Med Onco

Question 1

What is the effect of hormone replacement therapy on risk for

endometrial CA
colorectal CA
fractures
breast CA

Answer 1

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.

Question 2

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

Answer 2

● 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

Question 3

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

Answer 3

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

Question 4

How do you differentiate the luminal staging of Breast CA?

Answer 4

Question 5

Example of TKI for breast CA that targets HER2

Answer 5

Lapatinib, neratinib, tucatinib

Question 6

Example of TKI for breat CA that targets mTOR

Answer 6

Everolimus

Question 7

Example of immunotherapy for breast CA that targets CDK4/6

Answer 7

Palbciclib, ribociclib, abemociclib

Question 8

Example of immunotherapy for breast CA that targets PIK3CA

Answer 8

Alpelisib

Question 9

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

Answer 9

Atezolizumab

Question 10

Example of immunotherapy for breast CA that targets TROP 2

Answer 10

Sacizutumab govitecan

Question 11

Example of SERMs

Answer 11

Tamoxifen, Raloxifene, Toremifene

Question 12

Example of Aromatase inhibitors

Answer 12

Anastrozole, Letrozole, Exemestane

Question 13

Example of LHRH agonists

Answer 13

goserelin, leuprolide

Question 14

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

Answer 14

Basal

Question 15

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

Answer 15

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

Question 16

How is breast CA prognosis affected by pregnancy?

Answer 16

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

Question 17

How does fats affect the risk of prostate CA?

Answer 17

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

Question 18

Medications that prevent prostate CA

Answer 18

Currently, no approved preventive agent for prostate cancer

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

MRI

Question 21

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.

Answer 21

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).

Question 22

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

Answer 22

Peripheral

Question 23

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

Answer 23

Small Cell lung CA

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

Question 24

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

Answer 24

RT

Question 25

Most common type of malignancy causing metastatic spinal cord compression

Answer 25

Lung CA

Question 26

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

Answer 26

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

Question 27

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

Answer 27

MRI of the spine

Question 28

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

Answer 28

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.

Question 29

Electrolyte abnormalities associated with Tumor Lysis syndrome

Answer 29

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.

Question 30

Tumors associated with TLS

Answer 30

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

Question 31

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

Answer 31

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.

Question 32

How do you prevent TLS?

Answer 32

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

Question 33

Indications for HD if with TLS

Answer 33

Question 34

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

Answer 34

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

Question 35

What is the primary therapy or prevention for polyposis coli?

Answer 35

Total colectomy

Question 36

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

Answer 36

5-FU

Question 37

Most common site of distant metastasis in colorectal cancer

Answer 37

Liver

Question 38

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

Answer 38

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

Question 39

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

Answer 39

Question 40

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

Answer 40

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.

Question 41

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

Answer 41

PMNs

Question 42

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?

Answer 42

Metoclopramide

Question 43

ideal time to administer primary G-CSF prophylaxis

Answer 43

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

Continue until ANC > 10,000 /uL

Question 43

What are the preventive uses of G-CSF?

Answer 43

Question 44

Dose of G-CSF

Answer 44

Question 45

pathognomonic finding of anthracycline-induced cardiotoxicity

Answer 45

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.

Question 46

Chemotherapy or hormonal agents associated with CHF

Answer 46

Question 47

Chemotherapy or hormonal agents associated with Pulmonary fibrosis

Answer 47

Question 48

Chemotherapy or hormonal agents associated with pneumonitis

Answer 48

Question 49

Chemotherapy or hormonal agents associated with secondary malignancies or myelodysplasia

Answer 49

Question 50

Chemotherapy or hormonal agents associated with immune dysfunction and recurrent infections

Answer 50

Question 51

Chemotherapy or hormonal agents associated with infertility

Answer 51

Question 52

Chemotherapy or hormonal agents associated with hemorrhagic cystitis

Answer 52

Question 53

Chemotherapy or hormonal agents associated with renal tubular dysfunction

Answer 53

Question 54

Chemotherapy or hormonal agents associated with neuropathy

Answer 54

Question 55

Chemotherapy or hormonal agents associated with ataxia

Answer 55

Question 56

Chemotherapy or hormonal agents associated with vasomotor symptoms

Answer 56

Question 57

Chemotherapy or hormonal agents associated with sexual dysfunction

Answer 57

Question 58

most significant risk factor for cancer overall

Answer 58

age

Question 59

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

Answer 59

3

Question 60

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

Answer 60

Question 61

Definition of progressive dse based on RECIST criteria

Answer 61

Question 62

Conditions associated with elevated HCG

Answer 62

Question 63

Conditions associated with elevated calcitonin

Answer 63

Question 64

Conditions associated with elevated catecholamines

Answer 64

Question 65

Conditions associated with elevated AFP

Answer 65

Question 66

Conditions associated with elevated prostatic acid phosphatase

Answer 66

Question 67

Conditions associated with elevated neuron specific enolase

Answer 67

Question 68

Conditions associated with elevated LDH

Answer 68

Question 69

Conditions associated with elevated PSA

Answer 69

Question 70

Conditions associated with elevated monoclonal globulin

Answer 70

Question 71

Conditions associated with elevated CA19-9

Answer 71

Question 72

Conditions associated with elevated CD 30

Answer 72

Question 73

Conditions associated with elevated CD 25

Answer 73

Question 74

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

Answer 74

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

Question 75

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

Answer 75

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

Question 75

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

Answer 75

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)

Question 76

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

Answer 76

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

Question 77

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

Answer 77

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

Question 78

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

Answer 78

Ponatinib

Question 79

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

Answer 79

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

Question 80

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

Answer 80

Olaparib

Question 81

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

Answer 81

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)

Question 82

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

Answer 82

Answer: D. Methotrexate

Question 83

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

Answer 83

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

Question 84

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

Answer 84

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).

Question 85

25. 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

Answer 85

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.

Question 86

Contraindications for curative resection for lung CA

Answer 86

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

Question 87

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

Answer 87

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.

Question 88

Recommended 1st line tx for metastatic thymoma

Answer 88

CAP protocol

Cisplatin, Doxorubicin, Cyclophosphamide

Question 89

Etiologic factors assoc with esophageal adeno CA

Answer 89

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

Question 90

Risk factors for SCCA of the esophagus

Answer 90

Question 91

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

Answer 91

Esophageal UTZ

Question 92

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

Answer 92

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.

Question 93

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

Answer 93

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)

Question 94

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

Answer 94

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

Question 95

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

Answer 95

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

Question 96

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

Answer 96

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

Question 97

What is the most common molecular aberration in hepatocellular carcinoma?

Answer 97

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.

Question 98

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

Answer 98

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.

Question 99

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

Answer 99

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

Question 100

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

Answer 100

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

Question 101

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

Answer 101

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).

Question 102

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

Answer 102

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%)

Question 103

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

Answer 103

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

Question 104

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

Answer 104

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).

Question 105

Examples of highly emetogenic chemo drug

Answer 105

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

Prevention: Dexa, 5HT3 antagonist, neurokinin receptor antagonit

Question 106

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

Answer 106

PFT with DLCO

Question 107

Age to start screening for mammography

Answer 107

40-provide opportunity

Question 108

How frequent should mammography be done for screening breast CA

Answer 108

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

Question 109

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

Answer 109

Question 110

When can you stop screening for cervical CA using pap smear

Answer 110

if more than 65 yrs and with negative prior screening

Question 111

Age to start screening for colon CA

Answer 111

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

Question 112

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

Answer 112

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

Question 113

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

Answer 113

Question 114

What screening should be used to screen for ovarian CA

Answer 114

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

Question 115

When should you start screening for prostate CA

Answer 115

Question 116

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

Answer 116

inverse

Question 116

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

Answer 116

Angiosarcoma of the liver

Question 117

Chromium is a carcinogen associated with what CA

Answer 117

Lung CA

Question 118

Phenacetin is a carcinogen associated with what CA

Answer 118

Cancer of the renal pelvis and bladder

Question 119

Diethylstilbestrol is a carcinogen associated with what CA

Answer 119

clear cell vaginal CA

Question 120

Benzene is a carcinogen associated with what CA

Answer 120

AML

Question 121

Aromatic amines is a carcinogen associated with what CA

Answer 121

bladder CA

Question 122

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

Answer 122

MRI

Question 123

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

Answer 123

6

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

Question 124

MOA of Abiraterone

Answer 124

Antiandrogen ; CYP17 inhibitor

Question 125

Risk factors of breast CA

Answer 125

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

Question 126

Indications for testing for BRCA1/2 mutations

Answer 126

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

Question 127

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

Answer 127

10-30

Question 128

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

Answer 128

2-4 weeks

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

Question 129

Diagnostic test recommended to evaluate cardiotoxicity of Trastuzumab

Answer 129

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

Question 130

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

Answer 130

Delayed after the delivery

Question 131

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

Answer 131

Villous = 3x as often as tubular

Question 132

Lynch syndrome is associated with what germline mutation

Answer 132

hMSH2 or hMLH1

Question 133

Gene implicated in Familial adenomatous polyposis

Answer 133

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

Question 134

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

Answer 134

Ulcerative colitis

Question 135

Stage of colon CA invading muscularis propria but no LN metastasis

Answer 135

Stage II

if meron na lymph node mets, Stage III

Question 136

Predictors of poorer outcomes following total surgical resection of Colon CA

Answer 136

Question 137

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

Answer 137

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

Question 138

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?

Answer 138

Broad spectrum antifungal eg.amp b or newer azoles

Question 139

Vaccines required priorto splenectomy

Answer 139

PCV 13, PPSV13 , meningococcal , Hib vaccines

Question 140

Needed FEV 1 if for pneumonectomy for lung CA

Answer 140

> 2 L

if for lobectomy, adequate na and > 1.5L

Question 141

Examples of ROS 1 inhibitors

Answer 141

Crizotinib, Lorlatinib , Entrecitinib

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

** Crizotinib and Lorlatinib also inhibit ALK

Question 142

When is surgery followed by adjuvant chemo indicated in Lung adenoCA

Answer 142

Stage IB >4 cm and stage II and III

Question 143

Tx of choice for N2 nodes in Lung CA

Answer 143

Combined chemoRT + Durvalumab

N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes

Question 144

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

Answer 144

Pembrolizumab OR
Atezolizumab

Question 145

Most effective regimen for SCLCA confined to ipsilateral hemothorax

Answer 145

Concurrent chemoRT

Question 146

Recommended method of screening for px at risk of HCC

Answer 146

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

Question 147

Hallmark of HCC on 4 phase contrast enhanced CT scan

Answer 147

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

Question 148

When is biopsy required for HCC

Answer 148

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

Question 149

Criteria for transplant criteria for HCC

Answer 149

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

Question 150

Risk factors for cholangiocarcinoma

Answer 150

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

Question 151

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

Answer 151

Gemicitabine + Cisplatin

Question 152

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

Answer 152

Definitive chemoRT

Question 153

Molecular diagnostics impt for working up Stage IV gastric CA

Answer 153

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

Question 154

Preferred tx option for Stage 2 gastric carcinoma

Answer 154

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

Question 155

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

Answer 155

Platinum based + Trastuzumab

Question 156

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

Answer 156

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

if noted progression , may give RCHOP

Question 157

Tx of choice for high risk GITS with positive cKIT mutation

Answer 157

Imatinib

Question 158

Best initial management for known px with cancer with suspected myelopathy

Answer 158

High dose dexamethasone

Question 159

most common cause of seizure in cancer patients

Answer 159

direct tumoral effect

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

Question 160

First line definitive tx for massive hemoptysis in lung ca

Answer 160

Bronchial artery embolization

Question 161

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

Answer 161

MESNA or 2 mercaptoethanesulfonate

Question 162

Causes of Bone marrow transplant hemorrhagic cystitis

Answer 162

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

Question 163

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

Answer 163

Anti B cell antibodies (eg rituximab)

Question 164

Ipilimumab is an anti ____ agent

Answer 164

Anti CTLA4

Question 165

treatment for irinotecan associated diarrhea

Answer 165

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

Question 166

Effect of Leucoverin on Methotrexate and 5FU

Answer 166

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

Question 167

MOA of Afatinib

Answer 167

anti EGFR

Question 168

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

Answer 168

LHRH agonists (goserelin and leuprolide)

Question 169

Indications for primary GCSF administration (preventive)

Answer 169

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

Question 170

Indications for SECONDARY GCSF administration (preventive)

Answer 170

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

Question 171

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

Answer 171

C. Constipation

Question 172

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

Answer 172

C. Passive euthanasia

Active if giving a drug
Passive since withholding only

Question 173

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

Answer 173

D. Smoking cessation

Question 174

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

Answer 174

B. Mammogram

Question 175

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

Answer 175

D. Meropenem

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

Question 176

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

Answer 176

D. Multiple myeloma

CLL and MM = antibodies

Question 177

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

Answer 177

D. Squamous cell carcinoma of the lung

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

Question 178

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

Answer 178

B. Decompressive surgery followed by radiation therapy

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

Question 179

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

Answer 179

C. Tumor lysis syndrome

Question 180

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

Answer 180

C. Nodular

Question 181

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

Answer 181

A. Elevated serum LDH

Question 182

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

Answer 182

C. Brain MRI

Question 182

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

Answer 182

C. Core biopsy of the left supraclavicular lymph nodes

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

Question 183

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

Answer 183

D. Prolonged breastfeeding

**interrupted estrogen exposure

Question 184

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

Answer 184

C. Annual mammogram and breast MRI starting now

Question 185

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

Answer 185

B. Days 5-7 during the follicular phase

Question 186

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

Answer 186

Renal CA

Question 187

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

Answer 187

Stage III

(70%0

Question 188

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

Answer 188

Well to moderately diffrentiated adenoCA (60%A

Question 189

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

Answer 189

A. Deep vein thrombosis

Question 190

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

Answer 190

B. Ovarian ablation + aromatase inhibitors

Question 191

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

Answer 191

B. High estrogen

Question 192

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

Answer 192

D. Squamous cell

Hypercalcemia of malignancy common in SCCA

Question 193

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

Answer 193

True

Question 194

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.

Answer 194

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