Test 3 Flashcards by Kristin Connolly

One of the first cause/effect correlations made by Ramazzini concerning cancer was

a. Tobacco and lung cancer
b. Sexual activity and cervical cancer
c. Sexual activity and prostate cancer
d. Leather industry and nasal cancer

b. Sexual activity and cervical cancer

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What is epidemiology

a. Study of people and their interactions with others
b. Study of the relationship between organisms and their environment
c. Study of the causes of disease
d. The study of distribution and causes of diseases in populations

d. The study of distribution and causes of diseases in populations

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Which of the following is NOT a modifiable risk factor?

a. Genetics
b. Exercise
c. Diet
d. Smoking

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Which virus is not linked to increased cancer risk?

a. EBV (Epstein Barr virus)
b. HPV (human papillomavirus)
c. Hepatitis B
d. Influenza virus

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Which is not a goal of cancer epidemiology?

a. To uncover environmental risks
b. To uncover new etiologic leads
c. All of these are goals of cancer epidemiology
d. To investigate predictors of survival
e. To assess efficacy of preventive measures

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Which is the correct definition for mortality?

a. Number of death due to a specific disease
b. Deaths per population
c. Number of death occurring within a unit of time
d. Number of deaths due to a specific disease within a defined population in a given period of time

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Which of the following measurements are used to quantify the burden of disease on a population?

a. Potential years of life lost
b. Quality adjusted life years
c. All of these are use to quantify burden of disease
d. Disability adjusted life years

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Which term is used for the measurement of new cases occurring within a population?

a. Incidence
b. Occurrence
c. Prevalence
d. Mortality

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What is the purpose of relative survival?

a. Adjusts for normal life expectancy
b. Allows comparison between different populations
c. Allows for completion of data sets
d. Allows for better quality of information for patients wanting to know success of treatment options

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Which type of of studies are designed to answer the questions who, what, when, and where?

a. Both descriptive and analytic
b. Descriptive
c. Analytic
d. Neither descriptive and analytic

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(T or F) There are many points along the natural history of cancer when interventions may be initiated to prevent progression.

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Concerning the natural history of cancer, how many years generally passes between toxic exposures and the detection of cancer?

a. It happens instantly
b. 1 year
c. 10 or more years

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When are makers for risk factors useful?

a. Once cancer has developed but before it has been diagnosed
b. Once cancer treatment has begun
c. Once cancer has been diagnosed
d. Before cancer develops

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Which level of prevention is indicated once a cancer diagnosis has been made?

a. Secondary prevention
b. Primary prevention
c. Primordial/societal prevention
d. Tertiary prevention

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Which level of prevention is focused on health promotion from an economic, structural, urban planning locus?

a. Primordial/societal prevention
b. Tertiary prevention
c. Secondary prevention
d. Primary prevention

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Which level of prevention is focused on treating or preventing risk factors?

a. Primordial/societal prevention
b. Tertiary prevention
c. Primary prevention
d. Secondary prevention

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Which of the following is an example of tertiary prevention?

a. Needle exchange
b. Monitoring for early detection of cancer
c. Chemotherapy
d. Vaccine development

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Which of the following is an example of a secondary prevention?

a. Needle exchange
b. Pain management and hospice
c. Condoms
d. Pap test for the early detection of cervical dysplasia

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Myeloproliferative disorders can mimic benign or reactive blood conditions.

a. False, because myeloproliferative disorders are too poorly differentiated to be mistaken as benign
b. True, because many conditions can cause an increase in blood products

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Which of the following is NOT true about CALR?

a. One study found it to be more associated with abnormal blood markers than JAK2
b. It’s a Ca++ binding protein located primarily in the endoplasmic reticulum
c. Type 1 and type 2 mutations have the same effect on thrombopoiesis
d. CALR mutations are associated with lower hemoglobin and leukocyte counts

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Which of the following are established risk factors for polycythemia vera? (multiple)

a. Males
b. Malnutrition
c. Exposures to intense radiation
d. Certain genetic mutations
e. Individuals over the age of 60
f. Individuals under the age of 20
g. Females

a, c, d, e

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(T or F) Presence of the JAK2 mutation is required for the diagnosis of polycythemia vera.

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Which is considered best practice for the treatment of low-risk polycythemia vera?

a. Allopurinol
b. Low dose aspirin
c. Phlebotomy
d. Ruxolitinib

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In polycythemia vera, phlebotomy is associated with (multiple)

a. Decreased risk of leukemic transformation
b. Increased risk of thrombotic events
c. Increased risk of leukemic transformation
d. Decreased risk of thrombotic events

a and d

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Which of the following is the most indolent myeloproliferative disorders? a. Essential thrombocytosis b. Polycythemia vera c. Chronic myelogenous leukemia d. Myelofibrosis

What percentage of patients with essential thrombocytosis are asymptomatic? a. 25% b. 50% c. 5% d. 80%

What does the term 'triple negative' refer to in myeloproliferative disorders? a. Absence of JAK2, CALR or MPL mutations b. The tumor is not sensitive to any hormones c. A patient who has been misdiagnosed 3 times d. A rare presentation in which RBCs, WBCs and platelets are unaffected

(T or F) Females and individuals over 60 are at greater risk of developing essential thrombocytosis.

Which of the following is true about systemic mastocytosis? a. It's fairly common in middle aged individuals b. It is caused by a mutation which leads to an overproduction of white blood cells c. Symptom presentation is usually limited to the skin d. It is caused by a mutation leading to an overproduction of mast cells

Which of the following is the 'minor' criteria for essential thrombocythemia diagnosis? a. Bone marrow biopsy showing proliferation of the megakaryocytic lineage b. Platelet count >450x109 c. Presence of JAK2, CALR, or MPL mutation d. Presence of clonal marker or absence of evidence for reactive thrombocytosis

What is the most common presenting complaint in primary myelofibrosis? a. Anemia b. Bone pain c. Weight loss d. Severe fatigue

(T of F) Due to the nature of the disease, primary myelofibrosis always requires use of a JAK1/JAK2 inhibitor.

The major criterion for diagnosis of systemic mastocytosis requires there be multifocal, dense aggregates of at least _____ mast cells in the bone marrow or other extracutaneous organs. a. 50 b. 15 c. 150 d. 5

Hypereosinophilic syndrome is caused by a. Lymphadenectomy b. A mutation that increases production of eosinophils c. Overactivation of eosinophils from allergies d. Overactivation of eosinophils from parasitic infection

What is the most commonly involved system in hypereosinophilic syndrome? a. Pulmonary b. Hematologic c. Cardiac d. CNS

(T or F) Hypereosinophilic syndrome is found in males 90% of the time

Which of the following is often used as the initial treatment for hypereosinophilic syndrome? a. Tyrosine kinase inhibitors b. Corticosteroids c. Low dose aspirin d. Chemotherapies

(T or F) Smoking is associated with an increased risk of developing CML?

Which of the following is NOT true concerning the chronic stable phase of CML? a. It may present with splenomegaly b. It will present with extramedullary blastic infiltrates c. It is the most common stage at the time of diagnosis d. You will likely see increased platelets and basophils

Which of the following are major complication of the myeloproliferative disorders? a. Depression b. Stroke c. Leukemia d. Diabetes e. Syncope f. Anemia g. Neuropathy h. Hepatosplenomegaly i. Excessive bleeding j. Osteopenia

b, c, f, h, j

What is integrative medicine? a. Simple, singular therapies b. Combination of the best of non-traditional care with mainstream traditional therapies c. Therapies that exclude chemotherapy and radiation as cancer therapies d. Nutrition based therapies combined with homeopathy

What is naturopathic oncology? a. Treatment of cancer utilizing functional medicine b. Integrative medicine with a focus on treating patients with cancer c. Treatment of cancer utilizing only natural therapies d. Chemotherapy and radiation administered by a naturopathic doctor

(T or F) survival rates are reduced when patients solely utilize alternative medicine for the treatment of their cancer.

Which of the following are side effects of cancer treatment that can be improved using integrative cancer care? a. Fatigue b. Pain c. Nausea d. Depression/anxiety

all

(T of F) Conventional oncology treatments (non-naturopathic) are all evidence based.

What does the 0, 5, 10, 30, 150 refer to in Frenkel's article? a. O cigarettes, 5 veggies, 10 minutes of meditation, <30 BMI, 150 minutes of exercise a week b. 0 cigarettes, 5 veggies, 10 cups of green tea, 30 minutes of exercise per day 150 minutes of meditation per week c. 0 alcoholic beverages, 5 cups of green tea, 10 veggies, 30 minutes of meditation, 150 min of meditation per week d. 0 alcoholic beverages, 5 minutes of exercise per day, 10 minutes of meditation, 30 minutes of exercise per week, 150 veggies per week

What percentage of cancers are due to infectious causes? a. Close to 100% b. 20-40% c. 15-20% d. 50-75%

(T or F) Infectious disease as a cause of cancer is equally distributed between developed and developing countries.

Which of the following associations is incorrect? a. Gastric cancer and EBV b. Kaposi sarcoma and HIV c. Bladder cancer and schistosomiasis d. Nasopharyngeal cancer and EBV

Which of the following is NOT a mechanism of infection-induced malignancy? a. Chronic inflammation b. Immunosuppression c. Genomic instability d. None are mechanisms e. All are mechanisms

Which of the following factors is NOT associated with increased risk of H pylori infection? a. Household crowding b. Each of these are associated with an increased risk c. Decreased household sanitation d. older age

By which mechanism is H pylori able to survive the acidic environment of the stomach? a. Invades epithelial cells b. Production of urease c. Flagella mask the bacterial from the immune system d. H pylori does not survive in the stomach

(T of F) Individuals with H pylori are always symptomatic.

Which of the following are factors associated with the development of gastric carcinoma? a. Cigarette smoking b. Strain virulence c. Host genetics d. High sodium diet

all

Which of the following factors are NOT protective against the progression to gastric carcinoma? a. None are protective b. All are protective c. Helminthic infection d. H pylori infection e. Antioxidant intake

Which of the following is an indication for H pylori testing? a. First degree relative with cancer b. Annual screening exams c. Bloody diarrhea d. Workup for symptoms associated with a peptic ulcer

Which of the following is considered the gold standard for H pylori testing? a. Stool antigen testing b. Urea breath test c. Serum antibodies d. Histological ID following biopsy

Which of the following is a mechanism by which hepatitis B causes hepatocellular carcinoma? a. Chronic inflammation b. IV drug use c. Production of oncogenic proteins d. Immune suppression e. DNA integration

a, c, and e

By which transmission route do the majority of individuals contract chronic hepatitis B? a. Sexual contact b. Breastmilk c. Birth d. Needle sticks

Which marker demonstrates vaccination for HBV? a. HBsAg b. HBsAB c. Anti-Hbe d. HBV-DNA

You order a hepatitis B panel for someone you suspect to be infected. Which of the following results confirm your suspicion of a CHRONIC infection? a. Positive HBsAg, negative IgM anti-HBc, negative anti-HBs and negative total anti-HBc b. Negative HBsAg, negative total anti-HBc, negative IgM anti-HBc and positive anti-HBs c. Positive HBsAg, positive total anti-HBc, positive IgM anti-HBc, negative anti-HBs d. Positive HBsAg, positive total anti-HBc, negative IgM anti-HBc and negative anti-HBs

Which population is most likely to clear an HBV infection? a. Infants b. Adults c. Children d. No one clears HBV

Which of the following is NOT a risk factor associated with HCV transmission? a. IV drug use b. HBV c. Organ transplant recipients before the mid 80s d. Multiple sex partners

(T or F) HBV vaccination program in the US has led to a decrease in the incidence of hepatocellular carcinoma.

(T or F) People typically form immunity to HCV through antibody production.

What is the "window" from exposure to testing positive for HCV? a. 4 weeks b. 1 year c. 3 days d. 4 months

What percentage of cervical cancers are linked to high risk HPV infections? a. 50% b. 75% c. 90% d. 28%

Which of the following are oncogenes encoded in high-risk HPV genomes? a. E1 b. E4 c. E6 d. E7 e. No oncogenes are produced by high-risk HPV

c and d

Which of the following is NOT a risk factor for development of cervical cancer? a. HIV b. Smoking c. Early onset of sexual activity d. Hepatitis B positivity e. Low SES

Which of the following screening guidelines for cervical cancer is correct? a. Stop screening at 65 yo regardless of history b. Begin screening at 21yo independent of sexual activity c. Co-screening for HPV and cytology from 21-29 d. Continue screening after hysterectomy regardless of history

(T or F) HPV vaccines protect against cervical cancer and only females should receive them.

By which mechanism are schistosomes believed to cause bladder cancer? a. Gene transfer b. parasitic oncogene production c. Chronic inflammation d. Immune suppression

What energy source to cancer cells use for aerobic fermentation? a. Proteins b. Fatty acids c. Glucose d. Triglycerols

Which of the following is NOT a feature of the Warburg effect? a. Increased glucose uptake b. Aerobic fermentation c. Lactic acid production in the presence of oxygen d. Increased response to growth-inhibition

What are flavins? a. Taste receptors b. Products of aerobic fermentation c. Materials used in the creation of FAD d. Materials used in the creation of NAD

Which of the following are actions of ATP in cellular metabolism? a. Cellular division b. Redox balance c. Growth inhibition d. Housekeeping functions

a, b, and d

Why is glycolysis an inefficient means of ATP production in mammalian white muscle? a. Glycolysis doesn't occur in white muscle fiber b. Glycolysis produces lactic acid due to anaerobic metabolism inhibiting glycolysis c. Glycolysis produces minimal ATP in this tissue d. Glycolysis produces ATP about 5x slower in this tissue

(T or F) Glucose is rate limiting in cellular metabolism.

(T or F) Glucose produces ATP faster (via glycolysis) than oxidative phosphorylation.

What percentage of glucose is diverted into biosynthetic pathways upstream of pyruvate in proliferating cells? a. 50% b. 70% c. 20% d. 10%

What is the primary end product of glycolysis within proliferating tissue or tumor? a. All pyruvate is used for oxidative phosphorylation and none is converted to lactate b. Glycolysis cannot occur in proliferating tissue c. The majority of pyruvate supports oxidative phosphorylation d. The majority of pyruvate is converted to lactate

What is the pyruvate kinase isoform PKM2? a. Key metabolic regulator in normally dividing cells b. An isoform only existing as a high activity dimer c. An isoform only existing as a low activity dimer d. Key metabolic regulator in rapidly dividing cells

What effect does reduction in PKM2 levels have on glycolysis? a. Speeds up the rate of glycolysis b. Allows more glycolytic intermediates to be used for biosynthesis c. Reduces the amount of glycolytic intermediates available for biosynthesis d. slows down the rate of glycolysis

Increased 3PG leads to an increase in which amino acid? a. Valine b. Serine c. Proline d. Leucine

Serine is converted to which amino acid when it donates a carbon to the folate pool? a. Glycine b. Arginine c. Isoleucine d. Proline

The functions of serine in the body include a. Reducing cellular proliferation b. Producing glycolytic intermediates c. Increasing biomass d. Producing nucleotides

c and d

What does glycine contribute to in the nucleotide structure? a. 4 carbons b. 2 nitrogen and 3 carbons c. 2 nitrogens d. 1 nitrogen and 2 carbons

(T or F) Glutamine can be used by proliferating cells as a fuel source.

Which of the following is a role or function of glutamine in cellular metabolism of proliferating cells? a. Carbon source for acetyl-CoA b. Anaplerotic for the TCA cycle c. Nitrogen source d. Directly contributes to oxidative phosphorylation

a, b, c

In the Krebs Cycle of the proliferating cell, glutamine donates carbon to alpha ketoglutarate which is converted to _______________. a. Malate b. Pyruvate c. Succinate d. Citrate

Under normal conditions, acetyl-CoA derives the majority of its contributions form a. Lipid/cholesterol synthesis b. Glutamine c. Fatty acid metabolism d. Glucose

Under hypoxic conditions, acetyl-CoA derives the majority of its contributions from a. Glucose b. Fatty acid metabolism c. Glutamine d. Lipids/cholesterol synthesis

The Warburg phenomena has suggested that __________- is a way of limiting rapid cell growth a. Ketogenic diet b. Calorie restriction c. Hyperthermia d. Aerobic exercise

Which of the following best describes the role of the Institutional Review Board (IRB)? a. Committee whose purpose is to review research proposals with an eye to scientific validity and subject protections b. Committee whose purpose is to submit research proposals aiming to improve ethical considerations in medicine c. Committee whose purpose is to select patients who should participate in clinical trials d. Committee whose purpose is to review clinical trials studying ethical issues

What is the name of the document used to safeguard human research issued by the National Committee for the Protection of Human Subjects in 1978? a. Declaration of Helsinki b. Belmont report c. International guidelines for biomedical research d. Flexner report

Which of the following is NOT addressed in the Declaration of Helsinki? a. Right to make informed decisions (informed consent) b. The experiment be based on previous knowledge justifying the experiment c. Respect for the individual d. Right to self determination

What do phase I trials aim to define or determine? a. Side effects, comparison with other treatments, safety b. Post marketing studies to provide additional information about the treatment c. Safety, toxic dose, absorption of drug d. Efficacy within a larger group

The recruitment goal for a phase II trial is approximately how many participants? a. 200-300 b. >1000 c. 5-25 d. 30-120

Randomized control trials are part of this trial phase. a. II b. IV c. I d. III

(T or F) Generally, both parents need to give consent for a child to participate in a clinical trial for cancer research.

(T or F) A large number of people in the population have genes coding for familial (hereditary) cancers.

Which of the following is NOT evidence to support the environmental-cancer link? a. Most cancer rates remain stable across the globe b. Immigrant's cancer risk parallels that of their new country c. The majority of cancer cases have no known risk factors d. Fewer than half of identical twins get the same cancer

Which type of cancer is the most common in the US? a. Carcinomas b. Lymphoma c. Leukemia d. Sarcomas

Which fraction of yearly cancer deaths in the US are related to exposure to carcinogens in tobacco products? a. 1 out of 10 (10%) b. 1 out of 3 (33%) c. 3 out of 4 (75%) d. 1 out of 4 (25%)

Obesity and physical inactivity may account for what percentage of severe major cancers? a. 40-50% b. 25-30% c. 5-10% d. 10-20%

H. pylori contributes to the development of which type of cancer? a. Breast b. Colon c. Esophageal d. Stomach

Exposure to elevated levels of radon gas are associated with which type of cancer? a. Lung b. Stomach c. Melanoma d. Lymphoma

Which solvent is found in pain thinners, glues, and dry cleaning and is known to cause leukemia? a. Xylene b. Benzene c. Acetone d. Turpentine

Which fine particle is linked to increased rates of mesothelioma? a. Pet dander b. Silica dust c. Asbestos d. Wood dust

What are dioxins? a. Unwanted byproducts of chemical processes containing chlorine and hydrocarbons b. Organofluorine molecules containing one carbon and one fluorine c. Colorless, sweet-smelling chemical derived from natural gas d. Chemicals naturally occurring in coal, crude oil and gasoline

People are exposed to 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) through a. Car exhaust b. Indoor ventilation c. Dairy, fish and meat d. Drinking water

Which types of cancers are linked to polycyclic aromatic hydrocarbon (PAH) exposures? a. Lung b. Skin c. Breast d. Urinary

a, b, and d

Which of the following are sources of polycyclic of polycyclic aromatic hydrocarbons (PAHs)? a. Eggs b. Smokes or barbecued foods c. Wood burning stoves for homes d. Sausages

b, c, and d

(T or F) There are medical interventions to reduce blood lead levels (BLLs)

Diesel exhaust particles are suspected of being carcinogens due to the increased incidence of this type cancer in the occupational groups exposed to diesel exhaust? a. Lung cancer b. Lymphoma c. Stomach cancer d. Melanoma

(T of F) Vinyl chloride can leach from plastic PVC bottles

Which of the following are known health effects of polychlorinated biphenyls (PCBs)? a. Stomach cancer b. Thyroid toxicity c. Breast cancer d. Developmental neurotoxicity

b, c, d

What are the primary routes of exposure to phthalates? a. Personal care products, food, children's toys b. Children's toys, wood burning stoves, smoked meat c. Perfumes, meat, dairy d. Drinking water, food, plastic water

(T of F) Phthalates are endocrine disruptors in both males and females.

(T of F) More than 90% of the US population has measurable levels of BPA in their body.