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Onco Flashcards

1
Q

Which of the following statements BEST describes visceral pain?

a. It is the result of chemical stimulation of nociceptors and normal neural signaling to the brain.

b. It is described as localized, aching, throbbing or cramping.

c. It is deep or colicky type of pain classically associated with pancreatitis.

d. It is described by patients as burning, electrical, or shock-like pain.

A

It is deep or colicky type of pain classically associated with pancreatitis.

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2
Q

The proportion of persons without the condition who test negative in a screening test is otherwise known as:

a. Positive predictive value

b. Negative predictive value

c. Sensitivity

d. Specificity

A

Specificity

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3
Q

What type of bias occurs when the tumor is detected by screening at an earlier stage than that at which it becomes clinically diagnosed?

a. Lead time bias

b. Length time bias

c. Selection Bias

d. Overdiagnosis

A

Lead time bias

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4
Q

Which of the following is the most common cause of an intracranial hemorrhagic metastasis?

a. Breast

b. Kidney

c. Lung

d. Thyroid

A

Lung

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5
Q

Which of the following drugs is the antiepileptic agent of choice for patients with brain tumors who present with seizures?

a. Carbamazepine

b. Clonazepam

c. Levetiracetam

d. Phenytoin

A

Levetiracetam

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6
Q

Which of the following screening tests is recommended in the patient described below?

a. 44/M with no family history of colon cancer: fecal occult blood test

b. 52/F at average risk of breast cancer, no family history of breast cancer: mammography every other year

c. 66/F at average risk of cervical cancer, with no prior history of cervical cancer or abnormal Pap smears: Pap screening every 3 years.

d. 70/M, former smoker who smoked 2 packs of cigarettes a day for 30 years, who quit smoking at age 60: annual chest x-ray.

A

52/F at average risk of breast cancer, no family history of breast cancer: mammography every other year

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7
Q

A 25/M with lymphoma presented with difficulty of breathing on follow-up at the outpatient department. He denied having cough, fever or sputum production. Two weeks ago, he presented with the same symptoms, with findings of pleural effusion on the right. Thoracentesis drained 1L of pleural fluid, which resolved the patient’s symptoms. PE showed stable vital signs, with decreased breath sounds over the right lower lung field. Initial workup showed a homogenous opacity on the right lung from mid to base with meniscal formation. What is the most appropriate next step for the patient?

a. Chest CT with IV Contrast

b. Broad spectrum antibiotics

c. Repeat Thoracentesis

d. Chest tube insertion

A

Chest tube insertion

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8
Q

Infection with Human papilloma virus can increase the risk of developing what type of cancer?

a. Kaposi’s sarcoma

b. Nasal T-cell lymphoma

c. Oropharyngeal carcinoma

d. Skin cancer (squamous cell and melanoma)

A

Oropharyngeal carcinoma

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9
Q

All of the following have been identified as risk factors for the development of squamous cell carcinoma of the head and neck EXCEPT:

a. Alcohol consumption

b. Tobacco consumption

c. Human papillomavirus infection

d. Treatment of prior head and neck cancer

A

Treatment of prior head and neck cancer

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10
Q

Which of the following risk factors is associated with both adenocarcinoma and squamous cell carcinoma of the esophagus?

a. Male sex

b. Cigarette smoking

c. Chronic gastroesophageal reflux disease

d. Excess alcohol consumption

A

Cigarette smoking

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11
Q

A 35/F diagnosed with breast cancer presents at the OPD with a 2-day history of fever (Tmax 38.9°C). She reports lightheadedness and shortness of breath. She received a cycle of doxorubicin + cyclophosphamide chemotherapy 10 days ago. On review of records, her pre-treatment CBC was Hgb 10.8 g/dL, WBC 8,500/µL, Platelets 204,000/µL. Her latest CBC now reveals: Hgb 8.5 g/dL WBC 1,700/µL, Neutrophils 35%, Lymphocytes 62%, Platelets 38,000/µL. PE showed BP 95/60, RR 28 breaths/min and O2 saturation 95% on room air. What is the most appropriate therapy for this patient?

a. Start broad-spectrum oral antibiotics, continue until afebrile, and follow up as an outpatient in 1 week.

b. Start broad-spectrum oral antibiotics, continue until neutropenia resolves, and follow up as an outpatient in 1 week

c. Admit to the hospital, start broad-spectrum IV antibiotics, and continue until neutropenia resolves.

d. Admit to the hospital, start broad-spectrum IV antibiotics, continue treatment until an infection source is found and patient is afebrile.

A

Admit to the hospital, start broad-spectrum IV antibiotics, and continue until neutropenia resolves.

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12
Q

A 50/F is treated with paclitaxel and carboplatin chemotherapy for Stage IIIB lung adenocarcinoma. She presents with fever 38.3°C and erythema at the exit site of her tunneled catheter. Blood cultures done were negative for any pathogen. Her ANC is 1550/μL. Which of the following is the most appropriate next step?

a. Remove IV catheter immediately

b. Begin treatment with ceftazidime and vancomycin

c. Begin treatment with vancomycin alone

d. Give vancomycin in addition to IV catheter removal

A

Begin treatment with vancomycin alone

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13
Q

A 40/F smoker came into the clinic due to an incidental finding of a 4-mm solitary, well-delineated solid pulmonary nodule with no calcifications on chest x-ray. Previous imaging studies showed no pulmonary nodules. What will you advise the patient?

a. No follow-up needed

b. Follow-up at 12 months; if unchanged, no further follow-up

c. Follow-up CT at 6-12 months; then 18-24 months if no change

d. Follow-up CT at 3, 9, and 24 months; dynamic contrast enhanced CT, PET, and/or biopsy

A

Follow-up at 12 months; if unchanged, no further follow-up

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14
Q

What is the likely histologic subtype of a right middle lobe mass initially read as poorly differentiated lung carcinoma, with the following immunohistochemical staining results: CK7 (+), CK20 (-), TFT1 (+), Napsin-A (+), p63 (-)?

a. Small cell lung carcinoma

b. Squamous cell carcinoma

c. Adenocarcinoma

d. Mesothelioma

A

Adenocarcinoma

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15
Q

Which of the following is the recommended surveillance for hepatocellular carcinoma when an incidental hepatic nodule of <1 cm has been detected?

a. Ultrasonography every 3 months

b. Computed tomography every 3 months

c. Ultrasonography every 6 months

d. Computed tomography every 6 months

A

Ultrasonography every 3 months

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16
Q

A patient presents with liver only neoplastic disease, no symptoms, and with mild to moderate liver dysfunction (Child-Pugh A-B) with three hepatic nodules of ≤3 cm in diameter. Which of the following is the correct staging for the patient?

a. Very early HCC (BCLC 0)

b. Early HCC (BCLC A)

c. Intermediate HCC (BCLC B)

d. Advanced HCC (BCLC C)

A

Early HCC (BCLC A)

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17
Q

Which of the following features are associated with higher probability of malignancy among gastrointestinal polyps?

a. Sessile

b. Pedunculated

c. Hyperplastic

d. <1.5 cm in size

A

Sessile

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18
Q

All of the following factors are associated with an increased risk to develop breast cancer EXCEPT:

a. Full-term pregnancy early in life

b. Longer duration of breastfeeding

c. Moderate alcohol intake

d. Diagnosis of depression

A

Longer duration of breastfeeding

19
Q

Which of the following is recommended in surveillance guidelines for breast cancer patients after primary and adjuvant therapy during routine follow-up?

a. Breast self-examination every 3 months

b. Mammography every 6 months

c. Pelvic exam annually as per age appropriate guidelines

d. Transvaginal endometrial ultrasonography annually

A

Pelvic exam annually as per age appropriate guidelines

20
Q

A 58/F diagnosed with stage I breast cancer asks about her prognosis. You will tell her that the percentage of breast cancer patients with similar stage as hers who are still alive after 5 years is:

a. 99%

b. 92%

c. 72%

d. 65%

A

92%

21
Q

A 48/F postmenopausal patient underwent modified radical mastectomy of the right breast after a core needle biopsy showed invasive ductal carcinoma. Post-operative staging is stage IA (T1N0M0) and immunohistochemistry staining showed ER +3/ +5, PR +3, HER2 +1. What is the recommended systemic adjuvant therapy?

a. Chemotherapy + trastuzumab

b. Chemotherapy + trastuzumab + tamoxifen

c. Tamoxifen for 5 years

d. Aromatase inhibitor for 5 years

A

Aromatase inhibitor for 5 years

22
Q

Which of the following dietary factors is associated with increased risk for prostate cancer growth and progression?

a. Lycopene

b. a-linoleic acid

c. Isoflavonoid genistein

d. Isothiocyanate sulforaphane

A

a-linoleic acid

23
Q

All of the following statements regarding prostate cancer prevention are true EXCEPT:

a. Lycopene found in tomatoes may be protective against prostate cancer.

b. 5α-reductase inhibitors have been shown in randomized controlled trials to reduce the risk of developing prostate cancer.

c. There are no agents currently approved for the prevention of prostate cancer.

d. Vitamin E has been shown in clinical trials to reduce the risk of developing prostate cancer.

A

Vitamin E has been shown in clinical trials to reduce the risk of developing prostate cancer.

24
Q

A monoclonal antibody that targets the epithelial growth factor receptor (EGFR):

a. Alemtuzumab

b. Bevacizumab

c. Cetuximab

d. Pertuzumab

A

Cetuximab

25
Q

A 56-year-old male presents to your clinic with abdominal CT scan showing a 3 cm contrast-enhancing right liver lobe mass. The rest of the liver findings show homogenous echopattern with no evidence of cirrhosis. There are no other abnormalities identified. He is non-alcoholic with the following serologic data:

HBs Ag (-), AntiHBs (+), AntiHCV (-). Your oncology consultant recommended biopsy of the liver mass. What could be the basis of this recommendation?

a. Solitary nature of the lesion
b. Location of the liver mass
c. The absence of enlarged lymph nodes or intestinal wall thickening on CT scan
d. The absence of background cirrhosis on CT scan

A

d. The absence of background cirrhosis on CT scan

26
Q

A 62-year-old male has a long-standing history of Hepatitis B cirrhosis. He had been undergoing a screening protocol with ultrasound and AFP every 6 months. However, a recent ultrasound reveals a 0.8 cm nodule in the left hepatic lobe. What will you do next?
a. Repeat ultrasound in 4 months
b. Order a dynamic contrast-enhanced MRI
c. Change surveillance imaging to CT scan with IV contrast
d. Refer to an interventional radiologist for biopsy

A

a. Repeat ultrasound in 4 months

27
Q

A 56-year-old male has been recently diagnosed with HCC. The solitary liver mass is 2.5 cms . His Child Pugh Score is A and ECOG PS is 0. What other information is necessary to plan out the patient’s treatment?

a. Serum bilirubin
b. Protime
c. Immunologic panel
d. Hepatitis serologic profile

A

a. Serum bilirubin

28
Q

A 70-year-old asymptomatic man has a recent PSA of 4.3 ng/mL. When evaluating the significance of this elevated PSA in pursuing further diagnostic modalities, which of the following is considered the foremost consideration?
a. Presence of comorbidities
b. Family history of malignancy
c. Abnormal finding on DRE
d. Estimated life expectancy

A

d. Estimated life expectancy

29
Q

The diagnosis of a castrate-resistant metastatic prostate cancer is based on disease progression despite:

a. Serum testosterone not more than 50ng/mL
b. Docetaxel chemotherapy
c. Bicalutamide and Abiraterone therapy
d. Multiple lines of treatment

A

a. Serum testosterone not more than 50ng/mL

30
Q

A 36-year-old man diagnosed with nasopharyngeal cancer will undergo daily radiotherapy concurrent with high dose Cisplatin chemotherapy every 21 days. The most appropriate antiemetic regimen for this patient should include:

a. A neurokinin 1 inhibitor and dexamethasone
b. A neurokinin 1 inhibitor, dexamethasone, and antidopaminergic phenothiazine
c. A serotonin antagonist, neurokinin 1 inhibitor, and dexamethasone
d. A serotonin antagonist, dexamethasone, and antidopaminergic phenothiazine

A

c. A serotonin antagonist, neurokinin 1 inhibitor, and dexamethasone

31
Q

A 22y/o female was diagnosed with mediastinal Hodgkin’s Lymphoma Stage II and completed 4 cycles of ABVD regimen underwent radiotherapy. Her risk for secondary malignancy would warrant including this test as part of her long-term surveillance.
a. Thyroid ultrasound
b. Breast MRI
c. Chest CT scan
d. Head and Neck CT scan

A

b. Breast MRI

32
Q

A 45-year-old male consults for advice on colorectal cancer prevention. His father was diagnosed with colorectal CA at the age of 55. Patient is inquiring about dietary measures to prevent occurrence of colon CA. How will you advise the patient?
a. Ketogenic diet has recently been found to prevent colorectal CA
b. It is best to minimize animal fat in diet as this has been associated with increased occurrence of colon CA
c. A diet rich in fibers have been definitely proven to decrease risk of colorectal CA
d. DASH diet also has benefit in decreasing risk for colorectal CA

A

b. It is best to minimize animal fat in diet as this has been associated with increased occurrence of colon CA

33
Q

A 40-year-old female banker is admitted for executive check-up. She is asymptomatic, with no comorbidities. She underwent total hysterectomy for myoma 3 years ago. She is a nonsmoker and occasional alcoholic beverage drinker. She has no personal or family history of cancer.
Which cancer screening test is recommended for her?

a. Colonoscopy
b. Mammography
c. Pap test with HPV test
d. Transvaginal ultrasound

A

b. Mammography

34
Q

Which of the following patients would require an MRI as part of breast cancer screening?

a. 30 y/o with BRCA 1 gene mutation
b. 50 y/o with previous history of breast cancer
c. 40 y/o with BMI >40
d. 60y/o with previous history of chest wall irradiation 5 years ago

A

a. 30 y/o with BRCA 1 gene mutation

35
Q

Which of the following is associated with increased risk of breast cancer?

a. Late menarche
b. Late first full-term pregnancy
c. Early menopause
d. High fat diet

A

b. Late first full-term pregnancy

36
Q

A 44-year-old premenopausal woman had a screening mammogram revealing an abnormality in the right breast despite having no palpable mass on physical examination. Core needle biopsy revealed ductal carcinoma in situ. What is the 5-year survival rate for this patient?
a. 65%
b. 82%
c. 92%
d. 99%

A

d. 99%

37
Q

A 35-year-old female, premenopausal teacher has a 7 cm breast mass in the right upper inner quadrant. Core needle biopsy revealed Invasive Ductal Carcinoma grade 3, ER+PR+ and HER2NEU +1. Baseline chest x-ray, bone scan, and liver ultrasound showed no evidence of metastases. Which is an appropriate recommendation?

a. Neoadjuvant chemotherapy then MRM followed by adjuvant chemotherapy and radiotherapy, then hormonal treatment.
b. Modified radical mastectomy (MRM), adjuvant chemotherapy with concurrent tamoxifen and trastuzumab
c. MRM then adjuvant chemotherapy then Aromatase Inhibitor x 5 years.
d. Breast conserving surgery followed by radiotherapy and trastuzumab

A

a. Neoadjuvant chemotherapy then MRM followed by adjuvant chemotherapy and radiotherapy, then hormonal treatment.

38
Q

Which of the following is not an endogenous factor favoring growth of nitrate-converting bacteria in the stomach (as a factor in the causation of gastric carcinoma)?

a. Decreased gastric acidity
b. Prior gastric surgery (antrectomy) (15- 20-year latency period)
c. Atrophic gastritis and/or pernicious anemia
d. H. pylori infection

A

d. H. pylori infection

39
Q

A 52-year-old male, chronic smoker is admitted due to dysphagia and dyspnea. He is cachectic with notable pale palpebral conjunctivae. Pertinent results revealed FOBT positive and hemoglobin of 8g/dl. Neither lymphadenopathies nor hepatomegaly are noted. What diagnostic work-up will you request next?

a. Barium swallow
b. CT scan of the abdomen
c. PET scan
d. Upper Endoscopy

A

d. Upper Endoscopy

40
Q

Who among the following individuals need to undergo screening for colorectal cancer?

a. 40/M who has S.bovis endocarditis
b. 20/F, smoker of 5 pack years
c. 55/F with irritable bowel syndrome
d. 30/M, who is on a vegan diet

A

a. 40/M who has S.bovis endocarditis

41
Q

A patient underwent hemicolectomy due to mass in the descending colon associated with hematochezia. On biopsy, the tumor was found to invade up to the muscularis propria with 2/12 lymph nodes found to have metastasis. Further work-up of this patient did not reveal any metastases to the bone, liver, or brain. What is the stage of the patient’s colon CA?

a. Stage I
b. Stage II
c. Stage III
d. Stage IV

A

c. Stage III

42
Q

A 55-year-old female complains of fatigue and palpitations when doing housework. On PE, she has pale palpebral conjunctivae and palmar pallor. CBC shows microcytic, hypochromic anemia with increased red cell width. She denies any overt bleeding or changes in bowel habits. Family history reveals some 1st and second-degree relatives were diagnosed with different solid malignancies. Other than tests to confirm iron-deficiency as a cause of anemia, which of the following should be your next step in the evaluation of this patient?

a. Whole abdomen CT scan with triple phase contrast
b. Fecal occult blood
c. Colonoscopy
d. Flexible proctosigmoidoscopy

A

c. Colonoscopy

43
Q

After undergoing colonoscopy due to a positive FOBT, a 35/M was diagnosed with polyposis coli. Surgery was strongly recommended; however, he was still hesitant due to cost and substantial morbidity. In the meantime, what medication can we give as a temporizing strategy that may decrease polyp number and size?

a. Dexamethasone
b. Celecoxib
c. Rifaximin
d. Psyllium

A

b. Celecoxib

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