Professional Documents
Culture Documents
Practice Test 2
D. AC combined with trastuzumab
E. AC alone
1. A 52-year-old woman with stage III melanoma is receiving high-dose interferon therapy. She has completed the
four weeks of daily intravenous therapy and is now in the
fifth month of maintenance subcutaneous therapy with
interferon. Laboratory analyses performed on the previous
day demonstrated a normal complete blood count and
differential count, but the serum bilirubin was 1.9 mg/dL,
the asparate aminotransferase was 420 U/L, and the
alanine aminotransferase was 380 U/L. The patient feels
well at this time except for fatigue. A physical examination
performed last week was normal.
A.
B.
C.
D.
A. It has no significance
B. It increases the risk of relapse to 40%, compared with 4%
if the assay were negative
C. It increases the risk of relapse to 80%, compared with 4%
if the assay were negative
D. It represents an early indication of inevitable relapse
5. Which of the following histologic subtypes of Hodgkins lymphoma is most likely to respond to treatment with rituximab?
Practice Test 2 |
A.
B.
C.
D.
E.
Nodular sclerosing
Nodular lymphocyte-predominant
Mixed cellularity
Lymphocyte depleted
None of the above
Tamoxifen therapy
Raloxifene therapy
Annual mammography
Adoption of a low-fat diet
Chemotherapy
Ketoconazole and hydrocortisone
Change to a different bisphosphonate
Discontinue bicalutamide but continue therapy with goserelin
Strontium-89 or samarium-153
8. A 62-year-old man presents for routine outpatient follow-up eight months after completing initial treatment
with concurrent cisplatin-based chemoradiotherapy for
T3, N2b, M0 squamous cell cancer of the right tonsil.
He was rendered free of disease. He has had mild dysphagia and odynophagia for approximately three weeks.
He is otherwise asymptomatic and reports having no
fever, chills, nausea, vomiting, weight loss, cough,
hemoptysis, or trismus. He continues to work full-time.
On physical examination, a recurrent ulcerated mass is
clearly noted in the area of the right tonsil, with exten2
| Practice Test 2
9. IFN-2 has been demonstrated to have clinically significant single-agent antitumor activity against which one
of the following malignant diseases?
A.
B.
C.
D.
E.
10. A 59-year-old man is referred for evaluation of persistent lymphocytosis. On physical examination, he is
found to have cervical, axillary, and inguinal lymphadenopathy. The white blood cell count is 19,000/L.
Your differential diagnosis includes CLL.
Which of the following tests is most likely to yield the
diagnosis?
A.
B.
C.
D.
15. A 62-year-old man presents with a one-month history of cough. Over the last week, he has had several
episodes of hemoptysis. On review of symptoms, he also
reports that he has had increasing fatigue, decreased
appetite, and a loss of five to 10 pounds. He has no
other meaningful medical history and has otherwise
been well. He smokes approximately two packs of cigarettes daily.
Figure 1.
Practice Test 2 |
| Practice Test 2
A.
B.
C.
D.
E.
Hodgkins lymphoma. Additional staging includes negative findings on bone marrow biopsy. CT shows multiple
two to three-centimeter retroperitoneal nodes. PET
scanning does not identify any other sites of disease.
Laboratory evaluation includes normal levels of liver
enzymes except for an LDH of 350 U/L. The plan is to
treat him with CHOP chemotherapy.
Which of the following are the likelihood of complete
response and the five-year disease-free survival?
A.
B.
C.
D.
87%
67%
55%
44%
and
and
and
and
73%
51%
43%
26%
26. A 47-year-old woman presents for a screening mammogram. Her mother, who is Jewish, had breast cancer at
age 36. A maternal aunt had breast cancer at age 40. The
woman has two preteen daughters. She has no siblings. A
mammogram detects a 0.8-centimeter suspicious abnormality in the lateral portion of the right breast. The patient
and her mother become very anxious, and before any
additional diagnostic work-up they request genetic testing.
Who should be tested?
A.
B.
C.
D.
E.
Woman
Mother
Aunt
Elder daughter
Younger daughter
Southern blotting
Comparative genomic hybridization
cDNA microarray analysis
Karyotyping
Taqman assay
| Practice Test 2
A
B.
C.
D.
E.
Nucleotide sequencing
Comparative genomic hybridization
cDNA microarray analysis
Karyotyping
Taqman assay
Daily aspirin
Prophylactic bilateral mastectomy
Oophorectomy
B and C
None of the above
32. Which of the following is the most favorable cytogenetic finding in patients with CLL?
A.
B.
C.
D.
34. A 47-year-old woman presents two year after completing therapy for high-risk stage II breast cancer.
Treatment included lumpectomy, radiation therapy, and
adjuvant chemotherapy with cyclophosphamide and
doxorubicin. She now has new-onset anemia and thrombocytopenia and is found to have AML with inv(16).
35. Which of the following describes some of the differences between atypical carcinoid and small cell lung
cancer?
A. Small cell lung cancer cells have a greater number of
neuroendocrine granules as detected by electron
microscopy
B. Small cell lung cancer cells have a greater number of
mitoses found by light microscopy
C. Atypical carcinoids found in the lung are likely to represent metastases from the gastrointestinal tract, whereas
small cell lung cancer is almost always primary to the lung
D. Atypical carcinoids are more likely to be associated with
smoking
A.
B.
C.
D.
E.
37. Which of the following describes the cancer mortality rate of a country?
A. Percentage of patients with cancer in a country who die
from cancer each year
B. Absolute number of patients with cancer in a country who
die of cancer in a given year
Practice Test 2 |
C. Number of people who die of cancer per 100,000 individuals living in the country in a given year
D. Number of people diagnosed with potentially fatal cancers
per 100,000 cases per year
39. A 68-year-old woman is referred to you for additional treatment four weeks after surgical resection for a
tumor in the ascending colon that was determined on
pathologic evaluation to be a moderately differentiated
adenocarcinoma of the colon arising from a villous
adenoma. The tumor had penetrated through the
serosa, and three of 12 lymph nodes were positive for
metastatic cancer. No other disease was seen at the
time of surgery.
Preoperatively, the CEA level was 1.2 ng/mL, and CT of
the chest, abdomen, and pelvis demonstrated no
metastasis.
She has recovered from surgery well except for a slow
recovery of normal bowel function, with two to three
stools a day, compared with one stool per day preoperatively. Her history includes diabetes controlled with oral
agents, hypertension poorly controlled with a betablocker and a diuretic, and a hysterectomy for fibroids.
She lives with her husband, is active, and is able to drive
and maintain her own household.
Which of the following would you recommend?
A. 12 months of treatment with fluorouracil and leucovorin
B. Six months of treatment with fluorouracil, leucovorin, and
levamisole
| Practice Test 2
Figure 2.
B. Total left mastectomy with immediate breast reconstruction, sentinel lymph node biopsy, four cycles of AC, and
tamoxifen for five years
C. Bilateral simple mastectomy with left sentinel node biopsy
and anastrozole for five years
D. Lumpectomy, bilateral breast radiation therapy, and tamoxifen for five years
E. Radiofrequency ablation of all three abnormal areas of
the breast, axillary dissection, radiation therapy, and
tamoxifen for five years followed by letrozole for five
years
10
| Practice Test 2
A.
B.
C.
D.
E.
11
56. A 66-year-old man with stage IV bronchogenic cancer metastatic to the mediastinal lymph nodes, adrenal
glands, and bone presents for routine follow-up. For the
past four months, he has received chemotherapy with
paclitaxel and carboplatin. His only complaint is fatigue.
The Karnofsky performance status is 70. Routine blood
work shows a hemoglobin level of 8.7 g/dL; the hemoglobin level had been 13.2 g/dL at the start of therapy.
Stool is negative for occult blood. He has been doing
research on the Internet and is curious about whether
he is a good candidate for erythropoietin.
Which of the following statements regarding erythropoietin is correct?
A. Treatment with erythropoetin should continue until the
hemoglobin level increases by 1 to 2 g/dL
B. The goal should be to normalize hemoglobin levels to more
than 12 g/dL
C. Iron, total iron binding capacity, and ferritin levels should
be obtained at least every two months
D. Patients with myeloma should begin treatment with
erythropoetin in conjunction with the start of
chemotherapy
E. Transfusion of packed red blood cells is contraindicated
before the initiation of erythropoietin
| Practice Test 2
A. Octreotide
B. Sucralfate
C. Ozalazine
D. Glutamine
Practice Test 2 |
13