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63 Cards in this Set

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1-75 y/o man w/ CHF & dementia w/ colon cancer; 3 out of 10 lymph nodes; he’s on simvastin & hydrochlorathiazide….otherwise living a good life. What additional treatment would u recommend?
ANS: Fluorouracil & Leucovorin
2-65 y/o man w/ Fe deficiency anemia….What would u do next?
ANS: Colonoscopy
3-Risk factor of osteoarthritis:
ANS: Obesity
4-Patient w/ blood in stool, 20lbs weight loss, decreased caliber of stool….
ANS: recommend colonoscopy
5-Patient w/ long standing Fe-deficiency, you would see: chelosis, smooth painful tongue, increase RDW, decrease serum ferritin
ANS: NOT increased retic count
6-Least common osteoarthritis joint affected:
ANS: MCP joint of hand
7-Risk factors of colorectal cancer are: obesity, inflammatory bowel disease, smoking, diabetes…
ANS: NOT folic acid supplementation
8-Function of normal synovium are: joint lubrication, antigen processing, removing debris, and cytokine production….
ANS: NOT structural support
9-Anemia of chronic disease:
ANS: low serum Fe, decreased TIBC, increased serum ferritin, low retic count
10-Genetic changes in colorectal cancer: p53 of chrom 17, APC of chrom 5, DCC of chrom 18, Ras gene mutations…
ANS: NOT long arm of chrom 21
11-Osteoarthritis characteristics: females affected more than males, can occur at site of previous trauma, osteophyte, joint narrowing on X-ray
ANS: NOT inflammatory process
12-See increased retic count in: SCA, acute blood loss, TTP, G6PD deficiency…
ANS: NOT pernicious anemia
13-Small cell lung cancer:
ANS: Brain radiation in extensive stage
14-Uric acid…
ANS: is excreted via kidneys
15-Schizocytes
ANS: Microangiopathic Hemolytic Anemia
16-Hypersegmented neutrophils:
ANS: Pernicious anemia
17-Most important prognostic factor in response to therapy & survival in stage IV non-small cell lung cancer:
ANS: Performance status
18-Hyperuricemia develops in majority of patients with which of the following?
ANS: Under excretion of uric acid
19-Risk factors for developing DVT are: obesity, sedentary lifestyle, pregnancy, cancer….
ANS: NOT diabetes
20-Common paraneoplastic syndrome encountered in lung cancer: Lambert-Eaton, SIADH, Hypercalcemia, hypertrophic osteoarthropathy…
ANS: NOT hyperkalemia
Q: 20 y/o man presents with pain and swelling of one knee and pain in
his heels of two week duration. He recalls having a recent diarrheal
illness which resolved without incident, now presents with "pink eye"
conjunctivitis
A: Reactive Arthritis (Reiter's)
Q: 66 y/o female with a hx of Coronary artery disease and high lipids
has acute MI. She was placed on continuous infusion of unfractionated
heparin and Abciximab. Despite being placed on heparin,on Day 7,
tender swollen left leg was noted. Doppler ultrasound confirms DVTE
of femoral vein. Intern notices platelet 40000 --- decreased from
300000.... what's the next step
A. STOP heparin immediately!
Q: Previously healthy 44 y/o male needs advice about his chances of
getting cancer. Hx: smoker for past 22 years, rarely exercises, 1
glass of wine daily, diet high in animal meats and cholesterol, no
family hx of cancer... you should advice the patient to do all of the
following EXCEPT..
A. Undergo colorectal cancer screening via colonoscopy immediately
other answers: advice to continue drinking wine with dinner, stop
smoking, increase amount of daily exercise, increase intake of fruit
and veggies
worse prognosis for breast cancer
increased HER-2 neu copies
most common malignant
infiltrating ductal (intraductal) carcinoma
old man with stroke and chondrocalcinosis
• pseudogout (old test question)
which is NOT vit K dependent
XIII
18 year old girl, camping with bf, monogamous for 2 years, 102F, acute pn, swelling of L wrist and R knee
N. gonorrhea
Most specific antibody for drug induced lupus
histone
Which has the highest risk
• 44F with maternal grandmother with breast cancer
allopurinol to treat acute gout?
NO allopurinol to treat acute gout
Connective tissue disorder with decreased complements (c3 and c4)
SLE
(pancreatic tumor marker?
Markers CA-19/9
ovarian tumor marker?
CA-125
gastric or breast tumor marker?
CEA
Which cause of VTE is NOT inherited?
antiphospolipid
Which cause of VTE IS inherited?
(Factor V leiden, antithrombin III, protein C/S, and prothrombin G20210A mutation are inherited)
T OR F? • Epstein-barr cause gain of function of oncogene
true
o Oncogenes can cause genetic mutation
o Tumor suppressor genes  negative growth regulation
o Cancer caused by loss of function of tumor supp genes
T OR F? o papilloma virus cause cancer by inactivating tumor supp gene
false
OA common cause of inflammatory joint disease?
false
- ideal tumor markers?
o sensitive and specific
o indicate tumor burden
o predict prognostic outcomes
o predict recurrence
o does NOT have to be able to predict metastatic site
HIV guy with purpuric rash on leg, fever, hypotension, anemia, increased retic count, plt 20,000, normal PT/PTT, acute renal failure, uncontrolled seizure
- TTP
Wegener’s positive for cANCA?
YES
EBV, alkylating chemicals, ionizing radiation, H pylori ASSOCIATED WITH CANCER?
YES
PROGESTERONE ASSOCIATED WITH CANCER?
NO
Disrupt plug formation by affecting primary hemostasis?
- scurvy, glanzman, Bernard, ttp (NOT hemophilia A)
56M, sob, cough, dec breath sound, wheezes R lung, XR
- large R effusion with complete opacification lower lobe, mass R upper lobe suggesting malignant neoplasia. CT  large suprahilar mass 5x4x3cm with calcification. 2 ipsilateral paratracheal nodes enlarged with 1 >2cm. Pleural tap positive for poorly differentiated adenocarcinoma in fluid. Bronchoscopy biopsy show RUL necrosis and adenocarcinoma. In addition to LYMPHATICS, will NOT metastasize to ESOPHAGUS.
-
Lung cancer ranks as the number ______ cause of cancer-related deaths the United States each year.
One
Non-small cell lung cancer accounts for 80 percent of all lung cancer cases.
True
Smokers are __________ times more likely to develop lung cancer     than nonsmokers.
More than ten
56 year old man presented with shortness of breath and cough. Physical examination of the chest revealed decreased breast sounds and wheezes on right. Chest X-ray revealed a large right pleural effusion with complete opacification of lower lobe of the right lung and a mass in R upper lobe, probable malignant neoplasm. CT chest showed a large suprahilar mass = 5.0 x 4 x 3 cm on right with some calcifications. Two ipsilateral paratracheal nodes were enlarged,1 of which is greater than 2 cm in diameter .A Pleural tap was done and cytology was positive for undifferentiated adenocarcinoma in pleural fluid. Bronchoscopic biopsy of the RUL showed small fragment of R upper lobe with necrosis and anaplastic adenoca.

What is the stage of this cancer:
Stage IIIB
The most important determinant in deciding response to therapy and survival for patients with stage IV NSCLC is :
Performance status
Bronchorrhea
Bronchioalveolar Ca
Squamous Cell Ca
SIADH
Eaten-Lambert Syndrome
Small cell Ca
Peripheral mass
Adenocarcinoma
A 36-year-old man comes to your office for your opinion concerning adjuvant therapy for stage III (T3N1M0) colon cancer. He was in good health until two months ago when he was found to have occult blood in his stool on a routine pre-employment physical examination. He underwent surgery without complications three weeks ago and has now established normal bowel habits. He is taking no routine medications, and neither smokes nor drinks. His paternal grandfather died of rectal cancer at age 49 years, and two paternal aunts had colon cancer. After review of his pathology, you conclude that he is a candidate for adjuvant therapy.
Which one of the following statements about this patient’s prognosis and surveillance is true?
If he develops a new primary colon cancer, he should undergo a complete colectomy.
Genetic changes in colorectal cancer include chromosomal aberrations in all the following except:
long arm of chromosome 21
A 36-year-old white woman comes to your office to discuss her risk of developing colon cancer. She has had symptomatic ulcerative colitis, which involves the majority of the colon, for 15 years.Which of the following statements is most characteristic of this patient’s condition?
The absence of extensive dysplasia on colonoscopic biopsies is associated with reduced risk of developing invasive cancer.
A 25-year-old white graduate student is referred to you one week after she underwent right hemicolectomy for adenocarcinoma of the cecum. Her medical history is unremarkable. Her mother had a hysterectomy for uterine cancer at age 38, and her maternal grandmother was found to have colon cancer at age 49. The patient has four sisters and two brothers who range in age from 15 to 34. All are in excellent health. Which of the following diagnoses is most consistent with this patient’s family history?
Lynch syndrome II
A 59-year-old white woman asks your advice concerning follow-up after removal of a 7mm adenomatous polyp detected during screening sigmoidoscopy. She has no family history of colorectal cancer.
In addition to recommending annual examination of stool for occult blood and repeat flexible sigmoidoscopy every three to five years, you should recommend that which of the following be done now?
Colonoscopy
Genes implicated in the genetic susceptibility to HNPCC are:
Mismatch repair genes
A 68-year-old woman is referred to you for additional treatment four weeks after surgical resection for a tumor in the ascending colon that was determined on pathologic evaluation to be a moderately differentiated adenocarcinoma of the colon arising from a villous adenoma. The tumor had penetrated through the serosa, and three of 12 lymph nodes were positive for metastatic cancer. No other disease was seen at the time of surgery. Preoperatively, the CEA level was 1.2 ng/mL, and CT of the chest, abdomen, and pelvis demonstrated no metastasis. Her history includes diabetes controlled with a beta-blocker and a diuretic, and a hysterectomy for fibroids. She lives with her husband, is active, and is able to drive and maintain her own household. Which of the following would you recommend?
Six months of treatment with fluorouracil, leucovorin and oxaliplatin