy for patients with stage III colon CA?
Every 3-5 years following a normal study at 1 year
What is the prognostic scoring system for patients with diffuse large B cell lymphoma?
Revised International Prognostic Index (r-IPI) score
What drug therapy is indicated for all patients with multiple myeloma to prevent or to treat bone disease?
Bisphosphonate therapy (zoledronic acid > pamidronate)
What type of stage I testicular cancer is most often cured by surgical resection alone?
Seminoma
What is the initial mgmt in patients with suspected malignant superior vena cava syndrome?
Biopsy for histoligic diagnosis
What preoperative imaging is needed to stage newly diagnosed colon CA?
Contrast-Enhanced CT of C/A/P
Indicated mgmt following surgical resection of nonmetastatic renal cell carcinoma?
Clinical observation
What is the first test in the diagnosis of a low pretest probability of DVT?
D dimer
What are three laboratory findings consistent with coagulopathy of liver disease?
Prolonged prothrombin time; Prolonged activated partial prothromboplastin time, and INCREASED factor VIII level (from WP bodies in endothelium)
Treatment of locally advanced cervical cancer
Chemoradiation (not surgery)
What tissue testing is indicated for patients with newly diagnosed head and neck cancers?
p16 tissue testing (IHC stain for HPV)
What is the treatment of high risk myelodysplastic syndrome?
Allogeneic Hematopoetic Stem Cell Transplant
What is the timing of bilateral prophylactic salpingo-oopherectomy for BRCA1 carriers?
By age 35 years and after child-bearing is complete
Two goals of posttreatment surveillance following therapy for head and neck cancer
Identify local recurrence; Identify distant second primary cancer
Genetic mutation commonly associated with polycythemia vera
JAK2 V617F activating mutation
What agent for acute treatment of tumor lysis syndrome catalyzes breakdown of uric acid? Testing needed before giving (theoretically)?
Rasburicase; G6PD level
What is a diagnosis for acute respiratory distress, elevated BNP, and elevated central venous pressure within 6 hours of transfusion?
Transfusion associated circulatory overload
What is the initial treatment of intracranial hypertension associated with central nervous system lymphoma?
High dose systemic glucocorticoids
What are two essential steps in managing heparin-induced thrombocytopenia?
Stop heparin; Start nonheparin anticoagulant (Lepirudin, ARGATROBAN, danaparoid)
What is the initial treatment of metastatic ER+ breast cancer limited to the bone?
Aromatase inhibitor (letrozole, exemestane)
What are three CONTRAindications to outpatient therapy for acute pulmonary embolism in a hemodynamically stable patient?
Need for supplemental oxygen; need for IV pain meds; presence of “significant” comorbid conditions
Recommended adjuvant therapy for SCC of head and neck with positive surgical margins following resection
Chemoradiation
What is the INITIAL treatment of malignancy-associated hypercalcemia?
NS infusion- liberal
What is a monoclonal antibody used to treat Waldenstroms Macroglobulinemia?
Rituximab (recall it is lymphoplasmacytic LYMPHOMA)
What is the treatment of solitary colon cancer metastasis to liver or lung
Surgicla resection
What tissue testing is indicated in patients with metastatic gastric cancer
HER2 tumor status
What is the first step in mgmt of suspected transfusion-transmitted bacterial infection?
Stop transfusion! Then broad spec abx
Immunosuppressed patients at greater risk for this lymphoma
Non-Hodgkin Type lymphomas
Therapy for mycosis fungoides limited to the skin
Topical glucocorticoids
What genotype testing is indicated in patients with metastatic colorectal cancer?
K-ras and N-ras
What is the intial diagnostic study for ALL patients with confirmed amyloidosis?
Amyloid typing (I think this is the microdissection that goes to Mayo)
Two measures of performance status commonly used to guide therapy in patients with metastatic cancer
Karnofsky Score and ECOG score (Zubrod score)
What are two adjuvant treatment options for stage III colon cancer?
FOLFOX (folinic acid = leucovorin, 5 FU, oxaliplatin); CAPOX- capecitabine and oxaliplatin
What are 7 treatment related complications following therapy for testicular cancer?
CV disease, Metabolic Syndrome, Kidney dz, Peripheral neuropathy, Chronic Pulmonary toxicity, Secondary malignancy, and sexual dysfunction
Genetic testing for metastatic melanoma
BRAF V600E mutation analysis
What are 3 possible indications for neoadjuvant chemotherapy for patients with localized breast CA?
HER2-amplified breast CA; Triple negative breast CA; large cancers in women who want breast-conserving tx
What are 3 conditions that are associated with iron malabsorption
Celiac disease, achlorhydria, and H. pylori infection (also bariatric surgery)
This intervention provides survival benefit in patients with early-stage ovarian CA
Exploratory surgery with intact removal of adnexal mass
Recommended screening for ovarian cancer in women of average risk
No screening
What is the target hemoglobin level for patients with sickle cell disease undergoing low to moderate risk surgery?
10 (TAPS study)
Syndrome characterized by rheumatoid arthritis, splenomegaly, and neutropenia?
Felty’s Syndrome
This is the initial treatment for patients with rectal cancer that invades into but not fully through the rectal wall without evidence of lymph node mets
Surgical resection (This is Stage I)
What are three risk factors for progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma?
Non IgG M protein; M protein of at least 1.5 g/dl; and abnormal serum free light chain ratio
What hormonal contraceptive option has the lowest risk for venous thromboembolism?
Progestin-releasing intrauterine device
What is the most common musculoskeletal adverse effect in patients taking an aromatase inhibitor?
Arthralgia (Aromatase Inhibitor-Induced Arthralgia Syndrome)
What is the treatment of ipilimumab-induced toxicity
DC ipilimumab and start systemic high-dose glucocorticoid tx
This is a term for chemotherapy that is given to a patient with an unresectable tumor to shrink it to a resectable size
Conversion Chemotherapy
What is the immediate treatment of multiple myeloma associated spinal cord compression?
IV high dose glucocorticoids
What is the recommended treatment for a patient with asymptomatic, nonbulky follicular lymphoma?
Clinical observation; but if stage I-IIA can do ISRT
What is the management of recurrent superficial bladder cancer following treatmetn with TURBT (transurethral resection of bladder tumor) or intravesical BCG?
Cystectomy
What are two indications to perform a SLNB in patients with newly diagnosed melanoma?
1-4 mm thickness; <1 mm thick but with HIGH RISK FEATURES - ulceration, > 1 mitosis/mm2, and lymphovascular invasion (LVI)
What is the general time frame to stop new oral anticoagulants (NOAC) before surgery?
24-36 hours before a surgery with standard risk of bleeding
What is the treatment of warm autoimmune hemolytic anemia?
Systemic Glucocorticoids
What is the mgmt of low risk myelodysplastic syndrome?
Clinical observation
Genetic mutation commonly associated with essential thrombocythemia
JAK2 V617F activating mutation
What is the diagnosis for a decrease in hemoglobin level, reticulocytosis, and elevated LDH several days following a transfusion?
Delayed Hyperhemolytic transfusion reaction
What is the most effective chemoprophylaxis in postmenopausal women with newly diagnosed atypical ductal hyperplasia?
Exemestane (Aromatase Inhibitor)
What are the two criteria for discontinuing heparin when initiating anticoagulant treatment for VTE with the combo of heparin and warfarin (i.e. bridging)
Heparin and Warfarin have overlapped for >5 days; INR is >2 for 24 hours
Therapy for gastric MALT lymphoma associated with H. pylori infection?
Treat the H. pylori
What is the diagnosis for episodic hemolysis in response to oxidant stressors?
Glucose-6-phosphate dehydrogenase deficiency
What are three indications for BRCA 1/2 testing in women with newly diagnosed breast cancer?
Patient under 45; Breast CA diagnsed at any age with one or more first, second, or third degree relatives dx with ovarian CA; Triple neg breast CA diagnosed prior to age 60
What is the diagnosis for a patient with mild microcytic, hypochromic anemia with target cells and a normal hemoglobin electrophoresis?
alpha thalassemia trait (alpha thalassemia minor)
What are three clinical parameters indicating a low risk of prostate cancer progression?
Clinically localized prostate CA; Serum PSA <10 ng/mL; Gleason Score <8
What is a cause of iron deficiency and red urine in a runner?
Exercise induced intravascular hemolysis
The treatment regimen for a woman with CUP presenting with abdominal carcinomatosis and ascites should be focused towards what cancer type?
Ovarian
Women with a personal and family history of ovarian, endometrial, or colon CA should undergo testing for this genetic syndrome
Lynch Syndrome (HNPCC)
What is the diagnostic test to perform for B12 deficiency if the level is borderline low?
Methylmalonic Acid level
This is the type of non-Hodgkin lymphoma characterized by extranodal involvement and overexpression Cyclin D1
Mantle Cell Lymphoma
What is an important genetic mutation screening test for patients with lung adenocarcinoma?
EGFR mutation testing
What is the threshold hemoglobin level to begin ESAs (erythropoiesis-stimulating agents) for patients with CKD and symptomatic anemia?
Hgb <10
What are two anticoagulants safe in breastfeeding?
Warfarin (though not safe in pregnancy) and LMWH
