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OS 217 Oncology > Cheers 2017 > Flashcards

Cheers 2017 Flashcards

1
Q

Which of the following situations is an example of self-sufficiency of growth signals in the development of cancer?

a. re-expression of the enzyme telomerase
b. elaboration of vascular endothelial growth factors
c. mutations in the epidermal growth factor receptor gene
d. over-expression of the BCL family of proteins

A

Ans C.

EGFR Inhibitors play a role in sustaining proliferative signalling (Hanahan and Weinberg, 2011)

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2
Q

Which of the following is associated ONLY with tumor suppressor genes?

a. Loss of heterozygosity
b. Microsatellite instability
c. Chromosomal translocations
d. Viral infections

A

Ans A.
Knudson’s 2-hit hypothesis applies to tumor suppressor genes. Heterozygosity here refers to having one normal and one abnormal gene which may result in malignancy

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3
Q

With regards to familial cancer syndromes, which of the following statements is CORRECT?

a. The average age of affected individuals is usually in the age group >50 years.
b. The tumor occurs in multiple generations of the affected family.
c. Loss of heterozygosity is associated with a gain of oncogene function.
d. Conditions that are inherited as autosomal dominant involve DNA repair genes.

A

Ans B.

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4
Q

Which of the following areas will have the HIGHEST risk for developing a somatic mutation that could give rise to malignancy?

a. bones of the ribs
b. striated muscle of the heart
c. mucosa of the oral cavity
d. sebaceous glands of the armpit

A

Ans C.

Tissues with high rates of cell division are at the greatest risk for developing malignancies

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5
Q

In a patient diagnosed to have breast cancer, which of the following would suggest the presence of an aggressive tumor?

a. The patient claims to have lost >20% of his body weight in more than 2 years.
b. The breast mass was noted to increase in size from 2 to 4 cm in 3 months.
c. Physical examination reveals a 2 cm hard, movable, non-tender axillary node.
d. Mammosonography reveals a 3 cm solid mass in the outer quadrant of the left breast.

A

Ans B.

The shorter the doubling time, the more aggressive the tumor. (doubling time of 3 mos)

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6
Q

Which of the following statements is TRUE with regards to the lag phase of the Gompertzian growth curve?

a. May be used as a clinical indicator of tumor aggressiveness.
b. During this phase, cells are highly sensitive to anticancer chemotherapy
c. Majority of tumor cells are in the G0 phase of the cell cycle growth.
d. Tumor growth is slow due to absence of an organized blood supply.

A

Ans D.
Angiogenesis occurs during the transition between lag and log phase and results in the rapid growth observed during log phase.

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7
Q

Which of the following events may contribute to the increase in the metastatic potential of a tumor?

a. well-differentiated histology
b. low S-phase fraction of dividing cells
c. formation of a rich tumor vascular supply
d. doubling time estimated in months

A

Ans C.

Angiogenesis

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8
Q

A biopsy was taken from a gastric mass by endoscopy. Which of the following would be consistent with the findings of a malignancy?

a. Cells have abundant cytoplasm.
b. Each cell has no more than 1 nucleolus in its nucleus.
c. The cells appear hyperchromatic on microscopic examination.
d. No encroachment of adjacent basement membranes is noted.

A

Ans C.

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9
Q

Which of the following is consistent with the initiation phase of carcinogenesis?

a. Effects are genotoxic
b. Damage is reversible
c. Process takes a long period of time
d. The end result is a malignant tumor

A

Ans A.

The initiation phase of carcinogenesis is rapid, genotoxic, and irreversible

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10
Q

Which of the following malignancies have a viral etiology?

a. Pancreatic cancer
b. Lung cancer
c. Breast cancer
d. Nasopharyngeal carcinoma

A

Ans D.

Nasopharyngeal carcinoma is caused by EBV

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11
Q

Which of the following tumors may be linked to a lifestyle-related carcinogen?

a. Non-Hodgkin’s lymphoma
b. Osteosarcoma
c. Angiosarcoma of the liver
d. Colorectal cancer

A

Ans D.

Incidence of Colorectal CA may be linked to a high BMI and a sedentary lifestyle.

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12
Q

Which of the following would be the LEAST important factor in evaluating the effects of a carcinogen?

a. Potency
b. Age during exposure
c. Dose
d. Duration of exposure

A

Ans A.
Dose and duration of exposure are properties of promoters of carcinogenesis. Age during exposure is always a consideration.

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13
Q

After exposure to a very high dose of radiation, which of the following would have the HIGHEST risk of developing into a malignancy?

a. Skin
b. Thyroid
c. Liver
d. Stomach

A

Ans B.
resistant tissues: bone, skin, and GIT
most susceptible: leukemias > thyroid CA > lung and breast CA

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14
Q

What is the significance of Nowell’s hypothesis?

a. Estimates the risk of developing a germline mutation based on epigenetic silencing of genes.
b. Predicts that the development of cancer requires the accumulation of activating mutations over time.
c. States that the deactivation of tumor suppressor gene function will require damage to both sets of genes.
d. Concludes that the graph of a tumor’s growth potential is not linear, with areas of slow growth in both the start and end of proliferation.

A

Ans B.
Nowell’s hypothesis states that cancer is the consequence of acquired genetic variation in the cells populating a neoplasm.

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15
Q

Which of the following features is associated with somatic mutations?

a. Multigenerational involvement
b. Results in tumor clustering in a patient or his family
c. Affected individuals are usually above the age of 50 years
d. May contribute to development of familial cancer syndromes

A

Ans C.

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16
Q

Which area of the cell cycle is most often affected in the development of cancer?

a. G0 phase
b. S phase, after duplication of DNA
c. Mitosis, during development of microtubules
d. G1 phase, just before entry into S phase

A

Ans D.

G1/S checkpoint is the area most often disrupted in cancer

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17
Q

By which of the following mechanisms can a cell overcome the problem of replicative senescence?

a. Maintenance of telomere length
b. Elaboration of VEGF family of proteins
c. Oncogene amplification
d. Recruitment of surrounding stromal cells

A

Ans A.

“Cheating your telomeres is a way to overcome replicative senescence” - Lec 01: Basic Neoplasia

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18
Q

In which situation would you expect a cell to undergo apoptosis?

a. Activation of p53
b. Overexpression of Bcl-2
c. Upregulation of BAX
d. Inhibition of mitochondrial cytochrome C

A

Ans C.

BAX is pro-apoptotic

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19
Q

Which of the following is believed to be the strongest stimulus for the development of tumor angiogenesis?

a. Hypoxia in the tumor bed
b. Logarithmic cellular growth
c. Elaboration of growth factors by the tumor
d. Mutations in the Rb gene

A

Ans A.

In order for tumors to grow larger than 1-2 mm^3, they must develop a new blood supply. (rate-limiting step)

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20
Q

Which of the following is believed to be a mechanism utilized in the epigenetic silencing of genes that may give rise to cancer?

a. Phosphorylation
b. Translocation
c. Methylation
d. All of the above

A

Ans B.

one of the possible mechanisms of activation of oncogenes

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21
Q

Which statement best reflects the cancer situation in the Philippines?

a. Cancer is the leading cause of illness in the country.
b. Lung cancer is the leading cause of cancer-related deaths in the country.
c. Liver cancer is the leading cause of cancer in Filipino males.
d. Lung cancer is the leading cause of cancer in Filipino females.

A

Ans B.
estimated leading causes of cancer deaths:
lungs> liver > breast> cervix> colon

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22
Q

When the objective of prevention is to detect the disease at the earliest possible stage, while the patient is still asymptomatic, this is consistent with which of the following?

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Palliative care

A

Ans A.

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23
Q

Which of the following malignancies is associated with a lifestyle-associated risk factor?

a. Hodgkin’s lymphoma
b. Prostate cancer
c. Colon cancer
d. Carcinoid tumors

A

C.

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24
Q

Which of the following cancers has a known, preventable risk factor?

a. Lung cancer
b. Ovarian cancer
c. Breast cancer
d. Prostate cancer

A

Ans

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25
Q

Practical, cost-effective cancer screening is available for which of the following malignancies?

a. Liver cancer
b. Lung cancer
c. Cervical cancer
d. Stomach cancer

A

Ans C. Pap smear to di ba?

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26
Q

Which of the following is a necessary characteristic of a screening test?

a. The malignancy is ranked 18th among leading causes of cancer in the country.
b. The test involved requires the use of sophisticated, computerized equipment.
c. The screening test is available only in large, tertiary medical hospitals.
d. The screening procedure is simple and does not cause discomfort to patients.

A

D. Pag screening test, gusto mo siyang magawa sa lahat ng tao agad-agad para mas maraming macover.

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27
Q

When the objective of prevention is to reduce tumor progression, prevent complications and reduce the chance of relapse, it is consistent with which of the following?

a. Identifiable risk factors
b. Incidence rate
c. Mortality rate
d. Age and sex-related characteristics.

A

Ans C.

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28
Q

Which of the following determines whether primary prevention can be achieved in a particular malignancy?

a. Identifiable risk factors
b. Incidence rate
c. Mortality rate
d. Age and sex-related characteristics

A

Ans A. When risk factors are identified, they can be addressed. Primary prevention aims to reduce risk factors.

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29
Q

In which condition should one suspect that an early warning sign of cancer is present?

a. 60-year-old female who consults for postmenopausal vaginal bleeding
b. 55-year-old male with complaints of urinary frequency and polyuria
c. 23-year-old female who reports a one-month loss of menstruation
d. 47-year-old female with crampy abdominal pain and diarrhea

A

Ans A.

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30
Q

In the area of primary prevention, which role of a physician would best contribute to its success?

a. Clinician / Clinical Oncologist
b. Psychosocial Scientist
c. Public Health Manager
d. Academician / Molecular Geneticist

A

Ans C. Kasi mostly risk factors ang target ng Public health managers di ba?

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31
Q

What is the goal of palliation in the tertiary care of cancer patients?

a. Survival time same as that of a non-cancer patient
b. Survival time is same as patient with same age and stage of disease
c. Survival time is the same as that of untreated patient
d. Survival is not the goal but the quality of life

A

Ans D. obvious na to grabe naman

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32
Q

The presence of which of the following should always make you consider the possibility of cancer in a patient:

a. Unexplained anemia
b. Chronic back pain
c. Pre-menopausal vaginal bleeding
d. Abdominal pain

A

Ans A. U sa CAUTIONUS ay unexplained anemia

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33
Q

Vaccination is an accepted preventive strategy in which of the following tumors?

a. Breast cancer
b. Lung cancer
c. Liver cancer
d. Prostate cancer

A

Ans C. vaccination against HBV helps prevent hepatocellular CA

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34
Q

What would be the BEST reason for advocating monthly self-breast examination inf women for the detection of breast cancer?

a. Evidence shows that mammography can detect early lesions but has no effect on survival.
b. Many Filipino women avoid annual mammographies because of the discomfort associated with the procedure
c. Self-breast examination is relatively easy to do, easy to teach and is a relatively inexpensive procedure when coupled with annual exam by physicians.
d. Few Filipino women will actually consent to have their breasts examined even by trained health professionals.

A

Ans C. Yun lang yung related sa breast self examination

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35
Q

The Department of Health recognizes the need to promote cancer awareness and mutual support to the grassroots level. Which of their strategies can BEST achieve this?

a. Preventive care seminars for physicians in government hospitals.
b. Continuing medical education on cancer causation and prevention
c. Increase budget and hiring of personnel dedicated to cancer control programs
d. Establishment of community-based cancer care and control networks in rural areas

A

Ans D. Community-based dabes!

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36
Q

When is the BEST time to start palliative and supportive care in any cancer patient?

a. At the time of diagnosis
b. When metastatic disease is discovered
c. When relapse occurs after primary therapy
d. Upon reaching the terminal phase of the disease

A

Ans D. Malamang pag terminal na, palliative na lang.

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37
Q

Which of the following should be done in establishing communication between the physician and the cancer patient?

a. Consult with relatives on what and what not to tell the patient
b. Avoid disclosing diagnosis, even when asked, to prevent depression
c. Circumvent any discussion that doesn’t involve medical problems.
d. End every visit with the patient with an invitation to ask questions.

A

Ans D. Mas ok ang open questions kasi maeelicit mo talaga yung feelings ng patient.

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38
Q

In a patient with intermittent pain, occurring one or 2x a day, with a visual analogue scale of 3-4, which agent would be your first choice?

a. Morphine sulfate 10 mg q4
b. Tramadol HCl 50 mg q6
c. Ibuprofen 500 mg every 6 hours
d. Any of the above

A

Ans C. 3-4 is mild to moderate pain and should be treated first with an NSAID (or paracetamol). You could step up to opioids if NSAIDs fail

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39
Q

Which of the following should NOT be observed when communicating the diagnosis of cancer to a patient for the first time?

a. Make sure that you are familiar with all the facts of the case.
b. Endeavor to explain the reasons behind the patient’s symptoms
c. Avoid making promises of non-disclosure to the patient’s family
d. Insist that the patient keep questions to as few as possible.

A

Ans D. Obvious na to

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40
Q

Which of the following statements would be consistent with the evolving concept of palliative care?

a. Palliative care begins the moment active anti-cancer therapy has failed
b. Important problems must be recognized early and evaluated comprehensively
c. The cancer patient is the sole recipient of the benefits from palliative care
d. There is no need of informing the patient of prognosis in order to avoid emotional trauma

A

Ans B.

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41
Q

A 65-year-old patient with colon cancer and multiple metastases to the liver, bone, and lungs is referred to you for management. He is malnourished and totally bed-ridden. The family asks you what your plan of management would be. You tell them that you have decided to defer systemic chemotherapy and concentrate on symptomatic care alone as you feel he may not be able to withstand the side effects. However, the patient insists on receiving systemic therapy despite your warnings on the contrary. Despite your misgivings, you agree to the procedure. Which bio-ethical principle are you following in this case?

a. Beneficence
b. Non-maleficence
c. Respect for Autonomy
d. Justice

A

Ans C. Sunod ka lang sa gusto ng patient kaya Respect for Autonomy.

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42
Q

Which of the following represents the most important goal of palliative therapy in the terminally-ill cancer patient?

a. Prolongation of survival
b. Decrease in the size of the tumor
c. Decrease in the number of metastatic sites
d. Improvement in quality of life

A

Ans D. Duh

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43
Q

What would be a good sign that a patient with cancer is ready to accept the news regarding his diagnosis?

a. The patient directly asks questions regarding the illness and its prognosis
b. The patient requests the family members to make all decisions for him
c. The patient has difficulty in making direct eye contact with you.
d. The patient refers you to the immediate family when talk of the illness is needed.

A

Ans A

44
Q

Which of the following interventions is NOT a potential part of palliative care in the terminal patient?

a. Opioids for the control of severe pain
b. Nasogastric tube feeding
c. Mechanical assisted ventilation
d. Emotional and spiritual comfort

A

Ans C. Hindi tumataas ang quality of life pag naka-ventilator ka

45
Q

Which of the following is an example of a weak opioid that may be useful when pain control cannot be achieved with NSAIDs alone?

a. Morphine
b. Tramadol
c. Nalbuphine
d. Fentanyl

A

Ans B.

46
Q

Which of the following is NOT a cardinal principle in communicating the bad news of a cancer diagnosis?

a. Explain the reasons behind the symptoms that they are suffering from.
b. Visit the patient when he is alone for better communication
c. Agree to make promises to the relatives, particularly on issues of non-disclosure
d. Use positive rather than negative overtones when talking to patients.

A

Ans C. Obvious naman masyado

47
Q

Which of the following should NOT be followed when listening to narratives from cancer patients?

a. Interrupt long periods of silence
b. Pay close attention
c. Listen with your eyes
d. Listen with a third ear

A

Ans A. Mas ok yung long silence para maka-isip.

48
Q

In which situation is a patient deemed ready to receive the bad news about a cancer diagnosis?

a. They will ask you to talk to their relatives instead of directly with them
b. The relatives are allowed to make all the decisions regarding the patient’s care
c. During visits, the patient remains aloof, quiet and responds with single words
d. When relaying information, the patient actively asks questions on his condition

A

Ans D.

49
Q

What has psycho-social research revealed regarding the perceptions of Filipinos with regards to terminal cancer?

a. Their awareness on advanced directives is very high
b. The relatives play a vital role in facilitating care of the terminal patient
c. Cancer patients report that the disease causes no problems with their sexual activity
d. Filipino cancer patient overall report that they have a poor quality of life.

A

Ans B. Family oriented talaga ang mga Pilipino

50
Q

Which of the following is a component of a free and informed consent?

a. It must always be in writing
b. It requires the presence of witnesses
c. Decisions are made under stress of abandonment
d. Consent is given voluntarily after a full disclosure

A

Ans D. Kailangan ng full disclosure para maging informed yung consent

51
Q
  1. Which of the following is consistent with the fractional cell kill hypothesis?

a. Chemotherapy becomes effective only in cells that are actively dividing.
b. Resistance due to cell kinetics may be overcome by prolonged infusion of the drug.
c. Effective systemic therapy of cancer entails multiple therapies that are given on time.
d. Combination of different agents would be most effective if they work on different areas of the cell cycle.

A

C. Effective systemic therapy of cancer entails multiple therapies that are given on time.

Fractional cell kill hypothesis states that every cycle of chemotherapy will kill a definite number of cancer cells. It is expected that one cycle of chemo will kill 99.9% of tumor cells.

52
Q

Which of the following is a distinct advantage of cycle non-specific agents?

a. effective in the G0 phase of the cell cycle
b. effective against most actively dividing cells
c. oral preparations are available
d. therapeutic index is narrow

A

A effective in the G0 phase of the cell cycle
Cycle non-specific drugs are both effective against dividing and non-dividing cancer cells, including the non-dividing G0 phase. Cycle specific drugs are only effective against actively dividing cells.

53
Q

A patient with colon cancer and liver metastasis is scheduled to receive systemic chemotherapy with 5-fluorouracil, an S-phase specific drug. Which of the following strategies will improve the response of the tumor to this agent?

a. Increase the total dose of the drug.
b. Administer as a continuous infusion over 24 hours.
c. Give the drug as a daily bolus injection.
d. Decrease the intervals between drug administration

A

B. Administer as a continuous infusion over 24 hours.

Para maimprove ang response, kailangan mas matagal ang exposure.
This is to allow the rest of the cells in different phases to enter the sensitive phase. That is why 5FU is hardly given as a single bolus if it is the main component of our chemotherapy.

Example: for colon cancer, 5FU is given for 5 days (bolus), continuous IV infusion over 14 hours, 21 days
every 4 weeks (IV infusion).

54
Q

Vinorelbine is a mitotic spindle poison that exerts its effect in the M phase of the cell cycle. This is an example of which of the following?

a. cycle non-specific drug
b. cycle specific, phase non-specific drug
c. cycle specific, phase specific drug
d. drug active against resting, non-dividing cells

A

C. cycle specific, phase specific drug

Parang obvious naman since sinabi na sa M-phase yung effect

55
Q

Which of the following would be an effective way of potentially overcoming resistance due to cancer cell kinetics?

a. Utilize drugs capable of penetrating potential sanctuary areas where tumor cells may escape their effects.
b. Use chemotherapy combinations in very high doses followed by blood cell re-growth stimulators.
c. Combine multiple treatment modalities such as surgery followed by systemic therapy to target cells with different growth rates.
d. Resistance from cancer cell kinetics usually occurs naturally in a tumor mass and is practically difficult to overcome.

A

C Combine multiple treatment modalities such as surgery followed by systemic therapy to target cells with different growth rates.

Overcoming resistance from cell kinetics: debulking, use combination drugs (CHOP), scheduling to prevent phase escape.

56
Q

Which of the following situations is NOT a true example of drug resistance of cancer cells?

a. The patient is a rapid metabolizer of the anti-cancer agents
b. Tumor cells have acquired the multi-drug resistance gene
c. The Goldie-Coldman hypothesis on occurrence of resistance in a proliferating tumor mass.
d. The patient presents with a very large, necrotic, foul smelling primary tumor.

A

A The patient is a rapid metabolizer of the anti-cancer agents

Rapid metabolizers of the drugs usually have low tissue levels of the drug in the patient, which would make you think that there is resistance when there is none.

57
Q

A 52 year old male is diagnosed to have adenocarcinoma of the R lung. After being referred to you, a staging workup reveals the following: primary lesion on chest and abdomen CT shows a 6 x 5 cm mass at the R mid-lung and about 150 cc effusion on the right; 3 lesions in the liver noted on ultrasound, measuring 1 x 1 cm, 2 x 1 cm, and 3 x 2 cm each at the right lobe; multiple bone metastases involving the thoracic and lumbar spine, 3 ribs on the left, the left hemi-pelvis, and the left mid-shaft of the femur. Physical exam also showed a palpable right supraclavicular node measuring 2 x 2 cm.

Which of the following would you designate as a non-measurable lesion?

a. right pleural effusion
b. right supraclavicular node
c. mass at the right mid-lung
d. liver nodules

A

A. Right pleural effusion

o Truly non-measurable lesions are:
Bone lesions, leptomeningeal disease, ascites,pleural/pericardial effusion, Inflammatory breast disease, lymphangitic cutis, cystic lesions, and abdominal masses that are not confirmed and followed by imaging techniques

58
Q

A 52 year old male is diagnosed to have adenocarcinoma of the R lung. After being referred to you, a staging workup reveals the following: primary lesion on chest and abdomen CT shows a 6 x 5 cm mass at the R mid-lung and about 150 cc effusion on the right; 3 lesions in the liver noted on ultrasound, measuring 1 x 1 cm, 2 x 1 cm, and 3 x 2 cm each at the right lobe; multiple bone metastases involving the thoracic and lumbar spine, 3 ribs on the left, the left hemi-pelvis, and the left mid-shaft of the femur. Physical exam also showed a palpable right supraclavicular node measuring 2 x 2 cm.

What is the sum of the longest diameter of all the target lesions?

a. 11 cm
b. 12 cm
c. 13 cm
d. 14 cm

A

D. 14 cm

SLD = 6+1+2+3+2 = 14cm

59
Q

The patient completed 6 cycles of chemotherapy and re-evaluation revealed the following: right mid lung lesion 3 x 2 cm; no change in the size of the liver nodules with 2 new lesions noted on the left lobe of the liver, 1 cm in size for each; disappearance of the pleural effusion on the right; no change in bone metastasis; disappearance of the right supraclavicular node. How would you grade the overall response to treatment?

a. complete response
b. partial response
c. stable disease
d. progressive disease

A

D. Progressive Disease
Appearance of new target lesions, so Progressive Disease in terms of target lesions = Overall response is still that of Progressive disease.
Please refer to chemotherapy trans

60
Q

Ablative hormonal therapy can be seen in which of the following circumstances?

a. treatment of increased intracranial pressure in brain metastasis
b. temporizing management of superior vena cava syndrome in lung cancer
c. alleviation of spinal cord compression due to bone metastasis
d. systemic therapy of metastatic adenocarcinoma of the prostate

A

D. systemic therapy of metastatic adenocarcinoma of the prostate

Ablative hormonal therapy is used mainly for prostate CAs

Basic principle of Ablative hormonal therapy: the Hypothalamus-Pituitary-Organ axis
should be interrupted

61
Q

Which of the following is an example of active, specific immunotherapy in cancer?

a. interferons and interleukins
b. monoclonal antibodies
c. cancer vaccines
d. dendritic cell therapy

A

C. Cancer Vaccines
Specific Active Immunotherapy: The generation of cell-mediated and antibody immune responses focused on specific antigens expressed by the cancer cells. Usually with a vaccine.

62
Q

In which of the following situations would you decide not to give cytotoxic chemotherapy in a patient?

a. hemoglobin level is 11 g/L
b. performance status score is 4
c. last chemotherapy cycle was given 3 weeks ago
d. underwent major abdominal surgery 2 months ago

A

B. performance status score is 4

By elimination.
+ from American Society of Clinical Onco
“Do not use cancer-directed therapy for patients with solid tumors who have the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and with no strong evidence supporting the clinical value of further anticancer treatment.”

63
Q

A 30-year-old premenopausal female consults for a 3 cm hard mass in her left breast. Core needle biopsy reveals invasive ductal carcinoma, grade 3. Physical exam reveals a 2 cm palpable node in her left axillary area. Metastatic work-up is negative. Immunochemical stains of the mass reveals that it is ER +3, PR +2, and Her 2 +3. She is aware of her condition, agrees to treatment, but declares her desire to have children once the treatment has been completed.

Which cytotoxic therapy strategy would be appropriate in her management?

a. Primary chemotherapy
b. Concomitant chemo-radiotherapy
c. Adjuvant chemotherapy
d. Palliative chemotherapy

A

B. Adjuvant chemotherapy.

64
Q

A 30-year-old premenopausal female consults for a 3 cm hard mass in her left breast. Core needle biopsy reveals invasive ductal carcinoma, grade 3. Physical exam reveals a 2 cm palpable node in her left axillary area. Metastatic work-up is negative. Immunochemical stains of the mass reveals that it is ER +3, PR +2, and Her 2 +3. She is aware of her condition, agrees to treatment, but declares her desire to have children once the treatment has been completed.

Because of the immunohistochemical profile of your patient, you decide that she will also benefit from hormonal therapy. Which of the following statements would BEST apply to her condition?

a. The best results would be achieved utilizing an aromatase inhibitor.
b. Her premenopausal status implies that Tamoxifen may be her best option.
c. Ovarian ablation, whether surgical or by RT, will give results equivalent to that of an aromatase inhibitor.
d. Hormonal therapy has no role here because of her desire to have children.

A

d. Hormonal therapy has no role here because of her desire to have children.

Not sure. But definitely not AIs

65
Q

You feel that she will also benefit from the addition of the newer targeted therapies in her management. Which of the ff would be appropriate in her case?

a. A small molecular inhibitor
b. An EGFR directed monoclonal antibody
c. An anti-angiogenesis agent
d. A phenotype-directed monoclonal antibody

A

d. A phenotype-directed monoclonal antibody

Trastuzumab, in particular.

66
Q

Which of the following statements regarding childhood cancer is TRUE?

a. Very common
b. Most are curable
c. Incidence is decreasing
d. All of the above

A

B. Most are curable
Childhood cancers account for 1% of all malignancies. There is a 1% increase per year in the number of pediatric cancers. Most cancers are curable, even as high as 90%.

67
Q

What is the benefit of early cancer detection in children?

a. It improves cure rate
b. It may decrease the intensity of therapy needed for cure
c. It makes chemotherapy unnecessary
d. A and B

A

D. a and b

68
Q

What is the most common childhood cancer?

a. brain tumor
b. lung carcinomas
c. leukemia
d. retinoblastoma

A

C Leukemia

Most common CA in childhood (31.5%) is leukemia. Second are brain tumors, followed by lymphomas.

69
Q

Since 2003, what is 5-year survival rate of acute lymphoblastic leukemia in children?

a. 20-30%
b. 40-50%
c.

A

Current survival rate of ALL in children is 80-90%

70
Q

The signs and symptoms of leukemia is caused by which pathology?

a. bone marrow infiltration
b. hepatic and splenic infiltration
c. CNS spread
d. renal invasion

A

A. Bone Marrow infiltration

This causes anemia, decreased platelets, neutropenia, and bone pain,

71
Q

Which of the following tumors commonly presents in the 2-5 year old age group?

a. hepatoblastoma
b. non-Hodgkins lymphoma
c. osteosarcoma
d. Wilms tumor

A

B. Non-Hodgkin’s lymphoma

Wilm’s tumor can also present in 2-5 age group pero mas common siya sa

72
Q

During the early stage, retinoblastoma often presents with which sign?

a. proptosis
b. leukocoria
c. diploplia
d. increased intracranial pressure

A

B leukocoria
Signs and symptoms of retinoblastoma: leukocoria, strabismus, decreased visual acuity, inflamed changes, hyphema, black pupil (vitreous hemorrhage)

73
Q

Which of the following is/are true regarding Wilms tumor?

a. presents as a painful abdominal mass in a well looking child
b. thrombocytopenia is a common finding
c. b-HCG is often elevated
d. often metastatic at presentation

A

B Thrombocytopenia is a common finding
Wilm’s is usually asymptomatic, so the answer is either B and C. Not sure about thrombocytopenia, but there is bleeding though, and AFP is only rarely elevated.

74
Q

Which of the following malignancies commonly presents with an increase in serum AFP?

a. neuroblastoma
b. Wilms tumor
c. hepatoblastoma
d. leukemia

A

C. hepatoblastoma

Hepatoblastoma, is the most common primary malignant liver tumor in infants and children, is usually associated with elevated serum alpha-fetoprotein (AFP) levels.

75
Q

Which of the following malignancies often present with paraneoplastic syndromes?

a. neuroblastoma
b. Wilms tumor
c. hepatoblastoma
d. retinoblastoma

A

A. Neuroblastoma

From pedia onco trans

Paraneoplastic syndrome:
Excessive catecholamines (VMA/HVA secretion)
o Attacks of sweating, flushing, pallor, headaches,
palpitations and hypertension (like pheochromocytoma in adults)

• Excessive VIP secretion
o Intractable watery diarrhea

76
Q

The following cellular events are implicated in oncogenesis EXCEPT:

a. activation of an oncogene
b. inactivation of a tumor suppressor gene
c. inactivation of a DNA repair gene
d. physical injury to the cell membrane
e. none of the above

A

D

77
Q

Radiation therapy plays an important role in cancer treatment. This is due to the ability of radiation to:

a. melt tumor cells
b. coagulate cytoplasm
c. disable the reproductive capacity of the cancer cell
d. burn molecules
e. all of the above

A

C

78
Q

Which of the following types of radiation is/are ionizing?

a. heat
b. infrared
c. visible light rays
d. gamma rays or x-rays
e. none of the above

A

D

79
Q

The mammalian cell is most radiosensitive in which phase of the cell cycle?

a. G0
b. G1
c. S
d. G2/M
e. all throughout the cycle

A

D

most sensitive = G2/M
most resistant = S

80
Q

The predominant mechanism by which radiation exerts its effect in the cells through an indirect action in this process, ionizing radiation reacts with the water molecule to:

a. create heat
b. coagulate cells
c. produce free radicals that break the DNA strand
d. shrinks blood vessels
e. none of the above

A

C

photon ejects electron > electron interacts with water > hydroxyl radicals formed > radicals interact with DNA bases > DNA damage > cell death or apoptosis

81
Q

In conventional radiation therapy, the predominant mechanism of cell death from radiation is:

a. loss of reproductive capacity f the cell
b. destruction of the nuclear membrane
c. coagulation of proteins
d. all of the above
e. none of the above

A

A

82
Q

The predominant injury produced by ionizing radiation in the nucleus is:

a. breaks in the chromosome strand
b. coagulation of protein
c. melting of the nuclear membrane
d. destruction of the mitochondria
e. none of the above

A

A

photon and/or radicals interact with DNA bases and break the DNA strand

83
Q

The following modalities/equipment are utilized in radiation therapy:

a. linear accelerator
b. cobalt machine
c. brachytherapy
d. radioisotopes
e. all of the above

A

E

84
Q

Which features is/are NOT TRUE for a linear accelerator:

a. utilizes a naturally-occurring radioactive substance as a source of radiation
b. artificially produces radiation by an electrically-powered mechanism
c. emits higher energy and more penetrating radiation
d. more complicated to operate and maintain
e. all of the above

A

Ans

85
Q

As a general rule, rapidly-proliferating cells are sensitive to radiation:

a. true
b. false

A

A

86
Q

A 45 year old female consulted because a 3x3 cm hard movable mass at left breast with palpable axillary lymph node. Core needle biopsy of the breast mass revealed invasive ductal carcinoma. The next best approach should be:

a. surgical treatment
b. cancer staging
c. primary chemotherapy
d. primary radiotherapy

A

B

Staging should be done after diagnosis in order to direct appropriate treatment to the patient.

87
Q

A 52 year old male complain of intermittent passage of blood-streaked stool with on and off hypogastric pain. Colonoscopy revealed 1x1 cm nodular mass at the rectosigmoid area. Biopsy revealed carcinoma in situ. Work up revealed liver metastasis. The most likely stage of this disease is:

a. 0
b. I
c. III
d. IV

A

D

Presence of distant organ metastasis automatically gives a stage of IV.

88
Q

The type of malignancy whereby the histologic grade is the most important prognosticating factor:

a. thyroid cancer
b. soft tissue sarcoma
c. breast cancer
b. lung cancer

A

B

Histologic grade is the most important prognostic factor for soft tissue sarcoma.

89
Q

A 44 year old female admitted because of a 2x2 cm hard thyroid nodule. FNAB reveled papillary thyroid cancer. No evidence of regional nor distant metastasis. The most likely stage according to AJCC TNM system will be:

a. 0
b. I
c. III
d. IV

A

Ans

90
Q

The stage classification of a cancer that serve as the final estimation of prognosis and need for adjuvant treatment is:

a. clinical stage
b. pathologic stage
c. retreatment stage
d. autopsy stage

A

B

91
Q

Which one among the diferent breast cancer stages that is associated with the worst prognosis:

a. pT4N1M0
b. pT3N3M0
c. pT4N3M0
d. pT5N3M0

A

D

With same nodal involvement, larger tumor size has worse prognosis.

92
Q

Which one is not considered as modalities for staging?

a. core needle biopsy of the primary tumor
b. CT scan of the chest
c. excision biopsy of a suspicious cervical lymphadenopathy
d. bone scan
e. NOTA

A

E

93
Q

Obtaining the pathologic stage is based on the information gathered from which one of the following?

a. preoperative imaging procedures
b. operative findings
c. pathologic report
d. all of the above

A

D

94
Q

The primary purpose why staging should be done in the overall cancer management:

a. selects primary and adjuvant treatment
b. estimates cancer prognosis
c. serves as a tool in evaluating outcome of treatment
d. all of the above

A

D

95
Q

Primary breast cancer with skin involvement will have the least possible stage.

a. II
b. IIIA
c. IIIB
d. IV

A

Ans

96
Q

The application of a unique set of surgical and multidisciplinary principles to the cancer patient is called:

a. cancer treatment
b. oncologic medicine
c. surgical oncology
d. radio surgery

A

C

self-explanatory

97
Q

The modality in cancer therapy associated with the most cures and follows zero-order kinetics is:

a. surgery
b. chemotherapy
c. radiotherapy
d. targeted therapy

A

A

98
Q

Adjuvant cancer therapy is best described as:

a. the main cancer treatment applied
b. the evidence behind oncologic therapy
c. surgery done for metastatic disease
d. additional therapy after primary cancer treatment

A

D

99
Q

A biopsy is a procedure done:

a. which triggers the spread of cancer
b. as a part of therapy for cancer
c. to establish the diagnosis of cancer
d. as adjuvant therapy for cancer

A

C

100
Q

In cases of solitary metastasis to the liver from colorectal cancer or isolated lung metastasis from a sarcoma, which modality is currently associated with the best long-term curative potential?

a. surgery
b. chemotherapy
c. radiotherapy
d. targeted therapy

A

D

101
Q

Cosmesis after wide excision of a tumor can best be achieved via application of which modality:

a. medical oncology
b. radiation therapy
c. reconstructive surgery
b. biologic treatment

A

C

self-explanatory

102
Q

Surgical oncology involves which components of cancer management:

a. diagnostic
b. palliative
c. supportive
d. investigational
e. all of the above

A

E

103
Q

Surgical lymphadenectomy or excision of lymph nodes for cancer is done for which of the following reason/s:

a. diagnostic
b. prognostic
c. therapeutic
d. all of the above

A

D

104
Q

The top three lead cancer sites in the Philippines and the world include/s:

a. breast
b. kidney
c. ovary
d. all of the above

A

A

105
Q

The recommended early detection method for lung cancer is

a. stop smoking
b. bi-annual CXR
c. annual MRI scan
d. CEA determination
e. none of the above

A

B

106
Q

Bonus: The current Philippine Health Secretary who happen to be both a surgeon and a UPCM graduate is:

a. Dr. Agnes Mejia
b. Dr. Enrique Ona
c. Dr. Alberto Roxas
b. Dr. Alberto Romualdez

A

B

OS 217 Oncology (14 decks)

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