Oncology

Question 1

next step with a BiRADs 2/3?

Answer 1

Breast USG - differentiates between cystic and solid masses

Question 2

next step with a BiRADS 4/5?

Answer 2

fine needle aspiration or biopsy of nodule must be done

Question 3

when should you test for BRCA1/2 mutations?

Answer 3

in women who appear to have genetic risk i.e. multiple relatives w/ breast or ovarian cancer, esp. early onset disease

Question 4

young woman has a persisent, scaling, eczematous and ulcerated lesion over her nipple/areola; this lesion does not respond to medications - what should you consider?

Answer 4

Paget’s dz of the nipple

- do a biopsy

Question 5

Biopsy finding in Paget’s dz of nipple?

Answer 5

malignant, intraepithelial adenocarcinoma cells w/in epidermis of nipple associated w/ underlying invasive ductal cancer

Question 6

lichen simplex chronicus

Answer 6

localized disorder with intense pruritus, which leads to localized areas of thickened skin with increased and exagerated skin markings due to scratching

Question 7

a women presents with a palpable breast mass but mammography comes back negative, what is the next best step?

Answer 7

fine-needle aspiration OR ultrasonagraphy

Question 8

what do you recommend to a woman who just had cyst aspiration of her breast?

Answer 8

come back in 4-6 weeks to evaluate for recurrence or presence of residual lump

Question 9

in whom should tumor estrogen/progesterone receptor assay be done?

Answer 9

patients with early stage breast cancer to determine optimal systemic therapy

Question 10

breast conserving therapy

Answer 10

breast lumpectomy + radiation therapy

Question 11

when do you perform axillary node dissection?

Answer 11

when sentinel LN shows metastatic involvement

Question 12

screening for CRC in a person with a positive family history of CRC

Answer 12

start screening at age 40 or 10 years earlier than diagnosis of affected member; if normal colonscopy, repeat ever 3-5 years

Question 13

when do you test for mutations of the APC gene?

Answer 13

in pts with polyposis

Question 14

screening for CRC in normal-risk people

Answer 14

beginning age 50, then every 10 years if result is normal

Question 15

screening recommendations for pts with IBD

Answer 15

annual colonoscopy beginning 8 years after diagnosis- take random biopsies in four-quadrants to evaluate for dysplastic changes

Question 16

what test do you do in a pt presenting with signs of colon cancer?

Answer 16

colonscopy

Question 17

findings that should prompt investigation for CRC

Answer 17

rectal or abdominal mass
hepatomegaly
abdominal tenderness
iron deficiency anemia

Question 18

when can you choose flexible sigmoidoscopy over colonscopy?

Answer 18

pts < 40 yo with rectal bleeding

Question 19

what is the appropriate follow-up for an asymptomatic patient with a positive FOBT sample?

Answer 19

colonscopy

Question 20

what is capsule endoscopy used for?

Answer 20

visualization of the small bowel

Question 21

how do you screen for lung cancer?

Answer 21

you dont

Question 22

what is the appropriate follow-up in a pt who was found to have a 3 mm pulmonary nodule (incidental finding from abdominal CT)?

Answer 22

no further testing needed for pulm nodules < 4 mm bc risk of malignancy is extremely low in low risk patients; if the patient is at high risk for lung cancer, follow-up is with CT-scan at 12 months

Question 23

first line management of someone with limited SCLC?

Answer 23

chemotherapy plus radiation therapy

- combo of carboplatin/cisplatin and etoposide/irinotecan

Question 24

what is the next step in a man who comes in with a rising PSA (> 0.75 ng/ml/year)?

Answer 24

do a transrectal biopsy - even if pt is asymptomatic and DRE is non-specific

Question 25

what is the appropriate screening method for prostate cancer?

Answer 25

inform patient about risks and benefits of screening; offer PSA testing to patients > 50 years old; no screening for men over 75

Question 26

how do you tx. metastatic prostate cancer?

Answer 26

androgen deprivation therapy, w/ leuprolide or surgical castration (orchiectomy)
- leuprolide should be given with brief course of flutamide to prevent tumor flare

Question 27

what is docetaxal+prednisone therapy used for?

Answer 27

patients with hormone-refractory prostate cancer

Question 28

samarium 153 - what is this useful for?

Answer 28

radionuclide taken up by bone - useful in treating prostate cancer with painful bone mets that is unresponsive to other therapies

Question 29

what is the next step in a female who has ASCUS on pap smear?

Answer 29

test for HPV

- if positive, do a colposcopy w/ biopsy

Question 30

for whom in the HPV vaccine recommended for?

Answer 30

all girls and women between ages 9-26 regardless of sexual activity; high success rates for preventing infections with HPV strains 6,11,16 and 18

Question 31

when should screening for cervical cancer begin?

Answer 31

within 3 years of onset of sexual activity but no later than at age 21

Question 32

how often can you screen a low-risk woman for cervical cancer?

Answer 32

every 3 years - wait until age 30 to lengthen the screening interval

Question 33

how should you screen women after total vaginal hysterectomy for cervical cancer?

Answer 33

you dont need to screen these women

Question 34

uniformly dark blue or black (berry-like) lesions in an older patient

Answer 34

think nodular melanoma

Question 35

solitary, well-defined pink, pearly translucent dome-shaped papule with telegiectasias on head or neck

Answer 35

superficial basal cell carcinoma

Question 36

solitary round nodule that grows rapidly with formation of a central keratotic plug and eventually, the lesion becomes crater-like

Answer 36

keratoacanthoma

- rarely progresses to invasive dz; often involutes

Question 37

precursor to squamous cell ca. of skin

Answer 37

actinic keratoses

Question 38

actinic keratoses

Answer 38

erythematous lesions w/ overlying hyperkeratoses

Question 39

for mild-moderate cancer associated pain, what is indicated tx. ?

Answer 39

short acting opioid (oxycodone, morphine, oxymorphone) when non-opioid drugs fail

Question 40

how would you tx. moderate-severe cancer-related pain that is not adequately controlled with short-release formulas?

Answer 40

sustained-release morphine twice daily with breakthrough pain strategy as needed

Question 41

what is an effective tx. of dyspnea in a terminally ill patient with either malignancy or cardiopulmonary disease?

Answer 41

opioids