Oncology

Question 1

best initial test breast cancer

Answer 1

biopsy

Question 2

which type of biopsy is the best initial for breast cancer

Answer 2

FNA

Question 3

FN rate of FNA for breast cancer

Answer 3

10%

Question 4

core needle biopsy

Answer 4

LARGER SAMPLE, more deforming, ER/PR/HER2/Neu; possibility that needle will miss the lesion

Question 5

most ACCURATE bx type for breast cancer

Answer 5

open biopsy– frozen section while in operating room; followed by immediate resection of cancer, followed by sentinel node bx

Question 6

mammography screening– age start at

Answer 6

50yo

Question 7

NB even if already getting FNA

Answer 7

do MAMMOGRAPHY – since 5-10% of patients = bilateral

Question 8

MRI use for breast cancer

Answer 8

PRECISE USE NOT clear yet;

young woman with dense breasts

Question 9

US breast cancer

Answer 9

indeterminant mass lessions
cystic vs. solid
if the lesion is PAINFUL
or VARIES in size/pain with MENSES

Question 10

PET scan breast cancer

Answer 10

determine CONTENT of abnormal lymph nodes that are not easily accessible to biopsy

Question 11

BRCA testing

Answer 11

a.w increased risk of breast cancer

Question 12

other cancers a/w BRCA

Answer 12

PANCREATIC and OVARIAN cancer

Question 13

BRCA positive… now what

Answer 13

WILL NOT BE ASKED–since NOT yet shown to add mortality benefit to usual mgmt;
(most go for bilateral mastectomy)

Question 14

sentinel lymph node biopsy

Answer 14

done AT THE TIME of lumpectomy/mastectomy

Question 15

negative sentinel node

Answer 15

ELIMINATES NEED FOR axially lymph node dissection

Question 16

RADIATION for breast cancer

Answer 16

INDISPENSIBLE in preventing cancer RECURRENCES

Question 17

premenopausal option of hormone manipulation breast cancer

Answer 17

tamoxifen

Question 18

postmenopausal option of hormone manipulation breast cancer

Answer 18

aromatase inhibitors

Question 19

letrozole

Answer 19

aromatase inhibitor

Question 20

exemestane

Answer 20

aromatase inhibitor

Question 21

side effect of aromatase inhibitors

Answer 21

OSTEOPOROSIS

Question 22

RADICAL MASTECTOMY

Answer 22

ALWAYS the wrong answer

Question 23

trastuzumab…

Answer 23

DECREASES risk of recurrent disease

INCREASES survival

Question 24

adjuvant chemotherapy for breast cancer

Answer 24

• lesions > 1 cm

- positive axillary nodes are found

Question 25

use tamoxifen when ...

Answer 25

multiple FDR's have breast cancer, | LOWERS RISK of breast cancer

Question 26

lowering mortality

Answer 26

- mammography - ER/PR testing, then tamoxifen/raloxifene - aromatase inhibitors - adjuvant CHEMO - LUMPECTOMY and RADIATION - modified radical mastectomy - TRASTUZUMAB (anti-Her 2/neu) - prophylaxis with tamoxifen/ raloxifene

Question 27

best initial test for prostate cancer

Answer 27

BIOPSY

Question 28

which is better for survival

Answer 28

prostatectomy MAY SLIGHTLY benefit more than radiation

Question 29

complications of prostatectomy

Answer 29

erectile dysfunction | urinary incontinence

Question 30

erectile dysfunction more likely post-prostatectomy OR radiation

Answer 30

post-prostatectomy

Question 31

side effect of radiation

Answer 31

diarrhea

Question 32

gleason grading

Answer 32

AGGRESSIVENESS or the | MALIGNANT POTENTIAL of prostate cancer

Question 33

high glassine grade

Answer 33

GET IT OUT before it mets

Question 34

helping to control size and progression of mets for prostate cancer

Answer 34

flutamide GnRH agonists (leuprolide) ketoconazole orchiectomy

Question 35

prostate US screening for prostate cancer

Answer 35

NOOOOOOO, always wrong

Question 36

prostate US use...

Answer 36

localize lesions to biopsy if high PSA

Question 37

lumpectomy for prostate cancer

Answer 37

NOOOOOOO, always wrong

Question 38

PSA

Answer 38

NO clear mortality benefit should NOT be routinely offered to patients normal PSA doesn't exclude possibility of prostate cancer above age 75-- DO NOT DO IT-- EVEN IF ASKED

Question 39

PSA and cancer

Answer 39

higher the PSA, GREATER RISK of cancer-- corresponds to volume of cancer

Question 40

patient is requesting a PSA to screen for cancer....

Answer 40

DO THE TEST

Question 41

surgery for lung cancer

Answer 41

SIZE DOES NOT MATTER-- depends on the surrounding lung (ie. BIG lesion with normal surrounding, vs. small lesion with abnormal surrounding)

Question 42

CANNOT DO SX FOR LUNG CANCER

Answer 42

- bilateral disease or lymph nodes positive on opposite side - malignant pleural effusion - involvement: heart, carina, aorta, vena cava

Question 43

screening for lung cancer

Answer 43

low dose chest CT: - 30 pack years - age 55-80

Question 44

ovarian cancer screening...

Answer 44

NOOOOOO SCREENING

Question 45

ovarian cancer tx

Answer 45

ONLY CANCER-- where removing local metastatic disease will benefit the patient

Question 46

cutting the scrotum for testicular cancer

Answer 46

NOOOOOOOOO DO NOT DO IT

Question 47

needle biopsy of the testicle

Answer 47

NOOOOO WRONG-- since seeding

Question 48

after seminoma orchiectomy, for local disease

Answer 48

radiation

Question 49

after seminoma orchiectomy, for widespread disease

Answer 49

chemo

Question 50

seminomas are sensitive to

Answer 50

CHEMO and RADIATION

Question 51

non-seminomas are sensitive to

Answer 51

CHEMO only

Question 52

does Pap smear lower mortality as much as mammography or colonoscopy

Answer 52

NOOOOO it doesn't

Question 53

HPV vaccines

Answer 53

all women between 11-26yo

Question 54

pap smears

Answer 54

starting at age 21, repeat every 3 years until 65yo

Question 55

of women with fatal cervical cancer-- what % have never had a pap smear

Answer 55

85%

Question 56

ASCUS present

Answer 56

do HPV testing | --> colposcopy

Question 57

ASCUS not associated with hpv

Answer 57

repeat pap smear at 6 months