Associations
Scoring
Treatments
Weird things
More cancer
100
Cancer Associations A - MLH1/MLH2 B - BRCA1 C - TP53 mutation D - PTEN mutation
A - MLH1/MLH2 - Lynch Syndrome B - BRCA1 - Breast caner C - TP53 mutation - Li-Fraumeni D - PTEN mutation - Cowden disease
100
Wells Score - for likelihood of DVT. What score is needed to be likely?
What is 4. S/S of DVT = 3, PE more than likely dx = 3, HR >100 = 1.5, Immobilization >3 days or surgery in past 4 weeks =1.5, Previous PE/DVT = 1.5 Hemoptysis = 1 cancer =1
100
Pregnancy with new diagnosis of invasive cervical cancer. When do you Do radical hysterectomy with fetus in situ? When do you do Radiation +chemotherapy +hysterectomy +Brachytherapy? When do you do chemotherapy + fetal maturity then treatment?
When do you Do radical hysterectomy with fetus in situ? ###Less than 24 weeks and does not desire to continue pregnancy and is STAGE iB-IIA### When do you do Radiation +chemotherapy +hysterectomy +Brachytherapy? ###Less than 24 weeks, de not desire pregnancy and STAGE IIB-IVA### When do you do chemotherapy + fetal maturity then treatment? ***Greater than 24 weeks or desires to continue pregnancy***
100
Gas embolisms 1 - Signs 2 - Treatment
SIGNS - tachycarida, arrythmia, hypotension, increase CVP, mill wheel murmur, cyanosis TREATMENT - release pneumoperitoenum, steep trendelenberg and to left side (DURANT maneuver), 100% O2, hyperventilation
100
Proliferative breast lesions - ductal hyperplasia (without atypia) - intraductal papillomas - sclerosing adenosis - radial scars - fibroadenomas
Small increased risk of breast cancer 1.5-2 times Ductal hyperplasia - increase in size and shape of cells but maintain cytologic characteristics of benign cells.
200
Lifetime Risks of Cancer A - Breast cancer - Lifetime with BRCA1 or 2 B - Ovarian cancer - lifetime with BRCA1 C - Ovarian cancer - lifetime with BRCA2
A - Breast cancer - Lifetime with BRCA1 or 2 is 65-74%. B - Ovarian cancer - lifetime with BRCA1 is 39-46%. C - Ovarian cancer - lifetime with BRCA2 is 12-20%. BRCA occurs in only 3-5% of all breast cancers though. Only 10-15% of ovarian cancers have a genetic disposition.
200
Non proliferative breast lesions - fibrocyctic changes - fibrocyctic disease - chronic cystic mastitis mammary dysplasia breast cysts
No increased risk of cancer
200
What is AGC and how is it managed? Think PAP smear :)
What is atypical glandular cells. 4 Types - 1 - AGC (endocervical, endometrial or Not otherwise specified) 2 - AGC favor neoplastic (endocervical or not otherwise specified) 3 - Endocervical adenocarcinoma in situ 4 - Adenocarcinoma #####Management - Colposcopy with endocervical sampling. AGC pap has a 9-38% risk of CIN2 or greater and a 3-17% risk of invasive cancer. If greater than 35 OR <35 with increased risk of endometrial neoplasia OR with AGC endometrial type - endometrial biopsy is also recommended.
200
Necrotizing fascciittis bacteria?
What is Polymycrobial Bowel flora and costridium septicum or tertium. Gynecological = clostridium sordellii. Streptococcl and staphylococcus are about 25% - rapidly progressing.
200
Calculate Sensitivity Calculate Specificity Calculate PPV Calculate NPV
Sensitivity - a/(a+c) (How many positives the test got right) Specificity - d/(d+b) (How many negatives the test got right) PPV - a/(a+b) (how many that tested + are actually +) NPV - d/(d+c) (how many that tested - are actually -)
300
Risk reducing BSO reduces breast cancer by how much? Ovarian cancer? How much does OCP use for 5 years reduce ovarian cancer risk?
What is 50% for breast cancer and 80-90% for ovarian. OCPS reduce risk of ovarian cancer by 33-38%
300
When looking at toxicity from chemotherapy - which parts of the CBC w/diff would cause you to delay therapy? (Hint: pick 2) A - Hematocrit B - Hemoglobin C - Platelets D - Granulocytes
What is C and D. Granulocytes the day of treatment should be >1500/mm3 Platelets should be wnl. Granulocytes at cycle nadir should be >1000 and platelets should be >50,000. Levels beloe these require delay of next treatment until counts recover and if >7 days require lowering dose by 1 level (or adding granulocyte colony stimulating factor)
300
Tumor marker stains 1 - cytokeratin 7 (KRT7 or CK7), CA 125, PAX8 and WT1 2 - cytokeratin 20 (KRT20 or CK20), CEA, CX2 3 - Vementin
1 - Serous ovarian tumors 2 - Gastrointenstinal 3 - endometrial or endocervical
300
Breast - proliferative lesions with atypical hyperplasia - atypical ductal hyperplasia - atypical lobular hyperplasia
Increased risk of breast cancer (3.7-5.3) Risk reducing strategies like semiannual breast exam and yearly mammogram.
300
Describe findings of hyperkalemia on an EKG? How do you treat?
What is short Q-T interval, wide QRS complex, peaked T waves. You should admit the pt, give IV calcium, insulin and glucose administration, possible diuretic use, correct the underlying cause
400
Using the WHO scoring System for GTN based on prognostic factors - which factors give you 4 points?
What is >13 months from index pregnancy, greater than 105IU/L BCHG initially, Brain metastases, greater than 8 metastases and failing >2 chemotherapy agents
400
Type I and Type II Endometrial Cancer Type I - ER/PR positive - rare TP53 mutations, 80%PTEN mutations - HER2 (ONLY 10-30%) - No BCL-2 - Younger, obese presents at lower stages
Type II - ER/PR negative - 90% have TP53 mutation, rare PTEN - HER2 (45-60%) - BCL-2 overexpressed - older, no excess estrogen - present at later stages
400
Mutations = which gyn cancers A - PTEN - B-catenin & KRAS B - TP53 - HER2/nu C - p16
What is A - PTEN - B-catenin & KRAS - endometriod adenocarcinoma of endometrium B - TP53 - HER2/nu - uterine papillary serous C - p16 - cervical cancer
400
Pseudomyxoma peritonei comes from what primary source? A - Overy B - Colon C - Stomach D - Appendix E - Uterus
What is D. Associated with mucinous ovarian tumors.
400
Risk of progression from hyperplasia to carcinoma? A - simple w/o atypia B - complex w/o atypia C - simple w/atypia D - complex w/ atypia
What is penny - nickle - dime - quarter :) Should get you close enough to pick the right answer. A - 1% B - 3% C - 8% D - 29%
500
Using the WHO scoring System for GTN based on prognostic factors - which factors give you 0 points?
What is age <40, antecedent molar pregnancy, less than 4 months from index pregnancy, pretreatment BCG <103IU/L, lung metastases All the other give you 1 or 2 points so you can ballpark :) Remeber over 7 points gets combo chemotherapy instead of single agent. Combo therapy is etoposide, Methotrexate, actinomycin D, cyclophosphamide and vincristine.
500
Malignant germ cell tumors 3 most common - dysgerminoma, endodermal sinus tumor, immature teratoma Surgical management w/ fertility preservation. Staging with washings, omentectomy, lymphadenectomy and staging biopsies is appropriate. Unilateral salphingoopheroectomy is appropriate. Avoid hysterectomy, contralateral salphingoophorectomy and wedge resection if possible.
Treatment after is with adjuvent chemotherapy. Bleomycin - etoposide - and cisplatin. 3-4 cycles.
500
Describe the changes of VIN3. (Histological)
What is loss of maturation, nuclear pleomorphism, cell crowding, abnormal mitoses, full thickness neoplastic cells that DO NOT invade the basement membrane.
500
When using cell saver during a hemorrhage - what things you do can prevent you from using the saved cells?
What is using a solution that causes red cell lysis ( sterile water, alcohol, hydrogen peroxide). Also use of topical clotting agents (fibrin sealant etc) Contamination with urine, amniotic fluid or bone chips.
500
Uterine carcinomasarcomas - <5% of uterine cancer 1-4/100,000 women Biphasic tumor with carcinomatous (epithelial) and sarcomatous (connective tissue) component What is Most common?
Most common - high grade serous carcinoma and high grade stromal sarcoma. Common epithelial (carcinomatous) components - endometrioid, clear cell or undifferentiated. Common connective tissue (sarcomatous) components - leiomyosarcoma, undifferentiated endometrial sarcoma. Common Heterologous sarcomatous (connective tiisue) compnents - rhabdomyosarcoms, chondrosarcoma, osteosarcoma and lipsarcoma. TREAT WITH SURGERY and for advanced disease CHEMO with ifosfamide-cisplatin.
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