This is the real torture deck though Flashcards
(1083 cards)
1
Q
Young woman - failed mtx, switch to what regimen?
A
Act D, Pulsed Act D, EMACO
2
Q
XRT vs brachy - which sx is shared?
A
Fatigue, vaginal stenosis
3
Q
Wrist drop
A
C5-C8 Radial nerve palsy
4
Q
Why is PEEP important for tx of ARDS?
A
Reduces FiO2 requirement with recruitment of alveoli
5
Q
WHO score - what has greatest impact: the one worth 4 points?
A
> 12 months, Liver/Brain/>100,000, pregnancy, interval months from index pregnancy > 12 months, GI met
6
Q
Which pressor not use in sepsis?
A
Dobutamine
Dobutamine - not a pressor but an inotrope, associated with hypotension, usually used for cardiogenic failure
7
Q
Which population of pts did not need MRI for screening along with mammogram?
A
Lifetime risk 15-20%, LCIS or ALH, ADH, dense breasts, personal hx of breast cancer including DCiS, <15% risk
8
Q
Which pathway is TNF-beta part of?
A
Extrinsic pathway of apoptosis
9
Q
Which opioid has the longest half life?
A
Methadone
10
Q
Which of the following is least likely to be associated with BRCA2?
A
Colon
small bowel, biliary, GU, breast, ovarian, colon
11
Q
Which is not in a proliferation pathway?
A
BAX
12
Q
Which is not associated with breast cancer?
A
MEN2
B. MEN2 (multiple endocrine neoplasia)
13
Q
Which is not a GF treatment targeted?
A
MTOR
so everolimus (aka affinitor) binds to FK binding protein to modulate activity of mTOR
14
Q
Which is not a gap acidosis Mnemonic for anion gap metabolic acidosis?
A
hyperchloremic (urinary diversion)
RTA (and diarrhea) and pancreatic leak
15
Q
Which is not a branch of the femoral artery?
A
Deep circumflex
16
Q
Which is most likely to cause non-gap acidosis?
A
Pancreatic leak
17
Q
Which is most likely to be a factor in oxygen enhancement ratio?
A
Tx of groins in vulvar ca, adjuvant tx to Pa nodes, 6 cm cervical mass
18
Q
Which is least attributed to OSA?
A
Cardiac arrythmia
19
Q
Which is least affected?
A
Selenium deficiency
20
Q
Which is a direct (rather than indirect) effect of radiation?
A
LET
21
Q
Which has the least ionotropy?
A
Phenylephrine
22
Q
Which gene is not breast cancer risk related?
A
APC
APC (familial adenomatous polyposis)
23
Q
Which factor leads to poor outcome in treatment of ovca with Her2neu?
A
No amplification of ERB2
24
Q
Which drug is a vesicant?
A
Vincas, Doxorubicin, Mitomycin, Dactinomycin, Trabectedin
25
Which drug increases platelets?
IL-11
## Footnote
actually used for ppx against thrombocytopenia!
26
Which chemo not active in S phase?
Taxol
27
Which chemo leads to amenorrhea in young woman?
Cisplatin
28
Which chemo don't have to renally dose?
Taxanes, Anthracyclines, Vincas
29
Which chemo are pro-drugs?
Capecitabine, cyclophosphamide, ifosfamide, gemcitabine, 5FU, dacarbazine
30
Which agent is cell cycle specific?
Taxanes, Vincas (M), Tamox (G1), BCNU (G1), Bleo/Etop (G2)
31
Where does the SMV drain?
Portal vein
32
Where does the IMV drain?
Splenic --> portal vein
33
Where does superficial epigastric come from?
Femoral artery
34
Where does internal pudendal come from?
Ant division of internal iliac
35
Where does external pudendal come from?
Femoral artery
36
Where does deep/inferior epigastric come from?
External iliac, which then becomes femoral after
37
Where do growth factors act?
Extracellular
## Footnote
extracellular signaling between cells
38
Where are progesterone receptors located?
Nucleus
39
Where are estrogen receptors located?
Transmembrane
40
When would you use a one tailed versus a two tailed?
When the alternative hypothesis only goes in one direction
41
When would you use 21 gene RT-PCR (aka oncotype Dx)?
if ER pos, Her2neu neg, LN pos early-stage invasive breast cancer with ER+, Her2- cancers
42
When is bev held?
Proteinuria >2g or BP > 180/110
43
What would adding TVUS do to elevated CA-125 screening value?
Improve Sensitivity
44
What were interferons originally thought to do?
Inhibit viral infection or interfering with viral machinery
45
What variable not used for power calculation?
Chi Square
46
What toxicity does mtx not have? What 'rescue' med is available?
Cardiotox
## Footnote
Leucovorin - derivative of folic acid
47
What to do if recognized pancreatic injury during debulk?
Place pelvic drain
48
What to do if on vent and low PaO2?
Increase FiO2
49
What to do if on vent and hypercapnea?
Increase TV and RR
50
What rad/xrt is used to treat superficial lesions (aka skin)?
Electrons
51
What preop abx is most associated with cdiff?
Clinda and 3rd/4th Gen Cephalosporins
52
What part of her2 is the target of intervention?
Extracellular portion
53
What nerve injury with foot drop?
Common peroneal nerve
54
What medical belief is aligned pt wanting to do 5th line chemo after bowel obstruction?
Autonomy
55
What med to give someone with normal wedge pressure and hypotension?
Phenylephrine
56
What lymph nodes drain below the pectineate line?
Superficial Inguinal
57
What is the other name for the protein CA125?
MUC16
58
What is the most common side effect of amifostine?
Hypotension
59
What is the least likely complication associated with extensive terminal ileum resection?
Intrinsic Factor
60
What is the least likely cancer in a pregnant patient with no history of malignancy?
Colon
61
What is the LEAST appropriate palliative intervention in a woman with a 12 cm cecum and malignant sigmoid lesion?
Gastric tube
62
What is the function of iressa? (generic: gefitinib)
Acts against EGFR mutations
63
What is the LEAST appropriate palliative intervention in a woman with a 12 cm cecum and malignant sigmoid lesion?
Gastric tube (too proximal)
64
What is the function of iressa? (generic: gefitinib)
EGFR acts against EGFR mutations (EGFR inhibitor)
65
What is the elemental source for brachytherapy/interstitial?
Iridium 72 days
## Footnote
Iridium (this one), cesium
66
What is the dose limiting toxicity of irinotecan?
Diarrhea
## Footnote
Diarrhea occurring during infusion - responsive to atropine (anti-cholinergic). Occurring subacute 2-3 weeks after is not responsive to that, so use anti-motility. Can be life-threatening.
67
What is the depth of dose for 12 MeV in radiation?
4cm
## Footnote
4 cm (R90 where beyond <90% of dose is administered)
68
What is the definition of linear energy transfer (LET)?
The rate of deposition of energy along the path of the radiation beam
## Footnote
Amount of energy transferred to local environment in form of ionizations and excitations. Average energy for a given path length traveled. Average path length for a given deposited energy. Unit = kEV/um.
69
What is the cause of refractory hypokalemia in the setting of K replacement?
low Mag
## Footnote
Bicarb, hypomag (this one), phosphorus, calcium. Patients with hypokalemia may also have hypomagnesemia due to concurrent loss with diarrhea or diuretic therapy or, in patients with hypomagnesemia as the primary abnormality, renal potassium wasting. Such patients can be refractory to potassium replacement alone. Thus, measurement of serum magnesium should be considered in patients with hypokalemia and, if present, hypomagnesemia should be treated.
70
What is the advantage of protons over electrons in radiation?
Protons are extremely precise
## Footnote
Dose stops at precise place due to Bragg peak (electrons are less precise; most of the dose is delivered 0.5-3 cm from patient's skin and then gradually loses energy until reaches its target; affecting non-target tissues).
71
What is most predictive of LN mets in pt with 3cm vulvar cancer 1 cm from midline?
Depth of invasion, contralateral LN pos (this one), tumor size, LVSI
72
What is methylation?
Epigenetic change
## Footnote
Methylation of cytosine residues residing next to guanine residues CpG dinucleotides, methylation silences gene expression. Not a SNP.
73
What is measure of intraobserver variability?
Kappa
74
What is the major reason to heat blood when transfusing during major intraop blood loss?
Maintain function of platelets and clotting factors
## Footnote
Viscosity, impact on plt (this one), other. Hypothermia decreases enzymatic activity of clotting factors and reduces # and fn of platelets.
75
What is least associated with ACOG colonoscopy recommendations?
D. double contrast barium enema
76
What is high LET radiation?
Neutron
## Footnote
High LET = alpha, neutrons. Low LET = electrons, gamma rays, and x-rays (both electromagnetic radiation).
77
What is better 6 month long term LSC vs. LAP endom ca staging?
LSC
## Footnote
LSC - physical function, QOL, scar, pain.
78
What is associated with worse IP chemo administration?
Smaller mol weight
## Footnote
For ideal IP: large molecular weight size, high conc in peritoneum, no need for liver activation, high volume. Low vol increases clearance which is bad.
79
What is associated with increasing opiate dose?
Tolerance
## Footnote
Tolerance associated with increasing dose (THIS ONE), dependence, 2 other choices.
80
What is % dose of XRT 1 cm vs 2 cm from source?
400
## Footnote
400%; because dose ~ 1/r squared.
81
What has been associated with decreased infection in groin dissection?
Preserve saphenous vein, don't use thrombin
## Footnote
Saphenous v. sparing.
82
What happens with TP53 mutation?
Bind to WT and inactivate (this one), directly impair DNA
## Footnote
p53 activates DNA repair proteins after DNA damage, arrests at G1/S after DNA damage, can initiate apoptosis.
83
What gives off the right gastroepiploic artery?
R gastroduodenal
## Footnote
Gastroduodenal artery.
84
What factors are important for power calculation?
Effect size, sample size
85
What drug is PPE associated with?
Doxil (not a choice); Xeloda aka capecitabine (15-20%)
86
What does ROC curve measure?
Optimal is upper left corner where false positive rate is 0 and true positive rate is 1
## Footnote
Diagonal through the center represents 'random' so if above it, 'better than random'. x-axis = False positive rate (or 1-specificity) and y-axis = True positive rate (or sensitivity). Each point on the ROC curve represents a sensitivity/specificity pair corresponding to a particular decision threshold.
87
What does not interact with imatinib?
EGFR
## Footnote
EGFR (this one), do interact: ckit, ABL, PDGFR.
88
What does more PEEP do to cardiac output?
Decreases
## Footnote
Decreases cardiac output (reduces right heart filling and thus decreased stroke volume); decreases PCWP.
89
What distinguishes PSTT from choriocarcinoma?
Intermediate trophoblasts, HPL
## Footnote
INTERMEDIATE trophoblasts, HPL and lower hCG.
90
What distinguishes endometrial stromal nodule from low grade ESS?
LVSI
## Footnote
Mitosis, atypia, spiral arterioles, LVSI (THIS ONE).
91
What chemo is most associated with constipation?
Vincas
## Footnote
Vincristine.
92
What chemo is primarily renally cleared?
A BICC THEM
## Footnote
Bleomycin.
93
What chemo blocks depolymerization of tubulins?
Taxanes
## Footnote
Taxol (vincas block polymerization).
94
What chemo cannot be given IP?
Any pro drug
## Footnote
Cyclophosphamide (or any of the prodrugs that require activation in the liver!).
95
What cancer type has the least acute effects?
Ovary, vagina (THIS ONE), bladder, small intestine
96
What artery is transected with en bloc rectosigmoid resection?
Superior Rectal
## Footnote
Superior rectal a (this one), inferior rectal a, marginal a of Drummond.
97
What are the parameters for carbo calculator?
Weight, Sex, Age, Cr
## Footnote
Age, CrCl (height), gender, weight, AUC.
98
What are G coupled receptors?
7 membrane spanning proteins that are activated with GTP then self hydrolyze to GDP and turn off
99
What abx is not renally cleared?
Flagyl
100
What is included in innate immunity?
Present at birth. NK, macrophages, dendritic cells
101
What is included in acquired immunity?
T cells and B cells
102
What is Calvert's formula?
AUC x (GFR + 25)
103
What element is required in RBC production?
Copper
104
Which is not associated with blind loop syndrome?
Overgrowth of bacteria, fat malabosprtion, Fe def, diarrhea, vitamin B12 def (answer: Fe def)
105
How much ileum resection will result in B12 deficiency?
60 cm
106
How much ileum resection will disrupt bile salt/fat malabsorption?
100 cm
107
Oxygen dissociation curve - to the right means what?
Hgb has less affinity for O2 so harer to bind but releases it more readily
108
What causes right shift of oxygen dissociation curve?
CADET - face RIGHT. Increased CO2, acidosis, elevated DPG, exercise, temp.
109
What is a normal TV setting based on weight?
10-15 cc/kg
110
What is a normal A-a gradient?
10-15 mmHg
111
What does PCWP approximate?
LA pressure
112
Are psammoma bodies in high grade serous ovary good or bad?
Good/favorable prognosis
113
Do complete or incomplete moles have villous capillaries present?
Partial mole have villous capillaries intact - maybe b/c there is a whole fetus there?
114
Which patients with Bartholin's gland adeno need LND?
All - 20% risk of LN mets
115
How deep laser in non hair bearing?
1 mm
116
How deep laser in hair bearing?
3 mm
117
Which germ cell tumors do NOT need chemo?
Stage I dysgerm, stage I low grade immature
118
What nervse are Klumpke's
C8-T1, claw hand
119
What nerves are Erb's palsy
C5-C6 (can happen from t-burg), cannot lift arm above head
120
What is ipilimuab?
Monoclonal ab for CTL-4 - for melanoma
121
What cells make hCG?
Syncytiotrophoblast
122
What makes up OVA1
CA-125, transthyretin (pre-albumin), Apo A-1, Beta2 microglobulin, transferrin
123
What stain is used for melanoma?
S100
124
Role of LND for vulvar melanoma?
Strictly prognostic, so +/-
125
What are the phases of wound healing?
Coagulation (mast cells, histamines, fibrin clot, vasoconstriction) Inflammatory response (release of PMNs, macrophages) Fibroplasia (collagen deposition) Remodeling
126
Tensile strength at 10% for PDS
56 days / 8w
127
Tensile strength at 10% for polyslycolic acid (vicryl)
28 days / 4w
128
Tensile strength at 10% for chromic catgut
14 days / 2w
129
Tensile strength at 10% for catgut
5 days / 1w
130
What is max total local lido w/o epi
300 mg
131
What is max total local lido w/ epi
500 mg
132
What is max mg/kg lido w/o epi
4 mg/kg
133
What is max mg/kg lido w/ epi
7 mg/kg
134
Tx for lidocaine tox
Usual supportive - use benzos for seizures
135
Definition of acute renal failure
Cr > 3x baseline or UOP 0.3 cc/kg/hr for 24h or 12 hours of anuria
136
Causes of hypocalcemia
Hyperphos, tumor lysis, acute pancreatitis, resp alkalosis, sepsis, osteoblastic mets, hypomag
137
Which diuretics may lead to HYPERKALEMIA
Triamterene (K sparing) or spironolactone
138
Which hyperK tx affect serum but not total K levels
Things that push into cells - B2 agonist, glucose/insulin, bicarb
139
Which hyperK tx affect both serum and total K levels
Kayexalate, dialysis, loop or thiazide diuretic
140
What is refeeding
Glu load leads to insulin, cells shift P and K into cells, can lead to life threatening hypoP and hypoK
141
What is pulsus paradoxus and associated with what?
Inspiratory fall in systolic blood pressure >10 mmHg, cardiac tamponade
142
When placing Swan ganz- where are you if you see dicrotic notch
PULMONARY VALVE
143
What cels secrete histamine
Basophils and Mast cells
144
Which cannot transmit CMV?
FFP (b/c no leukocytes)
145
Which factors are the following Fibrinogen Prothrombin Thrombin
Fibrinogen = factor I Prothrombin = factor II Thrombin = factor IIA
146
PTT
Intrinsic (PITT like pittsburgh)
147
PT
Extrinsic (PET like pets!)
148
Adverse effects from transfusion massive
HYPOcalcemia and alkalosis due to citrate tox
149
How long can you store RBC
42 days (6 wees)
150
What cell do dendritic cells and macrophages come from
Monocytes (myeloid origin)
151
Where are MHC I expressed
Most normal tissue except erythrocytes, plt, trophoblast, germ cells
152
Where are MHC II expressed
APCs, lymphocytes, inflammatory
153
Which cells are MHC restricted vs not
Restrict = T cells, macrophages; Not = natural killer cells, lymphocytes
154
If Swan-ganz will not wedge, what value most closely corresponds?
PA pressure
155
Most common organisms line infection
Coag neg staph, staph auerus, Enterococcus
156
Leading cuase neutropenic sepsis
Gram negative aerobics: ie Pseudomonas, Klebsiella, E coli
157
Tx of SVT
Adenosine
158
29 yo 6 cm cervix cancer, received 10Gy, has right TOA
MRH, BSO, LND (b/c the other ovary is dead)
159
Call Exner bodies
Granulosa cell
160
Schiller-Duval
endodermal sinus tumor
161
Multinucleated giant cells
Dysgerminoma
162
Crockroft-Gault
CrCl = 0.85 for female * (140-age)*(weight kg) / 72*Cr
163
What phase of the cell cycle is most radio-resistant?
Mid to late S and early G1
164
Most radiosensitive?
G2 and M
165
At what energies do certain radiotherapy principles dominate?
Photo electric effect (below 50 kEv) Compton scattering (100 kEV to 10 MeV) Pair production (greater than 1.02 MeV)
166
What affects response/sensitivity to radiation? (4 R's)
Repair (if fractionated, time for recovery of sublethal injury) Repopulation (growth of cells between fractors) Redistribution (depending what part of the cell cycle) Reoxygenation (oxygenated cells are 3x more sensitive to radiation)
167
Advantage of LET
Does not depend on O2 so effective for hypoxic tumors (oxygen enhancement ratio = 1)
168
What organ is most sensitive to radiation?
Kidney
169
Dose to sterilize ovaries?
1500-2000 cGY
170
How to calculate energy to get to certain depth
Depth in cm x 3 = amount of energy in MeV
171
How to decrease acute effects of radiation
Decrease total dose and treatment time --> affects mucosal cells
172
How to decrease chronic effects of radiation
Decrease DOSE PER FRACTION --> affects endothelial cells
173
What does the shoulder of the cell survival curve represent?
Sublethal damage that is repaired
174
What is the minimum amt of energy to cause ionization?
35 eV
175
Max dose small bowel
45 Gy (that's why dose for cvx is that? And required to sterilize occult dz for adjv radiation)
176
Max dose for bladder and rectum and lower 1/3 vagina
75 Gy
177
Vaginal cancer - intracavaity alone Add interstitial threshold Add EBRT threshold
<5 mm > 5mm > 2 cm
178
Radiation procttitis
Steroid suppositores, low residue diet, anti-motility drugs, hydration
179
Chronic radiation enteritis
Can try cholestyriamine
180
What radiation particle is decay of radioactive isotope
Gamma rays originate within the nucleus, emitted from radioisotope
181
What type of radiation is caused by deceleration of high energy electrons?
X-rays originate outside of nucleus and produced by bombardment of target with high speed electrons
182
Alpha particle
Two protons and two neutrons (i.e. He nucleus)
183
Beta particle
high speed electrons
184
What is Gompertzian tumor browth?
Double time increases as the tumor size increases
185
What shifts the cell survival curve to the left
Left = less radiation needed Oxygen and higher energy radiation
186
What is max fetal dose during pregnancy?
10 Gy
187
BRCA1, p53
17
188
BRCA2, Rb
13
189
PTEN
10
190
BRCA1 founder
AG/C (185delAG, 5382insC)
191
BRCA2 founder
T (6174delT)
192
What gene is for the CSF receptor?
Fms
193
Exons most mutated in p53
Exons 5-8
194
Most common p53 mutation?
Missense (one base chair that alters function) - celll compensates by trying to make more So would have increase in detectable p53 Compared to nonsense mutation where the protein is not made, so absence of p53
195
Best test to test for HPV?
PCR (this one), not IHC, FISH
196
What is loss of heterozygosity?
Heterozygosity when you have a mutation in one copy of tumor suppressor gene Can still make tumor suppressor protein With LOSS of heterozygostity, there is a second hit and now both genes are defective
197
Best test for aneuploidy
Flow cytometry for propidium iodide
198
What does labeling index do?
Measures proliferation and cells that have COMPLETED S phase
199
What does FISH measure?
Hybridize specific base pair sequence then lights up with fluorescence
200
What is the difference with adenoviruses for gene therapy
Adenoviruses (DNA viruses) not incorporated into host DNA Not replicated when cell divides, so requires re-administration
201
What is the ?limitation of retroviruses for gene therapy
Retroviruses (RNA viruses) only infect dividing cells and depend on reverse transcriptive (RNA to DNA) to allow the virus to integrate into the host genome and be continuously produced Disadvantage: this can lead to leukemia
202
What is ELISA
Enzyme-linked immunosorent assay Ab bound to plate to capture the antigen; also attached to enzyme that can convert some chemical into something that can be measured by color
203
What is a Southern blot?
Measures RNA
204
What is a Northern blot?
Measures DNA
205
What secretes IL-1?
Macrophages
206
What does IL-1 do?
Stimulates Th (cell mediated response) Stimulates maturation of B cells (antibody mediated response or humoral immunity) Macrophages (inflammatory response)
207
What do dendritic cells do?
Antigen presenting cells
208
How do you make monoclonal antibodies?
Fuse myeloma cells with mouse spleen cells immunized with desired antigen
209
What do natural killer cells do?
Lymphocyte programs tumor cells and cells infected by viruses Do not require activation (i.e., with MHC1)
210
First and most sensitive to blood loss?
Pulse/tachycardia
211
What to give if patient has low fibrinogen?
Cryoprecipitate
212
Most common ELECTROLYTE abnormality with TPN
Hypophosphatemia
213
What is malignant hyperthermia?
Reaction to anesthesia, tx with dantrolene, get rhabdo
214
Which are vitamin K dependent coag factors?
II, VII, IX, X
215
OR is closer to RR if prevalence is high or low?
Low
216
What to do if suspect air embolism after Swan Ganz
Left lateral and t-burg, try to aspirate
217
Describe nec fasc
Gray margins, irregular borders, erythema, lymphangitis (I don't think lymphangitis is seen)
218
What is associated with zinc deficiency?
ALOPECIA, DRY SKIN, growth retardation, decrease taste/smell, depression, impaired wound healing NOT arrhythmia
219
Where is zinc absorbed?
Small intestine
220
What is associated with selenium deficiency?
CHF, cmo, muscle degeneration, white nailbeds
221
What vitamin is part of glutathione peroxidase?
Selenium
222
Where is copper absorbed?
Stomach and small intenstine
223
What percentage of copper is bound to ceruloplasmin?
0.9
224
What is associated with copper deficiency?
Anemia, neutropenia, m. weakness, ataxia, depigmentation, neurologic abnormalities NOT bloody diarrhea
225
What is the Goldman cardic risk index?
For patients undergoing non-cardiac surgery cardiac risk factors to predict perioperative M&M
226
What is the risk of reinfarction <3 months and >6 months after MI?
30%; then 1-2%
227
What abx for high risk endocarditis undergoing dental procedure?
Amp
228
What abx for high risk endocarditis undergoing abdominal surg?
None!!
229
Ideal time to stop smoking before surgery?
4 weeks
230
Which does not cause an increased A-a gradient?
Shunting, V/Q mismatch, hypoventilation (this one)
231
What is the diff between AC/IMV/PC ventilation?
AC = assist control Triggered with patient's resp effort but if not intiiated will deliver a breat at pre-specified interval, patient can overbreathe the vent IMV = intermittent mandatory ventilation Initiates breath at prespecified intervals if patient doesn't (but not triggered by ptatient breath), problem can have increased work of breathing
232
What is the relationship between adjusted PCWP and ARDS vs CHF
Adjusted PCWP < 44 mmHg below colloid oncotic pressure - likely ARDS Adjusted PCWP > 44 mmHg above colloid oncotic pressure - likely CHF
233
What is the goal of phase I, II, III, IV trials?
I = max tolerated dose II = biologic activity III = usually RCT IV = large scale to see if can translate to larger population
234
What is the relationship between SD and variance
SD is square root of variance
235
What is smaller than the SD? How do you calculate it?
SEM (standard error of the mean) = SD / square root of n
236
Doing multiple t-tests results in more of what type of error?
Type I
237
Is chi-square parametric or non-parametric?
Non-parametric
238
Which is worse - micropapillary or microinvasion in borderline tumors?
micropapillary
239
What is pathognomic for endodermal sinus tumors?
Schiller duval bodies
240
What % of benign teratomas contain thyroid tissue?
0.1
241
What % of struma ovarii are malignant?
0.1
242
PvLN mets - cervix cancer
stage IA1 - 1% any stage IA2 - 7% any stage IB - 15% stage II - 25-45% stage III - 45-60%
243
PaLN mets - cervix cancer
stage IB - 5% stage II - 15-20% stage III - 30% stage IV - 30%
244
DES exposure - breast cancer risk
increased
245
DES exposure for CHILDREN - how much higher risk vaginal clear cell?
40x (the MOTHERS do not have any increased risk)
246
Do complete or incomplete moles have villous capillaries present?
Partial mole have villous capillaries intact - maybe b/c there is a whole fetus there?
247
Which is not associated with GTD risk
Extremes of age, prior mole, low beta carotene, low fat, NLRP7 gene mut, Asian High animal fat intake (this one)
248
Basis of grading for immature teratoma?
Amount of neuroepithelium
249
What % dysgerminomas are bilateral?
10-15%
250
How often hair bearing areas involved with VIN?
0.5
251
What is the sensitiity of mammogram?
80-90%
252
What is the specificity of mammogram?
0.94
253
What % breast cancers are Her2+?
0.2
254
What % breast cancers are triple negative?
0.15
255
Which germ cell tumors do NOT need chemo?
Stage I dysgerm, stage I low grade immature
256
What is dose of EBRT for breast cancer
50Gy, if adj 10-15 Gy
257
What nerves are brachial plexus injury
C5-T1
258
Vemurafenib or dabrafenib to tx who/what?
Melanoma BRAF mutations
259
What cells make hCG?
Syncytiotrophoblast
260
What makes up OVA1
CA-125, transthyretin (pre-albumin), Apo A-1, Beta2 microglobulin, transferrin
261
What tumor marker is elevated for PSTT
HPL
262
Where is Breslow's depth measured from for melanoma?
From granular layer of surface epithelium
263
What are the levels of Clark
Level 1 = in situ Level 2 = through BM Level 3 = through papillary dermis Level 4 = through reticular dermis (survival starts to drop off from 90% or higher to 67%) Level 5 = through subcutaneous fat (33%)
264
What are the levels of Breslow
Level 1 = 0.75mm Level 2 = 0.75-1.5mm Level 3 = 1.5-4mm Level 4 = > 4mm
265
Where does the splenic artery run in relation to pancreas?
Superior to pancreas
266
What % is pancreas within 1 cm of splenic hilum
75% - so be careful
267
For transureteroureterostomy - where should it run in relation to IMA and great vessels
In front of great vessels can be in front of or behind IMA
268
What is the 10 year and lifetime risk of sepsis in a patient who has undergone splenectomy
5-year risk of sepsis: 7% Lifetime risk of sepsis: 25%
269
How often should spleenctomy patients get vaccinated?
Every 5 years
270
Which invade first PMNs or macrophages?
PMNs
271
Least important consideration for refluex in continent conduit
Ileal length -detubularizing eliminates peristalsis, longer colon segment = more capacity, ureteral insertion impt
272
Is dialysis useful for lidocaine overdose
No
273
Tx for lidocaine tox
Usual supportive - use benzos for seizures
274
How to calculate SVR
(MAP-CVP)/CO (SV x HR)
275
Most common abnormality in DIC
D-dimer elevation
276
Indications for dialysis
Uncontrolled hyperkalemia, acidosis, vol overload, uremic sx (i.e., pericarditis, neuropathy, AMS, coagulopathy)
277
Sx of hypercalcemia
Stones, bones, groans, psych overtones
278
Most common cause of hypercalcemia
HyperPTH
279
What drugs cause hypocalcemia
AG, cimetidine, heparin, theophylline
280
Calcium correction for albumin
For every 1 mg/dl decrease in albumin, increase calcium level by 0.8
281
Most abundant electrolyte in body?
Ca (bones!)
282
Most abundant extracellular cation
Na
283
Most abundant intracellular cation
K
284
What electrolyte issues can you give lasix (loop diuretic)
HyperK and HyperMg
285
What drugs cause hypoMg
AG, dig, cisplatin, loop diuretics, thiazide diuretics
286
Which diuretics may lead to HYPERKALEMIA
Triamterene (K sparing) or spironolactone
287
Which hyperK tx affect serum but not total K levels
Things that push into cells - B2 agonist, glucose/insulin, bicarb
288
Which hyperK tx affect both serum and total K levels
Kayexalate, dialysis, loop or thiazide diuretic
289
Sx of hypokalemia
Weakness, decreased DTR, mental status change, ileus, cardiac issues
290
Which is not a tx for short bowel syndrome?
Agents to slow intestines, nutritional support, octreotide (this one - b/c stomach), B12
291
What changes occur with short bowel syndrome to intestinal villi
Hypertrophy
292
Essential fatty acids
Omega 6 (linoleic acid) and Ometa 3 (alpha-linoleic acid)
293
What is the half life of pre-albumin
3 days
294
What is the half life of albumin
20 days / 3w
295
Calorie requirement based on weight for TPN
30 kcal/kg/day
296
Types of nec fasc I and II
Type I: aneaerobic/aerobic Type II: group A strep or other beta emolytic strep +/- staph aureus
297
Hyponatremia correction rate to avoid wha tcomplication
9 meQ/L/24h to avoid central pontine myelinolysis
298
Which is least likely to affect A-a gradient
ARDS, hypovent (this one), PNA, pulm edema, PE
299
Electrolyte abnormalities for hypoaldosteronism
Low Na, High K
300
Tx for HYPOaldosteronism
Steroids
301
Tx for HYPERaldosteronism
Sprionolactone
302
Main electrolyte abnromalities for HYPERaldosteronism
Low K
303
Best predictor of weaning off vent (what is number)
Rapid shallow breathing index (RR/TV); good if RSBI <105
304
What is contraindication to PA catheter placement
LBBB
305
What is measure of preload
PCWP
306
What is measure of afterload
SVR
307
What is the enzyme assoc with COPD
alpha-1-trypsin
308
Adverse effects from transfusion massive
HYPOcalcemia and alkalosis due to citrate tox
309
How long can you store RBC
42 days (6 wees)
310
What do CD4 cells do
B cell differentiation, CD8 proliferation, cytotoxic effector cells, recognitize MHC II
311
What do CD8 cells do
Suppress antibody synthesis, act as cytotoxic effector cells, recognize MHC1
312
Immunoglobulin function A, D, E, G, M
A = first response D = directs macrophages, dendritic cells E = allergy G = 2nd line Ab M = 1st line Ab
313
Null cells that don't express cell surface antigens
i.e., lymphocytes i.e., NK cells
314
Which cells are MHC restricted vs not
Restrict = T cells, macrophages; Not = natural killer cells, lymphocytes
315
What is a potent stimulator of T cells
IL-2
316
Where is ERBB2 (aka Her2) primarily expressed
Epithelial cells
317
Where is EGFR expressed
Epithelial and stromal cells
318
Another name for lesser omentum
Gastrohepatic ligament
319
What is the portal triad and what is it enclosed by
Bile duct, hepatic a, portal v, encased by hepatoduodenal ligament
320
What supplies the sartorious muscle? And tensor fascia lata
LATERAL femoral circumflex (v. medial for the gracilis)
321
What separates the subclavian artery and vein?
Anterior scalene muscle
322
What is the venous drainage above and below the pectineate line?
internal iliac above, superficial inguinal LN below
323
What is epo production stimulated by?
Decreased O2 in the renal artery
324
If Swan-ganz will not wedge, what value most closely corresponds?
PA pressure
325
ABG for PE
Alkalotic (tachypneach), decreased CO2 and PaO2; elevated A-a gradient
326
Malnutrition definition
Progressive weight loss >10% of desired body weight for age/sex
327
Most common injury L/S
Bowel
328
Nerves that are MOTOR and SENSORY
Pudendal, obturator, femoral
329
What GTD is more important for hyst
PSTT since chemoresistant
330
Tamox least likely to be associated with what benign
Hyperplasia wihtout atypia > Endometrial polyps > Endometriosis > Ovarian cysts > Fibroids
331
Average doubling time of tumors
50 days
332
What subunit of HCG is shared with other hormones
Alpha same as LH, FSH, TSH; beta is distinct
333
Innervation of bladder
S2-S4, parasympathetic - inferior hypogastric plexus, sympathetic - superior hypogastric pleux
334
Type of bladder malfunction after radhyst
Neurogenic (retention)
335
What nodes do cervical cancer drain to first?
Internal iliac nodes
336
Most common tumor in dysgenetic gonads
Gonadoblastoma (benign)
337
Most common malignant tumor in dysgenetic gonads
Dysgerminoma
338
Tamoxifen vs. raloxifene
Both anti-est in breast (tamox stronger than raloxifene, but raloxifene less risk VTE) Tamox pro-est in endometrium, but raloxifene is not Both pro-est in the bone
339
1 mg tumor = how many cells
10^6
340
1 cubic cm tumor = how many cells
10^9
341
What are static cells?
Well-differentiated that rarely undergo division as adults (ie neurons, oocytes, striated m, nephrons
342
What are expanding cells?
Normally quiescent but grow under stress/injury (ie hepatocytes, vascular endothelium
343
What are renewing cells
Constantly replicating (ie BM, epidermis, GI
344
First order cell kill kinetics
Constant FRACTION of cells killed with each treatment
345
To achieve "cure" how many tumor cells left
10-10K
346
What is Goldi-Coldman hypothesis?
Mutation towards drug resistance occurs spontaneously at a rate of 1 mut/million cell divisions or more Thus, as mass increases, likelihood of spontaneous mutation increases and drug exposure further increases mutations
347
What are the boundarie of the inguinal triangle
Rectus muscle, inferior epigastric artery, inguinal ligament
348
BRCA prevalence in Ashkenazi Jews
BRCA1 1.5%, BRCA2 1%
349
Mechanism of apoptosis (3 phases)
initiation, effector, degradation
350
Which is least emetogenic? Carbo, vinca, doxorubicin
Vincas
351
Which chemo is activated within a tumor cell?
Xeloda
352
When is LET best used?
necrotic tumor
353
IMRT differs from 4-field radiation in all ways except:
Delivers same dose
354
Most common side effect of whole pelvic XRT
ileum (this one), rectum, bladder, ureter
355
Which has highest LET?
alpha particle > neutron
356
Which does not come off the femoral nerve?
Deep circumflex (this one), superficial circumflex, external pudendal
357
What ligaments taken down for liver mobilization?
falciform, coronary, right triangular ligament
358
During inguinal LND, use of fibrin sealants increases risk of?
Infection (this one), drainage from site, wound separation
359
Most common complication after splenectomy?
Transient bacteremia with encapsulated organisms (This one), left atelectasis, abscess, pancreatic leak
360
Antibiotic to cause Achilles tendon rupture
Cipro
361
Antibiotic that causes pulmonary fibrosis
Macrobid
362
Medicine class most associated with delirium in elderly post-operative patients?
Benzos (This one), anticholinergics
363
What is least likely complication of premenopausal BSO?
Kidney stones (This one), anxiety/depression, CV dz, metabolic syndrome
364
What differentiates LMS from undifferentiated uterine sarcoma?
Cytologic atypia to the extent that they cannot recognize as arising from endometrial stroma
365
18yo with adnexal mass, alpha antitrypsin 1 staining?
Yolk sac tumor
366
Most predictive of postoperative cardiac performance?
Dobutamine stress test
367
What electrolyte abnormalities from massive transfusion?
HyperK, HypoCa
368
Ideal ROC curve AUC
Higher AUC, the more accurate
369
Difference in number of people who get a disease exposed to a risk minus people with a disease not exposed to a risk
Attributable risk (this one), absolute risk, risk difference
370
Which growth factors bind to serine-threonine kinase receptor?
Peptide growth factors
371
was there a difference in QOL during or after IP therapy
worse during and 6 weeks after
372
70 yo with DM, HTN, AFIB sp TLH/BSO what anti caog post op
lovenox
373
which is a watershed area
splenic flexure
374
what is a non specific immune modulator
interferon
375
MOA of ipilmumam
CTLA4
376
WHAT AFFECTS SAMPLE SIZE IN CLINICAL STUDIES
confidence interval
377
What affects HDR
applicator, distance and source
378
what opiate causes prolonged QT and torsades
methadone
379
what makes a tumor antigen a good immune target
expression on sell surface
380
what happens with trendelenburg and pneumoperitoneum
increase in CVP, PCRP, SVR, MAP and decrease in CO
381
Branches of the internal iliac "Posterior: ILS (iliolumbar
lateral sacral
382
Best initial test to start with to evaluate smoking and certain type of cancer Prospective RCT
case control (good initial study)
383
Base of the femoral triangle Pectineous*
iliopsoas
384
AMG386 (Trebananib) - What does this target? "AMG386 aka trebananib= angiopoietin (Ang) 1 and 2 neutralizing peptibody placental growth factor
hypoxia alpha something
385
AI most common side effect Arthralgias (15-20%)
HA (9-15%)
386
Afib in setting of heart failure in postop pt
how to treat acutely "Metop (this one if they are stable; multiple RCTs show decreased mortality with BB; **Initial tx should utilize rate control and diuretics)
387
Abdominal compartment syndrome "Measurement of bladder pressure (not imaging!) Conservative mgmt: avoiding positive fluid balance after initial resuscitation
evac intraluminal contents
388
% breast cancer risk reduction with oophorectomy in BRCA pos women
50%
389
know electrolytes abnormalities and ECG changes **At least 3 questions** "Hypercalcemia – shortened QT
Hypocalcemia – lengthened QT; Hypokalemia – flattened or inverted T waves
390
What test to use to compare mean among three groups
ANOVA
391
Most common mutation in mucinous ovarian cancer (p53
KRAS
392
What vessel is most commonly encountered in femoral triangle deep external pudendal
(femoral artery)
393
What effect does ionizing radiation have on DNA that results in largest impact (double strand break
single strand break
394
What is the best timing of vaccination after spelenctomy 2 weeks preop (choices: 1 day
10 days
395
What is most diagnostic of ARDS "bilateral pulm infiltrates
Pa/FiO2 ratio<200 (this one)
396
PPV is dependent on
Prevalence
397
What is the difference between cardiogenic and hypovolemic shock (PCWP = LA pressure) cardiogenic (high PCWP)
hypovolemic (low PCWP). PCWP better than BP
398
Which chemo requires adjustment for renal compromise Bleomycin
Cisplatin
399
Which chemo requires adjustment for liver compromise MTV3DC – methotrexate
taxotere
400
PARP inhibitors (multiple questions) **Need to know how side effect profiles differ between olaparib
rucaparib
401
What is the best adjuvant treatment for a pt s/p rad hyst with positive lymph node? Pelvic RT + chemo (cisplatin preferred) (Peters criteria
GOG 109: +LN
402
What nerve injury is associated with numbness over the thigh after a pelvic LND?
genfem
403
longest half life radio isotopes:
Cesium
404
Most common side effect of neurontin/gabapentin
dizziness
405
Superior border EBRT L4-5 interspace - this one
L4 verterbral body
406
What's the mechanism of action for Topotecan
Traps topoisomerase I on DNA causing unrepaired ssDNA break
407
PD-1 limits what? **Two nearly identical questions**
T-cell ACTIVATION
408
Which needs renal dosing more (etoposide vs. bleo)
- since both are renally cleared Bleo
409
Pre-renal findings urine osm high (this one) - not urine NA high
urine/plasma cr
410
Old lady
ppx lovenox after surgeyr
411
Phase III for platinum resistant recurrent ovarian cancer cytoxan/avastin
taxol/avastin (this one)
412
Floor of the femoral triangle
Medial --> Lateral: pectineous, psoas, iliacus "PPI"
413
Blood supply to gracilis
Medial femoral circumflex artery
414
Most likely to disrupt ilioinguinal nerve
Transverse incision
415
Sensory loss of anterior thigh after surgery
Genitofemoral nerve (femoral does anterio-medial and motor deficits)
416
Most likely cause of foot drop
Common peroneal nerve (branch from femoral; L4-5, S1)
417
Describe Apoptosis
418
Describe PI3k pathway
419
Describe PARP inhibitor mechanism
PARP prevent repair of SINGLE STRAND dna breaks. In HRD (BRCA) cells, they lack the capacity to repair these and ultimately turns into double strand breaks
420
Describe IGF1 and endometrial cancer
insulin DECREASES insulin like growth factor binding protein, which then ultimately INCREASES IGF-1. IGF-1 receptor --> upregulates PI3K/AKT/MTOR pathway, RAS/REF/MEK/ERK pathway --> transcriptional activation (proliferation, cell survival, growth) --> increased estrogen.
421
Estrogen receptor
Without hormone --> receptor in the cytosol. Hormone present --> binds --> migrates into nucleus, forms dimer and binds to specific sequences of DNA to regulate different genes -- it is a transcription factor. Some cell surface membrane receptors; complexes with G protiens, tyrosine kinases (i.e. EGFR and IGF-1) --> MAPK pathway and PI3K/AKT pathway.
422
CTLA-4 is on which cell type
T cell
423
CTLA-4 is the target of which drug; treating which cancer type; what is mech of action; main toxicity
ipilimumab (melanoma). It is a monoclonal antibody (-mab). CTLA4 is Inhibitory. So blocking it with ipilimumab up-regulates T cell. Enterocolitis.
424
PD-1 is on which cell
T-cell
425
PD-1 is the target of which drug; treating which cancer type; what is mech of action; main toxicity
pembrolizumab (cervix), nivolumab (melanoma, lung, renal). Monoclonal antibody (-mab). PD1 "programmed death-1" is immune checkpoint. It has Inhibitory action - (promotes apoptosis in antigen specific ells), reduces apoptosis in suppressive 'regulatory' t-cells. So blocking them with pembro/nivo up regulates T cell. Hyper or hypo thyroid.
426
PDL-1 is on which cell
Tumor
427
PDL-1 is the target of which drug; treating which cancer type; what is mech of action; main toxicity
atezolizumab (bladder ca). Dostarlimab (endometrial ca). Monoclonal antibody (-mab). Inhibiotry ligand for PD1.
428
RAS directly targets
affects RAF --> MEK --> MEKK/MAPK/MKK --> ERK --> CCDNI/CDK --> cell proliferation
429
Which cells are the best antigen presenting cells
Dendritic cells
430
minimally emetic chemo
vincas
431
mechanism of action of vincas
inhibit assembly/polymerization of microtubules (vs taxanes that inhibit disassembly/depolymerization)
432
gemcitabine mechanism
prodrug. Phosphorylated INTRACELLULARLY then incorporates into DNA as fraudulent base pair substituting for cytosine. Stops replication aka process called "masked chain termination"
433
Ang1/Ang2
act on TIE2 receptor (ang1 positive, ang2 inhibitory) --> intracellular cascade PI3K/AKT/FOXO1. Trabananib inhibits ang1/ang2
434
Ipilimumab
CTLA4 inhibitor
435
everolimus
MTOR inhibitor. FK protein; IL2 signaling, G1-S arrest.
436
Mechanism of increased Cr in patients using rucaparib
MATE1
437
Which PARPi most likely to cause elevated LFTs
Rucaparib
438
Most likely to have delayed myelosuppression
Mitomycin-C
439
AI/SERM side effects
bone pain
440
recurrent endometrial cancer (letrazole, tam, medroxyprogesterone, exemestrane)
Tam?
441
Best treatment for recurrent carcinosarcoma
Ifos/taxol (carbo/taxol not option)
442
Doxil vs doxorubicin
doxil - liposomal, less cardiotox, increased circulating drug concentration, decreased volume of distribution, longer lasting (prolonged half life), more stomatitis/mucositis/PPE. WORSE for endometrial cancer. Doxorubicin - VESICANT, bone marrow suppression, EMETOGENIC, alopecia, free/radical, s phase, DOSE ADJUST FOR HEPATIC dysfunction
443
taxol associated with what arrhythmia
asymptomatic bradycardia
444
BRCA1 associated breast cancers most likely to be (histopath, receptor status)
basal. Triple negative.
445
most likely to need p/palnd
uterine serous (other choice included squamous cervix ca)
446
best IHC stain to differentiate endocervical from endometrial cancer
p16
447
recurrent low grade endometrial stromal sarcoma fixed to sidewall - best treatment
megace
448
p53 tumor suppressor gene - germline mutation (name, clinical presentation, most likely cancer)
li-fraumeni. Breast/young sarcoma. MISSENSE. Ch 17
449
pten tumor suppressor gene - germline mutation (name, clinical presentation, most likely cancer)
cowden. Hemartomas. Breast (triple neg). (uterine endometrioid). PI3K --> AKT. DELETION. Ch 10
450
brca1 tumor suppressor
basal. Triple negative. Nonsense/frameshift. Ch 17
451
brca2 tumor suppressor
ductal, ER+. Least likely colon. Nonsense/frameshift. Ch 13.
452
brca1 largest impact on survival
RRBSO
453
BRCA1 woman at 40 most appropriate screening tet
annual mammo w MRI
454
which patient most likely to have BRCA2 mutation
50yo male w breast ca
455
biomarker for breast ca
ca 27-29
456
Tamoxifen during pregnancy?
discontinue it. Also during breastfeeding.
457
Mutation for Peutz-Jegers syndrome
STK11
458
Cervical cancer - E7 inactivates what?
Rb (E6 - p53)
459
What contributes to continence of continent ileal conduit
ileocecal valve?
460
What is the metabolic disturbance associated with continent ileal conduit
non-anion gap hyperchloremic metabolic acidosis (increased hydrogen, chloride absorbed through intestinal mucosa)
461
what is most common cause of metabolic ALKYLOSIS
prolonged NGT
462
What is best location to measure PCWP
right atrium (uhm no… not sure what the other answer choices are)
463
What is best initial treatment of hypercalcemia in woman with short QT & weakness
Hypercalcemia. Normal saline. Lasix. Calcitonin. Bisphosphonates.
464
Symptomatic, K 6.8, peaked T waves - best initial treatment?
calcium glucagon. (then can give gluc, insulin, albuterol etc)
465
rapid correction of hyponatremia causes what?
osmotic demyelination (central pontine myelysis)
466
what parameter is most associated with prerenal azotemia
High BUN/Cr >20:1 (bun absorbed as body tries to conserve), high osm >500 (as body concentrates urine), Urine Na <20 (low, bc body absorbs it to try to conserve water), FeNa <1%
467
Visual changes post robotic changes are due to what
prolonged OR case
468
PSTT is most associated with
intermediate trophoblasts.
469
Partial moes are
diandric
470
Which WHO scoring factor for GTN gives you the most points
4 points for: liver/brain met, >8 mets, beta 100k (10^5), >13mo prior preg
471
Most emetogenic chemo
doxorubicin (adriamycin). Then cyclophosphamide. Then cisplatin.
472
Most renally cleared
bleomycin (renally metabolized and cleared)
473
Topotecan mechanism of action
stabilizes topoisomerase 1-DNA complex (blocks it). Topo-1 normally causes **single strand breaks** in DNA to help un-coil DNA (relieves torsional strain) as it is replicated
474
Doxorubicin can be characterized as
anthracycline. Antitumor antibiotics. *Cell cycle non-specific* Complex with topo-II. Intercolates between base pairs. Free radical formation.
475
Etoposide mechanism of action
Topo-II target. Topo-II causes double strand breaks to relieve supercoils. Cant get through G2
476
Delayed myelosuppression in which chemo
Mitomycin-C
477
Least emetogenic
Vincas (bleomycin as well)
478
Tumor met to brain which chemo crosses BBB
methotrexate
479
Pazopanib side effect
diarrhea. HTN. n/v/fatigue.
480
Cell cycle specificity of radiation
G2/M.
481
What is most likely to help with acute cystitis during radiation treatment
oxybutinin
482
More likely complication with continent conduit rather than incontinent conduit
leak
483
most likely abnormality in ileal conduit
hyperchloremic metabolic acidosis
484
Li faumeni highest cancer risk
*sarcoma* (breast is actually more frequent)
485
Cisplain is a radiosensitizer by what mechanism
impairs DNA repair (sublethal damage, binds w DNA and causes INTRASTRAND crosslinks)
486
What would be one reason to avoid cis/RT in large IB2 cervix
pelvic kidney
487
Most common germline mutation in ovarian cancer
BRCA1
488
How does p53 mutation contribute to development of ovarian cancer
*mutant protein binds to wildtype and makes it nonfunctional* tumor suppressor gene - so if blocked then unregulated cell growth/replication.
489
Peak peritoneal cavity to plasma concentration of IP cis/carbo
0.8340277777777778
490
Most common complication of type 2 HIT
thrombosis
491
Cesium half life
30 years
492
Collateral with inferior epigastric - what vessel
obturator
493
Blood flow to gracillis - what blood vessel
medial femoral circumflex artery
494
Postop cant walk/ anterior thigh numbness - what nerve injury
femoral
495
Femoral nerve injury is more common in: 1) obese pt 2) thin pt 3) duration of surgery instead of type of retractor 4) another choice
thin patient
496
Origin of middle rectal artery
anterior branch internal iliac
497
Most commonmechanism of ilioinguinal nerve injury
transverse incision
498
Patient with unanticipated splenectomy most likely to die of
strep pneumococcus
499
When to vaccinate post splenectomy
> 14 days after
500
risk factor for GTN/molar
extremes of age ?
501
Not relieving somone's suffereing is violating which ethical principle
nonmalfesience
502
Taxanes most associated with what cardiotoxicity
asymptomatic bradycardia
503
Patient who is stable with afib and HR 130 - how to treat
betablocker
504
What is most radiosensitive cell in bone marrow
lymphocyte
505
What is the stage of a vulvar ca with two 6mm groin lymph nodes, lower vaginal invovement
IIIB
506
Predictor of septic shock mortality
Lactate
507
Contraindication to radical trachelectomy
3cm lesion (cutoff is >2; also histology small cell is contraindication)
508
Heterophile antibodies - what will other markers be
serum HCG pos, urine HCG neg
509
Which chemo is most constipating-inducing
vincas "vinconstipation"
510
Preg patient with 3cm mass what should next step be
biopsy
511
superior border for radiation treatment of cervical ca
L4-5 (treat to L4-L5 to keep you alive)
512
BRCA1 patient - which intervention most likely to reduce their mortality
RR-BSO
513
BSO in BRCA patient reduces breast cancer risk by what percent
0.5
514
What histologic type of ovarian cancer most likely to have nodal mets
germ cell (dysgerminoma)
515
What histologic type of ovarian cancer most likely to cause hemoperitoneum
granulosa cell tumor
516
FOX2L mutation - what kind of cancer?
adult granulosa cell
517
4cm incidental granulosa cell tumor at time of benign hyst with negative imaging - next steps?
observe
518
IB epithelioid ovarian cancer who has been staged? How to treat?
observe
519
Most common SE of aromatase inhibitors
arthralgias
520
Organ most likely to have toxicity in whole pelvic radiation
ileum
521
Avastin mechanism of action
binds VEGFA and blocks it from binding to VEGFR2 which generally sets off a pro-angiogenic pathway (RAS/RAF/MEK/ERK)
522
When does bleomycin work
G2
523
Metabolites for toxicity in ifos & how to treat
acrolein --> hemorrhagic cystitis. Tx with mesna. chloracetylaldehyde --> neurotox. Tx with methylene blue
524
Chemo that induces leukemia
melphalan the most (chromosome 13 inversion); etoposide (chromosome 11 inversion). Also platinum agents and cyclophosphamide.
525
taxol before platinum - why?
if platinum first then *poor clearance of taxol* and get profound *neuropathy*
526
Prodrugs - name them
gems, cars, cyclones, capes. Ifos, 5fu, amifostine
527
Gemzar dose limiting toxicity?
neutropenia
528
leiomyosarcoma - what is regimen of choice
gem/taxotere
529
Gemzar what is mechanism of action
substitutes nucleoside analog (cytosine) into DNA - DNA cant replicate. 'masked chain termination'
530
right colon / ileum resection -- what vitamin deficiency?
B12
531
IJ drains into
brachiocephalic (I think subclavian then brachiocephalic but not sure of all answer choices)
532
Postop infection with raised red lesions
strep
533
s/p vulvar I&D with crepitus - how to treat?
debride
534
side effect of gabapentin
dizziness
535
What is hayflick limit
cells only can replicate a certain number of times (40?) before planned senescence. Related to telomere length
536
Clinical targeted volume - define
amt of dose planned to certain area and microscopic spread
537
Function of EGFR receptor
cascade of events for cell growth and proliferation; activated by phosphorylation
538
Low grade serous mutations
BRAF, KRAS
539
Mucinous ovarian ca mutations
KRAS
540
Granulosa cell mutation
FOXL2
541
Risks for developing Differentiated VIN
older, not HPV, lichen sclerosis previously, pruritis
542
History of chest radiation when young, aside of mammogram what other test?
MRI
543
Reversal of coumadin after trying vitamin K and FFP
Kcentra (4 factor prothrombin complex)
544
Patient with HIT and a clot and score of T4 on 7 - how to treat
argatroban (direct thrombin inhibitor)
545
Most concerning thrombosis - arterial or venous?
arterial
546
How to treat neutropenic fever as outpatient?
quinolones. cipro/augmentin. Cipro/levaquin
547
Risk factos for LAR breakdown
<7cm from anal verge. Also low albumin, prolonged OR, severe sepsis, emergency surgery, anastomotoic ischemia.
548
How to protect rectosigmoid resection with primary anastomosis
loop ileostomy
549
Amifostine DLT
hypotension
550
Cesium half life
30 yrs
551
Photons in RT work by
compton effect
552
What does shoulder mean in radiation
sublethal damage
553
half life of cesium / cobalt / irridium
30y / 5.3y / 74 days
554
Radiation toxicity is caused by
endothelial cell fibrosis
555
Alpha 1 pressor does
vasoconstriction
556
Best pressor for septic patient
norepi
557
tumor lysis syndrome lab findings
hyperK, hyperphos, hyperuricemia. hypoCa.
558
pt with CHF and in DIC - how to treat DIC
give cryo
559
GTN treated with methotrexate but rapidly rising hCG what is next step
Actinomycin D
560
most ionotropic pressor
dobutamine
561
How to improve healing post vulvectomy - what kind of flap
sartorious flap if lateral??
562
Interleukin involved in sepsis
TNF-alpha
563
Prerenal AKI BUN:Cr
>20:1
564
Cdiff first treatment
PO vanc or fidaxomycin. Recurrence --> taperd and pulsed regimen. (if flagyl used first time, then give po vanc)
565
Hyperkalemia and peaked T waves - first give what?
Calcium gluconate.
566
What is most likely seen in BRCA induced breast ca vs sporadic ca?
basal type, triple neg
567
If breast ca pt has HER2 amplified what do you add
trastuzumab
568
LMS stage IB means - where is cancer, how big?
uterine-confined; >5cm
569
Carcinoscarcoma what treatment
ifos/taxol (carbo/taxol not a choice)
570
abdominal compartment syndrome
bladder pressure >20
571
Branches of femoral artery in femoral triangle
superficial and deep external pudendal. Superficial circumflex artery. Superficial epigastric.
572
Pudendal nerve
sensation to vulva. Motor anal and urethral sphincters. Branches S2-4
573
Most common type of cancer in pregnancy
breast
574
Foot drop post TLH
common peroneal (origin sciatic)
575
How to reduce pulmonary secretions in hospice patient
atropine
576
Hypovolemic vs cardiogenic shock - what is one measure (diagnostic test)
PCWP is high in cardiogenic shock (Left heart not working --> backs up into pulm circulation) PCWP is low in hypovolemic shock
577
Best way to tell if LV is failing
PCWP is high in cardiogenic shock (Left heart not working --> backs up into pulm circulation)
578
Most common ovarian tumor with LN involvement
germ cell (dysgerminoma)
579
Patient with ovarian tumor showing positive CK20 and negative CK7 - what is the next step
colonoscopy
580
Endometrial ca w MLH1 and PMS2 - what is next step
methylation studies
581
Why MMR proteins matter
epigenetic changes
582
Herceptin works on which receptors
Her2 (Erbb2)
583
Postop cbc hg 7 what to do
repeat cbc
584
Young pt getting chemo with amenorrhea, which chemo did she get
cyclophosphamide
585
EKG postop with MI - what will it show
ST depression
586
Most serious valvular problem for a perioperative patient
aortic stenosis
587
Percent radiation at 1 vs 2cm difference
4
588
Increase the distance from source of radiation leads to
exponentially decreased dose
589
aprepitant mechanism of action
NK1 inhibitor
590
p53 mutation is most often what kind of mutation
missense
591
ipilimumab targets
CTLA4 (on T cell)
592
Peutz-Jaeger
STK11. breast ca.
593
Define standard error of mean
standard deviation of sample distribution - (how likely is sample mean to be from population mean). Other answer included something about median
594
what test to compare 3 means
ANOVA
595
what test to compare 2 means
t-test
596
what test to compare proportions in large sample size
chi-squared
597
what test to look at effect of independent variable
logistic regression
598
why to use multivariage logistic regression
helps control for cofounders
599
what is best initial study design to look at association between smoking and cancer
Options: case control (I put this), retrospective cohort, case series, something else & did not include RCT
600
what test to look at effects of variables on survival
cox proportional hazard
601
upper border RT field for cervical ca
L4-5
602
Highest LET
neutrons
603
what effect RT most common
compton effect. Other options: photoelectric, pair production, something else
604
treating pt with cervix ca with 6MV what kind of radiation
options: pair production (I put this), photoelectric, compton, something else
605
Cobalt makes what kind of things
gamma rays
606
Cesium half life
30 years
607
Effect of RT on DNA
double strand breaks
608
Effect of radiosensitization of cis
inhibits DNA repair
609
why do we fractionate
decreases ability to repair
610
what is factor in radiosensitizing
redistribution (cells into radiosensitive G2 out of radioresistant G1/S)
611
Most likely complication after pelvic RT
ileal damage. Options: rectum, jejunum, duodenum
612
HDR vs LDR
less time per fraction
613
gross tumor and microscopic disease - what volume are you treating
Clinical treatment volume. Options: planning treatment volume and other things
614
Cell type most sensitive to RT
lymphocytes
615
Best way to prevent skin damage to vulva
split leg technique
616
how to deal w radiation cystitis in admitted patient
bladder irrigation
617
renal failure what is adjusted
etoposide. Other options: vinca, taxane, doxorubicin
618
what is more renally cleared
bleo. Other options included etoposide
619
how does topotecan work
some answer about blocks repair of single strand breaks. Other options were not it (i.e. blocks topo-II). But it was worded very poorly
620
emetogenic
carbo. Other optionss were vinca, taxane, something else non-emetogenic
621
amenorreha in young woman what chemo is she on
cyclophosphamide
622
how to treat extravasation injury
DMSO (dimethylsufoxide)
623
doxil vs doxorubicin
doxil worse in endometrial cancer. Other options; lower clearance (I think doxil has lower clearance), lower skin toxicities, more cardiotoxic
624
what chemo crosses BBB
methotrexate
625
GTN and rapidly rising beta on MTX what to do
pulsed Act-D
626
asymptomatic grade 4 neutropenia 10 days out how to treat
Options: neupogen (I put this), oral antibiotics, IV antibiotics, observe
627
gemcitabine DLT
neutropenia. Options: thrombocytopenia, others
628
treatment of carcinosarcoma
ifos/taxol (carbo/taxol not option)
629
biggest differentiating factor LMS vs leiomyoma
Options: atypia (I put this), crowding, LVSI, coagulative necrosis
630
best treatment for MSI tumors
checkpoint therapy
631
treatment of platinum resistant ovarian ca supported by phase III trial data
taxol/bev
632
ARID1A
clear cell
633
CA125 from what gene
MUC16
634
FOXL2
granulosa cell tumors
635
tumor marker not affected by pregnancy
LDH
636
upper border RT field for cervical ca
L4-5
637
Highest LET
neutrons
638
treating pt with cervix ca with 6MV what kind of radiation
options: pair production (I put this), photoelectric, compton, something else
639
Cobalt makes what kind of things
gamma rays
640
Cesium half life
30 years
641
Effect of RT on DNA
double strand breaks
642
Effect of radiosensitization of cis
inhibits DNA repair
643
why do we fractionate
decreases ability to repair
644
what is factor in radiosensitizing
redistribution (cells into radiosensitive G2 out of radioresistant G1/S)
645
Most likely complication after pelvic RT
ileal damage. Options: rectum, jejunum, duodenum
646
HDR vs LDR
less time per fraction
647
gross tumor and microscopic disease - what volume are you treating
Clinical treatment volume. Options: planning treatment volume and other things
648
Cell type most sensitive to RT
lymphocytes
649
Best way to prevent skin damage to vulva
split leg technique
650
how to deal w radiation cystitis in admitted patient
bladder irrigation
651
cediranib targets ckit and also what else
VEGF (other options were EGF, PDGF, one other)
652
imilimumab targets what
CTLA4
653
how do cancer cells evade immune system
PDL1/PD1; downregulate t cells
654
recurrent emca with thrombocytopenia how to treat
pembro. Other options included myelosuppressive chemo
655
kinases activated how
by phosphorylation
656
RAS acts directly on what
PI3K. don’t remember other options but they did not include RAS/RAF, MAPK
657
what valvular disease is worse for patient
AS. Other options: Aortic insufficiency, mitral stenosis, mitral insufficiency
658
patient on pembro and has BG now 248 was 240 last month how to handle
Options: insulin (I put this, since maybe T1DM), metformin, steroids (def no), observe (def no)
659
most direct actor on MTOR
metformin (if everolimus is not a choice)
660
PTEN mutation best treatment for emca
tesrimolimus
661
tamoxifen and megace. How does synergy happen
tamoxifen increases progesterone receptors
662
Insulin effect
decreases IGFBP1. Other options was decrease IGF-1 (def no), other things
663
PARPi how do they work
**base excision repair** of single strand breaks.
664
underexpressed MSH 2 and 6
intact MLH1 and PMS2 what to do germline testing. Options included: promotor methylation
665
underexpressed MLH1 what to do
methylation studies
666
MSI colon cancer most likely linked to early stage (I put this)
left sided colon ca (def no)
667
MSH2. what is best screening EGD. Other options: FOBT annually
breast imaging
668
BRCA2 mutation most likely to increase risk of what cancer Pancreatic. Others included colon
others that were not associated
669
microcalcifications in breast what is next best step Options: FNA biopsy (I put this)
core biopsy (I think this though)
670
3cm breast mass in 25yo woman preg at 10 weeks what is next best step Options: ultrasound (I put this)
biopsy
671
tamoxifen most common serious side effect Options: vasomotor (I put this)
uterine ca
672
Anastrozole causes
alopecia
673
on tamoxifen and 8 weeks preg what to do
dc tamoxifen and continue preg
674
Breast ca type in BRCA basal type
triple neg
675
Bard 1 mutation VUS --> how to screen?
routine
676
BRCA1 patient - which intervention most likely to reduce their mortality
RR-BSO
677
BSO in BRCA patient reduces breast cancer risk by what percent
50
678
Li faumeni highest cancer risk
*sarcoma* (breast is actually more frequent)
679
shortness of breath how to treat morphine. Options: fan blowing at face
supplemental O2
680
severe pain recurrent carcinosarcoma also renal insufficiency Options: methadone (I put this
not sure)
681
malignant bowel obstruction with g tube on steroids and persistent N/V Options: haldol (I put this)
reglan (def no)
682
what is best for secretions
atropine
683
malignant bowel obstruction with persistent n/v
dex
684
renal failure what is adjusted
etoposide
685
what is more renally cleared
bleomycin; etoposide included
686
how does doxorubicin work
topo II inhibitor
687
most emetogenic
dactinomycin
688
Amenorrhea in young woman -- what chemo
cyclophosphamide
689
how to treat extravasation injury
DMSO
690
Doxil vs doxorubicin
Doxil worse in endometrial cancer. Other options; lower clearance, lower skin toxicities, more cardiotoxic
691
Chemo crosses BBB
MTX
692
GTN and rapidly rising beta on MTX -- next step
Pelvic U/S, CT, ActD, EMACO
693
asymptomatic grade 4 neutropenia 10 days out how to treat
Neupogen, oral antibiotics, IV antibiotics, observe
694
gemcitabine DLT
neutropenia. Options: thrombocytopenia, others
695
treatment of carcinosarcoma
ifos/taxol (carbo/taxol not option)
696
RAS acts directly on
PI3K
697
p53 what kind of mutation
missense
698
small cell carcinoma of the ovary, hypercalcemic type - what tumor marker
SMARCA4
699
how does estrogen work
Transcription factor
700
how does tumor get through basement membrane
MMP2
701
estrogen isoforms created by
alternative splicing
702
cediranib targets ckit and also what else
VEGF (other options were EGF, PDGF, one other)
703
imilimumab targets what
CTLA4
704
how do cancer cells evade immune system
PDL1/PD1; downregulate t cells
705
recurrent emca with thrombocytopenia how to treat
pembro. Other options included myelosuppressive chemo
706
kinases activated how
by phosphorylation
707
RAS acts directly on what
PI3K. Wasn't sure about this one; don’t remember other options but they did not include RAS/RAF, MAPK
708
most direct actor on MTOR
metformin (if everolimus is not a choice)
709
PTEN mutation best treatment for emca
tesrimolimus
710
tamoxifen and megace. How does synergy happen
tamoxifen increases progesterone receptors
711
Insulin effect
decreases IGFBP1. Other options was decrease IGF-1 (def no), other things
712
PARPi how do they work
**base excision repair** of single strand breaks.
713
POLE most likely
grade 1 endometrioid
714
On olaparib what is most likely to increase Options: Cr (this one)
platelets
715
best antigen presenting cell Options: dendritic cell (I put this)
B cell
716
rising creatinine from rubraca MATE 1
2
717
Treatment of mOC Herceptin
trametinib
718
underexpressed MSH 2 and 6
intact MLH1 and PMS2 what to do germline testing. Options included: promotor methylation
719
underexpressed MLH1 what to do
methylation studies. Options included: BRAF testing
720
MSI colon cancer most likely linked to early stage (I put this)
left sided colon ca (def no)
721
MSH2. what is best screening EGD. Other options: FOBT annually
breast imaging
722
BRCA2 mutation most likely to increase risk of what cancer Pancreatic. Others included colon
others that were not associated
723
asymptomatic isolated increase in CA125 what to do Surveillance 3 mo
CT scan
724
pt on imilimumab has small increase in size of tumor what to do next Scan in 1 mo
add another immunotherapy agent
725
What is most a/w disease coming back in ovarian serous LMP Macroscopic residual disease
micropapillary
726
what is a/w better prognosis in secondary cytoreduction
complete surgical resection
727
Cervical cancer DOI 3mm
no LVSI
728
Cervical cancer 3.5cm
desires future fertility -- next step?
729
contributes the most to WHO score Liver mets. Other options: HCG 100k (so idk…)
preg interval >12mo
730
contra-indication to radical trachelectomy
3cm lesion
731
vulvar ca w 2 inguinal LN mets 6mm what stage
IIIB
732
inguinal LN positive how to treat
pelvic and groin RT
733
vulvar 1.5cm lesion
0.8mm depth
734
Vulvar ca 1.5mm micromet on sLNBx
next step? Unilat INFLD
735
What is most important factor when considering sLNBx in vulvar cancer Size
DOI
736
Perfed uterus during molar pregnancy
patient hemorrhaging -- physician making decision in best interest of patient paternalism
737
More DVT w regional anesthesia in ERAS -- next step Stop regional anesthesia
perform root cause analysis
738
Phase Ia vs Ib
Max Tolerated Dose
739
Cancer cachexia anorexia syndrome with hours to days left -- treatment?
740
Most predictive of coming off vent
RSBI
741
Optimal vent settings ARDS
low tidal volumes. high PEEP not an option
742
Treatment of CV collapse while using veress to insufflate
steep trendelenberg
743
pt with Hx CHF, now s/p exent with 1500mL ebl in ICU with high CO, low PVR, low PCWP
sepsis. Options: cardiogenic shock, hypovolemic shock
744
CHF and DIC with fibrinogen low
give cryo. Other options: FFP, fibrinogen (could have been this?), something else
745
HIT with plt <50 how to treat
argatroban
746
Warfarin reversal and have already tried FFP and vitamin K what to give
K centra - 4 factor prothrombin complex
747
what is most important factor in getting anti-Xa levels in pt on lmwh
if Cr cl is <30.
748
best pressor for sepsis
norepi
749
pulseless Vfib how to treat
epi. Other options: defibrillation, other things
750
mediator in sepsis
TNFalpha
751
most likely to cause non anion gap acidosis
pancreatic fistula. Other options: renal failure, other things
752
most likely to cause metabolic alkalosis
prolonged NGT
753
most likely to cause metabolic alkalosis #2
intractable NV. Other options: diarrhea, other things.
754
pt with ileal conduit who developed arrhythmia. What is most likley underlying cause
metabolic acidosis
755
Elderly, Cdiff
PO vanc 10 days
756
postop wound infection w lymphangitis, erythema, raised borders most likely culprit
strep. Other options: gangrene, staph, something else
757
EKG postop with MI - what will it show
ST depression
758
Most common metabolic abnl w TPN
Glucose
759
hypercalcemia what change on EKG
short QT
760
hyperK 6.8 with peaked T and prolonged QRS what to do
Calcium gluconate, gluc/insulin, albuterol, soemthing else
761
fastest to increase after protein feeds in hospice pt
prealbumin
762
half life of albumin
20 days
763
5cm cervical mass, cr 5.5 what is best imaging study
Options: MRI with gadolinium (I put this), renal protocol CT, renal sono, something else
764
fully staged IB grade 1 epithelial ovarian ca how to treat
Options: 3 cycles, observe (I put this), letrozole, something else
765
36yo who underwent hyst/LSO, found to have LMP with microinvasion what is next step
Stage , observe, 3 cycles, 6 cycles
766
asymptomatic isolated increase in CA125 what to do
Surveillance 3 mo, CT scan, chemo
767
pt on imilimumab has small increase in size of tumor what to do next
Scan in 1 mo, add another immunotherapy agent, dc immunotherapy, something else
768
What is most a/w disease coming back in ovarian serous LMP
Macroscopic residual disease, micropapillary, microinvasion, one other choice
769
what is a/w better prognosis in secondary cytoreduction
complete surgical resection
770
Cervical cancer DOI 3mm, no LVSI, no parametria, margins: +CIN3; desires fertility -- next step
Observation
771
Formula for odds ratio (OR) vs. relative risk (and when to use each) "(a/b) / (c/d) or (a*d)/(b*c) i.e.
gave numerator (exposed case/unexp case) and you give denominator (exp control/unexp control) see 4x4 table on next page RR = a/(a+b) / c/(c+d) Use OR for case control (b/c compares presence/absence of exposure knowing the outcome) Use RR for cohort study (know exposure status
772
For elective hyst pt with recent cardiac stent what should you do first? "Find out when/type of stent
wait 12 months
773
Femoral triangle Inguinal ligament
sartorious (lateral)
774
Estrogen receptor expression can help distingish LMS (40%) vs GIST (none) (THIS ONE)
small cell cervix vs endometrial
775
Estrogen isoforms created by Alterantive splicing (THIS ONE)
amplification
776
Esophageal doppler vs. conventional monitoring intraop for fluid resuscitation "Lower mortality
less ICU stays (THIS ONE)
777
EPO known risks death (maybe)
thrombosis (yes)
778
Endometrioisis related marker ARID1A
779
Endometrial cancer mutation associated with good prognosis Excellent prognosis regardless of grade POLE
780
Elevated CA19-9 and CEA mucinous tumor
781
EKG changes with HYPERmag Prolonged QT
782
EGFR receptor (how it works) Ligand binding causes dimerization of the transmembrane EGFR receptor which activates the tyrosine kinase domain
783
Effect of multiple variables on survival Cox proportional hazards model
784
Earliest lab value to measure in nutrition progress Prealbumin (THIS ONE)
albumin
785
Doxil versus doxorubicin "Liposomal bound (aka pegylated) witih MPEG methoxypolyethylene glycol to avoid detection by the mononuclear phagocyte system Results in: longer plasma life
reduced volume of distribution
786
Downstream effect of VEGF receptor binding Capillary permeability (THIS ONE)
increased intratumor pressure
787
Dose of brachy after hyst for endometrial cancer is dosed to where 0.5cm deep and 0.5cm wide
788
Doing an inguinal LND and injury nerve lateral/near the psoas
what will pt not be able to do Addut thigh
789
Direct and indirect radiation/xrt mechanisms "Direct = causes ds DNA break Indirect = free radical which produces oxidative change"
790
Diabetes/HTN med that should be discontinued before CT Metformin
791
Describe VEGF proteins and receptors "VEGF A-E and placental growth factor 1-2 VEGF-A
B
792
Describe HPV cancer pathway "E6/E7 are viral oncogene proteins: E6 inactivates p53 leading to its proteosomal degradation
E7 inactivates pRb by competing for binding and then frees transcription factor E2F to transactivate its targets"
793
Define obesity hypoventilation syndrome PCO2 >45
BMI>30
794
Deficits from obturator nerve injury Motor only; loss of adduction (see sheet 2)… (I think also does sensation to anterior thigh)
795
Deficits from genitofemoral nerve injury Sensory only; ipsilateral mons and labia majora; sensory of upper anterior thigh
796
Deficits from femoral nerve injury L2-L4
unable to flex hip or extend knee; knee DTR; sensory anteromedial thigh/leg/foot - aka can't walk
797
Cytokine pro-inflammatory in sepsis TNF-alpha (this one)
IL-2 - note: IL-1 may have some role but TNF-alpha is stronger
798
Cvx cancer 6 mm wide
2.5 mm deep
799
Criteria for trachelectomy "1. Desire to preserve fertility 2. Reproductive age 3. Squamous or adeno (i.e.
not neuroendocrine) 4. Stage IA1 with LVSI
800
Cowden What is the germline mutation? Clinical picture (non-cancer)? Screening?" "PTEN Clinical picture: GI polyps, thyroid disease, benign breast disease, mucocutaneous lesions Cancer risk: breast, thyroid, endometrial Screening for breast cancer: breast self awareness from 18yo, clinical breast exam q6-12mo from age 25 (or 10 years before earliest family dx), annual MMG from 30-35yo (or 5-10 years before earliest family dx) per NCCN 4/2018 Screening for endometrial cancer: observation and prompt eval of AUB. "consider annual random EMB +/- US from age 30-35" per NCCN 4/2018
801
Cowden most common gyn cancer Endometrial cancer (lifetime risk 19-28%)
802
Cowden most common cancer Breast
803
Copy number high (group 4) of endometrial cancer molecular subgroup is most likely what histology? Serous
804
COPD greatest preop eval risk O2 sat low
805
Contraindication to radical trachelectomy LVSI
size 3 cm (this one)
806
Contraindication to palliative surgery DNR
hemodynamic instability (this one)
807
What histology is a contraindication for radical trachelectomy Small cell (this one)
villous glandular adenoma
808
Complications of continent conduit "Leak (5% risk with ileal conduit)
perfusion complication (0.5% with ileal conduit)
809
Complication of cdiff Toxic megacolon
810
Colon cancer screening recs "for Average risk (no history of IBD
no family history) starting at age 50yo (or consider 45yo for African-Americans) per NCCN 4/2018: 1) Colonoscopy q10 years 2) Stool-based test (high-sensitive guaiac-based or immunochemical testing q1yr vs. FIT-DNA-based testing q3yr) 3) flex sig q5years 4) CT colonosgraphy q5years (this replaces barium enema) Least helpful: MD digital rectal exam"
811
What are advanced colon adenomas that increase colon cancer risk villous or tubulovillous histology
high-grade dysplasia
812
Collateral with obturator artery Deep external pudendal; INFERIOR EPIGASTRIC - either of these may be answer
813
Chemo for LMS Gemzar/taxotere (can also do doxorubicin +/- olaratumab per NCCN)
814
Chemo for carcinosarcoma (most efficaceous) Ifos/taxol - THIS ONE (carbotaxol was not an option)
ifoscarbo
815
Changes in apoptosis (two questions) "not cause inflammation
does cause chromatin condensation 1) cell shrinkage and rounding due to caspase 2) cytoplasm dense and organelles tightly packed 3) chromatin undergoes condensation against the nuclear envelop (PYKNOSIS) 4) nuclear envelope becomes discontinuous and DNA is fragmented (KARYORRHEXIS) 5) cell membrane buds into blebs 6) cell breaks apart into multiple vesicles called apoptotic bodies - these are phagocytosed"
816
Cervical cancer pt s/p RT presents with fever
diarrhea
817
Cancer with elevated CA-125 (ovary not a choice) Pancreatic (if not breast or lung)
breast (THIS ONE per Sjovall 2002 if option
818
Cancer vaccines general mechanism "Whole cell tumor lysates (?) Tumor-specific antigens needed to stimulate dendritic cells and activate T cells; MHC1 and CD8 cells Three phases of cancer development: elimination
equilibrium (tumor cell variants arise)
819
Cancer risk with Peutz-Jeghers Stk11 (tumor suppressor)
autosomal dominant - sex cord stromal with annular tubules**
820
Cancer risk with MEN2 Parathyroid hyperplasia (10-25%)
medullary thyroid ca (almost all will get this
821
Cancer risk with MEN1 "3 P's: pancreatic
parathyroid
822
Cancer risk with Li-Fraumeni p53 mut - sarcoma (15% by age 70 in women)
breast (54%)
823
Cancer risk with Cowden PTEN mut - breast (25-80%
triple neg)
824
Cancer for which smoking is protective Endometrial cancer
825
Calculator PPV
NPV
826
Brisk bleeding from deep pelvic LND Accessory obturator vein
827
Breast cancer screening for BRCA annual MRI 25-29yo; 30-75yo annual mammo +/- breast MRI/tomosynthesis (NCCN 5/2018)
828
Breast biopsy - atypical ductal cells - what is mgmt? Lumpectomy to r/o DCIS or cancer
occurs in up to 10-30%
829
BRCA1 most common type of breast cancer Triple negative
IDC
830
BRCA type of cancer risks "breast (41-90% lifetime risk)
ovary (8-62%)
831
BRCA 2 - most common type of breast cancer ductal ER+(THIS ONE)
lobular ER+PR+
832
Branches of the internal iliac "Posterior: ILS (iliolumbar
lateral sacral
833
Branches of SMA "Inferior pancreaticoduodenal
jejunal branches
834
Branches of IMA Left colic
sigmoid arteries
835
Branches of celiac Left gastric
common hepatic (proper hepatic
836
Brain radiation: which is not a side effect hair loss
seizures
837
BRAF "Serous borderline and recurrent low grade serous carcinoma BRAF and KRAS mutations are mutually exclusive"
838
Bowel injury during L/S no bowel prep
1 cm
839
Blood vessel most likely injured during right diaphragm stripping Phrenic artery
840
Blood supply to the lesser omentum Left gastric
841
Blood supply to gracilis flap Medial circumflex femoral artery
842
Biggest risk factor for LAR leak "Tension (this one)
no bowel prep
843
Best way to quantitate protein Western blot
844
Best way to check for PE Spriral CT
CT angiogram (this one)
845
Best way to amplify DNA PCR
846
Best test to eval association in case control trial Odds ratio
847
Best randomization method Coin flip
random # table blocks (this one)
848
Best med for anticipatory chemo-induced nausea 5HT3
benzos (this one)
849
Best initial test to start with to evaluate smoking and certain type of cancer Prospective RCT
case control (good initial study)
850
Best initial study to assess relationship between PNV and ovarian cancer Case control (this one)
cohort
851
Best imaging for the brain (ie: small cell cancer brain mets) MRI
852
Best imaging for myometrial invasion in uterine cancer MRI
853
Best imaging for localizing recurrent cervix PET/CT
854
Best criteria to diagnose HNPCC MSI
Amsterdam
855
Best abx for Klebsiella "Ceftaz (this one)
imipenema and clinda
856
Base of the femoral triangle Pectineous*
iliopsoas
857
ATN "FeNa >2%
will have normal BUN:Cr ratio (10 or 15:1)
858
at what age do you start HNPCC testing 20 (THIS ONE)
30
859
Associated with decreased SSI with rectosigmoid resection Chlorhexadine bath
normotheramia
860
Ascites and ovarian cancer - which VEGF
VEGFR2 by VEGF-A has major permeability enhancing effect
861
Artery in inguinal triangle
Inferior epigastric a
862
Appearance of radiation enteritis on imaging
Diffuse bowel wall thickening
863
Another cause of anastomotic leak Increasing ascites >4L
alb <2 (this one?)
864
Ang-1
Ang-2 targets "hypoxia-alpha something
865
AMG386 - target "AMG386 aka trebananib= angiopoietin (Ang) 1 and 2 neutralizing peptibody placental growth factor
hypoxia alpha something
866
Alternative statistical methods to maintain power? "Non-parametric (does not assume anything about the distribution; good for outliers
skewed distribution
867
AI most common side Arthralgias (15-20%)
HA (9-15%)
868
AGC-NOS during pregnancy
colpo neg at 22 weeks repap postpartum
869
Afib in setting of heart failure in postop pt
how to treat acutely "Metop (this one if they are stable; multiple RCTs show decreased mortality with BB)
870
Advantage of HDR vs LDR Less tx time (this one)
less tx
871
Abx that don't require renal dosing Ceftriaxone
clinda
872
Abdominal compartment syndrome "Measurement of bladder pressure (not imaging!) Conservative mgmt: avoiding positive fluid balance after initial resuscitation
evac intraluminal contents
873
8 cm defect between vulva and anus - best flap? Gracilis (this one)
VRAM
874
41 yo with choriocarcinoma 7 months from pregnancy with pulm mets too numerous to count - what to treat "multiagent (based on WHO score) - EMACO AGE >/=40 Antecedent Abortion
term pregnancy 4-6 months interpregnancy interval
875
32 weeks pregnant
7 cm cystic adnexal mass - what do you do? US after delivery or Vaginal delivery with operation if mass persists
876
300 dyne and increased CO - what type of shock?
Sepsis Distributive shock- low SVR (<900 dynes per second/cm^5) and normal or high CO Cardiogenic shock- high SVR (>1400 dynes/second/cm^5) and low CO ; high PCWP geater than 15 mmHg (right atrial pressure)"
877
3 ways that oncogenes are activiated
which is not mutation in prmoter region regulating inactivation
878
20 years after chemoRT
which risk factor led to lumbosacral radiculopathy cisplatin
879
18 weeks pregnant
s/p CKC for AIS with positive margins and ECC
880
14 weeks with ASCUS HPV
no gross lesions
881
12 weeks pregnant
endodermal sinus tumor Tx with chemo BEP
882
% breast cancer risk reduction with oophorectomy in BRCA pos women
50%
883
"**Which of the following is associated with steatosis aka fatty liver in TPN? 1. excess calories from glucose 2. excess calories from protein 3. excess calories from fat 4. excess calories from any source 5. insufficient fat soluble vitamins; 6. insufficient calories from fat"
excess calories from glucose/dextrose (aka overfeeding syndrome)
884
RR of raloxifene and thrombosis RR 2.1 (grady 2004
RCT of 7700+ women)
885
know vulvar staging "IA Tumor confined to the vulva or perineum
≤ 2cm in size with stromal invasion ≤ 1mm
886
What is best adjuvant treatment for woman referred to you s/p TAH/BSO with diagnosis of leiomyosarcoma (WPRT
gem/taxotere
887
Best adj tx for uLMS diagnosed post-hyst WPRT
gem/tax (THIS ONE)
888
What is function of gemzar prodrug
substitutes cytosine that stops replication by "masked chain termination"
889
What is least leukomegenic chemo
bleo
890
What are the axes on ROC x- 1-spec
y- sens
891
What is best way to diagnose HNPCC
genetic testing for MLH1/MSH2
892
What is best treatment for first relapse c. diff (IV flagyl
IV vanc
893
What preop abx is most associated with c. diff development (cefotetan
ertapenem
894
What has the most collateral circulation with the IMA (the external iliac
internal iliac
895
know electrolytes abnormalities and ECG changes "Hypercalcemia – shortened QT
Hypocalcemia – lengthened QT; Hypokalemia – flattened or inverted T waves
896
What do you do intraop if recognized pancreatic injury during ovarian cancer debulk (repair injury
pancreatectomy
897
What test to use to compare mean among three groups
ANOVA
898
Most common mutation in mucinous ovarian cancer (p53
KRAS
899
Advantage of HDR over LDR less exposure of staff to radiation for prolonged periods of time (THIS ONE)
other options included less treatments
900
What is biggest barrier to ovarian cancer screening
(I chose low specificity of existing tests) prevalence
901
Formula for odds ratio (OR) vs. relative risk (and when to use each) "(a/b) / (c/d) or (a*d)/(b*c) i.e.
gave numerator (exposed case/unexp case) and you give denominator (exp control/unexp control) see 4x4 table on next page RR = a/(a+b) / c/(c+d) Use OR for case control (b/c compares presence/absence of exposure knowing the outcome) Use RR for cohort study (know exposure status
902
For elective hyst pt with recent cardiac stent what should you do first? "Find out when/type of stent
wait 12 months
903
Femoral triangle Inguinal ligament
sartorious (lateral)
904
Estrogen receptor expression can help distingish LMS (40%) vs GIST (none) (THIS ONE)
small cell cervix vs endometrial
905
Estrogen isoforms created by Alterantive splicing (THIS ONE)
amplification
906
Esophageal doppler vs. conventional monitoring intraop for fluid resuscitation "Lower mortality
less ICU stays (THIS ONE)
907
EPO known risks death (maybe)
thrombosis (yes)
908
Endometrioisis related marker ARID1A
909
Endometrial cancer mutation associated with good prognosis Excellent prognosis regardless of grade POLE
910
Elevated CA19-9 and CEA mucinous tumor
911
EKG changes with HYPERmag Prolonged QT
912
EGFR receptor (how it works) Ligand binding causes dimerization of the transmembrane EGFR receptor which activates the tyrosine kinase domain
913
Effect of multiple variables on survival Cox proportional hazards model
914
Earliest lab value to measure in nutrition progress Prealbumin (THIS ONE)
albumin
915
Doxil versus doxorubicin "Liposomal bound (aka pegylated) witih MPEG methoxypolyethylene glycol to avoid detection by the mononuclear phagocyte system Results in: longer plasma life
reduced volume of distribution
916
Downstream effect of VEGF receptor binding Capillary permeability (THIS ONE)
increased intratumor pressure
917
Dose of brachy after hyst for endometrial cancer is dosed to where 0.5cm deep and 0.5cm wide
918
Doing an inguinal LND and injury nerve lateral/near the psoas
what will pt not be able to do Addut thigh
919
Direct and indirect radiation/xrt mechanisms "Direct = causes ds DNA break Indirect = free radical which produces oxidative change"
920
Diabetes/HTN med that should be discontinued before CT Metformin
921
Describe VEGF proteins and receptors "VEGF A-E and placental growth factor 1-2 VEGF-A
B
922
Describe HPV cancer pathway "E6/E7 are viral oncogene proteins: E6 inactivates p53 leading to its proteosomal degradation
E7 inactivates pRb by competing for binding and then frees transcription factor E2F to transactivate its targets"
923
Define obesity hypoventilation syndrome PCO2 >45
BMI>30
924
Deficits from obturator nerve injury Motor only; loss of adduction (see sheet 2)… (I think also does sensation to anterior thigh)
925
Deficits from genitofemoral nerve injury Sensory only; ipsilateral mons and labia majora; sensory of upper anterior thigh
926
Deficits from femoral nerve injury L2-L4
unable to flex hip or extend knee; knee DTR; sensory anteromedial thigh/leg/foot - aka can't walk
927
Cytokine pro-inflammatory in sepsis TNF-alpha (this one)
IL-2 - note: IL-1 may have some role but TNF-alpha is stronger
928
Cvx cancer 6 mm wide
2.5 mm deep
929
Criteria for trachelectomy "1. Desire to preserve fertility 2. Reproductive age 3. Squamous or adeno (i.e.
not neuroendocrine) 4. Stage IA1 with LVSI
930
Cowden What is the germline mutation? Clinical picture (non-cancer)? Screening?" "PTEN Clinical picture: GI polyps, thyroid disease, benign breast disease, mucocutaneous lesions Cancer risk: breast, thyroid, endometrial Screening for breast cancer: breast self awareness from 18yo, clinical breast exam q6-12mo from age 25 (or 10 years before earliest family dx), annual MMG from 30-35yo (or 5-10 years before earliest family dx) per NCCN 4/2018 Screening for endometrial cancer: observation and prompt eval of AUB. "consider annual random EMB +/- US from age 30-35" per NCCN 4/2018
931
Cowden most common gyn cancer Endometrial cancer (lifetime risk 19-28%)
932
Cowden most common cancer Breast
933
Copy number high (group 4) of endometrial cancer molecular subgroup is most likely what histology? Serous
934
COPD greatest preop eval risk O2 sat low
935
Contraindication to radical trachelectomy LVSI
size 3 cm (this one)
936
Contraindication to palliative surgery DNR
hemodynamic instability (this one)
937
What histology is a contraindication for radical trachelectomy Small cell (this one)
villous glandular adenoma
938
Complications of continent conduit "Leak (5% risk with ileal conduit)
perfusion complication (0.5% with ileal conduit)
939
Complication of cdiff Toxic megacolon
940
Colon cancer screening recs "for Average risk (no history of IBD
no family history) starting at age 50yo (or consider 45yo for African-Americans) per NCCN 4/2018: 1) Colonoscopy q10 years 2) Stool-based test (high-sensitive guaiac-based or immunochemical testing q1yr vs. FIT-DNA-based testing q3yr) 3) flex sig q5years 4) CT colonosgraphy q5years (this replaces barium enema) Least helpful: MD digital rectal exam"
941
What are advanced colon adenomas that increase colon cancer risk villous or tubulovillous histology
high-grade dysplasia
942
Collateral with obturator artery Deep external pudendal; INFERIOR EPIGASTRIC - either of these may be answer
943
Chemo for LMS Gemzar/taxotere (can also do doxorubicin +/- olaratumab per NCCN)
944
Chemo for carcinosarcoma (most efficaceous) Ifos/taxol - THIS ONE (carbotaxol was not an option)
ifoscarbo
945
Changes in apoptosis (two questions) "not cause inflammation
does cause chromatin condensation 1) cell shrinkage and rounding due to caspase 2) cytoplasm dense and organelles tightly packed 3) chromatin undergoes condensation against the nuclear envelop (PYKNOSIS) 4) nuclear envelope becomes discontinuous and DNA is fragmented (KARYORRHEXIS) 5) cell membrane buds into blebs 6) cell breaks apart into multiple vesicles called apoptotic bodies - these are phagocytosed"
946
Cervical cancer pt s/p RT presents with fever
diarrhea
947
Cancer with elevated CA-125 (ovary not a choice) Pancreatic (if not breast or lung)
breast (THIS ONE per Sjovall 2002 if option
948
Cancer vaccines general mechanism "Whole cell tumor lysates (?) Tumor-specific antigens needed to stimulate dendritic cells and activate T cells; MHC1 and CD8 cells Three phases of cancer development: elimination
equilibrium (tumor cell variants arise)
949
Cancer risk with Peutz-Jeghers Stk11 (tumor suppressor)
autosomal dominant - sex cord stromal with annular tubules**
950
Cancer risk with MEN2 Parathyroid hyperplasia (10-25%)
medullary thyroid ca (almost all will get this
951
Cancer risk with MEN1 "3 P's: pancreatic
parathyroid
952
Cancer risk with Li-Fraumeni p53 mut - sarcoma (15% by age 70 in women)
breast (54%)
953
Cancer risk with Cowden PTEN mut - breast (25-80%
triple neg)
954
Cancer for which smoking is protective Endometrial cancer
955
Calculator PPV
NPV
956
Brisk bleeding from deep pelvic LND Accessory obturator vein
957
Breast cancer screening for BRCA annual MRI 25-29yo; 30-75yo annual mammo +/- breast MRI/tomosynthesis (NCCN 5/2018)
958
Breast biopsy - atypical ductal cells - what is mgmt? Lumpectomy to r/o DCIS or cancer
occurs in up to 10-30%
959
BRCA1 most common type of breast cancer Triple negative
IDC
960
BRCA type of cancer risks "breast (41-90% lifetime risk)
ovary (8-62%)
961
BRCA 2 - most common type of breast cancer ductal ER+(THIS ONE)
lobular ER+PR+
962
Branches of the internal iliac "Posterior: ILS (iliolumbar
lateral sacral
963
Branches of SMA "Inferior pancreaticoduodenal
jejunal branches
964
Branches of IMA Left colic
sigmoid arteries
965
Branches of celiac Left gastric
common hepatic (proper hepatic
966
Brain radiation: which is not a side effect hair loss
seizures
967
BRAF
"Serous borderline and recurrent low grade serous carcinoma BRAF and KRAS mutations are mutually exclusive"
968
Bowel injury during L/S no bowel prep
1 cm
969
Blood vessel most likely injured during right diaphragm stripping
Phrenic artery
970
Blood supply to the lesser omentum
Left gastric
971
Blood supply to gracilis flap
Medial circumflex femoral artery
972
Biggest risk factor for LAR leak "Tension (this one)
no bowel prep
973
Best way to quantitate protein
Western blot
974
Best way to check for PE Spriral CT
CT angiogram (this one)
975
Best way to amplify DNA
PCR
976
Best test to eval association in case control trial
Odds ratio
977
Best randomization method Coin flip
random # table blocks (this one)
978
Best med for anticipatory chemo-induced nausea 5HT3
benzos (this one)
979
Best initial test to start with to evaluate smoking and certain type of cancer Prospective RCT
case control (good initial study)
980
Best initial study to assess relationship between PNV and ovarian cancer Case control (this one)
cohort
981
Best imaging for the brain (ie: small cell cancer brain mets)
MRI
982
Best imaging for myometrial invasion in uterine cancer
MRI
983
Best imaging for localizing recurrent cervix
PET/CT
984
Best criteria to diagnose HNPCC MSI
Amsterdam
985
Best abx for Klebsiella "Ceftaz (this one)
imipenema and clinda
986
Base of the femoral triangle Pectineous*
iliopsoas
987
ATN "FeNa >2%
will have normal BUN:Cr ratio (10 or 15:1)
988
at what age do you start HNPCC testing 20 (THIS ONE)
30
989
Associated with decreased SSI with rectosigmoid resection Chlorhexadine bath
normotheramia
990
Ascites and ovarian cancer - which VEGF
VEGFR2 by VEGF-A has major permeability enhancing effect
991
Artery in inguinal triangle
Inferior epigastric a
992
Appearance of radiation enteritis on imaging
Diffuse bowel wall thickening
993
Another cause of anastomotic leak Increasing ascites >4L
alb <2 (this one?)
994
Ang-1
Ang-2 targets "hypoxia-alpha something
995
AMG386 - target "AMG386 aka trebananib= angiopoietin (Ang) 1 and 2 neutralizing peptibody placental growth factor
hypoxia alpha something
996
Alternative statistical methods to maintain power? "Non-parametric (does not assume anything about the distribution; good for outliers
skewed distribution
997
AI most common side Arthralgias (15-20%)
HA (9-15%)
998
AGC-NOS during pregnancy
colpo neg at 22 weeks repap postpartum
999
Afib in setting of heart failure in postop pt
how to treat acutely "Metop (this one if they are stable; multiple RCTs show decreased mortality with BB)
1000
Advantage of HDR vs LDR Less tx time (this one)
less tx
1001
Abx that don't require renal dosing Ceftriaxone
clinda
1002
Abdominal compartment syndrome "Measurement of bladder pressure (not imaging!) Conservative mgmt: avoiding positive fluid balance after initial resuscitation
evac intraluminal contents
1003
8 cm defect between vulva and anus - best flap? Gracilis (this one)
VRAM
1004
41 yo with choriocarcinoma 7 months from pregnancy with pulm mets too numerous to count - what to treat "multiagent (based on WHO score) - EMACO AGE >/=40 Antecedent Abortion
term pregnancy 4-6 months interpregnancy interval
1005
32 weeks pregnant
7 cm cystic adnexal mass - what do you do? US after delivery or Vaginal delivery with operation if mass persists
1006
300 dyne and increased CO - what type of shock?
"Sepsis Distributive shock- low SVR (<900 dynes per second/cm^5) and normal or high CO Cardiogenic shock- high SVR (>1400 dynes/second/cm^5) and low CO ; high PCWP geater than 15 mmHg (right atrial pressure)"
1007
3 ways that oncogenes are activiated
which is not mutation in prmoter region regulating inactivation
1008
20 years after chemoRT
which risk factor led to lumbosacral radiculopathy cisplatin
1009
18 weeks pregnant
s/p CKC for AIS with positive margins and ECC
1010
14 weeks with ASCUS HPV
no gross lesions
1011
12 weeks pregnant
endodermal sinus tumor Tx with chemo BEP
1012
% breast cancer risk reduction with oophorectomy in BRCA pos women
50%
1013
"**Which of the following is associated with steatosis aka fatty liver in TPN? 1. excess calories from glucose 2. excess calories from protein 3. excess calories from fat 4. excess calories from any source 5. insufficient fat soluble vitamins; 6. insufficient calories from fat"
excess calories from glucose/dextrose (aka overfeeding syndrome)
1014
RR of raloxifene and thrombosis RR 2.1 (grady 2004
RCT of 7700+ women)
1015
know vulvar staging "IA Tumor confined to the vulva or perineum
≤ 2cm in size with stromal invasion ≤ 1mm
1016
What is best adjuvant treatment for woman referred to you s/p TAH/BSO with diagnosis of leiomyosarcoma (WPRT
gem/taxotere
1017
Best adj tx for uLMS diagnosed post-hyst WPRT
gem/tax (THIS ONE)
1018
What is function of gemzar prodrug
substitutes cytosine that stops replication by "masked chain termination"
1019
What is least leukomegenic chemo
bleo
1020
What are the axes on ROC x- 1-spec
y- sens
1021
What is best way to diagnose HNPCC
genetic testing for MLH1/MSH2
1022
What is best treatment for first relapse c. diff (IV flagyl
IV vanc
1023
What preop abx is most associated with c. diff development (cefotetan
ertapenem
1024
What has the most collateral circulation with the IMA (the external iliac
internal iliac
1025
know electrolytes abnormalities and ECG changes "Hypercalcemia – shortened QT
Hypocalcemia – lengthened QT; Hypokalemia – flattened or inverted T waves
1026
What do you do intraop if recognized pancreatic injury during ovarian cancer debulk (repair injury
pancreatectomy
1027
What test to use to compare mean among three groups
ANOVA
1028
Most common mutation in mucinous ovarian cancer (p53
KRAS
1029
Advantage of HDR over LDR less exposure of staff to radiation for prolonged periods of time (THIS ONE)
other options included less treatments
1030
What is biggest barrier to ovarian cancer screening
(I chose low specificity of existing tests) prevalence
1031
underexpressed MSH 2 and 6
intact MLH1 and PMS2 what to do germline testing. Options included: promotor methylation
1032
MSI colon cancer most likely linked to early stage (I put this)
left sided colon ca (def no)
1033
MSH2. what is best screening EGD. Other options: FOBT annually
breast imaging
1034
BRCA2 mutation most likely to increase risk of what cancer Pancreatic. Others included colon
others that were not associated
1035
Cowden highest cancer risk bladder
pancreas
1036
microcalcifications in breast what is next best step FNA
core biopsy
1037
3cm breast mass in 25yo woman preg at 10 weeks what is next best step Ultrasound
biopsy
1038
tamoxifen most common serious side effect Vasomotor
DVT
1039
Anastrozole causes Asthenias
alopecia
1040
Breast ca type in BRCA basal type
triple neg
1041
BRCA more likely to have what compared w BRCA wt LVSI
earlier stage
1042
shortness of breath how to treat Opioids. Options: fan blowing at face
supplemental O2
1043
severe pain recurrent carcinosarcoma also renal insufficiency Methadone
oxycontin
1044
malignant bowel obstruction with g tube on steroids and persistent N/V Options: dexamethasone
reglan (def no)
1045
malignant bowel obstruction w g tube and persistent n/v dexamethasone
octreotide
1046
best intraoperative anesthetic considerations for ERAS Options: weight-based fluid resuscitation (I put this)
regional anesthesia (a close second for me)
1047
most likely to shorten hospital stay Options: ambulation POD0 (I put this)
enteral feeding POD0
1048
who is best person for TPN Options: POD5 with ileus (I put this)
malignant SBO
1049
hyperK 6.8 with peaked T and prolonged QRS what to do Options: calcium (I put this)
gluc/insulin
1050
Regional anesthesia in ERAS a/w more DVTs -- next step? Root cause analysis
stop regional anesthesia
1051
Low urine Na <25, low urine osm < 100
primary polydipsia, malnutrition potomania, surreptitious diuretic use
1052
Hypocalcemia: know side effects - one of each asked
PROLONGED QT (this one), hyperreflexia #1 = tetany; others- seizure, hypotension, prolonged QT, papilledema, psychological sx (less common confusion)
1053
Hypercalcemia sx
SHORTENED QT (this one) mild Ca <12 asx or non-specific constipation, ftigue, depression moderate 12-14 polyuria, polydipsia (b/c can't concentrate urine), dehydration, anorexia, nausea, m. weakness, snesorium changes severe Ca >14 progression
1054
Hypercalcemia - which is not a treatment
D5W (this one) tx (mild) - hydrate with NS (NOT WATER), avoid thiazide diuretics tx (severe) - isotonic saline vol expansion, calcitonin, zoledronic acid; if refractory, can try denosumab
1055
How to tx DVT if renal failure
Don't use lovenox --> can use coumadin or argatroban or heparin or apixiban
1056
How to reduce small bowel complications with radiation
Tx with fll bladder (I think this one though), prone position (this one), decubitus position
1057
How to reduce PPE sx
Cold packs, emoillents, B6, dose reduction, vitamin E
1058
How to control for confounding
Multivariate logistic regression
1059
How to check impact of independent variable
Logistic regression
1060
How had addition of chemosensitizers affect radiation outcomes
enterocolitis, noninfectious bladder cystitis, fistula formation, mortality (or this one? TL: I think its this one.) In meta-analysis 2010 / HR death 0.69 or 10% absolute improvement, HR recurrence 0.66 (13% absolute improvement, OR 1.98 gr 3/4 esp GI tox)
1061
How does the HPV vaccine work
Recombinant L1 capsid protein (1 of 2 viral capsid proteins) Forms virus like particles (VLPs) which are combined with adjuvants Adjuvants stimulate the immune system (aluminum based) VLPs induce humoral response with antbiotides and some cell-mediated immune response
1062
How does LOH occur (two mechanisms)
Deletion most common, or methylation
1063
How does her2 work
Oncogene that is activated by AMPLIFICATION
1064
How does cisplatin augment radiation
Inhibit repair of sublethal damage
1065
How do kinases work
Phosphorylation
1066
HNPCC not cancer - long list
breast // does include endometrial, colon, gastric, ovarian, pancreatic, uretehral, brain (glioblastoma), small intestinal, sebaceous gland adenomatous polyps, keratoacanthomas
1067
HIT II pt - next best step vs HIT I where plt ~100K, not immune-mediated, and can continue heparin
argatroban=direct thrombin inhibitor (THIS ONE- and ok in renal failure), heparin, warfarin can also consider fondaparinux=inhibits anti-Xa activity through antithrombin III, synthetic or if liver failure, use bivalirudin (also a direct thrombin inhibitor) occurs in 5% of pt exposed to heparin, anti-PF4 (platelet factor 4) thrombocytopenia = plt <150K plt drop usu >50% baseline, occurs 5-10d after exposure (could be earlier if recently exposed to heparin) THROMBOSIS (50% those with HIT, venous > arterial, can lead to skin necrosis, limb gangrene, organ infarction) resolution after stopping heparin is usually 7d
1068
Histopath of leiomyosarcoma
LMS - have prominent cellular atypia, abundant mitoses (≥10 per 10 high power fields), and areas of coagulative necrosis. NOT infiltrative borders
1069
Highest risk for VRAM flap
Prior surgery (this one - prior Maylard?), smoking, obesity
1070
High LET has what effect on cancer cells?
Tumor necrosis
1071
HAMA (human anti-mouse antibody) - most likely to get immune response
longer oligonucleiotide fragment, chimeric human ab, part of human something or other where you just replicate a piece of murine DNA and create human copy
1072
GTN - quiescent versus active
Persistent, unchanging low levels M200 of real hcG for at least 3 months with hx of GTD or SAB but no detectable disease 6-25% will develop active disease (increase in hyperglycosylated hCG with cytotrophoblastic invasion) and total hCT Only tx once sustained rise or overt clinical disease detected
1073
Grade 3, IA endometrioid ovarian cancer
observation, 3 cycles chemo (THIS ONE based on GOG157), 6 cycles chemo
1074
Grade 1 endometrioid, young, normal weight - most likely expression
MSH2 (this one), CK7, ER, PR
1075
Germ cell tumor least likely to have elvated AFP
Dysgerminoma and choriocarcinoma both not elevated
1076
Genetic mut associated with type I endometrial cancer
PTEN (PTEN tumor suppressor is the most important negative regulator of PI3K signaling)
1077
Genes related to apoptosis
bcl (b cell lymphoma) - regulate apoptosis caspase - programmed cell death including apoptosis BAX (bcel-2 like protein 4) encoded by BAX gene - regulate apoptosis NOT VEGF
1078
Which of 4 PARP inhibitors is most likely to cause rise in LFTs/transaminitis?
Choices: Olaparib, Niraparib, Rucaparib, Velaparib
1079
What side effect is most likely with Gemcitabine?
NEUTROPENIA
1080
Marker/stain for Paget's disease of CUTANEOUS origin
Choices: S100, Melan-A, HMB45 and others I can't remember. Per lit search: Primary intra-epidermal Paget disease is GCDFP-15 positive, CK7 positive, and CK20 negative. Primary vulvar Pagets (ie: cutaneous) expresses CK7, GCDFP and CEA but NOT CDX2, S100, HMB45, ER or PR. Secondary vulvar Paget disease most commonly represents spread of urinary tract (CK20+, uroplakin+, thrombomodulin+) or colorectal adenocarcinoma (CK20+, CDX2+, CEA+). In contrast, cutaneous melanoma is Melan-A positive, S100 positive, and HMB45 positive.
1081
FOXL2 is associated with which type of tumor?
Adult granulosa cell tumor
1082
BRCA1 associated breast cancer is most likely to have what histology?
Choices: Basal-like (this one), HER2 pos, Luminal A, Luminal B Per lit search: BRCA1 breast cancers are triple negative and basal-like. BRCA2 breast cancers are luminal B type.
1083
Bleomycin active in which stage of cell cycle?
Choices: G1, G2 (this), S, M
