PA high yield

Question 1

which cancer is associated or has the strongest risk factor with high BMI (obesity)

Answer 1

Uterus, then gallbladder
assuming causality - 41% of uterine and 10% of gallbladder, kidney, liver and colon cancers could be attributable to excess weight

Question 2

what is the treatment of regional melanoma

Answer 2

• lymph node dissection, no generally accepted adjuvant therapy - but possible role for high dose interferon and ipilumumab - both reduce relapse but toxic

Question 3

what are the checkpoint inhibitors for melanoma

Answer 3

immunotherapy targeting T cell activation, Two examples

1) ipilumamab - CTLA-4 antibody
2) anti-PD1 - pembrolizumab, nivolumab

Question 4

what is the other immunotherapy for melanoma

Answer 4

interferon, high dose interleukin-2

vaccine - gp100 peptide - trend to improved survival vs IL-2

Question 5

what are the targeted agents for metastatic melanoma

Answer 5

B-raf inhibitors and MEK inhibitors

Question 6

what is the traditional response rate to chemotherapy for metastatic melanoma

Answer 6

agent is DTIC - dacarbazine, poor response rates - less than 20 percent

Question 7

what is the new serum test for focal segmental glomerulosclerosis

Answer 7

• suPAR - elevated in fsgs
• shed by inflamm cells, renal excretion
  also elevated in inflammation, CKD and primary fsgs
  suPAR (glycosylated) = ligand for B3 integrin,
  B3 integrin activation causes podocyte effacement which precedes proteinuria then loss of grr

Question 8

what is presentation and management of minimal change

Answer 8

• pure nephrotic syndrome,
  60-80% childhood N/S,
• acute renal failure 10% , ATN 2* to intravascular dry
  hits - normal light microscopy,flattened podocytes
  tx - excellent with steroids for children
  adults - slower response to steroids
• more frequent steroid resistance, relapses
  rx - cyclophosphamide - 63% remission
  cyclosporin 2nd choice - dependent
  rebiopsy if resistant/recurrent = fsgs

Question 9

FSGS presentation, hits and treatment?

Answer 9

• primary young adults, nephrotic syndrome
  histo - focal and segmental glomerulosclerosis and hyalinosis
  juxtamedullar nephrons involved first
  persistent proteinuria - ESRF >50%
  high recurrence rate in transplant
  tx - prednisolone, cyclophos, or cyclosporine

Question 10

primary membranous nephropathy - presentation ,histo management

Answer 10

nephrotic proteinuria, common 30% adults nephron (most common)
thickened GBM, silver stain –> intra-membranous protein deposits, spikes , late –> interstitial fibrosis
1/3 respond
males do worse,
tx - steroids alone - no benefit
need cyclophos + pred for 6 months
or tac/mmf/pred together
need to anticoag with warfarin if albumin less than 20

Question 11

what is the M-type Phospholipase A2 receptor?

Answer 11

it is the target antigen in membranous nephropathy
- auto ab to PLA2R isolated from serum and glomeruli from patients with MN, binds to PLA2R expressed by glomerular podocytes