MC Intracranial Tumor Meningioma PSAMMOMA Bodies Papillary carcinoma of the Thyroid Serous Adenocarcinoma of Ovary Meningioma Mesothelioma MC primary

Brain Tumor Astrocytoma Clues for Meningioma Not part of brain Pushed down of brain Eliptical on CT or MRI PSAMMOMA bodies Whenever there is calcification at the Gray-white junstion what is the meaning Metastasis List 3 types of astrocytomas Glioma Oligodendroglioma Ependymoma Clues for Glioma Unilateral Blindness Clues for Ependymoma Hydrocephalus MC in conus Medularis In Ventricles Clue for Oligodendroglioma Whirly pattern of biopsy MC primary cancer of brain GBM (Grade IV Astrocytopma) What imaging modality is used in children to find posterior fossa tumors? MRI MC tumor of Posterior fossa #1 Medulloblastoma #2 Craniopharyngioma Presentation of posterior fossa tumor Early morning vomiting Clues for Craniopharyngioma Looks like motor oil Can cause DI Derive from Rathkes pouch MC Pituatary Tumor Nonfunctional Pituitary Adenoma MC functional Tumor of pituitary Prolactinoma

What is true of all pituitary tumors? They cause increased Prolactin Clues for increased prolactin Galactorrhea and Amenorrhea What cell type make up most of the pituitary? Chromophobes 95% Clue for pituitary adenoma Bitemporal Hemi-anopsia becauses the tumor affects the nasal fibors in the optic chiasm. Why do all pituitary tumors cause increase prolactin? Dopamine inhibits PRL in the pituitary. Most tumors affect this inhibition and causes release of PRL. What are the only hormones made by acidophills? GH, PRL What pituitary cell type makes all hormones except GH, PRL? Basophils MC Pineal gland tumor Pinealoma Clue for pinealoma Precocious puberty in young female Irregular menstrual cycle in older female Eisotropia (medial deviation) affects LR MCC tumor and cancer in nasopharynx Fibroma Squamous cell carcinoma With what virus is nasopharyngeal carcinoma associated? EBV What is the most common risk factor for nasopharylgeal carcinoma? Smoking Location of oropharyngral cancer in smokers Floor of mouth Tip of tongue Hard palate Lip Location of oropharyngral cancer in tobacco chewers Lower Lip Tip of tongue Floor of mouth

MC of the brain Intracranial Tumor Meningioma 1 brain tumor Astrocytoma 1 brain cancer GBM 1 tumor in children Meduloblastoma, Craniopharyngioma Tumor of ventricular Ependymoma Pituitary tumor Nonfcn adenoma Functional pituitary tumor Prolactinoma Pineal gland tumor Pinealoma 5 Tumors in the anterior mediastinum Thymus Thyroid Teratomas T-cell Leukemia T-cell Lymphoma MEN I - Wormer Pituitary Adenoma Parathyroid Adenoma Pancreatic Adenocarcinoma MENII - Sipple Medullary carcinoma of thyroid Pheochromocytoma Parathyroid adenoma MENIII Medullary carcinoma of thyroid Pheochromocytoma Neuroma/Ganglioneuroma Rule of 10 for Pheos 10% Bilateral 10% Metastatic 10% Malignant 10% Familial 10% Seen in children MC Tomor of posterior mediasteinum Neuroma MC cancer of posterior mediasteinum Neuroblastoma Neuroblastoma & Pheochromocytoma Come from Ganglia Increase catecholamine release Paroxysmal HTN, HA, Palpitation, Diophoresis Urine test for Pheo & Neuroblastoma VMA, Metanephrines, HVA What drug can be used to test for Pheo Alpha blocker Phentolamine Drug used totreat Pheochromocytoma Phenoxybenzamine

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Most specific scan for Pheo MBGA MC presentation for Neuroblastoma Abdominal mass in child Clue for Pheochromocytoma Paroxysmal HTN, HA, diaphoresis Define Hypsarythmia Dancing eye due to Neuroblastoma Define Opsoclonos Dancing feet due to Neuroblastoma Give the most common Tumor of the Thymus Thymoma Tumor of the Thyroid Follicular Adeno Cancer of the Thyroid Papillary Carcino Cancer of para-follicular cells MCT Tumor of Parathyroid Gland Adenoma Tumor posterior mediastinum Neuroblas What tumor is found with all automimmune disease Thymoma What autoimmune disease does not have a thymonma? Graves Automimmune dz with highest incidence of Thymoma? Myesthenia Gravis #1 risk factor for papillary carcinoma of the thyroid Previous radiation to neck MC mass of the thyroid Cyst - Thyroglossal cyst Thyroglossal cyst Midline Moves up and down with swallowing Rx: FNA diagnostic and curative W/U a solid thyroid mass Thyroid scan cold or hot Cold previous radioation lobectomy no radiotionBxMalignantLobecto Which is malignant hot or cold nodule Cold is malignant. A Hot is still making thyroid hormone. Immature vs- Mature Teratoma Mature Mature structures Immature Immature structures

MC teratoma cancer Squamous Cell carcinoma What is the most common cause of hypercalcemia in adults? Parathyroid Adenoma From what is the superior and Inferior parathyroid glands derived? Superior 4th brachial pouch Inferior 3rd brachial pouch Middle Mediasteinum (Give the MC) Pleural Cancer - Mesothelioma Endocardiumal tumor - Myxoma Epicardial tumor - Rhabdomyoma Ca of the Epicardium - Rhabdomyosarcoma Cancer of the lung - Metastasis Lung mass in children - Hamartoma Lung mass in Adults - Granuloma Intrathoracic cancer SQCC of trachea Primary lung Ca Bronchogenic Adeno #1 Risk for lung cancer - smoking Bronchoalveolar Ca risk - Pneumoconiosis In what part of the lung can you find a SQCC? Bronchogenic Adenocarcinoma? Small cell carcinoma? Bronchialveolar SQCC Central BA Peripheral (Terminal Bronchioles) Small Cell Central Bronchoalveolar Peripheral 4 Hormones produced by small cell carcinoma of the lung ACTH ADH PTH TSH 3 Risk factors for Lung cancer Smoking Radon Exposure 2nd hand smoke Pneumoconiosis What affect does smoking have on the risk of lung cancer in combination with a pneumoconiosis? It has a synergistic effect. It increases the risk of cancer. Clue for Bissinosis Cotton Industry worker MC location for a carcinoid tumor Pancreas Ileum What is the only indication for surgery for a lung cancer? V/Q mismatch

Which Pneumoconisis does not predispose to lung cancer? Anthracosis (Coleminers lng) MC Risk for Asbestosis Shipyard worker Break Mechanic Insulation worker Pipe fitters MC Risk for Silicosis Sandblaster Glass blower MC Risk for Beryliosis Radio/TV industry worker Clues for Myxoma Diastolic Plop Woman passes our and comes back in 5sec Most common location for Myxoma Left Atria Why are most sarcomas seen in < 3yo? Cells are still rapidly dividing MC pericardial tumor Fibroma List 3 neuro-cutaneous syndromes Neurofibromatosis Tuberous Sclerosis Sturg Weber 3 clues for neuro-cutaneous syndromes? MR Seizures Cerebral Calcifications Clues for Neurofibromatosis Caf au le spots Neuromas Fibromas Describe are caf au le spots? Hyperpigmented macules Criteria Caf au le spots Greater than 3 spots At least 1.5 cm in diameter NF I vs- NF II NF I chr 17 NF II chr 22 Clues for Tuberous Sclerosis Ashen-Leaf Spots Risk of Tubors Risk of Rhabdomyoma Risk of Rhabdomyosarcoma Risk of Renal Cell Carcinoma

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Describe Ashen-Leaf Spots Hypopigmented macules Clues for Sturg-Webber Portwine stain in V1 Angiomas of Retina and CNS MC tumor of entire GI Leiomyoma MC cancer of entire GI Adenocarcinoma MC cancer of esophagus Top SQCC Lower 1/3 Adenocarcinoma (Barrets) MC presentation of esphoageal cancer Odynophagia (Painful swallowing) Name for mets from stomach to ovaries Krukenburg Clues for stomach cnacer Leather water bottle appearance Linitis Plastica Signet Ring Cells MC presentation for Stomach Cancer Early Satiety MC cancer of ileum Lymphosarcoma (Lymphoma) MC presentation of Lymphoma of the ileum Small bowel obstruction Bilious vomiting Treatment for obstruction NPO NG suction Abdominal X-ray MC presentation for cecal cancer Chronic Bleeding Microcytic hypochromic Anemia Risk factors for Colon cancer Low fiber diet High fat diet Polyps Characteristict of Puetz Jegar Polyposis Hyperpigmented mucosa Breast cancer Ovarian cancer Lymphatic cancer Familial Polyposis Autosomal Dominant 100% Occurance Gardners Syndrome Familial Polyposis Sebacious Adenomas Osteomas Clues for Turcots Syndrome Familial Polyposis Primary Brain tumors MC pancreatic: Mass Cyst Tumor Adenoma Cancer Adenocarcinoma Given the following clues, give the related tumor of the pancreas. InsulinGlu C-Peptide Insulinoma InsulinGlu C-Peptide baby Nessidos Blastosis Low Insulin High Glucose glucagonoma Bad constipation Somatostainoma Watery diarrhea VIPoma Flushing, diarrhea, and itching Carcinoid High insulin and low C-Pepetide? Exogenous injection of Insulin What is the 1st and 2nd most common locations for carcinoid tumors? MC location is the Pancreas 2nd MC site is the ileum What can you test for in the urine of someone with a carcinoid tumor? 5HIAA Clues for carcinoid Flushing Wheezing Diarrhea MEN syndrome is Pancreatic Ademona? MEN I MC presentation of pancreatic adenocarcinoma? Painless jaundice b.c. cancer obstructs the biliary duct MC location of pancreatic Adenocarcinoma? The head of the pancreas What is another presentation of pancreatic adenocarcinoma Trusseu Sign (Migratory Thrombophlebitis) Because pancreatic adenocarcinoma is very mucinous and forms clots. Complication of pancreatic cancer? Erosion into the peritoneum.

What is courvoisier's sign? Palpable, non-tender gallbladder in a jaundiced patient. In the gallbladder what is the most common: Tumor - Leiomyoma Cancer - Adenocarcinoma What is a risk factor for cancer of the gallbladder? Chronic gall stones. In the overies, what is the most common: Mass Benign follicular Cyst Tumor Serous Cysadenoma Cancer Serous Cystadenocarcinoma Which marker is associated with Serous Cystadenocarcinoma? CA-125 What effect do OCP's have on cancer of the ovaries? Decrease risk Name the mass/tumor/cancer of the ovaries: Psuedomyxoma peritonii - Mucinous Cystadenocarcinoma Acites/pleural effusion Ovarian fibroma Menstrual bleeding Granulosa cell Virilization/hirsutism Sertoli-Leidig Cell Produces AFP Yolk sac tumor Hair/teeth/bone/glands Teratoma What is Meig's syndrome? Ovarian fibroma in association with pleural effusion and ascites. What causes Meigs syndrome? Ovarian fibroma is highly osmotically active and it pulls fluid out of the lung causing pleural effusion and into the peritoneum causing ascites. What is the name for a teratoma that produces T4 and T3? Struma Ovarii MC kidney mass? Tumor? Cancer in a child? Cancer in an Adult? Cyst Adenoma Wilm's tumor (Nephroblastoma) Renal Cell Carcinoma Most common abdominal mass in children? Neuroblastoma

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Most common flank mass in children? Wilms Tumor of the kidney What is the most common presentation for Wilms ? #1 Abdominal Mass #2 Painless Hematuria What is the most common renal cancer in an adult? Renal Cell Carcinoma Most common presentation for Renal Cell Carcinoma? Painless Hematuria Flank Mass Part of the kidney that both Wilms and RCC occur? In the Upper pole of the kidney What is unique about them? They are very vascular because the produce angiogenin. To what organ do Wilms and RCC metastasize? Lung What are Wilms and RCC mets to the lung called? Cannonball mets What is the recurrence in the opposite kidney? 20% What are the two classical symptoms for wilm's tumr? Aniridia (Orphan Anne Eyes) no eyes color Hemi-hypertrophy 4 hormones produced by Renal Cell Carcinoma? Erythropoietin PTH FSH/LH What cancers produce PTH? Small cell carcinoma of the lung Squamous carcinoma of the lung Renal Cell carcinoma Parathyroid Adenoma Risk factors for cholilithiasis? Fat Female Forty Fertile What is murphy's sign? What does it signify?

Cessation of breathing on deep palpation of the gallbladder. Probably Cholecystitis What is charcot triad for Cholangitis? Jaunduce, Fever, Biliary colic What is the gray turner sign? What is the cullen's sign? What do they signify? Gray turner's sign is bleeding into flank causing bluish discoloration in the flank. Cullen's sign is bleeding into the peritoneum causing bluish dicoloration of periumbilical area? Acute Pancreatitis. MC uterine tumor? Leiomyoma Describe a Leimyoma Focal thikening of the uterus differentiates Describe Adenomyosis Concentric enlargement of the uterus MC presentation for leiomyoma Heavy menstrual bleeding (Menorrhagia) MC type of leiomyoma Submucosal What type of leiomyoma causes painful? Subsurosal MC common uterine cancer? #1risk? Adenocarcinoma Unopposed estrogen MC cervical mass? MC Cancer? MC presentation of cervical cancer? Wart Squamus cell carcinoma Post - coital bleeding What are the two types of cervical warts? Which is most common? What causes each? Condyloma Lata & Acuminatum MC Condyloma Acuminatum Acuminatum HPV 16, 18 Lata Syphilis Describe Condyloma Lata Fleshy wart growing like mushrooms on side of tree. Describe Condyloma Acuminatum Verucus When do you start a papsmear? Age 16 yo or earlier if sexually active.

What is the most common cause of low grade findings of pap smear? Infection What is the most common cause of high grade finding on pap smear? Cancer How do you work up Low grade finding on PAP Smear? You culture and treat for Gonorrhea and Chlamydia and see back in two to three weeks. If persistent, then culposcopy. If positive, cone biopsy or LEEP to see the depth of invasion. How do you work up high grade finding on PAP Smear? Start with culposcopy then Cone of LEEP. If malignant, then hysterectomy. How does culposcopy work? Stain with Acetic acid. If malignant will light up. Most common vaginal mass? Cancer? Squamous cell cancer in upper half of the vagina? Wart then Batholin Cyst Squamous Cell carcinoma, Rhabdomyosarcoma, Clear cell carcinoma. Uterine cancer coming down because there are no squamous cells in the upper half of the vagina. What is another name for Rhabdomyosarcoma of the vagina? Sarcoma Batyroides What is the most common risk factor for clear cell carcinoma? DES exposure in the mother. What are the three parts of bone? What is the predominant cell type in each ? Epiphysis - Chondroblast Metaphysis - Oseoblast Diaphysis - Osteoblast What is the most common type of epiphyseal bone tuomor? Cancer? Tumor - Chobdoblastoma Cancer - Chondrosarcoma What other cancer occurs in the epiphysis? Giant cell tumor - Moth eaten Describe Giant cell cancer of the epiphysis? Moth Eaten

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MC tumor of the metaphysis? Osteoma MC metaphyseal cancer in an adults? Osteosarcoma X-ray of an osteosarcoma will show? Starburst pattern Codman's triangle MC metaphyseal ancer in a child? Ewing's Sarcoma MC tumor of the diaphysis? Cancer? Osteoma Osteoid Osteoma How is an Osteoid Ostoma described? Painful at night, Large hole in the bone What cancer give multiple osteolytic lesions of the bone? Multiple Myeloma What are group gets Multiple Myeloma? What will you see in the serum? Older adult. IgG with mostly kappa light chains Most common skin mass? Skin tags and hemangioma MC skin Cancer? How is it described? Basal Cell carcinoma - Raise papule with central dimple MC cancer associated with sun exposure? From what does it develop? How is it described? Squamous cell carcinoma Actinic Keratosis - flat papule Which skin cancer has the worst prognosis? Melanona Portwine stain in V1 distribution and angioma of the retina? Sturgen webber syndrome What are the ABCD of skin cancer? A - Area (Larger BAD) B - Borders (More irregular bad) C - Color (Darker bad) D - Dept (deeper bad) Why is melanoma so malignant? It Produces a lot of digestive enzymes so it eats through your skin.

What SPF is needed for protection from sun? What effect does UVA and UVB rays have on skin? SPF 15 UVA - Aging UVB - Burning What percentage sun rays does a SPF of 15 block? Blocks 94% of sun rays What are the two uses of cancer antigens after surgery? Check for Recurrance Check for Metastasis Cancer Antigens/Markers CA-125 Ovarian PSA Prostate Phili Chr. CML TRAP Hairy Cell Leukemia Auer Rods AML S-100 Melanoma CEA Colon Cancer AFP Liver/Yolk sac cancer Beta-HCG Choriocarcinoma C-myc Burkett's Lymphoma L-myc Small cell carcinoma N-myc Neuroblastoma Bcl-2 Burkett's/Follicular CA-19 Pancreatic Cancer P-53/BRCA Breast/Ovarian cancer What is the most common prostate tumor? Cancer? Where does each start? BPH - central Adenocarcinoma - Periphery What are the symptoms of BPH? Post urinary dribbling Weak Urinary Stream Hesitency How do you treat BPH? #1- Alpha blockers Terazosin, Doxazosin #2 - 5-alpha reductase INH - Blocks teststerone production Finesteride #3 - DHT receptor Blockers - Blocks testosterone production Flutamide, Cyproterone Alpha blockers used to treat BPH Terazosin, Doxazosin 5-alpha reductase INH used to treat BPH Finesteride DHT receptor Blockers treat BPH Flutamide, Cyproterone What two drugs accidentally blocks alpha 1 reeptors?

Keoconazole and Spironolactone What is the number one side effect after prostatectomy? Impotence because of damage of the pudendal nerve. What is the management for prostatic adencarcinoma? Prostatectomy followed by either intralesional implantation of radioation, outside radiation, or hormonal therapy. What is the generic staging for prostate cancer? Stage I - limited to tissue Stage II - Penetrate outside the capsule Stage III - Local invasion Stage IV Metastesis Name 6 tumors/cancers of the breast Intraductal Carcinoma Lobular carcinoma Intraductal Papilloma Inflammatory Carcinoma Comedocarcinoma Cystosarcoma Phylloides MC breast mass? Tumor < age 25? Tumor > age 25? Cancer? Which are estrogen dependent and which are progesterone dependant? Mass Cyst Tumor < 25 Fibroadenoma Tumor > 25 Fibrocystic Breast disease Cancer Intraductal Papilloma Fibroadenoma Estrogen Intraductal Papilloma Estrogen Fibrocystic Breast disease Progesterone At what stage of the menstrual cycle would you expect a fibroadenoma to enlarge? Cyst from fibrocystic breast disease? Two weeks after menstrual cycle. Two weeks before menstrual cycle What causes Peu dOrange in the breast? Cancer infiltrates the lymphatic channels and pulls on the radial fibers of the breast. How do you work up a breast mass? Soft breast mass Sonogram to prove it is cystic If fluid, FNA Firm Breast mass Mammogram (micro-calcification) Lumpectomy and send to pathology If benign - close and finish If malignant - wide resection nodal dissection, and estrogen receptor assay. If positive, treat with Tomoxafin or roloxafin.

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How do Tamoxafin and roloxafin work? The Block estrogen at the pituitary and breast and are Pro-estrogen at liver and bone. Tamoxifen is proestrogen at the uterus promoting uterine cancer. Current recommendations for mammograms? 35-40 baseline breast exam by doctor 40-50 Annually by doctor & monthly by patient 50 Mammograms Annually If family history, 5 years before family member had breast cancer. What is paget's disease? Intraductal carcinoma with an ulcer/rash around the nipple. Risk factors for breast cancer? Breast Female Age Unopposed estrogen Previous cancer Cancer in the contra-lateral breast Family History Most common testicular mass in a baby? Hydorcoele Testicular mass in older children and adults? Hematoma Testicular mass in Older male? Vericocoele and Spermatocoele MC testicular cancer? In whom do they occur? Seminoma/Choriocarcinoma/Yolk sac Occurs in Young men Name the testicular mass Transillumincates - Hydrocoele Bag of worms - Vericocoele Firm mass - Seminoama Teeth, hair, skin - seminoma HCG - Choriocarcimoma AFT Yolk Sac tumor Most common GI Tumor/Mass/Cancer GI Tumor Leiomyoma Cancer of the esophagus SQCC Ca of lower esophagus Adenocarcinoma Cancer of the stomach Adenocarcinoma Cancer of Sm. Intestine Adenocarcinoma Cancer of the ileum Lymphoma Tumor/Cancer of the appendix Carcinoid Liver mass Cyst Tumor of the Liver Adenoma Cancer of the Liver Hepatoma

Pancreatic mass Cyst Pancreatic tumor Adenoma Pancreatic cancer Adenocarcinoma Most common Genitourinary Tract/skin 1. Ovarian Mass, Tumor, Cancer 2. Uterine Tumor, Cancer 3. Cervical Mass, Cancer 4. Vaginal Mass, Cancer 5. Prostatic Tumor, Cancer 6. Testicular tumor in a baby, Child/Adult, Older Male 7. Testicular Cancer 8. Skin Mass 9. Skin Cancer 10. Skin cancer associated with sun exposure 1. Cyst, Serous Cystadenoma, Cystadenocarcinoma 2. Leomyoma, Adenocarcinoma 3. Wart, Squamous cell carcinoma 4. (Wart, Bartilin Cyst), Squamous Cell Carcinoma 5. Adenoma (BPH), Prostatic carcinoma 6. Hydrocele, Hamartoma, (Vericocele, Spermatocele) 7. Seminoma 8. Skin tags and hemangioma 9. Basal Cell Carcinoma 10. Squamous Cell carcinoma Give the most common 1. Kidney Mass 2. Renal Tumor 3. Renal cancer in children 4. Flank mass in children 5. Abdominal mass in children 6. Renal cancer in adults 7. Tumor of the bone 8. Cancer of the bone 9. Breast mass 10. Tumor > age 25, < age 25 11. Breast cancer 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Cyst Adenoma Wilms (Nephroblastoma) Wilms Tumor Neuroblastoma Renal cell carcinoma Chondroma/Chondroblastoma Chondrosarcoma Cyst Firoadenoma, Fibrocystic disease Intraductal carcinoma of the breast

Renal cancer in adults Cancer of the bone Breast mass Tumor > age 25 Tumor < age 25 Breast cancer

Renal cell Chondrosarcoma Cyst Firoadenoma Fibrocystic dz Intraductal Ca

Name the tumor/cancer/mass 1. Tumor of optic nerve in children 2. Brain tumor with whirly pattern 3. Brain cancer with strange cells 4. Tumor in children in Posterior fossa 5. Pasty Goop/Motor Oil 6. Hydrocephalus 7. Bi-temporal hemi-anopsia 8. Precocious Puberty 9. Associated with autoimmune diseases 10. Presents as a cold nodule 11. 1 risk is previous radiation of the neck 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Glioma Schwannoma, Oligodendroglioma Glioblastoma Multiforme Meduloblastoma Craniopharyngioma Ependynoma Nonfunctional pituitary adenoma, Pineloma Thymoma Follicular Adenoma of the thyroid Papillary carcinoma of thyroid

Name the mass/cancer/tumor Rarest Lung cancer - Large Cell carcinoma Most common presentation is painless jaundice - Pancreatic cancer Single hole in bone, painful overnight osteoid osteoma Tumor of diaphysis in children, onion skinning, flask shaped - Ewing sarcoma Papillary with central dimpling on skin - basal cell carcinoma of skin Precursor is actinic keratosis Squamous Cell carcinoma Skin cancer with worst prognosis Melanoma Clue for Intraductal carcinoma of breast Associated with Paget's disease of breast Bleeding from nipple Singular dimple in breast Estrogen Dependant Lobular carcinoma of the breast Cells in single file Clues for Inflammatory carcinoma of the breast Lots of dimpling

Name the mass/tumor/cancer Kidney Mass Cyst Renal Tumor Adenoma Renal cancer in children Wilms Flank mass in children Wilms Abd mass in children Neuroblastoma

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Infiltrating lymph channels Peu' deronge Clue for Intraductal carcinoma of breast Associated with Paget's disease of breast Bleeding from nipple Singular dimple in breast Estrogen Dependant Clues for Comedocarcinoma Multiple focal areas of necrosis Cystosarcoma phylloides Rhabdomyosarcoma of the breast Grows like a fungus What disease has Multiple A-V Malformations (AVM) in brain Von Hipple Landow What disease has Multiple A-V Malformations (AVM) in the lung Osler-Webber-Randu

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