The Topic For Today Is CREOG ONC REVIEW

1

• Welcome!
• The Topic For Today Is CREOG ONC REVIEW
• Hosted by Emily Ko, MD

2
CREOG ONC REVIEW
Basic Science Staging Dysplasia Critical Care Random
200 200 200 200 200
400 400 400 400 400
600 600 600 600 600
800 800 800 800 800
1000 1000 1000 1000 1000
Bonus Question 5000 pts
3
Topic 1 200

• Question
• Name 2 tumor suppressor genes
• Answer
• P53, Rb, WT1, BRCA1, BRCA2
• Usually autosomal recessive

Back
4
Topic 1 400

• Question
• Name the 5 stages of the cell cycle
• Answer
• G0, alive but not actively dividing
• G1, growing
• S, replicates DNA
• G2, preparing for mitosis
• M, mitosis

Back
5
Topic 1 600

• Question
• Name 3 testing criteria for hereditary
  ovarian-breast cancer
• Answer
• Personal hx breast ca Dx age lt 45
• Dx age lt 45 and 1 close relative breast ca age lt
  50 or with ovarian ca
• 2 breast primaries
• breast ca 2 or more relatives with breast or
  ovarian ca
• close relative with male breast ca
• personal hx ovarian ca
• high ethnic risk

Back
6
Topic 1 800

• Question
• This type of HNPCC gene (name) causes cancers in
  these organs (name)
• Answer
• Mismatch repair
• Colon
• Endometrial
• Ovarian
• Ureteral and renal

Back
7
Topic 1 1000

• Question
• Answer
• A embryonal carcinoma
• B endodermal sinus tumor (Yolk sac tumor)
• Dysgerminoma
• Choriocarcinoma
• Immature teratoma

Name the Germ Cell Tumor AFP LDH HCG
A
B
C
D
E
Back
8
Topic 2 200

• Question
• Name this stage endometrial cancer with pelvic
  node metastasis
• Answer
• 3c1 (FIGO 2008)

Back
9
Topic 2 400

• Question
• ovarian cancer confined to right ovary ruptured
  intraoperatively (name stage), treatment after
  surgery will be (name treatment)
• Answer
• Stage IC
• Adjuvant chemotherapy

Back
10
Topic 2 600

• Question
• Name the indications for CKC, simple hyst,
  radical hyst
• Answer
• CKC- no visible lesion, microinvasive ca or high
  grade dysplasia
• Simple hyst- microinvasive ca, (IA1)
• Radical hyst- IA2 to IIA

Back
11
Topic 2 800

• Question
• Name indications for WLE, radical vulvectomy,
  unilateral LND, bilateral LND
• Answer
• WLE- IA (lt 2 cm lesion, lt 1 mm depth)
• Rad vulvectomy- IB and beyond
• Unilateral LND- unilateral lesion gt 2 cm from
  midline and gt 1 mm depth invasion
• Bilateral LND- lesion within 2 cm from midline
  and gt 1 mm depth invasion

Back
12
Topic 2 1000

• Question
• Name the treatment for DCIS of breast
• Answer
• Lumpectomy and radiation

Back
13
Topic 3 200

• Question
• Name 4 high risk HPV subtypes associated with
  cervical cancer
• Answer
• 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59,
  66, 68, and 73
• (6 and 11 associated with genital warts)

Back
14
Topic 3 400

• Question
• DES is associated with this cancer
• Answer
• Adenocarcinoma of the vagina

Back
15
Topic 3 600

• Question
• Treatment for 2 cm lesion of VIN 3
• Answer
• Wide local excision
• (alternatives laser for multifocal to 1 mm depth
  in non hair areas, 3mm in hair areas)
• (5-FU but it burns)
• VIN3? high risk prog to CA. 15 microinvas.

Back
16
Topic 3 800

• Question
• Name the treatment pap HSIL with colpo bx
  microinvasive SCC with 2 mm depth invasion
• Answer
• CKC
• (not simple hyst because do not know extent of
  disease, whether IA1 or IA2)
• (If turns out IA2? rad hyst)
• Prolog 80

Back
17
Topic 3 1000

• Question
• Treatment for 25 wks pregnant with 1.5 cm SCC of
  cervix
• Answer
• C-section rad hyst, node dissection when reaches
  fetal lung maturity
• (Immediate tx if bulky lesion gt 4cm)
• (vag delivery ok if microinvasive ca)

Back
18
Topic 4 200

• Question
• Name the blood product/s with fibrinogen
• Answer
• FFP
• cryoprecipitate

Back
19
Topic 4 400

• Question
• Treatment for 2 cm enterotomy of ileum
• Answer
• Primary repair in 2 layers, perpendicular to axis
  of bowel

Back
20
Topic 4 600

• Question
• Name 2 of 3 criteria for ARDS
• Answer
• Bilateral diffuse infiltrates on CXR
• Ratio of PaO2 to FiO2 200 mg Hg
• No evidence of heart failure (elevated left
  atrial pressure)
• Treatment is ventilation, abx, supportive care,
  avoid fluid overload

Back
21
Topic 4 800

• Question
• Name the condition and treatment
• Case intraoperative elevation of temp to 40.5,
  patient is tight and hands are mottled
• Answer
• Malignant Hyperthermia (triggered by depolarizing
  agent or volatile gases ie succinyl choline,
  autosomal dominent, genetic testing by muscle
  biopsy)
• Stop anesthesia, close incision site, give 100
  O2, Dantrolene, ICU, cooling blanket
• Prolog 43

Back
22
Topic 4 1000

• Question
• Match the type of shock to the correct row
• Hypovolemic, cardiogenic, early septic
• Answer
• Hypovol B
• Cardio A
• Early septic C
• Prolog 137

CI SVR SVO2 PAP PCWP
A ? ? ? ? ?
B ? ? ? ? ?
C ? ? ? ? ?
D ? ? ? ? ?
E ? ? ? ? ?
Back
23
Topic 5 200

• Question
• Name this vulvar lesion itchy, eczematous,
  raised, red background, dotted with small pale
  islands, maybe multifocal
• Answer
• Extramammary Pagets Disease
• lt1 vulvar malignancy
• Biopsy to prove
• Search for other sources of adenocarcinoma
• Prolog 56, 72

Back
24
Topic 5 400

• Question
• 1. Risk of persistence after DC 20
• 2. associated with HPL
• 3. clinical presentation may be like MAB
• 4. Fetal vessels present on HE stain
• 5. Chorionic villi not present
• Answer
• 1. B, 2. D, 3.A., 4.A., 5.C

A Partial Mole
B Complete Mole
C Choriocarcinoma
D Placental Site Trophob. Tumor
Back
25
Topic 5 600

• Question
• Name 3 methods of colon cancer screening
• Answer
• All starting at age 50 (for average risk)
• FOBT annually
• Flex sigmoid q5 years
• FOBT flex sig q5 years
• Double contrast barium enema q5yr
• Colonoscopy q10 yr
• Prolog 51, 70, 122

Back
26
Topic 5 800

• Question
• Name the gyn surveillance for women on tamoxifen
• Answer
• Annual gyn exam, workup for symptoms
• No routine use of U/S or EMB
• Agonist on endometrium
• 2.3-2.7x risk of endometrial cancer
• But OK to use after hysterectomy for endometrial
  cancer
• Prolog 17, 132

Back
27
Topic 5 1000

• Question
• Name the hormone therapy for 45 yo s/p TAHBSO for
  endometrial cancer, and risks/benefit associated
  with it based on WHI study
• Answer
• Estrogen only HRT
• WHI (Prolog 15, 77)
• E/P increased risk for CHD, breast ca, VTE,
  stroke.
• E/P decreased risk for osteoporotic fx and colon
  ca
• E alone decreases risk for osteoporotic fx

Back
28
Bonus Question 5000 pts.

• Question
• What day is Creogs
• Answer
• (The answer here!)

Back
29
Daily Double
The Winner Of The Last Round Write Down How Much
Money You Are Willing To Risk If You get the
Question write you win that money If you get it
wrong you Loss the money!
30
Daily Double

• The Winner Of The Last Round
• Write Down How Much Money
• You Are Willing To Risk
• If You get the Question write you win that money
• If you get it wrong you Loss the money!