Test 4 Flashcards
Which of the following is NOT true about tumor markers?
a. They can be produced by the host as a response to tumors
b. They can be biologic substances synthesized by cancer
c. They can be detected in urine
d. Most tumor markers are inflammatory cytokines
Most tumor markers are inflammatory cytokines
(T or F) A genetic mutation can be considered a tumor marker.
T
Which of the following is characteristic of an ideal tumor marker?
a. Marker is cancer specific
b. Marker has a long half-life
c. Produced only once the tumor has metastasized
d. Maker stays within the tumor
Marker is cancer specific
Which is true when comparing tumor markers for screening purposes to other screening methods (PAP, colonoscopy, mammography)?
a. Tumor marker screening testing is sometimes more accessible for patients with barriers to healthcare
b. Currently available tumor marker testing tends to be more sensitive and specific
c. Tumor marker screening testing is invasive
d. Tumor marker screening testing tends to be more expensive
Tumor marker screening testing is sometimes more accessible for patients with barriers to healthcare
Rank the screening tests for colorectal cancer in order of increasing sensitivity and specificity.
a. gFOBT < FIT-DNA < FIT < Cologuard
b. Colonoscopy < FIT-DNA < FIT < gFOBT
c. FIT-DNA < FIT < gFOBT < colonoscopy
d. gFOBT < FIT < FIT-DNA < colonoscopy
gFOBT < FIT < FIT-DNA < colonoscopy
Which of the following is true about PSA (Prostate Specific Antigen)?
a. It is only produced when a tumor reaches stage 2
b. Current guidelines recommend PSA testing starting at 50yo
c. It is specific to prostate tumor cells
d. It can become elevated by bike riding
It can become elevated by bike riding
Why does ovarian cancer have such poor survival rates?
a. Presentation is vague and is often diagnosed after metastasis has occurred
b. It does not respond well to chemotherapeutic agents
c. It progresses rapidly
d. Females avoid screenings due to discomfort and privacy concerns
Presentation is vague and is often diagnosed after metastasis has occurred
Which of the following is true about CA125? (Multiple)
a. It is strongly associated with ovarian cancer
b. It is increased in many cancers
c. It is highly sensitive for early stage disease
d. It is a newly identified biomarker and noes not have much clinical use
It is increased in many cancers
It is strongly associated with ovarian cancer
Alpha fetoprotein is used
a. To screen all individuals over the age of 60 for hepatocellular carcinoma
b. To identify individuals at risk for developing hepatitis
c. To screen high risk populations for hepatocellular carcinoma
d. To test for treatment response
To screen high risk populations for hepatocellular carcinoma
To test for treatment response
Which grade of tumors grow and spread slowly?
a. All are correct
b. Undifferentiated
c. Well differentiated
d. Poorly differentiated
e. None are correct
Well differentiated
(T or F) The grading system for different tumor types is all the same.
F
Breast cancer is graded based on which of the following?
a. None are used
b. All are used
c. Mitotic rate
d. Tubule formation
e. Nuclear grade
All are used
Which cancer uses the Gleason score for tumor grading?
a. Ovarian cancer
b. Breast cancer
c. Liver cancer
d. Prostate cancer
Prostate cancer
(T or F) A prognosis is formed based solely on the tumor’s grade.
F
Which of the following is true about staging?
a. Description of the tumor is based on how abnormal the cells appear
b. Its a description of the degree of disease spread at diagnosis
c. It indicates how likely the cancer is to grow and spread
d. It provides a prognosis for the patient
Its a description of the degree of disease spread at diagnosis
Which of the following is used to determine stage of cancer?
a. Tumor size
b. Grade
c. Tumor spread
d. Tissue differentiation
Tumor size
Tumor spread
Which of the following is incorrect about the TNM staging?
a. T refers to the extent of the primary tumor
b. N refers to lymph node involvement
c. M refers to distant metastases
d. TNM staging is the only staging system
TNM staging is the only staging system
At which point in the workup can cancer be pathologically staged?
a. During history
b. With blood work
c. Surgical removal
d. Any time during the patient’s care
Surgical removal
Which of the following refers to the stage where abnormal cells are present, but only found in the original layer of cells
a. T0
b. Tis
c. Tx
d. T3
Tis
Which of the following refers to the stage with no regional lymph node involvement
a. N0
b. T0
c. Nx
d. Tx
N0
Which of the following refers to the stage of metastasis?
a. Mx
b. M0
c. M1
d. M5
M1
Which of the following variables do NOT affect staging?
a. Cell type
b. Tumor location
c. Mitotic rate
d. Tumor markers
Mitotic rate
What does the “y” before a TNM notation indicate?
a. Youth patients (<18 yo)
b. Restaging after a recurrence
c. Restaging after a neoadjuvant therapy
d. Youth patients (<5yo)
Restaging after a neoadjuvant therapy
What stage is used to indicate locally advanced tumor?
a. I
b. II
c. IV
d. III
e. 0
II and III
What stage is used to indicate cancer spread to distant sites or with concerning features?
a. I
b. III
c. 0
d. IV
e. II
IV
Stage prognosis is expressed through
a. QALYs
b. Months to live
c. Survival rates
d. DALYs
Survival rates
Survival rates
a. Give doctors an idea of who to treat and who not to treat
b. Give a general idea of how likely treatment will be successful
c. Give patients an idea of how long they have left to live
d. Give an accurate prediction of how successful treatment will be
Give a general idea of how likely treatment will be successful
Which of the following factors affect prognosis?
a. All of these can affect prognosis
b. Overall health and wellness
c. Age of diagnosis
d. Type of cancer
All of these can affect prognosis
Over what period of time to epithelial cancers develop?
a. Several months
b. Several days
c. Several years
d. None of these are correct (there is really no way of knowing)
Several years
What type of surgery is most frequently used to identify metastatic disease in gallbladder cancer?
a. Staging laparoscopy
b. Cholecystectomy
c. Cholecystitis
Staging laparoscopy
What stage are most gallbladder cancers at diagnosis?
a. T1
b. T4
c. T2
d. T3
T2
Which of the following staging systems is used in multiple myeloma?
a. All of these are used
b. TNM
c. None of these are used
d. International staging system (ISS)
e. Durie-Salmon Staging system
International staging system (ISS)
Durie-Salmon Staging system
How is the dynamic risk stratification system used?
a. Reclassify prognosis at each follow up
b. Reclassify stage at each follow up
c. Reclassify grade at each follow up
d. Determine patient’s risk for developing thyroid cancer
Reclassify stage at each follow up
Which of the following cancer types in not typically able to be staged?
a. Glioblastoma
b. Gallbladder cancer
c. Gastric cancer
d. All cancers can be staged
Glioblastoma
What is the median survival for people diagnosed with liver cancer?
a. 6-20 years
b. 20-30 months
c. 2-3 years
d. 6-20 months
6-20 months
What stage of liver cancer is associated with the best 5-year survival rate?
a. Stage I
b. Stage II
c. Stage 0
d. Stage III
Stage I
What types of staging are utilized in lung cancer?
a. Surgical
b. None of these
c. All of these
d. Autopsy
e. Clinical
All of these
Which of the following is NOT a clinical finding suggestive of metastatic disease?
a. Lymphadenopathy
b. Fever
c. Weight Loss
d. Bone tenderness
Fever
At what stage of pancreatic cancer growth is it determined to be unresectable?
a. Invasion into the superior mesenteric artery
b. Invasion into local tissue
c. In situ
Invasion into the superior mesenteric artery
Which percentage of patients with pancreatic cancer are candidates for pancreatectomy?
a. 30-35%
b. 15-20%
c. 20-25%
d. 25-30%
15-20%
What is the most valuable prognostic factor for pancreatic cancer?
a. Tumor size
b. Nodal status
c. Metastasis status
d. Tumor staging
Tumor staging
(T or F) The FIGO and AJCC staging systems for ovarian cancer focus on different items and should be used in different patient populations.
F
Which of the following is NOT true about Leser Trelat?
a. It appears as sudden, diffuse seborrheic keratosis
b. It can be indicative of a benign process
c. It can be associated with gastrointestinal malignancy
d. It is pathognomonic for gastric cancer
It is pathognomonic for gastric cancer
Which of the following is true concerning CA 19-9?
a. It is used as a screening tool for pancreatic cancer
b. It has no association with prognosis
c. It has high specificity and sensitivity for pancreatic cancer
d. It is used as a monitoring tool during chemotherapy
It has high specificity and sensitivity for pancreatic cancer
What is the main difference between a gFOBT and a FIT bowel test?
a. gFOBT is more expensive
b. gFOBT requires bowel prep
c. FIT requires medication and food restriction
d. FIT is a more sensitive exam with improved patient compliance
FIT is a more sensitive exam with improved patient compliance
What is a commonly used method to improve biopsies?
a. Fast your patient for 24 hours leading up to the procedure
b. Always have the patient under anesthesia
c. Use endoscopic ultrasound guided biopsy
d. Circle the lesion before performing surgery
Use endoscopic ultrasound guided biopsy
Which of the following is not a good candidate for biopsy?
a. Individuals with a history of autoimmune disease
b. Children under the age of 3
c. An individual fit for surgery with likely malignancy and retractable lesion
d. An elderly individual with a poor prognosis
An individual fit for surgery with likely malignancy and retractable lesion
The majority of neoplasms in the gallbladder are:
a. Lymphoma
b. Adenocarcinoma
c. Squamous cell carcinoma
d. Sarcoma
Adenocarcinoma
X-rays are a _________________ modality.
a. No risk
b. Low risk
c. High risk
d. Moderate risk
Low risk
An endoscopy
a. Refers to insertion via a small surgical cut
b. Is ideal for visualization of gastric cancer
c. Helps to visualize external tissue
d. Uses a barium contrast dye
Is ideal for visualization of gastric cancer
When is it appropriate to use a PILLCAM2?
a. In patients older than 75 who can not tolerate colonoscopy
b. When a patient has had an incomplete colonoscopy
c. When an intestinal obstruction prevents a colonoscopy
d. After a colonoscopy is completed and further tumor assessment is warranted
When a patient has had an incomplete colonoscopy
Which of the following criteria suggests a malignancy during endoscopy?
a. Adhered
b. Movable
c. Smooth
d. Soft
e. Firm
f. Friable
g. Inflamed
h. Ulceration
i. Rough
Adhered
Firm
Friable
Ulceration
What is the benefit of laparoscopy?
a. Ability to directly visualize tissue
b. No risk of complications
c. Less invasive than most imaging techniques
Ability to directly visualize tissue
What is the preferred imaging for a patient with unexplained jaundice?
a. MRI of the abdomen
b. Transabdominal ultrasound
c. X-ray
d. CT scan
Transabdominal ultrasound
Endoscopic retrograde cholangiopancreatography (ERCP) is useful if there is suspicion of:
a. Pancreatic cancer
b. Hepatitis
c. Intestinal obstruction
d. Choledochlithiasis
Pancreatic cancer
Choledochlithiasis
What is the only method of breast cancer imaging that has been consistently been found to decrease breast cancer related mortality?
a. Breast ultrasound
b. Mammography
c. Clinical breast exam
d. Breast MRI
Mammography
The three types of screen film mammography are screening, diagnostic and:
a. Therapeutic
b. Surveillance
c. Post-operative
d. Observational
Surveillance
What is the most consistent mammographic feature of malignancy?
a. Cluster micro-calcification
b. Asymmetry
c. Density
d. Spiculated focal mass
Spiculated focal mass
Patients with breast implants:
a. Are not able to receive mammography
b. Can expect mammography tests to have lower sensitivity but higher specificity
c. Do not require screening mammography after surgery
Can expect mammography tests to have lower sensitivity but higher specificity
(T or F) Mammography is not typically performed on patients with breast reconstruction post-mastectomy.
T
When is male mammography performed?
a. If a patient presents with a mass and pain
b. If the individual tests positive for the BRCA gene
c. Routinely every 10 years
d. If the individual has a family history of breast cancer
If a patient presents with a mass and pain
What is the breast cancer screening recommendation for females with average risk?
a. Every 5 years starting from 50 to 75 years old
b. Every 2 years from 50-74 years old
c. Every 2 years starting at age 40 onward
d. Every year starting at age 50 onward
Every 2 years from 50-74 years old
The amount of radiation from mammography is equal to:
a. 1 year of background radiation
b. 3 months of background radiation
c. 1 month of background radiation
d. 6 months of background radiation
3 months of background radiation
What is the largest contraindication to using an MRI?
a. Age under 10
b. Diagnosed malignancy
c. Metal in the body
d. Allergy to contrast dye
Metal in the body
A functional MRI (fMRI) measures:
a. Moving tissue
b. Anomalies in activity
c. Blood flow
d. Anomalies in tissue structure
Anomalies in activity
MRI has ________ potential effect from radiation than a CT scan.
a. More
b. Less
Less
Standard practice is most patients with stage II, III or IV Colorectal cancer (CRC) undergo chest, abdomen and pelvic CT”
a. Following resection
b. Both are true
c. Neither are true
d. Prior to resection
Both are true
When is an abdominal CT the preferred imaging?
a. In a patient with RUQ pain radiating to the right shoulder
b. In a patient with epigastric pain and weight loss without jaundice
c. In a patient with a history of jaundice and pruritus
d. In a patient with lower abdominal pain and constipation
In a patient with epigastric pain and weight loss without jaundice
How is a PET scan generally used?
a. To access for metastasis
b. To diagnose suspected malignancy
c. To determine the location of a primary tumor
d. To assess for osteoporosis
To access for metastasis
Which cancer has the highest risk of developing associated with a genetic alteration?
a. Breast
b. Gastric
c. Colon
d. Prostate
Colon
(T or F) Acquired (somatic) mutations can be passed onto offspring.
F
(T or F) Germline mutations are present in every cell in the body
T
Which of the following is not a characteristic of hereditary cancer?
a. High rates of metastasis
b. High risk of multiple primary cancers
c. Early identification and prevention is key
d. Multiple family members affected
High rates of metastasis
Genetic testing
a. Identifies genes susceptible to cancer
b. Is referred when an individual has more than one primary cancer
c. Looks for one mutation at a time
d. Can only be done with blood samples
Is referred when an individual has more than one primary cancer
Males with BRCA 1 and 2 mutations have an established association of developing
a. Breast cancer
b. Prostate cancer
c. Pancreatic cancer
d. Colon cancer
e. Testicular cancer
a. Breast cancer
b. Prostate cancer
c. Pancreatic cancer
An inherited gene is most likely in a female who has
a. A father with prostate cancer and two sisters with breast cancer
b. Both grandmothers and a mother with breast cancer
c. Several cousins with ovarian and breast cancer
d. A father with colon cancer and a mother with breast cancer
a. A father with prostate cancer and two sisters with breast cancer
Which BRCA gene mutation has a greater impact on the risk of developing breast cancer?
a. BRCA 2
b. BRCA 1
b. BRCA 1
Identification and assessment of a genetic mutation through testing aids in cancer treatment when
a. The type of mutation guides the chemotherapeutic efficacy
b. Mutations are associated with metastasis patterns and prophylactic radiation can be performed on the tissue
c. Patients with high-risk mutations refuse treatment
d. Clarifying between primary and secondary cancers
The type of mutation guides the chemotherapeutic efficacy
(T or F) Colon cancer develops from a single mutation .
F
Which of the following is not one of the four mismatch repair genes associated with Lynch syndrome?
a. EPCAM
b. MLH1
c. MSH6
d. PMS2
EPCAM
Lynch syndrome is associated with an increased risk of developing
a. Gastric cancer
b. Prostate cancer
c. Colorectal cancer
d. Endometrial cancer
Colorectal cancer
Which is not associated with an increased risk of thyroid cancer?
a. KRAS
b. EGFR
c. RAS
d. BRAF
KRAS
Most gene mutations related to prostate cancer are
a. Acquired
b. Inherited
Acquired
Which of the following is associated with the greatest risk of pancreatic cancer?
a. Peutz-Jeghers syndrome
b. History of breast and ovarian cancer
c. Lynch syndrome
d. Hereditary pancreatitis
Peutz-Jeghers syndrome
Which mutation has the largest impact on the risk for stomach cancer?
a. GS
b. MSI
c. EBV
d. CIN
CIN
Which type of melanoma has the highest frequency of occurrence?
a. CSD (chronic sun-induced damage)
b. Acral
c. Mucosal
d. Non-CSD (chronic sun induced damage)
Non-CSD (chronic sun induced damage)
EGFR appears in _________% of non-small-cell lung carcinomas?
a. 50%
b. 10-20%
c. 2-5%
d. 70-80%
10-20%
How are genetic tests generally taken for lung cancer?
a. From salivary samples
b. From biopsy samples
c. From urine samples
d. From blood samples
From biopsy samples
What genetic mutation is most associated with lung cancer?
a. KRAS
b. EGFR
c. ALK
d. Unknown
Unknown
MTHFR 677TT genotype is related to a 2-fold increased risk of
a. AMP
b. ALL
c. CLL
d. CML
ALL
(T or F) The “Philadelphia chromosome” present in CML is a germline mutation.
F
(T or F) JAK2 mutation is mostly found in essential thrombocytosis and rarely found in polycythemia vera.
F
(T or F) MTHFR is highly associated with a number of diseases and is often tested for in clinical practice.
F
What is the ultimate goal of germline testing?
a. To identify at risk individuals
b. To assist with diagnosis
c. To determine who will develop cancer
d. To understand cancer epidemiology
To identify at risk individuals
Which of the following is NOT a situation which ASCO recommends genetic testing?
a. A personal or family suggests a genetic cause of cancer
b. A test will clearly show a specific genetic change
c. The results will help with a diagnosis of with the management of a condition
d. An individual has concerns about passing on a germline mutation
An individual has concerns about passing on a germline mutation
When should genetic counseling occur?
a. Both before and after genetic testing
b. Before genetic testing
c. Whenever a patient has questions
d. After genetic testing
Both before and after genetic testing
(T or F) Providing a family pedigree is a component of the pre-test genetic counseling.
T
Which of the following is NOT one of the potential results of genetic testing?
a. Positive for mutation
b. Positive for variant of unknown significance
c. Inconclusive
d. Negative for variant of unknown significance
Negative for variant of unknown significance
A negative result on a genetic test is most helpful when
a. An individual has a past history of cancer
b. An individual does not know their family history
c. Cancer is unresponsive to current treatments
d. There is a known gene mutation in the family
There is a known gene mutation in the family
(T or F) Cancer cells can develop drug resistance.
T
What is the target of most antineoplastic medications?
a. RNA replication and cell division
b. DNA replication and cell division
c. cell wall
d. nutrient absorption
DNA replication and cell division
What is tumor lysis syndrome treated with?
a. Antibiotics and IV fluids
b. Chemotherapeutics
c. Allopurinol and IV fluids
d. Gabapentin
Allopurinol and IV fluids
Drug resistance and be decreased by using _______________, administered at the _________________ dose possible.
a. Multiple chemotherapeutic drugs; highest
b. Multiple chemotherapeutic drugs; lowest
c. A single chemotherapeutic drug; highest
d. A single chemotherapeutic drug; lowest
Multiple chemotherapeutic drugs; highest
Which adverse effect is specific to cyclophosphamide?
a. GI upset
b. Fatigue
c. Hemorrhagic cystitis
d. Neurotoxicity
Hemorrhagic cystitis
Which topoisomerase inhibitor is nicknamed “the red devil”
a. Cyclophosphamide
b. Doxorubicin
c. 5-fluorouracil
d. Doxil
Doxorubicin
Which of the following is a folate analog that inhibits dihydrofolate reductase?
a. 5-fluorouracil
b. Methotrexate
c. Cyclosporin
d. Corticosteroids
Methotrexate
Which adverse effect is specific to cisplatin?
a. Hemorrhagic cystitis
b. Neurotoxicity
c. Cardiotoxicity
d. GI upset
Neurotoxicity
(T or F) Homeopathy is safe and effective to use with cancer patients undergoing treatment with chemotherapy drugs.
f
Which of the following is NOT a role of homeopathy in cancer patient care?
a. Improve response to treatment
b. Increase vitality
c. Treatment of cancer
d. Symptom and side effect palliation
Treatment of cancer
When using a remedy to address nausea, which of the following remedy and potency would be the most appropriate choice?
a. Tabacum 12C
b. Lycopodium 30 C
c. Cocculus 200C
d. Sepia 30C
Tabacum 12C
(T or F) Giving a constitutional remedy to a patient will result in more profound responses than treating symptomatically.
T
Which of the following is not a keynote of Carbo Vegetabilis? a. Weakness b. Bloating and gas c. Runs hot d .Air hunger
Runs hot
When treating a terminal patient who has fears and anxiety around death, what remedy is most considered?
a. Sulphur
b. Arsenicum Album
c. Aconite
d. Phosphorus
Arsenicum Album
Which of the following is not a keynote of Sulphur?
a. Burning pains
b. Insomnia
c. Symptoms better with heat
d. Egotism and haughtiness
Symptoms better with heat
Each person has approximately _________ tumors developing within them at any time.
a. 1-2
b. 15-20
c. 2000+
d. 50-100
15-20
What distinguishes tumor cells from “self”?
a. Tumors do not have the same DNA as “self”
b. Tumors often display the same antigens as microbes
c. Tumors are not distinguished from “self”, which is why they evade the immune system
d. Tumors have mutation producing “neo-antigens” and danger signals
Tumors have mutation producing “neo-antigens” and danger signals
Macrophages produce which tumor killing cytokines?
a. IL-1
b. GSF
c. TNF-alpha
d. TGF-beta
TNF-alpha
Which response is specific to tumors?
a. Th2
b. Treg
c. Th1
d. Th17
Th1
Which of the following is true about tumor antigens?
a. The immune system has a general response to tumors
b. Tumors change antigens over time
c. Tumors generally present the same type of “malignancy” antigen, regardless of location within the body
d. Tumors have specific and variable antigens
Tumors have specific and variable antigens
In the experiment presented on cancer immunology, cancer develops in the irradiated mouse but not in the the mouse without radiation exposure. What does this tell us?
a. The tumor was killed by irradiation
b. The tumor injected into the mouse was live, not dead
c. Irradiation likely caused the cancer
d. The immune system plays a significant role in tumor suppression
The immune system plays a significant role in tumor suppression
Necrosis is:
a. Silent cell death
b. Capable of stimulating an immune response
c. Part of the normal cell cycle
d. An inflammatory cell death
An inflammatory cell death
Capable of stimulating an immune response
Immune response to tumors is generated in
a. The nearest lymph node
b. The bone marrow
c. The thymus
d. The spleen
The nearest lymph node
IN regards to cancer, how is IFN-gamma production blocked?
a. The tumor produces TGF-beta
b. Tumor angiogenesis prevents the body from producing other proteins
c. Overproduction of IFN-gamma in the presence of cancer leads to a negative feedback loop
d. The body produces an inflammatory response, shutting down the immune response
The tumor produces TGF-beta
Which of the following statements about hTERT is FALSE?
a. It allows tumor cells to extend their life cycle longer than healthy cells
b. All tumor cells have this mutation
c. It stands for Human Telepathic Enzymes Reverse Transcriptase
d. Drugs targeting this mutation may impact stem cells
It stands for Human Telepathic Enzymes Reverse Transcriptase
What is a side-effect of chemotherapeutic agents targeting MAGE-1?
a. Male sterilization
b. Brain damage
c. Vertigo
d. Skin lesions
Male sterilization
How did Dr. Cooley induce fever?
a. None of these are correct
b. Placed the patient next to a fire
c. Wrapped the patients in blankets
d. Injected dead bacteria into the patient
e. Each of these is correct
Each of these is correct
Which of the following cytokines is not induced by Cooley’s toxin?
a. IL-5
b. TNF alpha
c. IFN gamma
d. IL-1
IL-5
What factor limits the use of Dr. Cooley’s method for treating cancer?
a. Not reliable
b. Not safe
c. Not regulatable
d. Not effective against cancer in vivo
Not regulatable
What is the main concern with injecting tumors with CD86 plasmids?
a. Causing bacterial infections
b. Causing immune suppression
c. Triggering autoimmunity
d. Triggering a cytokine storm
Triggering autoimmunity
In Ralph Steinman’s method of delivering CD86 to the tumors, at what location were dendritic cells exposed to the tumor cells?
a. In vitro
b. In the lymph nodes
c. In the bone marrow
d. In the spleen
In vitro
(T or F) Steinman’s method is just as effective as second-line therapy after patients have gone through chemotherapy.
F
Which of the following receptors do checkpoint inhibitors work on CD-8 T cells?
a. CD28
b. CTLA-4
c. CD4
d. MHC 2
CTLA-4
What do PD-1 inhibitors do?
a. Block tumors from killing T cells
b. Provide antibodies targeting tumor cells for killing
c. Block tumors from deactivating T cells
d. Prevent tumors from activating T cells
Block tumors from killing T cells
Which pairing leads to a net positive T cell signal?
a. CD87 and CD28
b. Each of these is true
c. CD87 and CTLA-4
d. MHC and TCR
e. None of these is true
CD87 and CD28
