Oncology

Question 1

Breast cancer tx:
- lumpectomy with radiation
- adjuvant chemo
- trastuzumab or pertuzumab
- atezolizumab
- serm or aromatase inhibitor

Answer 1

• best initial
• if cancer in axilla and cancer >1cm
• if her2/neu positive
• if triple neg
• if est or progest rec positive

Question 2

Colon cancer tx

Answer 2

Resection and chemo with 5fu

Question 3

Colon cancer screening that most lowers mortality

Answer 3

Colonoscopy starting at 50 and every 10 yrs

Question 4

Tx for metastatic prostate cancer

Answer 4

Hormonal: flutamide first to block T receptors, then leuprolide or goserelin (gnrh agonists)

Also abiraterone, 17 hydroxylase inhib blocks androgen production

Question 5

How to diagnose testicular cancer?

Answer 5

Orchiectomy , not biopsy

Question 6

Tx for:
AML
APML
ALL

Answer 6

Curable with chemo! Unlike chronic leukemias
AML - chemo with idarubicin and cytosine arabinoside
APML - add atra
ALL - add intrathecal MTX

Question 7

MDS tx

Answer 7

Transfusions, lenalidomide (esp if 5q-)

Question 8

Philadelphia chromosome

Answer 8

CML - bcr/abl, test via pcr or fish

Question 9

CML tx

Answer 9

TK inhibitors (-tinibs)
Bmt is only curative but tki—> 90% hematologic remissions without AEs

Interferon if pregnant

Question 10

CLL smear finding

Answer 10

Smudge cells - ruptured lymphocytes (which produce abnormal Ig which hemolyze rbcs—>anemia and permit infection)

Question 11

CLL tx

Answer 11

• no tx if early
• more advanced: fludarabine and ritux, add cyclophosphamide if young/fxal
• if fails, alemtuzumab (anticd52) and ibrutinib
• venetoclax if fail initial tx and 17p deletion

Question 12

Teardrop cells on smear, jak2 mut

Answer 12

Myelofibrosis

Also pancytopenia, splenomeg, fibrotic marrow

Question 13

Jak2 mutation

Answer 13

Myelofibrosia, pvera, essential thrombocythemia

Ruxolitinib is jak2 inhib

Question 14

Multiple myeloma workup

Answer 14

• punched out lesions on skel survey
• elevated ig on spep
• bence Jones proteins in upep
• rouleaux stacked blood cells on periph smear
• bun and cr often up bc of kidney injury - give bortezomib
• hyperca and Uric acid, anemia

Question 15

CRAB

Answer 15

MM - hyperCa, renal failure, anemia, bone lesions

Question 16

Waldenstrom macroglobulinemia

Answer 16

Hypervisc from igm overproduction —> blurry vision, ha etc

Spep will show igm, increased serum viscosity, no cbc findings

Tx with plasmapheresis if sx

Question 17

Vwd

Answer 17

Vwf stabilizes factor 8 so may have normal level but abnml ristocetin assay tells you it’s not working —> bleeding

Tx desmopressin or ddavp

Question 18

ITP

Answer 18

Large, dysfxal plts, normal spleen size

Tx mild with pred, severe acute with ivig or rhogam to raise plt ct

Tx chronic with ritux (stop B cells from making ig against plts), splenectomy, romiplostim or eltrombopag to directly stim megakaryocytes

Question 19

Pt vs ptt

Answer 19

Pt extrinsic and common
Ptt intrinsic (12, 11, 9, 8)

Question 20

Ddavp only works for

Answer 20

Vwd and factor 8 deficiency

Question 21

Evaluation of breast masses

Answer 21

<30yo, us First, mammo and or bx if solid mass
Older, mammo first
Evaluate when hormone levels are low (ie after menses in early follicular)

Question 22

MM imagine workup

Answer 22

Whole body CT, mri, or pet to look for bone lesions (prognostic)

Vs technetium 99 identifies areas of bone remodeling (blastic lesions)

Question 23

Hypercalcemia causes and which cancers cause them

Answer 23

Pthrp- squamous cell, breast and ovarian, kidney and bladder

Bone Mets - breast and mm - give ivf, calcitonin and bisphos

Vit d release in lymphoma - give pred

Question 24

Lung cancer common location of masses and paraneoplastic stuff

Answer 24

• small cell - hilar, siadh
• mesothelioma - pleural thickening
• large cell - peripheral mass, can be painful if infiltrated chest wall
• squamous - cavitation lesion in bronchus, pthrp—> hyperca