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27 Cards in this Set
- Front
- Back
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What diseases is alpha fetoprotein associated with?
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AFP is associated wiht the development of:
1) hepatocellular carcinoma 2) ovarian cancer 3) non-seminomatous germ cell tumors |
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When do you answer AFP?
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Answer AFP when you see a patient with alcoholic cirrhosis or chronic hepatitis B or C. AFP together with radiologic imaging is used to screen for hepatocellular carcinoma.
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What is carcinoembryonic Antigen (CEA)?
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CEA is a protein that is elevated in teh serum in a variety of cancers, including colorecttal cancer (CRC).
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For which disease does CEA have prognostic value?
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Serum levels of CEA have prognostic value in patients with newly diagnosed CRC. Those with higher levels have a worse prognosis than those with lower levels.
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When do you answer CEA?
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Answer CEA level to monitor colon cancer patients after surgical resection. This determines the presence of persistent, recurrent, or metatatic disease.
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When do you answer CEA as a screening test?
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CEA levels are never the right answer as a screening test for colon cancer.
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What is colposcopy?
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A colposcopy is the direct visualization of the cervix by placing a magnifying scope with a lamp into the vagina.
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What must be visualized for a sufficient study?
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The transition zone must be visualized to ensure an adequate colposcopy. This is the border between squamous and columnar epithelium.
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When is colposcopy the answer?
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Answer colposcopy when the case describes a patient with an abnormal Pap smear. The following findings on Pap smear necessitate colposcopy:
1) Atypical squamous cells - cannot exclude high grade lesion (ASC-H) 2) Low-grade squamous intraepithelial lesion (LSIL) 3) High-grade squamous intraepithelial lesion (HSIL) 4) Atypical sqamous cells of undetermined significance (ASCUS) if HPV DNA testing is positive. |
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What are estrogen and progesterone receptor tests?
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Estrogen and progesterone receptors should be done on all patients with breast cancer in order to determine who should receive hormone receptor therapy.
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What is the therapy for breast cancer?
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Therapy with either tamoxifen or raloxifene should be added for any patient wiht positive receptors. This is either for estrogen or progesterone positiveity alone or in combination. The response to tamoxifen is better if both receptors are positive.
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When do you answer mammogram?
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Screening mammogram should begin at age 40 and should be performed every 1-2 years. Screening after age 50 is yearly.
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When there is an abnormality what is the next best step?
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When the mammogram shows abnormalities, a core biopsy including sentinel node biopsy is the next best test. Carcinomas of the breast are associated with clustered polymorphic microcalcifications. Mammography is also used when a breast mass is found on exam to locate additional lesions in the same breast or bilateral disease.
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When does screening lower mortality the most?
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Screening lowers mortality most after age 50, and the decrease is greater than that with colonoscopy or Pap smear.
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What is Papanicolaou (Pap) Smear?
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The Pap smear is a test that examines the cells of the cervix. it is a screening method to find cancerous or precancerous cervical lesions. Pap smear does derease mortality in screened populations.
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When is Pap smear the answer?
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Pap smear should be started at age 21 or within 3 years of the onset of sexual activity, whichever is earlier. The test should be done every 2-3 years and can be stopped at age 65.
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If results are positive, what is the next best test?
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Abnormalities on Pap smear are evaluated with colposcopy in order to biopsy the cervix.
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What is PET Scanning?
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PET means "positron emission tomography." The measures teh metabolic activity of a lesion seen on a CT or MRI scan. It is based on teh ability of most cancers and some infections to have the increased uptake of 18-fluorodeoxyglucose. It is a noninvasive test of the actual function of a mass lesion, not just its size and location.
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What makes PET Scanning abnormal?
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Most cancers and some infections have an increased uptake of the tagged glucose.
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When is PET Scanning the answer?
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A PET scan can tell if a lesion, such as a lung mass, that might otherwise look malignant, really is malignant. For instance, if you are shown a case of a localized lung cancer diagnosed wit biopsy, you can use the PET scan to see if there are metastases. If there is a mass in the contralateral chest that is malignant, it makes the patient ineligible for surgery with curative intent. If the PET scn shows a low uptake of the tagged glucose, then the lesion is likely benign and you should proceed wiht the surgery to remove the primary tumor site.
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What is PSA (Prostate-Specific Antigen)?
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PSA increases can occur in prostatitis, BPH, prostate cancer, and prostate biopsies. Levels are undetectable after total resection of the prostate.
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When should PSA be done?
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PSA testing is extremely controversial. There is no evidence that PSA testing lowers mortality when used as a routine screening test. If the question says the patient is requesting teh test, then you should do it.
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What is the most accurate test for prostate cancer?
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Biopsy of hte prostate is the most accurate diagnostic test.
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When test is done next if the PSA is positive?
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If the PSA is elevated, a digital rectal exam is performed to palpate a lesion. If a lesion is found, it should be biopsied. If no lesion is found, a trans-rectal US should be performed to find a lesion to biopsy. If no lesion can be found, then "blind biopsies" should occur.
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What is the sentinal node evaluation?
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The sentinel node biopsy is used in the evaluation of breast cancer.
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How si sentinel node evaluation done?
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A sentinel node biopsy is when dye is introduced into the operative field. The first node it goes to it the "sentinel" node. If it has cancer, you dissect teh axilla. If it is negative, you do not need to do an axillary lymph node dissection.
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When is sentinel ode evaluation the answer?
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Look for a patient with an abnormal mammogram in whom the biopsy shows cancer. The answer sentinel node biopsy. Sentinel node biopsy is the best test to do after the initial diagnosis of breast cancer has been made with either a needle or excisional biopsy. Sentinel node biopsy can eliminate the need for axillary lymph node dissection.
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