REI and Onc

Question 1

Primary Amenorrhea, DDx and how to make the diagnosis?

No breast, but has a uterus

Answer 1

ovarian failure - FSH increased
pituitary failure - GNRH stim- LH does not increase
hypothalamic failure - GNRH stim- LH increases

Question 2

Primary Amenorrhea, DDx and how to make the diagnosis?

breast present, uterus absent

Answer 2

mullerian agenesis (MRKH) vs AIS

karyotype or testosterone level, but testosterone level is cheaper

absent uterus means either mullerian agenesis or Y chromosome present

Question 3

Primary Amenorrhea, DDx and how to make the diagnosis?

no breast, no uterus, but with normal external female genitalia

Answer 3

gonadal agenesis, agonadism, rare gonandal enzyme deficiency

Question 4

Primary Amenorrhea, DDx and how to make the diagnosis?

breast and uterus present

Answer 4

Normal genotype/phenotype
bcg, tsh, prolactin, progesterone challenge (bleeding within 2 weeks)

no menses or secondary sex characteristics by 14
or secondary sex characteristics by 16.

Question 5

Lynch syndrome markers

Answer 5

MLH-1
MSH-2
MSH-6
PMS-2

Question 6

tumor marker association

HE4
APC
CDKN

Answer 6

human epidimis - epithelial ovarian cancers
APC- familial adenomatous polyps
Peutz-Jeghers

Question 7

Most common in the ovary

malignancy
primary malignancy
neoplasm
mass of the ovary

Answer 7

malignancy - metastatic
primary malignancy - serous cystadenocarcinoma
neoplasm- mature teratoma
mass of the ovary - functional cyst

Question 8

germ cell tumor markers

dysgerminoma
yolk sac
choriocarcinoma

Answer 8

hcg and LDH (german betta had long distance)
AFP, schiller duvall bodies
hcg

Question 9

germ cell tumor markers

immature teratoma
embryonal carcinoma

Answer 9

AFP, CA 125 (immature ladies Are From Pasadena, CA)

hcg, AFP

Question 10

tumor marker

mucinous

Answer 10

CEA

Question 11

histogenesis of these epithelial ovarian cancers

serous
mucinous
endometriod
clear cell
brenner

Answer 11

serous - ciliated tubal epithelium (psammoma bodies)
mucinous- columnar endocervical epithelium (pseudomyxoma peritonei)
endometrioid- endometrial glands
clear cell- mesonephric tissue
brenner-transitional urothelium (Walthard Cell rests)

Question 12

endo bx and risk of cancer
simple hyperplasia without atypia
complex hyperplasia without atypia
simple with
complex with

Answer 12

1%
5%
10%
25-40%

Question 13

septic shock

PCWP
CO
SVR

Answer 13

septic shock

PCWP - decreased
CO - increased
SVR - decreased

Question 14

cardiogenic shock

PCWP
CO
SVR

Answer 14

cardiogenic shock

PCWP - increased
CO - decreased
SVR -increased

Question 15

hypovolemic shock

PCWP
CO
SVR

Answer 15

hypovolemic shock

PCWP - decreased
CO - decreased
SVR - increased

Question 16

Quick Onc Associations

1. Hob nail cells
2. leydig cells
3. pseudoxanthoma cells
4. fibrous septae and lymphocytes
5. nesting tumors

Answer 16

1. Hob nail cells- clear cell
2. leydig cells- hilus cell
3. pseudoxanthoma cells- endometrioid
4. fibrous septae and lymphocytes- dysgerminoma
5. nesting tumors- brenners and granulosa

Question 17

chemotox

1. adriamycin
2. vincristine
3. vinblastine
4. cisplatinum
5. 5-FU (2)
6. cyclophosphamide (3)

Answer 17

1. cardio
2. high neuro, low bone
3. high bone marrow, low neuro
4. renal
5. cerebellar ataxia and myelosuppresion
6. hemorrhagic cystitis, SIADH, myelosuppression

Question 18

what's happening in each cell phase?
G0
G1
S
G2
Mitosis

Answer 18

G0 - resting phase-cell may skip this phase
G1 - gap between mitosis and S phase, no DNA replication but the cell is active
S - DNA replication
G2 - protein synthesis and prep for mitosis
M- cell division

Question 19

cyclophosphamide

class
mechanism of action
phase most active

Answer 19

cyclophosphamide

1. alkylating agent
2. interacalates DNA
3. S phase

Question 20

methotrexate and gemcitabine

class
mechanism of action
phase most active

Answer 20

methotrexate and gemcitabine

1. antimetabolites
2. dihydrofolate reductase–> cant make purines, inhibit DNA synthesis
3. s phase

Question 21

cis and carboplatinum

class
mechanism of action
phase most active

Answer 21

cis and carboplatinum

1. platinum
2. DNA helix distortion and base pair bonding
3. any phase

Question 22

another name for adriamycin

class
Mechanism of action
phase most active

Answer 22

doxorubicin

1. anti-tumor abx
2. inhibits topoisomerase II- dna breaks, free radicals formation
3. G1

Question 23

how does bleomycin work?

phase most active?

Answer 23

uses copper and iron to create superoxide free radicals

G2

Question 24

how do vincristine and vinblastine work?

what phase?

Answer 24

binds to tubulin subunits to block mitosis

M phase

Question 25

etoposide

Mechanism of Action
and phase most active

Answer 25

inhibit topoisomerase 2

G2 phase

Question 26

topotecan MOA and phase

Answer 26

binds topoisomerase 1 leading to DS DNA breaks

G2 phase

Question 27

paclitaxol MOA and phase

Answer 27

stabilizes microtubules

M phase

Question 28

which hormonal chemo agent down regulates estrogen receptors in the tumor?

in which phase do hormonal agents work?

Answer 28

megesterol acetate

G1 phase

Question 29

how does bevacizumab work?

Answer 29

inhibits VEGF-A thus inhibiting angiogenesis

Question 30

how does olaparib work?

Answer 30

PARP inhibition thus imparing DNA synthesis

Question 31

which of the following is NOT part of lynch syndrome?

breast
ovarian
colon
pancreatic
endometrial
brain

Answer 31

BREAST

Question 32

what is the risk of miscarriage if IUD is left in place after early IUP diagnosed?

Answer 32

50% so take that sh*t out!

even if you can’t see the strings, use sono and alligator forceps with abx (due to instrumentation)