DIP Episode 102 - The “Clutch” Cancer Podcast

Okay, welcome. My name is Devine. I am a PGY1 transitional year resident that's ultimately going into radiology. This will be the 102nd episode of the Divine Intervention Podcasts and in this podcast I know for episode 100 I had a clutch micro podcast. I'm gonna call this the clutch cancer podcast. I mean obviously the cancer is not clutch for the patient. I'm just calling this a clutch podcast because it's oriented towards getting you like many questions right on the USMID exams. So let's just go ahead and jump right into it. So what if you get a question about like a kid that's presenting with like Etaxia and they tell you that on imaging they find like an acritic mass in the cerebellum. What and let's assume like it's in the middle of the cerebellum so like around the vermicere. What kind of tumor are you thinking about? I really hope you're thinking about like a middle of the stomach okay. That's the classic we present on on the USMID exams. Although if you saw an answer that says juvenile Pylocytic Astrosyctoma you should probably go ahead and choose that one first over a medalloblastoma because they can have very similar presentations. That is why on MBM is they almost always never put both as answer choices in the same question because actually a Pylocytic Astrosyctoma is the most common very high. It is the most common brain tumor in kids and again it usually arises in the posterior force usually in the cerebellum okay.

So just sort of keep those two things at the back of your mind but usually for some reason they go off-tomatoidyloblastomas on the MBM exams and remember that the Pylocytic Astrosyctomas right they contain those using the phylic fibers do you remember what those are? I really hope you're thinking about them those rose-anthol fibers right and then what if they give you a question about a you know a person that has like some brain mass and they tell you that it's attached by like some girl tail like or the telly that it's a parasagidol mass or they tell you that the mass is kind of like stuck to the meninges. What kind of brain tumor are you thinking about? I really hope you're thinking about a meningoma right. Remember meningomas they tend to are like they tend to attach to the to like the what is it called to like the meninges so they can attach to like girl folds that's why they can erase parasagidol. Right and what's the classic histologic finding in in meningiomas? I really hope you're telling me the classic Samu bodies right? Okay now what if you get a question about a patient that presents with like bilateral hearing loss and they tell you that this person has a history of some genetic disease what are you thinking about? Again I hope you're thinking about NF2 right and remember those people tend to get bilateral acoustic neuromus right?

So bilateral acoustic schwannomas those tend to arise in the at the cerebellum point in angle okay so that's something you definitely want to keep at the back of your mind and remember that these bilateral acoustic neuromus are essentially diagnostic of neuro fibromatosis type 2.

Remember that's a chromosome 22 problem versus NF1 that's more of a chromosome 17 problem and in NF1 right to remember your your coffee or leaf spots remember your neurofibromas remember the association with the optic nerve gliomas right and those people also have an increased risk of acoustic neuromus but acoustic neuromus you really want to think we're about NF2 on your exam okay now what if you get a question about like a farmer and they tell you that this farmer you know he over the last few months he's had like these lesions on his like forehead that kind of like rough like rough like there's more there's like multiple they kind of like rough and it is a farmer and it works a lot like in the Hudson and they're like multiple multiple lesions on like his face on his hand I mean on his forearms and stuff what kind of lesion are you thinking about I really hope you're thinking about actinic aratosis right at any carotosis remember son exposure is the biggest risk factor but the most likely outcome for these farmers is it you're likely resolve right but remember that there is there's an association with the future development of swim or cell carcinoma of the skin actinic aratosis is a precursor to swim or cell carcinoma of the skin now what are the classic I guess skin findings and people in lesion that be telling that this may be melanoma right so remember your ABCDE right so like your A for asymmetry right so the lesion is not like super well circumscribed it's not like perfectly symmetrical and then the B right is for the borders right and then this is like the color variation so like it may be dark brown here and you black here and all that stuff and then the D is the diameter right so it's like usually like greater than six millimeters and then the E is the evolving right so like the thing is beginning to like change character change appearance that sort of makes

you worried about worried about a melanoma right then remember that for melanomas the biggest the prognostic factor right is the breast load depth right is one of those weird things you want to keep at the back of your mind on MV Ms and the thing is remember that there are certain like unusual spots that melanomas can arise right so they can arise like under the fingers I mean under like the nails right that's like the that's the one that's called like the acrolytic genus kind test alright like more in African Americans so that's like the classic demographic that you'll see given on on the USMELY exams so that's something I'd really like you to sort of keep at the back of your mind as you're taking your test okay now what if they give you a question about a person that you know comes in has this lesion on his face and or the metallic that of the media's crevice as a lesion that has like perly grip papules or the tell you that oh it has like telling the tiges and it's above the lip what kind of skin cancer are you thinking about I really hope you're thinking about like bizzle cell cancer of the skin right that's the classic way that presents on on MV Ms okay and remember right if you're thinking about scumosel cancer of the skin since I'm talking about it already I remember that marjorline ulcers right so like ulcers that just just seems to not kill right and usually that's just like burn ones and all that crap you really want to think about a scumosel cancer marjorline ulcers basically a scumosel cancer of the skin okay now what if you get a question about a kid that over the last like three months this kid has had like bone pain and he kind of hurts and he's been having like these fevers and then they show you like like an x ray of the involved extremity and you say like this sombers pattern what kind of cancer are you thinking of right I hope you're thinking about os

teosarcoma right and the thing is osteosarcoma it's actually not that hard to detect on MV Ms right because they usually give you like some kind of risk factor they give you the classic image and finding right so remember osteosarcoma has the association with the coden's triangle right so that's what you want to know don't forget your sombers pattern right and then some risk factors right they can give you a question about like a child that they say oh a newborn instead of having a red reflex on fundoscopic exam the newborn has a white reflex right if you see the white reflex right you're thinking about retinoblastoma and then they can ask this child is this patient is that increase risk for what in the future right obviously will be osteosarcoma because whenever you have that RBG mutation right that increases your risk of that increases your risk of I mean first you'll be diagnosed retinoblastoma in childhood but that certainly does increase your risk of osteosarcoma in the future okay now all the things that increase your risk of osteosarcoma right so one is Pajet's disease right because remember your bone is sort of green in a kind of like a disorganized fashion right so you can get into trouble with that in the future and then another one is this drug it's like a PTH analog that you're given a pulsatile fashion to build bone terryparatite remember you're basically given a growth factor or like a stimulating factor for bone so that can certainly increase your risk of osteosarcoma in the future so you sort of want to keep that at the back of your mind okay now what if you get a question about a kit and they tell you that this kid it's like two years old or whatever and they tell you that this child has like hypertension and has like a flank mass and in the tale you that the perform imaging and like a cat's kind of the abdomen and they see a mass that's like crossing

the midline right it's like a flank mass but it's crossing the midline and it contains calcifications um what kind of tumor are you thinking about I really hope you're thinking about neuroblastoma right so remember it's a mass the flank mass that crosses the midline and it's calcified right that's the classic we present on mbms and remember that it can also present as a posterior medius thinal mass right because it's a tumor of a neurogenic origin right so um calcified crosses the midline contrasted with the womb tumor that um it's a flank mass the child can present with hypertension but it will not be calcified and it will not cross the midline on mbms exams and remember your womb tumors are associated with the w-a-g-r complex right so like the uh womb tumor and erudia g-u and anomalies and like the uh mentory tradition which i guess this is called an intellectual disability so i'd like you to keep that in the back of your mind for tests and remember right that on histology for these are neuroblastomas right you can actually um see like the homerite and pseudo-resets um they're kind of like it's almost like like circles of chrominepithelium that's running like an empty space that's kind of how it looks on on histology so just sort of keep that at the back of your mind and remember that um the there's this oncogene that is kind of associated with um neuroblastomas like in mech okay so that's something you want to again keep in keep at the back of your mind with mbms and remember that neuroblastoma can actually be associated with something called obsoclonas myoclonas syndrome so they may describe like a little kid with like weird hand movements and a little kid with like weird eye movements if you see like weird eye movements weird hand movements in a kid i really want to think about obsoclonas myoclonas syndrome you need to go ahead and screen that kid for a neuroblas

toma okay it tends to show up in very very young kids on mbms um i guess while we're on that topic right so if you see a kid with like coriform arm movements um and he tell you that this kid had a sulfate like back in the day um you want to think about a sequelae of a rheumatic fever right it's called a pandasas syndrome right so it's like the pediatric autoimmune neurocyte disorder associated with a strep right so basically if you see coriform movements in a kid you want to think about a pandas it's a uh sequelae of a groupase strep infection with a rheumatic fever okay so let's keep going so what if you get a question about um i don't know let's say you get a question about some patient the thing that this patient has like episodic uh um headache and hypertension like he just has like this in cephalopathy that sort of seems to occur periodically and when he has that in cephalopathy he checks his pressures and it's like crazy high like like 200 over 150 or some crazy number right um what kind of tumor are you thinking about well i hope you're thinking about a fiochromosytoma right fiochromosytoma remember those tumors arise from the adrenomidola okay um so like the chromophine cells of the adrenomidola so under those circumstances um come on divine think um so those cells right if they ask you like what kind of receptor will be found on the surfaces of those cells i really hope you're thinking about the nicotinic acetylcholine receptors because remember the adrenomidola is basically a kind of modified opposed genglionica um sympathetic neuron right so you should have nicotinic acetylcholine receptors on its surface and remember that feels right the um you can uh check like the level of urinary or serimeterneference they'll be elevated right and then before you take those people to surgery remember you want to block our first receptors first before you block a bitter

receptors so that you don't have like unopposed alpha one stimulation and get like a massive massive massive massive hypertension and diet right so um it's just one of those things you block out first before you block beta kind of similar to the whole cocaine overdose crap um person overdoses on cocaine you don't want to give a bitter blocker because they can have an opposed alpha and get hypertension and diet right so you usually don't want that that's usually not a not a great outcome although on mbm is right if a person has cocaine overdose you probably want to go ahead and give them a benzodiazepine first but if you don't see a benzodiazepine answer you can give an alpha blocker right so like phenoxybenzamine or phentolamine alternatively you can give an alpha-beta blocker right so like a carvidi long or a labeta long so just again keep those options at the back of your mind now um and remember that feels right what's like this genetic syndrome that appears to be associated with feels right I hope you're thinking about your immune syndrome right if you want to be a little more specific um your mian 2 syndrome right so like mian 2a2b remember mian 2a right that's where the people have like the medallary thyroid cancer they have the fiochromosytoma and then they can also have the primary hyperparthyroidism and I remember um that primary hyperparthyroidism that you find in the in the um in the mian syndrome is parathyroid hyperplasia that causes it not parathyroid at the numa so here's the thing the most common cause the most common cause of hyperpar of hyperparthyroidism from a parathyroid problem is a parathyroid at the numa okay but specifically in the subset of patients that have the mian syndrome the most common cause very high you to notice the most common cause of hyperparthyroidism is a is parathyroid hyperplasia so hyperplasia of the parathyroid is not an ad

enoma of the parathyroid that's actually kind of high you to know and then remember mian 2b right that's where they have like the medallary thyroid cancer they have the fiochromosytomas right and then we have the um ucosonuromas right so like the lip neuromas um so um and they also have like this marphanoid a habitus right so remember you see a marphanoid habitus on your mbme exams they kind of like three things you want to think think off I guess or you want to think about like mian 2b right and these other associations um you want to think about um marphan syndrome right remember marphan syndrome as arises from like a fibrillina defect those people tend to have like the lenses dislocated upwards right and it vibrates on aorosomal dominant disorder right and it's a chromosome 15 problem right and then these people are morphan syndrome remember they tend to get other problems like like mitrovap's prolapse they tend to get like aortic dissection they can get aortic regurg they can get many different problems right back to six to bottom and all that crap so just so they keep that at the back of your mind right with a marphan's um and then another thing that can cause a marphanoid habitus on mbme is hyper homocysteinemia right so those people may have like an empty ch FR deficiency so I believe it's like methylene tetrahydrofolid or they can have a CBS edificiency so like cystothionine, abitus and thiz if you listen to my biochem videos you'll see I basically describe the pathophys behind the many of those are problems okay so since we're talking about cancers right so we talked talked about how the medallary how a fiochromosytoma can be associated with the emian syndrome um remember that fio is also associated with um uh command divine think NF1 right so neurofibromatosis type 1 that's actually a high yield concept you want to keep at the back of your mind so um other as

sociations right for fear right so I talked about the emian syndrome um since I've talked about the emian syndrome it probably makes sense to talk about the medallary thyroid cancer right so medallary thyroid cancer what's the tumor marker for medallary thyroid cancer that's calcytonin right and if what's like the special thing that's used for medallary thyroid cancer right it's kung-gore remember if you see amaloid right um in the uh uh around the thyroid gland I really want to think about medallary thyroid cancer um the amaloid basically is just from deposits of a calcytonin associated with the tumor right so remember the medallary thyroid cancer it arises from the c cells right that kind of surround the thyroid okay now um all the things you want to keep in mind with medallary thyroid cancer uh basically if a patient has a history of like emian 2b or 2a you want to go ahead and resect the thyroid because it's not a matter of if they will get medallary thyroid cancer it's more a matter of when they'll get medallary thyroid cancer so those people need to get a prophylactic a thyroidectomy because the risk of developing medallary thyroid cancer is about 100 percent okay now um what if they give you a question about a person that has like a neck mass and you take a biopsy and you discover it to be a popular thyroid cancer what is the classic risk factor that must have been exposed to that increase the risk of getting that okay thinking about like neck radiation right so um classic classic classic thing right so like they tell you about like a patient a good like chest or neck radiation for like I don't know like a Hodgkin's them former Wendy were teenagers and then they present a neck mass and they say like oh what's the most likely blah blah blah right think about popular thyroid cancer it's actually very high you to know the especially for step 2ck and step 3 the big

gest risk factor for popular thyroid cancer is a prior histrovredition to the anterior chest wall to the neck okay and remember that popular thyroid cancers right on histology they tend to have those fancy shmancy some homobodies right so that's something again you want to keep at the at the back of your mind for test and then since we're sort of kind of talking about the thyroid cancers remember that popular thyroid cancer it loves to metastasize through the lymphatic system contrasted with a folicula thyroid cancer that basically does not metastasize through the lymphatic system it's more like more like a hematogenous met's right so that's actually again a high olfactory want to keep at the back of your mind and remember that um uh many of these thyroid cancers right they tend to present as like cord nodules right so remember obviously right on the mbm is if you see like a nodule in the thyroid first thing one of these go ahead and check the TSH right the TSH super low that tells you that the nodule is hyper function it's a hot nodule right very unlikely to be malignant but the TSH is higher normal right that tells you that okay the level of cord nodule here right then basically the your next steps in diagnosis or management for both kinds of nodules are completely different right so if for example if the TSH super low you're like okay crap this is a hot nodule you're like okay good though it's not a cancer so your next step will be to get a ryeu scan right like a radio iodine optic scan right so you get those scans you see a single focus of like uptake that's like a toxic adenoma you see like multiple discreet ears of uptake that's like a multi-model no goiter you see like the fuse intense optic throughout the thyroid um then you're thinking more about graves disease right then contrast that with a cord nodule where your next step in diagnosis or management right w

ill be to go ahead and get like an ultrasound of the thyroid gland with a biopsy right so just again keep those things at the back at the back of your mind okay so I think I've sort of said enough with the thyroid cancers now what if you get a question about a kid that has um they tell you that this kid has like you know like he's having like a ton of seizures and they tell you that he get an EEG during one of these seizure episodes and let's assume it's a kid less than a year old and they tell you that they see like a super chaotic disorganized pattern um what kind of genetic syndrome do you think I'm talking about I hope you're thinking about tuberous sclerosis right tuberous sclerosis remember it's a rosomo dominant disorder and what kind of seizure does this kid have that's west syndrome right all like your classic infantile spasms I remember that um that responds pretty well to a acth if you don't see acth as an answer choice on your mbmi go ahead and pick a vaigabatrin okay fly gaba tree that's another thing that me show up that's like a gaba analog used to treat seizures and again this kid has tuberous sclerosis um remember that in tuberous sclerosis um we can have like the subipendum all like a hematomas and remember the other malignancies right even in more domain of them up in nine that has to do with tuberous sclerosis right so like the um the cardiac aryptomioomas right they can have like the renal angiomyelipomas right so like a like a tumor containing blood vessels and muscles and fat right um so those are classic associations you want to keep at the back of your mind and then there's one more it is one of those things that if most people saw it on the mbmi is you're probably getting wrong um there's this tumor that's actually found a lot of people with tuberous sclerosis a brain tumor is called so like a subipendum all giant cell astrocytoma and that's

actually another pretty classic association with tuberous sclerosis uh the pop suppocationally on the mbmi's and that chaotic pattern on e.e.g.

I'm describing for west syndrome remember that's um that's uh the classically described a hypsiridmia right hypsiridmia if you see that boss phrase uh you really want to pretty much stop reading the question think about tuberous sclerosis think about um west syndrome all or um infantile spasms okay now what if they give you a question about a patient uh let's assume he's a female and she's like like post-mediposal and she's having like visual difficulty uh like tunnel vision sort of deal um and she's having like a lactoria or they may present it as a younger female that's having like infertility problems um if you see that like visual field deficits infertility sort of see that cluster right um you kind of want to think about a prolactinoma right uh remember it's a type of pituitary adenoma um remember it's response very well to like bromocryptin carburegolene that is I'll say like 99% of the time on the mbmi's does the best treatment don't go straight for transphenoidal resection um most bit most uh prolactinomas result with um um um dopaminurgic therapy remember I know that name for dopamin is uh is prolactin inhibitor in a factor okay and right pituitary adenomas right they can compress the optic chiasm they can cause the bi-temporal um hemianopsia um so the people will get a tunnel vision so basically they will lose the left visual field and uh um uh I don't want to mistake I don't want to uh mistake myself this is something I have to draw to make sure mommy give me sticks but don't really have time for that right now but yeah they get a bi-temporal heteronomas uh hemianopsia so basically they don't it's not like they lose the left visual field in the eonoma yeah let me let that go just bi-temporal heteronomas uh hemianopsia it's something I have to draw and that will take take me away I don't want to delete the spot cast because this spot cast is probably gonna g

o for a little longer uh than I planned okay now right so pituitary adenomas remember pituitary adenomas actually has to show the mian 1 right so like the pituitary adenomas parathyroid problems pancreatic problems um and the most common kind of pituitary adenoma right is uh is a prolactinoma okay um now what if they give you a question about a child that has like visual field problems or they give you a question about a child and you see on imaging they find like a calcified mass what kind of tumor are you thinking about that's a cranial firing gem right um cranial firing gem is don't forget the embryologic time there right so like the raki spout so many shows of quite commonian exams uh I remember it drains like that motor oil fluid right um on on when you're doing like when you get like a pathologia specimen okay now what if you get a question about a lady right and the tale that over the past month which has lost a ton of weight is having high fevers one of her breasts is like super enlarged super tender an exam and um um it looks like a dimmed us what kind of tumor are you thinking about right i hope you're thinking about like an inflammatory carcinoma right of the breast uh just awful awful awful prognosis basically the it's a kind of infiltrating a doctor carcinoma that has kind of like invaded the dermal lymphatics right so that's the classic we will present on exams right uh so please don't confuse that with like my stitis right my stitis it's usually like a unilateral breast problem um shows up like related to like recent delivery of her child right so like her own pregnancy delivery time so that's like the classic we present on exams remember the right stuff for us is like you'll culprit there I want to go ahead and give like a napcil in or die clock sass in it on the USM is for that I have I don't think I've ever seen vancomycin ever be correct as a treatme

nt for my stitis so just don't pick a vancomycin just pick that lock sass in or sass in or napcil in those are your anti-staff lococcal or penicillins they cover MSC MSC that are pretty well and then what if they give you a question about a lady has like an exemplatory change of her nipple and what kind of disease are you thinking about right pudge is disease of the breast right i remember right this usually is as real like some kind of underline infiltrating a balkyrie carcinoma okay so um what if you get a question about um like a 25 26 year old female she tells it over the last month she has found some lump in a breast and the lump is like movable and it's like firm um what kind of tumor are you thinking about right it's a fibroid I know right usually you just go ahead and re-insure the patient if you're asking for imaging you can do an ultrasound of the breast because the patient is less than 30 um but yeah there'll be a fibroidanoma grows kind of as grows with a menstrual cycle um usually it's like it's pretty it's usually pretty b9 right so for these patients you can re-insure them do a physical exam like a few weeks uh it may have resolved by then and whatnot so just so that I keep keep that the back of your mind but don't forget the lady is less than 30 and she's presenting with um with uh like a poppable breast mass uh don't go for a mammogram for a scoffer and ultrasound because remember if you're less than 30 you have like pretty dense breasts um so mammograms not not super helpful under those under those circumstances at least on nbm's okay now what if they give you a question about a lady um you know they tell you that she um she's at 10 weeks just station but um hi uterus kind of measures like from the pubic synthesis to the fondest kind of measures like 20 centimeters um that's like size greater than dates right and then they tell you that you perform a

n ultrasound and you see like ill-defined like an ill-defined mix of like high point hypericwic structures in the uterus uh what what are you thinking about I hope you're thinking about like uh like um all of our pregnancy right so like a high-data form or um remember right if you do like the thology of those you see like the grape-like clusters whatever uh classically an ultrasound right they describe that snowstorm appearance but they know that everyone has memorized snowstorms so they usually don't put that crap on nbm's anymore um snowstorm appearance um that's why I said oh ill-defined mix of hypo and hypericwic crap you see that think about a high-data form or um remember right there are two kinds of those molds right there's like the complete mold and then there's the there's the incomplete mold the incomplete mold even if it sounds you're like yeah incomplete sounds bad no the incomplete mold is actually better than the complete mold um the incomplete mold right it's the one that has like the um like the it's like usually like triploid so it's like 69 xxy or whatever um and um that's the one that actually contains like some fiddle parts right and it's the one that's less likely to progress to a choreocardi nomad contrast that with the complete mold that usually does not contain any like intact fiddle parts um it's usually deployed right so it can be like for the six xx for the six xy and this complete mold actually has a higher risk of a progression to uh to a choreocardi nomad right and remember choreocardi nomad don't forget your tumor marker it's like your classic beta HCG um uh and if you're the describer lady that you know kind of has like a had a recent he's shrub like a molar pregnancy and in detail that she's presented with a shortness of breath and yes we have an ex-tipping diagnosis you're gonna go ahead and get some kind of chest imaging right so li

ke a chest x-ray because remember the most common location of a choreocardi cancer meds on mbm is the lungs right and remember that these people if they ask him for like a management option you know go ahead and put in a methyl trexite it's that a fancy schmancy um inhibitor of a dihydrofolate reductase that's also a demard okay um it's used as the drug of choice in the treatment of choreocardi nomads on on mbm exams okay now what if you get a question about uh patient and they tell you that her mom um you know like maybe like for morning sickness she used like a drug that has been discontinued uh that was discontinued like I think in the 80s or whatever I was um as certain it was not born then uh and then they tell you that she presents like uh like some kind of vaginal cancer um what kind of exposure are you thinking about for starters I'll be thinking about ds right so like diethyl as still best role or remember that that increases your risk of uh clear cell adnocarcinoma of the vagina um it was really like ds basically what it does is like sort of mix um um some of your molarian duct like epithelium kind of like hang around uh like because usually the sort of like disappear from the vagina like embryology wise but if they sort of hang around and then you then have like some risk factor that makes you hyper as fruginic right so let's say your b so remember like that aromatic that you find in all these adipose cells and all that crap um that can basically make those molarian structures that persist in the vagina from ds exposure to sort of the go like hyperplasia and then turning to like adnocarcinoma because remember usually on mbm is vaginal cancer is uh swim cell cancer right um and remember hpv as your classic risk factor but if you see like adnocarcinoma especially like clear cell adnocarcinoma of the vagina um you want to think about a ds exposure it's a very

kind of vaginal cancer and has that very strong uh association and then what if they give you a question about like a 67 year old female they tell you that um she's been having like abdominal fullness early satiety and then they tell you that uh they perform like imaging uh of the abdomen right so like a CT abdomen pelvis and they find like uh ton of the cides they find umental kicking that's a boss phrase you're looking for basically if you see the word omentum measured right extensive societies omento kick in and all that crap uh what are you thinking about what kind of cancer are you thinking about that's ovarian cancer right that's ovarian cancer ovarian cancer has used awful prognosis I always feel very bad whenever I find out about a person that has ovarian cancer because it's it's it's it's it's one of the it's probably one of the worst if not the worst um g u a malign uh like malignancy infinites so ovarian cancer uh remember again right classically produces like nasty nasty asides omental because it's press throughout the omentum that's the classic presentation on uh on ambiennes remember you'll see 125 atomomarker and um ovarian cancer is done right they could present it in like um kind of like multiple flavors on ambiennes right so for example they could tell you about uh uh patient that has like ovarian tumor and then they tell you that this person is having like shotness or breath and then they tell you that oh they perform chest imaging and they find like blunting of the constofrenic angles on the right i'm working a syndrome are you thinking about right that's uh that's a mig syndrome right remember it's like a right side deploran infusion in the sitting of an ovarian mass think about a mig's uh mig's uh syndrome um and then what if they give you an ovarian cancer and they tell you that um this person has like almost like myoclonus or like new onset e-f

ib or i don't know what else um or they tell you that this person has like lead lag on so like lead so like the eyelids so like lead lag on uh on exam right you i hope you're thinking about like a struma ovarii um under those are circumstances remember struma ovarii they tend to contain um uh it's like an ovarian mass that we contain like functioning a thyroid tissue right and those can cause um those can cause uh uh basically like hyper thyroid signs right so that's one thing you want to keep on the back of your mind and then in the ovarian cancer world don't forget your teratomas right we can contain like multiple tissue types they can have like teeth they can contain like hair um you can arise in the ovaries especially like in a younger person um think about a teratomas and remember teratomas like the neuroblastomas that show up in the post-traumatic stenome your teratomas show up in the anterior medias thine on mbmexemps right and then what if they give you a question about a lady that has um like a ovarian mass and then they tell you on histology they find us um momobodies um what kind of tumor you're thinking about right that's like a serous cystadmocarsinoma of the ovary right and then uh i'll just mention this just in case you saw it on a test well this is probably more for step one but if they tell you that oh they see an ovarian mass in a lady and then they perform like histology and you see like tumor cells surrounding a blood vessel um what kind of tumor are you thinking about and i'll give you a hint this tumor makes afp as it's tumor marker that's like an endodermal sinus tumor right sometimes they call it a yoke sac tumor right these things i basically describe that your classically this your classic uh sheeler duval bodies okay so just something to keep at the back of your mind and then don't forget right that man right you see like a twin something yo

ur old guy for the last few months uh he has like a painless mass and it's testicle right that's a testicle cancer most likely gonna be like a semi-noma on mbmex right and again remember semi-nomas in the shopping the medias thine on those germ cell tumors think about an anterior medias thine on a mass okay now um what if they give you a question about a patient that has been having like early satiety severe pigastric pain and then they tell you that the fine like uh like the persons of like stomach is in the in move up like not moving basically and then they tell you that they also see like an ovarian mass on imaging and then you do pathology and you see like signet ring cells what kind of tumor are you thinking about right that's uh that's a crooked verte tumor right it's like a gastric arsonoma that has potentially metastasized to the to the ovaries so you know i just keep these things at the back of your mind with uh on uh on uh mbms okay now what if you get a question about let's see um about a guy that has worked worked in the textile industry um or a guy that has been treated for malignancy in the past with um cyclophosphamide and then he's presenting like hematuria presenting with weight loss and then the ask for your next best stepping diagnosis what do you want to do i would really hope you're thinking about like a cystoscopy with uh with biopsy right remember these people basically have bladder cancer remember cyclophosphamide right it has this um uh come on divine think it has this it can cause a hemorrhagic cystitis right because it has this uh breakdown product i'm just trying to remember what it is i know you can prevent it with uh with mesna uh always this breakdown product just give me a second sorry again this is one of these podcasts i'm given from a memory hmm breakdown product of cyclophosphamide well i'll think about it as we go along in the podc

ast if it comes to mind i will uh i will mention it but um cyclophosphamide can cause a hemorrhagic cystitis so for these people um you basically want to think about um getting as this scotoscopy right with uh with biopsy and then uh you'll find like the bladder cancer right although even if i mentioned that this person worked in the textile industry right so textile industry um you're thinking about like exposure to like a die right so like uh an anelene die right remember those things increase risk off of bladder cancer right so uh anelene die so working in the textile industry or um or what's the other thing i mentioned uh so what am i forgetting the things i just mentioned so working in the textile industry is one risk factor another risk factor is exposure to like she's to somahematobium right and then the other risk factor i just mentioned like 30 seconds to a minute ago that i'm not remembering right now think about bladder cancer on that those are circumstances although remember and you want to do a cystoscopy with biopsy so go ahead and uh uh make the diagnosis right but the thing is on mbm is you actually want to remember that the biggest risk factor for bladder cancer is actually smoking right that's something that actually shows up uh uh pretty pretty commonly on uh on mbm is the biggest risk factor for bladder cancer is smoking so you want to keep that at the back of your mind as you as you take your exam so cyclophosphamide she's to somahematobium um and working in the textile industry and exposure to dyes like aneline dyes those all increase your risk of uh bladder cancer right and remember right the classic things that cause hemorrhagic cystitis on mbm is one cyclophosphamide which like i said you can basically prevent that with um uh prevent that with um mesna right and then there's also um adenovirus adenovirus can actually cause um uh adenovirus can

actually cause um hemorrhagic cystitis as well remember that adenovirus can cause like firing go conjunctiveitis right so like so on through and pink i you can pretty much stop reading the question on the mbm is is adenovirus that's it so let's uh let's keep going uh but one thing i just again is pop it is popped up in my mind is remember this cancer drugs is platin remember it's nephrotoxic and you can prevent that nephrotoxicity with an agent known as amifostin on mbm is and oh so this again just popped in my mind cyclophosphamide and mastinus that causes bladder problems is uh something called acroline right and mesna binds of that acroline so you can use that to sort of prevent the hemorrhagic cystitis that's associated with a cyclophosphamide therapy and don't forget that um um you also want to like basically irrigate those people's bladder basically like portona ceiling into the bladder so you can decrease the amount of contact time between cyclophosphamide or its breakdown products and those people's uh bladders okay now what if you get a question about uh let's see how do i present this what if you get a question about a patient that has um um you check their hemoglobin it's like i don't know like 20 so like crazy high and then you tell her that they have a flank mass on imaging and you tell her that this person has smoked for a long period of time and you tell her that i don't know maybe this person has like uh and like um let's see like a right-sided varico cell what kind of cancer are you thinking about really hope you're thinking about like renal cell cancer right on those circumstances uh right so you can present like the hematuria flank mass um and remember that you can produce ipo as a panneoplastic phenomena and remember that renal cell cancer is most to metastasize to bone on nbm is it causes ledic lesions right kind of like long and thyroid cancer a

nd if you see a right-sided varico cell right probably means the renal cell cancer is like metastasized and involved like um i don't know like uh it has involved like the like the IVC or it involved like the gonato vein on the right so that's why the person is having like a varico cell because remember the most common location of varico cells is on the left because if you remember that fuzzy schmancy thing from embryology where the like the left renal vein has to cross the midline and then join up with the IVC I mean sorry the left gonato vein drains into the left renal vein right and then the left renal vein has to like cross over go with the uh and then join up with the IVC on the right so that's kind of like a circuitus route right so it's like kind of increases your risk of like stasis and all that crap so you can get varico cells with that so um so if you see a right-sided varico cell right you want to begin to think about renal cell cancer because a right-sided varico cell it's kind of rare because the right gonato vein drains directly into the IVC doesn't drain into the renal vein right this is one of those like anatomy uh makes a match thing is uh they can do to people on the exams right so again renal cell cancer um can produce ipo in a primary or plastic phenomenon that's why the clinical vignette I meet up the person's hemoglobin was like crazy high and then um uh it can show up as like flank mass, hematuria, all that stuff hypertension um so just again keep that at the back of your at the back of your mind and remember that it causes um um causes um lyric, lyric bone met on mbm is not plastic, lyric the things that cause black cause plastic met on mbm is a prostitutes breast cancer okay but lyric met think about renal cell cancer thyroid cancer and lung cancer on mbm's okay now what if they give you a question about a patient that's like in their 50s 60s t

hey present with like jaundice they have um they have had like really bad weight loss and they present like epigastric pain what kind of cancer are you thinking about uh we think about pancreatic cancer right so like the tumor of the head of the pancreas I remember on mbm you want to go ahead and make that diagnosis with a CT scan of the abdomen right remember pancreatic cancer loves to invade like the supermiss and terricottery and all that stuff and basically once you have like an encasement of a blood vessel those people are not surgical candidates anymore pretty much um and then they may ask like oh let's assume these patients have like bad echin and bad jaundice i want to sort of like palliative relieve their symptoms that what can you do you can basically please like a billiary stent to sort of help do that um the badness like the pilliary being drained right so like you can do any RCB please a stent um yeah pancreatic cancer is bad and don't forget your tumor markers like your CA 1999 right and if they give you like LFT anomalies on an mbm you right in a patient that has pancreatic cancer those patients will have like really nasty elevations in their outfoss right and then they will have a direct hyperbiliary beingemia right because remember that pancreatic cancer sort of causes like a cholestatic pattern of a LFT anomalies right because it's it's an obstructive lesion pretty much okay now what if a person has like colon cancer where what's the most likely organ it will metastasized to an mbm is that's the lever right that's the lever colon cancer goes to a lever on mbm is can go to many other spots but it goes to the lever on mbm is that's the thing i want you to keep at the back of your mic as this we're talking about the lever right remember your hepatocellular carcinoma remember right anything that increases your risk of cirrhosis right so like a chronic kb

chronic kc um there's this weird thing called thorough trust that occasionally pops up but that's more like step one father or if you eat like a certain kind of like mushroom with those aflotoxins or if you have like carodytry hemocromatosis remember bronz diabetes with that a person has like well-synced disease right that copper problem where they have the where they have the like the weird spots in their eye the kaiser flesher rings or if a person has like um uh what is it called let's say the like they have a history of um there's this other classic disease so what is it called um it's not hemocromatosis uh uh they've like been alcoholic for long periods of time and then you have cirrhosis with that those can all increase your risk of hepatocellular carcinoma remember hepatocellular carcinoma um it can produce um many things in a panoplasmic fashion right so it can produce ipo right um and remember that actually measuring like the afp levels afp is a pretty decent or tumor marker for for hepatocellular carcinoma so that's something you want to keep at the back of your mind for for endemic exams and then one thing i want to keep uh one dimension is they may ask you uh they may give you a patient and they say like which of the following could have decreased this person's risk of hepatocellular carcinoma actually getting the hep B vaccine decreases your risk of hepatocellular carcinoma because remember that if you get the hep B vaccine basically will not get hep B if you don't get hep B you cannot get chronic hep B if you don't get chronic hep B you cannot get hepatocellular carcinoma from chronic hep B okay so it's a prevent they can basically frame that as a preventive medicine question on the mbms now what if you get a question about um i guess i mean since i've talked about colon cancer going to the liver remember that colon cancer right can arise from like an ad

enoma um then it's like the tubular adenomas it's like the villas adenomas remember that the villas adenomas are villas right so they have the higher risk of progression to colonic adenocarcinoma compared to the tubular adenomas and remember these are genetic syndrome for that so we don't like colon cancer so like a familial adenomadas or ponyposis remember like it's like autosomodominant abc gene mutation um these people basically they need to get like a collecting prophylaxically when they're like in their teens or 20s right because well it's not a matter of whether they will get colon cancer it's just a matter of when right so in fact they get they start getting screened like at the age of like 15 like some super young age and remember right those people if they have like um like a brain mass you want to think about the torco syndrome and then if you have like these soft tissue sarcomas you want to think about gardener syndrome okay um so apc gene mutation bring tumors torcoar syndrome remember like we're not um you know what I don't want to offend another religion so I'm not gonna use the numonic people you remember but think about torco syndrome that's it um you can look up the numonic on your own and then um if they have like soft tissue tumors like soft tissue sarcomas and think about a gardener syndrome right so torco syndrome gardener syndrome and remember we call on cancer I remember the adenoma carcinoma sequence I actually describe this I describe the pathophysiology behind this I believe in my cell biology podcast I think they're like in like one of my episode 50 or whatever but basically remember the ak 53 um progression right so like you have the apc gene mutation first and then you have the care as mutation and then after they get the p53 mutation and then you progress to calling cancer that's the adenomato carcinoma sequence that's something actually s

hows a pretty commonly on step one and occasionally on step three so that's something you want to sort of keep at the back at the back of your mind now what if they give you a question about a patient that has um they tell you that they have like um that's the only friend this right so bam bam okay so what if they give you a question about a patient that has like um um uh a systolic murmur that's her best at like the left low sternal border and then they tell you that this person has um um all right we'll do this this person has like they've been having diarrhea and they've been having like episodes where they have like strider what kind of tumor are you thinking about and they tell you that they have like an abdominal mass I'll just give you that I didn't see the right lower quadrant what kind of mass are you thinking about that's what a carcinoid tumor right a carcinoid tumor and remember if you want to screen for a carcinoid and right the carcinotum is most commonly in the appendix right so right lower quadrant area so that's why I said that in the in the veneath I was giving you but real quick question here carcinotum um how do you speak the diagnosis what do you do first I hope you're thinking about checking like levels of five hi a in the year right so that's like the classic uh classically describe that nb and e a screening test and then a few other things you want to know about carcinoid syndrome right why was I saying that this person has like skin visions who can the deficiency I might try to clue you into clue to words I hope you're thinking about like a nice indecency right so remember that carcinoid tumor right carcinoid is a tumor that secrets a crop tone of serotonin right now the problem is serotonin comes from a amino acid known as triptophane so if you have carcinoid syndrome it's effectively diverting all your triptophane to making serotonin in fact

remember right serotonin is known as five heat five hydroxy triptophane the thing is that's not all you need triptophane for in the body unfortunately you also need triptophane to make niacin right I believe that's vitamin B3 right that's vitamin B3 um vitamin B3 right so if a person has carcinoid syndrome they already know their triptophane to make serotonin and they are making less niacin if you make less niacin you can get palagra remember and they remember the 40s of palagra right so like diarrhea dermatitis dimension death right so I mean I'm not a hundred presenture about this but I'm wondering if one of the reasons people cross-noyged diarrhea is because of the niacin deficiency but who knows remember right carcinoid syndrome radio present with like the bronchospasm they can get like right-sided heart lesions because remember the lungs will break down that carcinoid so they usually do not get left-sided heart problems so like they get like right-sided heart problems and usually on the right side usually get like tricospid regurg and pomonix stenosis nice we remember that is with the mnemonic tips right so like tips so tricospidine and sufficiency and pomonix stenosis that's a classic way that presents on mbms and then these people they remember that they will not have symptoms until the tumor metastasizes to the liver right because the liver also has the ability to break down the carcinoid product okay so that's all I'm gonna go ahead and uh go ahead and say about that and remember that carcinoid if you were to shop in the media stine on mbms or shop in the posterior media stine okay we'll shop in the posterior media stine now what if they give you a question about a patient that has had like a long history of like uh uh good and then they present with a mass in the distal of suffragous what kind of mass are you thinking about really hope you're thinking about

like an esophageal adnukarcinoma remember that's the most common kind of esophageal cancer in the u.s and the biggest risk factor is what baritone esophagus and don't forget what baritone esophagus actually means right it's like an intestinometer pleaser right so you go from like the squamous cell carcinoma sorry you go from the squamous cells that are classically found in the esophagus and then you have a metapleaser to intestinal epithelium right so like those I believe are like the non-sileted columnar cells with so like non-sileted columnar epithelium with goblet cells so yeah so keep that at the back of your mind so baritone esophagus biggest risk factor for esophageal adnukarcinoma contrast that with other exposures right so like ecalysia zankers diverticulum you the person drank dreno or lie 20 years ago or the person I don't know like basically like pretty much everything else on mbme's in crazier risk of esophageal squamous cell carcinoma okay so adnukarcinoma basically the only thing that causes of agil adnukarcinoma or mbme's is gird baritone esophagus every other thing you see on mbme's causes is of agil squamous cell cancer right so again keep those at the back at the back of your mind and right classic lead classic question that many people for some reason get wrong on mbme's is if a person presents with dysphysia right if a person presents with dysphysia and they have like alarm symptoms so let's say they have like painful swallowing see they have like or dynophysia or they have weight loss and all that stuff your next step in that knows you used to get an egd right so an esophagol gastrodewardenoscopy right because you're trying to rule out this over joke cancer but under classic thing they tend to do to people especially like on surgery exams is I don't know they tell you that this person presents with dysphysia they won't have any weight loss they w

on't have any painful swallowing nothing so they will have low no alarm symptom but there will be more than 50 years old for patient is more than 50 years old being more than 50 on mbme's is an alarm symptom for those patients you want to go ahead and also get an egd and probably get like a biopsy just again to rule out esophagol cancer and remember right usually they'll have like dysphysia first to solids and then to both solids and liquids okay now what if they give you a question about a patient and detail you that doc like I have sort of like I have a command divine thing I have a weakness in my like I have difficulty getting out of a chair and it tells you that this patient is smoked for a long time and then they tell you that you know what that when you keep telling the person lift your arm lift your arm lift your arm the patient's weakness gets sort of gets better what kind of tumor are you thinking about for those people I really hope you're thinking about a small cell on cancer right so the thing I just described is lumbar it in my austenic syndrome right so lumbar it in my austenic syndrome so remember if a person has lung cancer right classic in mbme is there's three that you're thinking about right small cell swim cell and adnocarcinoma now small cell carcinoma is like the poster child of pernioplastic phenomena on mbme exams right so for example small cell cancer already can cause lumbar it in my austenic syndrome right so lumbar it in my austenic syndrome that's a pernioplastic phenomenon that arises when you make auto antibodies against the pristine aptec voltage gated calcium channels right so pristine aptec voltage gated calcium channels so you basically do not ringgillize a neurotransmitter so those people basically have like muscle weakness it kind of presents like myastinia but there's a key difference myastinia those people if you keep stressing o

ut those muscles the weakness gets worse so the weakness worsens with use in myastinia graves but the weakness gets better with use in lumbar it in myastinic syndrome there is a way it gets better with use is that the more you exercise that muscle the more you recruit calcium to outcompete those nasty pristine aptec voted gated calcium channel auto antibodies and then the weakness improves another way they can actually present that on mbme's is they can talk about responses to repetitive nerve stimulation so if for example they tell you that a patient has a decremental response with repetitive nerve stimulation on an mbme you really want to think about myastinia graves right so a decremental getting worse response with repetitive nerve stimulation contrast that with lumbar it in myastinic syndrome when they have an incremental response with repetitive nerve stimulation okay because they know gets better with use get worse with use blah blah blah everyone has memorized that crap so that's just a very nifty way of them essentially explain the same concept but just being a little more confusing on the mbme's so that's something when you keep at the back of your mind and then don't forget right small cell lung cancer can also produce an acth right so like a topic acth remember this is the one that will not suppress with the high dose dexamethasone suppression test right so remember that high dose dexamethasone suppression that's like cushions disease so that's like an epitutory of the numa that's making it to th but if you have like a failure to suppress with high dose dexamethasone then that basically on mbme's is a small cell lung cancer and remember another thing those things can also make it make sidh right so that can present with the uvolemic hyponitremia so remember those patients will have like a low serum osmolality right but they'll have a high urine osmolality

and obviously the treatment for that kind of uvolemic hyponitremia is fluid or restriction or I remember I already talked about that in one of my medicine of videos okay now and then scream of cell lung cancer remember and that's the one that produces a phthrp so it can cause like hypercalcemia so they can have like the stones bones groans and psychic overtones obviously for those people you want to go ahead and put them on a best phosphonit right remember hypercalcemia of malignancy is treated with a best phosphonits although if the patient is acutely ill and they have like skin tinted and really severe symptoms your first step in management is to put them on normal celling hydration hydration hydration is the first step in management of any hypercalcemia crisis on mbim exams and remember the right that your scream of cell cancer your small cell cancer those are rising that's the central mass is remember this type of an s right and don't forget that abno carcinoma already they give you like a non-descript lung cancer question like a female or a person that doesn't smoke think about abno carcinoma of the lungs and that tends to arise in the periphery not in the central part of the lung and then some other weird things we see with lung cancer right so they me give you a lung cancer question and the person has um um like facial fullness and all that stuff um and they have like headaches and facial swelling think about like SVC syndrome right so superior than a kiva syndrome so basically lung cancer is in case the SVC so you're not draining all those like head and neck veins so they can have like the SVC syndrome and then what if a vision presents with like unilateral like droopy eyes and they're not sweating on one side of their face um obviously thinking about a pancholstrumor right so they have like the honor syndrome right so the toses meiosis and uh and uh and uh an

d hydroces remember uh a partial hunger syndrome is associated with um a cluster headache right so again it's one of those weird things when you keep at the back of your mind where you avoid the headache with like 100% high-floor oxygen okay now now I remember I just talked about um my astenia gravis was the tumor in the in the chest in the anterior medius thinum then maybe a sujito mi astenia gravis that's a thymoma right that's a thymoma so again please please please keep these things at the back of your mind I promise you like this podcast like it's one of those things I can pretty much guarantee just take any usmeli exam you're gonna get multiple multiple multiple questions correct from this one podcast because basically I'm just telling you the way these things will show up on these exams now some other things I guess with these are lung cancers that you can keep at the back of your mind uh they can describe a patient that recently just had like um they sit over the last month he's been having like joint pain and has have like finger clubbing and his fingers are getting big and swollen and then he has for the next step in management or diagnosis you want to go ahead and get some kind of chest imaging like a chest x-ray because those people also have a parnioplastic phenomenon right it's called a hypertrophic osteoarthloopathy right so if you see that I want to it has a very strong association with uh with a lung cancer okay um we think I've said a lot about lung cancer um just trying to think it's a little big malignancy I want to talk about um cervical cancer I remember big risk factors HPV um and remember that cervical cancer right you can have like the CIN123 and then you go to full blown uh cervical cancer and remember the most common cause of death right it's like renophelial right because the tumour can spread and involve the ureters so basically if you see

a patient that's like in their 40s and it tell you that they have like a mass in the pelvis and then they tell you that the presence creatinine is like super high or they tell you that the patient has like hydro-uraterronephorosis on imaging you know pretty much stop reading the question the patient has cervical cancer end of story that's the classic way it presents on uh on mbme exams okay now um remember I just talked about how hypertrophic or pulmonary osteoarthloopathy is a pyrneoplastic phenomenon as such that a lung cancer one thing I'll just keep at the back of your mind is this is something that I to be honest to this day I have absolutely no clue why this is the case but hypertrophic pulmonary osteoarthloopathy may be associated with hypoglycemia on an mbme so just sort of keep that on the back of your mind in fact I will tell you this many times on mbme's they love love love love love to test these are pyrneoplastic phenomena right so like ipoproduction which like hepatocellulocarcinoma and renocell carcinoma acthi acid h and um lumbaridinemastinic syndrome with small cell cancer of the lungs pth rp with scrimocell cancer of the lungs um pancus tumor and hunter syndrome hypertrophic pulmonary osteoarthloopathy with lung cancer right um you can also see like the i mean we can bring this as a question we're over like a month or a few weeks a patient just has like all these like black splotches that just shows up all over their skin um you basically want to go ahead and get like some kind of imaging of the abdomen and the chest in those patients right that's the sign of lesser trellot or the lesser trellot sign right pretty indicative of visceral malignancy classically on mbme's it's either pancreatic cancer or gastric cancer okay and one thing you want to keep at the back of your mind with gastric cancer is they may give you the boss phrase a succussion splas

h on mbme's think about gastric cancer with that uh because remember right anything that causes a gastric outlet obstruction or causes a caution splash okay it's indicative of a gastric outlet obstruction um although they may also put it as like like pyloric stenosis right so again so question splash think of anything that can obstruct outflow from the stomach on mbme's um another classic brand new plus they can give you they can give you the um what is it called they can give you like the velvet illusions like on the axilla blah blah blah that's like you can't those cis-nigre can so though that probably the most common cause of that in the US is like diabetes and obesity okay well think about like a visceral malignancy with that like gastric cancer and all that fun stuff okay now um let's see is there any other big cancer I want to talk about I don't know I feel like I've talked about many of the high-yield things um let's see um don't forget you um sheepyard worker um and mesothelium right remember smoking does not increase your risk of mesothelium um remember as bestosis and like your phyrrigenous bodies um remember mesothelium also has those as samamabadi right so remember samamabadi's popular thyroid cancer syracis adnokar samamabadi ovary meningioma and then malignantum mesothelium right those all have as samamabadi's so those are your laminated calcifications on mbme's and then um um um remember that smoke again I already said that smoking does not increase your risk of mesothelium and remember that if people have a histra vasbestosis the most common cancer they get is actually bribogenic carcinoma not mesothelium okay and mesothelium right is a plural malignancy so present like plural thickening it usually presents with like a bloody bloody a plural effusion on on mbme exams so that's something uh keep at the back of your mind if I were you now what if you get

a question about a patient that has um I don't know like um uh they have like let's see they have like risky behaviors like prostitution ivy drug use so the deal and then you tell you that you have like these um purple lesions all like all over the skin um what kind of cancer you thinking about that's kaposi sarcoma right kaposi sarcoma remember it's associated with like a kshv right so like hhv 8 so basically a herpes uh herpes 8 and then what did they tell you about like some immigrant or some kid from africa and you have like this jaw mass kind of cancer you thinking about hope you think about like bricket slump form right um don't forget your 8 14 translocation uh so you have like overexpression of the I believe it's the c-mic on kujin and that can cause like proliferation I mean basically like the cells uh the proliferate fast body diurelative liquid is like lithaz diontanoc cancer um and remember the classic a stary sky pattern on on imaging I mean on histology and then um remember right what if they give you a question about a patient that has like some kind of hematologic malignancy and then they tell you that as they are being treated let's assume I don't know like whatever in the or whatever they become like profoundly hypotensive they start bleeding from venipontar sites um so kind of like a diic picture what kind of tumor are you thinking about I hope you're thinking about like apml right so like acupromylocytic leukemia uh remember your 15 17 translocation with that I remember you treated with all trans or ectmoic acid and don't forget that those things have our rods right and um basically those our rods can cause di acid you can activate the coagulation cascade and then you have like a hot mess right so um you want to be careful when you're dealing with those are transocancers and basically right these hematologic malignancies they're kind of easy on mbm

's if you see like a hematologic malignancy like uh six weeks off like weight loss fevers all that crap in a kid that's like in like a five years old or less okay let's say like eight years old or less on mbm's right that's al right simple as that versus the super old person like 70s 80s they coming with like pneumonia and you check their white tones like 80 or like 90 thousand some crazy high number that's al you can pretty much dig that to the bank end of story on mbm's and then if you're thinking about midlife all you have to ask yourself is do they give you a picture with our rods that's a cute email that's a cute promo your silly clochimic right but if they don't give you our rods then it has to be cml right remember cml your 922 translocation bcr abl um fusion protein and then you trade that with a tyrosine kinase inhibitor like a magnet right that's it so super young el super old cl so the l else and remember a comes before seeing the alphabet so a young kids see old people right people in the 70s 80s people in their 50s do not get cl on mbm exams can they get it in the world they absolutely can but on mbm is they usually do not okay people would cl on mbm is like 99.9% of the time i in their 70s or 80s and they usually present with infection and they usually present with a crazy high white count that is like 70 80 90 thousand and then if you see midlife remember midlife cml ml midlife right cml aml we give you our rods so a in our rods for a in aml for a in a cute promo your silly clochimic and then your cml is the one way they don't give you our rods right and they will have that philadelphia chromosome from the 922 translocation i remember that kids with a history of Down syndrome they have a risk right off off uh i don't know they have like a high risk of getting um getting ill remember this nomonic that they all fall down right so Down syndrome try somethi

ng 21 ill okay now um oh let's see what else do i want to talk about here um remember your ishtumbberg cells with our Hodgkin's lymphoma and remember right these are Hodgkin's lymphomas so basically these are hematologic malignancies they actually have an association with minimal change disease right so that's one thing you really want to keep at the back of your mind like these oncologic associations with nephrodite syndromes whatever bizarre is in the love love the eat that stuff up on mbm is right so i think of them as the liquid cancers right so hematologic problems right so like blood problems like lymphomas leukemias and all that crap think about minimal change disease under those circumstances what if you see like solid cancers like colon cancer and all that crap think more about um membrane osnephyrpoethy okay membrane osnephyrpoethy and remember on mbm is this is one of those questions where it's like the 270 style questions where don't forget that um membrane osnephyrpoethy is associated with like antibodies against like phospholipase A2 R okay it's one of those weird bizarre things that shows up shows up on mbm exams okay and um so that's that's that i'm just running things and i'm gonna pick you know i'm gonna talk about um i mean don't forget this genetic condition that can increase your risk of like pancreatic cancer they'll classically show the people that's having um like these us like black splotches on their lips um think about like pure zegers syndrome right so they get like hematomas in the GI tract but they can also get like pancreatic cancer with that um skin cancer don't forget like their derma pigment osm right so those people the the adenine repair mechanisms don't work so well so they have an increased risk of uh of skin cancer and then don't forget right that um if you're looking at like the the Hodgkin's lymphomas right any Hodgkin's lymphom

a that contains more like immune cells so like more lymphocytes um tends to do better so like the lymphocyte predominant blah blah blah has like a great prognosis and you want to remember right the most common kind of Hodgkin's lymphoma is like the nodula sclerosin kind right so those are just like epidemiology uh weirdness they can ask on exams and then um if you get radiation to the neck right for Hodgkin's lymphomas that increases your risk of papillary thyroid cancer in the future and then also one other thing I know it's like a bio-stats association with Hodgkin's lymphomas is this whole concept of a bimodal distribution that's one thing that they love to put on the US Emily step one um so bimodal distribution um we're like you have like this uptake in prevalence of Hodgkin's lymphoma like teenagers and then like older people so just keep that at the back of your mind again I apologize in fact I'm sorry this podcast seems kind of disorganized but I don't know I kind of find many of these podcasts to be high-yield I just uh sit down think about all the high-yield things I know from head to toe about like a certain topic and then I just sort of talk you through many of them so just sort of keep that at the back of your mind um another classic thing that presents with that bimodal distribution on nbm is like is like a fastened slaseter leaders um especially with like isonias and what not so just again keep those things at the back of your mind as you study for for tests so um I think um um just think from head to toe so if you look at the brain the glioblastoma multi-formy crosses the corpus callusum GFA is the tumor marker right and it usually has like a lot of visogenica dimo centrona crosses that's the classic we did describe it on nbm is um and then remember people that have a history of vichl right so like um when he poe landau they can have like hemanguoblasto

ma in the brain remember that produces ipo as a pernoplastic phenomenon so if you see like a brain tumor um and a high hematocrit think about hemanguoblastoma remember that vichl also increases your risk of like bilateral um renal cell carcinomas like the clear cell type and remember that those people can also have like cysts in the pancreas um that's uh that's another classic representation you can also have like some problems in the temporal bone but i don't think that's very high yield for the usml is and then um if you're thinking about like the uh chugrin syndrome remember it's association with like a lymphoma of a gland like the parodid gland or like a salivary gland and then don't forget like lymphomas of the GI tract with uh ciliac disease remember for those you check their antibodies against that tissue transglutaminis or the anti-endomisial antibodies and then don't forget that uh each pionori or remember it like steins positive or silver this i'm just gonna just sort of try to run through relatively quickly this podcast has gone on for real long but it's a real high yield podcast um i just want to make sure i thoroughly deal with cancers in this one podcast right so remember um motlin formus with hibiscus and it's like silver stein positive and you can treat it with like triple therapy so like the claritromycin amoxysylin and a ppi so remember like cap so claritromycin that's a macrolate 50s inhibitor a for amoxysylin and then p for a ppi right or if that doesn't work you can try quadruple therapy right so with like a metronidazole um bismuth tetracycline and ppi okay so that's like quadruple therapy for for hibiscus and then um remember that thyroid lymphoma is associated with like Hashimoto's a thyroiditis so that's another thing you want to keep at the back of your mind and then if you describe a patient like that's postmenopausal presenting like bleedin

g um you want to think about the most common cause would be like an atrophic vaginitis is the most common cause of like bleeding i mean like a piece like vaginal bleeding in in a in a postmenopausal female but you want to do an endometrial biopsy or some kind of endometrial sampling right because you want to go ahead and rule out endometrial cancer and remember that tamoxifen right um does increase your risk of endometrial cancer uh because remember that it has estrogen receptor agonist activity in the uterus but it has antagonist activity in the breast and uh in the breast versus reloxifen that's another serum it has estrogen receptor antagonist both in the breast and the uterus but it has estrogen receptor agonist activity in the bone so it can decrease your risk of osteoporosis and then um so head neck neck ears have talked about schwannomas neck have talked about lungs heart right so remember your cardiac ruptum uh ruptum uh myomas with um tuberous sclerosis um also don't forget right so like if they tell you about like a dastolic murmur in a patient that has been losing weight and the murmur seems to disappear when you change position and the patient has been getting febral because this tumor actually makes like interlooking one think about a cardiac mix sum okay it's most common location is the left etra on mbm is and then um i've talked about like teratomas i've talked about stereovarii i've talked about neuroblastomas in the posterior medius thinam um i've talked about thymomas and the association with myestinia gravis um um i've talked about stomach cancers talked about crooked brittrumors right don't forget your lynitis plastica like a lettery water bottle style stomach i've talked about the socusion splash with those um i've talked about pancreatic cancers you meet the diagnosis or the cat scan um don't forget she's two stomach hematobium and bladder cancer

especially a person from Egypt when mbm is don't forget um um this bug it can increase your risk of like a biliary cancer like colandio carcinoma i believe it's like clonorchis and nces that's like a bogar sensation when you keep at the back of your mind don't forget right ebv right increases your risk of like nizofarin jo carcinoma and um also plays a role in brachetslam phoma um let's see um don't forget your cancers basically of the lower productive tract the hbv association especially the hbv's like 16 18 and the ones in the thirties um let's see sobal cancer appendix with carstenoid talked about that already uh cancer under the nails with melanomas um breast load death with melanomas okay i think i have said most of the high-yield things i want to mention so as i always do when i conclude every podcast i do offer one on one two-drain for many exams step one step two ck two cs step three prickly nickel exams and med school shelf exams and med school medicine in training exam medicine board exams um i do offer tutoring for those and then if you're a college student that's taking the MCAT or needs bio-camp physiology histology general chemistry organic chemistry whatever tutoring i do offer tutoring for all those things physics even um and then if you're a med student applying to residency so like an iris application or a college student is applying to med school so an anca and amca's application i do offer like consulting for those so like interview prep help with personal statements putting the application together um i've done those for many people and pretty much everyone i've worked it so far has matched um i mean i was an admissions committee for a top two medical school for a year so i've shifted through thousands of super quality applications and i know what gets you set up properly for these interviews and increases your risks of uh i mean not your risk yo

ur chances of um matching um so yeah dig that for what you will so if you have anyone or you you need any of these services feel free to reach out to me so i wish you all the best um in the future have a wonderful week ahead god bless you and i'll see you next time thank you

Attachment to the dura/meninges; pseudo-rosettes on histology.

Neurofibromatosis Type 2 (NF2).

Smoking, Schistosoma haematobium exposure, and aniline dye exposure (from textiles).

Renal Cell Carcinoma (RCC), due to anatomical drainage patterns.

Calcitonin.

Squamous cell lung carcinoma.

Diarrhea, dermatitis, flushing (the "DDF" triad), due to excess serotonin production and subsequent niacin deficiency.

Small cell lung cancer (SIADH, hypercalcemia); Renal Cell Carcinoma (PT HrP); Thymoma/Small Cell Lung Cancer (Myasthenia Gravis).

Bitemporal hemianopsia (due to optic chiasm compression).

Papillary Thyroid Cancer.

Medullary Thyroid Cancer, Pheochromocytoma, and Hyperparathyroidism (specifically parathyroid hyperplasia).

Hydatidiform mole.

Barrett's esophagus, chronic GERD, and intestinal metaplasia.

Omental caking (or "omental cake").

Small cell lung cancer (SIADH, hypercalcemia); Renal Cell Carcinoma (PT HrP); Thymoma/Small Cell Lung Cancer (Myasthenia Gravis).

Bitemporal hemianopsia (due to optic chiasm compression).

Papillary Thyroid Cancer.

Medullary Thyroid Cancer, Pheochromocytoma, and Hyperparathyroidism (specifically parathyroid hyperplasia).

Hydatidiform mole.

Barrett's esophagus, chronic GERD, and intestinal metaplasia.

Omental caking (or "omental cake").