Paraneoplastic, SVC, Prostate Cancer, Multiple Myeloma

Question 1

Most cancers develop in what zone of the prostate?

Answer 1

Peripheral zone

Question 2

What serum test increases tenfold up to 8-10 weeks after performing a prostate biopsy?

Answer 2

PSA

Question 3

After the prostate has been removed surgically, how long until the PSA levels are undetectable?

Answer 3

6 weeks after removal

Question 4

Men of what age range would benefit from checking serum PSA levels?

Answer 4

Men age 55-69 years

Question 5

Procedure for diagnosis of prostate cancer?

Answer 5

Transrectal ultrasound or MRI guided needle biopsy

Question 6

What surgical procedure is advised for patients with prostate cancer with a life expectancy of at least 10 years?

Answer 6

Radical prostatectomy

Question 7

What medications are given to block the disease flare that may occur with the rise of serum testosterone with GnRH therapy?

Answer 7

Antiandrogens - Flutamide, Bicalutamide, Nilutamide

Question 8

Gold standard procedure for treatment of noncastrate metastatic prostate cancer?

Answer 8

Surgical orchiectomy + GnRH agonist and antiandrogens

Question 9

In young adults, what is the leading cause of SVC?

Answer 9

Malignant lymphoma

A bulk is also due to lung Ca

Question 10

What positions may aggravate symptoms of SVC?

Answer 10

Bending forward

Lying down / supine

Question 11

The clinical picture of SVC is milder if the obstruction is located proximal to what vein?

Answer 11

Azygos vein

Question 12

What medications can cause cardiac arrest or respiratory failure in SVC?

Answer 12

Sedatives

General anesthesia

Question 13

Difference of varices caused by SVC vs portal hypertension

Answer 13

SVC - downhill varices, blood flow is cephalad to caudad

Portal hypertension - uphill varices, blood flow is caudad to cephalad

Question 14

If obstruction to the SVC is proximal to the azygos vein, where do varices in the esophagus develop?

Answer 14

Upper 1/3 of the esophagus

Question 15

If obstruction to the SVC is distal to the azygos vein, where do varices in the esophagus develop?

Answer 15

Entire length of the esophagus

Question 16

Most significant chest radiographic finding in SVC

Answer 16

Widening of the superior mediastinum (most commonly on the right side)

Question 17

Characteristic of pleural effusion in SVC (Occurs in only 25% of patients)

Answer 17

Usually right sided
Exudative
Sometimes chylous

Question 18

Imaging modality that provides most reliable view of the mediastinal anatomy in SVC?

Answer 18

CT scan - absent opacification of central venous structures with prominent collateral venous circulation

Question 19

One potentially life threatening complication of SVC

Answer 19

Tracheal obstruction

Question 20

Among patients with SVC, what medication is helpful to shrink lymphoma mass but provide NO benefit in patients with lung cancer?

Answer 20

Glucocorticoids

Question 21

Primary treatment for SVC caused by non small cell lung ca?

Answer 21

Radiation therapy

Question 22

What drug has been shown in randomized trials to reduce the future risk of prostate cancer?

Answer 22

Finasteride (5alpha reductase inhibitor)

Selenium, vitamin C and E showed no benefit over placebo

Question 23

What recommended next step is best for men with incidental abnormal DRE findings?

Answer 23

Transrectal ultrasound guided biopsy (TRUS)

Question 24

Most powerful predictor of survival in MM?

Answer 24

Serum beta2 microglobulin