2021 Flashcards
(292 cards)
1
Q
Which of 4 PARP inhibitors is most likely to cause rise in LFTs/transaminitis?
A
Choices: Olaparib (I think this one), Niraparib, Rucaparib, Velaparib
NN: Rucaparib has transaminitis and elevated Cr.
2
Q
What side effect is most likely with Gemcitabine?
A
?Thrombocytopenia… can’t remember the other choices
NN: Per Chi, neutropenia is actually most significant bone marrow toxicity.
3
Q
Marker/stain for Paget’s disease of CUTANEOUS origin
A
Choices: S100, Melan-A, HMB45 and others I can’t remember.
Per lit search: Primary intra-epidermal Paget disease is GCDFP-15 positive, CK7 positive, and CK20 negative. Primary vulvar Pagets (ie: cutaneous) expresses CK7, GCDFP and CEA but NOT CDX2, S100, HMB45, ER or PR.
Secondary vulvar Paget disease most commonly represents spread of urinary tract (CK20+, uroplakin+, thrombomodulin+) or colorectal adenocarcinoma (CK20+, CDX2+, CEA+).
In contrast, cutaneous melanoma is Melan-A positive, S100 positive, and HMB45 positive.
4
Q
FOXL2 is associated with which type of tumor?
A
Adult granulosa cell tumor
5
Q
BRCA1 associated breast cancer is most likely to have what histology?
A
Choices: Basal-like (this one), HER2 pos, Luminal A, Luminal B
Per lit search:
BRCA1 breast cancers are triple negative and basal-like.
BRCA2 breast cancers are luminal B type.
6
Q
Bleomycin active in which stage of cell cycle?
A
Choices: G1, G2, S, M
NN: G2. Bleomycin complexes with ferrous (Fe2+) ion to become potent oxidase, producing DNA strand breaks by oxygen free radicals
7
Q
Cobalt-60 emits what?
A
Choices: Electrons, photons, …..??
NN: Radionuclide decay releases photons/gamma rays
8
Q
How do you treat vesicant extravasation in tissue?
A
Choices: Tylenol, dimethyl sulfoxide (listed twice as answer choices B and D.. nice) and Dexrazoxane/aka Zinecard
NN: DMSO and steroids (doxorubicin), sodium thiosulfate (mechlorethamine), hyaluronidase (vinca alkaloids).
9
Q
Type 1 endometrial cancers are associated with what?
A
Choices: IGF1, FGF, other options…
NN: In obesity, increased adiposity associated with chronic inflammatory state (due to increased chemokines, cytokines, adipokines and decreased adiponectin) –> insulin resistance -> hyperglycemia -> hyperinsulinemia -> liver to make more IGF1 and less IGFBP1. IGF1 binds to its receptor to activate PI3K/AKT/mTOR pathway
10
Q
Increased insulin leads to increased risk of EMCA how?
A
Choices: decreased IGF1 receptors, decreased IGFBP1, increased progesterone receptors and other options
NN: See Q10
11
Q
Intermittent/alternate use of Tamoxifen with progesterone to tx EMCA works by:
A
Choices: increasing progesterone receptors (this one), increasing E2 receptors, and other options
Per lit search:
Tamoxifen, acting through ER, is thought to increase expression of PR, and thus sensitivity to medroxyprogesterone acetate.
12
Q
Not adequately treating a patient’s pain goes against what principle?
A
Nonmaleficence
13
Q
What can you do to decrease skin damage from XRT to vulva?
A
Choices: topical E2 cream, application of cold packs, open leg positioning, and 1-2 other choices
14
Q
CA19-9 is most associated with what?
A
Mucinous CRC, pancreatic cancer, breast cancer, and 1-2 other options
15
Q
What is best lab test in setting of a suspected myocardial infarction?
A
I chose Troponin… can’t remember other choices
16
Q
What is best treatment for recurrent low grade ESS with mass fixed to pelvic sidewall?
A
Choices: radiation, megace, a few cytotoxic chemotherapeutics
NN: For LG ESS, if resectable favor surgery since given more indolent nature. If not resectable, favor hormonal therapy with progestin (Megace), GnRH agonist (leuprolide) or AI (letrozole). For HG ESS, chemotherapy is more appropriate.
17
Q
Mechanism of tumor evasion of immune system?
A
I have no idea what I put.
NN: ?Inactivation of T cell activation using via PD-1 and CTLA4
18
Q
What type of virus is HPV?
A
Chocies: Single strand RNA, single strand DNA, double strand DNA (this one), single strand DNA
HPV is a small double-stranded circular DNA virus
19
Q
What does “restrictive” intraoperative fluid resuscitation do?
A
Choices: decrease mortality, increase hospital stay, decrease postop complications, and other choice
Uptodate: “Standard” fluid replacement associated with higher risk for pneumonia, pulmonary edema, as well as longer hospital stay when compared with a “restrictive” approach. Although, a restrictive (zero-balance) fluid regimen was associated with a higher rate of acute kidney injury (AKI) compared with a liberal fluid regimen.
NN: Per Chi, restrictive management in colorectal surgery decrease cardiopulmonary complications and overall morbidity. However, too restrictive increased morbidity and mortality.
20
Q
Pregnant patient has a 3cm palpable breast nodule, what should you do?
A
Choices: observe, mammo, ultrasound, biopsy (this one!)
NN: UTD says mammogram then US and then biopsy
21
Q
Young patient with new dx grade 1 EMCA, wants to preserve fertility. What should you do next?
A
Choices: Pelvic MRI, CT (I chose this), Ultrasound, Saline-infused hysterosonogram
NN: Per NCCN, do pelvic MRI to make sure disease limited to endometrium/no myometrial invasion.
22
Q
What vessel are you likely to get bleeding from during anterior mobilization of the liver?
A
Choices: hepatic vessels, portal vein, and others
NN: Hepatic veins
23
Q
Flaps: 2 questions about lowest failure in vulvar reconstruction surgery
One question was: small vulvar defect after radical vulvectomy which flap is best (least likely to fail) - rhomboid, singapore, gracilis or another option
A
Choices included: TRAM, gracilis, V-Y, Singapore, Rhomboid
NN: ?V-Y - no pedicle, no muscle
24
Q
Most direct mTOR inhibitor? (mTOR inhibitors like everolimus were not one of the answer choices)
A
Choices: Gleevec, metformin (this one; via AMPK), parp, pertuzumab and one other…
NN:?Rapamycin; other drugs we commonly think of like everolimus, sirolimus, temsirolimus are rapalogs (rapamycin derivatives)
25
Most sensitive cell type to whole pelvic XRT?
Choices: Erythrocytes, granulocytes, lymphocytes (this one), megakaryocytes
26
?Definition of Haylfick principle in radiation?
NN: Hayflick limit is the number of times a normal somatic, differentiated cell will divide before no longer undergoes cell division; determined by telomeres. IR causes DNA damages that causes irreversible cell cycle arrest before Hayflick limit reached = stress-induced premature senescence. Since tumor cells make telomerase, suspect that SIPS is telomere-independent process.
27
Which pelvic tumor is most associated with prior pelvic radiation?
Carcinosarcoma and undifferentiated uterine sarcoma
28
Which cancer is most commonly associated with prior radiation?
Leukemia
29
After attempted insufflation with a Veress needle, an air embolus is suspected. What should you do first?
Answer = Steep trendelenburg; Choices: Steep trendeleburg, R lateral positioning, exploratory laparotomy, administer nitrous oxide
NN: Stop insufflation and release pneumoperitoneum, position in Trendelenberg or L lateral decubitus with steep head down, stop nitrous oxide (can make air embolus bigger) and ventialte with 100% oxygne (wash out CO2 and try compensate for V/P mismatch), rapid volume expansion to increase CVP (stop further entry of CO2).
30
What vitamin deficiency is most likely after a right hemicolectomy?
Choices: Iron, B12, Folate, Calcium, and 1 other
31
What is standard error of the mean (SEM)?
Answer choices did not ask for calculation, but had descriptions of what it measures and how it relates to SD.
NN: SD looks at how samples deviate from the sample mean. SEM looks at how sample mean differs from true mean.
32
SE of pazopanib
NN: ~50% will have diarrhea. Other common (>30%): HTN, hair color changes, myelosuppression, elevated LFTs, electrolyte abnormalities including glucose.
33
POLE group most likely to be which TCGA category
Ultramutated
34
Pharmacokinetic profile of doxorubicin is most likely due to...
Choices: protein binding, biliary excretion, 2 other choices
35
on PARP with recurrent ovary and now has rising Cr - most likely due to..
Choices: ureteral obstruction, CYP induction, some other thing I have never heard of
36
how does PD-1/PD-L1 interaction work
37
mechanism of lung injury from TRALI
Choices: cytokines, leukotrienes, can't remember the other answers
38
most common cause of mortality from massive transfusion
TRALI, TACO, ABO incompatibility, non-ABO incompatibility, and another choice
39
lady with 5cm IB2 SCC of cervix, reason that cis/RT would be contraindicated
Choices: pelvic kidney, irritable bowel syndrome, morbid obesity, one other choice
40
Most inotropic pressor
epinephrine: Low dose beta-mimetic vs high dose alpha-mimetic; norepinephrine and phenylephrine only have alpha and vasopressin doesn’t have iontropic effect
41
Dopamine effect at intermediate dose (3-7.5)
lower doses --> dopaminergic receptors --> increases circulation in mesenteric, cerebral, renal vascular beds
intermediate doses --> beta receptors --> tachycardia, increased SV, increased CO
high doses --> alpha agonist --> vasoconstriction
42
Young woman with low-risk GTN - failed mtx
switch to what regimen? Pulsed Act D (THIS ONE bc low risk)
43
WHO score - what has greatest impact: ie the one worth 4 points Choices: 6cm tumor
hcg 100k
44
Which opioid has the longest half life
Methadone
45
Which is not a gap acidosis?
Know mnemonic for anion gap metabolic acidosis" "RTA (and diarrhea), pancreatic leak, and spironolactone cause non-gap acidosis
Rhabdo causes increased anion gap acidosis!
MUDPILES
methanol
uric acid (aka uremia/ARF)
DKA
paraldehyade, phenformin
iron, INH
lactic acidosis
ethylene glycol
salicylates
46
Which drug is a vesicant
"Vinca
47
List of ones I care about from uptodate: A D M V Y (actD
doxorubicin
48
Which chemo do or don't you have to renally dose (**Multiple questions**)
"Cytoxan (def no), topo (def yes), gem (time if on HRD), methotrexate (def yes)
A BICC THEM (ones to renally dose)
Act D, bleo, ifos, cis/carbo, cytoxan, capcitabine, topotecan, hydroxyurea, etoposide, mtx/pemetrexed"
49
Act D
bleo
50
Which chemo are pro-drugs Capecitabine
ifosfamide
51
Where does the SMV drain
Portal v
52
Where does the IMV drain
Splenic v to portal v
53
Where does external pudendal come from
Femoral artery
54
Where are estrogen receptors most often located? Cytosol initially once activated by estrogen
move into nucleus; I think nucleus is the answer bc it's a "nuclear" receptor
55
when would you use a one tailed versus a two tailed
When the alternative hypothesis can only go in one direction (rather than two)
56
What is the other name for the protein CA125
MUC16 or mucin16
57
What is the function of iressa?
(generic: gefitinib) EGFR inhibitor
58
What is the advantage of protons over electrons in radiation
"Dose stops at precise place due to Bragg peak (electrons are less precise; most of the dose is delivered 0.5-3 cm from patient's skin
59
and then gradually loses energy until reaches its target; affectingn the non-target tissues) Question answer choices: increased dose at desired depth
less scatter
60
What is methylation
"epigenetic change (methylation of cytosine residues residing next to guanine residues CpG dinucleotides methylation silences gene expression) not a SNP"
61
What is high LET radiation? "High LET = alpha
neutrons (**2 separate questions. 1 asked for which had HIGHEST LET - choices: Pimeson
62
Low LET = electrons
gamma rays and x-rays (both electromagnetic radiation)"
63
Which has highest LET?
alpha particle > neutron
64
What is % dose of XRT 1 cm vs 2 cm from source?
400%; b/c dose ~ 1/r squared (1/1 vs 1/4)
65
What has been associated with decreased infection in groin dissection?
Saphenous vein sparing
66
What happens with TP53 mutation Mutated p53 bind to wild-type p53 and inactivate them (this one = answer)
directly impair DNA
67
What gives off the right gastroepiploic artery
Gastroduodenal artery
68
What does ROC curve measure?
"Optimal is upper left corner where false positive rate is 0 and true positive rate is 1 Diagonal through the center represents ""random"" so if above it ""better than random""
x-axis = False positive rate (or 1-specificity) and y-axis = True positive rate (or sensitivity) (ROC) curve the true positive rate (Sensitivity) is plotted in function of the false positive rate (100-Specificity) for different cut-off points. Each point on the ROC curve represents a sensitivity/specificity pair corresponding to a particular decision threshold. A test with perfect discrimination (no overlap in the two distributions) has a ROC curve that passes through the upper left corner (100% sensitivity 100% specificity). Therefore the closer the ROC curve is to the upper left corner
69
What distinguishes PSTT from choriocarcinoma
PSTT: INTERMEDIATE trophoblasts, HPL and lower hCG **Both have NO VILLI.
70
What chemo most asscoiated with constipation
Vincristine
71
What chemo is primarily renally cleared
Bleomycin (**Bleo more renally cleared than etoposide; both were possible choices)
72
Vulvar cancer: 1 cm vulvar cancer
2 pos LN in right groin
73
Vulvar cancer staging: 1 question - vulvar lesion with two 6mm LN pos
IIIB
74
Vessels encountered during inguinal LND
"Vessels encountered: Femoral artery superficial circumflex (lateral)
Answer is which is not: deep circumflex femoral"
75
Type I error Erronerously rejects null hypothesis (like false positive) - this is sort of worse; alpha (ype I error is to falsely infer the existence of something that is not there
while a type II error is to falsely infer the absence of something that is.)
76
Tx of HYPERmagnesemia Fluids and loop diuretic (i.e.
lasix) this one; other options included calcium
77
Treatment of cystitis during xrt Oxybutinin (anti-cholinergic
antagonizes M1
78
Timing of splenectomy vaccination At least 14d before
otherwise 14d after (not sooner!)
79
Target for areprepitant
NK1 receptor (located centrally and peripherally); dominant ligand is substance P
80
Survival analysis for multiple variables
Answer: Cox proportional hazard; (Cox prop hazard evaluates survival using both categorical and quantitative variables and can be used with 1 or more variables. Kaplan Meier curves and log rank test are both UNIVARIATE and evaluate categorical variables only.
81
Statistical test used for evaluation of independent variables
Logistic regression
82
Statistical test for comparing the means of 3 variables
ANOVA
83
Statistical analysis for before and after intervention in same subjects (i.e.
BP readings) Paired t-test
84
Staining if ovarian met from colon CK7 neg
C20 pos for colon cancer whereas ovary CK7 pos
85
Staging for endometrial cancer - presence of superficial cervical glandular involvment
positive cytology
86
Stage I endodermal sinus tumor @ 18 weeks s/p surgery. Best step now?
Immediate chemo (3-4 cycles BEP)
87
Specific mechanism of action for bev
Inhibints VEGF-A it directly binds it (NOT THE RECEPTOR!!!!!)
88
Screening for HNPCC;
Answer choice involved EGD "CRC (50-80% risk) - colonoscopy between ages 20-25 or 2-5 years before youngest dx in family every 1-2 yrs
Endom (16-60% risk) - no definite evidence of EMBx or US; can consider TAH/BSO after childbearing
Stomach/small bowel- EGD every 3-5 years starting age 30-35 for certain (i..e asian)
urothelial - consider annual UA (MLH1)
Pancreatic - none
CNS - none
89
Route/course of femoral nerve **TWO questions**
From posterior the posoas and emerges at lower part of lateral border between psoas and iliacus muscle
90
Risks factors for GTD
"age <20 (this one), blood type O
From lit: extremes maternal age
OB hx prior molar pregnancy or SAB
Pt with elevated serum hCG no other signs of GTD
what is next step? "uPT (to r/o phantom hCG - this one)
due to heterophilic Ab which are not excreted in the urine **My question asked which set of labs is consistent with heterophile antibody/no pregnancy: answer = neg UPT/pos serum hcg."
91
Pt on tam x 2 years, 8 weeks pregnant: what do you recommend
termination
92
PPV affected by what
"Prevalence (whereas likelihood ratios do not depend on prevalence)
Higher prevalence will increase PPV and decrease NPV; no impact on sensitivity or specificity"
93
Postop pt VSS and afib
: answer choices beta adrenergic blocker, anticoagulation
94
Peutz Jeghers
What is the clinical picture?
What cancers are they at risk for?
What screening test is not needed?"
"Clinical picture: GI polyps, pigmented lesions on lips/mouth
Cancer risk: GI and breast cancer
Gyn issues: SCTAT (sex cord stromal tumors with annnular tubules of ovary) and adenoma malignum of the cervix
Colonoscopy, pap smears, ultrasound, EMB (THIS ONE), breast imaging
**My question asked which inherited syndrome is most associated with adenoma malignum of the cervix (answer: Peutz Jeghers)
95
PEEP and ARDS
high peep strategy: PEEP 10-15 most important variable
96
Partial (vs complete) mole
**My question asked which is most consistent with a partial mole?
"PARTLY paternal triploid Answer choices: diploid (no)
diandric (this is what i chose?)
97
PARP inhibitor mechanism
Causes ss dna breaks that can't be repaired by BRCA defective cells; blocks base excision repair (BER) which is responsible for ss DNA break repair; these are converted to ds DNA breaks
98
p53 mutation
"deactivates proteins (??)
DNA-binding ability of mutant p53 or changes in interaction of mutant p53 with proteins (esp transcription factors) or other proteins
normal activity of p53- binds to transcriptional regulatory elements of genes that act to arrest cells in G1
cancer often have missense mutations in 1 copy of TP53 gene does NOT require inactivation of both TP53 alleles if a MISSENSE mutation bc it acts in ""dominant negative"" fashion b/c if cancer cell has one normal TP53
99
Origin of middle rectal artery
Internal iliac anterior division
100
Old lady died after unvaccinated and splenectomy (which organism is most likely to be cause of her death?)
"Encapsulated organisms: Mengigococcus, H. flu, pneumo
OPSI - overwhelming post-splenectomy infection; flu-like syndrome with rapid deterioration to fulminant septic shock within 24-48 hours. Usually due to S.pneumoniae."
101
Non-epithelial ovarian cancer that sometimes needs secondary cytoreduction
"Immature teratoma (THIS ONE)
Cases where pt received adj chemo for immature teratoma and have bulky residual even w/ normaliztion of negtive markers; reasonable to do surgery; sometimes path during secondary debulk with not be malignant then observe if malignant viable tissue then addtll chemo"
102
Most reliable way to confirm endotracheal tube is in correct position
Distance pCO2
103
Most likely to be associated with lymphatic spread "
MMMT (this one)
choices were: GCT, Adenosarcoma, UPSC
104
Most lethal impact of radiation
Double strand break; other options: single strand break
105
Most emetogenic "????
High risk = Anthracycline (ie. Doxorubicin) cyclophosphamide IV (or ifosfamide)
cis
Moderate risk = Carbo AUC >4
106
Most diagnostic of ARDS
Pa/FiO2 ratio <200 (this one)
other option: Bilateral pulm infiltrates
107
Most common reason for hyperkalemia postop
renal dysfunction
108
Most common germline ov ca mutation p53
BRCA 1 (THIS ONE)
109
Most common electrolyte disturbance from urinary diversion **2 questions** "Excess chloride (absorption of excreted metabolites through intestinal mucosa); leads to metaboilc acidosis
110
NAGA/hyperchloremic metabolic acidsosis (HARDSUPS)"
111
Most common cuase of ilioinguinal nerve injury Transverse incision (this one)
retractor
112
Most common complication of HIT Thrombosis (this one)
hypersplenism
113
Most common complication continent ileal conduit compared to incontinent conduit? "Can't cath aka stomal stricture (2-14%
this one)
114
infection early 1-13%
late 3-10%
115
TL: Lit search suggests the answer is stricture
116
Stricture/cath issues was NOT an answer choice... Choices included anastomotic leak (I chose this one?)
pyelo
117
Most common cause of prolonged metabolic alkalosis? "Sheet says: NG tube
118
119
two most common causes of metabolic alkalosis in general are loss of gastric acid (vomiting
NG drainage) and diuretics (specifically furosemide and thiazides)"
120
MicroRNA when bind to 3UTP region - targeted mechanism of action "silencing of mRNA via mRNA degradation or translational repression
121
microRNA = small non-coding RNA that functions in RNA silences and post-transcriptional regulation of gene expression
122
silencing?
123
TL: ""Gene silencing may occur either via mRNA degradation or preventing mRNA from being translated. For example
miR16 contains a sequence complementary to the AU-rich element found in the 3'UTR of many unstable mRNAs
124
Mechanism of cisplatin with radiation "Cell repair inhibited
inhibits repair of sublethal damage
125
Mechiansm of action: binding with DNA causing INTRAstand cross-links and DNA adducts
126
In vitro assays cisplatin + IR has persistence of gamma-H2AX suggesting delayed repair of DSBs."
127
Mechanism of action: topotecan Inhibit TOPO-I (a nuclear enzyme that relieves torsional strain in DNA by opening single strand breaks); forms stabilized ternary topotecan-TOPO-I-DNA complex with replication enzymes which results in dsDNA breaks and cellular death
128
Mechanism of action: etoposide "Inhibits TOPO-II enzymes (does NOT bind directly to DNA rather stabilizes transition form of DNA-TOPII / by stabilizing this it ""poisons""
129
TOPOII enzymes which usually helps cells progress out of G2"
130
Main differences between HDR and LDR "LDR is 0.4-2.0 Gy per hour vs HDR is >12 Gy per hour
131
More fractions and dose for HDR - perhaps ""better tumor control"" b/c less time for tumor to repair
but studies equivocol; overall LESS TX TIME PER FRACTION
132
Less fractions and dose for LDR - better tissue repair esp for ""late responding tissues""
133
LDR where radioactive source positioned inside for a few days vs HDR remporary placement of radioactive source; more precise"
134
Lots of HNPCC what are the most common MMR defects? "MLH1/MSH2 (this one); PMS2
MSH6
135
NN: MLH1 - 32% of mutation and MSH2 - 38% of mutations
136
"
What to do if MLH1 expression absent/low in tumor sample? Test for MLH1 methylation
LMS staging - IB is what size cut off 5cm
Liver and renal clearance: one question each asking which agent is not dose adjusted BICC THEM, MTV3D (2 questions)
Least emetogenecity "Vinca (THIS ONE)
carbo
137
"
Least bone marrow suprresive Bleomycin (main dose-limiting side effect is pulm tox, 10%; nephrotoxicity)
Least associated with germline mutation p53 (Li Fraumeni), HER2 (this one- overamplification), APC (assoc with familiar adenomatous polyposis), MSH2 (Lynch)
KRAS associated with mucinous histology and with recurrent low grade serous carcinoma
IP chemo pharmacokinetics "Generally - IP chemo should be LARGER
HYDROPHILIS
138
maintain concentration; penetrate tumor nodules through PASSIVE diffusion (up to 2-3 mm) but that's why we cytoreduce"
139
Integrin role in cancer "metastases role (cell invasion and migration)
140
adhesion of leukocytes to endothelial cells"
141
Inpatient treatment for neutropenic fever "Need to cover Pseudomonas and other gram neg
142
IV monotherapy ie.
cefepime
143
Do not need vanco or aminoglycoside unless there is a clear clinical indication"
144
Infection assoc with spreading erythema
raised borders
145
IMA collateral
Which IS a collateral?" "SMA and IMA communicate via marginal a. of Drummond (spleneic flexure and arc of Riolan aka meandering mesenteric artery is collateral that connectes the middle and left colic artery in the LUQ); but since absent/underdeveloped in 5% places splenic flexure at risk of ischemia
IMA and internal iliac a. communicate via superior and middle/inferior rectal (hemorrhoidal) arteries (thus, rectum has dual blood supply from mesenteric and iliac arteries so more resistant to ischemia)
Ext iliac, int iliac (this one), pancreaticoduodenal
146
Hypocalcemia: know side effects - one of each asked "PROLONGED QT (this one)
hyperreflexia
147
#1 = tetany; others- seizure
hypotension
148
Hypercalcemia sx "SHORTENED QT (this one)
149
mild Ca <12 asx or non-specific constipation
ftigue
150
moderate 12-14 polyuria
polydipsia (b/c can't concentrate urine)
151
severe Ca >14 progression"
152
Hypercalcemia - which is first line for tx of acute hypercalcemia? "Answer = Saline
153
tx (mild) - hydrate with normal saline (NOT WATER)
avoid thiazide diuretics tx (severe) - isotonic saline vol expansion
154
How to tx DVT if renal failure Don't use lovenox --> can use coumadin or argatroban or heparin or apixiban
155
How to control for confounding "Multivariate logistic regression
156
OR stratification"
157
How to check impact of independent variable Logistic regression
158
How do kinases work Phosphorylation **Via INTRACELLULAR DOMAIN
not extracellular or transmembrane**
159
HNPCC not cancer - long list "NOT breast //
160
HNPCC is assocated with incr risk of endometrial
colon
161
sebaceous gland adenomatous polyps
keratoacanthomas"
162
HIT II pt - next best step
vs HIT I where plt ~100K, not immune-mediated, and can continue heparin" "argatroban=direct thrombin inhibitor (THIS ONE- and ok in renal failure), heparin, warfarin
can also consider fondaparinux=inhibits anti-Xa activity through antithrombin III, synthetic
or if liver failure, use bivalirudin (also a direct thrombin inhibitor)
occurs in 5% of pt exposed to heparin, anti-PF4 (platelet factor 4)
thrombocytopenia = plt <150K
plt drop usu >50% baseline, occurs 5-10d after exposure (could be earlier if recently exposed to heparin)
THROMBOSIS (50% those with HIT, venous > arterial, can lead to skin necrosis, limb gangrene, organ infarction)
resolution after stopping heparin is usually 7d
163
Grade 3
IB endometrioid ovarian cancer observation
164
Formula for odds ratio (OR) vs. relative risk (and when to use each) "(a/b) / (c/d) or (a*d)/(b*c) i.e.
gave numerator (exposed case/unexp case) and you give denominator (exp control/unexp control)
165
see 4x4 table on next page
166
RR = a/(a+b) / c/(c+d)
167
Use OR for case control (b/c compares presence/absence of exposure knowing the outcome) Use RR for cohort study (know exposure status
then calculate probability of event)"
168
Best test to eval association in case control trial Odds ratio
169
Estrogen isoforms created by Alterantive splicing (THIS ONE)
amplification
170
Endometrioisis/Clear cell carcinoma related marker "ARID1A
171
NN: ARID1A 50% in clear cell vs 40% in endometrioiod ovarian cancer"
172
Endometrial cancer mutation associated with good prognosis Excellent prognosis regardless of grade = POLE (question basically asked which scenario was most assoc with a POLE mutated EMCA: choices included low grade tumor
LVSI
173
Earliest lab value to measure in nutrition progress Prealbumin (THIS ONE)
albumin
174
Doxil versus doxorubicin "Liposomal bound (aka pegylated) witih MPEG methoxypolyethylene glycol to avoid detection by the mononuclear phagocyte system
175
Doxil: longer plasma life
reduced volume of distribution
176
Doing an inguinal LND and injury nerve lateral/near the psoas
what will pt not be able to do Addut thigh
177
Deficits from genitofemoral nerve injury Sensory only; ipsilateral mons and labia majora; sensory of upper anterior thigh
178
Cytokine pro-inflammatory in sepsis TNF-alpha (this one)
IL-2 - note: IL-1 may have some role but TNF-alpha is stronger
179
Criteria for trachelectomy "1. Desire to preserve fertility
180
2. Reproductive age
181
3. Squamous or adeno (i.e.
not neuroendocrine)
182
4. Stage IA1 with LVSI
IA2
183
5. Lesion
larger lesion
184
Contraindication to radical trachelectomy LVSI
size 3 cm (this one)
185
Cowden most common gyn cancer Endometrial cancer (lifetime risk 19-28%)
186
Cowden most common cancer Breast
187
What are advanced colon adenomas that increase colon cancer risk Risk factors: villous or tubulovillous histology
high-grade dysplasia
188
Cancer MOST at risk for with Li-Fraumeni p53 mut - sarcoma (15% by age 70 in women)
breast (54%)
189
BRCA1 most common type of breast cancer "Triple negative
IDC
190
True… but these were NOT choices :( My answer choices were: basal-like
HER2 positive
191
NN: Triple negative is BASAL-LIKE vs LUMINAL is HR positive with A being low Ki67 and luminal B being high Ki67 (faster growing than luminal A type)"
192
Branches of the internal iliac "Posterior: ILS (iliolumbar
lateral sacral
193
Anterior: Oranges under some ice might peel
194
Obturator
uterine + umbilical
195
Best initial test to start with to evaluate smoking and certain type of cancer Prospective RCT
case control (good initial study)
196
Base of the femoral triangle Pectineous*
iliopsoas
197
AMG386 (Trebananib) - What does this target? "AMG386 aka trebananib= angiopoietin (Ang) 1 and 2 neutralizing peptibody
198
placental growth factor
hypoxia alpha something
199
AI most common side effect Arthralgias (15-20%)
HA (9-15%)
200
Afib in setting of heart failure in postop pt
how to treat acutely "Metop (this one if they are stable; multiple RCTs show decreased mortality with BB; **Initial tx should utilize rate control and diuretics)
201
Amiodarone or dogoxin can be used if diminished ejection fraction
202
NOT adenosine"
203
Abdominal compartment syndrome "Measurement of bladder pressure (not imaging!)
204
Conservative mgmt: avoiding positive fluid balance after initial resuscitation
evac intraluminal contents
205
Surgical mgmt: abdominal decompression if pressure >25 mmHg (possibly 15-25 mmHg) with temporary wall closure"
206
% breast cancer risk reduction with oophorectomy in BRCA pos women 50%
207
know electrolytes abnormalities and ECG changes **At least 3 questions** "Hypercalcemia – shortened QT
208
Hypocalcemia – lengthened QT;
209
Hypokalemia – flattened or inverted T waves
ST depression
210
Hyperkalemia – peaked T waves
ST depression;
211
Hypomagnesemia – inreased PR and QT
torsades
212
Hypermag – increased PR
QRS (level >13)
213
What test to use to compare mean among three groups ANOVA
214
Most common mutation in mucinous ovarian cancer (p53
KRAS
215
What vessel is most commonly encountered in femoral triangle deep external pudendal (femoral artery)
216
What effect does ionizing radiation have on DNA that results in largest impact (double strand break
single strand break
217
What is the best timing of vaccination after spelenctomy 2 weeks preop (choices: 1 day
10 days
218
What is most diagnostic of ARDS "bilateral pulm infiltrates
Pa/FiO2 ratio<200 (this one)
219
220
Berlin diagnostic criteria:
221
1. respiratory symptoms started wtihin 1 week
222
2. Bilateral opacities on CXR or CT (not explained by lung collapse
nodules
223
3. Respiratory failure not explained by cardiac failure or fluid overload
224
4. PaO2/FiO2 <300 mmHg with PEEP > 5 (Mild = 200-300mmHg
moderate 100-200mmHg
225
PPV is dependent on Prevalence
226
What is the difference between cardiogenic and hypovolemic shock (PCWP = LA pressure) "cardiogenic (high PCWP)
hypovolemic (low PCWP). PCWP better than BP
227
NN: PCWP or RAP is measure of preload. Low in hypovolemic vs high in cardiogenic (essentially obstructive physiology). Preload normal to slightly decreased in distributive/septic shock. "
228
Which chemo requires adjustment for renal compromise Bleomycin
Cisplatin
229
Which chemo requires adjustment for liver compromise MTV3DV – methotrexate
taxotere
230
PARP inhibitors (multiple questions) "**Need to know how side effect profiles differ between olaparib
rucaparib
231
NN: Class effects = nausea/vomiting
loss of appetite
232
What is the best adjuvant treatment for a pt s/p rad hyst with positive lymph node? Pelvic RT + chemo (cisplatin preferred) (Peters criteria
GOG 109: +LN
233
What nerve injury is associated with numbness over the thigh after a pelvic LND? genfem
234
"longest half life radio isotopes:
NN: Cesium-137 has half life of 30 years vs Iridium-192 has half life of ~75 days (need to replace Q3 months)" Cesium
235
Most common side effect of neurontin dizziness
236
Superior border EBRT L4-5 interspace - this one
L4 verterbral body
237
What's the mechanism of action for Topotecan Traps topoisomerase I on DNA causing unrepaired ssDNA break
238
PD-1 limits what? **Two nearly identical questions** T-cell ACTIVATION
239
Which needs renal dosing more (etoposide vs. bleo) - since both are renally cleared Bleo
240
Pre-renal findings urine osm high (this one) - not urine NA high
urine/plasma cr
241
Old lady
ppx lovenox after surgeyr
242
Phase III for platinum resistant recurrent ovarian cancer "cytoxan/avastin
taxol/avastin (this one)
243
NN: AURELIA was provider chosen chemotherapy (Taxol
Doxil or topotecan) +/- bevacizumab in patients with PR recurrent HGS ovarian cancer. Median PFS 3.4 months with chemotherapy alone vs 6.7 months with addition of bevacizumab.
244
"
Epithelial to mesenchymal transition WNT/Beta-catenin
What is ipilimuab? Monoclonal ab for CTL-4 - for melanoma
Adverse effects from massive transfusion HYPOcalcemia and alkalosis due to citrate tox
What phase of the cell cycle is most radio-resistant? Mid to late S and early G1 (Answer = S)
Most radiosensitive? G2 and M (M is best answer, but wasn't answer choice… G2 was)
What organ is most sensitive to radiation? Kidney
Most common p53 mutation? Missense (one base pair that alters function) - celll compensates by trying to make more So would have increase in detectable p53 Compared to nonsense mutation where the protein is not made, so absence of p53
What is the half life of albumin 20 days / 3w
Hyponatremia correction rate to avoid what complication "9 meQ/L/24h to avoid central pontine myelinolysis (osmotic demyelination)
245
NN: Acute cases of hyponatremia 5mEq/L/hr vs chronic cases 0.5mEq/L/hr"
246
"What supplies the sartorious muscle?
And tensor fascia lata"
LATERAL femoral circumflex (versus medial femoral circumflex for the gracilis)
247
nerve most likely to be injured with sartorius transposition
"Lateral femoral circumflex wasn't an option... one choice was lateral femoral cutaneous and others
NN: Innervation to sartorius is from branch off femoral nerve"
248
Which chemo is activated within a tumor cell?
Xeloda (aka Capcitabine)
249
Most common side effect of whole pelvic XRT ileum (this one)
rectum
250
what opiate causes prolonged QT and torsades
methadone
251
what happens with trendelenburg and pneumoperitoneum increase in CVP
PCRP
252
Which of 4 PARP inhibitors is most likely to cause rise in LFTs/transaminitis?
Choices: Olaparib (I think this one), Niraparib, Rucaparib, Velaparib
NN: Rucaparib has transaminitis and elevated Cr.
253
What side effect is most likely with Gemcitabine?
?Thrombocytopenia... can't remember the other choices
NN: Per Chi, neutropenia is actually most significant bone marrow toxicity.
254
Marker/stain for Paget's disease of CUTANEOUS origin
Choices: S100, Melan-A, HMB45 and others I can't remember.
Per lit search: Primary intra-epidermal Paget disease is GCDFP-15 positive, CK7 positive, and CK20 negative. Primary vulvar Pagets (ie: cutaneous) expresses CK7, GCDFP and CEA but NOT CDX2, S100, HMB45, ER or PR.
Secondary vulvar Paget disease most commonly represents spread of urinary tract (CK20+, uroplakin+, thrombomodulin+) or colorectal adenocarcinoma (CK20+, CDX2+, CEA+).
In contrast, cutaneous melanoma is Melan-A positive, S100 positive, and HMB45 positive.
255
FOXL2 is associated with which type of tumor?
Adult granulosa cell tumor
256
BRCA1 associated breast cancer is most likely to have what histology?
Choices: Basal-like (this one), HER2 pos, Luminal A, Luminal B
Per lit search:
BRCA1 breast cancers are triple negative and basal-like.
BRCA2 breast cancers are luminal B type.
257
Bleomycin active in which stage of cell cycle?
Choices: G1, G2, S, M
NN: G2. Bleomycin complexes with ferrous (Fe2+) ion to become potent oxidase, producing DNA strand breaks by oxygen free radicals
258
Cobalt-60 emits what?
Choices: Electrons, photons, …..??
NN: Radionuclide decay releases photons/gamma rays
259
How do you treat vesicant extravasation in tissue?
Choices: Tylenol, dimethyl sulfoxide (listed twice as answer choices B and D.. nice) and Dexrazoxane/aka Zinecard
NN: DMSO and steroids (doxorubicin), sodium thiosulfate (mechlorethamine), hyaluronidase (vinca alkaloids).
260
Type 1 endometrial cancers are associated with what?
Choices: IGF1, FGF, other options…
NN: In obesity, increased adiposity associated with chronic inflammatory state (due to increased chemokines, cytokines, adipokines and decreased adiponectin) --> insulin resistance -> hyperglycemia -> hyperinsulinemia -> liver to make more IGF1 and less IGFBP1. IGF1 binds to its receptor to activate PI3K/AKT/mTOR pathway
261
Increased insulin leads to increased risk of EMCA how?
Choices: decreased IGF1 receptors, decreased IGFBP1, increased progesterone receptors and other options
NN: See Q10
262
Intermittent/alternate use of Tamoxifen with progesterone to tx EMCA works by:
Choices: increasing progesterone receptors (this one), increasing E2 receptors, and other options
Per lit search:
Tamoxifen, acting through ER, is thought to increase expression of PR, and thus sensitivity to medroxyprogesterone acetate.
263
Not adequately treating a patient's pain goes against what principle?
Nonmaleficence
264
What can you do to decrease skin damage from XRT to vulva?
Choices: topical E2 cream, application of cold packs, open leg positioning, and 1-2 other choices
265
CA19-9 is most associated with what?
Mucinous CRC, pancreatic cancer, breast cancer, and 1-2 other options
266
What is best lab test in setting of a suspected myocardial infarction?
I chose Troponin... can't remember other choices
267
What is best treatment for recurrent low grade ESS with mass fixed to pelvic sidewall?
Choices: radiation, megace, a few cytotoxic chemotherapeutics
NN: For LG ESS, if resectable favor surgery since given more indolent nature. If not resectable, favor hormonal therapy with progestin (Megace), GnRH agonist (leuprolide) or AI (letrozole). For HG ESS, chemotherapy is more appropriate.
268
Mechanism of tumor evasion of immune system?
I have no idea what I put.
NN: ?Inactivation of T cell activation using via PD-1 and CTLA4
269
What type of virus is HPV?
Chocies: Single strand RNA, single strand DNA, double strand DNA (this one), single strand DNA
HPV is a small double-stranded circular DNA virus
270
What does "restrictive" intraoperative fluid resuscitation do?
Choices: decrease mortality, increase hospital stay, decrease postop complications, and other choice
Uptodate: "Standard" fluid replacement associated with higher risk for pneumonia, pulmonary edema, as well as longer hospital stay when compared with a "restrictive" approach. Although, a restrictive (zero-balance) fluid regimen was associated with a higher rate of acute kidney injury (AKI) compared with a liberal fluid regimen.
NN: Per Chi, restrictive management in colorectal surgery decrease cardiopulmonary complications and overall morbidity. However, too restrictive increased morbidity and mortality.
271
Pregnant patient has a 3cm palpable breast nodule, what should you do?
Choices: observe, mammo, ultrasound, biopsy (this one!)
NN: UTD says mammogram then US and then biopsy
272
Young patient with new dx grade 1 EMCA, wants to preserve fertility. What should you do next?
Choices: Pelvic MRI, CT (I chose this), Ultrasound, Saline-infused hysterosonogram
NN: Per NCCN, do pelvic MRI to make sure disease limited to endometrium/no myometrial invasion.
273
What vessel are you likely to get bleeding from during anterior mobilization of the liver?
Choices: hepatic vessels, portal vein, and others
NN: Hepatic veins
274
Flaps: 2 questions about lowest failure in vulvar reconstruction surgery
One question was: small vulvar defect after radical vulvectomy which flap is best (least likely to fail) - rhomboid, singapore, gracilis or another option
Choices included: TRAM, gracilis, V-Y, Singapore, Rhomboid
NN: ?V-Y - no pedicle, no muscle
275
Most direct mTOR inhibitor? (mTOR inhibitors like everolimus were not one of the answer choices)
Choices: Gleevec, metformin (this one; via AMPK), parp, pertuzumab and one other…
NN:?Rapamycin; other drugs we commonly think of like everolimus, sirolimus, temsirolimus are rapalogs (rapamycin derivatives)
276
Most sensitive cell type to whole pelvic XRT?
Choices: Erythrocytes, granulocytes, lymphocytes (this one), megakaryocytes
277
?Definition of Haylfick principle in radiation?
NN: Hayflick limit is the number of times a normal somatic, differentiated cell will divide before no longer undergoes cell division; determined by telomeres. IR causes DNA damages that causes irreversible cell cycle arrest before Hayflick limit reached = stress-induced premature senescence. Since tumor cells make telomerase, suspect that SIPS is telomere-independent process.
278
Which pelvic tumor is most associated with prior pelvic radiation?
Carcinosarcoma and undifferentiated uterine sarcoma
279
Which cancer is most commonly associated with prior radiation?
Leukemia
280
After attempted insufflation with a Veress needle, an air embolus is suspected. What should you do first?
Answer = Steep trendelenburg; Choices: Steep trendeleburg, R lateral positioning, exploratory laparotomy, administer nitrous oxide
NN: Stop insufflation and release pneumoperitoneum, position in Trendelenberg or L lateral decubitus with steep head down, stop nitrous oxide (can make air embolus bigger) and ventialte with 100% oxygne (wash out CO2 and try compensate for V/P mismatch), rapid volume expansion to increase CVP (stop further entry of CO2).
281
What vitamin deficiency is most likely after a right hemicolectomy?
Choices: Iron, B12, Folate, Calcium, and 1 other
282
What is standard error of the mean (SEM)?
Answer choices did not ask for calculation, but had descriptions of what it measures and how it relates to SD.
NN: SD looks at how samples deviate from the sample mean. SEM looks at how sample mean differs from true mean.
283
SE of pazopanib
NN: ~50% will have diarrhea. Other common (>30%): HTN, hair color changes, myelosuppression, elevated LFTs, electrolyte abnormalities including glucose.
284
POLE group most likely to be which TCGA category
Ultramutated
285
Pharmacokinetic profile of doxorubicin is most likely due to...
Choices: protein binding, biliary excretion, 2 other choices
286
on PARP with recurrent ovary and now has rising Cr - most likely due to..
Choices: ureteral obstruction, CYP induction, some other thing I have never heard of
287
how does PD-1/PD-L1 interaction work
288
mechanism of lung injury from TRALI
Choices: cytokines, leukotrienes, can't remember the other answers
289
most common cause of mortality from massive transfusion
TRALI, TACO, ABO incompatibility, non-ABO incompatibility, and another choice
290
lady with 5cm IB2 SCC of cervix, reason that cis/RT would be contraindicated
Choices: pelvic kidney, irritable bowel syndrome, morbid obesity, one other choice
291
Most inotropic pressor
epinephrine: Low dose beta-mimetic vs high dose alpha-mimetic; norepinephrine and phenylephrine only have alpha and vasopressin doesn’t have iontropic effect
292
Dopamine effect at intermediate dose (3-7.5)
lower doses --> dopaminergic receptors --> increases circulation in mesenteric, cerebral, renal vascular beds
intermediate doses --> beta receptors --> tachycardia, increased SV, increased CO
high doses --> alpha agonist --> vasoconstriction
