M. Testicular cancer + Prostate cancer vs BPH points 04-13 (1)

Question 1

M. Most common testicular cancer; occurs teenage years and older. Dx?

Answer 1

Seminoma

Question 2

M. Large, uniform cells with watery cytoplasm. Chemo- and radiosensitive. Dx?

Answer 2

Seminoma

Question 3

M. Placental ALP can be a tumor marker. Tumor?

Answer 3

Seminoma

Question 4

M. Seminoma. tumor marker?

Answer 4

Placental ALP can be a tumor marker.

Question 5

M. Aka endodermal sinus tumor. Dx?

Answer 5

Yolk sac tumor

Question 6

M. Most common in kids under 3. Dx?

Answer 6

Yolk sac tumor

Question 7

M. Yolk sac tumor - tumor marker?

Answer 7

AFP is tumor marker.

Question 8

M. AFP is tumor marker. Tumor?

Answer 8

Yolk sac tumor

Question 9

M. Immature/anaplastic cells. Dx?

Answer 9

Embryonal carcinoma

Question 10

M. Embryonal carcinoma. Tumor markers?2

Answer 10

Combined AFP and hCG are tumor markers.

Question 11

M. Combined AFP and hCG are tumor markers. What tumor?

Answer 11

Embryonal carcinoma

Question 12

M. Embryonal carcinoma - age?

Answer 12

Usually adult men

Question 13

M. Secrete androgens. Dx?

Answer 13

Sertoli-Leydig cell tumor

Question 14

M. Sertoli-Leydig cell tumor. can cause what breast?

Answer 14

Can cause gynecomastia (shows up on NBME). This is because ­incr. androgens can be aromatized into estrogens.

Question 15

M. Secrete androgens. Can cause gynecomastia (shows up on NBME). This is because ­ androgens can be aromatized into estrogens. Dx?

Answer 15

Sertoli-Leydig cell tumor.

Question 16

M. Secretes estrogen. Dx?

Answer 16

Granulosa cell tumor

Question 17

M. Granulosa cell tumor. secretes what?

Answer 17

Secretes estrogen.

Question 18

M. Granulosa cell tumor. cause what on breast?

Answer 18

Can also cause gynecomastia.

If NBME gives you Q with Sertoli-Leydig cell tumor causing gynecomastia, they won’t simultaneously list granulosa cell tumor as an answer.

Question 19

M. Secretes estrogen.
Can also cause gynecomastia. If NBME gives you Q with Sertoli-Leydig cell tumor causing gynecomastia, they won’t simultaneously list granulosa cell tumor as an answer.

Answer 19

M. Granulosa cell tumor.

Question 20

M. Composed of syncytiotrophoblastic placental cells. Dx?

Answer 20

Choriocarcinoma

Question 21

M. Choriocarcinoma. age?

Answer 21

Can occur in males, yes. Usually 20s-30s.

Question 22

M. Choriocarcinoma. tumor marker?

Answer 22

­ Incr. incr. (2arrows) hCG as tumor marker.

Question 23

M. ­ Incr. incr. (2arrows) hCG as tumor marker. Dx?

Answer 23

Choriocarcinoma.

Question 24

M. Adenocarcinoma (i.e., glandular); most common cancer in men.?

Answer 24

Prostate cancer

Question 25

M. Prostate cancer. Stimulated by ?

Answer 25

DHT

Question 26

!!!!M. Prostate cancer. what metastases?

Answer 26

Causes osteoBLASTIC metastases (highest yield point on USMLE).

Question 27

M. Can present as random guy over 50 with no PMHx who just suddenly has neurologic symptoms in the legs and two blastic lesions in his spine picked up on MRI. Dx?

Answer 27

Prostate cancer

Question 28

M. Prostate cancer. If neuro Sx are present due to spinal mets, give what drug?

Answer 28

Give IV methylprednisolone.

Question 29

M. Prostate cancer. If no neuro Sx are present and they just say vertebral blastic lesions, answer will be ??? Tx

Answer 29

radiotherapy

Question 30

M. Prostate cancer. Radiotherapy for mts without neuro. I’ve seen distractor answers in this case such as “morphine + corticosteroids,” where the student says, “I thought we give steroids though.” Yeah, if the patient has neuro Sx, which he doesn’t here, plus jumping to morphine before trying other pain management first is wrong.

Answer 30

.

Question 31

M. Prostate cancer. Orchiectomy will decr. what?

Answer 31

Orchiectomy will decr. androgen production -> leads to atrophy and shrinkage of prostatic cancer cells.

Question 32

M. Prostate cancer. what drugs given? 2

Answer 32

Flutamide blocks androgen receptor. It is given prior to leuprolide, which is a GnRH receptor agonist that, when given continuously, causes desensitization at GnRH receptor. Since leuprolide can incr.­ LH and FSH prior to desensitization, the flutamide is given first.

Question 33

M. Prostate cancer. PSA?

Answer 33

Prostate-specific antigen (PSA) will often be elevated. Free-PSA (i.e., not bound to protein) is low compared to bound-PSA in prostate cancer.

Question 34

M. Prostate cancer. what scale used?

Answer 34

Gleason scoring is used to grade prostate cancer.

Question 35

M. Prostate cancer. ..... are at greatest risk of injury during radical prostatectomy (asked somewhere on NBMEs).

Answer 35

The parasympathetic nerves (for erection) are at greatest risk of injury during radical prostatectomy (asked somewhere on NBMEs).

Question 36

M. BPH. All old dudes have enlarged prostates due to lifetime exposure to DHT, which causes prostatic enlargement.

Answer 36

.

Question 37

M. BPH. CP?

Answer 37

Presents as dribbling, hesitancy commencing urination, or interrupted stream in a male over 60 (but usually 70s+).

Question 38

M. “Old dude + high creatinine = Dx?

Answer 38

BPH till proven otherwise.”

Question 39

M. BPH. Discontinue anti-cholinergic meds because they cause urinary retention. This concept shows up a lot on NBMEs. Three classes of drugs in particular: ??? 3

Answer 39

1) First-gen H1 blockers (i.e., diphenhydramine, chlorpheniramine); 2) TCAs (i.e., amitriptyline). 3) Anti-psychotics.

Question 40

M. You’ll get a Q where an older male has high Cr and then the answer is just ?? about drugs

Answer 40

BPH. “discontinue anticholinergic meds,” or “discontinue the diphenhydramine.”

Question 41

M. BPH. examination?

Answer 41

Can be described as “nodular” on palpation.

Question 42

M. BPH. PSA?

Answer 42

Prostate-specific antigen (PSA) will often be elevated. Free-PSA is high compared to bound-PSA in BPH.

Question 43

M. BPH. Tx? drugs

Answer 43

Tx is alpha-1 blocker, such as tamsulosin/terazosin; or the 5-alpha-reductase inhibitor, finasteride.

Question 44

M. BPH. When surgery?

Answer 44

Transurethral resection of prostate (TURP) for refractory cases.

Question 45

M. BPH vs cancer PSA?

Answer 45

BPH: PSA will often be elevated. Free-PSA is high compared to bound-PSA in BPH. Cancer: PSA will often be elevated. Free-PSA (i.e., not bound to protein) is low compared to bound-PSA in prostate cancer.

Question 46

Uw. If presents with hard mass + Ug consistent with testicular tumor, next step?

Answer 46

Radical orchiectomy no biopsy due to risk of seeding