Clin Med Exam 1

Front 1

Squamous cell cancers are found in:

Back 1

skin, bronchi

Front 2

Adenocarcinoma cancers are found in:

Back 2

GI, prostate, lung

Front 3

Transitional cell cancers are found in:

Back 3

GU system

Front 4

Sarcoma cancers are found in:

Back 4

skeletal mucsle, CT and bone

Front 5

Teratomas are found in:

Back 5

ovary or testis

Front 6

Glioma cancers are found in:

Back 6

neural tissue

Front 7

For the Tumor classification system, T stands for _____ and is graded......

Back 7

tumor; X-4

Front 8

For the Tumor classification system, N stands for _____ and is graded......

Back 8

nodes; X-3

Front 9

For the Tumor classification system, M stands for _____ and is graded......

Back 9

Metastasis; X-1

Front 10

Induction phase of chemotherapy is:

Back 10

being the process of eradicating cancerous cells and allows new cell generation. Puts pt in remission

Front 11

Consolidation phase of chemotherapy is....

Back 11

a solidifying or continuation of remission; kills any left over cells

Front 12

Maintenance phase of chemotherapy is...

Back 12

long term tx aimed at preventing relapse

Front 13

What is the sequence of the development of colon cancer?

Back 13

small adenamatous polyp--> large adenamatous polyp--> dysplasia--> adenocarcinoma

Front 14

Where to colon polyps tend to be found more with increasing age?

Back 14

proximally

Front 15

Hyperplastic colon polyps are typically _____ in size and more ____ located.

Progression to cancer is _____

Back 15

small; distally; rare

Front 16

Adenomatous polyps are _____ likely to progress to colon cancers with a _____ prognosis than hyper plastic polyps.

Back 16

more; worse;

Front 17

What are some screening options for colon cancer?

Back 17

fecal occult blood, sigmoidoscopy, sigmoidoscopy plus FOBT, optical colonoscopy/colonoscopy, double contrast barium enema

Front 18

What are some common clinical manifestations of colon cancer?

Back 18

abdominal/pelvic pain, change in bowel habits, hematochezia or melena, weakness, anemia, weight loss

Front 19

Hematochezia is more often caused by _____ cancer instead of colon cancer.

Back 19

rectal

Front 20

Which types of colon cancers have a higher blood loss associated with them?

Back 20

cecal and ascending tumors

Front 21

Change in bowel habits is more often a presenting symptom for colon cancer located where?

Back 21

left side

Front 22

Gardners syndrome is....

Back 22

colorectal cancer with benign extracolonic tumors

Front 23

Turcot's syndrome is ....

Back 23

CRC with brain involvement

Front 24

What is a major disadvantage for fecal occult blood screening?

Back 24

only detects blood and the majority of polyps don't bleed

Front 25

Sigmoidoscopy is able to examine the colon up to.....

Back 25

the splenic flexure

Front 26

What is the preferred screening test for colon cancer?

Back 26

colonoscopy

Front 27

What treatment options are there for colon cancer?

Back 27

surgical removal, adjuvant chemotherapy, and nonsurgical treatments

Front 28

Which type of esophageal cancer is more common in AAs? Caucasians?

Back 28

squamous cell carcinoma; adenocarcinoma

Front 29

Squamous cell carcinoma can occur where in the esophagus? Where is it most commonly located?

Back 29

anywhere along the length of the esophagus. Most commonly the first 2/3rds, usually the middle esophagus

Front 30

Adenocarcinoma of the esophagus is usually located where?

Back 30

distal 1/3rd

Front 31

In order for Adenocarcinoma of the esophagus to occur, what needs to happen first?

Back 31

replacement of an area of squamous cells by glandular cells (Barrets esophagus)

Front 32

What is the process of the formation of Barrets esophagus?

Back 32

gastric reflux-->metaplasia--> low grade dysplasia--> high grade dysplasia--> adenocarcinoma

Front 33

Achalasia is....

Back 33

when the LES does not relax properly allowing food to pass in to the stomach. food gets stuck above and the esophagus will dilate

Front 34

What are the three things associated with Plummer Vinson syndrome?

Back 34

post cricoid dysphagia, upper esophageal webs, iron deficiency anemia

Front 35

People with strong risk factors for esophageal cancer should undergo endoscopy and biopsy....

Back 35

at regular intervals

Front 36

In patients with Barrets esophagus: If they have no evidence of dysplasia, repeat endoscopy every ______; If low grade dysplasia is present, repeat every _______; if high grade dysplasia is present, repeat every __________

Back 36

2 years; 6-24 months; 3-6 months

Front 37

Which cancers can metastasis to the esophagus to cause esophageal cancer?

Back 37

liver, lung and bone

Front 38

What is the mosts common symptom of esophageal cancer?

What are some other symptoms?

Back 38

dysphagia;

mid chest pain that can radiate to back, odynophagia, hematemesis, wt loss, drooling, hoarseness, adenopathy

Front 39

What is the typical patient presentation with esophageal cancer?

Back 39

progressive dysphagia of 3-6 months with associated weight loss

Front 40

What type of anemia can be seen in esophageal cancer?

Back 40

microcytic

Front 41

Which tumor marker can be seen in esophageal cancer and can be an indicator of therapy or tumor recurrence?

Back 41

CA 19-9

Front 42

Besides labs, what are some diagnostic tests done to evaluate esophageal cancer?

Back 42

barium swallow/upper GI X-rays, endoscopy, CXR, CT or MRI, Endoscopic US

Front 43

In treatment of esophageal cancer, surgery is usually only done in stages ____ and _____ when there is no ______ associated with the cancer.

Back 43

I, II; metastasis

Front 44

What is photodynamic therapy (as used for tx of esophageal cancer)?

Back 44

light activated drug localizes in cancer tissue, shine a laser on the area which triggers a chemical reaction to kill the cancer cells. leaves healthy tissue untouched.

Front 45

What are the most common symptoms at presentation of gastric cancer?

Back 45

wt loss, persistent abdominal pain (epigastric), dysphagia, early satiety

others: H/V, heart burn, malignant ascites

Front 46

Which lesions are most common in Gastric cancer? which have the worst prognosis?

Back 46

distal; proximal

Front 47

What are the two types of gastric cancer?

Back 47

Intestinal type and diffuse type

Front 48

The intestinal type of gastric cancer effects which group of patients? diffuse type?

Back 48

males, older age; both sexes, younger aged

Front 49

Which gastric cancer tumors tend to have similar features as Barrets esophagus and tend to be more aggressive?

Back 49

proximal

Front 50

An enlarged left supravlavicular node is called....

Back 50

Virchows node

Front 51

Enlarged periumbilical nodules are referred to as.....

Back 51

sister mary josephs nodes

Front 52

Enlarged left axillary nodes are referred to as....

Back 52

Irish nodes

Front 53

When there is peritoneal spread of gastric cancer to the ovaries, this is referred to as....

Back 53

Krukenbergs tumor

Front 54

When there is peritoneal spread of gastric cancer to the cul-de-sac this is referred to as......

Back 54

Blumer's shelf

Front 55

An enlarged left supravlavicular node is called....

Back 55

Virchows node

Front 56

Enlarged periumbilical nodules are referred to as.....

Back 56

sister mary josephs nodes

Front 57

Enlarged left axillary nodes are referred to as....

Back 57

Irish nodes

Front 58

When there is peritoneal spread of gastric cancer to the ovaries, this is referred to as....

Back 58

Krukenbergs tumor

Front 59

When there is peritoneal spread of gastric cancer to the cul-de-sac this is referred to as......

Back 59

Blumer's shelf

Front 60

Which diagnostic test for gastric cancer is able to accurately delineate the depth of the tumor and lymph node involvement?

Back 60

endoscpic ultrasound

Front 61

What are the 5 layers of the stomach? (From inner to outer)

Back 61

mucosa, muscularis mucosa, submucosa, muscularis propria and serosa

Front 62

Abdominal CTs when investigating gastric cancer are unable to...

Back 62

differentiate early from late lesions

Front 63

What are some characteristics that distinguish benign lesions from metastatic lesions (gastric cancer)?

Back 63

symmetric round or oval ulcer, smooth surrounding mound of edema, no modularity, nondistorted adjacent mucosa

Front 64

What are some characteristics that distinguish metastatic lesions from benign lesions (gastric cancer?

Back 64

assymetric distorted ulcers, ulcer on an irregular mass with irregular, distorted mucosal folds, adjacent mucosa obliterated or distorted and theres modularity

Front 65

What is the most significant prognostic factor for gastric cancer?

Back 65

depth of tumor invasion

Front 66

Biological or immunotherapy drugs function to....

What are some symptoms?

Back 66

boost the bodies IS to block growth of cancer cells.

fever, chills, aches, fatigue, bruising, rashes, N/D

Front 67

What is "dumping syndrome" and what are the symptoms?

Back 67

symptoms related to food and liquids moving into the intestines fast;

diarrhea, nausea, cramps and dizziness

Front 68

What are three precursor lesions that can lead to gastric cancer?

Back 68

atrophic gastritis, intestinal metaplasia, dysplasia

Front 69

What is Atrophic gastritis?

Back 69

progressive atrophy of the glandular epithelium with loss of parietal and chief cells. This causes an increase in the pH of the stomach that permits microbial colonizations

Front 70

What is intestinal metaplasia?

Back 70

a potentially reversible change from one fully differentiated cell type to another.

Front 71

Gastric carcinoid is a....

Back 71

rare neuroendocrine tumor of the stomach

Front 72

What is the strongest risk factor for pancreatic cancer?

Back 72

smoking

Front 73

What is the biggest risk factor for esophageal cancer?

Back 73

Barrets esophagus

Front 74

What is the most common risk factor for hepatocellular carcinoma?

Back 74

chronic hep C

Front 75

If serum iron is elevated, the TIBC will be....

Back 75

decreased

Front 76

What is the most common presenting complaint of pancreatic cancer?

Back 76

pain in the upper abdomen that feels like a dull ache and radiates straight through to the back

Front 77

What are some common symptoms associated with pancreatic cancer?

Back 77

weight loss, pain, jaundice

Front 78

What is the common initial presentation of a tumor in the head of the pancreas?

Back 78

steatorrhea, wt loss and jaundice

Front 79

What is the common initial presentation of a tumor in the tail or body of the pancreas?

Back 79

pain and wt loss

Front 80

What is the initial study in pts who present with jaundice?

Back 80

abdominal US

Front 81

When doing an abdominal ultrasound, what findings suggest the presence of a pancreatic tumor?

Back 81

dilated bile ducts or mass in the head of the pancreas

Front 82

What diagnostic study is useful in patients being investigated for pancreatic cancer who are not jaundiced and whom may have intestinal gas that interferes with abdominal US?

Back 82

CT

Front 83

A CT study investigating pancreatic tumors may reveal....

Back 83

bile and pancreatic duct dilation,a mass/lesion, evidence of extra pancreatic spread

Front 84

Which test for pancreatic cancer is useful in getting information regarding major vessel involvement?

Back 84

CT angiography

Front 85

What is the most widely used diagnostic tool for pancreatic cancer?

Back 85

ERCP

Front 86

An ERCP is most useful if......(2).....

Back 86

the CT/US does not reveal a mass or lesion (or) chronic pancreatitis is the ddx

Front 87

What are some findings that are suggestive of a malignant tumor (through ERCP)?

Back 87

superimposible strictures or obstructions, pancreatic duct stricture/obstruction, absence of changes suggestive of chronic pancreatitis

Front 88

Superimposable stricutres or obstructions of the common bile and pancreatic ducts is referred to as the ______ sign and indicates.....

Back 88

"double duct";

a mass in the head of the pancreas

Front 89

What is an advantage of ERCP?

Back 89

Tissue samples can be collected

Front 90

When is an MRCP more beneficial than an ERCP?

Back 90

pts have gastric outlet or duodenal stensois or any condition in which the ducts cannot be assessed/ to detect bile duct obstruction occuring in the setting of chronic pancreatitis

Front 91

The production of serum tumor marker CA 19-9 requires the presence of ___________. IF not, they can't synthesize this marker.

The degree of elevation of this marker is associated with...

Back 91

lewis blood group antigen;

long-term prognosis

Front 92

What is a concern of preop percutaneous biopsy?

Back 92

dissemination of tumor cells intraperitoneally or along the needle path in pts who are believed to be candidates for potentially curative resection

Front 93

A pancreatic tumor is considered resectable if the tumor does not involve (2):

Back 93

any site that would not be a part of the resection; any adjacent critical vascular structures

Front 94

In the standard Whipple procedure, what are the indications and what is removed?

Back 94

cancer in the head or uncinate process of the pancreas;

pancreatic head, duodenum, first 15 cm of jejunum, common bile duct and gallbladder with partial gastrectomy

Front 95

What are some signs and symptoms associated with anemias?

Back 95

weakness, malaise, cold intolerance, SOB, pica, abdominal pain, numbness, tingling

Front 96

What labs would you do to workup for anemias?

Back 96

CBC (includes HCT hub RBC count, WBC count, MCV, MCH, MCHC, RDW and platelet count); peripheral smears (looking at RBC shape, size, and color); and WBC diff

Front 97

Folate and B12 deficiencies present as _____ anemia.

Back 97

macrocytic

Front 98

Iron deficiency is a _____ anemia

Back 98

microcytic

Front 99

In iron deficiency anemia, serum iron and ferritin is greatly _____; and TIBC is _____

Back 99

decreased; increased

Front 100

In Anemia of chronic disease, serum iron is greatly _____, TIBC is _____ and serum ferritin is ____ or _____

Back 100

decreased; decreased; normal or increased

Front 101

Thalassemia major has serum iron greatly _____, TIBC is ____ and serum ferritin is ______

Back 101

increased; normal; increased

Front 102

Thalassemia minor has serum iron, ferritin and TIBC all _____

Back 102

normal

Front 103

Sideroblastic anemia has serum iron moderately _____, TIBC _____ and serum ferritin ______

Back 103

increased; normal; increased

Front 104

What are some lab findings associated with Iron deficiency anemia?

Back 104

hypochromic, microcytic, RDW increased, retic count normal or slightly increased

Front 105

What are some clinical features of megaloblastic anemia?

Back 105

pallor, mild jaundice, beefy red tongue, irritability, neuro issues

Front 106

What are some lab findings of megaloblastic anemia?

Back 106

macrocytosis, indirect bilirubin slightly elevated, decreased vit B12, red cell folate decreased

Front 107

What is the treatment for megaloblastic anemia?

Back 107

oral cobalmin if B12 deficient (if malabsorption give parenterally); oral folate deficiency (if thats the problem)

Front 108

Hemolytic anemias usually present with ____ and ____

Back 108

hepatosplenomegaly; jaundice

Front 109

What are some lab results for hemolytic anemias?

Back 109

increased bilirubin (indirect fraction) and serum LDH; positive blood urinalysis due to urine hemosiderin, and increased retic count

Front 110

What can cause hemolytic anemias?

Back 110

sickle cells, thallassemias; RBC membrane defects; HUS, RBC enzyme deficiencies

Front 111

In sickle cell patients, why are there no symptoms before 3-4 months of age?

Back 111

there is a high level of fetal hgb left in their blood cells

Front 112

How is HbSS diagnosed?

Back 112

electrophoresis

Front 113

What are some symptoms of sickle cell anemia?

Back 113

pallor, fatigue, gallstone formation, pain due to ischmia, functional asplenia

Front 114

Lab findings of sickle cell anemia include....

Back 114

normo/macrocytic anemia, peripheral smears showing sickled RBC and target cells, retic count usually elevated

Front 115

Target cells are associated with which disease?

Back 115

sickle cell anemia

Front 116

In sickle cell treatment, prophylaxis using PCN should be started by age ____ and continued until age ____.

Also give normal childhood ________.

Transfusions should only be used during....

Back 116

2; 5/6;

immunizations;

crisis

Front 117

In a sickle cell trait patient, they have ___% HgB A and ___% HgB s.

Typically have no.....

Back 117

60; 40;

symptoms or anemia

Front 118

Which type of anemia do you want to avoid certain drugs and fava beans?

Back 118

G6PD deficiency anemia

Front 119

How do you dx aplastic anemia and pure RBC aplasia?

Back 119

bone marrow biopsy

Front 120

How do you diagnose sickle cell, thallassemias, hereditary sphero/elliptocytosis?

Back 120

osmotic fragility test

Front 121

Coombs test-direct is used to ID ______ and or _____ on RBC membranes;

Coombs test-indirect looks for ________.

Back 121

IDs immunoglobulin ABs (autoimmune)/ complement

antibodies

Front 122

What hemoglobin level is considered anemic (men and women)?

Back 122

Men= <13; women <12

Front 123

Anemia in CKD pts becomes more common and more severe as.....

Back 123

renal function declines

Front 124

Chronic kidney disease is defined as.... (2)

Back 124

kidney damage for more than 3 months;

GFR <60 for more than 3 months with or without kidney damage

Front 125

What is the number one cause of anemia in CKD?

Back 125

reduced endogenous EPO