Miscellaneous Flashcards
(84 cards)
1
Q
LEMS mechanism
A
reduced acetylcholine (ACh) release from the presynaptic nerve terminals
2
Q
LEMS clinical features
A
- slowly progressive muscle weakness
- proximal lower extremity weakness (gait alteration, difficulty arising from a chair)
- Oculobulbar findings (ptosis, diplopia)
- Improvement in strength with vigorous muscle activation
- Respiratory failure in late stages
3
Q
Effect of finasteride for chemoprevention of prostate cancer
A
- 25% reduced incidence of prostate cancer
- small but significant increase in risk of high-grade prostate cancer (likely from detection bias)
- no effect on OS
4
Q
Management of G1 pneumonitis from T-Dxd (asymptomatic) per package insert
A
- steroids
- Stop enhertu until resolved to G0
- If resolved in 28 days or less, maintain dose
- If resolved in greater than 28 days, dose reduce
5
Q
Clinical features of inflammatory breast cancer
A
rapid-onset breast erythema (No more than 6 month history) + edema + peau d’orange appearance + warm breast
6
Q
Differential for anterior mediastinal mass
A
small cell lung cancer →
lymphoma (T-ALL, nodular sclerosing HL, primary mediastinal b-cell lymphoma) →
germ cell tumor → carcinoma) (50%) →
7
Q
Differential for posterior mediastinal mass
A
Neurogenic →
Meningocele →
Thoracic spine lesions →
8
Q
Differential for middle mediastinal mass
A
Lymphadenopathy (most commonly) →
Benign cystic tumor →
Cardiovascular aneurysm or anomaly →
Esophageal tumor →
9
Q
Most common symptoms of leptomeningeal disease
A
- pain
- seizures
10
Q
1) Newly approved NTRK inhibitor 2) clinical benefit
A
Repotrectinib
*high ORR in second line + CNS penetraton
11
Q
NTRK inhibitors target what specifically
A
FUSIONS
12
Q
GCSF indications
A
1) neutropenic fever risk > 20%
2) ***Maintain dose density
13
Q
Risk factors to consider GCSF for intermediate risk for neutropenic fever
A
- prior chemo or radiation
- age > 65
- liver dysfunction
- CrCl <50
- chronic immunosuppression
- bone marrow involvement
- recent surgery or wounds
14
Q
Risk factors to consider GCSF for intermediate risk for neutropenic fever
A
- prior chemo or radiation
- age > 65
- liver dysfunction
- CrCl <50
- chronic immunosuppression
- bone marrow involvement
- recent surgery or wounds
15
Q
Other brand name for pegfilgrastim
A
Udenyca
16
Q
GCSF toxicity
A
- ARDS
- bone pain
- bleomycin lung toxicity has higher incidence when given with GCSF
- sickle cell crisis
- splenic rupture
- MDS/AML
17
Q
Management of bone pain from GCSF
A
- NSAIDs
- loratadine
18
Q
GCSF contraindication
A
Within 14 days of CAR-T (exacerbating CRS)
19
Q
Chemo induced thrombocytopenia management per boards
A
1) plt transfusion as per standard goals
2) dose reduce subsequent cycle
3) consider romiplostim
20
Q
Chemo induced anemia transfusion goals per boards
A
- goal hgb 7, 8 if comorbid cardiovascular disease
21
Q
Chemo induced anemia transfusion goals per boards
A
- goal hgb 7, 8 if comorbid cardiovascular disease
22
Q
Use of ESAs for chemo related anemia per boards
A
- can be considered if CKD + cancer
23
Q
Use of ESAs for chemo related anemia per boards
A
- can be considered if CKD + cancer (already receiving)
- declining and refusing transfusions
24
Q
Breast cancer screening modality and timing for women with history of chest wall radiation + at what age it is indicated
A
- MRI + mammogram annually (typically alternated every 6 months)
- annual breast MRI after age 25
25
Most common testicular cancer histology in older men
Seminoma
26
HPV vaccination recommendation
- age 11-12 up to age 26
*can be offered 27-45 to those most likely to benefit
27
alcohol and BMI and exercise as RF's for breast cancer
*High BMI is only a a risk factor for postmenopausal women, in premenopausal women low BMI is actually a RF
- minimal alcohol intake (even if less than 1 drink per day) has been shown to increase breast cancer risk
*sedentary/lack of physical activity is also a risk factor
*increased breast density is also a RF
28
In what ALL subtype is CRLF2 gene rearrangement found in?
Ph-like ALL
29
Ethnic + genetic variant RF for Ph-like ALL
1) latino
2) GATA3
30
How to reduce risk of pancreatic cancer
- weight loss, including bariatric surgery
31
Most common environmental RF for lung cancer
- residential radon exposure
32
Drug that requires fixed dosing as opposed to actual weight
Bleomycin
33
Blood thinner contraindicated with tamoxifen
Warfarin
34
Mutations seen in prostate cnacer with neuroendocrine differentiation
TP53
RB1
35
Statistical test that is less sensitive to outliers
Wilcoxon rank-sum test
36
Trial design that allows determination of efficicacy and ability to terminate early for futility
Simon two-stage design
37
Statistical test best suited to compare populations with small sample sizes
Fisher exact test
38
Pemetrexed mechanism
Folate antagonist
39
Drug contraindicated with second generation BCR-ABL TKI's
PPI’s (pH dependent absorption)
40
Problems of 3+3 phase I design
- doesn't minimize sample size
- can give poor estimate of MTD
41
First line for NETs per boards
SSA
42
Point of a Phase 4 trial
- evaluate toxicity and outcomes after a new treatment has been approved under real-life conditions
43
What is the healthy volunteer effect?
Volunteers are healthy and not representative
44
Most common mechanism of radiation-induced cell death in solid tumors
mitotic castastrophe
45
VHL funtion
Tumor suppressor
46
Recurrent metastatic head and neck
IF recurrence <6 months (platinum refractory),
IF low-moderate volume of disease AND PD-L1+, pembrolizumab
IF high volume disease, cetuximab + pembro (Phase II, OS, ORR benefit)
IF PD-L1 negative, cetuximab + pembro
IF recurrence >6 months, treat as de novo metastatic
47
Antibody associate with paraneoplastic cerebellar degeneration in SCLC
Ant0Hu
48
CRC in surveillance imaging indication
CT torso q6-12 months
49
Stage IA ovarian cancer management in patient desiring fertility
- unilateral salpingo-oophorectomy with adjuvant carbo/taxol (stage IA is isolated involvement of one ovary, this is the only scenario in ovarian where fertility preservation is possible)
50
What qualifies as low risk PC
PSA <10
T2a or lower
Grade group 1
51
Low risk PC options
IF life expectancy >10 years
Active surveillance (preferred)
XRT
RP without ADT
52
Very low risk PC options
Active surveillance if life expectancy >10 years
IF <10 years, observation (do nothing)
53
Unfavorable intermediate PC
- Grade group 3
- >50% positive biopsy cores
- PSA 10-20
54
favorable vs. unfavorable intermediate risk PC in terms of ADT w/ RT
- ADT only indicated with RT if unfavorable
55
When zytiga is indicated for localized prostate cancer
node positive on conventional scan OR 2 of following: T3/T4, grade group 4 to 5 (GS 8-10), PSA ≥40 ng/mL
56
Clinical benefit of cetuximab added to RT vs. RT alone
- OS benefit but still understudied so hasn't replaced standard of care
57
Stage IIb cervical cancer management
Chemoradiation w/ cisplatin then brachytherapy
58
What defines tage IIb cervical cancer
parametrial involvement
59
Chemo-induced neuropathy treatment
- duloxetine
- gabapentine
60
Indications for treatment in WM
hyperviscosity
hepatosplenomegaly
cryoglobulinemia
cold agglutinin disease
b symptoms
bulky adenopathy (>5cm)
Cytopenias
61
Metastatic merkel cell - prognosis better w/ known vs. uknown primary
Better prognosis if unknown primary
62
First line for MSI-H BRAF V600 E mutant metastatic colon
chemoimmunotherapy - mFOLFOX + pembro (Accumulating evidence that sporadic MSI-H has high disease heterogeneity. BRAF mutant needs upfront intensification of therapy but dMMR/BRAF still do better than pMMR/BRAF)
63
Anticipatory nausea management
Behavioral therapy per guidelines
Lorazepam 0.5 mg-2mg before pretreatment if no improvement with behavioral therapy
64
Biomarker predictive of improved response from margetuximab vs. trastuzumab
CD16A 158F allele
65
management of pulmonary toxicity from chlorambucil in CLL
steroids
66
Drugs for lowering potassium in TLS
IF available, sodium zirconium cyclosilicate (SZC) 10 g TID for 48h (preferred, since more rapid acting)
IF SZC not available, patiromer 8.4 g daily (repeated daily as needed)
Avoid sodium polystyrene sulfonate (bowel necrosis, toxicity)
67
When to hold and discontinue bev for proteinuria
>2 = hold
>3.5 = permanently discontinue
68
Opioid risk tool - score indicating high risk
Greater than or equal to 8
69
Biomarker used in CLL IPI
beta-2
70
most common genetic abnormality in SCLC
p53 mutations (nearly all SCLC tumors)
71
First line for papillary thyroid cancer
RAI
72
localized NPC treatment
definitive XRT
73
locally advanced NPC management
induction chemo then CRT
74
Effect of CYP3A inducers on chemo drugs
Decrease concentration and efficacy
75
Examples of CYP3A inducers
- seizure drugs
- TB
- PPI's
- St. John's wort
76
Effect of CYP3A inhibitors on chemo drugs
- increase serum chemo levels and increase opioid toxicity
77
Examples of CYP3A inhibitors
- grapefruit
- HIV
- Fungal drugs
- macrolides
- fluoroquinolones
- anti-depressants
78
Smear findings in cirrhosis
- acanthocytes (spur cells)
*see photo online
79
Drug in CRC that's contraindicated with bili >2
irinotecan
80
Why does brigatinib require step up dosing?
pulmonary toxicity
81
CLL pts for whom chemoimmunotherapy (eg FCR) is contraindicated
- IGHV unmutated
- p53 mutant
82
Paget's disease management
central breast excision
83
second line for papillary thyroid cancer
lenvatinib
84
clinical benefit of sunitinib for RCC
PFS
