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Nazir Pearls Flashcards

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1
Q

Classify glial tumors

A

Astrocyte
Grade 1: pilocytic astrocytoma
Grade 2: gemistocytic astrocytoma, fibrillary
Grade 3: anaplastic, diffuse astrocytoma
Grade 4: GBM

ependymal tumor
Sub ependymoma
Myxopapillary ependymoma
Anaplastic ependymoma

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2
Q

Tumors having retro orbital extension

A

Breast
Lymphoma
Leukemia
Lung

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3
Q

Type of brain surgery

A

STR
GTR
intraoperative functional mapping

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4
Q

Causes lung cancer

A

Smoking
Alcohol
Family factor: Li fraumeni
Occupational factor
- radon
-asbestos
-silica
Previous lung disease:
- COPD
- Idiopathic pulmonary fibrosis
- Interstitial lung disease
Infectious agent:
- HPV
-HIV

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5
Q

Benign condition where radiotehrapy is needed?

A

Graves opthalmopathy
Pituitary adenoma
Keloids
Bowens disease
Rheumatoid arthritis
Aneurysmal bone cyst
Trigeminal neuralgia (75-80Gy)
Adamantinoma
Cystic hygroma
Neurofibroma
Phaechromocytoma
Arteriovenous malformation
Cavernous hemangioma (18Gy)

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6
Q

What is rampant breast cancer

A

Rampant Breast cancer:
Age 30-32
Hormone receptor negative
Aggressive
Spread rapidly
Died within 6 months
TNBC
Pre neoplastic/ centrosome amplification→ tumor invasiveness

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7
Q

What is glomus tumor

A

It is a benign neuro endocrine tumor of neural crest origin, which can develop in the carotid bodies in head and neck
Aortic bodies in the thorax
Adrenal gland in the abdomen
Embolization and surgery is treatment of choice
Radiation can be considered
45-54 Gy

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8
Q

When Ki 67 expression is high

A

When it is above 20% (nazir sir)
30% ( pathology outline)

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9
Q

In case of breast cancer molecular classification which mutation has worst prognosis

A

P53 mutation
ER/PR negative and Her 2 positive

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10
Q

Which of the drug when given intrathecally becomes deadly

A

Vincristine

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11
Q

When breast boost should be given

A

Tumor bed boost
invasive disease
- age below 50 years any grade
- age 51-70 with high grade
- positive margin
DCIS
Age below or equal to 50 years
High grade
Positive margin
Close (<2mm ) margin
Dose
10 gy in 4-5 fractions recommended for most patients
If positive margin or young age and close margin, 14-16 Gy in 7-8 fractions or 12.5 Gy in 5 fractions may be used.

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12
Q

Four features of pagets disease of breast

A

Erythemaous
Crusting
Redness
Inflammatory

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13
Q

How mycosis fungoides is formed

A

patch plaque tumor erythroderma

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14
Q

Other name of interstitial cell of cajal and where it lies

A

(CD34)
Lies between the submucosa and muscle layer. It acts as a pacemaker of colon
Auerbachs plexus lies in between two muscle layer.

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15
Q

Lymphatic staging of carcinoma stomach

A

NO= no regional lymph node
N1: one or two regional lymph nodes
N2: three to six regional lymph nodes
N3:
N3a: seven to 15 regional lymph nodes
N3b: metastasis in 16 or more regional lymph nodes.

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16
Q

Name the lymphatic stations of stomach

A

N1 nodes
1. Right paracardial
2. Left paracardial
3. Lesser curvature side
4. Greater curvature side
5. Supra pyloric (including gastroduodenal)
6. Infra pyloric
N2 nodes
7. Left gastric
8. Common hepatic
9. Celiac
10. Splenic hilum
11. Splenic artery
N3 nodes
12. Along hepatoduodenal ligament
13. Superior mesenteric
14. Middle colic
15. Para aortic
16. Portal, retroperitoneal

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17
Q

Name the shunt. Used to reduce ICP

A

Ventriculo peritoneal shunt
Endoscopic third ventricular shunt
External ventricular shunt

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18
Q

Radiotherpay dose for primary CNS lymphoma

A

Phase 1: 45 Gy in 25 daily fractions over 5 weeks
Phase 2: 9-10 Gy in 4 fractions over 1 weeks
Total 54 Gy around
CR 23.4
Non response 45-50
If leptomeningeal disease:
CSRT: 30-35 Gy in 25 daily fractions over 5 weeks mtx 12 mg

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19
Q

Pelvic radiotherapy(cervix radiotherapy complication)?

A

Acute
- pruritus
- desquamation
- nausea
- colitis
-proctitis
Late
- stenosis
- Stricture
-VVF
-RVF
- intestinal obstruction/ perforation
- femoral head necrosis (dose below 50 years)

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20
Q

Brachytherapy side effects in carcinoma cervix

A

Immediate
Mild soreness
Bruising
Swelling
Blood in urine
Uterine perforation
Laceration, shock
Late
Chronic cystitis
Proctitis
Urethral stenosis
Vaginitis
Second primary at UB and rectum
Frequency of loose stool or constipation

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21
Q

Histopathological variant of carcinoma cervix

A

Histological variety of cervical carcinoma: (AJCC)
* Squamous cell carcinoma
▪ Invasive
▪ Keratinizing
▪ Nonkeratinizing
▪ Verrucous
* Adenocarcinoma
* Endometrioid adenocarcinoma
* Clear cell adenocarcinoma
* Adenosquamous carcinoma
* Adenoid cystic carcinoma
* Adenoid basal cell carcinoma
* Small cell carcinoma
* Neuroendocrine
* Undifferentiated carcinoma/Anaplastic

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22
Q

Gardasil 9 contains which HPV strain

A

HPV16, HPV18, HPV6, and HPV11, plus five
additional high-risk HPV types (HPV31,
HPV33, HPV45, HPV52, and HPV58)

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23
Q

name some posterior fossa tumors

A

Extrinsic
Neurilemomma
Meningioma
Epidermoid cyst
Dermoid cyst
Metastases
Intrinsic
Metastases
Haemangioblastoma
Medulloblastoma
Astrocytoma

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24
Q

chest x ray PA view showing multiple cannon ball shadows of variable sizes in both lung. what are differentials

A

germ cell tumor
osteosarcoma
soft tissue sarcoma
renal cell carcinoma
melanoma
thyroid carcinoma
colonic carcinoma

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25
name some common cause of brain mets according to sex
**male** lung GIT melanoma kidney unknown bladder prostate **female** lung breast unknown origin GIT melanoma kidney ovary uterus
26
common pathological variation of stomach mass
primary: adenocarcinoma >95% squamous cell carcinoma small cell carcinoid MALTOMA GIST adenosquamous cell carcinoma sarcoma melanoma
27
meningioma dose of RT
55-60 Gy in 1.7-2.0 Gy per fraction in total of 5-6 weeks
28
name some common CNS tumor (nazir version)
**neuro epithelial tumor** astrocytoma oligodendroglioma ependymoma mixed glioma **meningeal tumor** meningioma **choroid plexus tumor** choroid plexus carcinoma choroid plexus papilloma **tumor of pineal gland** pineocytoma pineoblastoma **tumor of sellar region** pituitary adenoma craniopharyngioma **tumor of cranial and paraspinal nerve** scwannoma neurofibroma MPNST **embryonal tumor** medulloblastoma PNET **germ cell tumor** *primary CNS lymphoma* **mesenchymal tumor** hemangiopericytoma angiosarcoma PNET Chordoma Ewings sarcoma liposarcoma fibrosarcoma
29
where cell cycle check point inhibitors act
1st: G1 phase. just before S1 2nd: just before M phase
30
type of epilepsy
grand mal seizure petit mal seizure
31
prognostic factors of breast cancer
nodes size grades estrogen receptor biological marker of prognosis: - P53 -cathepsin - EGFR - Her 2 neu
32
brain tumor classification according to fossa
**anterior fossa** olfactory meningioma esthesioneuroblastoma frontal lobe glioma **middle cranial fossa** pituitary adenoma craniopharyngioma temporal lobe glioma **Posterior fossa** medulloblastoma pilocytic astrocytoma ependymoma hemangioblastoma brain stem glioma atypical teratoid
33
stomach lesion type according to borrman
type I: polypoid or fungating Type II: ulcerated with elevated border Type III: ulcerated and invading the gastric wall Type IV: diffuse infiltrative Type V: unclassifiable
34
name some syndrome associated with nephroblastoma
WAGR syndrome: - wilms - anirida - Growth abnormality - Retardation Denny Drash syndrome Beckwith Wiedman syndrome
35
Drug that crosses blood brain barrier
Methotrexate Vincristine Procarbazine Etoposide Cisplatin Carboplatin Temozolomide Nitrosamine Dacarbazine Carmustine, lomustine Cyclophosphamide osimertinib thiotepa, cytarabine **PCV jabei, Tmz(dacarbazine derive), platinum methotrexate intrathecal dei drug**
36
site of rhabdomyosarcoma
**head and neck** jaw, near spine near the eye **genito urinary** urinary bladder prostate gland any of the female organ **arms and legs trunk** child: orbital RMS paratesticular RMS: infancy
37
extranodal site of lymphoma
CNS ocular salivary thyroid lung breast stomach colon kidney liver adrenal gland skin testis uterus bone blood etc
38
para neoplastic syndrome of lung
SIADH Cushing lambert eaton syndrome hypercalcemia hyponatremia hypoglycemia carcinoid syndrome myasthenia gravis dermatomyositis hypertrophic pulmonary osteoarthropathy
39
Para neoplastic syndrome of gastric cancer
acanthosis nigricans circinate erythema idiopathic venous thrombosis leser trelat sign dementia cerebellar ataxia ectopic cushing syndrome carcinoid
40
causes of malignant pericardial effusion
lung breast esophagus thyroid germ cell tumor
41
how to use bleomycin in pleurodesis
2 vial of 15 IU total 30 IU used. mixed in 15ml N/S. given for 2 hours
42
MGMT methylation full name
6 methyl guanine DNA methyl transferase
43
dose of pembrolizumab
200 mg 3 weekly 400 mg 6 weekly
44
dose of nivolumab
240 mg 2 weekly 480 mg 4 weekly
45
EBRT energy in BSMMU
6,10,15 MV linac photon electron: 4,6,8,10,12,15,18,22,25
46
EBRT energy in LINAC
L1: 6,10 L2: 6,23 L3: 6,15 L4: 6,10 electron: 4,6,9,12,15,18,20
47
Brain RT complication
**Acute** CNS: pretreatment deficit worsens: causing fatigue, headache, drowsiness nausea, vomitting skin: erythema mucosa: edema, patchy mucositis mucositis esophagitis conjunctivitis **sub acute** headache somnolence fatigability deterioration of pre existing deficits **late** vascular injury irreversible progressive nerve injury neurocognitive damage diffuse leuko encephalopathy hormone insufficiency Lhermittes syndrome moya moya syndrome
48
Oesophagus risk factor
smoking alcohol diet: nitrates, fungi dried persemon fruit hot beverage H pylori infection HPV baretts esophagus GERD plummer vinson Hiatal hernia obesity reflux esophagitis history of Ionizing RT Achalasia
49
investigation for liver SOL
H and P alpha fetoprotein: 0-20 hep B,C abdominal usg triple phase CT laparoscopy cXR full blood count blood chemistry
50
causes of multiple mets in liver
CRC small bowel carcinoid GIST lung breast renal melanoma gyne malignancy
51
esophageal stricture site
cricopharyngeal junction : 15 cm aortic arch: 22 cm left principal bronchus: 27 cm gastro esophageal junction: 38 cm
52
Histopathology of esophageal carcinoma
**epithelial** squamous: --basaloid, spindle, verrucous adenocarcinoma adenosquamous **non epithelial** lymphoma melanoma sarcoma myoblastoma carcinoid
53
EMA-CO schedule
ETO: 100 mg/m2 D1,2 MTX: 100 mg/m2 bolus than 200 mg/m2 in 12 hours D1 Actinomycin: 0.5 mg D1-2 folinic acid: 15 mg QDS 4 dose than cyclo 600 mg/m2 D8 oncovin: 1 mg/m2 D8
54
what is monoclonal antibody
immunotherapy developed as a technology/technique with the discovery of the structure of antibody and development of hybridoma technology which provided the first reliable source of monoclonal antibody type: murine chimeric humanized
55
VDC IE total time
-48-52 weeks VCR: 2 mg IV bolus D1 Doxo 75 mg/m2 D1 cyclo 1200 mg/m2 D1 than IE Ifosfamide: 1800 mg/m2 D1-5 etoposide 100 mg/m2 D1-5 when doxo exceeds cumulative dose of 375mg/m2 changed with actinomycin 1.25mg/m2
56
intra thoracic malignancy? mode of death
great vessel rupture esophageal involvement tension pneumothorax acute pulmonary embolism
57
lung metastasize to which sites
opposite lung adrenal gland CNS bone liver breast testis
58
name some common cardiotoxic drug
doxorubicin daunorubicin epirubicin trastuzumab pertuzumab 5 fu capecitabine paclitaxel cyclophosphamide
59
common lung panel
EGFR ALK ROS Kras BRAF MET NTRK RET ERBB2 PDL1
60
PCI is used in
SCLC leukemia lymphoma testicular carcinoma high grade B cell lymphoma
61
drug causing 2nd malignancy
1st: etoposide 2nd: cyclophosphamide 3rd: ifosfamide 4th: doxorubicin
62
drug causing infertility
alkylating agent: cyclo, ifos 5 fu bleomycin dactinomycin daunorubicin MTX
63
drug causing alopecia
cyclo ifos doxo etoposide irinotecan paclitaxel, docetaxel vincristine vinblastin
64
Radiation complication of lung
**Acute** dysphagia oesophagitis fatigue dermatitis **Late** pneumonitis fibrosis brachial plexopathy pericarditis esophageal stricture rib fracture intercostal nerve pain 2nd malignancy
65
OAR dose: oesophagus brachial plexus opposite lung kidney small bowel
oesophagus: 34 gy brachial plexus: 60gy opposite lung: 8 Gy kidney: 20 Gy small bowel: V15<120 cc (50 Gy)
66
OAR dose: femoral head bladder rectum heart
femoral head: 50 Gy bladder: 65 Gy heart :26 Gy
67
Carcinoma cervix histopathology
**epithelial** squamous cell carcinoma: keratinizing, non keratinizing adenocarcinoma adenosquamous Endometrioid clear cell glassy cell adenoid cystic small cell neuroendocrine undifferentiated **other** sarcoma botryoid lymphoma melanoma
68
what is 90-70-90
90% of the girls should be vaccinated by the age 15 years 70% of the woman be screened by the age of 35, and 45 treatment of 90% of the woman with pre invasive lesion and 90% woman with invasive cancer
69
carcinoma lung histopathology
**Primary** *epithelial* SCLC NSCLC - squamous - adeno -adenosquamous - neuro endocrine -large -sarcomatoid *mesenchymal* *lymphohistocytic: lymphoma* *melanoma* *ectopic* **secondary** - Germ cell tumor - GTT - Sarcoma -OS -breast - CRC -Renal
70
malignant tumor of salivary gland
muco epidermoid adenoid cystic acinic cell polymorphous adenocarcinoma clear cell basal cell
71
tongue muscle nerve supply
all the muscle except palatoglossus supplied by hypoglossal nerve. whereas palatoglossus supplied by spinal accessory nerve

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