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MKSAP - Internal > Oncology > Flashcards

Flashcards in Oncology Deck (41)
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next step with a BiRADs 2/3?

Breast USG - differentiates between cystic and solid masses


next step with a BiRADS 4/5?

fine needle aspiration or biopsy of nodule must be done


when should you test for BRCA1/2 mutations?

in women who appear to have genetic risk i.e. multiple relatives w/ breast or ovarian cancer, esp. early onset disease


young woman has a persisent, scaling, eczematous and ulcerated lesion over her nipple/areola; this lesion does not respond to medications - what should you consider?

Paget's dz of the nipple
- do a biopsy


Biopsy finding in Paget's dz of nipple?

malignant, intraepithelial adenocarcinoma cells w/in epidermis of nipple associated w/ underlying invasive ductal cancer


lichen simplex chronicus

localized disorder with intense pruritus, which leads to localized areas of thickened skin with increased and exagerated skin markings due to scratching


a women presents with a palpable breast mass but mammography comes back negative, what is the next best step?

fine-needle aspiration OR ultrasonagraphy


what do you recommend to a woman who just had cyst aspiration of her breast?

come back in 4-6 weeks to evaluate for recurrence or presence of residual lump


in whom should tumor estrogen/progesterone receptor assay be done?

patients with early stage breast cancer to determine optimal systemic therapy


breast conserving therapy

breast lumpectomy + radiation therapy


when do you perform axillary node dissection?

when sentinel LN shows metastatic involvement


screening for CRC in a person with a positive family history of CRC

start screening at age 40 or 10 years earlier than diagnosis of affected member; if normal colonscopy, repeat ever 3-5 years


when do you test for mutations of the APC gene?

in pts with polyposis


screening for CRC in normal-risk people

beginning age 50, then every 10 years if result is normal


screening recommendations for pts with IBD

annual colonoscopy beginning 8 years after diagnosis- take random biopsies in four-quadrants to evaluate for dysplastic changes


what test do you do in a pt presenting with signs of colon cancer?



findings that should prompt investigation for CRC

rectal or abdominal mass
abdominal tenderness
iron deficiency anemia


when can you choose flexible sigmoidoscopy over colonscopy?

pts < 40 yo with rectal bleeding


what is the appropriate follow-up for an asymptomatic patient with a positive FOBT sample?



what is capsule endoscopy used for?

visualization of the small bowel


how do you screen for lung cancer?

you dont


what is the appropriate follow-up in a pt who was found to have a 3 mm pulmonary nodule (incidental finding from abdominal CT)?

no further testing needed for pulm nodules < 4 mm bc risk of malignancy is extremely low in low risk patients; if the patient is at high risk for lung cancer, follow-up is with CT-scan at 12 months


first line management of someone with limited SCLC?

chemotherapy plus radiation therapy
- combo of carboplatin/cisplatin and etoposide/irinotecan


what is the next step in a man who comes in with a rising PSA (> 0.75 ng/ml/year)?

do a transrectal biopsy - even if pt is asymptomatic and DRE is non-specific


what is the appropriate screening method for prostate cancer?

inform patient about risks and benefits of screening; offer PSA testing to patients > 50 years old; no screening for men over 75


how do you tx. metastatic prostate cancer?

androgen deprivation therapy, w/ leuprolide or surgical castration (orchiectomy)
- leuprolide should be given with brief course of flutamide to prevent tumor flare


what is docetaxal+prednisone therapy used for?

patients with hormone-refractory prostate cancer


samarium 153 - what is this useful for?

radionuclide taken up by bone - useful in treating prostate cancer with painful bone mets that is unresponsive to other therapies


what is the next step in a female who has ASCUS on pap smear?

test for HPV
- if positive, do a colposcopy w/ biopsy


for whom in the HPV vaccine recommended for?

all girls and women between ages 9-26 regardless of sexual activity; high success rates for preventing infections with HPV strains 6,11,16 and 18