Ob Casefiles 5

Front 1

Which ovarian cancer has LDH as a tumor marker?

Back 1

dysgerminoma

Front 2

Which ovarian cancers have AFP as tumor markers?

Back 2

embryonal and yolk sac (endodermal sinus)

Front 3

Which ovarian cancer has hcg as a tumor marker?

Back 3

choriocarcinoma

Front 4

Which ovarian tumor is made from fetal tissues?

Back 4

teratoma

Front 5

Which ovarian tumor is made from placental tissues?

Back 5

choriocarcinoma

Front 6

high bhcg can cause what sx

Back 6

n/v
dizziness, photophobia (preeclamptic sx)
tremors, nervousness (hyperthyroid sx)

Front 7

most common sx of GTD

Back 7

irregular or heavy bleeding during early pregancy

Front 8

bilateral theca lutein cysts ass w/ ?

Back 8

complete molar pregnancy (high bhcg)

Front 9

tx for molar pregnancy

Back 9

remove tissue with D&E
curetage
Rhogam for mother
follow bhcg to zero (8-14 weeks), prevent pregnancy during this period

Front 10

What percent of molar pregnancies develop persistent / invasive type?

Back 10

20%

Front 11

Most common mets site of GTD malignancy

Back 11

lungs !
vagina / pelvis second
brain

Front 12

Treatment for malignant GTD?

Back 12

It is sensitive to chemotherapy.
methotrexate or actinomycin-D;
Outside of US, etoposide and 5-FU are used.

Front 13

Poor prognosis malignant GTD receives multiple-agent chemo. What drugs are used in the common regimens?

Back 13

EMA-CO
etoposide
methotrexate
actinomycin
ctyoxan
oncovin (vincristine)

Front 14

How are persistent moles diagnosed?

Back 14

bhcg continues to rise after evacuation

Front 15

Tx for persistent moles

Back 15

methotrexate or actinomycin D

Front 16

Where is choriocarcinoma a leading form of gyn cancer?

Back 16

Africa

Front 17

T/F Choriocarcinoma can arise after a normal gestation as well as a molar pregnancy.

Back 17

true (25%)
another 25% follows SAB and ectopic

Front 18

milk letdown is caused by ?

Back 18

oxytocin

Front 19

ductal development and fat deposition of breast regulated by ?

Back 19

estrogen

Front 20

lobular-alveolar development of breast for lactation regulated by ?

Back 20

progesterone

Front 21

definition of lumpectomy vs. excisional biopsy

Back 21

lumpectomy has 1 cm margin, so if it's malignant nothing more need be done.

Front 22

bloody nipple discharge, suspect ?

Back 22

intraductal papilloma or invasive papillary cancer

Front 23

yellow nipple discharge, suspect ?

Back 23

galactorrhea or fibrocystic change

Front 24

green sticky nipple discharge, suspect ?

Back 24

duct ectasia; fibrocystic change can also produce green nonsticky discharge

Front 25

T/F Breast pain is rarely a sign of cancer.

Back 25

true

Front 26

Beside vitamin supplementation, what are some medical treatments that may help fibrocystic change?

Back 26

bromocriptine
danazol
progestins
tamoxifen
evening primrose oil

Front 27

A large fibroadenoma may be ?

Back 27

cystosarcoma phylllodes

Front 28

workup and tx for fibroadenoma?

Back 28

FNA
follow clinically if no fam hx of breast cancer

Front 29

workup and tx for cystosarcoma phyllodes?

Back 29

10% malignant;
wide local excision
for very large, mastectomy

Front 30

Tx for intraductal papilloma and duct ectasia

Back 30

excision of ducts

Front 31

?% of breast tumors in reproductive age women are benign

? % of breast tumors in perimenopausal women are malignant

Back 31

66%

50%

Front 32

T/F Alcohol abuse increases the risk of breast cancer.

Back 32

true

Front 33

What is the mnemonic for breast cancer treatment steps?

Back 33

CLaRA-AM

1. Conservation vs mastectomy
2. Lymph node status
3. Receptor status (hormone receptor)
4. Age and menopause status (premen usually receptor negative, postmen usually receptor positive)
5. Adjuvants needed
6. Mets treatment

Front 34

How are lymph nodes assessed in breast cancer?

Back 34

sentinel lymph node biopy- inject ink to find the first LN, excise and examine, full LN dissection if positive

Front 35

Positive hormone receptor status means the tumor and prognosis are ?

Back 35

tumor is well differentiated
prognosis is better; can treat with tamoxifen

Front 36

If lymph nodes are positive in breast cancer assessment, what adjuvant treatment do you assign?

Back 36

CMF chemo
cyclophosphamide
methotrexate
5-FU

Front 37

If hormone receptors are negative, in breast cancer assessment, what adjuvant treatment do you assign?

Back 37

chemotherapy

maybe CMF?

Front 38

If hormone receptors are positive in breast cancer assessment, what adjuvant treatment do you assign?

Back 38

tamoxifen

Front 39

What treatment for breast cancer METS if estrogen receptor negative?

Back 39

AV: adriamycin (doxycycline) and vincristine

Front 40

What treatment for breast cancer METS if estrogen receptor positive?

Back 40

tamoxifen if postmenopausal

GnRH antagonists if premenopausal

Front 41

What is the most reliable predictor of breast cancer survival?

Back 41

state at diagnoses
1- 80%
2- 60%
3- 20%
4 - minimal

Front 42

What is followup for breast cancer tx?

Back 42

q 3 months first year
q 4 months second year
q 6 months afterward

mammograms every 6 months
blood tests for alk phos (bone dz) and LFTs every 6 months

Front 43

T/F Pregnancy after breast cancer tx is contraindicated b/c of estrogen effects.

Back 43

False. No difference in survival rates, no adverse effects of OCPs. Probably no difference in survival rates with HRT.