Important Questions Repeated in MD Exams | Set 3

1. Which of the following proto-oncogenes is least likely to be associated with an increased risk of breast cancer?

2. A 40-year-old male is operated on for a medullary carcinoma of the thyroid. He expresses concern about his 10 years son getting the disease. The best test:

A. Yearly calcitonin in son

B. yearly pentagastrin-stimulated calcitonin in son

C. DNA analysis for RET proto-oncogene in tumor

D. DNA analysis for RET proto-oncogene in peripheral blood

E. Thyroid ultrasound in son

Correct : D. DNA analysis for RET proto-oncogene in peripheral blood

3. Patient with germ cell tumor receiving BEP. Which side-effect would necessitate cessation of the responsible drug:

4. A female presents with shortness of breath. CXR is shown with whiteout of Left lung. Told neurone-specific enolase +ve, next best step in management:

5. Which of the following best describes the incidence of colon cancer with age:

A. Linear increase with age

B. Linear increase with plateau after age 50

C. Parabolic

D. Exponential rise after age 50

E. Bimodal distribution with peaks at age 50 and 70

Correct : D. Exponential rise after age 50

6. All of the following can occur in germ line leading to breast cancer except which one:

7. Which of the following is the least likely to be involved in hereditary colon cancer:

8. A 50 year patient presents with metastatic renal cell carcinoma. The best management would be:

9. The genetic defect in hereditary non-polyposis coli lies in:

10. A female with a history of breast cancer removed. Examination revealed previous modified radical mastectomy scar. Diffuse erythema, with nodules and plaquing over and around scar with some extension onto contralateral breast is evident. The most likely diagnosis is:

11. Which is the strongest predictor of an increased risk of breast cancer in a 40 ys woman:

A. Early menarche

B. Late first pregnancy > 30 years

C. Previous breast carcinoma in contralateral breast

D. Mother with breast cancer at age 70

E. Hormone replacement therapy

Correct : C. Previous breast carcinoma in contralateral breast

12. A young male has non-Hodgkin's lymphoma. The LMO starts prednisone whilst awaiting a haematology admission. He presents unwell with WCC previously 30, now 2, urate 2.3, K 8.0, phosphate 10, Cr .25. The most likely diagnosis?

13. A young female (30 years) had mantle radiotherapy in her teens. The most likely cancer site in her now:

14. The most common mechanism of spread of epithelial ovarian cancer is:

15. A man with metastatic prostate cancer with increasing bone pain. The decision is made to start a GnRH agonist Your advice regarding the likely effect of this:

A. Immediate resolution of symptoms

B. Initial worsening of symptoms over two weeks followed by gradual resolution

C. Delayed resolution of symptoms

D. Slow progressive improvement of symptoms

E. Initial resolution followed by severe worsening of symptoms

Correct : B. Initial worsening of symptoms over two weeks followed by gradual resolution

16. Concerning lung cancer:

A. In Australia, the incidence in women is falling.

B. The use of chemotherapy in combination with radiotherapy in patients with stage III non-small cell lung cancer is associated with improved survival.

C. Chemotherapy for metastatic non-small cell lung cancer improves quality of life but not survival.

D. The optimal treatment for limited stage small cell lung cancer is with chemotherapy alone.

E. Paraneoplastic manifestations occur in the majority of patients.

Correct : B. The use of chemotherapy in combination with radiotherapy in patients with stage III non-small cell lung cancer is associated with improved survival.

17. Regarding familial breast cancer, which of the following statements is true?

A. The majority of cases are also associated with mutations of the p53 gene.

B. mutation of the BRCA1 gene may be associated with an increased risk of both breast and ovarian cancer.

C. chemoprevention with tamoxifen is of proven benefit.

D. most affected families share the same specific mutation of the BRCA1 gene.

E. about 75% of affected family members develop breast cancer before the age of 35 years

Correct : B. mutation of the BRCA1 gene may be associated with an increased risk of both breast and ovarian cancer.

18. BRCA-1:

A. Type of oncogene

B. Associated with male breast cancer

C. Associated with breast and ovarian cancer

D. Associated with sporadic breast cancer

E. Produces a truncated protein

Correct : C. Associated with breast and ovarian cancer

20. Small cell lung cancer is more associated with ( than NSCLC)

21. Regarding cell kinetics of cancer:

A. 1 cm tumor = 109 cells

B. Cells in G0 are highly sensitive to chemotherapy

C. Common cancers have doubling times of 20 days

D. Intrinsic mutation rate in common cancers ~ 1 in 106 cells

E. Growth in primary cancer decreases in the later stages of development

Correct : A. 1 cm tumor = 109 cells

22. 73 years female with metastatic breast cancer, on tamoxifen for 6/12. 2/7 Hx of nausea and thirst. Na+ 155, K+ 5.2, urine osm 137. Has multiple mets including sella turcica. Next most appropriate treatment:

23. Pre-menopausal woman found to have left axillary and supraclavicular nodes. Biopsy showed poorly differentiated cancer, oestrogen receptor poor. She has no other Symptoms, examination is otherwise normal and CXR and mammogram are normal. Next step:

24. A patient with known disseminated lymphoma is anaemic, with Hb = 100, MCV = 74, Fe = 4, Ferritin = 300. This is best explained by:

A. Fe deficiency

B. Impaired release of Fe from macrophages

C. Reduced erythropoietin

D. Reticulocytosis

E. Increased plasma clearance of Fe

Correct : C. Reduced erythropoietin

26. Which of the following is more likely to result from the administration of bleomycin?

27. Patient with metastatic bowel cancer is taking Codeine 30 mg q4h without adequate analgesia. What is the most appropriate therapy?

A. continue Codeine and add Paracetamol 1g qid

B. stop Codeine, start MS Contain l0 mg bd and Paracetamol 1g qid

C. stop Codeine, start MS Contain 20 mg bd and Paracetamol 1g qid

D. stop Codeine, start MS Contain l0 mg bd and Panadeine ii qid

E. nerve block is now indicated

Correct : A. continue Codeine and add Paracetamol 1g qid

28. Concerning the prophylactic use of G-CSF during cancer chemotherapy:

A. it decreases the duration of neutropenia

B. it decreases the severity of the neutropenic nadir

C. it increases platelet numbers

D. it potentiates the effect of chemotherapy

E. it is only useful in established neutropenia

Correct : B. it decreases the severity of the neutropenic nadir

29. Phase 2 trial of new cancer drug. Which is least likely to account for variation in results:

31. In women the biggest risk factor for breast cancer is:

A. Family history

B. Previous contra lateral breast cancer

C. Benign breast disease.

D. Hyperplasia

E. Breast feeding

Correct : B. Previous contra lateral breast cancer

34. Patient gets bleomycin, etoposide, and cisplatin. Which cause for cessation of specific drug?

35. 55 year female - breast cancer 3 yrs ago had mastectomy only Presents with lower back pains. Some neurology - mild --> equivocal plantar. MRI Shows lesions in 3- 4 different vertebra - partially compressing spinal cord.

36. Cisplatin based chemotherapy. Which anti-emetic is most effective >24 post chemotherapy:

37. Least effective for identifying an unknown primary

A. Axillary lymphadenopathy  adenocarcinoma

B. Secondary hepatic metastases  adenocarcinoma

C. Mediastinal undifferentiated carcinoma

D. Bone blast secondary

Correct : C. Mediastinal undifferentiated carcinoma

38. Middle aged smoker. Whole of left lung – white, collapse. Bronchoscopy shows an undifferentiated carcinoma in the left main bronchus. Presents with cough and haemoptysis. Small left clavicular lymph node palpable. Treatment:

39. Smoker with carcinoma of the lung. Well until recently. Bronchoscopy shows extrinsic compression of the bronchus. Low serum sodium. Diagnosis:

A. Small cell carcinoma

B. Adenocarcinoma

C. Squamous cell carcinoma

D. Large cell carcinoma

Correct : A. Small cell carcinoma

40. In a young man testicular malignancy, how does  HCG cause gynaecomastia?

A. By stimulating breast directly

B. By increased testosterone

C. By increased oestrogen

D. Action of testicular tumor

Correct : C. By increased oestrogen

41. Young lady had radiotherapy for Hodgkin‟s disease. 10 years later, most likely sequelae:

42. DNA microsatellite - best description

A. Single locus 2 - 4 base pairs repeats

B. DNA fragments

C. CAG repeat

D. DNA folding

Correct : A. Single locus 2 - 4 base pairs repeats

43. Which drug is least likely to affect cytokine production - especially IL-2 in T cells?

44. Among viruses which are activated due to immunosuppression the least oncogenic virus is

45. Disease least likely to have a family predisposition

46. Which one of the following drugs has the least bone marrow suppression?

48. Changes least likely with familial colonic cancer

A. APC gene mutation

B. DNA repair gene mutation

C. Chromosomal translocation

D. Microsatellite instability

E. Loss of heterozygosity for tumour suppressor genes

Correct : C. Chromosomal translocation

49. Small cell lung carcinoma can cause (?all of the following except)

50. BRCA-1

A. Associated with male breast cancer

B. Associated with sporadic breast cancer

C. Less associated with truncated protein

D. Associated with breast & ovarian carcinoma

E. Is an oncogene

Correct : D. Associated with breast & ovarian carcinoma

51. Predisposing factors to oesophageal adenocarcinoma include the following except

52. Young woman with amenorrhoea & large uterus. CXR shows rounded opacities. What is the best test to monitor this condition?

A. CEA

B. HCG

C. -fetoprotein

D. LDH

Correct : C. -fetoprotein

53. How would you treat metastatic Ca Breast in a postmenopausal woman?

54. What is the best prognostic indicator of post op survival for Ca Breast?

55. Which malignancy is least amenable to treatment?

A. Adeno Ca of axillary lymph nodes

B. Adeno Ca with sclerotic lesion in bone

C. Adeno Ca in liver

D. Squamous cell Ca in cervical lymph nodes

E. Poorly differentiated Ca in chest – midline (?mediastinal lymph nodes) in a young man

Correct : B. Adeno Ca with sclerotic lesion in bone

56. Associations for 1o Ca can be made for all of the following except

A. Adeno Ca mets in the liver in a middle aged man

B. Adeno Ca mets in axillary lymph nodes in a woman

C. Squamous Cell mets in cervical lymph nodes in a smoker

D. Mediastinal Adeno Ca in a young man

E. Skeletal sclerotic lesion in vertebrae in an elderly man

Correct : D. Mediastinal Adeno Ca in a young man

57. Mechanism of drug resistance of chemotherapeutic drugs

A. P glycoprotein

B. P53

C. Bcl 2

D. P450

Correct : A. P glycoprotein

58. A middle-aged man has a melanoma fully excised. What is the most important reason to follow him closely?

59. A 68 year old man is admitted to the ER having had three large maroon colored stools. On arrival, he passes more bloody stools and clots. He is pale, orthostatic and tachycardic. NG aspirates are bilious. After resuscitation is begun, which of the following is the most appropriate initial test?

60. The most common mode of spread of colon cancer is

A. Hematogenous

B. Lymphatic

C. Direct extension

D. Implantation

Correct : B. Lymphatic

61. The following is the most important prognostic determinant of survival after treatment for colorectal cancer?

62. A 68-year-old man presents to his primary care physician for a routine physical examination. The patient‟s medical history is significant for hypertension. The patient is found to have guaiac-positive stools and is subsequently referred for colonoscopy. Colonoscopy reveals a “golf ball”-size, near-obstructing tumor in the descending colon, not admitting the scope. The biopsy is positive for adenocarcinoma of the colon. Which of the following is the next step in the management of this patient?

A. Full metastatic workup first, and if negative, then plan for colon resection

B. A course of radiation therapy prior to any resection

C. Plan for pre-operative chemotherapy

D. Do metastatic work up, but plan for colon resection anyway

E. Schedule a barium enema to evaluate the proximal colon

Correct : D. Do metastatic work up, but plan for colon resection anyway

63. For previous patients, after the appropriate evaluation, the patient undergoes surgery. No intraoperative evidence of metastases is identified. Postoperatively, the pathology report reveals that the tumor is an adenocarcinoma invading into the pericolonic fat, with 2 involved lymph nodes. After the patient recovers from surgery, which of the following is the most appropriate next step in his management?

A. Abdominal CT scan every 6 months

B. No further therapy is indicated, because the involved nodes were removed

C. Chemotherapy with 5-fluorouracil (5-FU) based regimen

D. Measurement of CEA levels yearly

E. Colonoscopy every 6 months

Correct : C. Chemotherapy with 5-fluorouracil (5-FU) based regimen

64. A 65-year-old woman with no significant past medical history presents to the emergency department with a 2-day history of left lower quadrant abdominal pain. The patient denies nausea and vomiting, although she claims decreased oral intake. She also reports a low-grade fever and mild diarrhea. She describes a milder episode several years ago, which resolved on its own. On physical examination, the patient is found to have left lower quadrant tenderness with some mild guarding, but no rebound. She is hemodynamically stable, and her heart rate is 82 per minute. In the initial management of this patient, which of the following is the most sensitive diagnostic test?

A. Complete blood count, SMA-7

B. An obstructive series

C. A barium enema study

D. Abdominal/pelvic CT with oral contrast

E. Abdominal ultrasound

Correct : D. Abdominal/pelvic CT with oral contrast

65. A 60-year-old man presents for an annual physical examination. The examination is normal except for a palpable mass in the rectum on digital rectal examination. The patient denies any change in bowel habits and feels well. Rectal cancer is suspected. What is the next best step in the evaluation of this patient?

A. Computed tomography scan of the abdomen and pelvis

B. Double-contrast barium enema

C. Flexible sigmoidoscopy with biopsy of the lesion

D. Full colonoscopy with biopsy of the lesion

E. Magnetic resonance imaging scan of the abdomen and pelvis

Correct : D. Full colonoscopy with biopsy of the lesion

66. A 78-year-old woman with coronary artery disease and severe chronic obstructive pulmonary disease is admitted to the hospital with painless jaundice. CT scan reveals the presence of multiple lesions in the liver, suggestive of metastases, and a nearly obstructing upper rectal mass. Colonoscopy demonstrates a large, ulcerated tumor in the proximal rectum and a residual lumen of less than 1 cm in diameter. While in the hospital, the patient develops a large bowel obstruction. What is the best treatment modality for this patient?

A. Immediate radiation therapy of the rectal mass

B. Placement of a colonic decompression tube

C. Emergency surgery with resection of the mass

D. Emergency surgery with creation of a diverting colostomy

E. Placement of a rectal self-expanding metal stent

Correct : E. Placement of a rectal self-expanding metal stent

67. A 57-year-old man is found to have a rectal mass 3 cm from the anal verge on digital rectal examination. Subsequent colonoscopy and biopsy confirm rectal adenocarcinoma. EUS examination demonstrates penetration of the tumor into, but not through, the muscularis propria, but shows significant perirectal lymph nodes. CT scan of chest/abdomen/pelvis demonstrates no metastases. The patient is staged as T2N1M0. What procedure should be attempted to remove the primary lesion in this patient?

A. Endoscopic mucosal resection (EMR) to remove the lesion

B. Endoscopic argon plasma coagulation (APC) therapy to cauterize and ablate the lesion

C. Surgical transanal excision of the lesion

D. Neo-adjuvant chemoradiation followed by transanal excision

E. Neo-adjuvant chemoradiation followed by abdominoperineal resection (APR)

Correct : E. Neo-adjuvant chemoradiation followed by abdominoperineal resection (APR)

68. A 70-year-old man is found to have distal rectal cancer during a screening colonoscopy. The patient undergoes preoperative staging and is found to have a 1.5-cm rectal mass that does not invade the muscularis propria of the rectal wall. There is no regional lymphadenopathy and no evidence of distant metastases. The patient is staged at T1N0M0. The patient is advised to undergo APR but refuses because it will lead to anal sphincter loss and permanent colostomy. Which of the following represents a viable alternate therapeutic option for this patient?

A. Chemotherapy alone

B. Radiation therapy alone

C. Chemoradiation therapy

D. Full-thickness surgical removal of tumor (transanal excision)

E. Endoscopic ablation of the tumor with Argon Plasma Coagulator (APC).

Correct : D. Full-thickness surgical removal of tumor (transanal excision)

69. Which of the following may be appropriate initial therapy for a 4 cm cancer of the anal canal?

A. Local excision

B. Abdominoperineal resection

C. Combined chemotherapy and radiotherapy

D. Laser therapy

E. Cryotherapy

Correct : C. Combined chemotherapy and radiotherapy

70. Which of the following processes is most likely to be associated with apoptosis?

A. Nucleosomal DNA laddering

B. Loss of plasma membrane integrity

C. Swelling of the nucleus

D. Endoreduplication

Correct : A. Nucleosomal DNA laddering

71. The purpose of a phase II clinical trial is to:

A. estimate the toxicity of treatment to be tested.

B. estimate the efficacy of treatment to be tested.

C. estimate the preclinical toxicity of an experimental agent.

D. determine a safe starting dose of an experimental agent.

Correct : B. estimate the efficacy of treatment to be tested.

72. Which of the following chemotherapy agents is most effective against soft tissue sarcoma?

A. Thiotepa

B. Cyclophosphamide

C. Dactinomycin

D. Doxorubicin

Correct : D. Doxorubicin

73. What number of axillary lymph nodes removed for sampling during a level I/ II node dissection for breast cancer most likely would require postoperative radiation therapy to the axilla?

A. 02

B. 06

C. 08

D. 10

Correct : A. 02

74. Which of the following types of cancer was associated with a statistically significant improvement in survival for patients who had one to three solitary brain metastases and received whole brain radiation therapy with the addition of stereotactic radiosurgery, according to results of the RTOG 9508 phase III trial?

A. Breast cancer

B. Renal cell cancer

C. Non-small cell lung cancer

D. Melanoma

Correct : C. Non-small cell lung cancer

75. In RTOG 8501, what was the 5-year overall survival rate for patients who had esophageal cancer and received radiation therapy alone?

A. 00%

B. 10%

C. 25%

D. 35%

Correct : A. 00%

76. Which of the following tumor stages is correctly matched to the appropriate prostate cancer involvement or invasion?

A. Stage T2b is associated with tumor involvement of more than one half of one lobe but not both lobes of the prostate.

B. Stage T2c is associated with nonpalpable tumor involvement of both lobes of the prostate via needle biopsy.

C. Stage T3a is associated with tumor invasion of the prostate apex.

D. Stage T4 is associated with tumor invasion of the seminal vesicles.

Correct : A. Stage T2b is associated with tumor involvement of more than one half of one lobe but not both lobes of the prostate.

77. According to GOG 122 (Randall), the survival rate of patients who have surgical stage III-IV endometrial cancer and receive adjuvant abdominopelvic irradiation compared to adjuvant chemotherapy is:

A. worse.

B. similar.

C. improved.

D. not able to be analyzed.

Correct : A. worse.

78. A well-lateralized, stage T3N0 squamous cell carcinoma of the nasopharynx has at least a 15% risk of metastasis to the:

A. ipsilateral parotid lymph nodes.

B. ipsilateral submandibular lymph nodes.

C. posterior triangle lymph nodes bilaterally.

D. occipital lymph nodes bilaterally.

Correct : C. posterior triangle lymph nodes bilaterally.

79. What is the second leading cause of lung cancer?

A. Exposure to arsenic

B. Exposure to asbestos

C. Exposure to benzene

D. Exposure to radon

Correct : D. Exposure to radon

80. Which of the following chromosomal translocations is most commonly associated with Burkitt lymphoma?

A. t(8;14)

B. t(9;22)

C. t(11;14)

D. t(14;18)

Correct : A. t(8;14)

81. What is the most common secondary malignant neoplasm inside the radiation field for patients with retinoblastoma?

A. Squamous cell carcinoma

B. Non-Hodgkin lymphoma

C. Fibrosarcoma

D. Osteosarcoma

Correct : D. Osteosarcoma

82. Three different lung cancer radiation treatments are being assessed for maximum- tolerated dose. This study is an example of what type of clinical trial?

A. Phase I

B. Phase II

C. Phase III

D. Pilot

Correct : A. Phase I

83. Which of the following factors is the most important predictor of disease-free survival and overall survival in patients with breast cancer?

A. Tumor size

B. Mitotic index

C. Axillary lymph node status

D. Histopathologic tumor grade

Correct : C. Axillary lymph node status

84. Which of the following diagnostic tests is most useful for determining the tumor stage of esophageal cancer?

A. Esophagogastroduodenoscopy

B. Endoscopic ultrasound

C. PET scan

D. CT scan

Correct : B. Endoscopic ultrasound

85. Which of the following studies compared surgery alone versus surgery plus external-beam pelvic irradiation in patients with early-stage endometrial cancer and required all patients to undergo surgical staging with pelvic lymphadenectomy?

A. GOG 99 (Keys)

B. GOG 33 (Morrow)

C. PORTEC (Creutzberg)

D. Norwegian (Aalders)

Correct : A. GOG 99 (Keys)

86. Which of the following findings is most likely to be caused by loss of function of right cranial nerve XII?

A. Deviation of the tongue to the left side with protrusion

B. Deviation of the tongue to the right side with protrusion

C. Loss of sweet taste on the right side of the tongue

D. Loss of salty taste on the right side of the tongue

Correct : B. Deviation of the tongue to the right side with protrusion

87. Which of the following statements about video-assisted thoracic surgery for patients with lung cancer is FALSE?

A. The postoperative period is shorter.

B. It decreases the risk of intraoperative bleeding.

C. It is a viable alternative to thoracotomy in patients who are frail.

D. Locoregional recurrence is increased.

Correct : D. Locoregional recurrence is increased.

88. According to GOG 99 (Keys), which of the following sites is most likely to be associated with cancer recurrence in a patient who has early-stage endometrial cancer and undergoes TAH-BSO without adjuvant irradiation?

A. Liver

B. Vaginal vault

C. Pelvic lymph nodes

D. Paraaortic lymph nodes

Correct : B. Vaginal vault

89. Which of the following laboratory tests is most appropriate for determining if a patient with acromegaly has responded favorably to radiation therapy?

A. Serum glucose level

B. Growth hormone (GH)

C. Thyroid stimulating hormone (TSH)

D. Insulin-like growth factor-1 (IGF-1)

Correct : D. Insulin-like growth factor-1 (IGF-1)

90. Which of the following soft tissue sarcomas is most likely to be found in a patient with neurofibromatosis, type 1?

A. Liposarcoma

B. Fibrosarcoma

C. Leiomyosarcoma

D. Malignant peripheral nerve sheath tumor

Correct : D. Malignant peripheral nerve sheath tumor

91. Which of the following survival times is most likely to be associated with a patient who has a class II brain metastasis, based on the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA)?

A. 10.2 months

B. 07.1 months

C. 04.2 months

D. 02.3 months

Correct : C. 04.2 months

92. Radiation-induced cell death in carcinomas typically occurs immediately after attempting to traverse which phase of the cell cycle?

A. G0

B. G1

C. G2

D. M

Correct : D. M

93. Which of the following antigens is a T-cell marker?

A. CD7

B. CD20

C. CD30

D. CD40

Correct : A. CD7

94. Which of the following statements about adenocarcinoma of the lung is true?

A. It is the most common histologic subtype.

B. It is treated differently than squamous cell carcinoma.

C. It is less likely to metastasize to the brain than other histologies.

D. It is rarely associated with TTF-1.

Correct : A. It is the most common histologic subtype.

95. A 9-month-old infant has a mass in the left flank, periorbital ecchymosis, and bone metastasis to the right femur. Biopsy results are consistent with neuroblastoma. What cancer stage would be most appropriate for this patient's condition?

A. Stage 2

B. Stage 3

C. Stage 4

D. Stage 4S

Correct : C. Stage 4

96. Hypoxia adversely affects the treatment and management of cancers because it:

A. increases blood flow to the tumor.

B. impedes adequate blood flow to the tumor.

C. activates molecular pathways contributing to resistance.

D. causes dyspnea and tachypnea in the patient.

Correct : C. activates molecular pathways contributing to resistance.

97. What is the best method for minimizing bias in a national trial comparing two arms therapy regimens?

A. Randomization

B. Patient stratification

C. Univariate analysis of prognostic factors

D. Multivariate analysis of prognostic factors

Correct : A. Randomization

98. Which of the following primary bone tumors is most common?

A. Ewing sarcoma

B. Malignant giant cell tumor

C. Chondrosarcoma