Onc 4 Flashcards
1
Q
symptoms of inhibiting parasympathetic
A
dry red hot mad bloated blind
2
Q
tumor marker:
PSA
A
prostate
3
Q
tumor marker:
AFP
A
HCC
yolk sac
4
Q
tumor marker:
CA 125
A
ovarian
5
Q
tumor marker:
alk phosph
A
biliary
bone
6
Q
tumor marker:
CEA
A
colon
pancreatic
stomach
breast
7
Q
tumor marker:
bHCG
A
choriocarcinoma
8
Q
tumor marker:
S100
A
melanoma
astrocytoma
9
Q
treatment for:
giardia,entameoba, trichomonas
A
metro
10
Q
treatment for:
vivax/ovale
A
chloroquine
primaquine
11
Q
treatment for:
flukes, tapeworms
A
praziquantel
12
Q
treatment for:
worms
A
bendazoles
pyrantel pamoate
13
Q
chemo:
nitrogen mustard, alkylates DNA
A
cyclophosphamide
14
Q
chemo:
mechanism similar to antivirals acyclovir and foscarnet
A
cytarabine
15
Q
chemo:
free radical induced DNA breakage
A
blemycin
-rubacin
16
Q
Rx for choriocarcinoma
A
methotrexate
vincristin/blastin
17
Q
Rx for AML
A
cytarabine
18
Q
Rx for CML
A
imatinib
busulfan
19
Q
MOA of tituximab
A
monoclonal antibody vs CD20
20
Q
SE of imatinib
A
fluid retention
21
Q
SE of trastuzumab
A
cardiotoxicity
22
Q
MOA of bortezomib
A
proteasome inhibitor
23
Q
Rx for MM
A
bortezomib
24
Q
Rx for hairy cell leukemia
A
cladribine
25
what drugs cause nephrotoxicity and ototoxicity
-platins
vancomycin
aminoglycosides
loops
26
how do you prevent nephrotoxicity caused by
| -platins
amifostine
27
MOA of -platins
cross link DNA
28
what drugs work on the M phase
vincristin/blastin
-taxols
29
SE of vincristine
neurotoxicity
30
SE of vinblastin
BM suppression
31
how do you prevent cardiotoxicity caused by
| -rubacin
dexrazoxane
32
MOA of dexrazoxane
iron chelating agent
33
how does -rubacin cause cardiotoxicity
cardiac fibrosis
| -dilated cardiomyopathy
34
Rx for testicular cancer
etoposide
bleomycin
cisplatin
35
MOA of busulfan
alkylates DNA
36
MOA of cyclophosphamide
covalently X link DNA at the guanine N-7
37
what is required for cyclophosphamide to work
biactivation by liver
38
what causes the heorrhagic cystitis by cyclophosphamides
toxic metabolites
| -Acrolein
39
SE of cyclophosphamide
hemorrhagic cystitis
transitional cell carcinoma of the bladder
SIADH
40
MOA of bleomycin
induces free radicals which break DNA strand
41
MOA -rubacin
generates free radicals which intercalate DNA
42
MOA of dactinomycin
intercalates DNA
43
MOA of cytarabine
inhibits DNA polymerase
44
5FU can be used to Rx
actinic keratosis
basal cell carcinoma
45
Rx for 5FU toxicity
thymidine
46
Rx for MTX toxicity
leucovorin
| -folinic acid
47
what drugs inhibit DHF reductase
MTX
TMP
pyrimethamine
48
what drugs work in G2
bleomycin
etoposide
49
what drugs work in the S phase
MTX
6MP/TG
5FU
cytarabine
etoposide
50
a/w anterior mediastinal mass
thymoma
teratoma
thyroid neoplasm
terrible lymphoma
51
Rx for chemotherapy induced nausea
ondasetron
52
Rx for cancer associated anorexia
progestins
- megestrol acetate
- medroxyprogesterone acetate
53
features of tumor lysis syndrome
cell breakdown which releases Urate, P and K
P binds to Ca which causes hypocalcemia
54
how can breast cancer present
skin changes
palpable mass
nipple retraction
nipple discharge
55
best initial test for breast cancer
FNA
56
most accurate test for breast cancer
open biopsy
57
which breast cancer test allows to test for ER, PR and HER 2
core needle biopsy
58
what is the most important factor for prognosis and Rx of breast cancer
HER 2
59
which receptors are a/w worst breast cancer prognosis
HER 2
60
which receptors are a/w better breast cancer prognosis
ER and PR
61
screening for breast cancer
mammography starting at 50 yo but not required after 75
62
what cancer is a/w pagets disease of the breast
adenocarcinoma
63
how does pagets disease present
rash on nipple with ulcerating eczematous appearance
64
what is seen on biopsy of pagets disease of the breast
large cells with clear halo
65
next step in suspected fibrocystic disease of the breast
aspiration
66
what is seen on aspiration of fibrocystic disease of the breast
clear fluid
67
what should be done in all females with a suspicious breast mass who are undergoing FNA and why
mammography
could be bilateral
68
when should an US be done done in breast mass
painful
varies in size or pain with menstruation
69
when is PET scan indicated for breast mass
determine the content of abnormal lymph nodes
70
what does a positive BRCA mean
increased risk for breast and ovarian cancer
nothing else
71
what is the sentinel node
first node to be identified near the operative field in identified breast cancer
72
what is the significance of a negative sentinel node in breast cancer
no need for axillary lymph node dissection
73
Rx for breast cancer
if meet criteria
-lumpectomy with radiation
ER or PR positive should recieve
- aromatase -
- tamoxifen
- raloxifene
74
why is radiation done in breast cancer
prevents recurrence
75
criteria for surgery in breast cancer
primary tumor is resected
no other site of cancer
no comorbidities
complete resection is possible
76
SE of tamoxifen
endometrial cancer (uterine sarcoma)
clots
77
SE of aromatase inhibitors
osteoporosis
78
what are the aromatase inhibitors
anastrazole
letrozole
exemestane
79
what is the benefit of recieving trastuzumab
decreases risk of recurrence
80
who should recieve trastuzumab
those positive for HER 2
multiple first degree relatives have breast cancer
81
SE of trastuzumab
cardiotoxicity
82
what test should be done before starting trastuzumab
echocardiogram
83
when is adjuvant chemotherapy used in breast cancer Rx
lesions larger than 1 cm
positive axillary lymph nodes
84
where in the prostate does prostate cancer occur
peripheral zone
85
best initial test for prostate cancer
biopsy
86
most accurate test for prostate cancer
biopsy
87
how does prostate cancer present
obstructive symptoms when voiding
palpable lesion
-nodular or irregular
88
complications of prostatectomy
erectile dysfunction
urine incontinence
89
how are BPH and prostate cancer presentation different
BPH
- center
- smooth
prostate cancer
- peripheral
- nodular/irregular
90
what should all px with BPH be checked for
hydronephrosis
| -if present place foley
91
what is the goal of hormonal manipulation in prostate cancer
shrink lesions that are already present
92
what is used to shrink prostate cancers
flutamide
leuprolide
ketoconazole
orchidectomy
93
next best step in a px with prostate cancer with suspected lumbar metastasis
glucocorticoids to preserve neurologic functions
94
what can an increased PSA be a/w
BPH
prostatitis
prostate cancer
95
what PSA level is most a/w prostate cancer
>4
96
when is surgery not indicated in lung cancer
bilateral disease
malignant pleural effusion
heart, carina, aorta or vena cava are involved
small cell cancer
97
what are some risk factors for ovarian cancer
BRCA + (multiple first degree relatives)
estrogen replacement
98
what should be done in a px with positive BRCA and family history of ovarian cancer
pelvic US or CA-125
99
how does ovrian cancer present
woman above 50 with wieght loss and increased abdominal girth
100
best initial test for ovarian cancer
US or CT
101
most accurate test for ovarian cancer
biopsy
102
what is protective against ovarian cancer
increased pregnancies
OCP
103
Rx for ovarian cancer
remove all visible tumor and pelvic organs and give chemo
104
next step in a px with a painless lump in the scrotum
transluminate or US
105
diagnostic test for testicular cancer
inguinal orchiectomy
106
next step in a px with a painless lump in the scrotum and US shows suspicious mass
inguinal orchiectomy
107
testicular cancer a/w:
| increased B-hCG
seminoma
108
testicular cancer a/w:
| increased AFP
yolk sac (endodermal sinus)
109
testicular cancer a/w:
| increased AFP and B-hCG
embryonal
choriocarcinoma
teratoma
110
how is testicular cancer staged
CT or the
- abdomen
- pelvis
- chest
111
how does testicular cancer metastasize
retroperitoneum and up into chest
112
Rx for testicular cancer
orchiectomy with
- radiation if local
- chemo if widespread
113
management for advanced cervical cancer
hysterectomy
114
when is HPV vaccine indicated
woman between ages 11-26
| -try to do before initiating sex
115
HPV serotype a/w cancer
16 and 18
116
HPV serotype a/w warts
6 and 11
117
when are pap smears indicated
21 - 30 every 2 years
30-65 every 3 years
118
what increases the risk of cervical cancer
smoking
119
what cancer is lynch syndrome a/w
endometrial cancer
120
how is a solitary brain lesion managed
surgical resection
| then whole brain radiotherapy
121
best initial test for squamous cell carcinoma of the head or neck
panendoscopy followed by biopsy
122
next best step if bone tumor is suspected
refer to orthopedic surgeon
123
SE of megestrol acetate and medroxyprogesterone acetate
DVT
124
what meds are a/w cochleardysfunction
platins
aminoglycosides
loops
125
Dx
| bloody discharge from nipples
intraductal papilloma
126
Dx
| bilateral breast pain and lumps that vary with periods
fibrocystic change
127
Dx
| painless, firm mobile mass that does not change with periods
fibroadenoma
128
what is seen on CT of craniopharyngioma
cystic calcification of parasellar lesions
129
type of cancer therapy:
| Rx before standard
neoadjuvant
130
type of cancer therapy:
| radiation before prostatectomy
neoadjuvant
131
type of cancer therapy:
| Rx is standard therapy fails
salvage
132
type of cancer therapy:
| Rx given in addition to standard
adjuvant
133
type of cancer therapy:
| radiation at the same time as prostatectomy
adjuvant
134
type of cancer therapy:
| initial dose to kill tumor cells and put px into remission
induction
135
type of cancer therapy:
| given after induction
consolidation
136
type of cancer therapy:
| multidrug regiemn to reduce tumor
consolidation
137
type of cancer therapy:
| given after induction and consolidation
maintenance
138
type of cancer therapy:
| kills residual cells and keeps px in remission
maintenance
139
type of cancer therapy:
| daily antiandrogen therapy in prostate cancer
maintenance
140
which cancer screening lowers mortality the most
mammography after 50 yo
141
what should be given to women with multiple first degree relatives with breast cancer
SERMs
- tamoxifen
- raloxifene
142
next best step if colonoscopy shows polyps
colonoscopy in 3-5 years
143
screen for colon cancer
colonoscopy at 50 yo every 10 years
start 10 years earlier than family member if they had cancer
144
what meds can help quit smoking
bupropion and TCA
145
what is the single most beneficial disease prevention method of any type
stop smoking
146
when is lipid screening indicated
men above 35
women above 45
any one with
- DM
- HTN
- CAD
- aortic disease
- carotid disease
- peripheral vascular disease
147
screening for HTN
indicated to all px over 18 yo at every visit
148
therapy for hyperlipidemia
0-1 risk factors
>160 life style changes
>190 meds
2 or more risk factors
>130 life style changes
>160 meds
149
screening for DM
fasting blood glucose in px with
- HTN
- hyperlipidemia
150
what are the 2 most beneficial vaccines in adults
influenza
| pneumococcus
151
when is the tetanus diptheria toxoid indicated
severe dirty wounds
those who recieved booster >5 years ago
152
when is tetanus immune globulin indicated
severe dirty wound
unclear or incomplete immunization
153
when is Tdap given
once every 10 years after age of 18
154
who can recieve the intranasal influenza vaccine
healthy, non pregnant adults
155
indications for influenza vaccine
everyone yearly (including pregnant women)
156
indications for pneumococcal vaccine
everyone above 65 (must be given 5 years later if done prior to 65 because of chronic disease)
cochlear implant
CSF leaks
alcoholics
157
what vaccines have an egg allergy
influenza
yellow fever
158
when is varicella zoster vaccine indicated
all children
all px over 60
159
why is zoster vaccine given to px over 60
prevents shingles
160
who benefits most from hepatitis A and B vaccine
chronic liver disease
161
when is hepatitis A and B vaccine indicated
```
children
chronic liver disease
men who have sex with men
multiple sexual partners
household contacts with hepatitis
IVDA
```
162
what should be done in an unvaccinated px who is exposed to hepatitis
give vaccine and HBIG
163
when is meningococcal vaccine indicated
age 11
asplenia
terminal compliment deficiency
military recruits
dorms
travelers for asia, africa, arabia
164
what is the strongest indication for meningococcal vaccine
asplenia
165
screening for osteoporosis
DEXA scan for every woman >65 yo
166
Dx
| DEXA T-score = 1.5-2.5
osteopenia
167
Dx
| DEXA T-score = >2.5
osteoporosis
168
who has the highest risk factor for osteoporosis
postmenopausal women
169
screening for AAA
US all men over 65 with smoking history
170
MC infection in AAA
salmonella or staph
171
when is AAA repaired
>5 centimeters
172
MC complication of AAA repair
bowel ischemia
173
how can bowel ischemia from AAA repair be avoided
check sigmoid perfussion after aortic graft placement
174
screening for chlamydia
sexually active females
