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34 Cards in this Set
- Front
- Back
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Rate of relapse with advanced-stage (II-IV) NHL?
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50-60%
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findings concerning for breast cancer
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bloody nipple discharge, overlying skin changes, lump characterized as rock-hard/fixed/irregular-surface, spiculated calcifications on mammogram
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false negative rat of mammography
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premenopause: 25%; post-menopause: 10%
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management of palpable breast mass
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if no concerning features, watch for 1 menstrual cycle; if persistent or concerning features, FNA, follow until resolution or definitive diagnosis
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definition of erythroplakia
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velvety, red mucosal abnormality -- can be carcinoma in situ or frank carcinoma
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management of erythroplakia
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if persists > 1month, biopsy;
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tx of metastatic prostate cancer
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androgen ablation (blockade)
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1st tx of h.pylori associated MALT lymphoma
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eradicate h.pylori --> 50% complete remission! If no remission in 1 yr, try chemo
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big picture requirement for palliative chemotherapy
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adequate performance status
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use of PSA in prostate Ca diagnosis
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inappropriate -- 25% pts going to surgery have normal PSA
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total vs free PSA in prostate cancer vs BPH
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prostate Ca generally a/w lower free:total PSA ratio
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management of discrete localized firm region in DRE
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biopsy of prostate
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left testicular varicocele that doesn't subside when supine
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probably due to obstruction of venous outflow -- look for RCC
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preferred imaging modality for testes
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ultrasound
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lab findings in seminoma vs nonseminomatous testicular cancer (vs malignant lymphoma)
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seminoma: elev HCG; nonseminomatous: elev HCG+AFP; malig lymphoma: neither (occurs in old men)
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tx of limited-stage small cell lung cancer
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chemo! Not surgical resection b/c almost all SCLC a/w micrometasteses
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tx of metastatic colon cancer
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systemic chemo (if performance status allows) -- 5-FU; non-curative, therefore comfort measures only also an option
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when to resect primary tumor in metastatic colon cancer?
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only if symptomatic -- obstruction or bleeding
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female with adenocarcimona and diffuse pertional involvement -- MCC
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ovarian cancer
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tx of breast cancer
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mastectomy only if multifocal/multicentric or margins not obtainable with wide excisions; otherwise, breast-conserving surgery + XRT +/- chemo
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role of tamoxifen in breast cancer with axillary lymph nodes
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none!
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diagnostic step with new supraclavicular node + night sweats
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CXR
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FNA of new lymphadenopathy for diagnosis?
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no -- not enough tissue for histologic/immunologic/genetic analysis
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usual approach to new lymphadenopathy in a young person
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watch and wait -- in young person, LAD usu benign
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back pain + retrocardiac density on CXR suggests ______
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descending aortic aneurysm
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how to dx thoracic aortic aneurysm
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helical CT w/ contrast, esp if ?rupture
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what to do if CT w/ contrast contraindicated by renal insufficiency?
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MRI with gadolinium (not nephrotoxic)
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tx of thoracic aortic aneurysm + pain
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surgery! (pain = bad; if no pain, beta blockers first to stabilize, then mgmt based on location of aneurysm)
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location of pain with spinal cord compression
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either radicular or localized to spine
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what to do if suspect spinal cord compression (low back pain with known malignancy / osteoarthritis)
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MRI -- can progress to myelopathy over weeks w/o tx, so can't afford to wait and watch
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defn of cauda equina syndrome
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low back pain, unilateral or usu bilateral sciatica, saddle sensory disturbances, bladder/bowel dysfunction, and variable LE motor/sensory loss
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tx of sciatica
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in absence of cauda equina syndrome, bed rest + NSAIDs is sufficient
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cause of back pain worsened by coughing/sneezing
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herniated disk
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what findings suggest inflammatory source of back pain?
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worse in morning, improves with activity, elev ESR, elev CRP
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