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Important Questions Repeated in MD Exams | Set 4

1. What is the risk of metastasis to the lymph nodes in a patient with stage T2N0 squamous cell carcinoma of the lateral aspect of the oral tongue?

A. There is a greater risk of metastasis to the retropharyngeal nodes than to the mid-jugular nodes.

B. There is a greater risk of metastasis to the superior jugular nodes than to the submandibular nodes.

C. There is a similar risk of metastasis to the retropharyngeal nodes as to the mid- jugular nodes.

D. There is a similar risk of metastasis to the submandibular nodes as to the mid-jugular nodes.

Correct : D. There is a similar risk of metastasis to the submandibular nodes as to the mid-jugular nodes.

2. Which of the following factors is included in the international prognostic index (IPI) for non-Hodgkin lymphoma?

A. Histology

B. Weight loss

C. Lactate dehydrogenase (LDH) level

D. Erythrocyte sedimentation rate (ESR)

Correct : C. Lactate dehydrogenase (LDH) level

3. Which of the following factors most adversely affects patients receiving radiation therapy for squamous cell carcinoma of the head and neck?

A. Concurrent HPV infection

B. Concurrent tobacco use

C. Gender of the patient

D. Grade of the cancer

Correct : B. Concurrent tobacco use

4. Which of the following pathological findings is associated with patients who have meningioma?

A. Verocay bodies

B. Psammoma bodies

C. Small, round blue cells

D. Flexner-Wintersteiner rosettes

Correct : B. Psammoma bodies

5. According to Intergroup Trial 0116, adjuvant chemotherapy and radiation therapy after gastrectomy were more likely than gastrectomy alone to:

A. result in an unacceptable level of toxicity in the majority of patients.

B. result in a statistically significant decrease in the rate of distant metastases.

C. result in a statistically significant improvement in overall patient survival.

D. be most beneficial after D2 lymph node dissections.

Correct : C. result in a statistically significant improvement in overall patient survival.

6. Which of the following statements about post-prostatectomy radiation therapy used in the EORTC 22911 Trial is true?

A. It resulted in more frequent grade 2 or grade 3 late effects.

B. It improved local control, biochemical progression-free survival, and overall patient survival.

C. It was beneficial for patients who had prostate cancer with positive lymph nodes.

D. Hormone therapy was added to the treatment regimen for patients with positive lymph nodes.

Correct : A. It resulted in more frequent grade 2 or grade 3 late effects.

7. Which of the following symptoms is most common in patients who present with endometrial cancer?

A. Pelvic pain

B. Low back pain

C. Vaginal bleeding

D. Hematuria

Correct : C. Vaginal bleeding

8. Which of the following stages of oropharyngeal squamous cell carcinoma is associated with the lowest risk of contralateral cervical lymph node metastases?

A. T2N1 with the primary tumor confined to the tonsillar fossa

B. T1N1 involving the most lateral section of the soft palate

C. T1N1 confined to the glossal-tonsillar sulcus

D. T1N0 involving the lateral aspect of the base of tongue

Correct : A. T2N1 with the primary tumor confined to the tonsillar fossa

9. Which of the following equations is used to determine a positive predictive value?

A. True positive / (True positive + false negative)

B. True positive / (True positive + false positive)

C. True negative / (True negative + false negative)

D. True negative / (True negative + false positive)

Correct : B. True positive / (True positive + false positive)

10. Which of the following treatment outcomes is associated with patients who have DCIS, according to prospective randomized trials?

A. In NSABP B-17, the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery only was 24%.

B. In NSABP B-17, the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery plus breast irradiation was 16%.

C. In NSABP B-24, breast irradiation reduced the risk of breast cancer recurrence in all subgroups except for the patients with positive surgical margins.

D. In EORTC 10853, the subtype of DCIS histology had no effect on patients' risk for breast cancer recurrence.

Correct : B. In NSABP B-17, the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery plus breast irradiation was 16%.

11. Which of the following lymph nodes is NOT commonly associated with prostate cancer metastases?

A. Inguinal

B. External iliac

C. Presacral

D. Obturator

Correct : A. Inguinal

12. Which of the following FIGO stages is associated with a patient who has endometrial cancer with extension through the entire myometrium and involvement of the surface of the uterine serosa?

A. IC

B. IIB

C. IIIA

D. IIIC

Correct : C. IIIA

13. Which of the following histologic subtypes of rhabdomyosarcoma has the worst prognosis?

A. Alveolar

B. Embryonal

C. Spindle cell

D. Botryoid

Correct : A. Alveolar

14. Primary surgery is most appropriate for patients with which of the following types of squamous cell carcinoma?

A. Stage T1N0 of the oropharyngeal portion of the posterior pharyngeal wall

B. Stage T1N0 of the floor of mouth

C. Stage T1N0 of the soft palate

D. Stage T2N0 of the base of tongue

Correct : B. Stage T1N0 of the floor of mouth

15. Which of the following statements about radiation-induced fibrosis is true?

A. It is usually irreversible.

B. It can be easily managed by surgical excision.

C. It can be effectively treated using hyperbaric oxygen.

D. The severity is reduced with concurrent chemotherapy.

Correct : A. It is usually irreversible.

16. Median survival is defined as the:

A. most prevalent time to death in the sample population.

B. point in time a survival probability on a Kaplan-Meier curve is 50%.

C. median of the survival-time intervals.

D. mean of the survival-time intervals.

Correct : B. point in time a survival probability on a Kaplan-Meier curve is 50%.

17. A 43-year-old man presented with vomiting and 4-kg weight loss. His performance status was 1. He was found to have a pre-pyloric gastric carcinoma gastric outlet obstruction. A CT scan showed no metastases. What is the most appropriate next step?

18. What is the stage of a 5-cm gastric tumor that extends into, but not through, the muscularis propria with 16 of 23 positive lymph nodes?

A. I

B. II

C. III

D. IV

Correct : D. IV

19. Which of the following chemotherapy agents recently has been shown to be effective in treating hormone-refractory prostate cancer?

A. Docetaxel

B. Gemcitabine

C. Oxaliplatin

D. Topotecan

Correct : A. Docetaxel

20. Which of the following tumor stages is associated with a patient who has vulvar cancer arising on the labia minora with involvement of the lower urethra?

A. T1

B. T2

C. T3

D. T4

Correct : C. T3

21. Which of the following statements about staging for non-small cell carcinoma of the lung is true?

A. CT scan provides approximately 95% sensitivity and specificity.

B. Screening tests have reduced the mortality rate for high-risk patients.

C. PET scanning has replaced mediastinoscopy for determining cancer staging.

D. Positive PET scan findings require pathological confirmation.

Correct : D. Positive PET scan findings require pathological confirmation.

22. What is a major criterion for the diagnosis of multiple myeloma?

A. Calcium level of >12 mg/dL

B. Hemoglobin level of 8.5 g/dL

C. Plasmacytoma on tissue biopsy

D. Lytic bone lesions on skeletal survey

Correct : C. Plasmacytoma on tissue biopsy

23. Which of the following body sites is most commonly involved in patients with rhabdomyosarcoma?

A. Thorax

B. Extremities

C. Head and neck

D. Genitourinary tract

Correct : C. Head and neck

24. Which of the following statements about the management of brain metastases secondary to breast cancer is true?

A. Prednisone therapy should be initiated with a loading dose of 20 mg, followed by 10 mg four times daily.

B. Symptomatic improvement is expected between 24 to 72 hours after initiation of therapy.

C. Treatment is more effective for focal neurological deficits than for headaches.

D. Dexamethasone must be administered four times daily because of its half-life properties.

Correct : B. Symptomatic improvement is expected between 24 to 72 hours after initiation of therapy.

25. What is the most common histology of tumors involving the terminal ileum?

A. Sarcoma

B. Carcinoid

C. Lymphoma

D. Adenocarcinoma

Correct : B. Carcinoid

26. Which of the following pathological stages of breast cancer is associated with a patient who has a 5.0-cm primary tumor and 12/15 positive, non-fixed lymph nodes?

A. pT3N2

B. pT3N3

C. pT2N1

D. pT2N3

Correct : D. pT2N3

27. What stage of non-small cell lung cancer is most appropriate for a patient who has a 3-cm mass in the right upper lobe, mediastinal adenopathy, and a 2-cm nodule in the right lower lobe of the lung?

A. Stage IIB

B. Stage IIIA

C. Stage IIIB

D. Stage IV

Correct : D. Stage IV

28. What is the most common group classification of rhabdomyosarcoma at initial diagnosis?

A. Group I

B. Group II

C. Group III

D. Group IV

Correct : C. Group III

29. Where is vulvar carcinoma most commonly located?

A. clitori*s

B. Mons pubis

C. Vaginal vestibule

D. Labia

Correct : D. Labia

30. What is the best treatment for malignant mesothelioma?

A. Extrapleural pneumonectomy, followed by chemotherapy and adjuvant radiation therapy to a dose of 50 Gy to 60 Gy

B. Pleurodesis, followed by systemic chemotherapy with subsequent external-beam radiation therapy to a dose of 60 Gy in 20 fractions

C. IMRT to a localized positive margin to a radiation dose of 70 Gy

D. IMRT to the entire lung to a radiation dose of 45 Gy

Correct : A. Extrapleural pneumonectomy, followed by chemotherapy and adjuvant radiation therapy to a dose of 50 Gy to 60 Gy

31. Which of the following factors is most strongly linked to an increased risk for the development of multiple myeloma?

A. Alcohol use

B. Tobacco use

C. Mustard gas exposure

D. Ionizing radiation exposure

Correct : D. Ionizing radiation exposure

32. Which of the following results is associated with concurrent chemoradiation therapy versus radiation therapy alone for patients with locally advanced laryngeal cancer, based on the RTOG 91-11 study?

A. Same rate of distant metastases

B. Improved swallowing function

C. Improved overall survival

D. Improved local control

Correct : D. Improved local control

33. Which of the following side effects is NOT associated with long-term hormonal therapy combined with radiation therapy for prostate cancer?

A. Decreased sexual libido and hot flashes

B. Osteoporosis and muscle weakness

C. Increased late GU toxicity

D. Increased late GI toxicity

Correct : C. Increased late GU toxicity

34. What is the second most common histology associated with vulvar cancers?

A. Adenocarcinoma

B. Adenosquamous carcinoma

C. Squamous cell carcinoma

D. Melanoma

Correct : D. Melanoma

35. What is the most common genetic abnormality associated with low-grade gliomas?

A. 1p

B. 10q

C. 17p

D. 19q

Correct : C. 17p

36. Which of the following processes is associated with the loss of heterozygosity?

A. Activation of oncogenes

B. Inactivation of tumor suppressor genes

C. Hypermethylation of histone proteins

D. Initiation of apoptosis

Correct : B. Inactivation of tumor suppressor genes

37. Which of the following statements about asbestos exposure and mesothelioma is true?

A. The carcinogenic effects appear to result from its physical properties rather than its chemical structure.

B. Mesothelioma cell lines appear to be less sensitive than non-small cell lung cancer cell lines to radiation.

C. Screening of asbestos workers for mesothelioma is an effective way to improve the cure rate of this disease.

D. It is rare for mesothelioma to be misdiagnosed.

Correct : A. The carcinogenic effects appear to result from its physical properties rather than its chemical structure.

38. Which of the following anatomical sites is most commonly associated with extraosseous, soft tissue plasmacytomas?

A. Back

B. Pelvis

C. Lower extremity

D. Head and neck

Correct : D. Head and neck

39. Which of the following cell markers is most commonly associated with classic Hodgkin lymphoma?

A. CD15+, CD30+

B. CD15+, CD30-

C. CD15-, CD30+

D. CD15-, CD30-

Correct : A. CD15+, CD30+

40. Which of the following statements about brain metastases secondary to breast cancer is not true?

A. Breast cancer is the most common cause of brain metastases in women.

B. HER-2/neu gene overexpression is associated with an increased risk of brain metastases.

C. Increased tumor size and number of positive lymph nodes are associated with an increased risk of brain metastases.

D. Brain metastases are most likely to involve a solitary site.

Correct : A. Breast cancer is the most common cause of brain metastases in women.

41. What percent of patients diagnosed with testicular seminoma have elevated α- fetoprotein serum levels?

A. 00%

B. 10%

C. 20%

D. 30%

Correct : B. 10%

42. Which of the following types of gynecologic cancer has a similar pattern of tumor spread as that associated with fallopian tube cancer?

A. Vulvar

B. Ovarian

C. Endometrial

D. Cervical

Correct : B. Ovarian

43. Regarding breast cancer, all of the following are correct EXCEPT:

A. The incidence increases steadily with age.

B. Approximately 75% of all cases are diagnosed in postmenopausal women.

C. The lifetime risk is 1 of 8 for women living into their 80s.

D. The disease is uncommon in women younger than 40 years of age.

E. It is the most common cancer during pregnancy

Correct : E. It is the most common cancer during pregnancy

44. Which of the following statements about malignant mesothelioma is true?

A. The median patient survival time is 24 months.

B. Most patients have bilateral disease at presentation.

C. Diagnosis is most commonly established via cytology of pleural effusions.

D. It commonly spreads along the biopsy tract.

Correct : D. It commonly spreads along the biopsy tract.

45. Clinical radiation sensitivity is consistently associated with the absence of:

A. p53.

B. HER-2/neu.

C. gamma-H2AX.

D. ATM.

Correct : D. ATM.

46. Which of the following statements about osteosarcoma is true?

A. It rarely occurs in African Americans.

B. The amount of tumor necrosis at resection is an important prognostic factor.

C. The addition of ifosfamide and etoposide to standard VACA-based chemotherapy improves survival for patients with nonmetastatic disease.

D. Radiation therapy is the preferred treatment for local control.

Correct : B. The amount of tumor necrosis at resection is an important prognostic factor.

47. Which of the following statements about leptomeningeal metastases secondary to breast cancer is true?

A. A headache is the most common symptom in patients at presentation.

B. A contrast-enhanced CT scan is best for establishing the diagnosis.

C. Radiation therapy should be administered to the entire CNS axis.

D. The median survival rate is 4 months, but longer survival times are associated with breast cancer.

Correct : D. The median survival rate is 4 months, but longer survival times are associated with breast cancer.

48. Which of the following statements about TNM staging for lung cancer is FALSE?

A. Stage N1 involves lymph node stations 10-14.

B. Stage N2 involves the ipsilateral mediastinal lymph nodes.

C. Stage N3 involves the contralateral hilar and mediastinal lymph nodes.

D. Stage M1 involves the contralateral supraclavicular lymph nodes.

Correct : D. Stage M1 involves the contralateral supraclavicular lymph nodes.

49. Which of the following statements about squamous cell carcinoma of the larynx is true?

A. Primary tumors more commonly arise from the supraglottic laryngeal structures than from the glottic region.

B. At the time of diagnosis, 50% of tumors have extended beyond the laryngeal structures.

C. Supraglottic tumors are more likely to present with palpable lymphadenopathy than glottic lesions.

D. Subglottic tumors tend to present with early lesions that are easily managed with primary surgical resection.

Correct : C. Supraglottic tumors are more likely to present with palpable lymphadenopathy than glottic lesions.

50. Which of the following statements about breast cancer in men is true?

A. The tumor is most commonly ER-positive.

B. The disease should be treated with cisplatin-based chemotherapy.

C. The majority of patients who undergo genetic screening will be found to have a BRCA1 germline mutation.

D. Approximately 25% of patients will have noninvasive disease at diagnosis.

Correct : A. The tumor is most commonly ER-positive.

51. Which stage is most appropriate for a patient who has testicular seminoma involving the spermatic cord with multiple 2- to 5-cm paraaortic lymph nodes?

A. Stage IB

B. Stage IIB

C. Stage IIC

D. Stage IIIA

Correct : B. Stage IIB

52. Which of the following statements about malignant mesothelioma is true?

A. Chemoradiation therapy alone offers promising results.

B. Most patients die of metastatic disease and not of local recurrence.

C. Patients who have the epithelial subtype have a worse prognosis.

D. Mediastinal lymph node involvement affects the prognosis.

Correct : D. Mediastinal lymph node involvement affects the prognosis.

53. Hodgkin lymphoma most commonly occurs during which decade of life?

A. Second

B. Third

C. Fourth

D. Fifth

Correct : B. Third

54. BRCA2 is responsible for breast cancer and characterized by:

A. Chromosomal 17 is the location

B. It is less common than BRCA1 in risk of breast cancer

C. Its mutation can be present in sporadic breast cancer

D. It is not responsible for breast cancer in men.

E. It is one of oncogenes

Correct : C. Its mutation can be present in sporadic breast cancer

55. Soft tissue sarcoma most commonly arises from what site?

A. Head and neck

B. Retroperitoneum

C. Lower extremity

D. Upper extremity

Correct : C. Lower extremity

56. Which of the following adjuvant systemic therapies would be most appropriate to recommend for an otherwise healthy patient who has HER-2/neu-positive (FISH) ER/PR-negative breast cancer with positive axillary lymph nodes?

A. Four cycles of dose-dense doxorubicin and cyclophosphamide (AC) in conjunction with four cycles of paclitaxel.

B. Four cycles of AC, four cycles of paclitaxel with concurrent trastuzumab, and continuation of trastuzumab for 1 year.

C. Four cycles of paclitaxel, four cycles of AC with concurrent trastuzumab, and continuation of trastuzumab for 1 year.

D. Six cycles of docetaxel, doxorubicin, and cyclophosphamide.

Correct : B. Four cycles of AC, four cycles of paclitaxel with concurrent trastuzumab, and continuation of trastuzumab for 1 year.

57. Which histology is most likely in men older than 60 years with testicular cancer?

A. Yolk sac tumor

B. Classical seminoma

C. Choriocarcinoma

D. Lymphoma

Correct : D. Lymphoma

58. Which of the following factors is NOT typically associated with improved overall survival for patients who present with unknown primary tumors of the head and neck region?

A. Radiation doses of >50 Gy

B. Complete resection of the involved lymph nodes

C. Subsequent presentation of the primary tumor

D. Stage N1 versus stage N2 lymph node involvement

Correct : C. Subsequent presentation of the primary tumor

59. Which of the following conditions should be treated like small cell lung cancer?

A. Combined small cell lung cancer and non-small cell lung cancer

B. Non-small cell lung cancer with neuroendocrine features

C. Large cell neuroendocrine tumors

D. Atypical carcinoid tumors

Correct : A. Combined small cell lung cancer and non-small cell lung cancer

60. The basal molecular phenotype of breast cancer most commonly is:

A. ER-positive, PR-positive, HER-2/neu-negative.

B. ER-positive, PR-positive, HER-2/neu-positive.

C. ER-negative, PR-negative, HER-2/neu-negative.

D. ER-negative, PR-negative, HER-2/neu-positive.

Correct : C. ER-negative, PR-negative, HER-2/neu-negative.

61. A 22-year-old man with Hodgkin disease has adenopathy of the right cervical and right supraclavicular regions and weight loss of >10% of his baseline body weight. Which of the following cancer stages is most likely to be associated with this patient's condition?

A. Stage IA

B. Stage IB

C. Stage IIA

D. Stage IIB

Correct : B. Stage IB

62. A 72-year-old man was found to have an anterior rectal cancer at 2 cm from the anal verge. A CT scan of chest, abdomen and pelvis showed no evidence of metastatic disease. An MR scan of pelvis showed an anterior tumour abutting the prostate gland, radiologically staged as a T3, N1, M0 cancer. What is the most appropriate next step in management?

A. abdominoperineal resection

B. chemotherapy

C. long-course chemoradiation

D. short-course radiotherapy

E. total mesorectal excision

Correct : C. long-course chemoradiation

63. Which of the following statements about pancreatic cancer is FALSE?

A. Approximately 10% to 20% of pancreatic cancers are associated with hereditary factors.

B. New-onset diabetes mellitus may be the first clinical feature in 10% of patients.

C. Tumors of the pancreatic head arise to the right of the superior mesenteric vein- portal vein confluence and include tumors of uncinate origin.

D. The most common physical finding at initial presentation is Courvoisier's sign.

Correct : D. The most common physical finding at initial presentation is Courvoisier's sign.

64. Which of the following statements about unknown primary head and neck tumors is true?

A. PET imaging is able to detect the primary tumor in 60% of cases.

B. Random biopsies will reveal the primary lesion in 40% of cases.

C. Chest imaging will reveal a primary lung tumor in 20% of cases.

D. Tonsillectomy may reveal the occult primary tumor in 20% of cases.

Correct : D. Tonsillectomy may reveal the occult primary tumor in 20% of cases.

65. Taxane derivatives elicit cytotoxic effects mainly by which of the following mechanisms?

A. Stabilization of microtubules and prevention of their disassembly

B. Intercalation into DNA and inhibition of DNA replication

C. Inhibition of topoisomerases

D. Inhibition of DNA repair

Correct : A. Stabilization of microtubules and prevention of their disassembly

66. Which of the following statements about patients who are diagnosed with breast cancer and have supraclavicular lymph node involvement is true?

A. The diagnosis should be classified as stage M1 breast cancer.

B. Approximately 30% of patients will have clinically detectable internal mammary lymph nodes on CT scan of the chest.

C. Over 20% of patients will have lymphedema and brachial plexopathy.

D. Over 20% of patients will survive 10 years with aggressive trimodality therapy.

Correct : D. Over 20% of patients will survive 10 years with aggressive trimodality therapy.

67. Bladder cancer associated with hydronephrosis and invasion limited to the outer half of the bladder muscle layer corresponds to which T stage?

A. T2

B. T3

C. T4a

D. T4b

Correct : A. T2

68. A 42-year-old man presented with a 1-month history of altered personality and increased seizure frequency. An MR scan of brain demonstrated an enhancing lesion in the right frontal lobe. Histology revealed a grade 3 oligodendroglioma, with loss of heterozygosity of 1p/19q. What is the most appropriate treatment?

A. chemoradiation with temozolomide

B. cranial irradiation

C. craniospinal irradiation

D. procarbazine, vincristine and lomustine (PCV)

E. temozolomide

Correct : B. cranial irradiation

69. Which of the following Hodgkin lymphoma subtypes is most closely associated with the development of non-Hodgkin lymphoma?

A. Nodular sclerosis

B. Lymphocyte depleted

C. Lymphocyte predominant

D. Lymphocyte rich

Correct : C. Lymphocyte predominant

70. Which of the following primary sites is most commonly involved in patients who are diagnosed with Ewing sarcoma?

A. Pelvis

B. Humerus

C. Fibula

D. Tibia

Correct : A. Pelvis

71. During gene therapy, genes are most commonly transferred into cells by:

A. viral vectors.

B. bacterial plasmids.

C. synthetic oligonucleotide primers.

D. small-interfering RNA (siRNA).

Correct : A. viral vectors.

72. Which of the following statements about desmoid tumors is true?

A. They commonly metastasize to the lungs.

B. They commonly metastasize to the bones.

C. Surgical excision is the most common treatment of choice.

D. Definitive radiation therapy can achieve local control in 25% of cases.

Correct : C. Surgical excision is the most common treatment of choice.

73. Multidrug resistance in tumor cells is often attributed to extrusion of drugs mediated by overexpression of which of the following proteins?

A. P-glycoprotein

B. Bcl-2

C. BAX

D. TP53

Correct : A. P-glycoprotein

74. Which of the following lymph node chains is most commonly involved in patients who present with Hodgkin lymphoma?

A. Inguinal

B. Paraaortic

C. Mediastinal

D. Cervical

Correct : D. Cervical

75. Which of the following cell cycle phases is most radiosensitive?

A. M

B. S

C. G1

D. G0

Correct : A. M

76. Based on the results of SWOG 8797 (Peters), which of the following pathologic findings after a radical hysterectomy and pelvic lymph node dissection is an indication for adjuvant chemotherapy with radiation therapy for patients with high-risk cancers of the cervix?

A. Tumor size >5 cm

B. Lymphovascular space invasion

C. Depth of invasion into the deep third of the cervical stroma

D. Microscopic involvement of the parametrium

Correct : D. Microscopic involvement of the parametrium

77. A 29-year-old woman had a 2.5-mm Breslow thickness melanoma removed from her right shin. She was referred for wide local excision of the scar and consideration of sentinel node biopsy. In what proportion of patients with a negative sentinel node biopsy does nodal recurrence subsequently develop in the same lymph node basin?

78. According to the VA Lung Cancer Group's classification, which of the following sites of lymphadenopathy is associated with extensive-stage small cell lung cancer?

A. Ipsilateral hilar lymph nodes

B. Ipsilateral supraclavicular lymph nodes

C. Contralateral supraclavicular lymph nodes

D. Contralateral mediastinal lymph nodes

Correct : C. Contralateral supraclavicular lymph nodes

79. Which of the following factors increases a patient's risk for the development of leukemia?

A. Occupational exposure to benzene

B. Occupational exposure to aluminum

C. Use of mitomycin C

D. Exposure to HPV

Correct : A. Occupational exposure to benzene

80. Which of the following genetic abnormalities is most commonly associated with Ewing sarcoma?

A. t(8;14)

B. t(11;22)

C. 1p/19q gene deletion

D. Loss of heterozygosity (LOH) of the retinoblastoma gene

Correct : B. t(11;22)

81. Which of the following statements about the diagnosis of inflammatory breast cancer is true?

A. There may not be a discrete palpable mass at presentation.

B. At presentation, a patient may report having a longstanding breast mass that developed skin changes over time.

C. A biopsy is not required, since the diagnosis is clinically established.

D. Dermal lymph node involvement must be demonstrated.

Correct : A. There may not be a discrete palpable mass at presentation.

82. Which of the following cell cycle phase transitions is most affected when the TP53 gene is lost or mutated?

A. G → G01

B. G → S1

C. G2 → M

D. S → G2

Correct : B. G → S1

83. Which of the following molecular mechanisms is specifically implicated in the oncogenesis of cervical cancer associated with prior HPV infection?

A. The E7 protein expression inactivates p53.

B. The E7 protein expression inhibits Rb function.

C. The E6 protein expression suppresses G -M cell cycle arrest. 2

D. The E6 protein expression activates c-myc.

Correct : B. The E7 protein expression inhibits Rb function.

84. A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm seminomatous germ cell tumour without non-seminomatous components. There was evidence of vascular invasion within the testis.Investigations: serum lactate dehydrogenase (LDH) 1250 U/L (10–250) serum α-fetoprotein normal serum β-human chorionic gonadotrophin (HCG) 700 U/L (<5) A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3- cm mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver, brain or bone metastases. What is the most appropriate International Germ Cell Cancer Collaborative Group classification?

A. good prognosis because of the absence of liver, bone and brain metastases

B. good prognosis because of the raised HCG and LDH

C. intermediate prognosis because of the presence of lung metastases

D. intermediate prognosis because of the raised serum HCG and LDH

E. poor prognosis because of the raised serum HCG and LDH

Correct : A. good prognosis because of the absence of liver, bone and brain metastases

85. What is the most common site of metastatic disease in patients with Ewing sarcoma?

A. Lung

B. Bone

C. Bone marrow

D. Lymph nodes

Correct : A. Lung

86. A 50-year-old woman with early breast cancer presented with fatigue to the accident and emergency department on day 7 of her first adjuvant chemotherapy cycle. On examination, her temperature was 38.5°C, her pulse was 110 beats per minute and her blood pressure was 110/70 mmHg. A full blood count was requested. What is the most appropriate next step?

A. await full blood count result

B. intravenous broad-spectrum antibiotics

C. intravenous broad-spectrum antibiotics and granulocyte colony-stimulating factor (G-CSF)

D. oral broad-spectrum antibiotics

E. oral broad-spectrum antibiotics and G-CSF

Correct : B. intravenous broad-spectrum antibiotics

87. Which of the following statements about metastasis of breast cancer to the bone is true?

A. Metastasis to the epidural spine is most commonly associated with worsening back pain in the supine position or with the Valsalva maneuver.

B. Compression of the epidural spinal cord associated with breast cancer most commonly has a single site of vertebral metastasis.

C. Radicular pain in the thoracic spine is typically unilateral.

D. Pain from T12, L1 vertebral lesions is not associated with a referred pain pattern to the bilateral iliac crests or to the bilateral sacroiliac joints.

Correct : A. Metastasis to the epidural spine is most commonly associated with worsening back pain in the supine position or with the Valsalva maneuver.

88. A 62-year-old man with limited-stage small cell lung cancer and proximal muscular weakness is most likely to have which of the following conditions?

A. SIADH

B. Myasthenia gravis

C. Cerebellar degeneration

D. Eaton-Lambert syndrome

Correct : D. Eaton-Lambert syndrome

89. A 3-year-old girl has Wilms tumor with a favorable histology and a positive surgical margin. CT scan of the chest does not reveal any pulmonary nodules. What cancer stage is most appropriate for the patient's condition?

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

Correct : C. Stage III

90. Which of the following types of cancer is most frequently associated with isolated hepatic metastases at presentation?

A. Colorectal

B. Esophageal

C. Gastric

D. Lung

Correct : A. Colorectal

91. Which of the following statements about the treatment of bone metastases secondary to breast cancer is true?

A. Radiation therapy will achieve partial or complete pain relief within 4 weeks.

B. Single-fraction irradiation provides equivalent results to protracted radiation treatment schedules for pain control durability and reduced risk of subsequent fracture.

C. Metastatic sites with extraosseous bone involvement should be treated with 153Sm only, because localized external-beam irradiation is not beneficial.

D. An 8-Gy dose of hemibody irradiation should be administered in a single fraction to the upper, middle, or lower hemibody regions for treatment of painful bony metastases.

Correct : A. Radiation therapy will achieve partial or complete pain relief within 4 weeks.

92. A 35-year-old man sought advice about the increased risk of cardiac complications following chemotherapy. Eight years previously, he had been successfully treated for Hodgkin‟s disease with six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine, and mediastinal radiotherapy. For how many years from the end of treatment will this increased risk persist?

93. A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness. He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3, M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis revealed that EGFR and K-ras genes were both wild type. What is the most appropriate first-line therapy?

94. Which of the following diagnostic tests is NOT included in the staging of small cell lung cancer?

A. CT scan of the chest and upper abdomen

B. Brain imaging

C. Bone scan

D. PET scan

Correct : D. PET scan

95. Which of the following types of cancer is most commonly associated with myasthenia gravis?

A. Small cell lung cancer

B. Non-small cell lung cancer

C. Mesothelioma

D. Thymoma

Correct : D. Thymoma

96. A 55-year-old man underwent resection of a T2 clear cell renal carcinoma. What is the most likely pathogenesis?

A. activating mutations of the VHL gene

B. MET oncogene activity

C. mutation of p53

D. up-regulated expression of HIF-controlled genes

E. von Hippel–Lindau syndrome

Correct : D. up-regulated expression of HIF-controlled genes

97. During evaluation of tumor biopsy specimens, which of the following markers can be used as a histochemical indicator of cell proliferation?

A. Ki-67

B. TP53

C. c-myc

D. Nuclear/cytoplasmic ratio

Correct : A. Ki-67

98. Which of the following statements about the effectiveness of cancer is true? for treating thyroid

A. Medullary carcinoma is treated more effectively than Hürthle cell carcinoma.

B. The follicular variant of papillary carcinoma is treated more effectively than Hürthle cell carcinoma.

C. Tall cell carcinoma is treated more effectively than the follicular variant of papillary carcinoma.

D. Insular carcinoma is treated more effectively than the follicular variant of papillary carcinoma.

Correct : B. The follicular variant of papillary carcinoma is treated more effectively than Hürthle cell carcinoma.

99. Which of the following processes is NOT commonly involved in the development of bone metastases?

A. Avascular necrosis

B. Activation of osteoclasts

C. Cell adhesion molecules

D. Chemotaxis of metastatic cancer cells

Correct : A. Avascular necrosis

100. SBLA syndrome is another name of