MTB - Oncology/ Preventive Medicine Flashcards Preview

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Flashcards in MTB - Oncology/ Preventive Medicine Deck (49):
1

screening mammography

starts at age 50, ends at age 75

2

BRCA mutation is assoc. with

increased risk of familial breast ca. and ovarian ca.

3

BRCA mutation screening

NOT a routine screening test --> only for at-high risk patients

4

when do you use tamoxifen as preventative therapy?

if the patient has 2 or more first degree relatives with breast ca.; start therapy at age 40

5

adjuvant chemotherapy in breast ca.

if tumor > 2 cm (1 cm) or there is axillary LN involvement
more likely to be effective in menstruating women

6

s/e of tamoxifen

DVT
hot flashes
endometrial cancer

7

how are aromatase inhibitors different from tamoxifen?

no selective ER agonist activity
NO risk of DVT
do cause osteoporosis (antagonist in bone)

8

routine colonoscopy

age 50, every 10 years

9

CRC screening - one family member with CRC

colonoscopy age 40 or 10 years earlier than age of dx (whichever is earlier)

10

CRC screening - HNPCC (3 family members, two generations, one premature <50 yo)

colonoscopy at age 25, then every 1-2 years

11

CRC screening - FAP

screening sigmoidoscopy at age 12, then every 1-2 years

12

screening test for lung ca

none

13

52 yo smoker with 1.5 cm calcified nodule found on CXR; no symptoms. Next step?

Excisional biopsy on all lesions > 1 cm in smokers

14

Surgery is excluded in lung cancer if any of the following are present...(5)

bilateral lesions
mets
malignant pleural effusion
involvement of aorta, vena cava, heart
lesions w/in 1-2 cm of carina

15

follow-up for LSIL or HSIL found on pap smear

colposcopy and biopsy

16

follow-up for ASCUS found on pap smear

HPV testing
- if positive: colposcopy
- if negative: repeat pap in 6-12 months

17

which lowers mortality more? mammography or pap smear?

mammography

18

when do you start Pap Smears?

age 21 - regardless of onset of sexual activity
Every 3 years if normal results

19

when can you stop pap smears?

age 65

20

screening for prostate cancer

only if patient asks --> do PSA and DRE until age 75

21

do PSA and DRE testing lower mortality from prostate cancer?

no

22

most important prognostic factor in prostate ca.

Gleason score (measure of level of differentiation)

23

Tx. localized prostate ca.

surgery or external radiation or implanted radioactive pellets --> both are equal in efficacy

24

Tx. metastatic prostate ca.

androgen blockade w/ flutamide and leuprolide or goserelin

25

fastest way to lower androgen /testosterone levels

orchiectomy (not first line though)

26

man w/ prostate ca. presents with signs of cord compression on MRI - managements?

1. Steroids
2. Flutamide - prevents androgen flare
GnRH agonists should NOT be started too soon - can worsen compression

27

a 60 year old woman presents with increasing abdominal girth at the same time as weight loss - dx?

likely ovarian ca.

28

Ca-125

NOT a screening test - marker of progression and response to therapy for ovarian ca.

29

Tx. ovarian ca.

surgical debulking + chemotherapy
- even in cases of extensive local metastatic disease`

30

diagnostic testing of suspected testicular ca.

inguinal orchiectomy of affected testicle

31

MC type of testicular ca.

germ cell tumors (seminoma and non-seminoma)

32

what types of testicular ca. secretes AFP

non-seminoma

33

what hormones/markers do you measure in testicular ca.

AFP
bHCG
LDH

34

staging of testicular ca.

CT abdo and pelvis

35

Tx. local disease testicular ca.

radiation

36

Tx. widespread testicular ca.

chemotherapy - can cure mets

37

cancer screening test that lowers mortality the most

mammogram

38

mortality benefit of mammogram is greatest above what age?

50

39

indications for influenza and pneumococcal vaccination

1. pts with chronic lung, heart, liver, kidney and cancer
2. HIV positive patients
3. patients on steroids
4. patients with diabetes

40

who benefits the most from influenza vaccine?

everyone > 50
pregnant women
healthcare workers

41

when do you give pneumococcal vaccine normally?

all patient > 65 yo

42

when is meningococcal vaccine given?

age 11
- earlier if pt has functional/anatomic asplenia OR terminal complement deficiency

43

who should receive the varicella-zoster vaccine?

everyone above age 60

44

most effective method of achieving smoking cessation

oral medication - bupropion, varenicline

45

osteoporosis screening

all women > 65 --> should receive bone densitometry

46

AAA screening

all men, > 65 who were every smokers

47

diabetes screening

only routine in those with HTN

48

HTN screening

all patients > 18 yo should have their BP checked at every visit

49

Hyperlipidemia screening

men > 35 and women > 45