Oncology And Hematology multiple choice questions 6

Q 1 All of the following statements regarding tobacco

usage and cessation are correct except

A. Most Americans who quit do so on their own without

involvement in an organized cessation program.

B. Over 80% of adult Americans who smoke began before

the age of 18.

C. Smokeless tobacco is associated with gum and dental

disease, not cancer.

D. Tobacco cessation messages and programs are more

effective for light smokers than for heavy smokers.

E. Tobacco use is the most modifiable cancer risk factor.

Answer    C

Q 2 .  A 29-year-old male is found on routine chest radiography

for life insurance to have right hilar adenopathy.

He is otherwise healthy. Besides biopsy of the lymph

nodes, which of the following is indicated?

A. Angiotensin-converting enzyme (ACE) level

B. β-hCG

C. Thyroid stimulating hormone (TSH)

D. PSA

E. C-reactive protein

Answer   B

Q 3 . Which of the following is correct regarding small-cell

lung cancer compared with non-small cell lung cancer?

A. Small-cell lung cancer is more radiosensitive.

B. Small-cell lung cancer is less chemosensitive.

C. Small-cell lung cancer is more likely to present peripherally

in the lung.

D. Small-cell lung cancer is derived from an alveolar cell.

E. Bone marrow involvement is more common in nonsmall

cell lung cancer.

Answer   A

Q 4 .  Which of the following statements regarding esophageal

cancer is true?

A. Cigarette smoking and heavy alcohol intake are synergistic

risk factors for adenocarcinoma.

B. Chronic gastric reflux is a risk factor for development

of esophageal squamous cell carcinoma.

C. Esophageal cancer is most common in the middle

third of the esophagus.

D. Incidence of squamous cell carcinoma has decreased

over the past 30 years while adenocarcinoma continues

to increase.

E. The prognosis for patients with adenocarcinoma is

consistently better than for those with squamous

cell carcinoma.

F. All of the above are true.

Answer   D

Q 5 . All the following conditions are associated with an

increased incidence of cancer except

A. Down’s syndrome

B. Fanconi’s anemia

C. Von Hippel–Lindau syndrome

D. neurofibromatosis

E. fragile X syndrome

Answer   E

Q 6 . A 50-year-old female presents to your clinic for

evaluation of an elevated platelet count. The latest complete

blood count is white blood cells (WBC) 7,000/mm 3,

hematocrit 34%, and platelets 600,000/mm 3. All the following

are common causes of thrombocytosis except

A. iron-deficiency anemia

B. essential thrombocytosis

C. chronic myeloid leukemia

D. myelodysplasia

E. pernicious anemia

Answer  E

Q 7 .  A 76-year-old man presents to an urgent care

clinic with pain in his left leg for 4 days. He also describes

swelling in his left ankle, which has made it difficult

for him to ambulate. He is an active smoker and has

a medical history remarkable for gastroesophageal reflux

disease, prior deep venous thrombosis (DVT) 9

months ago that resolved, and well-controlled hypertension.

Physical examination is revealing for 2+ edema in

his left ankle. A D-dimer is ordered and is elevated.

Which of the following makes D-dimer less predictive of

DVT in this patient?

A. Age >70

B. History of active tobacco use

C. Lack of suggestive clinical symptoms

D. Negative Homan’s sign on examination

E. Previous DVT in the past year

Answer   A

Q  8 . A patient with longstanding HIV infection, alcoholism,

and asthma is seen in the emergency room for 1–2

days of severe wheezing. He has not been taking any medicines

for months. He is admitted to the hospital and

treated with nebulized therapy and systemic glucocorticoids.

His CD4 count is 8 and viral load is >750,000. His

total white blood cell (WBC) count is 3200 cells / μL with

90% neutrophils. He is accepted into an inpatient substance

abuse rehabilitation program and before discharge

is started on opportunistic infection prophylaxis, bronchodilators,

a prednisone taper over 2 weeks, ranitidine,

and highly-active antiretroviral therapy. The rehabilitation

center pages you 2 weeks later; a routine laboratory

check reveals a total WBC count of 900 cells/ μL with 5%

neutrophils. Which of the following new drugs would

most likely explain this patient’s neutropenia?

A. Darunavir

B. Efavirenz

C. Ranitidine

D. Prednisone

E. Trimethoprim-sulfamethoxazole

answer    E

Q 9 . Which of the following symptoms is most suggestive

of an esophageal mass?

A. Early satiety

B. Liquid phase dysphagia only

C. Odynophagia with chest pain

D. Oropharyngeal dysphagia

E. Solid phase dysphagia progressing to liquid phase

dysphagia

Answer   E

Q 10 . All of the following have been associated with development

of a lymphoid malignancy except

A. celiac sprue

B. Helicobacter pylori infection

C. hepatitis B infection

D. HIV infection

E. human herpes virus 8 (HHV8) infection

F. inherited immunodeficiency syndromes

Answer    C

Oncology and Haematology multiple choice questions 5

Q 1. A 68-year-old man seeks evaluation for fatigue,

weight loss, and early satiety that have been present for

about 4 months. On physical examination, his spleen is

noted to be markedly enlarged. It is firm to touch and

crosses the midline. The lower edge of the spleen reaches

to the pelvis. His hemoglobin is 11.1 g/dL, and hematocrit

is 33.7%. The leukocyte count is 6200/ μL, and platelet

count is 220,000/ μL. The white cell count differential

is 75% PMNs, 8% myelocytes, 4% metamyelocytes, 8%

lymphocytes, 3% monocytes, and 2% eosinophils. The

peripheral blood smear shows teardrop cells, nucleated

red blood cells, and immature granulocytes. Rheumatoid

factor is positive. A bone marrow biopsy is attempted, but

no cells are able to be aspirated. No evidence of leukemia

or lymphoma is found. What is the most likely cause of

the splenomegaly?

A. Chronic idiopathic myelofibrosis

B. Chronic myelogenous leukemia

C. Rheumatoid arthritis

D. Systemic lupus erythematosus

E. Tuberculosis

Answer    A

Q 2 . The most common cause of high serum calcium in a

patient with a known cancer is

A. ectopic production of parathyroid hormone

B. direct destruction of bone by tumor cells

C. local production of tumor necrosis factor and IL-6

by bony metastasis

D. high levels of 1,25-hydroxyvitamin D

E. production of parathyroid hormone–like substance

Answer   E

Q 3.  A 72-year-old man with chronic obstructive pulmonary

disease and stable coronary disease presents to the

emergency room with several days of worsening productive

cough, fevers, malaise, and diffuse muscle aches. A

chest x-ray demonstrates a new lobar infiltrate. Laboratory

measurements reveal a total white blood cell count of

12,100 cells/μL, with a neutrophilic predominance of

86% and 8% band forms. He is diagnosed with community-

acquired pneumonia, and antibiotic treatment is initiated.

Under normal, or “nonstress,” conditions, what

percentage of the total body neutrophils are present in the

circulation?

A. 2%

B. 10%

C. 25%

D. 40%

E. 90%

Answer    A

Q 4 . All of the following laboratory values are consistent

with an intravascular hemolytic anemia except

A. increased haptoglobin

B. increased lactate dehydrogenase (LDH)

C. increased reticulocyte count

D. increased unconjugated bilirubin

E. increased urine hemosiderin

Answer    A

Q 5 . All the following match the anticoagulant with its

correct mechanism of action except

A. abciximab—GpIIb/IIIa receptor inhibition

B. clopidogrel—inhibition of thromboxane A 2 release

C. fondaparinux—inhibition of factor Xa

D. argatroban—thrombin inhibition

E. warfarin—vitamin K—dependent carboxylation of

coagulation factors

Answer   B

Q 6 . All the following are late complications of bone

marrow transplant preparative regimens except

A. growth retardation

B. azoospermia

C. hypothyroidism

D. cataracts

E. dementia

Answer    E

Q 7 . Which of the following best describes the mechanism

of action of clopidogrel?

A. Activates antithrombin and inhibits clotting enzymes

B. Binds to the activated GPIIb/IIIa receptor on the

platelet surface to block binding of adhesive molecules

C. Inhibits cyclooxygenase 1 (COX-1) on platelets to

decrease production of thromboxane A 2

D. Inhibits phosphodiesterase to block the breakdown

of cyclic adenosine monophosphate (cAMP) to inhibit

platelet activation

E. Irreversibly blocks P2Y 12 to prevent adenosine

diphosphate (ADP)–induced platelet aggregation

Answer     E

Q 8 . A 45-year-old man is evaluated by his primary care

physician for complaints of early satiety and weight loss.

On physical examination, his spleen is palpable 10 cm below

the left costal margin and is mildly tender to palpation.

His laboratory studies show a leukocyte count of

125,000/μL with a differential of 80% neutrophils, 9%

bands, 3% myelocytes, 3% metamyelocytes, 1% blasts,

1% lymphocytes, 1% eosinophils, and 1% basophils. Hemoglobin

is 8.4 g/dL, hematocrit 26.8%, and platelet

count 668,000/μL. A bone marrow biopsy demonstrates

increased cellularity with an increased myeloid to eryth-

roid ratio. Which of the following cytogenetic abnormalities

is most likely to be found in this patient?

A. Deletion of a portion of the long arm of chromosome

5, del(5q)

B. Inversion of chromosome 16, inv(16)

C. Reciprocal translocation between chromosomes 9

and 22 (Philadelphia chromosome)

D. Translocations of the long arms of chromosomes 15

and 17

E. Trisomy 12

Answer    C

Q  9 . A 35-year-old patient comes into your office with

persistent iron deficiency anemia. His past medical history

is significant for end-stage renal disease on hemodialysis,

hypertension, and rheumatoid arthritis. His

medications include calcium acetate, a multivitamin, nifedipine,

aspirin, iron sulfate, and omeprazole. His hemoglobin

6 months ago was 8 mg/dL. One week ago, it

was 7.9 mg/dL. His ferritin is 8 mg/dL. He reports no

bright red blood per rectum, and his stool guaiac examinations

have been repeatedly negative over the past 6

months. What is the most likely cause of this patient’s

iron deficiency anemia?

A. Celiac sprue

B. Colon cancer

C. Hemorrhoids

D. Medication effect

E. Peptic ulcer disease

Answer   D

Q 10 . A 32-year-old male presents complaining of a testicular

mass. On examination you palpate a 1-by 2-cm painless

mass on the surface of the left testicle. A chest x-ray shows

no lesions, and a CT scan of the abdomen and pelvis shows

no evidence of retroperitoneal adenopathy. The α fetoprotein

(AFP) level is elevated at 400 ng/mL. Beta human

chorionic gonadotropin ( β-hCG) is normal, as is LDH.

You send the patient for an orchiectomy. The pathology

comes back as seminoma limited to the testis alone. The

AFP level declines to normal at an appropriate interval.

What is the appropriate management at this point?

A. Radiation to the retroperitoneal lymph nodes

B. Adjuvant chemotherapy

C. Hormonal therapy

D. Retroperitoneal lymph node dissection (RPLND)

E. Positron emission tomography (PET) scan

Answer    D

Oncology and Hematology multiple choice questions 3

 

Q 1 . A 22-year-old pregnant woman of northern European

descent presents 3 months into her first pregnancy

with extreme fatigue, pallor, and icterus. She reports being

previously healthy. On evaluation her hemoglobin is 8

g/dL, reticulocyte count is 9%, indirect bilirubin is 4.9

mg/dL, and serum haptoglobin is not detectable. Her

physical examination is notable for splenomegaly and a

normal 3-month uterus. Peripheral smear is shown below .

What is the most likely diagnosis? (See Figure III-21,

Color Atlas.)

A. Colonic polyp

B. G6PD deficiency

C. Hereditary spherocytosis

D. Parvovirus B19 infection

E. Thrombotic thrombocytopenic purpura

Answer   C

Q 2 . A patient with acute lymphoid leukemia (ALL) is

admitted with respiratory distress and chest pain. The patient

reports 1 day of shortness of breath not associated

with cough. There have been no sick contacts, and before

the onset of the respiratory symptoms, the patient only

recalls fatigue. A chest radiograph shows faint diffuse interstitial

infiltrates without pulmonary edema. The cardiac

silhouette is normal. An arterial blood gas shows a

PaO2 = 54 mmHg, while the pulse oximetry is 97% on

room air. A carbon monoxide level is normal. All of the

following laboratory abnormalities are expected in this

patient except

A. bcr-abl mutation

B. blast count >100,000/ μL

C. elevated lactate dehydrogenase levels

D. increased blood viscosity

E. methemoglobinemia

Answer   E

Q 3 . A 48-year-old male is referred for evaluation by an

acute care center because of a nodule on chest radiography.

Three weeks ago he was diagnosed with pneumonia after

reporting 3 days of fever, cough, and sputum production.

The chest radiogram showed a small right lower lobe alveolar

infiltrate and a left upper lobe 1.5-cm round nodule.

He was treated with antibiotics and is now asymptomatic.

A repeat chest radiogram shows that the right lower lobe

pneumonia is resolved, but the nodule is still present. He is

asymptomatic. He smoked one pack of cigarettes per day

for 25 years and quit 3 years ago. He never had a prior chest

radiogram. CT scan shows that the nodule is 1.5 by 1.7 cm

and is located centrally in the left upper lobe, has no calcification,

and has slightly scalloped edges. There is no mediastinal

adenopathy or pleural effusion. Which of the

following is the appropriate next step in his management?

A. Bronchoscopy

B. Mediastinoscopy

C. MRI scan

D. 18FDG PET scan

E. Repeat chest CT in 6 months

Answer    D

Q 4 . All the following types of cancer commonly metastasize

to the central nervous system (CNS) except

A. ovarian

B. breast

C. hypernephroma

D. melanoma

E. acute lymphoblastic leukemia (ALL)

Answer    A

Q 5 . A 54-year-old woman with atrial fibrillation is anticoagulated

with warfarin, 5 mg daily. She developed a urinary

tract infection that her primary care physician has treated

with ciprofloxacin, 250 mg orally twice daily for 7 days. She

presents to the emergency room today complaining of

blood in her urine and easy bruising. Her physical examination

shows ecchymoses on her arms. Her urine is bloody

in appearance, but no clots are present. After flushing the

bladder with 100 mL of sterile saline, the urine returns

with a slight pink hue only. A urinalysis shows 3–5 white

blood cells per high power field and many red blood cells

per high power field. There are no bacteria present. The international

normalized ratio (INR) is 7.0. What is the best

approach to treatment of this patient’s coagulopathy?

A. Administer vitamin K 10 mg IV.

B. Administer vitamin K 2 mg SC.

C. Administer vitamin K 1 mg sublingually.

D. Hold further warfarin doses until the INR falls to 2.0.

E. Transfuse four units of fresh-frozen plasma.

Answer    C

Q  6 . Which of the following statements about cardiac

toxicity from cancer treatment is true?

A. Doxorubicin-based cardiac toxicity is idiosyncratic

and dose-independent.

B. Anthracycline-induced congestive heart failure is reversible

with time and control of risk factors.

C. Mediastinal irradiation often results in acute pericarditis

during the first few weeks of treatment.

D. Chronic constrictive pericarditis often manifests

symptomatically up to 10 years after treatment.

E. The incidence of coronary atherosclerosis in patients

who have a history of mediastinal irradiation

is the same as that in age-matched controls.

Answer     D

Q 7 . A 23-year-old woman is diagnosed with a lower extremity

deep venous thrombosis. Which of the following

medical conditions represents a contraindication to therapy

with low-molecular-weight heparin (LMWH)?

A. Pregnancy

B. Obesity

C. Dialysis-dependent renal failure

D. Uncontrolled diabetes mellitus

E. Jaundice

Answer    C

Q 8  . Which of the following pairs of chemotherapy and

complication is incorrect?

A. Daunorubicin—CHF

B. Bleomycin—interstitial fibrosis

C. Cyclophosphamide—hematuria

D. Cisplatin—liver failure

E. Ifosfamide—Fanconi syndrome

Answer    D

Q 9 . A 70-year-old man is admitted to the cardiac care

unit for complaints of chest pressure occurring at rest radiating

to his left arm with associated diaphoresis and presyncope.

His admission electrocardiogram (ECG) showed

ST depressions in V4–V6. The chest pain and ECG

changes resolve with sublingual nitroglycerin. He is

treated with IV heparin, aspirin, metoprolol, and lisinopril.

His cardiac catheterization shows 90% occlusion of

the left anterior descending artery, 80% occlusion of the

distal circumflex artery, and 99% occlusion of the right

coronary artery. He remains in the cardiac care unit awaiting

coronary artery bypass. He has a history of rheumatic

heart disease and underwent mechanical mitral valve replacement

at age 58. On admission, his hemoglobin is 12.2

g/dL, hematocrit 37.1%, white blood cell (WBC) count

9800/μL, and platelet count 240,000/μL. His creatinine is

1.7 mg/dL. On the fourth hospital day, his hemoglobin is

10.0, hematocrit 31%, WBC count 7600/μL, and platelet

count 112,000/μL. His creatinine has risen to 2.9 mg/dL

after the cardiac catheterization. What is the most appropriate

treatment of the patient at this time?

A. Continue heparin and give a platelet transfusion.

B. Discontinue heparin infusion and start argatroban.

C. Discontinue heparin and start lepirudin.

D. Discontinue heparin and start warfarin.

E. Send serum to assess for the presence of heparin–

platelet factor 4 (PF4) IgG antibody and continue

heparin.

Answer  B

Q 10 . A 24-year-old woman presents to the emergency

room complaining of a red, tender rash that has been

spreading across her arms and legs over the past 2 days. She

also describes severe diffuse muscle pain that has worsened

over a week’s time. She woke up feeling as though she could

not catch her breath and has developed a dry cough over

the past several days. She is without any significant medical

history but recalls that she had similar symptoms several

years ago, and was told she was having an allergic reaction.

Her symptoms abated with an oral glucocorticoid taper.

She takes no prescription medications but takes a number

of over-the-counter nutritional supplements daily. She cannot

describe any allergic trigger to her previous episode or

her current one. Her family history is unremarkable, and

her close contacts are not ill. She works in an office, has no

pets, and has not travelled internationally. Her laboratory

results are remarkable for a leukocyte count of 12,100 cells/

μL and a total eosinophil count of 1100/μ L. Which of the

following is the most likely cause of her symptoms?

A. Early stage of systemic lupus erythematosus

B. Gluten allergy

C. Ingestion of L-tryptophan

D. Lactose intolerance

E. Recent viral upper respiratory tract infection

Answer    C