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Clinical oncology Flashcards

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1
Q

Who decides to start a complex oncology treatment for a newly diagnosed cancer patient?
A) The surgeon, because the tumor primarily requires resection
B) The oncologist, because he/she knows best about chemotherapy protocols
C) The pathologist, who determines the exact diagnosis using immunohistochemical methods
D) The radiotherapy specialist
E) All of the above

A

E) All of the above

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2
Q

What is the relationship between dysplasia and cancer?
A) Dysplasia always leads to the development of a cancer.
B) All cancer is preceded by dysplasia.
C) The progression of cancer is dysplasia.
D) A and C.
E) All of the above.

A

B) All cancer is preceded by dysplasia.

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3
Q

At cellular level tumor growth does not depend on the following:
A) time of cell cycle
B) growth fraction (proliferating tumor cell ratio)
C) cell death rate inside the tumor
D) time of duplication of tumor volume
E) apoptosis

A

E) apoptosis

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4
Q

The prognosis of the following tumor was the most significantly improved by combined chemotherapy:
A) Small cell lung cancer
B) Medulloblastoma
C) Seminoma
D) Neuroblastoma

A

C) Seminoma

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5
Q

Chemotherapy before surgery is important for the treatment of the following tumor:
A) Wilms-tumor
B) medulloblastoma
C) Burkitt-lymphoma
D) retinoblastoma
E) Gallbladder cancer

A

A) Wilms-tumor

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6
Q

After a curative surgery, the treatment for the prevention of recurrence:
A) neoadjuvant
B) adjuvant
C) palliative
D) supportive
E) none of the above

A

B) adjuvant

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7
Q

To evaluate the effectiveness of adjuvant treatment, the following parameter is chosen:
A) The time to relapse
B) Disease-free survival
C) Overall survival
D) All of the above

A

D) All of the above

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8
Q

In case of treatment of cancer patients, improvement of the disease is called:
A) remission
B) stable disease
C) progression
D) refractory disesase
E) none of the above

A

A) remission

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9
Q

Criteria for evaluating the therapeutic response during treatment of cancer patients:
A) Dukes-staging system
B) RECIST-staging system
C) Forrest-staging system
D) Bismuth-staging system
E) All of the above

A

B) RECIST-staging system

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10
Q

In oncological clinical studies progression free survival (PFS) is often evaluated. How do you define this term?
A) Progression-Free Survival (PFS) is the time that elapses in a progressive/metastatic tumor from starting treatment (from clinical trial randomization) to repeated tumor growth and/or death of a patient.
B) PFS is the time that elapses from the onset of the therapy of an advanced / metastatic disease (in clinical trials from randomization) to the death of a patient.

A

A) Progression-Free Survival (PFS) is the time that elapses in a progressive/metastatic tumor from starting treatment (from clinical trial randomization) to repeated tumor growth and/or death of a patient.

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11
Q

Definition of overall survival (OS):
A) Overall Survival (OS) is the time that elapses in a progressive / metastatic tumor from starting treatment (from randomization in clinical trials) to repeatedly confirmed tumor growth and / or death of the patient.
B) Overall survival (OS) is the time that elapses from the onset of tumor treatment (in clinical trials from randomization) to the death of a patient.

A

B) Overall survival (OS) is the time that elapses from the onset of tumor treatment (in clinical trials from randomization) to the death of a patient.

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12
Q

The overall response rate (ORR) is used to express the effectiveness of treatment in clinical trials. Which components does the ORR consist of? (CR is the complete response, PR is partial response, SD is stable disease / and PD is progressive disease /.)
A) ORR= CR+PR+ SD + PD
B) ORR= CR+PR+ SD
C) ORR= CR+PR

A

C) ORR= CR+PR

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13
Q

PRO abbreviation is often used in oncology drug development. It is the abbreviation of:
A) Progression Related Outcome
B) Patient Reported Outcome

A

B) Patient Reported Outcome

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14
Q

What is the RECIST criteria used for in oncology and in oncological clinical trials?
A) In solid tumors, the response to anticancer treatment in imaging studies is evaluated by these criteria.
B) RECIST relates to the determination of cell surface receptors in solid tumors.

A

A) In solid tumors, the response to anticancer treatment in imaging studies is evaluated by these criteria.

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15
Q

In ca. 10% of cancer patients, hypercalcaemia occurs due to tumor cells producing materials. Such materials are the following, except:
A) production of parathormon-like peptide
B) calcitonin
C) active metabolits of Vitamin-D
D) prostaglandins
E) TGF-α és TGF-β

A

B) calcitonin

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16
Q

Which gene’s defect is the most common in human tumors?
A) c-raf
B) c-myc
C) K-ras
D) p53
E) c-fos

A

D) p53

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17
Q

What is the meaning of MDR?
A) minimal disease residue
B) multiple drug resistance
C) maximal dose rate
D) mesenchymal disease risk
E) medulloblastoma gene receptor

A

B) multiple drug resistance

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18
Q

For which chemotherapeutic agent is the citrovorum factor or folic acid used as a “rescue” compound (for the protection of normal tissues and thus high dosage chemotherapy)?
A) methotrexat
B) bleomycin
C) cyclophosphamid
D) adriamycin
E) vincristin

A

A) methotrexat

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19
Q

Mesna may reduce the toxic damage of the bladder. Which cytostatic agent is it used for?
A) 5-fluorouracil
B) adriamycin
C) cisplatin
D) cyclophosphamid
E) methotrexat

A

D) cyclophosphamid

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20
Q

The following side effects may occur immediately or early after cytotoxic therapy except (indicate the exception):
A) nausea / vomiting
B) urocystitis
C) renal failure
D) phlebitis
E) azoospermia

A

E) azoospermia

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21
Q

Which phase of the cell cycle is affected by taxane type cytostatics?
A) G0
B) G1
C) S
D) G2
E) M

A

E) M

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22
Q

What is the machanism of action of camptothecin cytostatics (irinotecan, topotecan)?
A) inhibits the depolymerization of microtubules
B) topoizomerase II. inhibitors
C) topoizomerase I. inhibitors
D) Inhibition of DNA function and cell division in phase M

A

C) topoizomerase I. inhibitors

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23
Q

The following is valid for antimitotic chemotherapeutic drugs:
A) causes covalent crosslinking of the two polynucleotide chains in the dual spiral of DNA
B) they inhibit DNA synthesis through the inhibition of important enzymes of purine or pyrimidine synthesis.
C) they inhibit the polymerization of tubulins, i.e. the formation of mitotic spindles.
D) They inhibit the depolymerization of tubulins, i.e. blocking the mitotic spindle.
E) C and D

A

E) C and D

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24
Q

Which compound belongs to the strong opiates?
A) codein
B) oxycodon
C) tramadol
D) dextropropoxyphen

A

B) oxycodon

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25
Q

Targeted therapies for treatment of solid tumors, except (indicate the exception):
A) adalimumab
B) imatinib
C) sorafenib
D) cetuximab
E) sunitinib

A

A) adalimumab

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26
Q

CA-19-9 tumor marker test is the most valuable in the follow-up of the following disease:
A) ovarian cancer
B) hepatocellular carcinoma
C) testicular cancer
D) breast cancer
E) pancreas cancer

A

E) pancreas cancer

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27
Q

CA-15-3 tumor marker test is the most valuable in the follow-up of the following disease:
A) ovarian cancer
B) hepatocellular carcinoma
C) testicular cancer
D) breast cancer
E) pancreatic cancer

A

D) breast cancer

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28
Q

AFP (alfa-foeto-protein) tumor marker test is the most valuable in the follow-up of the following disease:
A) ovarian cancer
B) hepatocellular carcinoma
C) testicular cancer
D) breast cancer
E) pancreatic cancer

A

B) hepatocellular carcinoma

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29
Q

CA-125 tumor marker test is the most valuable in the follow-up of the following disease:
A) ovarian cancer
B) hepatocellular carcinoma
C) testicular cancer
D) breast cancer
E) pancreatic cancer

A

A) ovarian cancer

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30
Q

β-HCG tumor marker test is the most valuable in the follow-up of the following disease:
A) ovarian cancer
B) hepatocellular carcinoma
C) testicular cancer
D) breast cancer
E) pancreatic cancer

A

C) testicular cancer

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31
Q

In case of prostate cancer, which of the following tumor markers should be followed?
A) β-HCG
B) CEA
C) PSA
D) CA-125

A

C) PSA

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32
Q

Which factor is not used for monitoring or as prognostic factor in tumors?
A) CEA
B) PSA
C) β-HCG
D) TSH
E) p53

A

D) TSH

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33
Q

What is the most common histological type of malignant oesophageal cancer?
A) leiomyosarcoma
B) epithelial carcinoma
C) adenocarcinoma
D) rhabdomyosarcoma
E) melanoma

A

B) epithelial carcinoma

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34
Q

What is the most common primary tumor site in Krukenberg tumor?
A) breast cancer
B) gallbladder cancer
C) rectum cancer
D) pancreas cancer
E) gastric cancer

A

E) gastric cancer

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35
Q

In case of haematogenous dissemination, the following tumors usually give a pulmonary metastases first, except one type of tumor:
A) gastric cancer
B) breast cancer
C) renal cancer
D) chorionepithelioma
E) osteosarcoma

A

A) gastric cancer

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36
Q

Which drug was the first approved „targeted therapy” in the treatment of hepatocellular carcinoma?
A) sorafenib
B) bevacizumab
C) gefitinib
D) vandetanib
E) ipilimumab

A

A) sorafenib

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37
Q

According to clinical studies, the sorafenib treatment in patients diagnosed with primary hepatic cancer (hepatocellulray carcinoma),increases the overral survival. Is this true or false?
A) true
B) false

A

A) true

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38
Q

Choose the correct answer.
A) The mortality of colon cancer is constantly increasing.
B) The mortality of colon cancer has been decreasing since the introduciton of effective chemotherapy.
C) The mortality of colon cancer was rapidly increasing between 1965 and 2000, since then it has been stagnant.
D) The mortality of colon cancer hasn’t changed significantly in the past few decades.
E) In first world countries,colon cancer has the highest mortality rate of all cancers.

A

C) The mortality of colon cancer was rapidly increasing between 1965 and 2000, since then it has been stagnant.

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39
Q

Chemotherapy drugs used in the treatment of colorectal cancer, except:
A) 5-fluorouracil
B) capecitabine
C) oxaliplatin
D) irinotecan
E) docetaxel

A

E) docetaxel

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40
Q

Treatment option in the therapy of rectal cancer:
A) total mesorectal excision
B) neoadjuvant chemotherapy
C) adjuvant chemotherapy
D) VEGF inhibitor drugs
E) all of the above

A

E) all of the above

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41
Q

In which malignant disease ”DNA mismatch repair error” is the most frequent?
A) Li–Fraumeni-sydrome
B) MEN-2 syndrome
C) retinoblastoma
D) hereditary, non polyposis colon cancer (HPNCC)
E) Wilms-tumor

A

D) hereditary, non polyposis colon cancer (HPNCC)

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42
Q

Which of the following malignant cancers don’t ususally metastatize to the bones?
A) thyroid cancer
B) breast cancer
C) renal cancer
D) colon cancer
E) prostate cancer

A

D) colon cancer

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43
Q

Correct statements regarding the neuroendocrine tumor (NET), except:
A) Neuroendocrine tumors are rare entities
B) The incidence of neuroendocrine tumors has been increasing in the past 30 years.
C) Most of the neuroendocrine tumors are classified as “non-functioning” types.
D) Neuroendocrine tumor most typically affects the pancreas.
E) Carcinoid syndrome is present in less than 10% of all neuroendocrine tumors.

A

D) Neuroendocrine tumor most typically affects the pancreas.

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44
Q

The following malignant tumors,during hematogenous spreading metastatize at first to the liver, except:
A) gastric cancer
B) colon cancer
C) panreatic cancer
D) adrenal gland carcinoma
E) gallblader cancer

A

D) adrenal gland carcinoma

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45
Q

Of the following factors which ones should be measured-calculating the Notthingham Prognostic Index?
A) size of the tumor in centimeter
B) histological grade
C) lymph node status
D) all of the above three factors

A

D) all of the above three factors

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46
Q

During the histological evaluation of breast cancer we use the „NPI” abbreviation. What does it stand for?
A) Norfolk Predictive Index
B) Notthingam Prognostic Index

A

B) Notthingam Prognostic Index

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47
Q

In the case of breast cancer which NPI score is considered as poor prognosis?
A) below 3,14
B) above 5,4

A

B) above 5,4

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48
Q

Which of the following ones is NOT a risk factor of breast cancer?
A) no children
B) early menarche, late menopause
C) promiscuity
D) BRCA1 mutation
E) sister’s breast cancer

A

C) promiscuity

49
Q

What is the most common sypmtom of the intraductal papilloma of the breast?
A) peau d’orange symptom (orange peel symptom)
B) enlarged lymph node at the unilateral side
C) bloody fluid discharging from the nipple
D) ekzematous skin lesion
E) painful,red, swollen, palpable mass in the breast

A

C) bloody fluid discharging from the nipple

50
Q

Which type of breast cancer affects typically both sides?
A) invasive ductuscarcinoma
B) medullar carcinoma
C) mucinosus carcinoma
D) lobular carcinoma
E) papiliar carcinoma

A

D) lobular carcinoma

51
Q

In the case of an 22-years-old female patient, a mobile, non-painful palpable mass was discovered in the right breast with a diameter of 2,5 cm, and no change in size during the menstrual cycle. What is the most probable diagnosis?
A) fat necrosis
B) fibroadenoma
C) carcinoma phylloides
D) mastopathia fibrocystica
E) tubularis carcinoma

A

B) fibroadenoma

52
Q

Which one is not a paraneoplastic symptom of renal cancer?
A) anaemia
B) weight loss
C) fever, subfebrility
D) tiredness and fatigue
E) hematuria

A

E) hematuria

53
Q

Choose the INCORRECT answer!
A) The survival rate of renal cancer- thanks to the widely used screening methods- has increased in the last few years.
B) In the case of obvious imaging test findings, which suggest malignant tumor, surgical therapy can be indicated.
C) In the treatment of renal cancer, surgery is the only definitive and possibly curative option.
D) In the case of metastatic.renal cancer palliative nephrectomy should be performed, even if the patients are in good general condition
E) In the case of small peripheric tumor of the kidney laparoscopic partial neprehctomy is an option. The most common indication of radiotherapy is the palliative treatment of intracranial and bone metastasis.

A

A) The survival rate of renal cancer- thanks to the widely used screening methods- has increased in the last few years.

54
Q

Diagnostic methods in the screening of prostate cancer:
A) rectal digital examination
B) PSA-test
C) PET-CT
D) transrectal ultrasound-guided biopsy
E) A, B and D

A

E) A, B and D

55
Q

The gold standard for treatment of bone metastases of prostate cancer is:
A) GnRh analogue drugs
B) radiotherapy
C) antiandrogen drugs
D) bisphophonates
E) chemotherapy

A

D) bisphophonates

56
Q

Choose the CORRECT answer!
A) In spite of the increasing incidence of prostate cancer, the mortality caused by the disease has been slightly decreasing.
B) Increased risk was observed with family history of the disease, as hereditary genes which can cause susceptibility to prostate cancer were indentified.
C) Although prostate carcinoma can be observed in 30-40 % of men above the age of 55, the disease is ususally diagnosed over the age of 65.
D) In 95% of the cases, prostate cancer orginates from the “peripherial zone”, and it is usually multifocal.
E) All statements are true.

A

E) All statements are true.

57
Q

Choose the INCORRECT answer.
A) After radical prostectomy, if the PSA level is above 0,4 ng/ml, hormone and/or radiotherapy is necessary.
B) Treatment with antiandrogene drug should be introduced few days before applying the LHRH analogue at the start of hormone therapy.
C) In the case of metastatic prostate cancer systemic chemotherapy should be started as soon as possible.
D) During intermittent hormone therapy, in the “treatment holidays” the sexual potential of the patient usually is restored.
E) When prostate cancer metastatizes to the bones, hormone and bisphosphonate therapy is the first choice treatment.
F) Radiotherapy in prostate can be used for curative or palliative purpose as well.

A

C) In the case of metastatic prostate cancer systemic chemotherapy should be started as soon as possible.

58
Q

Elder man is hospitalized with back pain. X-ray describes oval masses in the lumbal spine, and PSA-level is elevated What is the most likely diagnosis?
A) metastatic thyroid cancer
B) multiple myeloma
C) metastatic prostate cancer
D) metastatic pacreatic cancer
E) Ewing-sarcoma

A

C) metastatic prostate cancer

59
Q

Which type of germ-cell testicular tumor cannot be classified into the non-seminoma group?
A) choriocarcinoma
B) Yolksac tumor
C) teratoma
D) spermatocytic
E) polyembrioma

A

D) spermatocytic

60
Q

Which cell-type does the majority of testicular cancers originate from?
A) Leydig-cell
B) Sertoli-cell
C) germ cell
D) endothel cell
E) epithelial cell

A

C) germ cell

61
Q

Which one is the most common testicular germ-cell tumor?
A) teratoma
B) endodermal sinus tumor
C) embryonal carcinoma
D) choriocarcinoma
E) seminoma

A

E) seminoma

62
Q

Choose the CORRECT answer.
A) The additon of cisplatin chemotherapy to the treatment of testicular cancer led to excellent results.
B) In the case of metastatic testicular cancer surgery is not recommended, only systemic chemotherapy and radiotherapy.
C) In the case of advanced testicular cancer prior to surgery, neoadjuvant chemotherapy is recommended.
D) In the case of relapse of testicular cancer salvage chemotherapy is useless since the disease is threapy-resistent.
E) Since testicular seminoma is highly-sensitive to radiotherapy, after-surgery irradiation of paraaortic and parailiac lymph node region on the same side is part of standard treatment.

A

A) The additon of cisplatin chemotherapy to the treatment of testicular cancer led to excellent results.

63
Q

Choose the INCORRECT answer!
A) Choosing the most adequate treatment centre is essential in the aspect of complex therapy since testicular cancer has excellent healing results.
B) In the majority of testicular cancer cases the first step of treatment is surgical high-castration.
C) In the case of testicular seminoma the cumulative dose of supplementary irradiaton of the primary lymph node regions has been decreasing in the last few years.
D) In the case of stage I. testicular cancer, after surgery only regular check-ups are necessary.
E) In the case of early testicular seminoma, according to recent studies, the carboplatin-based monochemotherapy is equivalent to the irradiation of the paraaortic region.

A

D) In the case of stage I. testicular cancer, after surgery only regular check-ups are necessary.

64
Q

Which one is the most important risk factor of the transitional-cell carcioma of the bladder?
A) alcohol
B) smoking
C) HPV infection
D) E. coli infection
E) HBV infection

A

B) smoking

65
Q

Wich one is NOT typical to the familiar ovarian cancer?
A) Family history of two or more breast/ovarian tumor
B) It is usually diagnosed at young age.
C) It is an agressive cancer.
D) The genotype of the disease is already well-known.

A

D) The genotype of the disease is already well-known.

66
Q

Typical of germ-cell ovarian cancer:
A) It is more frequent in old age.
B) It is often discovered during pregnancy.
C) It is always bilateral.
D) It is usually resistent to chemo- and radiotherapy.

A

B) It is often discovered during pregnancy.

67
Q

Which one is NOT part of the treatment of the epithelial ovarian cancer?
A) combined systemic chemotherapy
B) hysterectomy, bilateral salpingo-oophorectomy, omentectomy
C) P32 intraabdominal irradiation
D) intraperitoneal chemotherapy

A

C) P32 intraabdominal irradiation

68
Q

The incidence of cervical cancer:
A) It is the most frequent among women in their thirties and forties.
B) The primary risk factor is HPV 15 and 17 infection.
C) It is usually occurs among women of higher social-economical status.
D) It is usually discovered in older age and at early stage

A

A) It is the most frequent among women in their thirties and forties.

69
Q

Choose the correct answer regarding cervical cancer:
A) The most common type is the planocellular carcinoma
B) the adenocarcinoma is extremely rare
C) the neuroendocrine type has good prognosis
D) the incidence of planocellular carcinoma has been increasing

A

A) The most common type is the planocellular carcinoma

70
Q

The treatment of early cervical cancer:
A) Can be administered in every surgical department
B) Radiotherapy is ineffective
C) The standard therapy is surgery
D) Neoadjuvant chemotherapy is widely used

A

C) The standard therapy is surgery

71
Q

Most effective treatment of advanced cervix cancer:
A) radical surgery
B) chemotherapy and irradiation
C) only chemotherapy
D) only irradiation

A

B) chemotherapy and irradiation

72
Q

In case of a recurrent, disseminated cervix cancer:
A) the primary care is the palliation
B) recto- and vesico-vaginal fistulas are frequently onset
C) chemotherapy is usually ineffective
D) all of the listed above

A

D) all of the listed above

73
Q

In case of endometrium cancer:
A) most frequent symptom is the onset of ascites
B) can be prevented by screening
C) In case of a postmenopausal hemorrhage you should think about this
D) curettage is no longer used in the diagnosis

A

C) In case of a postmenopausal hemorrhage you should think about this

74
Q

In the treatment of uterine cancer
A) The most commonly used treatment is surgery
B) pre- and postoperative radiotherapy is indispensable
C) hormone therapy and chemotherapy are equally effective
D) all of the above

A

A) The most commonly used treatment is surgery

75
Q

Endometrial carcinoma
A) is the most common gynecological tumor
B) it practically does not occur in premenopausal status
C) squamous cell cancer is more frequent than the glandular origin
D) Estrogen excess is not a risk factor

A

A) is the most common gynecological tumor

76
Q

Cuboidal epithelium of the bronchi is replaced by squamosal cells. What is this phenomenon?
A) dysplasia
B) metaplasia
C) anaplasia
D) hyperplasia
E) neoplasia

A

B) metaplasia

77
Q

It is true for lung cancer screening:
A) Pulmonary X-ray screening is one of the primary prevention tools.
B) Regular, yearly performed chest X-ray tests reduce lung cancer mortality.
C) Regular lung chest x-rays combined with sputum cytology will further reduce the mortality rate caused by lung cancer.
D) Regular chest CT scan is not considered as a screening test due to overdiagnosis and radiation exposure.
E) PET-CT test is a general cancer screening test, also suitable for the screening of lung cancer.

A

D) Regular chest CT scan is not considered as a screening test due to overdiagnosis and radiation exposure.

78
Q

For the relationship between smoking habits and malignant tumors of the lungs are not true:
A) 85-90% of the tumors are related to smoking habits.
B) Female smokers are more vulnerable to lung cancer than men.
C) Small cell lung tumors are almost always produced in smokers.
D) Smoking habits do not affect the response to oncological treatment.
E) There is a nicotinerg receptor antagonist that has been clinically proven to be able to help to quit smoking.

A

D) Smoking habits do not affect the response to oncological treatment.

79
Q

It is not true for the neuroendocrine tumors of the lung:
A) Small cell lung cancer is a neuroendocrine carcinoma.
B) 80-85% of the lung neuroendocrine tumors are well and moderately differentiated tumors.
C) Good and moderately differentiated carcinomas can produce biologically active mediators.
D) Small cell lung cancer is considered to be a systemic disorder, so surgical intervention is not recommended.
E) Primary treatment of small cell lung cancer is chemotherapy and radiochemotherapy.
F) If SCLCs show full or partial remission, prophylactic skull radiation is recommended.

A

D) Small cell lung cancer is considered to be a systemic disorder, so surgical intervention is not recommended.

80
Q

It is true for medullary thyroid cancer, except (indicate the exception):
A) Sporadic medullary thyroid cancer is usually a solitaer lesion, while familial cancers are more often multifocal. 20-30% of medullary thyroid cancer is sporadic.
B) In the case of tumors above 1 cm, surgery should be followed by radio-iodine treatment.
C) In case of the diagnosis of medullary thyroid gland cancer, genetic testing is always recommended to be performed.
D) If a RET protooncogene mutation is detectable during the screening of the family, prophylactic thyroidectomy is recommended.
E) Serum calcitonin and CEA level is essential to be controlled after thyreoidectomy to follow-up of medullary thyroid cancer.

A

B) In the case of tumors above 1 cm, surgery should be followed by radio-iodine treatment.

81
Q

Which disease does not belong to the cutaneous lymphoma group?
A) blastic plasmacytoid dendritic cell neoplasia
B) Sezary-syndrome
C) lupus vulgaris
D) mycosis fungoides

A

C) lupus vulgaris

82
Q

What is the most important prognostic factor in malignant melanoma?
A) type of melanoma cells
B) proliferation rate of melanoma cells
C) the degree of depth propagation
D) the intensity of the peritumoral reaction of the host
E) tumor localization

A

C) the degree of depth propagation

83
Q

Gene mutations that are involved in the development of melanoma malignant – please indicate the one exception:
A) C-KIT
B) B-RAF
C) Her 2
D) CDKN2A

A

C) Her 2

84
Q

What is the main direction of haematogenic spread of malignant melanoma of the skin?
A) lungs
B) bone
C) brain
D) liver
E) adrenal gland

A

D) liver

85
Q

What is the most common intraocular tumor in adults?
A) meningeoma
B) lymphoma
C) metastasis
D) melanoma
E) rhabdomyosarcoma

A

C) metastasis

86
Q

COPP protocol is a highly effective chemotherapeutic regimen to treat the tumor - first of all in which cancer?
A) squamous cell pulmonary cancer
B) gastric cancer
C) colorectal cancer
D) Hodgkin-disease
E) CML

A

D) Hodgkin-disease

87
Q

Select the correct statement from the following:
A) During teletherapy irradiation an external radiation source is used.
B) During brachytherapy the radioactive source is delivered directly to the tumor or its immediate vicinity.
C) Brachytherapy can be divided into interstitial, intracavital, intraluminal and moulage based on the technique of insertion into the irradiated area.
D) The combination of teletherapy and brachytherapy is frequently adviced to reach the optimal tumor destruction.
E) All of the above are true.

A

E) All of the above are true.

88
Q

Which of the two tumor marker tests is recommended for gastric cancer?
1) beta-HCG
2) CEA
3) CA 19-9
4) CA 125

A) 1st, 2nd and 3rd answers are correct
B) 3rd and 4th answers are correct
C) 2nd and 3rd answers are correct
D) all of the answers are correct

A

C) 2nd and 3rd answers are correct

89
Q

Palliative treatment for esophageal cancer:
1) esophageal stent implantation
2) implantation of percutaneous endoscopic gastrostoma (PEG)
3) preparation of a nourishing jejunostoma
4) making a gastro-entero-anastomosis (GEA)
5) radiofrequency ablation

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

A) 1st, 2nd and 3rd answers are correct

90
Q

Criteria for liver resection:
1) Three or less metastases, located in one lobe.
2) The metastasis is smaller than 5 cm.
3) Keep at least 1 cm intact surgical margin.
4) For synchronous metastases, if all metastases can be removed.
5) Residual liver tissue is expected to be sufficient, good functioning.

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

D) all of the answers are correct

91
Q

The following factors may play a role in the development of primary liver cancer (primary hepatocellular carcinoma):
1) chronic hepatitis C infection
2) chronic hepatitis B infection
3) toxic liver diseases.
4) metabolic liver disease

A) 1st, 2nd and 3rd answers are correct
B) 1st and 2nd answers are correct
C) none of the answers are correct
D) all of the answers are correct

A

D) all of the answers are correct

92
Q

Select which radiological intervention method can be used to treat liver metastasis of colorectal carcinoma!
1) percutaneous alcohol infiltration
2) J-131-MIBG treatment
3) radiofrequency ablation
4) embolization

A) 1st, 2nd and 3rd answers are correct
B) 1st, 3nd and 4rd answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct

A

B) 1st, 3nd and 4rd answers are correct

93
Q

Classification systems used for the staging of colorectal carcinoma (CRC):
1) TNM assignment
2) Modified Astler-Coller (MAC) classification
3) Dukes Classification
4) FIGO position
5) each of the above listed

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

A) 1st, 2nd and 3rd answers are correct

94
Q

What malignant disease(s) can be treated with tyrosine kinase inhibitor imatinib (Glivec)?
1) colon cancer
2) gastrointestinal stromal tumor (GIST)
3) pancreatic cancer
4) breast cancer
5) chronic myeloid leukemia (CML)

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 2nd and 5th answers are correct
D) all of the answers are correct

A

C) 2nd and 5th answers are correct

95
Q

The following approaches are used to treat breast cancer:
1) neoadjuvant chemotherapy
2) chemotherapy according to the DeGramont protocol
3) radiotherapy
4) trastuzumab treatment in HER-2 negative tumors
5) each of the above listed

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 1st and 3rd answers are correct
D) all of the answers are correct

A

C) 1st and 3rd answers are correct

96
Q

It is true for prostate tumors:
1) Patients can be divided into three risk groups based on T stage, PSA value and Gleason score.
2) In case of a prostate tumor detected by rectal digital examination (RDV) and diagnostic imaging modalities, with an elevated PSA level FNAB is enough to be performed to confirm the diagnosis and initiate the primary treatment.
3) If malignant cells are found in the map-biopsy specimen of the prostate, the oncological treatment must be initiated as soon as possible.
4) Radical prostatectomy is recommended only if the patient’s life expectancy exceeds 10 years.
5) If the histological finding of prostate cancer in a pure or mixed form suggests a neuroendocrine tumor, it means a poor prognosis.

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 1st, 4th and 5th answers are correct
D) all of the answers are correct

A

C) 1st, 4th and 5th answers are correct

97
Q

It is true for prostate cancer:
1) Lymph node metastases are most commonly onset in the triangle of vena iliaca externa and n. obturatorius.
2) Distant metastases most often appear in the bones.
3) Radical prostatectomy is still recommended even in case of already onset bone metastases.
4) Treatment of localized prostate cancer radiotherapy with curative doses can be a reasonable alternative to radical surgery.
5) The total dose of radiotherapy has been reduced in the recent years to minimize side effects.

A) 1st, 2nd and 4th answers are correct
B) 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

A) 1st, 2nd and 4th answers are correct

98
Q

Which of the following statement (s) are true for non-seminomas?
1) increased AFP level
2) elevated beta HCG level
3) radiation sensitivity
4) chemotherapy sensitivity

A) 1st, 2nd and 3rd answers are correct
B) 1st, 2nd and 4th answers are correct
C) 3rd and 4th answers are correct
D) all of the answers are correct

A

B) 1st, 2nd and 4th answers are correct

99
Q

Select the correct statements from the following.
1) In case of primary testis/retroperitoneal non-seminoma if the AFP, HCG, and LDH levels are low before the surgery the tumor has good prognosis; even if pulmonary metastases are already onset.
2) Since seminomas rarely produce beta hCG and never produce AFP, when elevated AFP level is detected histological revision is needed to clarify the diagnosis if pure seminoma was described earlier.
3) Because of its pulmonary toxicity, bleomycin is no longer recommended to be used in combinational chemotherapy protocols
4) Since non-seminomas with good prognosis are sensitive to chemotherapy, the therapeutic goal must be the achievement of a long lasting result with the lowest possible toxicity, even in advanced disease.
5) For patients with non-seminomas belonging to the moderate or poor prognostic group, radiotherapy is part of standard therapy.
6) Although non-seminomas are less sensitive to irradiation, a good palliative effect can be achieved by radiotherapy in a chemotherapy-resistant, inoperable cases.

A) 1st, 2nd, 4th and 6th answers are correct
B) 2nd, 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

A) 1st, 2nd, 4th and 6th answers are correct

100
Q

It’s true for the bladder tumors:
1) About 90% of the bladder tumors are transitional cell carcinomas.
2) The symptoms cannot be used to distinguish between superficial and muscle-infiltrating tumors.
3) After a transurethral resection (TUR) it is recommended to wait at least 4 weeks to perform CT or MRI examination due to post procedure edema, inflammation and lymph node enlargement.
4) Definitive radiotherapy is not recommended because of the high risk of bladder- shrinkage.
5) Palliative radiotherapy of the urinary bladder should be performed with fewer fractions with a higher daily dose and a lower total dosage compared to the treatment of definitive irradiation.
6) Concomitant radiochemotherapy is not used in urinary bladder tumors.

A) 1st, 2nd, 4th and 6th answers are correct
B) 1st, 2nd, 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

B) 1st, 2nd, 3rd, 4th and 5th answers are correct

101
Q

The tumors of the head and neck region are (select the true statements):
1) Squamous cell carcinoma of the tonsils and tongue are more common in HPV infection.
2) In the case of epipharynic tumors, radiotherapy is contraindicated due to the proximity of the surrounding dose-limiting organs (e.g. brain stem, cerebral cortex, hypophysis, etc.).
3) Radiochemotherapy and radio-target therapies can also be used for the definitive treatment of head and neck cancer.
4) The development of second primary tumors in the lungs or esophagus is relatively common in patients with head and neck squamous cell carcinoma associated with smoking and alcohol abuse.
5) Definitive radiotherapy in this region is only relevant for advanced disease.

A) 1st, 3rd and 4th answers are correct
B) 1st, 2nd, 4th and 5th answers are correct
C) 2nd and 4th answers are correct
D) all of the answers are correct

A

A) 1st, 3rd and 4th answers are correct

102
Q

It is true for the tumors of the central nervous system:
1) Metastases are more common than primary tumors.
2) Most common first symptoms of a CNS tumor in the case of low-grade tumors are the symptoms of increased brain pressure. In case of high grade tumors, epileptic seizures are more common signs.
3) The survival probability of oligodendroglioma is worse than astrocytoma.
4) Glioblastoma multiforme is the most common adult primary brain tumor.
5) Anaplastic gliomas have worse prognosis than glioblastomas.
6) Cancers of the central nervous system do not give any metastasis.

A) 1st, 2nd and 4th answers are correct
B) 1st, 3rd, 5th and 6th answers are correct
C) 2nd, 3rd and 5th answers are correct
D) 1st, 2nd, 4th and 6th answers are correct
E) 1st and 4th answers are correct

A

E) 1st and 4th answers are correct

103
Q

It is true for the treatment of brain tumors:
1) In case of cerebral metastases, active oncological treatment is not an option.
2) Stereotactic brain irradiation is possible even in case of multiple brain lesions.
3) Cancers of the central nervous system cannot be treated by chemotherapy because chemotherapeutic agents do not pass through the blood-brain barrier.
4) In case of radical surgery, adjuvant therapy is not recommended, due to expected late toxicities even in case of highly malignant tumors.
5) Although there is no lymphoid tissue in the nervous system, lymphoma may occur in central nervous system
6) In some cases of central nervous system irradiation of the tumor is the first choice therapy, not surgery.

A) 1st, 2nd, and 4th answers are correct
B) 1st, 2nd, 3rd and 5th answers are correct
C) 2nd, 5th and 6th answers are correct
D) 1st, 2nd, 4th and 6th answers are correct

A

C) 2nd, 5th and 6th answers are correct

104
Q

It is true for the treatment of malignant melanoma:
1) In case of a suspected melanoma, it is strictly forbidden to take a biopsy, immediate excision with 2-3 mm intact edges of the suspected lesion is required.
2) Superficially spreading melanoma is lentigo maligna.
3) The necessary edge of the excision depends on the depth of the tumor.
4) In the treatment of melanoma, clinical studies have shown that new molecularly targeted therapies and vaccination may play a significant role.
5) Metastasectomy is not recommended due to the high metastatic tendency of melanoma malignant.
6) In case of melanoma with a thickness greater than 4 mm, or with an ulceration, regional block dissection is required.

A) 1st, 2nd, and 3rd answers are correct
B) 1st, 3rd, and 5th answers are correct
C) 3rd, 4th, and 6th answers are correct
D) 3rd and 4th answers are correct
E) 1st, 2nd, 5th and 6th answers are correct

A

D) 3rd and 4th answers are correct

105
Q

It is true for the malignant tumors of the lung:
1) 80-85% of the tumors are non-small cell lung cancer (NSCL).
2) 80% of the adenocarcinomas are centrally localized processes.
3) Squamous cancers are more commonly peripheral.
4) Squamous cancers have worse prognosis than adenocarcinomas and evolve especially in smokers.
5) Pulmonary malignancies are generally histologically homogeneous, combinations of different tumor types are rarely observed.
6) Non-small cell lung cancer is not a separate entity, segregation into subgroups is essential to determine personalized therapy.

A) 1st, 2nd, and 3rd answers are correct
B) 2nd, 3rd,4th and 5th, answers are correct
C) 1st, 4th, and 6th answers are correct
D) 1st, 4th, 5th and 6th answers are correct
E) all of the answers are correct

A

C) 1st, 4th, and 6th answers are correct

106
Q

It is true for the treatment of non-small cell lung cancer:
1) In case of a reduced cardiopulmonary reserve or if the patient rejects the surgery, definitive radio- or radiochemotherapy is recommended.
2) Positive resection edge or pN1-2 status requires additional chemotherapy or radiotherapy.
3) In case of potentially resectable cases, curative perioperative chemo- or radiochemotherapy is recommended.
4) If the tumor is greater than 5 cm or lymph nodes are involved, chemotherapy is required, even if R0 resection was performed.
5) Brachytherapy is an option in case of central bronchus cancers
6) Active tbc, inflammation, empyema or haemoptoe are contraindications for radiation therapy.

A) 1st, 2nd and 3rd answers are correct
B) 2nd, 3rd, 4th and 5th answers are correct
C) 1st, 4th, and 6th answers are correct
D) 1st, 4th, 5th and 6th answers are correct
E) all of the answers are correct

A

E) all of the answers are correct

107
Q

It is true for locally advanced, recurrent and metastatic non-small cell lung cancer:
1) A paradigm-change was made in their treatment.
2) In the case of non-squamous cell carcinoma, EGFR and KRAS mutation analysis are essential for therapeutic decision.
3) The use of VEGF and EGFR inhibitors is part of everyday practice.
4) If EGFR activating mutation cannot be detected, but if an ALK mutation is onset, ALK
5) EGFR tyrosine kinase inhibitors do not pass through the blood-brain barrier, so they cannot be used in brain metastases.
6) Vaccination is proven to be effective in clinical trials.

A) 1st, 2nd and 3rd answers are correct
B) 1st, 2nd, 3rd and 4th answers are correct
C) 1st, 4th, and 6th answers are correct
D) 1st, 4th, 5th and 6th answers are correct
E) all of the answers are correct

A

B) 1st, 2nd, 3rd and 4th answers are correct

108
Q

What are the “B” symptoms of Hodgkin’s disease?
1) Sweat
2) Weight loss
3) Fever
4) Diarrhoea
5) Itching

A) 1st, 2nd and 3rd answers are correct
B) 3rd, 4th and 5th answers are correct
C) 4th and 5th answers are correct
D) all of the answers are correct

A

A) 1st, 2nd and 3rd answers are correct

109
Q

Which factors help in the development of lymphomas?
1) AIDS
2) Wiskott-Aldrich syndrome
3) Wegener granulomatosis
4) effective chemotherapy
5) Immunizations

A) 1st, 2nd, 3rd and 4th answers are correct
B) 1st and 4th answers are correct
C) only answer 1 is correct
D) 1st, 2nd, and 4th answers are correct
E) all of the answers are correct

A

D) 1st, 2nd, and 4th answers are correct

110
Q

Which factors or diseases caused by them can be associated with the onset of malignant tumors?
1) Schistosoma haematobium
2) Helicobacter pylori
3) Streptococcus pyogenes
4) Aspergillus flavus
5) Actinomycosis

A) 1st, 2nd, 4th and 5th answers are correct
B) 1st, 2nd, and 4th answers are correct
C) 2nd, 3rd, and 4th answers are correct
D) 1st and 5th answers are correct
E) all of the answers are correct

A

B) 1st, 2nd, and 4th answers are correct

111
Q

Which cytostaticum belongs to which group of compounds?
A) Actinomycin D
B) vinblastine
C) carmustin
D) melphalan
E) 5-fluorouracil

INT - 17.126 - Alkylating agent
INT - 17.127 - Antimetabolite
INT - 17.128 - Alkaloid
INT - 17.129 - Antibiotic
INT - 17.130 - Nitrosourea

A

126- D
127- E
128- B
129- A
130- C

112
Q

Which cytostatic agent causes toxic damage to the listed organs - primarily?
A) kidney
B) heart
C) lung
D) bladder
E) Intestine

INT - 17.132 - cisplatin
INT - 17.133 - cyclophosphamide
INT - 17.134 - adriamycin
INT - 17.135 - bleomycin

A

132- A
133- D
134- B
135- C

113
Q

Which factor plays an important role in the development of certain listed tumors?
A) larynx cancer
B) mesothelioma
C) Hodgkin’s disease
D) skin cancer
E) leukemia

INT - 17.136 - Asbestos
INT - 17.137 - Benzene exposition
INT - 17.138 - UV radiation
INT - 17.139 - Chemotherapy
INT - 17.140 - Cigarette

A

136- B
137- E
138- D
139- C
140- A

114
Q

Find a correlation between viruses and tumors that are probably involved in the development of the tumors.
A) cervical cancer
B) Burkitt lymphoma
C) Kaposi sarcoma
D) liver cancer
E) T-cell lymphoma

INT - 17.141 - EBV
INT - 17.142 - HBV
INT - 17.143 - HTLV-1
INT - 17.144 - HHV-8
INT - 17.145 - HPV

A

141- B
142- D
143- E
144- C
145- A

115
Q

Find a correlation between tumors and the products often secreted by them which are frequently causing paraneoplastic symptoms:
A) Serotonin
B) AFP
C) erythropoetin
D) catecholamines
E) ADH

INT - 17.146 - Kidney cancer
INT - 17.147 - Lung cancer
INT - 17.148 - Phaeochromocytoma
INT - 17.149 - Carcinoid
INT - 17.150 - Hepatoblastoma

A

146-C
147-E
148- D
149- A
150- B

116
Q

A milk-like ascites indicates what of the following? (simple choice)
A 65 year old woman is complaining about an abdominal distension which increased in the last 2 weeks. In the last 6 months she had a 5.5 kg weight loss, however, in the last 2 weeks her weight increased with almost 3 kg. Physical examination showed a cachectic woman, with faint mucous membranes and with a visible ascites. During the discharge of ascites it proved to be milk-like. Also a painless, 3x4 cm sized, enlarged left inguinal lymph node is detected. Htc: 0,30, fvs: 9,8 G / l.
A) transsudatum
B) chylus
C) none
D) all

A

B) chylus

117
Q

The milk-like, above listed type of ascites may occur in the following cases:
A 65 year old woman is complaining about an abdominal distension which increased in the last 2 weeks. In the last 6 months she had a 5.5 kg weight loss, however, in the last 2 weeks her weight increased with almost 3 kg. Physical examination showed a cachectic woman, with faint mucous membranes and with a visible ascites. During the discharge of ascites it proved to be milk-like. Also a painless, 3x4 cm sized, enlarged left inguinal lymph node is detected. Htc: 0,30, fvs: 9,8 G / l.
1) lymphoma
2) pancreatic cancer
3) tuberculosis
4) nephrosis syndrome

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

A) 1st, 2nd and 3rd answers are correct

118
Q

The final diagnosis can be determined by the following test:
A 65 year old woman is complaining about an abdominal distension which increased in the last 2 weeks. In the last 6 months she had a 5.5 kg weight loss, however, in the last 2 weeks her weight increased with almost 3 kg. Physical examination showed a cachectic woman, with faint mucous membranes and with a visible ascites. During the discharge of ascites it proved to be milk-like. Also a painless, 3x4 cm sized, enlarged left inguinal lymph node is detected. Htc: 0,30, fvs: 9,8 G / l.
A) gastrointestinal examinations
B) lymph node biopsy
C) rectum biopsy
D) iv. pyelographia
E) arteriogram

A

B) lymph node biopsy

119
Q

The most likely diagnosis: (simple choice)
A 65 year old woman is complaining about an abdominal distension which increased in the last 2 weeks. In the last 6 months she had a 5.5 kg weight loss, however, in the last 2 weeks her weight increased with almost 3 kg. Physical examination showed a cachectic woman, with faint mucous membranes and with a visible ascites. During the discharge of ascites it proved to be milk-like. Also a painless, 3x4 cm sized, enlarged left inguinal lymph node is detected. Htc: 0,30, fvs: 9,8 G / l.
A) colon cancer
B) lymphoma
C) syphilis
D) gastric cancer
E) pneumococcal peritonitis

A

B) lymphoma

Internal states (17 decks)

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