Onc Final Flashcards
1
Q
a/w anterior mediastinal mass
A
thymoma
teratoma
thyroid neoplasm
terrible lymphoma
2
Q
Rx for chemotherapy induced nausea
A
ondasetron
3
Q
Rx for cancer associated anorexia
A
progestins
- megestrol acetate
- medroxyprogesterone acetate
4
Q
features of tumor lysis syndrome
A
cell breakdown which releases Urate, P and K
P binds to Ca which causes hypocalcemia
5
Q
how can breast cancer present
A
skin changes
palpable mass
nipple retraction
nipple discharge
6
Q
best initial test for breast cancer
A
FNA
7
Q
most accurate test for breast cancer
A
open biopsy
8
Q
which breast cancer test allows to test for ER, PR and HER 2
A
core needle biopsy
9
Q
what is the most important factor for prognosis and Rx of breast cancer
A
HER 2
10
Q
which receptors are a/w worst breast cancer prognosis
A
HER 2
11
Q
which receptors are a/w better breast cancer prognosis
A
ER and PR
12
Q
screening for breast cancer
A
mammography starting at 50 yo but not required after 75
13
Q
what cancer is a/w pagets disease of the breast
A
adenocarcinoma
14
Q
how does pagets disease present
A
rash on nipple with ulcerating eczematous appearance
15
Q
what is seen on biopsy of pagets disease of the breast
A
large cells with clear halo
16
Q
next step in suspected fibrocystic disease of the breast
A
aspiration
17
Q
what is seen on aspiration of fibrocystic disease of the breast
A
clear fluid
18
Q
what should be done in all females with a suspicious breast mass who are undergoing FNA and why
A
mammography
could be bilateral
19
Q
when should an US be done done in breast mass
A
painful
varies in size or pain with menstruation
20
Q
when is PET scan indicated for breast mass
A
determine the content of abnormal lymph nodes
21
Q
what does a positive BRCA mean
A
increased risk for breast and ovarian cancer
nothing else
22
Q
what is the sentinel node
A
first node to be identified near the operative field in identified breast cancer
23
Q
what is the significance of a negative sentinel node in breast cancer
A
no need for axillary lymph node dissection
24
Q
Rx for breast cancer
A
if meet criteria
-lumpectomy with radiation
ER or PR positive should recieve
- aromatase -
- tamoxifen
- raloxifene
25
why is radiation done in breast cancer
prevents recurrence
26
criteria for surgery in breast cancer
primary tumor is resected
no other site of cancer
no comorbidities
complete resection is possible
27
SE of tamoxifen
endometrial cancer (uterine sarcoma)
clots
28
SE of aromatase inhibitors
osteoporosis
29
what are the aromatase inhibitors
anastrazole
letrozole
exemestane
30
what is the benefit of recieving trastuzumab
decreases risk of recurrence
31
who should recieve trastuzumab
those positive for HER 2
multiple first degree relatives have breast cancer
32
SE of trastuzumab
cardiotoxicity
33
what test should be done before starting trastuzumab
echocardiogram
34
when is adjuvant chemotherapy used in breast cancer Rx
lesions larger than 1 cm
positive axillary lymph nodes
35
where in the prostate does prostate cancer occur
peripheral zone
36
best initial test for prostate cancer
biopsy
37
most accurate test for prostate cancer
biopsy
38
how does prostate cancer present
obstructive symptoms when voiding
palpable lesion
-nodular or irregular
39
complications of prostatectomy
erectile dysfunction
urine incontinence
40
how are BPH and prostate cancer presentation different
BPH
- center
- smooth
prostate cancer
- peripheral
- nodular/irregular
41
what should all px with BPH be checked for
hydronephrosis
| -if present place foley
42
what is the goal of hormonal manipulation in prostate cancer
shrink lesions that are already present
43
what is used to shrink prostate cancers
flutamide
leuprolide
ketoconazole
orchidectomy
44
next best step in a px with prostate cancer with suspected lumbar metastasis
glucocorticoids to preserve neurologic functions
45
what can an increased PSA be a/w
BPH
prostatitis
prostate cancer
46
what PSA level is most a/w prostate cancer
>4
47
when is surgery not indicated in lung cancer
bilateral disease
malignant pleural effusion
heart, carina, aorta or vena cava are involved
small cell cancer
48
what are some risk factors for ovarian cancer
BRCA + (multiple first degree relatives)
estrogen replacement
49
what should be done in a px with positive BRCA and family history of ovarian cancer
pelvic US or CA-125
50
how does ovrian cancer present
woman above 50 with wieght loss and increased abdominal girth
51
best initial test for ovarian cancer
US or CT
52
most accurate test for ovarian cancer
biopsy
53
what is protective against ovarian cancer
increased pregnancies
OCP
54
Rx for ovarian cancer
remove all visible tumor and pelvic organs and give chemo
55
next step in a px with a painless lump in the scrotum
transluminate or US
56
diagnostic test for testicular cancer
inguinal orchiectomy
57
next step in a px with a painless lump in the scrotum and US shows suspicious mass
inguinal orchiectomy
58
testicular cancer a/w:
| increased B-hCG
seminoma
59
testicular cancer a/w:
| increased AFP
yolk sac (endodermal sinus)
60
testicular cancer a/w:
| increased AFP and B-hCG
embryonal
choriocarcinoma
teratoma
61
how is testicular cancer staged
CT or the
- abdomen
- pelvis
- chest
62
how does testicular cancer metastasize
retroperitoneum and up into chest
63
Rx for testicular cancer
orchiectomy with
- radiation if local
- chemo if widespread
64
management for advanced cervical cancer
hysterectomy
65
when is HPV vaccine indicated
woman between ages 11-26
| -try to do before initiating sex
66
HPV serotype a/w cancer
16 and 18
67
HPV serotype a/w warts
6 and 11
68
when are pap smears indicated
21 - 30 every 2 years
30-65 every 3 years
69
what increases the risk of cervical cancer
smoking
70
what cancer is lynch syndrome a/w
endometrial cancer
71
how is a solitary brain lesion managed
surgical resection
| then whole brain radiotherapy
72
best initial test for squamous cell carcinoma of the head or neck
panendoscopy followed by biopsy
73
next best step if bone tumor is suspected
refer to orthopedic surgeon
74
SE of megestrol acetate and medroxyprogesterone acetate
DVT
75
what meds are a/w cochleardysfunction
platins
aminoglycosides
loops
76
Dx
| bloody discharge from nipples
intraductal papilloma
77
Dx
| bilateral breast pain and lumps that vary with periods
fibrocystic change
78
Dx
| painless, firm mobile mass that does not change with periods
fibroadenoma
79
what is seen on CT of craniopharyngioma
cystic calcification of parasellar lesions
80
type of cancer therapy:
| Rx before standard
neoadjuvant
81
type of cancer therapy:
| radiation before prostatectomy
neoadjuvant
82
type of cancer therapy:
| Rx is standard therapy fails
salvage
83
type of cancer therapy:
| Rx given in addition to standard
adjuvant
84
type of cancer therapy:
| radiation at the same time as prostatectomy
adjuvant
85
type of cancer therapy:
| initial dose to kill tumor cells and put px into remission
induction
86
type of cancer therapy:
| given after induction
consolidation
87
type of cancer therapy:
| multidrug regiemn to reduce tumor
consolidation
88
type of cancer therapy:
| given after induction and consolidation
maintenance
89
type of cancer therapy:
| kills residual cells and keeps px in remission
maintenance
90
type of cancer therapy:
| daily antiandrogen therapy in prostate cancer
maintenance
91
which cancer screening lowers mortality the most
mammography after 50 yo
92
what should be given to women with multiple first degree relatives with breast cancer
SERMs
- tamoxifen
- raloxifene
93
next best step if colonoscopy shows polyps
colonoscopy in 3-5 years
94
screen for colon cancer
colonoscopy at 50 yo every 10 years
start 10 years earlier than family member if they had cancer
95
what meds can help quit smoking
bupropion and TCA
96
what is the single most beneficial disease prevention method of any type
stop smoking
97
when is lipid screening indicated
men above 35
women above 45
any one with
- DM
- HTN
- CAD
- aortic disease
- carotid disease
- peripheral vascular disease
98
screening for HTN
indicated to all px over 18 yo at every visit
99
therapy for hyperlipidemia
0-1 risk factors
>160 life style changes
>190 meds
2 or more risk factors
>130 life style changes
>160 meds
100
screening for DM
fasting blood glucose in px with
- HTN
- hyperlipidemia
101
what are the 2 most beneficial vaccines in adults
influenza
| pneumococcus
102
when is the tetanus diptheria toxoid indicated
severe dirty wounds
those who recieved booster >5 years ago
103
when is tetanus immune globulin indicated
severe dirty wound
unclear or incomplete immunization
104
when is Tdap given
once every 10 years after age of 18
105
who can recieve the intranasal influenza vaccine
healthy, non pregnant adults <50 yo
106
indications for influenza vaccine
everyone yearly (including pregnant women)
107
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
108
what vaccines have an egg allergy
influenza
yellow fever
109
when is varicella zoster vaccine indicated
all children
all px over 60
110
why is zoster vaccine given to px over 60
prevents shingles
111
who benefits most from hepatitis A and B vaccine
chronic liver disease
112
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
```
113
what should be done in an unvaccinated px who is exposed to hepatitis
give vaccine and HBIG
114
when is meningococcal vaccine indicated
age 11
asplenia
terminal compliment deficiency
military recruits
dorms
travelers for asia, africa, arabia
115
what is the strongest indication for meningococcal vaccine
asplenia
116
screening for osteoporosis
DEXA scan for every woman >65 yo
117
Dx
| DEXA T-score = 1.5-2.5
osteopenia
118
Dx
| DEXA T-score = >2.5
osteoporosis
119
who has the highest risk factor for osteoporosis
postmenopausal women
120
screening for AAA
US all men over 65 with smoking history
121
MC infection in AAA
salmonella or staph
122
when is AAA repaired
>5 centimeters
123
MC complication of AAA repair
bowel ischemia
124
how can bowel ischemia from AAA repair be avoided
check sigmoid perfussion after aortic graft placement
125
screening for chlamydia
sexually active females <24 yo
