Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

OBGYN Oral Boards > ONC > Flashcards

ONC Flashcards

(90 cards)

Start Studying
1
Q

when to stop mammograms?

A

Consider stopping at 75. If otherwise healthy, can continue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Breast screening for BRCA, PTEN and P53 mutations, lifetime risk of 20%

A

twice yearly clinical breast exam
annual mammo at 10 years before earliest dx, but not before 25
annual breast MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Breast screening for hx of thoracic rads

A

start at 25 years old
clinical breast exam q6-12 months
annual mammo
annual breast MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of mammo miss breast cancer?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Concerning features on mammo

A

mass
calcfications- 5 or more clustered is concerning
architectural distortion-skin changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Patient has a breast cyst and FNA is performed. What features would require further work via bx?

A

mass is solid and you get no fluid.
fluid is bloodly
mass is persistent after aspiration,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

lifetime risk of breast cancer

A

1 in 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

most common breast cancer histology

second most common

most common location of breast cancer

A

ductal carcinoma

infiltrating lobular carcinoma

upper outer quadrant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors for breast cancer

A 
65+ yrs
BRCA, Li-fraumeni, Cowden
2 or more 1st degree relatives with breast cancer dx at an early age
biopsy confirmed atypical hyperplasia
nulliparity
menarhe <12, menopause >55
no breastfeeding
post-menopausal obesity
recent long term use of estrogen and progestin
EtOH
askenazi jewish heritage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

inflammatory breast disease is what stage?

A

stage 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which patients are NOT candidates for breast conservation surgery

A 
stage 3 and 4 dz
his of rads
pregnancy
persistent  margins
family hx
tumor greater than 5cm
diffuse calcifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Good prognostic factors for breast cancer

A

small tumor size, negative node, ER or PR positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Breast CA adjuvant Therapy

  • positive lymph nodes?
  • Negative nodes, tumor <1cm?
  • negative nodes, tumor >1cm?
A
  • chemo, plus tamoxifen (if receptor positive), if post menopausal (tamoxifen plus aromatase inhibitor)
  • consider tamoxifen if receptor positive. or nothing further
  • tamoxifen if receptor positive with or without chemo, chemo is must if receptor negative.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is DCIS?

treatment?

A

precursor to invasive breast cancer

mastectomy vs wide local excision with rads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you counsel patients on tamoxifen?

A

Risks: VTE, uterine cancer, fatty liver disease, vasomotor symptoms

Benefits: reduced risk of invasive breast cancer, but not in cancer deaths,
-reduced hip, radius, spine fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Can BRCA patients get HRT after having BSO?

A

yes! so long as they don’t have a history of breast cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Letrozole inhibits the conversion of what to what?

workup before starting letrozole

A

androsteindione to estrone

BMD assessment with FRAX or DEXA and continue annual DEXA while on letrizole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Gest Troph Dz is comprised of GTN and benign molar pregnancy. What percentage is molar?

Of them, what percentage is partial vs complete?

Of GTN, name to metastatic types of disease?

A

80% benign mole

90% are complete mole, 10% partial

choriocarcinoma
placental site troph tumor
epitheliod troph tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of a complete mole

A

hyperthyroidism, theca-lutein cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Preop molar pregnancy workup

A 
Hcg
TSH 
pelvic sono
CBC
PT/INR
Type and screen
CMP-renal and liver functions
CXR- to rule of GTN as lung is the most common site of mets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the differences between partial and complete mole?

A
  • Partial mole has fetal parts (normal ovum, fertilized with two sperm or diploid sperm).
  • Complete mole-two sperm fertilize empty egg or one sperm fertilizes empty egg and duplicates it s DNA
  • partial mole has focal villous edema abd trophoblastic hyperplasia

Partial mole is triploid

Partial mole has lower risk of GTN. Complete mole has 19% chance of invasive mole (aka nonmetastatic GTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Post op Molar follow up

A

HCG 48hrs after evacuation
weekly while elevated then monthly for 6 months

contraception to reduce the risk of a normal pregnancy causing a rise in hcg vs GTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

You are following a molar pregnancy. What hcg findings would make you suspicious for GTN?

A
  • hcg plataeu over 4 values over 3 weeks (day 1, 7, 14, 21) +/- 10%
  • > 10% rise over 3 values (day 1, 7, 14).
  • Hcg +more than 6 months

rule out new pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When to suspect phantom hcg?

A

low level plataeu hcg in blood

due to heterophilic antibody, check urine hcg to rule it out. antibody is not excreted in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which BRCA patients should get tamoxifen?
BRCA2 bc they are ore estrogen dependent
26
Risk of cancer with EIN?
40% need ONC present for possible lymph node dissection
27
GTN workup
``` HCG CXR CBC CMP CT Head chest abd pelvis ```
28
Type of trophoblasts for Placental site trophoblastic tumor? What is the tumor marker?
intermediate trophoblasts human placental lactogen
29
Good prognostic factors in GTN
last pregnancy <4 months low HCG titer <40k no brain or liver mets no prior chemo
30
WHO Staging system What constitutes low risk?
= 6 which means they can have single agent chemo
31
GTN - Patient has complete mole..You follow hcg but it plateaus over 4 values. - you dx GTN. - she gets CT H/A/P, CXR, CMP, CBC, Hcg. - WHO score is <6 so she startes single agent chemo. - HCG rises. - What is our next step?
-change to other chemo agent -consider TAH -switch to EMA-CO etoposide, methotrexate, actinomycin D, cyclophosphomide, vincristine
32
When to stop paps?
age 65, 2 prior negative HPV tests, 2 negative cotests, 3 negative cytology with the past 10 years. most recent test must be within the last 3-5 yrs after total hysterectomy with no history CIN 2 or worse in the past 25 years
33
How do you manage ASCUS?
get HPV If positive--> colpo if negative--> repeat cotesting in 3 years
34
What should you do with the following results? 1. cytology neg, HPV neg 2. cytology neg, HPV pos
1. repeat in 5 year 2. cotest in 1 year or reflex to 16/18 and if positive-do colpo, if negative for 16/18, retest in 1 year
35
You test for HPV alone, like the new guidelines say and your patient is HPV positive. Next step?
get cytology or if HPV 16/18 positive then do a colpo
36
How long do you keep doing cervical cancer screening in patients with a history of HSIL?
HPV with or without cytology every 3 years for 25 years
37
How to manage HSIL?
LEEP for everyone except if pregnant or age 21-24, then do colpo
38
ASCUS with +HPV and negative colpo. next step?
repeat co test in 1 year. if ASCUS with +HPV again, repeat in 1 year again. if still ASCUS with +HPV for 2 years, then colpo again.
39
How to manage LSIL?
colpo, expect 21-24 then repeat cytology in 1 year
40
postmenopausal endometrial cells on pap? Next step? premenopausal endometrial cells on pap?
post-menopausal - EMB pre-menopausal - do nothing
41
Atypical glandular cells next step <35 >35
Colpo/ECC for everyone <35-->EMB if risk factors for endometrial cancer >35--> EMB
42
Pap comes back with atypical endometrial cells. next step?
emb and ecc, if negative, then do a colpo
43
Pap comes back with adenocarinoma in situ next step?
colpo, ecc, emb
44
colpo comes back with adenocarcinoma in situ next step?
refer to onc for CKC vs hyst.
45
colpo comes back with adenocarcinoma in situ. CKC come back with positive margins. next step?
simple hyst for those done with children repeat cone with counseling for those who still want children, follow with Co-testing at 1 year
46
What are you looking for on colpo?
acetowhite changes, abnormal blood vessels, mosaicism (network of fine-caliber blood vessels), area of punctation
47
How does lugols work?
stains glycogen so abnormal cells are pale
48
adequate colpo requires two things
see the whole cervix/lesion | see the squamocolumnar junction
49
What does LEEP stand for?
Loop electrosurgical procedure
50
Risks of preterm delivery after LEEP and CKC
CKC are 2.5 more likely to have Preterm delivery, low birth weight, and/or c/s. LEEP 1.5 times more likely to have PTD.
51
LEEP path comes back with positive margins. next step?
repeat pap and ecc in 4-6 months
52
Treatment options for cervical dysplasia
``` cryosurgery LEEP CKC Laser ablation Hysterectomy ```
53
How does gardasil work? age for giving it? how many doses? can you get it while pregnant? can you get it while breastfeeding?
vaccinates against the L1 virus like particles 9-45 2 dose if under 15, 3 if over 15 not while pregnant okay while breastfeeding
54
Cervical Cancer staging What stage can you do a cone?
1A1- nonvisible lesion with = 3 mm stromal invasion simple hyst is okay as well.
55
Cervical Cancer staging If the lesion is visible, it is at least what stage?
1B1 1B1 <2cm 1B3 >4cm
56
Cervical Cancer staging If the patient has hydronephrosis, she is at least what stage?
3B
57
Cervical Cancer staging What stages get rad hyst? What if she wants future fertility?
IA2 thru 2A nonvisible lesion with 3-5mm of invasion up through visible lesion in upper 2/3 of the vagina radical trachalectomy for 1b1 and 1a2
58
Margins of a rad hyst
parametrial, pelvic lymph nodes, upper 2 cm of vagina
59
Who gets chemo/rads?
Stage II-4B
60
Consequences of DES exposure
``` cervico-vaginal clear cell CA congenital GU tract anomalies infertility, PTL, PTD CIN Vaginal adenosis HIgher risk of breast ca ```
61
-mammo and pap recommendations for pts with DES exposure
annual mammo | annual pap and colpo of cervix and upper vagina
62
Pt in her 40% with bartholins. next step?
must excise to rule out adenoma carcinoma
63
Vulvar cancer If pt has inguinal lymph node mets, what stage is that? What is the stromal invasion cut off for performing a lymphadnectomy?
stage 3 1mm
64
Vulvar skin cancer counseling and treatment basal cell
localized, rarely mets treat with wide local excision of 1cm margin
65
Vulvar skin cancer malignant melanoma ABCD
asymetry irregular borders color variation diameter >5mm
66
Vulvar skin cancer malignant melanoma treatment
Radical local excision >1mm--> 1cm margin 1-4mm --> 2cm margin > 4mm --> 3cm margin excellent chance for cure if pregnant, send placenta due to mets!
67
Which class of vulvar dysplasia is associated with lichen sclerosis
VIN differentiated type (dVIN) --->treat like high grade other types are low-grade, and high grade
68
postmenopausal woman presents with genital warts. next step?
biopsy because it could be vulvar dysplasia
69
Vulvar skin cancer treatment
excision, can consider laser, or topical treatments if no concern for occult invasion
70
Pagets dz of the vulva appearance
- red and velvety - white islands of hyperkeratosis, cupcake frosting appearance pruritis, will always have postitive margins
71
Pagets dz of the vulva histologic findings after biopsy
large, round cells, pale cystoplasm, cells may be clustered giving an acinar appearance stain for CEA and CK-7 to differentiate from melanoma
72
Pagets dz of the vulva what screening tests would you recommend to this patient?
I recommend mammogram, colonoscopy, CT looking for GU tumors
73
Pagets dz of the vulva treatment
wide local excision
74
Pap comes back with VAIN I next step?
slow progressing, retest in 1 year, colpo after 2 years if persistent, can extend to retest in 2-3 years or refer for treatment with laser
75
Pap comes back with VAIN 2/3 next step?
refer for treatment
76
Pagets dz of the vulva Where else can it manifest?
perianal, axilla
77
Ovarian Cancer Types
Epithelial-clear cell, high grade serous, low grade serous, endometrioid, mucinous Germ cell-dysgerminoma, endodermal sinus, embryonal, polyembryoma, choriocarcinoma, immature teratoma, (DEEP CT) Sex cord stromal-sertoli-laydig, granulosa metastic-GI
78
Most common type of ovarian cancer
high grade serous
79
Sex cord stromal Granulosa cell tumor age range tumor markers
<30 and >60 inhibin (A and) B, AMH secrete estrogen, but not monitored with estrogen, need EMB call exner bodies-rosettes coffee bean nuclei
80
Sex cord stromal Sertoli Leydig tumor age tumor markers treatment
20s and 30s testosterone oophorectomy in reproductive age women hyst BSO if postmenopausal -high survival
81
Germ Cell Cancer dysgerminoma tumor markers treatment
LDH bhcg leave other ovary and uterus in place if they look normal for all germ cell. most common malignant germ cell tumor
82
Which epithelial ovarian cancer patients should get referred for genetic testing?
ALL women with epithelial ovarian cancer except mucinous
83
Germ Cell Cancer immature teratoma tumor markers treatment
AFP Ca 125 at least unilateral BSO. if stage 1A grade 1 then no adjuvent therapy (BEP) immature neural components determine the grade
84
Lynch Syndrome patients routine screening
- colonoscopy q1-2 year starting at age 25 - annual UA to screen for GU cancers - hyst BSO in early 40s after EMB
85
Germ Cell Cancer endodermal sinus (yolk sac) histology tumor markers treatment
Schiller-duval bodies, aggressive, rupture in abdomen with hemorrhage AFP unilateral BSO, responds to chemo and every needs chemo
86
Germ Cell Tumor chemo regimen
BEP bleomycin etopiside cisplatnin
87
What is the OVA1 test?
screening tool as to whether or not GYN ONC referral is needed pre-operatively combines CA 125, transferrin, prealbumin, apolipoprotein AI, and Beta2 microglobulin pre-menopausal >5 and post >4.4 call ONC
88
Epithelial ovarian cancer chemo regimen
carboplatin and paclitaxal
89
Borderline tumors are precursors to what type of ovarian cancer
low grade serous
90
EIN = complex atypical hyperplasia What about endometrial hyperplasia without atypia? Management
Weight loss D+C MRI Progestin therapy for example IUD provera 30mg daily EMB q 3 months then surgical management

OBGYN Oral Boards (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions