Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RITE/PSBIM review > Med Onco > Flashcards

Med Onco Flashcards

1
Q

What is the effect of hormone replacement therapy on risk for

endometrial CA
colorectal CA
fractures
breast CA

A

Hormone replacement therapy (HRT) with conjugated equine estrogens plus progestins increases the risk of breast cancer. Epidemiologic studies have demonstrated a rapid decrease in elevated breast cancer incidence coincident with the discontinuation of HRT. it takes 6-7 years to double breast cancer risk.

HRT increases the risk of endometrial cancer, however, administration of conjugated estrogens with progesterone abrogates the increased risk of endometrial cancer compared to estrogen alone HRT

HRT decreases the risk of bone fractures and colorectal cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which subset of patient is MRI recommended for screening for breast cancer

A

● Women with dense breasts
● First cancer was not detected by mammography
● Axillary breast cancer presentation but no definable breast mass on PE or mammography
● History of radiation therapy to the chest between ages 10 and 30 years
● High genetic risk, such as BRCA1 or BRCA2 carriers or those with Li-Fraumeni, Cowden’s, or Bannayan-RileyRuvalcaba syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

35/F with a solitary breast mass left underwent MRM. Her histopathology report revealed invasive ductal carcinoma. Her breast panel IHCs findings revealed ER (+) PR (-) Her 2 (2+). What would be the BEST recommendation to this patient?
A. Request for repeat IHCs
B. Request for HER-2 FISH testing
C. Proceed with treatment with Hormonal therapy only
D. Proceed with treatment with Hormonal and Anti-Her2 Therapy

A

Answer: B. Request for HER-2 FISH testing

The two most important predictive factors in breast cancer are ER and HER2 expression, and they should be performed on all primary or metastatic cancer biopsy specimens. HER2 status is determined using either IHC staining for protein overexpression or fluorescent in situ hybridization (FISH) for gene amplification. IHC staining of 3+ (on a scale of 0–3+) is considered positive, whereas 0–1+ is considered negative. For cases with 2+ staining, reflex FISH analysis is recommended. FISH can either be used as the initial evaluation or for additional evaluation in IHC 2+ cases. HER2 is considered amplified if the ratio of HER2 to centromere signal on chromosome 17 is ≥2.0. FISH is unnecessary if IHC is 3+ or 0–1+, nor is there a reason for IHC testing if FISH is ≥2.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you differentiate the luminal staging of Breast CA?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Example of TKI for breast CA that targets HER2

A

Lapatinib, neratinib, tucatinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Example of TKI for breat CA that targets mTOR

A

Everolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Example of immunotherapy for breast CA that targets CDK4/6

A

Palbciclib, ribociclib, abemociclib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Example of immunotherapy for breast CA that targets PIK3CA

A

Alpelisib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Example of immunotherapy for breast CA that targets PDL-1/PD-1

A

Atezolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Example of immunotherapy for breast CA that targets TROP 2

A

Sacizutumab govitecan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Example of SERMs

A

Tamoxifen, Raloxifene, Toremifene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Example of Aromatase inhibitors

A

Anastrozole, Letrozole, Exemestane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Example of LHRH agonists

A

goserelin, leuprolide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

BRCA 1 gene mutation commonly fall to which molecular subtype of breast cancer

A

Basal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for Post Mastectomy Radiation due to high risk of locoregional recurrence

A

● Tumors ≥5 cm
● Four or more positive axillary lymph nodes
● Postoperative positive margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is breast CA prognosis affected by pregnancy?

A

Breast cancer prognosis during pregnancy is similar, stage for stage, as that for age-matched women who are not pregnant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does fats affect the risk of prostate CA?

A

High consumption of dietary fats, such as α-linoleic acid or polycyclic aromatic hydrocarbons that form when red meats are cooked, is believed to increase the risk of prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Medications that prevent prostate CA

A

Currently, no approved preventive agent for prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which is TRUE about PSA testing in prostate cancer screening, diagnosis, and treatment?

A. PSA test is prostate cancer-specific
B. Digital rectal exam (DRE) may increase PSA levels
C. PSA is a useful test for screening 50 years old men for prostate cancer
D. PSA level is strongly associated with the risk and outcome of prostate cancer

A

D. PSA level is strongly associated with the risk and outcome of prostate cancer

The level of PSA in the blood is strongly associated with the risk and outcome of prostate cancer. A single PSA measured at age 60 is associated (area under the curve [AUC] of 0.90) with a lifetime risk of death from prostate cancer. Most (90%) prostate cancer deaths occur among men with PSA levels in the top quartile (>2 ng/mL), although only a minority of men with PSA >2 ng/ mL will develop lethal prostate cancer.
Option A is incorrect. PSA is produced by both nonmalignant and malignant epithelial cells and, as such, is prostate-specific, not prostate cancer–specific.

Option B is incorrect. Serum levels of PSA may increase from prostatitis, BPH, or prostate cancer. Serum levels are not significantly affected by the DRE.

Option C is incorrect. Recommendations for screening with PSA are based on shared decision-making for men between the ages of 55 and 69. PSA-based screening is a target age group for whom benefits may outweigh the harm. Outside this age range, PSA-based screening as routine is not recommended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which diagnostic test is recommended for staging and treatment planning for prostate cancer?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

This androgen deprivation therapy (ADT) used in managing metastatic non-castrate prostate cancer may initially cause a clinical flare of disease and is relatively contraindicated when given alone for patients with spinal cord compromise.

A

Leuprolide

GnRH agonists/antagonists, such as leuprolide acetate and goserelin acetate, initially produce a rise in LH and FSH followed by a downregulation of receptors in the pituitary gland, which effects a chemical castration. The initial rise in testosterone may result in a clinical flare of the disease, and as such, these agents are relatively contraindicated in men with significant obstructive symptoms, cancerrelated pain, or spinal cord compromise, events that do not occur with GnRH antagonists such as degarelix (Option D).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most common anatomic site of the prostate where prostate cancer develops?

A

Peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most common malignancy that can cause Superior Vena Cava (SVC) syndrome among adult cancer patients?

A

Small Cell lung CA

Lung cancer, particularly of small-cell and squamous cell histology, accounts for ~85% of all cases of malignant origina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors

A

RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common type of malignancy causing metastatic spinal cord compression

A

Lung CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most common site of spine involvement in metastatic spinal cord compression?

A

Thoracic

The thoracic spine is the most common site (70%), followed by the lumbosacral spine (20%) and the cervical spine (10%). Involvement of multiple sites is most frequent in patients with breast and prostate carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Next step when patient with CA presents with back pain and + Lhermitte sign

A

MRI of the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the initial management for suspicious or confirmed metastatic spinal cord compression?

A

High-dose steroids

The treatment of patients with spinal cord compression (SCC) is aimed at relief of pain and restoration/preservation of neurologic function. Radiation therapy plus glucocorticoids is generally the initial treatment of choice for most patients with SCC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Electrolyte abnormalities associated with Tumor Lysis syndrome

A

Tumor lysis syndrome (TLS) is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia and is caused by the destruction of a large number of rapidly proliferating neoplastic cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tumors associated with TLS

A

TLS is most often associated with the treatment of Burkitt’s lymphoma, acute lymphoblastic leukemia, and other rapidly proliferating lymphomas, but it also may be seen with chronic leukemias and, rarely, with solid tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Preventive approaches for tumor lysis syndrome among high-risk cancer patients include the following; EXCEPT:

A. Aggressive hydration
B. Allopurinol
C. Febuxostat
D. Sodium bicarbonate

A

Urinary alkalinization with sodium bicarbonate is no longer recommended. It increases uric acid solubility, but a high pH decreases the solubility of xanthine, hypoxanthine, and calcium phosphate, potentially increasing the
likelihood of intratubular crystallization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How do you prevent TLS?

A

Hydration 3000 mL/ m2 with PNSS or 0.45 NSS
Allopurinol 300 mg/ m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Indications for HD if with TLS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What treatment modality has been shown to be successful in managing chemotherapy-induced Hemolytic - Uremic Syndrome (HUS)?

A

Rituximab

This condition may rarely occur after treatment with antineoplastic drugs. Mitomycin and gemcitabine are the most common offenders. Other antineoplastic drugs are gemcitabine, cisplatin, bleomycin, and proteasome inhibitors, and with VEGF inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the primary therapy or prevention for polyposis coli?

A

Total colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

This chemotherapeutic agent remains the backbone of systemic therapies in colorectal cancer

A

5-FU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Most common site of distant metastasis in colorectal cancer

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Clinical criteria for the diagnosis of Lynch syndrome or also known as hereditary nonpolyposis colon cancer

A

Bethesda criteria for clinical diagnosis of Lynch Syndrome ( Remember 3-2-1)
3 - three or more relatives with histologically documented colorectal cancer, one of whom is a first-degree relative of the other two
2 - at least two generations with colorectal cancer involvement
1 - one or more cases of colorectal cancer diagnosed before age 50 in the family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What symptoms are more common in right sided compared to left sided colon CA?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

This is the most common side effect of Irinotecan when used in colorectal cancer

A

diarrhea

Diarrhea is the major side effect of irinotecan. Irinotecan-induced diarrhea is enhanced by the intestinal bacterial production of beta-glucuronidases, causing the transformation of SN38-G to SN38 causing diarrhea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Chemotherapeutic agents affect bone marrow function. In general, which bone marrow cell type is MOST susceptible to the effects of cytotoxic drugs?

A

PMNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which drug used in the prevention of chemo-induced nausea and vomiting (CINV) acts primarily by promoting gastric motility by inhibiting peripheral dopamine receptors and is used in high doses for highly emetogenic chemotherapy?

A

Metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

ideal time to administer primary G-CSF prophylaxis

A

The best time to give primary G-CSF administration is 24-72 hours after chemotherapy

Continue until ANC > 10,000 /uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the preventive uses of G-CSF?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Dose of G-CSF

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pathognomonic finding of anthracycline-induced cardiotoxicity

A

The pathognomonic finding of anthracycline-induced cardiotoxicity is myofibrillar dropout on
endomyocardial biopsy

Myocardial toxicity of anthracyclines is dose-dependent. Approximately 5% of patients receiving >450–550 mg/m2 total dose of doxorubicin will develop CHF, but it can also develop at substantially lower doses in some patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Chemotherapy or hormonal agents associated with CHF

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Chemotherapy or hormonal agents associated with Pulmonary fibrosis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Chemotherapy or hormonal agents associated with pneumonitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Chemotherapy or hormonal agents associated with secondary malignancies or myelodysplasia

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Chemotherapy or hormonal agents associated with immune dysfunction and recurrent infections

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Chemotherapy or hormonal agents associated with infertility

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Chemotherapy or hormonal agents associated with hemorrhagic cystitis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Chemotherapy or hormonal agents associated with renal tubular dysfunction

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Chemotherapy or hormonal agents associated with neuropathy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Chemotherapy or hormonal agents associated with ataxia

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Chemotherapy or hormonal agents associated with vasomotor symptoms

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Chemotherapy or hormonal agents associated with sexual dysfunction

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

most significant risk factor for cancer overall

A

age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

ECOG status of a 70 year old female with metastatic breast cancer to the spine, capable of only limited self-case and confined to her bed more than 50% of waking hours

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you differentiate complete vs partial response to tx based on RECIST criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Definition of progressive dse based on RECIST criteria

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Conditions associated with elevated HCG

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Conditions associated with elevated calcitonin

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Conditions associated with elevated catecholamines

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Conditions associated with elevated AFP

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Conditions associated with elevated prostatic acid phosphatase

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Conditions associated with elevated neuron specific enolase

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Conditions associated with elevated LDH

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Conditions associated with elevated PSA

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Conditions associated with elevated monoclonal globulin

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Conditions associated with elevated CA19-9

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Conditions associated with elevated CD 30

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Conditions associated with elevated CD 25

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which of the following statements describes the mechanism of action of cyclophosphamide accurately?

A. Forms covalent bonds with DNA bases, leading to cross-linkage of DNA strands
B. Interferes with purine synthesis, conveying the greatest toxicity to cells in the S-phase
C. Creates double stranded breaks through which another segment of DNA duplex passes before rejoining
D. Binds to DNA through the DNA minor groove eventually leading to the disruption of the FUS-CHOP transcription action

A

Option A is the mechanism of action of alkylating agents such as cyclophosphamide (cell cycle nonspecific).

Option B is the MOA of anti-metabolites (like 5FU or capecitabine).

Option C is the MOA of Top-2 inhibitors (like doxorubicin), and

option D is the specific MOA of trabectedin, another alkylating agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

The efficacy of which drug is enhanced by leucovorin by increasing the binding of a ternary complex with thymidylate synthase?
A. Methotrexate
B. 5-fluorouracil
C. Pemetrexed
D. 6-Thioguanine

A

The action of 5-fluorouracil is synergistic with leucovorin.

Option A is incorrect because leucovorin lessens the toxicity of methotrexate to normal tissues (folate rescue, otherwise cells die a thymine-less death) .

Options C and D are also incorrect because leucovorin has no role in enhancing their efficacy.

Additional information: Pemetrexed: give folate and VitB12 to reduce hematologic toxicity 6-thioguanine: Increased toxicity with thiopurine methyltransferase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Which mechanism explains early diarrhea, occurring less than 24 hours after irinotecan administration?
A. Acetylcholinesterase inhibition by the prodrug
B. Acetylcholinesterase inhibition by the active metabolite, SN-38
C. Direct mucosal cytotoxicity from the prodrug
D. Direct mucosal cytotoxicity by the active metabolite, SN-38

A

Early diarrhea is caused by acetylcholinesterase inhibition by the prodrug, Irinotecan. In order to prevent this, patients are premedicated with atropine. Late diarrhea occurs due to direct mucosal cytotoxicity by the active metabolite, SN-38. For late diarrhea, use loperamide 4mg after the first stool then 2mg Q2 hours until 12h without stool (max 16mg/24h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

This antibody drug conjugate (ADC) uses an antibody to NECTIN 4 to treat advanced urothelial neoplasms expressing this target. Internalization of the ADC-Nectin complex allows the release of auristatin, an antimicrotubule.

A. Belantamab mafodotin
B. Ziv-aflibercept
C. Ado-trastuzumab emtansine
D. Enfortumab vedotin

A

This is the MOA of Enfortumab vedotin

Belantamab mafodotin targets B-cell maturation (BCMA) expressed myeloma, ziv-aflibercept targets VEGF and is used in colorectal cancer with 5fubased chemotherapy.

Ado-trastuzumab emtansine targets Her2/neu receptors as treatment in advanced breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Which agent may be given to patients with metastatic prostate cancer to inhibit androgen synthesis by blocking the action of CYP17A1? To counteract adverse events related to mineralocorticoid excess, this is often given together with corticosteroids.

A. Abiraterone
B. Leuprolide
C. Enzalutamide
D. Relugolix

A

Abiraterone inhibits the action of CYP17A1, thus preventing androgen biosynthesis

Leuprolide is an LHRH agonist, while Relugolix is a GNRH antagonist, preventing the release of LH and FSH, and consequently testosterone.

Enzalutamide is a second generation androgen receptor (AR) antagonist inhibiting androgen binding to AR, androgen receptor nuclear translocation, and subsequent interaction with chromosomal DNA for signaling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

A third generation TKI and the only agent with T315I activity for CML

A

Ponatinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

A patient with metastatic non-small cell lung cancer starts taking a tyrosine kinase inhibitor that targets ALK but also has anti-ROS activity. After 2 months on the treatment, he reports having suicidal ideations, altered mood and sleep. Which among the following TKIs did the patient receive?
A. Ceritinib
B. Crizotinib
C. Lorlatinib
D. Larotrectinib

A

Answer: C. Lorlatinib

Explanation: Lorlatinib targets both ALK but also has anti-ROS activity. Apart from suicidal ideations, altered mood, sleep and cognitive disturbances, this is also known to cause dyslipidemia.

Ceritinib is an ALK-inhibitor, Crizotinib inhibits both ALK and ROS but both drugs are not known to affect mood or cognition.

Larotrectinib does not have ALK or ROS activity, but rather, targets NTRK fusion mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Only oral medication approved as maintenance treatment for germline BRCA mutated pancreatic adenocarcinoma after stable disease or response to first line platinum based chemotherapy

A

Olaparib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Which of the following cancer treatments warrants periodic monitoring for hyperglycemia?
A. Abemaciclib
B. Adagrasib
C. Alpelisib
D. Axitinib

A

Answer: C. Alpelisib

Alpelisib is a PI3K inhibitor that can cause uncontrolled hyperglycemia. It is important to monitor glucose levels and hba1c.

MTOR inhibitors (everolimus, temsorolimus) and BRAF inhibitors (regorafenib, dabrafenib) can also cause hyperglycemia

Abemaciclib is a CDK4/6 inhibitor that can cause neutropenia, diarrhea and hepatotoxicity.

Adagrasib targets KRAS G12C mutated non-small cell lung cancer.

Axitinib is a multikinase inhibitors that causes hemorrhaging, clotting, diarrhea, hand foot syndrome, high blood pressure, proteinuria and even posterior reversible encephalopathy syndrome (like other multikinase inhibitors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Necrotizing encephalopathy is the most severe form of radiation injury and almost always is associated with concurrent use of which chemotherapeutic drug?
A. 5-fluorouracil
B. Capecitabine
C. Gemcitabine
D. Methotrexate

A

Answer: D. Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which specific genetic alteration is usually seen in etoposide-related acute myeloid leukemia?
A. Chromosome 5 or 7 deletion
B. Chromosome 11q23 translocation
C. Chromosome T(14;18) translocation
D. Chromosome T(15;17) translocation

A

B. Chromosome 11q23 translocation
This mutation in AML patients is seen after exposure to top-inhibitors (with etoposide conferring the highest risk), rarely preceded by MDS.

Chromosome 5 or 7 mutations, may be seen in patients on previous alkylating agents especially when combined with radiation ad is often preceded by myelodysplasia.

Chromosome T(14;18) translocation is the defining molecular event in follicular lymphoma.

While chromosome T(15;17) translocation is the defining molecular event in acute promyelocytic leukemia, conferring sensitivity to retinoic acid

84
Q

A 65 year old woman, nonsmoker, underwent a biopsy of an incidental lung mass. It yielded the following pathologic findings: well-differentiated, glandular carcinoma with a mix of acinar and solid features. Which combination of IHCs best represents the histology of his lung cancer?
A. TTF-1 positive, Napsin-A negative
B. TTF-1 negative, Napsin-A negative
C. TTF-1 negative, Napsin-A positive
D. TTF-1 positive, Napsin-A positive

A

Answer: D. TTF-1 positive, Napsin-A positive Explanation: The pathologic findings point to an adenocarcinoma histology, which confers the following positive IHC results: napsin A (>90% of the time) and TTF1 (>70% of the time).

85
Q
  1. Which of the following statements is accurate regarding the use of sputum cytology in the diagnosis of lung cancer?

A. Although lower yield than other specimen types, the yield is highest for peripherally located tumors such as adenocarcinomas
B. The specificity is about <70%, while sensitivity is 100%
C. This specimen is usually adequate for PDL1 testing and molecular testing
D. At least three sputum specimens are recommended

A

Answer: D. At least three sputum specimens are recommended Explanation:

Option D is correct because it increases specificity

Option A is incorrect because the yield is highest for centrally located tumors (not peripheral) such as small cell or squamous tumors.

Option B is incorrect: it should be specificity of 100%, while sensitivity of <70%.

Option C is incorrect since specimen or tumor cells are usually scars, preventing PDL1 testing and other molecular testing.

86
Q

Contraindications for curative resection for lung CA

A

necessitating chemoradiation or chemotherapy instead

Extrathoracic metastases, super vena cava syndrome , vocal cord paralysis, phrenic nerve paralysis, tumor within 2cm of the carina, metastases to the contralateral lung, metastases to the supraclavicular lymph nodes, metastases to contralateral mediastinal node, involvement of main pulmonary artery

87
Q

For a patient who will undergo first-line palliative chemotherapy for his metastatic lung adenocarcinoma, which chemotherapy agent will you combine with Cisplatin for improved survival?
A. Gemcitabine
B. Pemetrexed
C. Paclitaxel
D. Ramucirumab

A

Answer: B. Pemetrexed

Pemetrexed in combination with platinum chemotherapy has high activity in adenocarcinomas.

Higher thymidylate synthase is seen in squamous cancer – hence, lower responsiveness to pemetrexed. Activity of gemcitabine is not impacted by levels of thymidylate synthase – thus cisplatin/gemcitabine combination or cisplatin/paclitaxel would be used for squamous histology.

Lastly, ramucirumab in combination with docetaxel is used in the second line setting for squamous or non-sqauamous histologies– not as first line.

88
Q

Recommended 1st line tx for metastatic thymoma

A

CAP protocol

Cisplatin, Doxorubicin, Cyclophosphamide

89
Q

Etiologic factors assoc with esophageal adeno CA

A

Chronic gastroesophageal reflux
Obesity
Barrett’s
Male sex
cigarette smoking - also risk factor for SCCA

90
Q

Risk factors for SCCA of the esophagus

A
91
Q

Which diagnostic modality is most appropriate to determine the clinical T-stage of esophageal carcinomas?

A

Esophageal UTZ

92
Q

Which germline mutation increases one’s risk of developing gastric signet ring cell adenocarcinoma? Patients with this inherited mutation can be considered for prophylactic gastrectomy.
A. RHBDF2
B. CDH1
C. MMR
D. BRCA2

A

Answer: B. CDH1

Option B, CDH1, causes a specific subtype of gastric cancer: the diffuse or signet ring cell adenocarcinoma histology)

RHBDF2 is the germline mutation associated with tylosis palmaris et plantaris – a syndrome at high risk for esophageal SCCs.

MMR deficiency is seen in lynch syndrome (also increases one’s risk of gastric cancer).

BRCA 2 germline mutations also increases one’s risk for gastric cancer, pancreatic and prostate cancer, but more implicated in male and female breast cancers.

93
Q

Which genomic result will influence your therapeutic choice when treating metastatic gastric adenocarcinomas?
A. Epstein Barr Virus DNA by PCR
B. MMR protein deficiency
C. CDH1 mutation
D. TP53 mutation

A

B. MMR protein deficiency

Explanation: For MSI-high or dMMRP gastric cancers, Pembrolizumab is used (currently approved in second line setting)

Determining the EBV, TP53 or CDH1 status of the gastric malignancy does not influence treatment (although, these can be prognostic).

Other genomic findings that can influence treatment include: MSIH and PDL1 result (using pembrolizumab or adding nivolumab to chemotherapy), and Her2 expression or amplification (adding trastuzumab or trastuzumab deruxtecan)

94
Q

8A patient presents with stage II gastric MALT lymphoma. Upon further testing, the tumor tests positive for H.pylori on histopathology and t(11;18) by PCR. What is the most appropriate treatment for this patient?
A. Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (RCHOP)
B. RCHOP and radiation
C. Antibiotics for H.pylori
D. Antibiotics for H. pylori and Rituximab

A

Answer: D. Antibiotics for H. pylori and Rituximab

Option D is correct - adding radiation or rituximab is done due to lower response of t(11;18) translocation positive gastric MALT tumors to H. pylori eradication alone (making option C incorrect).

Options A and B (RCHOP+/- radiation) would be appropriate for diffuse large b cell lymphomas

95
Q

A patient presents with a large, localized gastric mass. Resection was done and histopathology reveals a spindle cell subtype, with a high mitotic count. Further testing reveals positivity for cKIT 11 mutation. Which postoperative treatment option is appropriate?
A. Rituximab
B. Octreotide
C. Sorafenib
D. Imatinib

A

Explanation: For high-risk GISTs (larger size, higher mitotic index), adjuvant therapy with imatinib for 3 years improves relapse-free and overall survival.

Furthermore, patients with cKIT mutations (especially in exon 11) have good response and median survival with Imatinib

Other options are not indicated as adjuvant treatment for resected GIST

96
Q

A patient has hepatocellular carcinoma, child-pugh B, ECOG 1, with portal invasion. Which is the most appropriate treatment option for his Barcelona stage?
A. Transplantation
B. Chemoembolization
C. Systemic therapy
D. Best supportive care

A

Child Pugh A-B, ECOG 1-2 with portal invasion, N1 or M1 = Barcelona C, which necessitates systemic therapy.

Transplantation is for Barcelona A, if a transplant candidate.

Chemoembolization or TACE is for Barcelona B.
Best supportive care is for Barcelona D

97
Q

What is the most common molecular aberration in hepatocellular carcinoma?

A

TERT promoter

TERT promoter mutations are common in 56% of HCC tumors.

TP53 mutavons are the most frequent alteravons with a specific hotspot of mutavon (R249S) in pavents with aflatoxin B1 exposure.

While Alcohol abuse and HCV infecvon have been associated with CTNNB1 mutavons.

98
Q

Which of the following is not a radiologic hallmark of hepatocellular carcinoma?
A. Presence of nodule of any size
B. Cirrhotic liver
C. Vascular uptake in the arterial phase
D. Washout in the portal venous or delayed phases

A

Answer: A. Presence of nodule of any size

Explanation: Option A should be >1cm; <1cm is unlikely to be HCC, repeat ultrasound at 4 months is recommended.

The other options are radiologic hallmarks of HCC.

99
Q

Criteria for hepatocellular carcinoma that is eligible for liver transplant according to Milan criteria

A

1 nodule <5cm, 2-3 nodules <3cm, no microvascular invasion, no extrahepatic spread.

100
Q

What is your preferred treatment option for a patient with HCC, with a 5cm single nodule, no vascular involvement but with significant comorbidities?
A. Transplantation
B. Resection
C. Ablation or TACE
D. Systemic therapy

A

Answer: C. TACE.

Size of single tumor precludes transplantation (1 nodule, <5cm in milan criteria).

Significant comorbidities precludes resection. Patient, however, is still eligible for TACE

101
Q

A patient with HCC has already received two lines of systemic treatment. His latest scans show tumor progression and his latest serum AFP is still >400 (same as baseline). What is your next best treatment option?
A. Regorafenib
B. Cabozantinib
C. Durvalumab
D. Ramucirumab

A

Answer: D. Ramucirumab

This may be given as a third line treatment, for patients with baseline AFP value of >400, specifically. Other treatment options (A and B) may be given as third line options as well. Durvalumab can be given as first line treatment (not preferred, but noninferior to sorafenib based on the Himalaya trial – NCCN guidelines).

102
Q

Which classification of cholangiocarcinomas often present with FGFR2 fusions or IDH1/2 mutations?
A. Perihilar
B. Intrahepatic
C. Distal
D. Mixed

A

Answer: B. Intrahepatic

Intrahepatic cholangiocarcinomas often present with FGFR2 fusions or IDH1/2 mutations. ERBB2/3 amplificavons and SMAD4 aberravons are characterisvc of extrahepavc CCA. Moreover, Perihilar subtypes are the most common type (50-60%)

103
Q

Which adjuvant treatment for resected cholangiocarcinoma is reported improve overall survival?
A. Gemcitabine
B. Gemcitabine-oxaliplatin
C. Capecitabine
D. Capecitabine-oxaliplatin

A

Answer: C. Capecitabine

Explanation: Capecitabine, according to the BILCAP trial, can be given in the adjuvant se|ng for in all types of cholangiocarcinoma for improved overall survival

Other agents have no proven efficacy in the adjuvant setting

104
Q

Which second line treatment for metastavc cholangiocarcinoma is your preferred opvon for pavents without any targetable driver mutavons?
A. Gemcitabine and cisplatin
B. Leucovorin, fluorouracil and oxaliplavn
C. Capecitabine and oxaliplatin
D. Pembrolizumab

A

Answer: B. Leucovorin, fluorouracil and oxaliplavn (mFOLFOX)

Explanatio: In the second-line se|ng, a phase 3 study randomized pavents who had progressed on cisplavn and gemcitabine (preferred first line for metastavc cholangiocarcinoma) to mFOLFOX (leucovorin, fluorouracil, and oxaliplavn) versus best supporvve care. The chemotherapy regimen showed an improvement in median OS.
Meanwhile, two molecular targeted therapies have been approved in the second-line se|ng in iCCA pavents with IDH1/2 mutavons (ivosidenib) or FGFR2 aberravons (pemigavnib).

105
Q

Examples of highly emetogenic chemo drug

A

Dacarbazine
Cisplatin
Cylophosphamide> 1500 mg/m2
Steptozocin
Doxo-Cyclophosphamide

Prevention: Dexa, 5HT3 antagonist, neurokinin receptor antagonit

106
Q

Baseline lab test to be requested to monitor pneumonitis before giving bleomycin

A

PFT with DLCO

107
Q

Age to start screening for mammography

A

40-provide opportunity

108
Q

How frequent should mammography be done for screening breast CA

A

yearly but biennial starting 50 (IJPSTF) or at least 55 (ACS)

109
Q

How frequent should you screen patients for cervical CA using pap smear

A
110
Q

When can you stop screening for cervical CA using pap smear

A

if more than 65 yrs and with negative prior screening

111
Q

Age to start screening for colon CA

A

IJPSTF (50)
ACS: 45- qualified recommendation; at least 50- strong recommendation

112
Q

How frequent should you screen for colon CA using the ff:
Sigmoidoscopy
FOBT
Colonoscopy
Fecal DNA testing
FIT
CT colonography

A

Sigmoidoscopy - 5 yrs (5igmoidoscopy)
FOBT- every yr
Colonoscopy - 10 yrs
Fecal DNA testing- 3 yrs
FIT - every yr
CT colonography- 5 yrs

113
Q

When should you screen for lung CA and what modality should you use?

A
114
Q

What screening should be used to screen for ovarian CA

A

Currently no reliable screening test for the early detection of ovarian CA

115
Q

When should you start screening for prostate CA

A
116
Q

Relationship of high BMI and prostate and pre-menopausal breast CA

A

inverse

116
Q

Vinyl chloride is a suspected carcinogen in the devt of what CA

A

Angiosarcoma of the liver

117
Q

Chromium is a carcinogen associated with what CA

A

Lung CA

118
Q

Phenacetin is a carcinogen associated with what CA

A

Cancer of the renal pelvis and bladder

119
Q

Diethylstilbestrol is a carcinogen associated with what CA

A

clear cell vaginal CA

120
Q

Benzene is a carcinogen associated with what CA

A

AML

121
Q

Aromatic amines is a carcinogen associated with what CA

A

bladder CA

122
Q

Imaging modality with has a good sensitivity in visualizing LN and assessing local dse extent for surgery or RT planning for prostate CA

A

MRI

123
Q

After radical prostatectomy, PSA should become undetectable in the blood within ___ weeks

A

6

If PSA remains or becomes detectable after, patient is considered to have persistent or recurrent dse

124
Q

MOA of Abiraterone

A

Antiandrogen ; CYP17 inhibitor

125
Q

Risk factors of breast CA

A

Risk of developing breast cancer is higher in women with early menarche (<12 years) and late first fullterm pregnancy (>35 years), and it is increased by exogenous hormone replacement therapy

126
Q

Indications for testing for BRCA1/2 mutations

A

Any breast CA with triple negative breast CA
< 40 yrs old
Synchronous and metachronous contralateral breast CA
First degree relative with breast or ovarian CA
Personal hx of ovarian CA

127
Q

Breast MRI should be done for px with high genetic risk and for those with hx of RT to the chest between ages _____

A

10-30

128
Q

In premenopausal women, lesions that are nonsuspicious on PE should be reexamined in ____ weeks during the FOLLICULAR phase of menstrual cycle

A

2-4 weeks

Day 5-7 of cycle –> best time for breast PE

129
Q

Diagnostic test recommended to evaluate cardiotoxicity of Trastuzumab

A

2d echo every 3 months but NOT after it is discontinued

130
Q

When should you give endocrine therapy in an ER PR + patient who is also pregnant

A

Delayed after the delivery

131
Q

Which has higher risk of becoming malignant? villous or tubular adenoma?

A

Villous = 3x as often as tubular

132
Q

Lynch syndrome is associated with what germline mutation

A

hMSH2 or hMLH1

133
Q

Gene implicated in Familial adenomatous polyposis

A

APC gene; there is deletion in the long arm of chromosome 5

134
Q

Which has higher risk of developing colon CA? ulcerative colitis or chron’s?

A

Ulcerative colitis

135
Q

Stage of colon CA invading muscularis propria but no LN metastasis

A

Stage II

if meron na lymph node mets, Stage III

136
Q

Predictors of poorer outcomes following total surgical resection of Colon CA

A
137
Q

Location of colon CA that may spread systemically to lungs or supraclavicular LN WITHOUT hepatic involvement

A

Distal rectum- tumor mays pread through paravertebral venous plexus –> lungs/ supraclavicular LN without hepatic involvement

138
Q

What should be added to antibiotics for febrile neutropenia if there is no obv infectious site identified and patient remained febrile despite 4-7 days of abx?

A

Broad spectrum antifungal eg.amp b or newer azoles

139
Q

Vaccines required priorto splenectomy

A

PCV 13, PPSV13 , meningococcal , Hib vaccines

140
Q

Needed FEV 1 if for pneumonectomy for lung CA

A

> 2 L

if for lobectomy, adequate na and > 1.5L

141
Q

Examples of ROS 1 inhibitors

A

Crizotinib, Lorlatinib , Entrecitinib

Si Criz and si Lor nagorder ng Entre-e sa ROStaurant

** Crizotinib and Lorlatinib also inhibit ALK

142
Q

When is surgery followed by adjuvant chemo indicated in Lung adenoCA

A

Stage IB >4 cm and stage II and III

143
Q

Tx of choice for N2 nodes in Lung CA

A

Combined chemoRT + Durvalumab

N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes

144
Q

TX for choice for Lung SCCA or non SCCA with PDL 1>= 50%

A

Pembrolizumab OR
Atezolizumab

145
Q

Most effective regimen for SCLCA confined to ipsilateral hemothorax

A

Concurrent chemoRT

146
Q

Recommended method of screening for px at risk of HCC

A

Ultrasound every 6 months with or withou AFP

At risk
> Cirrhosis of any cause
> FMHx of HCC
> Chronic HBV (with or without cirrhosis)
> Asian and > 40 yrs old
> African and > 20 yrs old

147
Q

Hallmark of HCC on 4 phase contrast enhanced CT scan

A

Contrast uptake in arterial phase and washout in venous or delayed phase

148
Q

When is biopsy required for HCC

A

if without cirrhosis and if imaging is not typical in at least one of 2 imaging techniques (CT and MRI)

149
Q

Criteria for transplant criteria for HCC

A

Single nodule <= 5 cm or <= 3 nodules each <= 3cm
no macrovascular invasion
no extrahepatic dse or comorbidities
AFP level <=1000 ng/mL

150
Q

Risk factors for cholangiocarcinoma

A

Primary sclerosing cholangitis
Biliary duct cysts/ Caroli’s dse
Hepatolithiasis
Parastic infection (Opisthorchis viverrini, Clonorchis sinensis)
HBV, HCV
Cirrhosis

151
Q

Preferred first line tx for a px with metastatic gallbladder CA with ECOG 1 status

A

Gemicitabine + Cisplatin

152
Q

For px with SCCA of the upper esophagus < 5cm from cricopharyngeus, what is the standard of care

A

Definitive chemoRT

153
Q

Molecular diagnostics impt for working up Stage IV gastric CA

A

HER2, PDL1, MSI, dMMR should be part of the pathology work up of metastatic gastric CA

154
Q

Preferred tx option for Stage 2 gastric carcinoma

A

preoperative systemic chemotx followed by resection and if tolerable postop chemo is a standard of care for stage ii - iii gastric ca

if did not undergo, preop chemo, may do post op chemoRT instead

155
Q

Most appropriate systemic tx for HER 2 + gastric and esophageal CA

A

Platinum based + Trastuzumab

156
Q

Treatment for stage III gastic MALToma positive for H.pylori and t (11;18)

A

abx for H.pylori + RT
if cannot be given RT, Rituximab

if noted progression , may give RCHOP

157
Q

Tx of choice for high risk GITS with positive cKIT mutation

A

Imatinib

158
Q

Best initial management for known px with cancer with suspected myelopathy

A

High dose dexamethasone

159
Q

most common cause of seizure in cancer patients

A

direct tumoral effect

Metastatic dse to CNS = most common in px with cancer esp with primary brain tumors

160
Q

First line definitive tx for massive hemoptysis in lung ca

A

Bronchial artery embolization

161
Q

Medication that may be given to decrease risk of developing hemorrhagic cystitis if given ifosfamide

A

MESNA or 2 mercaptoethanesulfonate

162
Q

Causes of Bone marrow transplant hemorrhagic cystitis

A

Early- usually tx related eg cyclophosphamde
Late- infection eg. Polyoma BKV or Adenovirus Type 11

163
Q

Chemotherapeutic agents that may reactivate chronic infection eg. chronic hepa B and C

A

Anti B cell antibodies (eg rituximab)

164
Q

Ipilimumab is an anti ____ agent

A

Anti CTLA4

165
Q

treatment for irinotecan associated diarrhea

A

If early- due to acetylcholine release, may give atropine

if late >24 hrs due to direct mucosal cytotoxicity from intestinal SN 38 ; tx with loperamide but may also be given atropine or octerotide for severe diarrhea

166
Q

Effect of Leucoverin on Methotrexate and 5FU

A

Methotrexate- side effects are lessened
5FU- exacerbates side effects

167
Q

MOA of Afatinib

A

anti EGFR

168
Q

Hormone directed therapy that requires pre tx with flutamide or bicalutamide to avoid initial surge in testosterone

A

LHRH agonists (goserelin and leuprolide)

169
Q

Indications for primary GCSF administration (preventive)

A

for first cycle of chemotx with:
>Probability of febrile neutropenia >= 20%
>preexisting neutropenia or active infection
>Age > 65 tx for lymphoma with curative intent or other tumors tx with similar regimen
>poor performance status
> dose dense regimen
> with extensive prior chemotherapy

170
Q

Indications for SECONDARY GCSF administration (preventive)

A

> febrile neutropenia in the cycle
if prolonged neutropenia (expected neutropenia > 7-10days) (even without fever) delays therapy

171
Q

An 80-year-old with metastatic prostate cancer is brought to the ER for bone pains. Upon consult with the palliative medicine service, the patient is prescribed oxycodone and he decides to spend his remaining time at home with his family. Which of the following is an anticipated side effect of this medication?
A. Addiction
B. Nausea
C. Constipation
D. Respiratory depression

A

C. Constipation

172
Q

A 28-year-old with refractory acute leukemia is admitted for increasing dyspnea. He has undergone multiple cycles of chemotherapy with no improvement. He is febrile, hypotensive, with crackles in bilateral lung fields on auscultation. Upon discussion with his doctor, he decides on a “do not intubate/ do not resuscitate” advance directive, since he feels that he is a burden to his family. Which of the following is being practiced in this scenario?
A. Voluntary active euthanasia
B. Involuntary active euthanasia
C. Passive euthanasia
D. Physician-assisted suicide

A

C. Passive euthanasia

Active if giving a drug
Passive since withholding only

173
Q

Which of the following cancer preventive measures has the strongest evidence?
A. High fiber diet
B. Reduction of dietary fat
C. Physical activity
D. Smoking cessation

A

D. Smoking cessation

174
Q

A 55-year-old woman comes in for a wellness check. She has no personal or family history of malignancy. She inquires about breast cancer screening. What will you advise?
A. Clinical breast examination
B. Mammogram
C. Self-examination
D. Breast cancer screening is not indicated at this time

A

B. Mammogram

175
Q

She is admitted to the medicine wards, and over the next several days her fever persists. She remains hemodynamically stable. You decide to administer G-CSF, but a repeat CBC after 2 doses now reveals: Hgb 7.0 g/dL WBC 750/uL (N0% L98%) Plt 18,000/uL. Aside from blood transfusion, you decide to order antibiotics. Which of the following is appropriate empiric therapy? (C70 P509)
A. Aztreonam
B. Ciprofloxacin
C. Gentamicin
D. Meropenem

A

D. Meropenem

if prolonged neutropenia >7 days, may give any
TZP
FEP or CAZ
MEM/ Imipinem/Cilastatin

176
Q

Which of the following malignancies predispose to infection through disruption in humoral immunity and lack of antibodies?
A. Acute lymphocytic leukemia
B. Acute myeloid leukemia
C. Hodgkin’s disease
D. Multiple myeloma

A

D. Multiple myeloma

CLL and MM = antibodies

177
Q

Which of the following conditions is most commonly associated with the signs and symptoms this patient is experiencing?
A. Adenocarcinoma of the lung
B. Hodgkin’s lymphoma
C. Mediastinal germ cell tumor
D. Squamous cell carcinoma of the lung

A

D. Squamous cell carcinoma of the lung

Small cell and squamous cell –> 85% of SVC
Primary tx: RT

178
Q

A 78-year-old man is admitted for a 1-week history of progressive back pain and weakness in both legs. He has multiple myeloma that has been followed with periodic examinations; his last assessment was 3 months ago and was stable. On PE, there is point tenderness over the T10 and T11 vertebral bodies, decreased lower extremity muscle strength (3+/5), increased reflexes isolated to both lower extremities, and bilateral extensor plantar responses. MRI of the thoracic and lumbar spine shows a vertebral body mass with extension into the epidural space at T12 and compression of the spinal cord. Which of the following is the next step in the management of this case?
A. Bisphophonates +/- denosumab
B. Decompressive surgery followed by radiation therapy
C. Multiagent chemotherapy
D. Symptomatic therapy +/- radiation therapy

A

B. Decompressive surgery followed by radiation therapy

Since may epidural mets –> surg + RT
if no epidural mets –> letter D

179
Q

A 19-year-old patient with Burkitt’s lymphoma undergoes a cycle of a chemotherapy regimen that includes rituximab. 4 days later, he develops oliguria, and a repeat metabolic panel reveals: Na 131 mmol/L, K 6.6 mmol/L, crea 2.7 mg/dL, Ca 6.89 mg/dL, P 4.40 mmol/L, Uric acid 12.0 mg/dL. What is the most likely diagnosis? (Actual PSBIM question; C71 P519)
A. Hemolytic uremic syndrome
B. Human antibody infusion reaction
C. Tumor lysis syndrome
D. Urate nephropathy

A

C. Tumor lysis syndrome

180
Q

Which of the following types of cutaneous melanoma does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion?
A. Acral lentiginous
B. Lentigo maligna
C. Nodular
D. Superficial spreading

A

C. Nodular

181
Q

Which of the following, when present in patients with metastatic melanoma, is a poor prognostic factor and places the patient in stage M1c regardless of the site of the metastasis?
A. Elevated serum LDH
B. Low serum albumin
C. Microcytic anemia
D. Visual changes with no other explanation

A

A. Elevated serum LDH

182
Q

Regardless of symptoms, what investigation is recommended in the staging of all patients with small-cell lung cancer?
A. Bone marrow aspiration and biopsy
B. Bone scintigraphy
C. Brain MRI
D. Sputum cytology

A

C. Brain MRI

182
Q

A 64-year-old man is evaluated for left-sided pleuritic chest pain, localized to the upper left chest and supraclavicular region. He is a 35-pack-year smoker. On PE, there are multiple firm, enlarged, nonmobile lymph nodes in the left supraclavicular space. The lungs are clear on auscultation. A plain chest radiograph shows a left upper lobe opacity and bilateral hilar lymphadenopathy. A chest CT scan reveals a left apical mass. Which of the following is the most appropriate diagnostic test to perform next?
A. Bronchoscopy with needle aspiration of mediastinal lymph nodes
B. Bronchoscopy with transbronchial biopsy of the left apical mass
C. Core biopsy of the left supraclavicular lymph nodes
D. CT-guided biopsy of the left apical mass

A

C. Core biopsy of the left supraclavicular lymph nodes

for lung ca with suspected mets, biopsy of distant site preferred

183
Q

Which of the following is associated with a decreased risk for breast cancer?
A. Early menarche
B. Late menopause
C. Late first pregnancy
D. Prolonged breastfeeding

A

D. Prolonged breastfeeding

**interrupted estrogen exposure

184
Q

A 38-year-old comes in for consult. She has received cycles of chest radiotherapy for non-Hodgkin lymphoma at age 19. She is well and her surveillance last year shows no recurrence. She is concerned about breast cancer due to prior radiation exposure. Physical examination, including breast exam, is normal. According to the American Cancer Society (ACS), what is the next step?
A. Annual mammogram at age 40
B. Annual mammogram starting now
C. Annual mammogram and breast MRI starting now
D. Mammogram every 2 years at age 50

A

C. Annual mammogram and breast MRI starting now

185
Q

A 24-year-old woman comes to your clinic due to a palpable breast mass she recently noted. She is currently on her period. When is the best time to perform a breast examination?
A. Days 1-4 during the menstrual phase
B. Days 5-7 during the follicular phase
C. Days 14-16 during the ovulation phase
D. Days 16-28 during the luteal phase

A

B. Days 5-7 during the follicular phase

186
Q

What was historically called the “internist’s tumor,” since it was often discovered from the initial presentation of a paraneoplastic syndrome?

A

Renal CA

187
Q

Majority of women with ovarian cancer will present at what stage?

A

Stage III

(70%0

188
Q

Pathologic examination of the most accessible biopsied tissue specimen in patients with cancer of unknown primary will most likely yield what histology?

A

Well to moderately diffrentiated adenoCA (60%A

189
Q

A 57-year-old postmenopausal woman is recently diagnosed with breast cancer after her screening mammogram. She undergoes breast- conserving surgery, and the histology shows ductal carcinoma in situ expressing estrogen receptors (ER). A decision to start tamoxifen is made. She asks about possible side effects, and you advise her to discontinue the drug when she develops which of the following?
A. Deep vein thrombosis
B. Hot flashes
C. Osteoporosis
D. Renal insufficiency

A

A. Deep vein thrombosis

190
Q

Barring any contraindications, what is the appropriate adjuvant endocrine therapy in a pre-menopausal patient with node-positive, ER (+), HER2 (-) breast cancer?
A. Aromatase inhibitors
B. Ovarian ablation + aromatase inhibitors
C. Tamoxifen
D. Trastuzamab

A

B. Ovarian ablation + aromatase inhibitors

191
Q

A 40-year-old man consults for a palpable breast mass. He has a history of chronic hepatitis B infection, alcohol abuse, and is recently diagnosed with liver cirrhosis. Which of the following explains his risk for breast cancer?
A. Age
B. High estrogen
C. Low testosterone
D. Viral hepatitis

A

B. High estrogen

192
Q

A 58-year-old man is recently diagnosed with esophageal cancer. He has no other co-morbid illnesses. He is a 40-pack year smoker and a chronic alcoholic drinker. His laboratory investigations are pertinent for anemia and hypercalcemia. What is the most likely histology of his cancer?
A. Adenocarcinoma
B. Carcinoid
C. Small cell
D. Squamous cell

A

D. Squamous cell

Hypercalcemia of malignancy common in SCCA

193
Q

T/F Esophagoscopy should be performed in ALL px suspected to have esophageal abnormality

A

True

194
Q

Which of the following is TRUE of the diffuse type of gastric adenocarcinoma?
A. They are highly associated with Epstein-Barr virus infections.
B. They are more commonly localized in the antrum and lesser curvature of the stomach.
C. They are often initiated by H. pylori infection. D. They usually develop throughout the stomach and carry a poorer prognosis compared to the intestinal type.

A

D. They usually develop throughout the stomach and carry a poorer prognosis compared to the intestinal type.

195
Q

strongest risk factor for developing pancreatic CA

A

smoking

196
Q

Most common histologic subtype of RCCA

A

clear cell (70%)

197
Q

A 77-year-old comes for a wellness check. He has a history of hypertension and diabetes and is compliant to losartan and long-acting insulin. He has a family history of prostate cancer in his paternal uncle. He reports infrequent urinary retention. A digital rectal exam (DRE) reveals a large, smooth prostate. He asks about measuring his PSA. What will be the indication to check his PSA?
A. Age
B. DRE findings
C. Family history of prostate cancer
D. Testing is not indicated at this time

A

D. Testing is not indicated at this time

198
Q

A patient with metastatic breast cancer is brought to the ER for mental status changes. Pertinent in the diagnostics is hypercalcemia (Ca 15.2 mg/dL) and hypophosphatemia (P 0.8 mmol/L). Which of the following is the BEST next step in management?
A. Aggressive hydration plus allopurinol
B. Aggressive hydration plus bisphosphonates
C. Aggressive hydration plus calcitonin
D. Aggressive hydration plus glucocorticoids

A

C. Aggressive hydration plus calcitonin

199
Q

most common cause of ectopic ACTH production?

A

Small cell lung CA

200
Q

The occurrence of breast cancer, lung cancer, and melanoma are seen as long-term treatment effects of which malignancy?
A. Head and neck cancer
B. Hodgkin’s lymphoma
C. Non-Hodgkin’s lymphoma
D. Thyroid cancer

A

B. Hodgkin’s lymphoma

201
Q
  1. Which of the following carcinogens is most related to increased incidence of lung cancer?
    A. Benzene
    B. Chromium
    C. H. Pylori
    D. Vinyl Chloride
A

B. Chromium

202
Q

What specific chromosomal deletion in colorectal cancer predicts poorer prognosis?
A. Mutation in the APC gene
B. Mutation in the b-raf gene
C. Mutation in the DCC gene
D. Mutation in the K-ras gene

A

B. Mutation in the b-raf gene

203
Q

A 55/M with hepatocellular carcinoma has single liver tumor <5cm, portal hypertension and Child Pugh B. Which of the following is the most appropriate treatment?
A.Ablation
B.Atezolizumab + Bevacizumab
C.Liver transplantation
D.Surgical resection

A

C.Liver transplantation

Satisfies Milan criteria

D is for those CP A

204
Q

Which of the following is a predictor of liver cancer development among cirrhotic patients?
A. Anemia
B. Eosinophilia
C. Leukocytosis
D. Thrombocytopenia ANSWER: C

A

C. Leukocytosis

205
Q

Mr. Divinagracia, 62/M, presenting with lower urinary tract symptoms, prostate enlargement and elevated baseline PSA underwent 12-core biopsy however had negative results. What would be the next appropriate plan?
A. Active surveillance
B. Finasteride
C. Repeat biopsy
D. Repeat PSA after 3 months

A

C. Repeat biopsy

206
Q

Mr. Tonog, 30/M, presented with thrombotic thrombocytopenic purpura after receiving Bevacizumab as treatment for his metastatic colon cancer. He will be receiving Eculizumab as treatment for his TTP. What vaccination will you give prior to therapy?
A. Hepatitis B
B. Human papilloma virus
C. Neisseria meningitidis
D. Streptococcus pneumoniae

A

C. Neisseria meningitidis

Eculizumab is a monoclonal antibody that inhibits complement protein C5, preventing the formation of the membrane attack complex (MAC). While effective in treating complement-mediated diseases such as thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), and paroxysmal nocturnal hemoglobinuria (PNH), it significantly increases the risk of infections caused by encapsulated bacteria, particularly Neisseria meningitidis.

207
Q

Mrs. Vinson was treated a week ago with Doxorubicin and high dose Ifosfamide for her metastaic soft tissue sarcoma. She developed fever and pyuria. Absolute neutrophil count is 200/uL. Culture returned coagulase negative staphylococci. What would be the best antibiotic to give?
A. Cefipime
B. Meropenem
C. Piperacillin Tazobactam
D. Vancomycin

A

D. Vancomycin

The patient has febrile neutropenia with a culture confirming coagulase-negative Staphylococci (CoNS), which is a common cause of bloodstream infections in neutropenic patients, particularly those with indwelling catheters or devices. CoNS are often resistant to beta-lactams, and the treatment of choice in this setting is vancomycin to cover for methicillin-resistant CoNS (MRCoNS).

RITE/PSBIM review (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions