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USMLE Step 1 > Oncology > Flashcards

Oncology Flashcards

1
Q

CEA is used to monitor for progression of these two cancers mainly:

A

Colon

Pancreatic

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2
Q

AFP is elevated in (2):

A

HCC

Yolk sac tumors

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3
Q

CA-125 is used to monitor:

A

Ovarian cancer

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4
Q

S-100 is used to monitor (2):

A

Melanoma

Schwannoma

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5
Q

Alk phos, when you have ruled out biliary disease, might be elevated in (2):

A

Bone metastases

Paget’s disease

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6
Q

Elevated bombesin levels can be associated with these three cancers:

A

Adrenal neuroblastoma
Lung cancer
Gastric

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7
Q

TRAP is associated with this malignancy:

A

Tartrate resistant acid phosphatase

Hairy cell leukemia

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8
Q

Two tumor markers elevated in pancreatic cancer:

A

CA-19-9

CEA

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9
Q

Four cancers in which you might see Psammoma bodies:

A

Papillary thyroid cancer
Serous cystadenocarcinoma of the ovary
Meningioma
Malignant mesothelioma

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10
Q

The cancers (2) associated with the tumor suppressor gene Rb:

A

Retinoblastoma

Osteosarcoma

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11
Q

The cancer associated with the tumor suppressor gene DPC:

A

Pancreatic

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12
Q

The cancer associated with the tumor suppressor gene APC:

A

FAP

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13
Q

The cancer associated with the tumor suppressor gene WTI:

A

Wilms tumor

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14
Q

Cancers associated with K-RAS (3):

A

Kolon, panKreatic
Colon
Pancreatic
Lung

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15
Q

The cancer associated with the H-RAS oncogene:

A

“H is for Hematuria”

Bladder / kidney

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16
Q

The cancers associated with the N-RAS oncogene (2):

A

Melanoma

Hematologic malignancies

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17
Q

Cancer associated with each of the following:
C-myc
L-myc
N-myc

A 
C-myc = Burkitt's lymphoma
L-myc = lung cancer
N-myc = neuroblastoma (adrenal)
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18
Q

Tumor in which you see Homer-Wright pseudorosettes:

A

Small cell lung cancer

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19
Q

Aflatoxins cause this cancer:

A

Hepatocellular carcinoma

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20
Q

Cancers associated with asbestos exposure (2):

A 
Bronchogenic carcinoma (most common)
Mesothelioma
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21
Q

Two major risks for transitional cell cancer of the bladder:

A

Smoking

Naphthalene exposure

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22
Q

Three cancers associated with tuberous sclerosis:

A

Astrocytoma
Angiomyolipoma
Rhabdomyoma

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23
Q

Plummer-Vinson syndrome is a risk for this type of cancer:

A

Squamous cell cancer of the esophagus

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24
Q

Pagets disease is a risk for these two cancers:

A

Osteosarcoma

Fibrosarcoma

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25
Q

Acanthosis nigricans may be a marker for this type of malignancy:

A

Visceral

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26
Q

Name three diseases associated with DNA repair defects:

A 
HNPCC = Lynch
Xeroderma pigmentosum
Ataxia telangiectasia (lymphoma / leukemia)
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27
Q

Strep. bovis infection is a risk for this cancer:

A

Colon

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28
Q

H. pylori infection is a risk for this cancer:

A

Gastric

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29
Q

Infection with Schistosoma haematobium is a risk for this cancer:

A

Small cell cancer of the bladder

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30
Q

Infection with Clonorchis sinensis is a risk for this cancer:

A

Biliary

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31
Q

Hep C is a risk for this kind of thyroid cancer:

A

Papillary

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32
Q

EBV is associated with these three cancers:

A

Burkitt’s
Hodgkin’s
Nasopharyngeal

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33
Q

This virus is associated with Kaposi’s sarcoma:

A

HHV8

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34
Q

Autosomal dominant mutation in p53 leads to what syndrome?

A

Li-Fraumeni syndrome, multiple cancers of all kinds.

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35
Q

RET mutation leads to these cancers (3):

A

MEN IIa
MEN IIb
Papillary thyroid cancer

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36
Q

Small cell lung cancer is known for causing three paraneoplastic syndromes:

A

Cushing (via ACTH secretion)
SIADH (via ADH secretion)
Lambert-Eaton (Ab vs. pre-synaptic nerve terminals, cause weakness)

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37
Q

How do you diagnose Lambert-Eaton?

A

Isometric muscle test, activity improves weakness.

38
Q

This peptide is secreted by squamous lung cancers and others and increases serum calcium:

A

Parathyroid hormone related peptide

39
Q

Four cancers that secrete erythropoietin:

A

Renal cell carcinoma
HCC
Hemangioblastoma
Pheochromocytoma

40
Q

Most common sources of metastases to bone:

A 
Permanently Relocated Tumors Like Long Bones:
Prostate
Renal
Thyroid / Testes
Lung
Lymphoma
Breast
41
Q

Most common sources of metastases to liver:

A 
Cancer Sometimes Penetrates Benign Liver:
Colon
Stomach
Pancreas
Breast
Lung
42
Q

Most common sources of metastases to brain:

A 
Lots of Bad Stuff Kills Glia:
Lung
Breast
Skin
Kidney
GI
43
Q

Stain for epithelial cancers:

A

Cytokeratin

44
Q

Tumor markers you would use to follow pancreatic cancer:

A

CA 19-9, CEA

45
Q

Tumor marker you would use to follow astrocytoma:

46
Q

Tumor marker used to follow hepatocellular carcinoma:

47
Q

What is the USPTF recommendation regarding screening for breast cancer?

A

Start at age 50 for sure, q2 years by mammography. At age 40 may want to do case-by-case.

48
Q

What is the USPTF recommendation regarding screening for cervical cancer?

A

Start at 21 or 3-years post intercourse, PAP every 3 years until age 65 or the lady doesn’t have the relevant parts anymore.

49
Q

What is the USPTF recommendation regarding screening for prostate cancer?

A

Below 75, no clear evidence to suggest PSA is a good tool, above 75 there is clear evidence of harm.

50
Q

What is the USPTF recommendation regarding screening for colon cancer?

A

Colonoscopy every 10 years after the age of 50 until age 75, after which there is no clear benefit.
OR Flex. sig every 5 years
OR annual FOBT.
If family history, start screening 10 years earlier than age of dx of affected family member.

51
Q

Single best preventive measure to avoid renal cell carcinoma?

A

Stop smoking.

52
Q

Mechanism of action of methotrexate:

A

DHFR inhibitor

S-phase antimetabolite that prevents dTMP formation and therefore slows DNA synthesis.

53
Q

The myelosuppression caused by methotrexate is reversible with this medication:
This drug, in the S-phase antimetabolite class, causes myelosuppression not reversible with leucovorin:

A

Leucovorin = folinic acid

5-FU

54
Q

Mechanism of action of 5-FU:

A

F* U:
Activated to 5F-dUMP which covalently binds folic acid.
Prevents dTMP from being made, prevents DNA synthesis.

55
Q

What is cytarabine?

A

Pyrimidine anti-metabolite, inhibits DNA pol.

56
Q

The “rescue” drug for 5-FU:

“Rescue” for methotrexate:

A

Thymidine

Leucovorin = folinic acid

57
Q

This antibiotic works at DHF reductase in a mechanism analogous to methotrexate:

A

Trimethoprim

58
Q

Azathioprine is converted to which active metabolite? What does this drug do?

A

Azathioprine -> 6-mercaptopurine

Decreases de novo purine synthesis.

59
Q

Special consideration re the metabolism of azathioprine by the body:

A

It is metabolized by xanthine oxidase.

Allopurinol inhibits this enzyme, can see toxicity if both are used together.

60
Q

This drug works in a similar manner to azathioprine, except it can be given with allopurinol:

A

6-thioguanine.

Not metabolized by xanthine oxidase.

61
Q

Mecahanism of action for dactinomycin:

A

DACTinomycin –
Intercalates itself into DNA.
Used in tumors in children (children ACT out, they also fit in small places)

62
Q

Three tumors dactinomycin can be used to treat:

A

Wilm’s
Ewing’s sarcoma
Rhabdomyosarcoma

63
Q

A drug that works in an entirely different manner from dactinomycin can also be used to treat some common childhood tumors. What is it, and what are the indications they share in common?

A

Vincristine can also be used to treat:
Wilm’s tumor
Ewing’s sarcoma
Rhabdomyosarcoma

64
Q

The drugs doxorubacin and daunorubicin work in two ways:

A
  1. Free radical generation

2. Intercalate in DNA (non-covalent)

65
Q

Special toxicity of doxorubicin / daunorubicin:

A

Cardiotoxicity

66
Q

This chelating agent is used to prevent the cardiotoxicity caused by doxorubicin and daunorubicin:

A

Dexrazoxane

67
Q

Mechanism of action of bleomycin:

A

Free radical generator.

68
Q

What is an alkylating agent?

A

Drug that adds an alkyl group to DNA and cross-links the strands.

69
Q

This alkylating agent class crosses the BBB and is used in treatment of brain tumors. Can you name all four?

A 
Nitrosoureas
Carmustine
Lomustine
Semustine
Streptozocin
70
Q

Mechanism of action of streptozocin:

Of carmustine:

A

Both are DNA alkylating agents, nitrosoureas.

Cross the BBB.

71
Q

Three anti-cancer drugs with pulmonary fibrosis as a common side-effect:

A

Bleomycin
Busulfan
Methotrexate

72
Q

Mechanism of action of busulfan:

A

Alkylates DNA.

73
Q

This alkylating agent requires bioactivation by the liver:

A

Cyclophosphamide

74
Q

Anti-cancer drug associated with hemorrhagic cystitis:

Drug used to partially prevent this complication:

A

Cyclophosphamide

Mesna

75
Q

Three most commonly used drugs for testicular CA:

A

Eradicate Ball Cancer:
Etoposide
Bleomycin
Cisplatin

76
Q

Drugs / classes that act on microtubules (5):

A 
Vinca alkaloids
Taxanes
Benzamidazoles
Griseofulvin
Colchicine
77
Q 
This class of anti-cancer drugs blocks microtubule polymerization:
This class of anti-cancer drugs hyper-stabilizes microtubules:
A

Vinca alkaloids block polymerization

Taxols hyper-stabilize (TAXes stabilize society)

78
Q

Vincristine has these main indications (6):

A

Solid tumors, leukemias, & lymphomas
Wilm’s
Ewing’s sarcoma
Rhabdomyosarcoma

79
Q

Taxols are used to treat:

A

Ovarian and breast cancer

80
Q

Mechanism of action of cisplatin / carboplatin:

A

Cross-link DNA.

81
Q

Anti-cancer drugs that cause acoustic nerve damage and are also nephrotoxic:
Can you think of three other random drugs that are both oto- and nephrotoxic?

A

Cisplatin / carboplatin
(Won’t be able to hear that PLATinum label)
Aminoglycosides (a MEAN guy hit the baby in the ear)
Vanc
Loop diuretics

82
Q

Mechanism of action of etoposide:

Drug that acts in an analogous fashion:

A

Inhibits topoisomerase II

Fluoroquinolones

83
Q

Mechanism of action of hydroxyurea:

A

Inhibits ribonucleotide reductase, decreases DNA synthesis (is S-phase specific).

84
Q

How are steroids useful in treatment of cancer?

A

They may trigger apoptosis.

85
Q

Troublesome side effect of vinblastine:

A

Serious bone marrow suppression

VinBLASTine BLASTs bone.

86
Q

Mechanism of action of tamoxifen / raloxifene:

A

SERMs. Antagonists in breast, agonists in bone.

87
Q

How do tamoxifen and raloxifene differ?

A

Both drugs = SERMs, antagonize estrogen receptors in breast and agonize them in bone.
Tamoxifen = partial agonist in endometrium, increases the risk of CA in women who do not have it.
Raloxifene = endometrial antagonist, safe for use in women without cancer.

88
Q

Drug used to treat cancers that over-express HER-2 and its two names:

A

Trastuzumab = herceptin

89
Q

This drug is used in CML and is a bcr-abl tyrosine kinase inhibitor, it has two names:

A

Imatinib = Gleevec

90
Q

This drug is used against B-cell neoplasms. How does it work?

A

Rituxumab.

Ab vs. CD20, B-cell surface marker.

91
Q

Mech. of action of Herceptin:

A

Binds HER-2, a tyrosine kinase, and kills cancer cells that over-express it.

92
Q

Mech. of action of Gleevec:

A

Gleevec = Imatinib

mAb vs. CD20, which is found on most B-cell CA.

USMLE Step 1 (18 decks)

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