Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Diabetic Medications (awesome review) > ONCOLOGY > Flashcards

ONCOLOGY Flashcards

1
Q

Colon cancer risk factors

A

-age>45
long standing uc and chrohns >8 years
-primary relatives with colon cancer
-BRCA: breast and ovarian cancer
-FAP: famililal polyposis: gardeners syndrome
-HNPCC: hereditary non polyposis colon cancer aka lynch syndrome
-adenomas (5-10 yrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Decreased risk

A

ASA>20 years
-celecoxib and sulindac: decrease polyp load
-estrogens
-less red meat, limited caloric intake and increased dietary fiber

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Colon cancer

A

-usually arises from adenomas; villous more than tubular; hyperplastic polyp haas no malignant potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Familial Adenomatous Polyposis

A

-family history of adenomatous polyposis and cancer
-mutation of the APC gene–>Chromosome 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gardener’s syndrome

A

Subtype of FAP involving adenomatous polyps involving the colon
-Extraintestinal manifestations include: osteomas of mandible, skull and long bones, soft tissue tumors, epidermoid and sebaceous cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Peutz Jegher Syndrome

A

-pigmented lesions on skin, lips and mouth
-do colonoscopy
-STK11 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HNPCC (hereditary non polyposis colon cancer) lynch syndrome

A

-autosomal dominant
-need to have 3 relatives with colon cancer; two generations with colon cancer, one must be primary relative; may have extra colonic cancer as well
-at least one relative with colon cancer <50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

50 year old woman with HNPCC had a colonoscopy done, whicch revealed adenomatous polyps, what to do?

A

Endometrial biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Colorectal screening guidelines
-Flexible sigmoidoscopy with FIT

A

Every year FIT + every 10 year sigmoidoscopy OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

FIT DNA

A

Every 1-3 years OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Colonoscopy

A

Every 10 years OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CT colonography

A

Every 5 years OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Flexible sigmoidoscopy

A

Every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A 45 year old man, asymptomatic for routine check up, FIT negative, sigmoidoscopy –>polyp

A

A. If biopsy of polyp is hyperplastic polyp, what to do? FIT q1 year +sigmoidoscopy 10 years OR sigmoidoscopy alone q 5 years
B. If biopsy polyp is adenoma, what to do? full colonoscopy
C. If biopsy of polyp is adenocarcinoma, what to do? full colonoscopy prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Elderly male or post menopausal female with unexplained iron deficiency anemia, what to do?

A

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Elderly male with hematochezia, history of hemorrhoids, what to do?

A

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A 45 year old patient on routine health maintanece exam had FIT 1 out of 6 cards + for occult blood, what to do?

A

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A 55 year old woman had screening colonoscopy done, 2 polyps removed; biopsy showed they were hyperplastic, when to do next colonoscopy?

A

10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patient had 2 tubular adenomas (<1cm) removed; when to repeat colonoscopy?

A

5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Patient had 1 tubular adenoma 1cm in size, next colonoscopy?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patient had 1 tubular adenoma 2.5 cm, next colonoscopy?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Patient had 3-10 tubular adenomas <1cm; next colonoscopy?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patient had 1 villous adenoma <1 cm, next colonoscopy?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Patient had 1 serrated polyp adenoma <1 cm, next colonoscopy?

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Patient had 1 serrated polyp adenoma >1 cm, next colonoscopy?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patient with obstructive colon cancer, underwent colonic resection, what to do next?

A

Full colonoscopy to rule out other concomitant lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Following curative resection of colon cancer, when is the next colonoscopy indicated?

A

Colonoscopy in 1 year, then 3 years, then every 5 years; measure CEA q 3-6months for 2 years, then every ear for 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Best diagnostic test to rule out colon cancer?

A

Colonoscopy with biopsy; best risk reduction in left colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When do you recommend against routine colon cancer screening?

A

75 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Crohns disease or ulcerative colitis

A

having disease for 8 years give colonoscopy then every 1-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Post colonic resection for colon cancer

A

Colonoscopy in 1 year, then in 3 years then every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

General population or distant relative with colon cancer

A

45 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

40 year old patient with two primary relatives with colon ca even after age 60; one primary even after age 60

A

Colonoscopy now and every 10 years
-FIT every year and sigmoidoscopy every 10 years OR
-sigmoidoscopy every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

40 years old; or 10 years younger than youngest affected relative: 2 first primary relatives or 1 first primary relative diagnosed before age 60 with colon cancer

A

Colonoscopy every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

25 years old or 10 years younger than the youngest affected relative with HNPCC

A

Colonoscopy every 2 years up to age 40 then every year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

12 years old with familial adenomatous polyposis

A

sigmoidoscopy 1-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

45 year old, asymptomatic, father had colon cancer age 45

A

Colonoscopy now then every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

40 year old asymptomatic, father had colon cancer at age 60, brother had colon cancer at age 52

A

Colonoscopy now and every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

35 year old asymptomatic, father had colon cancer at age 65

A

FIT or FIT DNA or colonoscopy, or CT colonography or flexible sigmoidoscopy or flexible sigmoidoscopy with FIT starting at age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

A 25 year old asymptomatic, family history of HNPCC

A

Colonoscopy now and then every 2 years up to age 40 then every year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Patient with ulcerative colitis diagnosed recently

A

Colonoscopy 8 years later and then every 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Patient with colon cancer Duke B and underwent resection of colon

A

Colonoscopy in 1 year, then 3 years then every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A 45 year old asymptomatic, family hx negative for colon cancer

A

FIT or FIT DNA or colonoscopy or CT colonography or flex sig or flex sig with FIT starting at age 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Young patient with family history of familial adenomatous polyposis

A

Colonoscopy age 16 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

40 year old asymptomatic, father had colon cancer at age 55

A

Colonoscopy now and every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

A 37 year old man whose father had colon cancer at age 65, presents to the office; brother had colon cancer at age 50, aunt had uterine cancer at age 48, what is more likely?

A

HNPCC (microsatellite mismatch repair genees MSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Colonoscopy negative with improper bowel prep

A

Repeat with proper prep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Colon cancer stage 1, node negative

A

RESECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Colon cancer stage IIa, node negative

A

RESECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Colon cancer staage IIB, IIC, node negative

A

RESECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Colon cancer stage III node positive

A

RESECTION + 5FU + leucovorin + oxaliplatin (FOLFOX)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Colon cancer Mets positive

A

Resection palliative; 5FU + Leucovorin + irinotecan + bevacizumab (FOLFIRI) + Zif-Aflibercept

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Patient with colon cancer underwent hemicolectomy; histopathology revealed infiltration of muscularis, LN-, what to do?

A

Observe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Patient with colon cancer, infiltrating serosa and pericolic structures like viscereal peritoneum

A

Adjuvant chemotherapy +RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Patient with colon cancer not infiltrating the serosa, 4/10 lymph nodes +; after hemicolectomy what else do you do?

A

Chemotherapy (5FU, leucovorin, oxaliplatin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Patient with stage B2 rectal cancer, local resection was done, what else will reduce relapse?

A

Adjuvant chemotherapy + RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

ANAL CANCER: cancer of anal margin, how to treat?

A

local excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Cancer of anal canal mucosa

A

External beam radiation + 5FU + mitomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Breast cancer screening

A

Begin at 50, stop at 75 OR <5-10 years prior to age in primary relative with breast cancer then every 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

BRCA1

A

Chrom 17; breast, ovarian cancer in women, prostate cancer in men; high penetrance; other family members should be made aware; offfer prophylactic salpingo oopherectomy to patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

BRCA2

A

chromosome 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Ductal carcinoma in situ

A

lumpectomy + RT + tamoxifen/aromatase inhibitor if ER receptor + OR mastectomy (no chemo or endocrine tx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Lobular carcinoma in situ

A

Observation or in ER + –>tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Infliltrating ductal cancer with LN -

A

Wide excision of mass with free margins + RT; adjuvant chemo for size >1 cm; tamoxifen/aromatase inhibitor if ER receptor +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Infiltrating ductal cancer with LN +

A

Wide excision + RT = modified radical mastectomy + adjuvant chemo + tamoxifen/aromatase inhibitor if ER receptor +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Locally invasive disease involving skin or chest wall

A

chemotherapy followed by mastectomy + tamoxifen/aromatase inhibitor if ER +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Most important prognostic factor

A

LN> tumor size > receptor > grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Adjuvant therapy for node + disease in premenopause

A

ER + chemotherapy + tamoxifen, if ER - chemotherapy, HER-2 + trastuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Adjuvant therapy for node + disease in post menopausal

A

ER + chemotherapy +aromatase inhibitor; ER - chemotherapy; HER2 + trastuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Adjuvant therapy for node - disease >.5 cms; premenopausal

A

ER+ Tamoxifen + HER 2 + Trastuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Adjuvant therapy for node - disease >.5 cm postmenopausal

A

ER+ aromatase inhibitors + HER2 + Trastuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

ER + HER 2 - –>Oncotype dx. RT PCR 21 Aka gene recurrence assay

A

<25 no chemotherapy
>25 chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Adjuvant therapy for node - disease >1 cm

A

Chemotherapy + endocrine therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Adjuvant therapy for node + disease, ER -, PR -, HER2-, aka triple negative

A

Atezolizumab or pembrolizumab + paclitaxel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

37 year oldwoman with family hx of breast carcinoma in mother at age 65 and sister age 35, the most important risk factor for the patient to get breast cancer is?

A

Her family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

A 65 year old woman with a family history of breast cancer in mother at age 67; most important risk facter for her to acquire breast cancer is?

A

Her age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Patient with breast cancer; primary relative with hx of breast cancer and ovarian cancer; you do genetic counseling for?

A

BRCA1 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

A 40 year old woman, genetic testing showed BRCA1 mutation, what to do next?

A

Annual mammogram and MRI screening starting now; also for BRCA2 and their first degree relatives, TP53, PTEN, CHEK2, RT to chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

50 year old woman presents for regular checkup; the best way to screen her for breast cancer is?

A

Mammogram every 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

How to screen for breast cancer in a woman with implants?

A

Mammogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

50 year old woman with dense breasts, what to do?

A

Digital mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

40 year old presents with thickening of left upper outer breast; no family hx of breast cancer, you advise her to come mid cycle; after 3 weeks thickening persists; mammogram and ultrasound is doone which reveals no calcifications or dominant mass, you would?

A

Core needle aspiration biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Above patient ultrasound reveals mass with mixed echo; fine needle core biopsy shows no malignancy, what to do?

A

Excision biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

50 year old diagnosed with breast cancer; most important prognostic factor is?

A

lymph node positivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

A 35 year old woman with a 1.5 cm mass; excision biopsy shows infiltrating ductal cancer and margins are free of cancer; axillary LN- ER +, what to do? she does not want mastectomy

A

RT + adjuvant chemotherapy + tamoxifen for 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

A 55 year old woman with a lump in the breast; lumpectomy was done which reveals infiltrating adenocarcinoma freee margins; Axillary LN +, ER+; adjuvant chemo + RT administered and tamoxifen given for 5 years; she is now menopausal, what to do?

A

Switch to aromatase inhibitor for 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

A 45 year old with heaviness, swelling and pain in breast for 4 weeks; on exam, erythema of right lower quadrant, thickened area, nipple retracted but no nipple discharge; +lymph nodes, no fever +/- mass

A

Inflammatory breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Patient s/p breast cancer treatment with surgery RT and chemotherapy; presents with lymphedema of right arm; what is best management?

A

Progressive resistance training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Decreases risk of new breast cancer; effective for treatment of metastatic breastcancer; works only if tumor is ER and PR +; effective in preventing cancer in high risk women; has both estrogenic and anti estrogenic effects

A

Tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Anti estrogenic effect

A

Anti breast tumor effect, hence used in treatment; menopausal symptoms (citalopram and effexor only, works for depression too)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Estrogenic effect

A

Increased risk of endometrial cancer x 3; increased bone density; increased thromboembolic risk/PE, NOT osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

A 45 year old patients 40 year old sister was diagnosed with breast cancer; your patient asks how to decrease risk of contracting breast cancer

A

Tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

A 54 year old woman diagnosed with infiltrating ductal carcinoma with LN 3/15 +; patient has breast conserving surgery. + RT + chemottherapy + tamoxifen; she is most likely to be at risk for?

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Patient with a history of breast cancer ; she received chemotherapy and started tamoxifen; 6 months ago; she presents with polyuria, constipation, fatigue, lethargy and dry mucous membranes, most likely etiology?

A

Hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Above patient has a schedule of yearly mammogram and pap smear; what else would you recommend?

A

Ask for gyn symptoms every visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Above pt continued taking tamoxifen 20mg po daily, 3 years later she presents for f/u and complains of a one time bloody discharge per vagina which resolved by itself about six months ago; no other complaints than hot flashes; no breast mass noted; mammogram and pap ssmear negative, what to do next?

A

Endometrial biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Pregnant women with Breast cancer

A

Treat like regular pt; surgery in 2nd and 3rd trimester; chemo in 2nd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is long term complication of aromatase inhibitors?

A

Osteoporosis; do DEXA scan prior to starting AIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Young nulliparous woman diagnosed with breast cancer, what will you do next?

A

Refer to fertility specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Patient presents with nipple discharge; exam reveals eczematous scaly lesion at nipple; pregnancy test negative; prolactin normal

A

PAGETS disease; local wide resection if there is no mass; treat as breast cancer if there is a mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Patient with history of breast cancer s/p lumpectomy and chemotherapy 5 years ago presents with pain in the hip and lower back; x ray of the hip reveals 3 cm lytic lesion and xray of L5 spine is normal, what to do?

A

MRI of L5 spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is first sign of epidural compression fracture?

A

Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

A 60 year old woman with hx of breast cancer s/p resected ER/PR + and had chemotherapy and aromatase inhibitors started; current meds include ace inhibitors, beta blockers and lasix; she is urinating more frequently; exam is normal labs are normal except ca is 11.2; what is best management?

A

Bone scan; the leading solid tumor causing hypercalcemia is breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

A 65 year old woman is diagnosed with infiltrating ductal carcinoma; she undergoes lumpectomy with free margins, RT and adjuvant chemotherapy; 6 months later she presents for f/u; she has no complaints; negative mammogram; what else would you recommend?

A

Mammogram + MRI yearly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Patient s/p mastectomy for breast cancer with mets; on increasing opiates for pain control; she is lethargic with decreased responsiveness; pupils non reactive, diplopia, tongue deviated to right, absent gag reflex, absent left ankle reflex, +urinary retention, most likely diagnosis?

A

Leptomeningeal spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

A 34 year old with breast lump which was excised adn found to be fibroadenoma; grandmother with breast cancer at age 55; how to f/u this patient?

A

Mammogram at 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

65 year old man has been taking spironolactone for ascites presents with unilateral breast mass, what to do?

A

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

A 30 year old woman presents with breast pain one wek prior to the onset of menstruation and resolves with onset of menstruation, what to do?

A

Supportive bra and reassurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Endometrial Cancer risk factors

A

-obesity
-early menarche
-late menopause
-nulliparity
-tamoxifen use
-HNPCC (lynch syndrome)
-PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Which cancer is associated with obesity?

A

Endometrial cancer (due to excess endogenous estrogen from conversion in the adipose tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Pap smear: screening between 21-29

A

Every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

For women above 30, Pap smear with HPV DNA every

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Dont do HPV DNA<30

A

Unless pap smear is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

High risk (multiple sex partners, stds, HIV)

A

Pap smear yearly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Stop pap smear screening at 65 if

A

at least 3 consecutive past pap smears are negative in past 10 years, most recent test 3 years ago OR 2 consecutive HPV tests negative in past 10 years, most recent one within 5 years OR 2 consecutive co tests negative in past ten years, most recent 5 years ag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

If ASCUS and HPV +

A

Colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

IF ASCUS and HPV -

A

Repeat pap in 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

If ASCUS - and HPV +

A

Repeat pap and dNA in 6months to a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

24 year old woman with vaginal discharge; pap smear shows clue cells and some ASCUS, what to do next?

A

Treat with metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

24 year old woman, pap smear shows ascus+, what to do next?

A

HPV testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

When is HPV vaccine contraindicated

A

pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

22 year old with ASCUS, HPV 16 infection, can she get vaccine?

A

yes, it will help with 8 other serotypes

123
Q

A 50 year old patient with hx of fibroids; 2 years ago fibroid size 2 cm; repeat exam now revels fibroid 3cm; no menorrhagia, what is best management?

A

Reassess in 1 year

124
Q

Patient had hysterectomy for fibroids, do you need pap smears post hysterectomy?

A

No

125
Q

Patient had hysterectomy for cervical cancer; do you need pap smears post hysterctomy?

A

Yes

126
Q

Patient with lesion in endocervical canal, what to do?

A

Biopsy

127
Q

Carcinoma in situ: confined to endocervical canal

A

Total hysterectomy or radical hysterectomy or conization

128
Q

Carcinoma in situ: upper 2/3’s of vagina

A

Radical hysterectomy and pelvic lymphadenectomy or RT with brachytherapy

129
Q

Carcinoma in situ: Lower 3rd of vagina

A

Cysplatin based chemo with RT

130
Q

Carcinoma in situ: disseminated

A

Cisplatin based chemo with RT palliative

131
Q

Patient with cervical cancer treated with cisplatin and RT last year;now presents with abdominal pain; bun/cr 30/2.0; ultrasound reveals hydronephrosis; most likely etiology?

A

Retroperitoneal fibrosis; diagnose with CT; treat with steroids

132
Q

Patient with abdominal distention; ultrasound shows a serous semi solid 6 cm septate mass in the right pelvic area; CEA elevated; what to do next?

A

CT scan to localize tumor before resection

133
Q

Prostate cancer risk factors

A

-african american x2
-family history
-do BRCA1/2
*PSA screening has not shown reduction in mortality

134
Q

66 year old man is diagnosed with prostate cancer with a gleason score of 8 (beyond the capsule); radiotherapy is done; what will you do next?

A

Androgen deprivation with GNRH agonist(leuprolide) and androgen blocker (bicalutamide) to prevent flare of GNRH agonist

135
Q

Prior to starting androgen blocking therapy, what to do?

A

Do DEXA: osteoporosis, CAD and decreased libido are long term complications; best Tx: bisphosphonates (zoledronate or denosumab)

136
Q

Patient with metastatic prostate cancer has been started on leuprolide; what do you most likely expect?

A

Vertebral compression fracture

137
Q

Patient post radical prostatectomy followed by decreased PSA levels; 3 years later PSA<10; patient is asymptomatic, what to do?

A

Repeat h/p in six months

138
Q

82 year old man found to have prostate cancer stage IIA, what to do?

A

Observe

139
Q

Patient with a fib on warfarin has hematuria, INR 2.2; RBCs in urine 10-15 HPF; repeat UA with persistent hematuria; rectal exam with enlarged prostate; the CT scan, cystoscopy and IVP are negative; prostate biopsy reveals prostate hyperplasia, but no cancer, what to do to treat hematuria?

A

Add finasteride

140
Q

65 year old chronic smoker presents with painless intermittent gross hematuria with clots; most likely diagnosis is:

A

Bladder cancer

141
Q

A patient presented with lower abdominal pain, exam reveals fullness in the suprapubic area; foley cath was inserted with relief of pain and drainage of urine; a psa was done which was elevated; what to do next?

A

Repeat PSA in 4-6 weeks (urinary retention of any cause will increase PSA)

142
Q

Patient with metastatic prostate cancer to bonek refractory to GNRH agonists and anti androgens with breakthrough pain on immediate relase morphine and NSAID, what to do?

A

Switch to sustained release morphine twice daily

143
Q

Most common presentation of lung cancer

A

persistent cough or increasing cough, hemoptysis or post obstructive pneumonitis

144
Q

Patient presents with hemoptysis >1 week; >40 years and chronic tobacco hx has a 40% chance of having cancer; so always evaluate patient further with above symptoms; what to do next?

A

chest x ray

145
Q

A 50 year old patient presents with increasing cough for the past month, no fever, chills or hemoptysis with weight loss of 8 pounds; chest x ray shows effusion; CT of chest shows efffusion with 2cm lesion, 1.5 cm from periphery of pleura; thoracentesis is exudative, cytology is negative for malignant cells; what to do?

A

Repeat thoracentesis with cytology

146
Q

LUNG CANCER TREATMENT

A

NON SMALL CELL LUNG CANCER

147
Q

Stage I: tumor >2cm from carina, node negative

A

Surgery and chemotherapy

148
Q

Stage II: tumor >2cm from carina, node positive

A

Surgery and chemotherapy

149
Q

Stage IIIa: Tumor <2cm from carina, or invading resectable structure or ipsilateral hilar or mediastinal LN +

A

surgery + chemotherapy + RT

150
Q

Stage IIIb: Tumor invading unresectable structure; contralateral mediastinal LN positive

A

Chemotherapy –> followed by radiotherapy

151
Q

Stage IV: metastatic disease: supraclavicular LN positive or pleural effusion with malignant cells

A

Check for EGFR mutation, ALK translocation and PD L1

152
Q

EGFR mutation

A

Erlotinib (tarceva)/ gefitinib (iressa)

153
Q

Alk translocation

A

Crizotinib (Xalkori)

154
Q

PD-L1

A

Pembrolizumab (keytruda) Nivolumab (opdivo)

155
Q

SMALL CELL CANCER

A
156
Q

Limited to one hemithorax

A

chemotherapy +RT lung +RT brain

157
Q

Elderly patients with small cell carcinoma should

A

Be treated with cisplatin based chemotherapy before RT and prophylactic RT to brain

158
Q

Patient >50 years old is successfully treated in hospital for a pneumonia with rocephin and azithromycin; 3 months later, cough persists; chest x ray reveals persistent density; most likely diagnosis?

A

Malignancy

159
Q

50 year old patietn has lung cancer in family, wants screening, 20 pack years and quit 20 years ago

A

No screening recommended

160
Q

50 year old patient with a smoking history of 20 pack years, quit smoking 15 years ago; presents for regular check up, what to do?

A

Low dose CT

161
Q

65 year old patient, low dose ct scan lung is positive, what will you inform patient?

A

More false positives than true positives

162
Q

To prevent highly emetogenic chemotherapy

A

Granisetron + DMS +Aprepitant (emend) + olanzapine

163
Q

Patient prior to administration of next cycle of chemotherapy is nauseous despite receiving granisetron and zofran, what to do?

A

Alprazolam

164
Q

Small cell carcinoma

A

-hyponatremia secondary to SIADH
-cushings syndrome secondary to ACTH
-Carcinoid: flushing and diarrhea
-Lambert eaton syndrome: power increases with repititon
-SVC syndrome
-Paraneoplastic cerebellar degeneration

165
Q

Squamous cell carcinoma

A

-hypercalcemia secondary to PTH related protein
-Horners syndrome: ptosis, miosis, anhydrosis
-pancoast tumor: compress 1st and 2nd thoracic nerve causing shoulder pain and ulnar aspect of hand and little finger

166
Q

Adenocarcinoma

A

Pulmonary osteoarthropathy: pain in hands or legs; x ray with periosteal thickening
-marantic endocarditis

167
Q

Large cell carcinoma

A

Gynecomastia and SVC syndrome

168
Q

65 year old patient with squamous cell carcinoma; hemorrhagic pleural effusion; bp 160/100; hypercalcemia +; FEV1 is 2.4 liters, hb 9; what prevents him from being a surgical candidate?

A

hemorhhagic pleural effusion

169
Q

What is the most important prognostic factor in a patient with advanced non small cell lung cancer?

A

Poor performance status

170
Q

A 45 year old s/p surgery and chemotherapy 5 years ago for lung cancer going for elective surgery; ECHO reveals EF 35%, what to do?

A

Ace inhibitor

171
Q

In a patient with pancoast tumor, which of the following has a worse prognosis?

A

Chest movement assymetry

172
Q

A 70 year old man presents with unsteady gait and history of falls; 3 days ago he had dizziness, nausea and vomiting; exam reveals he has diplopia, slurred speech and difficulty swallowing; chest x ray reveals a mass in the chest; ct/mri brain is negative; anitbody testing. reveals anti yo positive, ANA negative, Anti DNA ds negative; most likely diagnosis?

A

Paraneoplastic degenerative disease; cerebellar dysfunction

173
Q

The least likely paraneoplastic syndrome with small cell lung cancer is

A

Hypercalcemia

174
Q

Patient with history of lung cancer presents with chest pain; palpation with tenderness; x ray reveals multiple metastatic lesions on the rib, what to do?

A

Denosumab

175
Q

A 51 year old with lung cancer, gynecomastia and increased hcg

A

Large cell carcinoma

176
Q

a 62 year old chronic smoker with pain in his legs; chest x ray with coin lesion in the periphery of lung

A

Adenocarcinoma

177
Q

A 55 year old patient with lung cancer and hypercalcemia

A

Squamous cell carcinoma

178
Q

A 55 year old patient with lung cancer and weakness which gets better with movement

A

Small cell carcinoma

179
Q

A 55 year old manual laborer and heavy smoker presents with shoulder, arm, medial forearm, ring and little finger pain, what to do next?

A

Chest x ray

180
Q

Most common cancer in smokers and non smokers

A

adenocarcinoma

181
Q

The most common cancer in non smokers

A

adenocarcinoma

182
Q

ACTH producing neoplastic syndrome

A

Small cell carcinoma

183
Q

Assume mets at diagnosis

A

Small cell carcinoma

184
Q

Hyponatremia

A

Small cell carcinoma

185
Q

Squamous cell lung cancer 2 cm within carina and ipsilateral lymph node positive

A

surgical resection + chemotherapy + Radiation therapy

186
Q

Adenocarcinoma >2cm from carina, lymph node -

A

Surgery + chemotherapy

187
Q

Large cell carcinoma at carina and contralateral LN +

A

chemotherapy + RT lung

188
Q

Small cell carcinoma, extensive

A

chemotherapy + RT brain

189
Q

SVC Syndrome: dyspnea, facial swelling, arm swelling, cyanosis, plethora and dysphagia

A

-lung cancer (NSCLC: bronchogenic most common 65%
-lymphomas
-thymomas
-catheter induced thrombosis

190
Q

Management of SVC syndrome

A

Radiation therapy

191
Q

Above patient pain not relieved by fentanyl patch and opoids, what to do?

A

Strontium 89

192
Q

According to medicare guidelines, when is a hospital patient eligable for hospice?

A

<6 months to live

193
Q

Seminoma

A

no hcg or alpha fetoprotein

194
Q

Non seminoma

A

elevated hcg and alpha fetoprotien

195
Q

Testicular cancer

A

Radical orchiectomy first via high inguinal incision, then according to stage treat as follows

196
Q

Stage I: confined to testes

A

Seminoma: RT or carboplatin
Non seminoma: observe, reemove lymph nodes

197
Q

Stage II: Infradiagmatic +<5cm

A

Seminoma: RT or carboplatin
Nonseminoma:cisplatin based chemo

198
Q

Stage III: Beyond retroperitoneal nodes

A

Seminoma: chemotherapy
Non seminoma: Cisplatin based chemo, no RT

199
Q

The above patient has a lung nodule as well, what to do?

A

Resect: same principle as for breast ca or colon ca as well

200
Q

BHCH and alpha fetoprotein elevation

A

Non seminoma

201
Q

Alpha fetoprotein normal

A

Seminoma

202
Q

Inguinal approach for orichetomy

A

Both seminoma and non seminoma

203
Q

Respond to RT

A

Seminomas

204
Q

Don’t respond to RT

A

Non seminoma

205
Q

A 19 year old man with increasing breast enlargement for the past 2 years; no other complaints; firm sub areolar glandular tissue (gynecomastia) what to do?

A

Examine external genitalia;; check testosterone level (450) and estradiol level; LH .3 FSH .5, estradiol elevated at 304: next step: US of testes; if normal: Ct of adrenal

206
Q

LYMPHOMA

A
207
Q

Hodgkin lymphoma

A

Reed sternburg + cells,B cells, owl eyes, CD 15 and CD 30 positive

208
Q

Hodgkin lymphoma

A

lymphocyte predominance > nodular sclerosis> mixed cellularity> lymphocyte depletion

209
Q

Hodgkin lymphoma

A

Patients present with llymph node enlargement with contiguous sperad +/- paracrine effect: -fever -peripheral granulocytosis, - eosinophilia with pruruitis, - personality changes

210
Q

Lymphoma

A

Non hodgkin lymphoma: b cells 90%, T cells 10 %

211
Q

Treatment for Hodgkins Disease

A

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) varying cycles of A +VD –> (brentuximab vedotin, doxorubicin, vinblastine and dacarbazine +/- RT)–> if patients relapse or poor response–> high dose chemotherapy followed by autologous hematopoietic stem cell transplant

212
Q

Complications after therapy: CHemotherapy (alkylating agents, topoisomerase inhibitors, anthracyclie)

A

-cardiomyopathy
-AML
-Myelodysplastic syndrome
-infertility, amenorrhea (before RT or chemo –> refer to fertility specialist)

213
Q

Radiation therapy

A

-constrictive pericarditis
-accellerated CAD
-solid tumors ( breast, lung, thyroid ca)
-Radiation pneumonitis: ssubacute 4-12 weeks, late 6-12 weeks
-hypothyroidism

214
Q

A 38 year old with past history of hodgkins disease treated with RT 10 years ago presents with chest pain while shoveling snow for >30 min

A

Accellerated CAD

215
Q

A 40 year old man with past history of hodgkins tx with mantle RT to chest 10 years ago presents with palpitations, weight lost, JVD +, ascites, pedal edema; echo reveals thickened pericardium

A

Constrictive pericarditis

216
Q

A 42 s/p hodgkins lymphoma disease treated with chemotherapy >7 yearsago presents with easy bruising, hg 9, platelets 50,000; blood smear: anisocytosis; pelger huet anomaly; BM: dysplaasia of marro precursers and hypercellularity

A

Mylodysplasia

217
Q

A 35 year old woman with Hodgkins 10 years ago s/p mantle radiation; now presents with fatigue; what to do?

A

TSH and mammogram annually

218
Q

What are they prone to?

A

Breast, lung and thyroid cancer

219
Q

A 30 year old underwent chemotherapy for hodgkins disease 10 years ago; what is a likely complication?

A

Increased incidence of AML

220
Q

A 35 year old s/p R/T for hodgkins disease 6 weeks ago presents with SOB, low grade fever, cough, chest x ray normal

A

Acute radiation pneumonitis; treat with glucocorticoids

221
Q

NON HODGKINS LYMPHOMA

A

-spreads hematogenously
-diagnosis by excision of lymph node, not aspiration or core biopsy
-site –>supraclavicular lymph node
-if relapse; repeat aggressive chemo and stem cell transplant

222
Q

Above patient presents a year later with weakness and stiffness of joints , thickening of skin, dry eyes, ; most likely diagnosis?

A

GVHD

223
Q

Poor prognostic factor for NHL

A

-age >60
-serum LDH
-performance status <70
-Ann arbor stage III and IV
-hg <12

224
Q

NON HODGKIN LYMPHOMA

A
225
Q

Low grade lymphoma: Follicular, small lymphocytes

A

Treatment: + L, no symptoms –> observe; Agressive transformation/bulky disease –» Rituximab –>CHOP

226
Q

Intermediate Grade lymphoma: Follicular with large or small cell; diffuse; mixed

A

R-CHOP (cyclophophasmide, doxorubicin, vincristine, prednisone)

227
Q

High grade Lymphoma: large cell, immunoblastic; small. non cleaved cell

A

CHOP +/- rituximab + RT OR EPOCH + rituximab, NO RT (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) –> stem cell transplant

228
Q

Post renal transplant lymphomas

A

EBV associated lymphomas

229
Q

CNS lymphoma/burkitts/nasopharyngeal carcinoma

A

EBV

230
Q

MALT (gastric marginal zone lymphoma)

A

H pylori

231
Q

Kaposi sarcoma

A

HSV8

232
Q

Cervical cancer/anal cancer

A

HPV 16,18,31,33

233
Q

T cell leukemia

A

HTLV-1

234
Q

Patient post renal transplant 2 years ago presents with ataxia; ct of head shows ring enhancing lesion in the cerebellum; most likely diagnosis is?

A

EBV

235
Q

Patient with well differentiated lymphoma presents with fatigue and weakness; cbc with hb 9.5, retic 5% (.5-2.5); peripheral smear reveals spherocytes, polychromasia; what is the best diagnostic test?

A

COOMBS test to rule out warm autoimmune hemolytic anemia

236
Q

Best management for above patient?

A

steroids –> rituximab to treat underlying disease ( treats warm autoimmune hemolytic anemia)

237
Q

Patient with large hilar adenopathy is diagnosed as small cell or lymphoma presents with shortness of breath; exam reveals massive pleural effusion, what to do next?

A

Tap the effusion

238
Q

Pleural tap ph<7.3, lyphocytes, typically cancer induced pleural effusion; if pleural fluid not determining, then do CT chest before biopsy; what is best managment?

A

Chemotherapy

239
Q

Above patient comes back a couple months later with recurrent effusion, what to do?

A

Thoracosopy with talc poudrage?

240
Q

What can you expect one month after two infusions of rituximab?

A

lymphopennia

241
Q

Multiple myeloma

A

-lytic lesions, bone pain, hypercalcemia, serum and urine protein M spike; marrow cytosis >10%; plasma cells –>osteoclasts, faulty IgG; punched out bone lesions–>hypercalcemia M spike in serum and urine–> renal failure; increased ESR; platelet dysfunction; infections; decreased anion gap

242
Q

Multiple myeloma diagnosis:

A

Serum protein electrophoresis and free light chain analysis and or urine protein electrophoresis

243
Q

CRAB criteria

A

-calcium, renal dysfunction, anemia, bone lesions

244
Q

If CRAB is not present

A

Monitor for 3-6 months

245
Q

If CRAB is present and not HCT eligible?

A

NO; CHF>III, confined to bed, >77 years, cirrhosis –>VRd induction: Bortezomib + lenalidomide + low dose DMS–> lenalidomide (can cause dvt) maintenance; with bortezomib shingles prophylaxis with acyclovir

246
Q

If CRAB present and HCT eligible?

A

VRd induction. –> HCT–> lenalidomide maintenance

247
Q

Multiple myeloma

A

protein >3 g/dl; lytic lesions in bone; >10 % marrow plasma cells, hypercalcemia

248
Q

MGUS (monoclonal gammopathy of unknown significance

A

Protein <3 g/dL; no lytic bone lesions, <10 % marrow plasma cells, no hypercalcemia

249
Q

Smoldering myeloma

A

Protein > 3 g/dL; no lytic bone lesions; >10 % marrow plasma cells, no hypercalcemia

250
Q

Multiple myeloma

A

Hypercalcemia, increased proteins, renal dysfunction, platelet dysfunction, bone pain, infections, amylodosis, dilation of retinal veins

251
Q

Hyperviscosity can be caused by:

A

-waldenstrom macroglobinemia
-polycythemia vera
-leukemia

252
Q

A 65 year old patient found to have protein 8 gm; glovulins are 3.1 (2-3.5); serum protein electrophoresis shows increased IgG; the best way to differentiate between MM and MGUS is:

A

Low dose CT skeletal survey

253
Q

Above patient with plasma cells <10% in bone marrow biopsy and radiological skeletal survey is normal; calcium is normal and patient is diagnosed with MGUS, what to do?

A

Follow up in six months

254
Q

Patient with plasma cells >10% in bone marrow biopsy; radiological skeletal survey and calcium is normal, no end organ damage, cr and hb normal and no lytic lesions and the patient is diagnosed with smoldering multiple myeloma, what to do?

A

Follow up myeloma protein every 2 months

255
Q

A 60 year old man presents with headache, blurred vision, lymphadenopathy and fatigue, hb 9, lethargic and decreased power on one side; total proteins 8, albumin 3.6, ca 9; serum protein electrophoresis shows increased igM >2, ESR increased; what is this?

A

Waldenstrom macroglobulinemia

256
Q

Waldenstrom macroglobulinemia

A

-caused by IgM –>remains intravascular –> hyperviscosity
-no lytic bone lesions
- no hypercalcemia
-bone marrow shows pasmacytoid lymphocytes

257
Q

Waldenstrom Macroglobulinemia Treatment

A

-plasmapheresis
-bendamustin with rituxan
-velcade/decadron/rituxan
-cytoxan/rituxan/decadron

258
Q

Tumors of the pancreas

A
  • pancreatic carcinoma
    -glucagonoma
    -gastrinoma
    -VIPomas
259
Q

Elderly man with >40 pack years smoking history presents with weight loss, fatigue, anorexia, painless jauncice, +/-diarrhea, painless palpable gallbladder (courvoisiers sign); best diagnostic test is?

A

CT scan of pancreas to rule out pancreatic cancer–>mainly in the head of pancreas –>double duct sign positive

260
Q

Treatment of Pancreatic cancer with no metastasis

A

Surgery (pancreatoduodectomy) with chemo; can include minimal invasion of portal or mesenteric vein

261
Q

Above patient refuses surgery and has good functional status, what to do?

A

Gemcitabine + nab-paclitaxel chemotherapy

262
Q

Pancreatic cancer with mets

A

Palliative treatment with stent placement; gemcitabine (gemzar) + nab paclitaxel

263
Q

Patient with stage IV pancreatic cancer with severe itching; what is the best management?

A

Biliary stent

264
Q

A 46 year old woman with no previous history of pancreatitis has an incidental finding of 3.8 cm mass in the head of pancreas seen on multi detector dual phase contrast CT scan, what to do?

A

Surgical excision

265
Q

If mass is not clearly defined or borderline resectable on ct scan then the best test is:

A

endoscopic ultasound

266
Q

Diabetics are more prone to what kind of cancer?

A

Pancreatic cancer

267
Q

What is more commonly associated with pancreatic cancer?

A

Smoking

268
Q

Patient who had familial adenomatous polyposis are more prone to

A

Ampulla of vater cancer

269
Q

Patient with persistent hyperglycemia, weight loss, chronic diarrhea and anemia; exam reveals scaly necrotizing dermatitis; ct reveals mass in pancreas; glucagon injection doesnt increase glucose level

A

Dx: glucagonoma

270
Q

Patient with profuse watery diarrhea not responding to fasting; history of weight loss, serum k is 3.3 and hypochlorydhydria; serum vip is increased, stool osmolar gap low

A

VIPOMA; treatment: octreotride

271
Q

Courvoisiers sign

A

pancreatic cancer

272
Q

Trousseaus syndrome (migratory thrombophlebitis)

A

Pancreatic cancer

273
Q

Double duct sign

A

Pancreatic cancer

274
Q

Sentinal loop sign (small bowel ileus)

A

Acute pancreatitis

275
Q

Patient presents with diarrhea, hx of flushing sensation, exam reveals some telangiectasia, what will you do next?

A

5HIAA; most likely diagnosis? carcinoid

276
Q

Best surveillance for hepatocellular carcinoma?

A

Liver ultrasound

277
Q

Patient has ultrasound done which shows .8 cm lesion, what to do?

A

Repeat ultrasound in 3 months

278
Q

Above patient 6 months later the size is 1.2 cm, what to do?

A

Three phase CT scan (increased arterial phase enhancement, decreased venous and pearenchymal phase)

279
Q

How to diagnose hepatocellular carcinoma?

A

Imaging studies

280
Q

What is the first line treatment?

A

Resection OR radiofrequency ablation ethanol injection OR transplant

281
Q

Which agent has shown survival benefit in hepatocellular carcinoma?

A

Sorafenib (nexavar) or Lenvatinib (lenvima)

282
Q

THYROID CARCINOMA

A
283
Q

Parafollicular:
Medullary carcinoma

A

-Calcitonin increased
-dense calcification in tumor
-Associated with MEN II A and II B(check family hx)
-TX: total thyroidectomy

284
Q

Follicular

A

Papillary carcinoma –> cervical LN, pitted calcification, BRAF + (most common with best prognosis)
Follicular carcinoma –> mass and distant mets RAS+

285
Q

Best management for papillary and follicular carcinoma after surgery is?

A

Radioiodine ablation (it will not work for medullary carcinoma as radioiodine is not taken up by C cells)

286
Q

Medullary carcinoma recurrance (ct scan of neck)

A

Calcitonin level

287
Q

Papillary carcinoma recurrance

A

Thyroglobulin level

288
Q

Follicular carcinoma recurrence

A

Thyroglobulin level

289
Q

Swollen parotid glalnds, dry eyes and mouth with cervical and supraclavicular LN +

A

Lymphoma

290
Q

Swollen parotid glands, moist tongue sub mandibular LN+

A

bulimea

291
Q

Carcinoma of unknown origin

A

mostly adenocarcinoma

292
Q

Presentation

A

40% lymph nodes: cervical andsupraclavicular>mediastinal>axillary> 30% liver lung and bone; 20% will be identified; expected mean survival is six months

293
Q

Adenocarcinoma in Females with Axillary LN

A

-pursue breast cancer diagnosis
-do mammogram +/- MRI, ER/PR receptors
-Mastectomy

294
Q

Adenocarcinoma in female with bony involvement

A

Pursue breast cancer diagnosis

295
Q

Adenocarcinoma in males with bony involvement

A

Pursue prostate cancer diagnosis; ask for urinary symptoms, do PSA and rectal examination

296
Q

Poorly differentiated cancer in young males

A

Pursue germ cell tumor diagnosis; DO alpha fetoprotein and beta hcg; if + platinum based chemotherapy

297
Q

Squamous cell cancer

A

Prseentation with cervical LN +–>pursue head and neck cancer diagnosis
-Present with lower cervical LN + –>pursue lung cancer diagnosis

298
Q

Most common cause of carcinoma of unknown origin

A

Adenocarcinoma

299
Q

Most common place of presentation of carcinoma of unknown origin

A

Lymph node

300
Q

Female with axillary lymph node + most likely to have what type of cancer

A

Adenocarcinoma

301
Q

Head and neck cancer

A

Squamous cell carcinoma

302
Q

A 50 year old man, smoker with a single submandibular LN + which was found to be undifferentiated carcinoma; rest of physical exam is negative, chest x ray negative, what to do?

A

Upper panendoscopy

303
Q

The following screenings have shown to decrease mortality EXCEPT:

A

PSA

304
Q

Patient with metastatic cancer with persistent pain takes oxycodone with tylenol prn; he also takes morphine sulfate twice per day, what to do?

A

Use extended release oxycodone or morphone q 8-12 hours or fentanyl patch

Diabetic Medications (awesome review) (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions