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exam Orient > Nazir Pearls > Flashcards

Nazir Pearls Flashcards

1
Q

Classify glial tumors

A

Astrocyte
Grade 1: pilocytic astrocytoma
Grade 2: gemistocytic astrocytoma, fibrillary
Grade 3: anaplastic, diffuse astrocytoma
Grade 4: GBM

ependymal tumor
Sub ependymoma
Myxopapillary ependymoma
Anaplastic ependymoma

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2
Q

Tumors having retro orbital extension

A

Breast
Lymphoma
Leukemia
Lung

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3
Q

Type of brain surgery

A

STR
GTR
intraoperative functional mapping

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4
Q

Causes lung cancer

A

Smoking
Alcohol
Family factor: Li fraumeni
Occupational factor
- radon
-asbestos
-silica
Previous lung disease:
- COPD
- Idiopathic pulmonary fibrosis
- Interstitial lung disease
Infectious agent:
- HPV
-HIV

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5
Q

Benign condition where radiotehrapy is needed?

A

Graves opthalmopathy
Pituitary adenoma
Keloids
Bowens disease
Rheumatoid arthritis
Aneurysmal bone cyst
Trigeminal neuralgia (75-80Gy)
Adamantinoma
Cystic hygroma
Neurofibroma
Phaechromocytoma
Arteriovenous malformation
Cavernous hemangioma (18Gy)

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6
Q

What is rampant breast cancer

A

Rampant Breast cancer:
Age 30-32
Hormone receptor negative
Aggressive
Spread rapidly
Died within 6 months
TNBC
Pre neoplastic/ centrosome amplification→ tumor invasiveness

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7
Q

What is glomus tumor

A

It is a benign neuro endocrine tumor of neural crest origin, which can develop in the carotid bodies in head and neck
Aortic bodies in the thorax
Adrenal gland in the abdomen
Embolization and surgery is treatment of choice
Radiation can be considered
45-54 Gy

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8
Q

When Ki 67 expression is high

A

When it is above 20% (nazir sir)
30% ( pathology outline)

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9
Q

In case of breast cancer molecular classification which mutation has worst prognosis

A

P53 mutation
ER/PR negative and Her 2 positive

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10
Q

Which of the drug when given intrathecally becomes deadly

A

Vincristine

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11
Q

When breast boost should be given

A

Tumor bed boost
invasive disease
- age below 50 years any grade
- age 51-70 with high grade
- positive margin
DCIS
Age below or equal to 50 years
High grade
Positive margin
Close (<2mm ) margin
Dose
10 gy in 4-5 fractions recommended for most patients
If positive margin or young age and close margin, 14-16 Gy in 7-8 fractions or 12.5 Gy in 5 fractions may be used.

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12
Q

Four features of pagets disease of breast

A

Erythemaous
Crusting
Redness
Inflammatory

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13
Q

How mycosis fungoides is formed

A

patch plaque tumor erythroderma

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14
Q

Other name of interstitial cell of cajal and where it lies

A

(CD34)
Lies between the submucosa and muscle layer. It acts as a pacemaker of colon
Auerbachs plexus lies in between two muscle layer.

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15
Q

Lymphatic staging of carcinoma stomach

A

NO= no regional lymph node
N1: one or two regional lymph nodes
N2: three to six regional lymph nodes
N3:
N3a: seven to 15 regional lymph nodes
N3b: metastasis in 16 or more regional lymph nodes.

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16
Q

Name the lymphatic stations of stomach

A

N1 nodes
1. Right paracardial
2. Left paracardial
3. Lesser curvature side
4. Greater curvature side
5. Supra pyloric (including gastroduodenal)
6. Infra pyloric
N2 nodes
7. Left gastric
8. Common hepatic
9. Celiac
10. Splenic hilum
11. Splenic artery
N3 nodes
12. Along hepatoduodenal ligament
13. Superior mesenteric
14. Middle colic
15. Para aortic
16. Portal, retroperitoneal

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17
Q

Name the shunt. Used to reduce ICP

A

Ventriculo peritoneal shunt
Endoscopic third ventricular shunt
External ventricular shunt

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18
Q

Radiotherpay dose for primary CNS lymphoma

A

Phase 1: 45 Gy in 25 daily fractions over 5 weeks
Phase 2: 9-10 Gy in 4 fractions over 1 weeks
Total 54 Gy around
CR 23.4
Non response 45-50
If leptomeningeal disease:
CSRT: 30-35 Gy in 25 daily fractions over 5 weeks mtx 12 mg

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19
Q

Pelvic radiotherapy(cervix radiotherapy complication)?

A

Acute
- pruritus
- desquamation
- nausea
- colitis
-proctitis
Late
- stenosis
- Stricture
-VVF
-RVF
- intestinal obstruction/ perforation
- femoral head necrosis (dose below 50 years)

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20
Q

Brachytherapy side effects in carcinoma cervix

A

Immediate
Mild soreness
Bruising
Swelling
Blood in urine
Uterine perforation
Laceration, shock
Late
Chronic cystitis
Proctitis
Urethral stenosis
Vaginitis
Second primary at UB and rectum
Frequency of loose stool or constipation

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21
Q

Histopathological variant of carcinoma cervix

A

Histological variety of cervical carcinoma: (AJCC)
* Squamous cell carcinoma
▪ Invasive
▪ Keratinizing
▪ Nonkeratinizing
▪ Verrucous
* Adenocarcinoma
* Endometrioid adenocarcinoma
* Clear cell adenocarcinoma
* Adenosquamous carcinoma
* Adenoid cystic carcinoma
* Adenoid basal cell carcinoma
* Small cell carcinoma
* Neuroendocrine
* Undifferentiated carcinoma/Anaplastic

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22
Q

Gardasil 9 contains which HPV strain

A

HPV16, HPV18, HPV6, and HPV11, plus five
additional high-risk HPV types (HPV31,
HPV33, HPV45, HPV52, and HPV58)

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23
Q

name some posterior fossa tumors

A

Extrinsic
Neurilemomma
Meningioma
Epidermoid cyst
Dermoid cyst
Metastases
Intrinsic
Metastases
Haemangioblastoma
Medulloblastoma
Astrocytoma

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24
Q

chest x ray PA view showing multiple cannon ball shadows of variable sizes in both lung. what are differentials

A

germ cell tumor
osteosarcoma
soft tissue sarcoma
renal cell carcinoma
melanoma
thyroid carcinoma
colonic carcinoma

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25
Q

name some common cause of brain mets according to sex

A

male
lung
GIT
melanoma
kidney
unknown
bladder
prostate
female
lung
breast
unknown origin
GIT
melanoma
kidney
ovary
uterus

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26
Q

common pathological variation of stomach mass

A

primary:
adenocarcinoma >95%
squamous cell carcinoma
small cell
carcinoid
MALTOMA
GIST
adenosquamous cell carcinoma
sarcoma
melanoma

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27
Q

meningioma dose of RT

A

55-60 Gy in 1.7-2.0 Gy per fraction in total of 5-6 weeks

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28
Q

name some common CNS tumor (nazir version)

A

neuro epithelial tumor
astrocytoma
oligodendroglioma
ependymoma
mixed glioma
meningeal tumor
meningioma
choroid plexus tumor
choroid plexus carcinoma
choroid plexus papilloma
tumor of pineal gland
pineocytoma
pineoblastoma
tumor of sellar region
pituitary adenoma
craniopharyngioma
tumor of cranial and paraspinal nerve
scwannoma
neurofibroma
MPNST
embryonal tumor
medulloblastoma
PNET
germ cell tumor
primary CNS lymphoma
mesenchymal tumor
hemangiopericytoma
angiosarcoma
PNET
Chordoma
Ewings sarcoma
liposarcoma
fibrosarcoma

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29
Q

where cell cycle check point inhibitors act

A

1st: G1 phase. just before S1
2nd: just before M phase

30
Q

type of epilepsy

A

grand mal seizure
petit mal seizure

31
Q

prognostic factors of breast cancer

A

nodes
size
grades
estrogen receptor
biological marker of prognosis:
- P53
-cathepsin
- EGFR
- Her 2 neu

32
Q

brain tumor classification according to fossa

A

anterior fossa
olfactory meningioma
esthesioneuroblastoma
frontal lobe glioma
middle cranial fossa
pituitary adenoma
craniopharyngioma
temporal lobe glioma
Posterior fossa
medulloblastoma
pilocytic astrocytoma
ependymoma
hemangioblastoma
brain stem glioma
atypical teratoid

33
Q

stomach lesion type according to borrman

A

type I: polypoid or fungating
Type II: ulcerated with elevated border
Type III: ulcerated and invading the gastric wall
Type IV: diffuse infiltrative
Type V: unclassifiable

34
Q

name some syndrome associated with nephroblastoma

A

WAGR syndrome:
- wilms
- anirida
- Growth abnormality
- Retardation
Denny Drash syndrome
Beckwith Wiedman syndrome

35
Q

Drug that crosses blood brain barrier

A

Methotrexate
Vincristine
Procarbazine
Etoposide
Cisplatin
Carboplatin
Temozolomide
Nitrosamine
Dacarbazine
Carmustine, lomustine
Cyclophosphamide
osimertinib
thiotepa, cytarabine
PCV jabei, Tmz(dacarbazine derive), platinum methotrexate intrathecal dei drug

36
Q

site of rhabdomyosarcoma

A

head and neck
jaw, near spine
near the eye
genito urinary
urinary bladder
prostate gland
any of the female organ
arms and legs
trunk
child: orbital RMS
paratesticular RMS: infancy

37
Q

extranodal site of lymphoma

A

CNS
ocular
salivary
thyroid
lung
breast
stomach
colon
kidney
liver
adrenal gland
skin
testis
uterus
bone
blood etc

38
Q

para neoplastic syndrome of lung

A

SIADH
Cushing
lambert eaton syndrome
hypercalcemia
hyponatremia
hypoglycemia
carcinoid syndrome
myasthenia gravis
dermatomyositis
hypertrophic pulmonary osteoarthropathy

39
Q

Para neoplastic syndrome of gastric cancer

A

acanthosis nigricans
circinate erythema
idiopathic venous thrombosis
leser trelat sign
dementia
cerebellar ataxia
ectopic cushing syndrome
carcinoid

40
Q

causes of malignant pericardial effusion

A

lung
breast
esophagus
thyroid
germ cell tumor

41
Q

how to use bleomycin in pleurodesis

A

2 vial of 15 IU total 30 IU used. mixed in 15ml N/S. given for 2 hours

42
Q

MGMT methylation full name

A

6 methyl guanine DNA methyl transferase

43
Q

dose of pembrolizumab

A

200 mg 3 weekly
400 mg 6 weekly

44
Q

dose of nivolumab

A

240 mg 2 weekly
480 mg 4 weekly

45
Q

EBRT energy in BSMMU

A

6,10,15 MV linac photon
electron: 4,6,8,10,12,15,18,22,25

46
Q

EBRT energy in LINAC

A

L1: 6,10
L2: 6,23
L3: 6,15
L4: 6,10
electron: 4,6,9,12,15,18,20

47
Q

Brain RT complication

A

Acute
CNS: pretreatment deficit worsens: causing fatigue, headache, drowsiness
nausea, vomitting
skin: erythema
mucosa: edema, patchy mucositis
mucositis
esophagitis
conjunctivitis
sub acute
headache
somnolence
fatigability
deterioration of pre existing deficits
late
vascular injury
irreversible progressive nerve injury
neurocognitive damage
diffuse leuko encephalopathy
hormone insufficiency
Lhermittes syndrome
moya moya syndrome

48
Q

Oesophagus risk factor

A

smoking
alcohol
diet: nitrates, fungi
dried persemon fruit
hot beverage
H pylori infection
HPV
baretts esophagus
GERD
plummer vinson
Hiatal hernia
obesity
reflux esophagitis
history of Ionizing RT
Achalasia

49
Q

investigation for liver SOL

A

H and P
alpha fetoprotein: 0-20
hep B,C
abdominal usg
triple phase CT
laparoscopy
cXR
full blood count
blood chemistry

50
Q

causes of multiple mets in liver

A

CRC
small bowel carcinoid
GIST
lung
breast
renal
melanoma
gyne malignancy

51
Q

esophageal stricture site

A

cricopharyngeal junction : 15 cm
aortic arch: 22 cm
left principal bronchus: 27 cm
gastro esophageal junction: 38 cm

52
Q

Histopathology of esophageal carcinoma

A

epithelial
squamous:
–basaloid, spindle, verrucous
adenocarcinoma
adenosquamous
non epithelial
lymphoma
melanoma
sarcoma
myoblastoma
carcinoid

53
Q

EMA-CO schedule

A

ETO: 100 mg/m2 D1,2
MTX: 100 mg/m2 bolus than 200 mg/m2 in 12 hours D1
Actinomycin: 0.5 mg D1-2
folinic acid: 15 mg QDS 4 dose
than
cyclo 600 mg/m2 D8
oncovin: 1 mg/m2 D8

54
Q

what is monoclonal antibody

A

immunotherapy developed as a technology/technique with the discovery of the structure of antibody and development of hybridoma technology which provided the first reliable source of monoclonal antibody
type:
murine
chimeric
humanized

55
Q

VDC IE total time

A

-48-52 weeks
VCR: 2 mg IV bolus D1
Doxo 75 mg/m2 D1
cyclo 1200 mg/m2 D1 than
IE
Ifosfamide: 1800 mg/m2 D1-5
etoposide 100 mg/m2 D1-5
when doxo exceeds cumulative dose of 375mg/m2 changed with actinomycin 1.25mg/m2

56
Q

intra thoracic malignancy? mode of death

A

great vessel rupture
esophageal involvement
tension pneumothorax
acute pulmonary embolism

57
Q

lung metastasize to which sites

A

opposite lung
adrenal gland
CNS
bone
liver
breast
testis

58
Q

name some common cardiotoxic drug

A

doxorubicin
daunorubicin
epirubicin
trastuzumab
pertuzumab
5 fu
capecitabine
paclitaxel
cyclophosphamide

59
Q

common lung panel

A

EGFR
ALK
ROS
Kras
BRAF
MET
NTRK
RET
ERBB2
PDL1

60
Q

PCI is used in

A

SCLC
leukemia
lymphoma
testicular carcinoma
high grade B cell lymphoma

61
Q

drug causing 2nd malignancy

A

1st: etoposide
2nd: cyclophosphamide
3rd: ifosfamide
4th: doxorubicin

62
Q

drug causing infertility

A

alkylating agent: cyclo, ifos
5 fu
bleomycin
dactinomycin
daunorubicin
MTX

63
Q

drug causing alopecia

A

cyclo
ifos
doxo
etoposide
irinotecan
paclitaxel, docetaxel
vincristine
vinblastin

64
Q

Radiation complication of lung

A

Acute
dysphagia
oesophagitis
fatigue
dermatitis
Late
pneumonitis
fibrosis
brachial plexopathy
pericarditis
esophageal stricture
rib fracture
intercostal nerve pain
2nd malignancy

65
Q

OAR dose:
oesophagus
brachial plexus
opposite lung
kidney
small bowel

A

oesophagus: 34 gy
brachial plexus: 60gy
opposite lung: 8 Gy
kidney: 20 Gy
small bowel: V15<120 cc (50 Gy)

66
Q

OAR dose:
femoral head
bladder
rectum
heart

A

femoral head: 50 Gy
bladder: 65 Gy
heart :26 Gy

67
Q

Carcinoma cervix histopathology

A

epithelial
squamous cell carcinoma: keratinizing, non keratinizing
adenocarcinoma
adenosquamous
Endometrioid
clear cell
glassy cell
adenoid cystic
small cell
neuroendocrine
undifferentiated
other
sarcoma botryoid
lymphoma
melanoma

68
Q

what is 90-70-90

A

90% of the girls should be vaccinated by the age 15 years
70% of the woman be screened by the age of 35, and 45
treatment of 90% of the woman with pre invasive lesion and 90% woman with invasive cancer

69
Q

carcinoma lung histopathology

A

Primary
epithelial
SCLC
NSCLC
- squamous
- adeno
-adenosquamous
- neuro endocrine
-large
-sarcomatoid
mesenchymal
lymphohistocytic: lymphoma
melanoma
ectopic
secondary
- Germ cell tumor
- GTT
- Sarcoma
-OS
-breast
- CRC
-Renal

70
Q

malignant tumor of salivary gland

A

muco epidermoid
adenoid cystic
acinic cell
polymorphous adenocarcinoma
clear cell
basal cell

71
Q

tongue muscle nerve supply

A

all the muscle except palatoglossus supplied by hypoglossal nerve. whereas palatoglossus supplied by spinal accessory nerve

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