MKSAP STOCK2

Question 1

A treament regimen for adenocarcinoma of unknown primary below the diaphragm should target this type of cancer

Answer 1

Gastrointestinal primary

Question 2

What is the appropriate post-operative surveillance colonoscopy for patients with stage III colon CA?

Answer 2

Every 3-5 years following a normal study at 1 year

Question 3

What is the prognostic scoring system for patients with diffuse large B cell lymphoma?

Answer 3

Revised International Prognostic Index (r-IPI) score

Question 4

What drug therapy is indicated for all patients with multiple myeloma to prevent or to treat bone disease?

Answer 4

Bisphosphonate therapy (zoledronic acid > pamidronate)

Question 5

What type of stage I testicular cancer is most often cured by surgical resection alone?

Answer 5

Seminoma

Question 6

What is the initial mgmt in patients with suspected malignant superior vena cava syndrome?

Answer 6

Biopsy for histoligic diagnosis

Question 7

What preoperative imaging is needed to stage newly diagnosed colon CA?

Answer 7

Contrast-Enhanced CT of C/A/P

Question 8

Indicated mgmt following surgical resection of nonmetastatic renal cell carcinoma?

Answer 8

Clinical observation

Question 9

What is the first test in the diagnosis of a low pretest probability of DVT?

Answer 9

D dimer

Question 10

What are three laboratory findings consistent with coagulopathy of liver disease?

Answer 10

Prolonged prothrombin time; Prolonged activated partial prothromboplastin time, and INCREASED factor VIII level (from WP bodies in endothelium)

Question 11

Treatment of locally advanced cervical cancer

Answer 11

Chemoradiation (not surgery)

Question 12

What tissue testing is indicated for patients with newly diagnosed head and neck cancers?

Answer 12

p16 tissue testing (IHC stain for HPV)

Question 13

What is the treatment of high risk myelodysplastic syndrome?

Answer 13

Allogeneic Hematopoetic Stem Cell Transplant

Question 14

What is the timing of bilateral prophylactic salpingo-oopherectomy for BRCA1 carriers?

Answer 14

By age 35 years and after child-bearing is complete

Question 15

Two goals of posttreatment surveillance following therapy for head and neck cancer

Answer 15

Identify local recurrence; Identify distant second primary cancer

Question 16

Genetic mutation commonly associated with polycythemia vera

Answer 16

JAK2 V617F activating mutation

Question 17

What agent for acute treatment of tumor lysis syndrome catalyzes breakdown of uric acid? Testing needed before giving (theoretically)?

Answer 17

Rasburicase; G6PD level

Question 18

What is a diagnosis for acute respiratory distress, elevated BNP, and elevated central venous pressure within 6 hours of transfusion?

Answer 18

Transfusion associated circulatory overload

Question 19

What is the initial treatment of intracranial hypertension associated with central nervous system lymphoma?

Answer 19

High dose systemic glucocorticoids

Question 20

What are two essential steps in managing heparin-induced thrombocytopenia?

Answer 20

Stop heparin; Start nonheparin anticoagulant (Lepirudin, ARGATROBAN, danaparoid)

Question 21

What is the initial treatment of metastatic ER+ breast cancer limited to the bone?

Answer 21

Aromatase inhibitor (letrozole, exemestane)

Question 22

What are three CONTRAindications to outpatient therapy for acute pulmonary embolism in a hemodynamically stable patient?

Answer 22

Need for supplemental oxygen; need for IV pain meds; presence of “significant” comorbid conditions

Question 23

Recommended adjuvant therapy for SCC of head and neck with positive surgical margins following resection

Answer 23

Chemoradiation

Question 24

What is the INITIAL treatment of malignancy-associated hypercalcemia?

Answer 24

NS infusion- liberal

Question 25

What is a monoclonal antibody used to treat Waldenstroms Macroglobulinemia?

Answer 25

Rituximab (recall it is lymphoplasmacytic LYMPHOMA)

Question 26

What is the treatment of solitary colon cancer metastasis to liver or lung

Answer 26

Surgicla resection

Question 27

What tissue testing is indicated in patients with metastatic gastric cancer

Answer 27

HER2 tumor status

Question 28

What is the first step in mgmt of suspected transfusion-transmitted bacterial infection?

Answer 28

Stop transfusion! Then broad spec abx

Question 29

Immunosuppressed patients at greater risk for this lymphoma

Answer 29

Non-Hodgkin Type lymphomas

Question 30

Therapy for mycosis fungoides limited to the skin

Answer 30

Topical glucocorticoids

Question 31

What genotype testing is indicated in patients with metastatic colorectal cancer?

Answer 31

K-ras and N-ras

Question 32

What is the intial diagnostic study for ALL patients with confirmed amyloidosis?

Answer 32

Amyloid typing (I think this is the microdissection that goes to Mayo)

Question 33

Two measures of performance status commonly used to guide therapy in patients with metastatic cancer

Answer 33

Karnofsky Score and ECOG score (Zubrod score)

Question 34

What are two adjuvant treatment options for stage III colon cancer?

Answer 34

FOLFOX (folinic acid = leucovorin, 5 FU, oxaliplatin); CAPOX- capecitabine and oxaliplatin

Question 35

What are 7 treatment related complications following therapy for testicular cancer?

Answer 35

CV disease, Metabolic Syndrome, Kidney dz, Peripheral neuropathy, Chronic Pulmonary toxicity, Secondary malignancy, and sexual dysfunction

Question 36

Genetic testing for metastatic melanoma

Answer 36

BRAF V600E mutation analysis

Question 37

What are 3 possible indications for neoadjuvant chemotherapy for patients with localized breast CA?

Answer 37

HER2-amplified breast CA; Triple negative breast CA; large cancers in women who want breast-conserving tx

Question 38

What are 3 conditions that are associated with iron malabsorption

Answer 38

Celiac disease, achlorhydria, and H. pylori infection (also bariatric surgery)

Question 39

This intervention provides survival benefit in patients with early-stage ovarian CA

Answer 39

Exploratory surgery with intact removal of adnexal mass

Question 40

Recommended screening for ovarian cancer in women of average risk

Answer 40

No screening

Question 41

What is the target hemoglobin level for patients with sickle cell disease undergoing low to moderate risk surgery?

Answer 41

10 (TAPS study)

Question 42

Syndrome characterized by rheumatoid arthritis, splenomegaly, and neutropenia?

Answer 42

Felty's Syndrome

Question 43

This is the initial treatment for patients with rectal cancer that invades into but not fully through the rectal wall without evidence of lymph node mets

Answer 43

Surgical resection (This is Stage I)

Question 44

What are three risk factors for progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma?

Answer 44

Non IgG M protein; M protein of at least 1.5 g/dl; and abnormal serum free light chain ratio

Question 45

What hormonal contraceptive option has the lowest risk for venous thromboembolism?

Answer 45

Progestin-releasing intrauterine device

Question 46

What is the most common musculoskeletal adverse effect in patients taking an aromatase inhibitor?

Answer 46

Arthralgia (Aromatase Inhibitor-Induced Arthralgia Syndrome)

Question 47

What is the treatment of ipilimumab-induced toxicity

Answer 47

DC ipilimumab and start systemic high-dose glucocorticoid tx

Question 48

This is a term for chemotherapy that is given to a patient with an unresectable tumor to shrink it to a resectable size

Answer 48

Conversion Chemotherapy

Question 49

What is the immediate treatment of multiple myeloma associated spinal cord compression?

Answer 49

IV high dose glucocorticoids

Question 50

What is the recommended treatment for a patient with asymptomatic, nonbulky follicular lymphoma?

Answer 50

Clinical observation; but if stage I-IIA can do ISRT

Question 51

What is the management of recurrent superficial bladder cancer following treatmetn with TURBT (transurethral resection of bladder tumor) or intravesical BCG?

Answer 51

Cystectomy

Question 52

What are two indications to perform a SLNB in patients with newly diagnosed melanoma?

Answer 52

1-4 mm thickness; \<1 mm thick but with HIGH RISK FEATURES - ulceration, \> 1 mitosis/mm2, and lymphovascular invasion (LVI)

Question 53

What is the general time frame to stop new oral anticoagulants (NOAC) before surgery?

Answer 53

24-36 hours before a surgery with standard risk of bleeding

Question 54

What is the treatment of warm autoimmune hemolytic anemia?

Answer 54

Systemic Glucocorticoids

Question 55

What is the mgmt of low risk myelodysplastic syndrome?

Answer 55

Clinical observation

Question 56

Genetic mutation commonly associated with essential thrombocythemia

Answer 56

JAK2 V617F activating mutation

Question 57

What is the diagnosis for a decrease in hemoglobin level, reticulocytosis, and elevated LDH several days following a transfusion?

Answer 57

Delayed Hyperhemolytic transfusion reaction

Question 58

What is the most effective chemoprophylaxis in postmenopausal women with newly diagnosed atypical ductal hyperplasia?

Answer 58

Exemestane (Aromatase Inhibitor)

Question 59

What are the two criteria for discontinuing heparin when initiating anticoagulant treatment for VTE with the combo of heparin and warfarin (i.e. bridging)

Answer 59

Heparin and Warfarin have overlapped for \>5 days; INR is \>2 for 24 hours

Question 60

Therapy for gastric MALT lymphoma associated with H. pylori infection?

Answer 60

Treat the H. pylori

Question 61

What is the diagnosis for episodic hemolysis in response to oxidant stressors?

Answer 61

Glucose-6-phosphate dehydrogenase deficiency

Question 62

What are three indications for BRCA 1/2 testing in women with newly diagnosed breast cancer?

Answer 62

Patient under 45; Breast CA diagnsed at any age with one or more first, second, or third degree relatives dx with ovarian CA; Triple neg breast CA diagnosed prior to age 60

Question 63

What is the diagnosis for a patient with mild microcytic, hypochromic anemia with target cells and a normal hemoglobin electrophoresis?

Answer 63

alpha thalassemia trait (alpha thalassemia minor)

Question 64

What are three clinical parameters indicating a low risk of prostate cancer progression?

Answer 64

Clinically localized prostate CA; Serum PSA \<10 ng/mL; Gleason Score \<8

Question 65

What is a cause of iron deficiency and red urine in a runner?

Answer 65

Exercise induced intravascular hemolysis

Question 66

The treatment regimen for a woman with CUP presenting with abdominal carcinomatosis and ascites should be focused towards what cancer type?

Answer 66

Ovarian

Question 67

Women with a personal and family history of ovarian, endometrial, or colon CA should undergo testing for this genetic syndrome

Answer 67

Lynch Syndrome (HNPCC)

Question 68

What is the diagnostic test to perform for B12 deficiency if the level is borderline low?

Answer 68

Methylmalonic Acid level

Question 69

This is the type of non-Hodgkin lymphoma characterized by extranodal involvement and overexpression Cyclin D1

Answer 69

Mantle Cell Lymphoma

Question 70

What is an important genetic mutation screening test for patients with lung adenocarcinoma?

Answer 70

EGFR mutation testing

Question 71

What is the threshold hemoglobin level to begin ESAs (erythropoiesis-stimulating agents) for patients with CKD and symptomatic anemia?

Answer 71

Hgb \<10

Question 72

What are two anticoagulants safe in breastfeeding?

Answer 72

Warfarin (though not safe in pregnancy) and LMWH