ABSITE questions we miss by Dr. Meyers: 1/29/2009
1. Rx intraductal papilloma.
Most commonly present with bleeding/bloody nipple d/c. Generally resect via major duct excision or needle loc if seen on imaging. Remember, this isn’t malignant or premalignant, it’s a benign condition. 2. Anat level 3 LN’s (8 senior residents missed this in 2005) Never know how ? was written, so may have been misleading. But remember pec minor separates levels of axilla. I= lateral to II=posterior to and III= medial to pec minor and extends to Halstedt’s ligament/thoracic inlet. 3. Contraindications to BCT in stage I breast cancer. (8 senr residents missed 2005) Prior irradiation, inability to get negative margins, inappropriate size/breast ratio, inflammatory breast cancer. This was from 2005, so they may have wanted you to say a T3/4 tumor is a contraindication. It probably is if you don’t give neoadjuvant chemo, so if that’s the picture that is painted, then that’s the answer. Remember: + nodes is not a contraindication to BCT. 4. Breast tumor indic for SLN.
For our purposes, SLN indicated for any invasive cancer except T4. For test purposes, they might restrict it to T1 or T2 tumors. Of course, any patient with clinically proven nodes is not a SLN candidate, they need an ALND. Remember, mastectomy not a contraindication for SLN. Also remember, on the test DCIS is not an indication unless undergoing mastectomy (in real life there are a couple others, but those are gray areas). 5. Rx DCIS.
Remember, this is a form of breast cancer. Don’t need to worry about nodes (see above), but rx is same as invasive cancer. BCT + XRT or mastectomy. 6. Rx DCIS in male.
Mastectomy. (same is true for invasive cancer)
7. Rx Ca breast with negative SLN.
Do not need to do ALND. Only need to attend to breast which will be either BCT or mastectomy depending on tumor. This question may have been getting at additional therapy. Any ER+ tumor would get Tamoxifen x 5 years. In older patients with tumor <2cm, that’s probably all they are looking for on the test. In young patient with tumor >1cm, likely get chemo too. In ER-tumor, get chemo only. Remember chemo is some comination of adriamycin, cyclophosphamide and taxol. Primary side effect of adriamycin is cardiomyopathy. Primary SE for taxol is neuropathy. 8. Rx postmenopausal breast cancer.
See above. A bunch of people missed this in 2006.
9. Histology assoc with subsequent breast cancer.
3 benign proliferative lesions that increase risk of developing breast cancer (but aren’t themselves pre-malignant) and risk is bilateral, not just in ipsilateral breast. Atypical ductal hyperplasia (ADH). Atypical lobular hyperplasia (ALH). LCIS. Any of these found on needle biopsy warrant excision because of risk of assoc cancer. However, purpose of excision is to have adequate sample and once excised, don’t need negative margins. Consider chemoprevention with Tamoxifen if you diag these. 10. Rx LCIS breast.
See #1 above. A few people missed this.
11. Rx breast mass post neoadjuvant therapy.
Same options apply to these patients as any de novo breast cancer. BCT or mastectomy. Don’t have to do mastectomy just because it was big to start with, if it shrunk and is now amenable to BCT, then that’s ok. 12. Rx inflammatory breast cancer.
Neoadjuvant chemo first. Then mastectomy (modified radical). Then XRT. Liver:
1. Rx Amebic Liver Abscess.
Organism is Entamoeba histolytica which enters liver via portal system from primary GI infection. Often present with fever, RUQ pain and tenderness. Indirect hemagglutination test may be helpful in diagnosis. Rx with Metronidazole. Surgery or perc drainage reserved for abx failures. 2. Rx pyogenic liver abscess.
Primary causes are biliary infection (cholecystitis/cholangitis) or seeding from portal vein drainage (appendicitis/diverticulitis). E. coli, klebsiella and strep are most common organisms. Rx with abx and/or perc drainage and search for primary source. 3. Rx...
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