[IM] LE 6 - Cancer (pp 1-24 remastered)

B

1. Which of the following will provide

information on definitive diagnosis of cancer?

A. Triple phase CT of the liver showed

hypervascular tumors size ranging 3 to

5 cm the right lobe of the liver in the

portal venous phase

B. Biopsy of fungating colonic mass

reported adenocarcinoma

C. Liquid biopsy showed KRAS exon 2

G12D mutation with wild type BRAF

gene

D. All are correct

E. A and B only

A

2-3. A 55-year old male with recurrent fever and (+) multiple lytic lesions.
2. What is the most likely diagnosis?

A. Multiple myeloma

B. Acute promyelocytic leukemia

C. Pernicious anemia

D. Hodgkin’s Lymphoma

A

2-3. A 55-year old male with recurrent fever and (+) multiple lytic lesions.
3. What is the diagnostic modality?

A. Serum Electrophoresis

B. PCR

C. PET Scan

E

4-5. A 45/ healthy single Female consults for advice regarding cancer prevention after her best friend is diagnosed with breast cancer. She has no family history of cancer. She regularly attends gym classes but has a 5 pack year smoking history. Her physical exam findings are all normal. She has never undergone any cancer screening procedures in the past.

4. What primary prevention strategy can be

advised in order to prevent cancer?

A. Digital mammongraphy once year

B. Monthly self breast examination

C. MRI of Breast

D. Maintenance of her weight and physical

activity

E. Smoking cessation

B

4-5. A 45/ healthy single Female consults for advice regarding cancer prevention after her best friend is diagnosed with breast cancer. She has no family history of cancer. She regularly attends gym classes but has a 5 pack year smoking history. Her physical exam findings are all normal. She has never undergone any cancer screening procedures in the past.

5. What other cancer screening test is most appropriate for her age?

A. Low dose chest CT scan for lung cancer

B. Colonoscopy for colorectal cancer

C.Pelvic UTZ for ovarian CA

D. Annual CEA and Ca 125

E. Abdominal Ultrasound for liver cancer

B. Excision biopsy of nodes

6. A 28-year old male presenting with supraclavicular nodes associated with fever, weight loss, fatigability, with chills and night sweats. He noted to have also inguinal and axillary palpable nodes. Best definitive diagnosis?

A. Fine needle aspiration biopsy

B. Excision biopsy of nodes

C. CT scan

D. AFB and culture

A. Destruction of a large number of rapidly proliferating neoplastic cells by

chemotherapy

🧠 7-8. A patient with 🧠lymphoma (💵small cell lung carcinoma) receives chemotherapy then develops anorexia, vomiting and diarrhea. His serum uric acid elevates to 9 mg/dL, serum creatinine increases from 0.8 mg/dL to 2.1 mg/dL.

7. Which of the following is the most likely cause of the patient’s present problem?

A. Destruction of a large number of rapidly proliferating neoplastic cells by

chemotherapy

B. Release of a parathormone-related peptide (PTHrP)

C. Rapid metastasis to the kidneys

D. Toxicity of chemotherapeutic agent

E. Development of a paraneoplastic syndrome

B. Hyperphosphatemia, hyperkalemia, hypocalcemia

🧠 7-8. A patient with 🧠lymphoma (💵small cell lung carcinoma) receives chemotherapy then develops anorexia, vomiting and diarrhea. His serum uric acid elevates to 9 mg/dL, serum creatinine increases from 0.8 mg/dL to 2.1 mg/dL.

8. Which of the following laboratory findings

are other expected findings in this patient?

A. Hypophosphatemia, hyperkalemia,

hypercalcemia

B. Hyperphosphatemia, hyperkalemia, hypocalcemia

C. Hypophosphatemia, hyperkalemia,

hypocalcemia

D. Hyperphosphatemia, hypokalemia,

hypercalcemia

E. Hyperphosphatemia, hyperkalemia,

hypercalcemia

A & B only

🧠 7-9 A patient with 🧠lymphoma (💵small cell lung carcinoma) receives chemotherapy then develops anorexia, vomiting and diarrhea. His serum uric acid elevates to 9 mg/dL, serum creatinine increases from 0.8 mg/dL to 2.1 mg/dL.

9. Which is the part of the management for

this condition?

A. Aggressive hydration

B. Allopurinol with dose adjustment to

renal function

C. Sodium bicarbonate is a part of the

standard treatment

D. All of the above

E. A and B only

A

10. Which of the following will provide

information for TNM staging of a colon cancer?

A. Histopathological report showing that

tumor invades up to muscularis

mucosae of the sigmoid

B. An elevated CEA value of 200 ng/ml

C. A large circumferential mass at

sigmoid colon with approximately 90%

luminal obstruction

D. All of the above

E. A and B only

C

11. Which of the following demonstrate the

correct concept of multidisciplinary team

approach in management of cancer?

A. A breast surgeon after doing modified

radical mastectomy refers the patient

to a Medical Oncologist and Radiation

Oncologist for adjuvant therapy.

B. A patient underwent modified radical

mastectomy then refers the patient to a

Medical Oncologist for chemotherapy.

After chemotherapy, the patient is

presented in Tumor Board to get the

opinion of Radiation Oncologist

regarding benefit of adjuvant

radiotherapy.

C. A primary care physician present his

patient, with an incision biopsy of

breast mass showing invasive ductal

carcinoma, to a meeting of cancer

specialists. The team discuss and

recommend the plan of management

for the patient.

D. All of the above

E. A and C only

D

12. Which is TRUE regarding the role of

surgery in cancer treatment?

A. A cytoreductive procedure in renal

cancer with recurrent hematuria and

flank pain with pain VAS score of 8-9

B. Insertion of chest tube as a palliative

treatment to drain pleural effusion and

provide relief for dyspnea

C. Resection of liver metastasis from

colon with 3 masses size ranging from

3-4cm in the segments 6 and 7 of the

right lobe of the liver

D. All of the above

E. A and B only

D

13. Which of the following cytotoxic cancer

chemotherapy is classified as an alkylator and

known to cause cystitis?

A. Cisplatin

B. Gemcitabine

C. Doxorubicin

D. Cyclophosphamide

E. 5-Fluorouracil

B

15. A breast cancer patient on chemotherapy

developed easy fatigability and exertional

dyspnea. 2D echo done and showed that the

ejection fraction declined from a baseline of 65%

to 40%. Which of the following chemotherapy

most likely caused this problem?

A. Cisplatin

B. Doxorubicin

C. Vincristine

D. Paclitaxel

E. Cyclophosphamide

A

14. Tamoxifen as a form of hormonal therapy

is classified as

A. Selective Estrogen Receptor

Modulators

B. Aromatase inhibitor

C. Androgenic Agent

D. Selective Estrogen Receptor Down

Regulator

E. Progestational Agent

B

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

16. Which of the following diagnostic test

performed would provide a definite diagnosis of

breast cancer?

A. Digital mammography

B. Excision biopsy

C. Breast ultrasound

D. Serum CA 15-3

E. MRI of the Breasts

D

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

17. Which result of the following imaging

studies is suggestive of cancer that is incurable?

A. Abdominal CT scan: multiple hepatic

cysts

B. Chest x-ray: bronchiectatic changes

C. CT scan of the chest: ground glass

appearance in the right upper lobe

D. Bone scan: multiple lytic lesions along

entire spine

E. Liver ultrasound: Diffuse fatty

infiltration

E

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

18. In staging breast cancer, which of the

following test has the LEAST value in terms of

providing information regarding extent of the

tumor?

A. Chest X-ray

B. Cranial MRI

C. Liver ultrasound

D. PET CT scan

E. Serum tumor markers

D

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

19. The patient’s bone scan shows multiple

lytic lesions along the entire spine. Which

treatment modality would be LEAST beneficial for

the patient?

A. Biologic therapy

B. Chemotherapy

C. Hormonal therapy

D. Modified radical mastectomy

E. Radiotherapy of the spine

D

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

20. When should palliative and supportive care

be incorporated into the management of the

patient?

A. After disease progression

B. At the terminal phase

C. During chemotherapy

D. Upon diagnosis

E. When she develops spinal fracture

B

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

21. What should this patient have done years

ago to prevent diagnosis of her breast cancer at

an advanced stage?

A. Breast MRI

B. Screening Mammography

C. Serum CA 15-3 determination

D. Sonomammography

E. Whole body CT scan

A

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

22. Which drug for breast cancer is known to

cause cardiomyopathy when a cumulative level is

reached?

A. Doxorubicin

B. Anatrazole

C. Cyclophosphamide

D. Tamoxifen

E. Docetaxel

E

16-23. AB, a 45-year old female teacher, consults for a left breast mass which she first noted a month ago. Past medical history reveals that she is

diabetic maintained on metformin and that she has been previously treated for TB 5 years ago. Her mother died of breast cancer, while an older sister is

also diagnosed to have breast cancer but is still alive. She is a non-smoker and non-alcoholic beverage drinker. On PE, the breast mass is hard, slightly

movable, nontender and measures 2x3cm. There are no palpable axillary lymph nodes. The rest of the PE is unremarkable.

23. In terms of primary prevention, what

should you advise to the patient’s teenage

daughters who are concerned that they might

develop the same disease as their mother’s?

A. Annual mammography

B. Avoidance of sun exposure to the

breast

C. Bilateral prophylactic mastectomy

D. HPV vaccination

E. Low fat diet

D

24-25. A patient with right upper lobe mass of the lung develops distended neck veins, plethora of the face and neck and collateral circulation in the anterior chest wall

24. Which is the most common cause of this

clinical condition?

A. Prostate CA

B. Invasive ductal carcinoma of the breast

C. Adenocarcinoma of the descending

colon

D. Small cell and squamous cell

carcinoma of the lungs

E. Non-Hodgkins Lymphoma

B

24-25. A patient with right upper lobe mass of the lung develops distended neck veins, plethora of the face and neck and collateral circulation in the anterior chest wall

25. Which is the recommended treatment for

this patient?

A. Chemotherapy alone

B. Combination of radiation therapy and

chemotherapy

C. Saphenous vein graft

D. E. A and B are correct

A and C are correct

D

26. A patient with prostate cancer with bone

scan showing intense uptake in the thoracic and

lumbar vertebrae complains of lower back pain

with crescendo pattern. Which is TRUE regarding

this condition?

A. The pain is aggravated by cough,

sneezing or Valsalva

B. MRI of the spine is the most

appropriate imaging to confirm the

diagnosis

C. Steroid may alleviate the pain and

neurologic symptoms

D. All of the above

E. A and B only

D

27. Patient with prostate cancer was brought

to the ER because of anuria and inability to walk

for three days. Examination reveals a full

bladder (neurogenic bladder). Which of the

following supports the diagnosis of an oncologic

emergency?

A. Brain metastasis on CT Scan

B. Metabolic acidosis on ABG

C. Short QT interval on ECG

D. Complete motor and sensory deficit

from L3 and down

E. Water bottle sign on xray

C

28. Which of the following can be classified as

febrile neutropenia?

A. Absolute neutrophil count (ANC) 1,200

with one temperature 38.8C

B. ANC 600/ul with two readings of

temperature 38.3C in 24 hour

C. ANC 400/ul with one temperature

38.7dC

D. All of the above

E. A and B only

E

29. PA, 39/F diagnosed with acute myeloid

leukemia, admitted initially for chemotherapy

(now on Day 2 post chemotherapy), had sudden

onset of fever, Tmax -39C, and with mouth sores.

No cough, dyspnea. (+) diarrhea and abdominal

ain, with yellowish watery stools. On cbc, her WBC

decreased from 6 to 2.1 with Neutrophils at 25%.

Which drug is the most appropriate to be given to

treat the patient?

A. Fluconazole

B. Acyclovir

C. Cefuroxime

D. Naproxene

E. Filgastrim

B

30. Which is a type of bias where the

screening test only prolongs the time the subject

is aware of the disease since the test does not

influence the natural history of the disease?

A. Selection bias

B. Lead time bias

C. Length biased sampling

D. Respondent bias

E

31. Which is TRUE regarding use of low dose

CT scan for screening of lung cancer?

A. For patients with at least 30 pack years

smoking history

B. C. Start screening at age 50 years

NOT recommended if already stopped

smoking within the past15 years

D. All of the above

E. A and B only

D

32. Which is TRUE regarding breast cancer

screening?

A. Self breast examination is not in the

recommendation on both USPSTF and

ACS

B. Clinical breast examination is

recommended by both USPSTF and

ACS and given category B

C. Women with average risk

recommended to have biennial

mammography from age 50-74 and

given category B by USPSTF

D. A and C only

E. B and C only

E

33. Which is recommended by ACS as part of

screening for colorectal cancer starting age 50

years?

A. CEA

B. Colonoscopy

C. Fecalysis with occult blood

D. Only A and B are correct

E. Only B and C are correct

A

34. Which of the following is the most

common aggressive type of non-hodgkins

lymphoma?

A. Diffuse large B cell lymphoma

B. HTLV 1 leukemia/ Lymphoma

C. Burkitt lymphoma

D. MALT lymphoma

E. Follicular Lymphoma

B

35. AD 55/M with 2-month history of back

pains, pallor and later bipedal edema and oliguria.

On workup, there is noted spike M protein on

serum electrophoresis and (+) Bence Jones

proteins in urine. What is the most likely

diagnosis of this patient?

A. Hodgkins lymphoma

B. Multiple myeloma

C. CML

D. Non-Hodgkin’s lymphoma

E. AML

B

36. LB, 47/F is noted to have a 2 month history

of intermittent low grade fever, night sweats and

weight loss, and pallor. On PE, multiple

lymphadenopathy is noted at cervical and

bilateral axillary areas. On biopsy of lymph nodes,

there were noted aneuploid cells that are CD30

(+) and CD15 (+). What is the most likely

diagnosis of this patient?

A. CML

B. Hodgkin’s Lymphoma

C. AML

D. Multiple Myeloma

E. Non-Hodgkin’s Lymphoma

A

37. A patient on chemotherapy developed easy

fatigability and exertional dyspnea. On 2D echo

the ejection fraction declined from baseline of

55% to 33 %. Which of the following

chemotherapy most likely cause this problem?

A. Doxorubicin

B. Paclitaxel

C. Vincristine

D. Cisplastin

E. Bleomycin

A

38-40. A 64/F smoker with no known comorbidity presents with a 3 month history of weakness and easy fatigability with sudden weight loss for the past month, on PE, a hard 3 cm right supraclavicular nodule is palpated.

A. Biopsy

B. Tumor markers

C. Mammogroam

D. PET scan

E. Chest CT scan

C

39. Biopsy of the supraclavicular node is read

as metastatic squamous cell carcinoma. What

should be the next step after obtaining the biopsy

report?

A. Refer to hospice

B. Start chemotherapy

C. Order chest CT scan

D. Request for tumor markers

E. Surgically remove the entire chain of

neck lymph nodes

C

40. Which differential diagnosis should be

LEAST considered?

A. Lung cancer

B. Breast cancer

C. Cervical cancer

D. Gastric cancer

E. Lymphoma

A

41-42. A case of a patient with lymphoma, who had chemotherapy three days ago, consults the ER because of anuria. Physical examination shows BP 140/100 RR 36 O2 SAT 98% Crackles on both lung fields

41. What is the most likely picture of arterial

blood gas in our patient?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

B

42.. Which of the following is NOT an

appropriate prevention or treatment for tumor

lysis syndrome?

A. Hemodialysis

B. Alkalinization of the urine

C. Forced diuresis

D. Allopurinol administration

E. Aggressive hydration

B

43-46 A 34/F with left breast mass undergoes mastectomy. Her tumor is assessed to have aggressive features including Ki67 index, poor differentiation,

mitotic count and lymphovascular invasion. Few days after she starts chemotherapy, she is brought to ER because of generalized weakness and no

urine output for the past 4 hours. She is noted to have acidotic breathing and (+) crackles in both lung fields.
43. Which of the following is NOT an

appropriate prevention or treatment for tumor

lysis syndrome?

A. Hemodialysis

B. Alkalinization of the urine

C. Forced diuresis

D. Allopurinol administration

E. Aggressive hydration

E

43-46 A 34/F with left breast mass undergoes mastectomy. Her tumor is assessed to have aggressive features including Ki67 index, poor differentiation,

mitotic count and lymphovascular invasion. Few days after she starts chemotherapy, she is brought to ER because of generalized weakness and no

urine output for the past 4 hours. She is noted to have acidotic breathing and (+) crackles in both lung fields.
44. She is also noted to have elevated serum

calcium levels. What causes hypercalcemia in

this patient?

A. Direct lysis of bone by tumor cells

B. Expression of 1 alpha hydroxylase

enzyme

C. Part of tumor lysis syndrome

D. Increased sensitivity of the PTH

receptor

E. Production of parathyroid

hormone-related protein

D

43-46 A 34/F with left breast mass undergoes mastectomy. Her tumor is assessed to have aggressive features including Ki67 index, poor differentiation,

mitotic count and lymphovascular invasion. Few days after she starts chemotherapy, she is brought to ER because of generalized weakness and no

urine output for the past 4 hours. She is noted to have acidotic breathing and (+) crackles in both lung fields.

45. Which of the following is the most likely

cause of the patient’s problem?

A. Toxicity of chemotherapeutic agent

B. Rapid metastasis of the breast cancer

in the kidneys

C. Release of a parathormone-related

peptide (PTHrP)

D. Renal failure due to the destruction of

large number of rapidly proliferating

neoplastic cells by chemotherapy

E. Paraneoplastic syndrome

A & B only

43-46 A 34/F with left breast mass undergoes mastectomy. Her tumor is assessed to have aggressive features including Ki67 index, poor differentiation,

mitotic count and lymphovascular invasion. Few days after she starts chemotherapy, she is brought to ER because of generalized weakness and no

urine output for the past 4 hours. She is noted to have acidotic breathing and (+) crackles in both lung fields.

46. Which of the following is TRUE regarding

the standard preventive approach to tumor lysis

syndrome?

A. Aggressive hydration

B. Allopurinol

C. Sodium bicarbonate

D. AOTA

E. A and B only

D

47. Which of the following is TRUE statement

regarding spinal cord compression?

A. Localized back pain and tenderness

due to involvement of vertebrae by

tumor will be the most common initial

symptom

B. The pain is exacerbated when the

patient is supine

C. The pain is relieved or alleviated by

cough, sneezing or Valsalva

D. Only A and B

E. Only A and C

E

48. Which of the following is TRUE regarding

Superior Vena Caval Syndrome?

A. Patient usually presents with neck and

facial swelling

B. Characteristic physical findings dilated

neck veins, anterior chest wall with

increased collateral veins and edema of

arms

C. Facial swelling and plethora are

typically alleviated when the patient is

supine

D. AOTA

E. A and B only

A

49. Which of the following is an example of

primary prevention of cancer?

A. HPV vaccination for girls 11-12 years of

age

B. Flexible sigmoidoscopy every 5 years

beginning at age 50

C. Annual blood exam for tumor markers

starting at age 40 age

D. Monthly self-breast examination

beginning at age 20

E. Transvaginal ultrasound at age 40

E

50. Which of the following is NOT definitely

associated with increased risk of developing

colon cancer?

A. Diet high in animal fat

B. Low fiber diet

C. Inflammatory bowel disease

D. Polyposis coli

E. NOTA

B

51-52. A 45/ female single, asymptomatic consults for colonoscopy. She is concerned that she might develop colorectal cancer since her father died of

rectal cancer while 43yo sister is now undergoing chemotherapy for colon cancer. She is a smoker and works as a graphic artis who spend mos of her

time in front of acomputer. Her diet is composed mainly of vegetables and fruits with daily servings of pork and/or beef. Her height is 1.5 m and weight

is 60 kg. the rest of her PE is unremarkable.

51. What would be the best advice to give

this patient regarding screening for colorectal

cancer?

A. She can just observe for symptoms

first before subjecting herself to

colonoscopy

B. Colonoscopy as a screening test may

be scheduled as soon as possible

C. She may wait until she reaches 50

years old before colonoscopy is

performed

D. DRE alone may be sufficient screening

test

E. Colonoscopy has not been proven to

reduce mortality due to colon cancer.

F. Schedule for FOBT after 6 months

G. Schedule for CT colonagraphy as soon

as possible

A

51-52. A 45/ female single, asymptomatic consults for colonoscopy. She is concerned that she might develop colorectal cancer since her father died of

rectal cancer while 43yo sister is now undergoing chemotherapy for colon cancer. She is a smoker and works as a graphic artis who spend mos of her

time in front of acomputer. Her diet is composed mainly of vegetables and fruits with daily servings of pork and/or beef. Her height is 1.5 m and weight

is 60 kg. the rest of her PE is unremarkable.

52. What would be a suitable alternative ot

colonoscopy if the patient does not want to

undergoe this procedure?

A. Fecal occult blood testing every year

B. SIgmoidoscopy every 20 years

C. Abdominal CT every 5 years

D. DRE every 3 months

E. Fecal Immunochemical testing every 5

years

A

53. Which of the following is TRUE regarding

patient’s condition?

A. It is a malignant proliferation of plasma

cells

B. It is a solid tumor of the immune

system

C. It is an infiltration of blood and bone

marrow by neoplastic cells of the

hematopoietic system

D. It is the replacement of the bone

marrow by fat cells

E. It is due to ineffective erythropoiesis

caused by iron deficienc

E

54. Which of the following is TRUE regarding

this patient’s clinical features?

A. His recurrent chest and back pains are

most likely due to tumor expansion and

production of osteoclasts

His easy fatigability and weakness are

due to his anemia and hypercalcemia

C. He is less susceptible to bacterial

infections due to proliferation of

plasma cells

D. AOTA

E. A and B only

C

55. Which of the following is NOT part of the

triad of Multiple Myeloma?

A. Hypercalcemia

B. Lytic bone lesions

C. Serum/Urine IgM

D. Marrow plasmacytosis

C

56. Which of the following statement is TRUE

regarding bone involvement in Multiple Myeloma?

A. Bone lesion is due to proliferation of

tumor cells activation of osteoblasts by

several cytokines

B. Radiologic bone scanning is more

useful in diagnosis than the plain

radiography

C. Localized bone lesions may expand to

the point that mass lesions may be

palpated especially in the skull clavicles

D. AOTA

E. A and B only

B

57. Which of the following would be the most

common cause of renal failure in this patient?

A. Hyperuricemia

B. Hypercalcemia

C. Hyperviscosity

D. Light chain deposition

E. Bisphosphonate therapy

B

58. A 20-year old male has been having

recurrent fever and lumps over the neck and

axilla, associated with weight loss, night sweats,

easy fatigability, and itching for 2 months.

Physical Examination

BP 110/80 TEMP 37.8oC RR 19

HR 88 Conjunctival pallor

(+) Left supraclavicular and left axillary

lymphadenopathy

Biopsy: Left supraclavicular lymph node biopsy

reveals (+) Reed- Sternberg cells admixed with

inflammatory cells

Laboratory Findings: CBC:Hgb 9, Platelet 110,000

Chest X-Ray: Shows mediastinal

lymphadenopathy

PET Scan: No other nodal involvement other than

the left axillary and supraclavicular lymph node

What is the Ann Arbor Stage of the patient?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

E

59. What is the BEST advise that you can give

him with regard to lung cancer screening?

A. He is still too young to undergo

screening for lung cancer based on

guidelines

B. It is useless to screen because he will

eventually develop cancer just like his

brothers

C. Low dose chest CT scan is an effective

screening tool even for smokers

D. Low dose chest CT scan radiation will

increase his chances of getting lung

cancer

E. Screening would be useless if he does

not stop smoking

D

60. Which of the following is a measure of

physiologic reserve of a cancer patient?

A. Kamofsky performance index 70%

B. ECOG performance status 2

C. Age of 76 years

D. AOTA

E. A and B only

C

61. If a patient with malignancy has CT scan

done after cycles of chemotherapy showing 10%

reduction in the sums of the longest diameter in a

measurable lesions, what is this response

classified as based on RECIST criteria?

A. Complete response

B. Partial response

C. Stable disease

D. Progressive disease

A

62. A 23-year old male consults for easy

bruisability, occasional breathlessness, and

weight loss.

Physical Examination: Palpable axillary lymph

node, (+) Hepatosplenomegaly

Laboratory Findings: Hgb 8.1 Platelet count

60,000 (+) Coomb’s test (+) DAT PBS shows

smudge/basket cells

Biopsy: Immunotyping of bone marrow biopsy is

pending result

What is the most likely diagnosis of the patient?

A. B cell Chronic Lymphocytic Lymphoma

B. Burkitt’s Lymphoma

C. Diffuse Large B cell Lymphoma

D. Follicular Lymphoma

E. Matt Lymphoma

A

63. A 65-year old patient with multiple

myeloma diagnosed by a clerk at the ER with

humoral hypercalcemia of malignancy (HHM).

Which of the following principles of management

prevents osteoclast activation?

A. Bisphosphonates

B. Chemotherapy

C. Diuretics

D. Hydration

E. Radiotherapy

E / A ?

64. Which of the following is included in the

clinical staging of cancer?

A. Lung cancer patient with CT findings of

heterogenous masses in the liver, and

lytic bone lesions

B. Postmastectomy biopsy showing

metastasis on 2 out of 14 axillary

nodes examined

C. Colon cancer with CEA of 300

D. AOTA

E. A and B only

B. ECOG performance of 3

65. Which of the following indicates that the

patient is likely NOT able to cope with stress

caused by cancer and its treatment?

A. Age of 75 and higher

B. ECOG performance of 3

C. Karnofsky performance status of 90%

D. AOTA

E. A and B only

D

66. In a metastastic disease without an

apparent primary site, the primary site can be

defined based on:

A. Histology

B. Sites of involvement

C. Sex

D. AOTA

E. A and B only

C

67. Which is a part of primary cancer

prevention?

A. Screening mammogram

B. Screening pap smear

C. Cigarette smoking cessation

D. AOTA

E. A and B only

E

 68. Which is a part of secondary cancer

prevention?

A. Screening mammogram

B. Screening pap smear

C. Cigarette smoking cessation

D. AOTA

E. A and B only

D

69. Which cancer is associated with HIV?

A. Kaposi sarcoma

B. Non-Hodgkin’s lymphoma

C. Squamous cell carcinoma of the

urogenital tract

D. AOTA

E. A and B only

C

70. Which of the following is an initiator and

promoter of cancer?

A. Androgen

B. Asbestos

C. Cigarette smoking

D. Estrogen

D

71. Which is considered as highly recommended or Category A cancer screening measured by the US Preventive Services Task Force?

A. Breast clinical examination starting at

40 years

B. Colonoscopy starting at 40 years

C. Fecal DNA testing starting at 50 years

D. Pap smear beginning at 21 years

E. PSA for men below 75 years

C

72. Which of the following is an acceptable

treatment goal for patient with pancreatic cancer

with gut and biliary obstruction and liver

metastasis?

A. Curative bypass surgery followed by

radiotherapy

B. Curative radiotherapy

C. D. Morphine drip to ease the pain

Prolongation of survival through social

activities

E. Whipple’s surgery

A

73. Which of the following is considered as

neoadjuvant therapy?

A. Chemotherapy of a locally-advanced

breast cancer followed by surgery

B. C. Chemotherapy of Stage IV lung cancer

Diverting colostomy in a patient with

colon cancer

D. Excision of a localized sarcoma

followed by chemotherapy

E. Radiotherapy of a painful bone

metastasis followed by

bisphosphonates

C

74. Which of the following is the diagnostic

tumor marker?

A. Ki67

B. CEA in non-CEA colorectal cancer

C. Beta HCG in Choriocarcinoma

D. AOTA

E. A and B only

B

75. What is considered a predictive factor?

A. HCG on Choriocarcinoma

B. Present CEA on Colon cancer before

surgery

C. ECOG

D. Exposure to asbestos

E. Stable disease

A

76. Which of the following is TRUE regarding

cancer prevention?

A. Aspirin showed reduction in colorectal

cancer incidence

B. Based on ATBC and CARET trial, beta

carotene reduces incidence of lung

cancer

C. Cessation of cigarette smoking in

patient care of lung cancer has

markedly reduced the secondary

malignancy from aerodigestive tract

D. Risk of cancers of oropharynx due to

HPV infection only increase in

association with alcohol or cigarette

smoking

C

77. Which of the following group of cancers is

preventable by early smoking cessation?

A. Kidney, breast CA, and lymphoma

B. Liver, cervical CA, and leukemia

C. Bladder, pancreas, and lung cancer

D. Lymphoma, skin, and bladder CA

B

78. Which of the following is TRUE regarding

the risk for development of cancer?

A. Cancer related to cigarette smoking is

limited to cancer of aerodigestive tract

such as cancers of oral cavity,

esophagus, and lungs

B. Obesity is associated with increased

risk of cancer in the breast and

endometrium

C. Sunscreen decreases the risk of

melanoma

D. AOTA

E. A and B only

C

79. Which of the following is TRUE regarding

cancer screening?

A. CA-125 determination, transvaginal

UTZ, and ovarian palpitation to start at

women age 35 years of age

B. Low dose CT scan recommended to

screen current smokers to start at age

55 regardless of the number of pack

years of smoking history

C. PAP smear testing to screen cervical

cancer to start at age 21 years even for

individuals who began sexual activity

prior to this age

D. Screening sigmoidoscopy

recommended to start at age 50 years

with family history of hereditary

colorectal cancer

B

81-82. A case of mediastinal mass with dilated neck vein.

80. Which of the following is most likely?

A. Pericardial Effusion

B. SVC syndrome

C. Tumor Lysis Syndrome

A

81-82. A case of mediastinal mass with dilated neck vein.

 81. Treatment

A. Radiotherapy

B. Chemotherapy

C. Surgery