MTB - Oncology/ Preventive Medicine

Question 1

screening mammography

Answer 1

starts at age 50, ends at age 75

Question 2

BRCA mutation is assoc. with

Answer 2

increased risk of familial breast ca. and ovarian ca.

Question 3

BRCA mutation screening

Answer 3

NOT a routine screening test –> only for at-high risk patients

Question 4

when do you use tamoxifen as preventative therapy?

Answer 4

if the patient has 2 or more first degree relatives with breast ca.; start therapy at age 40

Question 5

adjuvant chemotherapy in breast ca.

Answer 5

if tumor > 2 cm (1 cm) or there is axillary LN involvement

more likely to be effective in menstruating women

Question 6

s/e of tamoxifen

Answer 6

DVT
hot flashes
endometrial cancer

Question 7

how are aromatase inhibitors different from tamoxifen?

Answer 7

no selective ER agonist activity
NO risk of DVT
do cause osteoporosis (antagonist in bone)

Question 8

routine colonoscopy

Answer 8

age 50, every 10 years

Question 9

CRC screening - one family member with CRC

Answer 9

colonoscopy age 40 or 10 years earlier than age of dx (whichever is earlier)

Question 10

CRC screening - HNPCC (3 family members, two generations, one premature <50 yo)

Answer 10

colonoscopy at age 25, then every 1-2 years

Question 11

CRC screening - FAP

Answer 11

screening sigmoidoscopy at age 12, then every 1-2 years

Question 12

screening test for lung ca

Answer 12

none

Question 13

52 yo smoker with 1.5 cm calcified nodule found on CXR; no symptoms. Next step?

Answer 13

Excisional biopsy on all lesions > 1 cm in smokers

Question 14

Surgery is excluded in lung cancer if any of the following are present…(5)

Answer 14

bilateral lesions
mets
malignant pleural effusion
involvement of aorta, vena cava, heart
lesions w/in 1-2 cm of carina

Question 15

follow-up for LSIL or HSIL found on pap smear

Answer 15

colposcopy and biopsy

Question 16

follow-up for ASCUS found on pap smear

Answer 16

HPV testing

• if positive: colposcopy
• if negative: repeat pap in 6-12 months

Question 17

which lowers mortality more? mammography or pap smear?

Answer 17

mammography

Question 18

when do you start Pap Smears?

Answer 18

age 21 - regardless of onset of sexual activity

Every 3 years if normal results

Question 19

when can you stop pap smears?

Answer 19

age 65

Question 20

screening for prostate cancer

Answer 20

only if patient asks –> do PSA and DRE until age 75

Question 21

do PSA and DRE testing lower mortality from prostate cancer?

Answer 21

no

Question 22

most important prognostic factor in prostate ca.

Answer 22

Gleason score (measure of level of differentiation)

Question 23

Tx. localized prostate ca.

Answer 23

surgery or external radiation or implanted radioactive pellets –> both are equal in efficacy

Question 24

Tx. metastatic prostate ca.

Answer 24

androgen blockade w/ flutamide and leuprolide or goserelin

Question 25

fastest way to lower androgen /testosterone levels

Answer 25

orchiectomy (not first line though)

Question 26

man w/ prostate ca. presents with signs of cord compression on MRI - managements?

Answer 26

1. Steroids
2. Flutamide - prevents androgen flare
   GnRH agonists should NOT be started too soon - can worsen compression

Question 27

a 60 year old woman presents with increasing abdominal girth at the same time as weight loss - dx?

Answer 27

likely ovarian ca.

Question 28

Ca-125

Answer 28

NOT a screening test - marker of progression and response to therapy for ovarian ca.

Question 29

Tx. ovarian ca.

Answer 29

surgical debulking + chemotherapy

- even in cases of extensive local metastatic disease`

Question 30

diagnostic testing of suspected testicular ca.

Answer 30

inguinal orchiectomy of affected testicle

Question 31

MC type of testicular ca.

Answer 31

germ cell tumors (seminoma and non-seminoma)

Question 32

what types of testicular ca. secretes AFP

Answer 32

non-seminoma

Question 33

what hormones/markers do you measure in testicular ca.

Answer 33

AFP
bHCG
LDH

Question 34

staging of testicular ca.

Answer 34

CT abdo and pelvis

Question 35

Tx. local disease testicular ca.

Answer 35

radiation

Question 36

Tx. widespread testicular ca.

Answer 36

chemotherapy - can cure mets

Question 37

cancer screening test that lowers mortality the most

Answer 37

mammogram

Question 38

mortality benefit of mammogram is greatest above what age?

Answer 38

50

Question 39

indications for influenza and pneumococcal vaccination

Answer 39

1. pts with chronic lung, heart, liver, kidney and cancer
2. HIV positive patients
3. patients on steroids
4. patients with diabetes

Question 40

who benefits the most from influenza vaccine?

Answer 40

everyone > 50
pregnant women
healthcare workers

Question 41

when do you give pneumococcal vaccine normally?

Answer 41

all patient > 65 yo

Question 42

when is meningococcal vaccine given?

Answer 42

age 11

- earlier if pt has functional/anatomic asplenia OR terminal complement deficiency

Question 43

who should receive the varicella-zoster vaccine?

Answer 43

everyone above age 60

Question 44

most effective method of achieving smoking cessation

Answer 44

oral medication - bupropion, varenicline

Question 45

osteoporosis screening

Answer 45

all women > 65 –> should receive bone densitometry

Question 46

AAA screening

Answer 46

all men, > 65 who were every smokers

Question 47

diabetes screening

Answer 47

only routine in those with HTN

Question 48

HTN screening

Answer 48

all patients > 18 yo should have their BP checked at every visit

Question 49

Hyperlipidemia screening

Answer 49

men > 35 and women > 45