Cancer. Diverticuli.

Front 1

179. What is the most important to know about cancer for the USMLE?

Back 1

note: the most important thing you need to know about: cancer, by far, is what screening to perform.

Front 2

180. Screening for colon cancer guidelines?

Back 2

1. Begin screening at age 50
screen with the following:
1. Colonoscopy every 10 years
2. Sigmoidoscopy every 5 years

3. fecal occult blood testing yearly
4. barium enema

Front 3

181. what is the best method of screening for colon cancer?

Back 3

a. Colonoscopy every 10 years, is the best method by far.
b. All other methods are less accurate

Front 4

182. when is a virtual colonoscopy by CT scan the answer?

Back 4

a. When you're asked what colon cancer screening test NOT to do.
b. It lacks both sensitivity and specificity, because you cannot biopsy and it misses small lesions.

Front 5

183. Screening for colon cancer if there is one family member with colon cancer?

Back 5

Colonoscopy starting at age 40 or 10 years before the age of the family member who had cancer.

Front 6

184. Screening for colon cancer with three family members, two generations, one premature (<50)?

Back 6

Colonoscopy every 1–2 years starting at age 25.
This is Lynch syndrome or hereditary non–polyposis colon cancer syndrome.

Front 7

What other cancers is Hereditary Nonpolyposis Syndrome (Lynch Syndrome) associated?

Back 7

There is a very high incidence of ovarian and endometrial cancer in this syndrome as well.

Front 8

Endocarditis bugs associated with colon cancer.

Back 8

1. Streptococcus bovis

2. Clostridium septicum

Front 9

Presentation of Right-sided vs Left-sided colon cancer.

Back 9

Right-sided: heme-positive, brown stool and chronic anemia.

Left-sided: symptoms of obstruction and with narrowing of stool caliber.

Front 10

Tx. of colon cancer.

Back 10

1. Cancer that is localized to the mucosa, submucosa, and muscularis layers can easily be resected and cured.

2. Widespread disease is treated with chemotherapy with 5-fluorouracil (5FU).

Treatment for a single liver metastatic lesion is surgical resection.

Front 11

185. Hamartomas and hyperplastic polyps: Benign or malignant?

Back 11

Benign

Front 12

186. dysplastic polyps: benign or malignant?

Back 12

Malignant.,

Front 13

187. When to start screening with Familial Adenomatous Polyposis (FAP)?

Back 13

a. Start screening sigmoidoscopies at age 12.
b. perform a colectomy, once polyps are found.

Front 14

193. What should be done if a dysplastic polyp is found?

Back 14

Repeat colonoscopy every 3–5 years after the polyp was found.

Front 15

Cowden syndrome?

Back 15

Another polyposis syndrome with hamartomas that gives only a very slightly increased risk of cancer compared with the general population.

Can present with rectal bleeding in a child.

Front 16

188. On routine x–ray, a man is found to have several osteomas. What do you recommend?

Back 16

a. Perform a colonoscopy to screen for cancer.
b. There is no additional screening indicated.
c. This is Gardner's syndrome.

Front 17

189. Presentation of Gardner's syndrome?

Back 17

a. Benign bone tumors, known as osteomas
b. other soft tissue tumors

Front 18

Turcot syndrome?

Back 18

Colon cancer with central nervous system malignancies.

Front 19

190. presentation of Peutz–Jeghers syndrome?

Back 19

a. Melontic spots on the lips
b. Hamartomatous polyps throughout the small bowel and colon

Front 20

191. what is the lifetime risk of colon cancer with Peutz–Jeghers syndrome?

Back 20

a. 10%.
b. Only slightly higher than the 6–8% risk of colon cancer in the general population.
c. There is no extra screening recommended

Front 21

192. presentation of Juvenile polyposis?

Back 21

a. There are multiple extra hammer traumas in the bowel.
b. Hammer traumas do not bring a significant increase in the risk of colon cancer.
c. There is no additional screening recommended.
d. This is markedly different from FAP.

Front 22

Screening recomandation for Gardner's syndrome, Turcot syndrome, Peutz–Jeghers syndrome, Juvenile polyposis?

Back 22

There is no recommendation to perform increased cancer screening in any of these patients.

Front 23

194. Is CEA used for screening?

Back 23

a. NO– CEA is never a screening test.
b. CEA is used to follow response to therapy.

Front 24

195. Diverticulosis?

Back 24

Diverticulosis is incredibly common in older Americans due to a low fiber, high–fat, hamburger, filled, low residue diet. Lack of fiber in the diet.

Front 25

196. Presentation of diverticulosis?

Back 25

a. Left lower quadrant abdominal pain
b. lower G.I. Bleeding

Front 26

Presentation of bleeding from a diverticula.

Back 26

Painless bleeding.

Front 27

197. most accurate diagnostic test for diverticulosis?

Back 27

Colonoscopy

Front 28

199. treatment diverticulosis?

Back 28

High–fiber diet

Metamucil

Bulking agents, such as psyllium husks

Front 29

200. diverticulitis?

Back 29

Is a complication of diverticulosis.

Front 30

201. Presentation of diverticulitis?

Back 30

a. Left lower quadrant abdominal pain
b. tenderness
c. fever
d. elevated serum WBC.

Front 31

202. Best diagnostic test for diverticulitis?

Back 31

Abdominal CT scan

Front 32

203. treatment diverticulitis?

Back 32

Combining agents against gram–negative bacilli, such as quinolone or cephalosporin, with an agent against anaerobes, such as metronidazole.
Cipro and Metro are a standard combination.

Front 33

204. What two tests are contraindicated in diverticulitis?

Back 33

Colonoscopy and barium enema–increase risk of perforation.

Front 34

205. LLQ pain + tenderness + leukocytosis=?

Back 34

Diverticulitis.