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34 Cards in this Set

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