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 4

Q 1. woman wants your advice regarding Papanicolaou

smears. She is 36 years old and is monogamous with her

husband since they were married 3 years ago. She has had

normal Pap smears every year for the past 6 years. She

would like to avoid the yearly test. What is your advice to

this patient, based on the current screening guidelines?

A. She may discontinue screening at age 50 if she has had

normal yearly Pap smears for the previous 10 years.

B. She may extend the screening interval to once every

2–3 years.

C. She may extend the screening interval to once every

5 years if she agrees to use barrier protection.

D. She may discontinue Pap screening if she receives

the human papilloma virus (HPV) vaccine.

E. The only indication to cease Pap testing is if she

were to have a total hysterectomy

Answer   B

Q 2 . The evaluation in a newly diagnosed case of acute

lymphoid leukemia (ALL) should routinely include all of

the following except

A. bone marrow biopsy

B. cell-surface phenotyping

C. complete metabolic panel

D. cytogenetic testing

E. lumbar puncture

F. plasma viscosity

Answer  F

Q 3 . Which of the following statements about lead-time

bias occurrence is true?

A. A test does not influence the natural history of the disease;

patients are merely diagnosed at an earlier date.

B. Slow-growing, less aggressive cancers are detected

during screening; aggressive cancers are not detected

by screening, due to death.

C. Screening identifies abnormalities that would never

have caused a problem during a person’s lifetime.

D. The screened population differs significantly from

the general population in that they are healthier.

E. A test detects disease at an earlier and more curable

stage of disease.

Answer   A

Q 4 . Which of the following is sufficient to make a definitive

diagnosis of porphyria?

A. Appropriate clinical scenario including positive

family history

B. Evidence of an enzyme deficiency or gene defect

C. Laboratory measurements in blood indicating accumulation

of porphyrin precursors

D. Laboratory measurements in urine indicating accumulation

of porphyrin precursors at the time of symptoms

E. Laboratory measurements in stool indicating accumulation

of porphyrin precursors at the time of symptoms

Answer   B

Q 5 . All but which of the following statements about the

lupus anticoagulant (LA) are true?

A. Lupus anticoagulants typically prolong the aPTT.

B. A 1:1 mixing study will not correct in the presence

of lupus anticoagulants.

C. Bleeding episodes in patients with lupus anticoagulants

may be severe and life-threatening.

D. Female patients may experience recurrent midtrimester

abortions.

E. Lupus anticoagulants may occur in the absence of

other signs of systemic lupus erythematosus (SLE).

Answer   C

Q 6 . The most common inherited prothrombotic disorder is

A. activated protein C resistance

B. prothrombin gene mutation

C. protein C deficiency

D. protein S deficiency

E. antithrombin deficiency

Answer    A

Q 7 . A 34-year-old woman presents for evaluation of left

lower extremity swelling and pain. She is obese and 8

weeks postpartum. She recently traveled 6 h by airplane

to visit her parents with her infant. She has had no dyspnea,

palpitations, or syncope. She is currently on no medications

except iron tablets. She is otherwise healthy. Her

vitals signs are: heart rate 86 beats/min, blood pressure

110/80 mm/Hg, temperature 37.0°C, and respiratory rate

12 breaths/min. Her weight is 98 kg, and height is 170

cm. The left lower extremity is swollen, tender, and warm

to touch. A Homan’s sign is present, but there are no palpable

cords. A lower extremity Doppler shows a thrombosis

in the common and superficial femoral veins of the

left leg. You are considering outpatient treatment with

enoxaparin. All of the following statements regarding

low-molecular-weight heparins (LMWH) are true except

A. In patients with uncomplicated deep venous thrombosis

(DVT), LMWH is a safe and effective alternative

to IV heparin and is associated with reduced

health care costs compared to IV heparin.

B. LMWH can be safely used in pregnancy, but factor

Xa levels should be monitored to ensure adequate

anticoagulation.

C. Monitoring of factor Xa levels is unnecessary in

most patients as there is a predictable dose-dependent

anticoagulation effect.

D. There is a decrease in the risk of development of heparin-

induced thrombocytopenia with use of LMWH.

E. This patient’s recent pregnancy is a contraindication

to use of LMWH because there is a greater risk of

bleeding with LWMH compared to IV heparin.

Answer   E

Q 8 . A 65-year-old man is brought to the emergency room

by ambulance after his daughter found him to be incoherent

earlier today. She last spoke with him yesterday, and at

that time, he was complaining of 2 days of myalgias, headache,

and fever. He had attributed it to an upper respiratory

tract infection and did not seek evaluation from his

primary care physician. Today, he did not answer when she

called his home, and she found him lying in his bed smelling

of urine. He was minimally arousable but appeared to

be moving all of his extremities. His past medical history is

significant for hypertension, hypercholesterolemia, and

chronic obstructive pulmonary disease. He was evaluated

2 weeks previously for a transient ischemic attack after an

episode where he had numbness and weakness of his left

arm and leg that resolved over 6 h without intervention.

His current medications include aspirin, 81 mg daily, clopidogrel,

75 mg daily, atenolol, 100 mg daily, atorvastatin,

20 mg daily, and tiotropium, once daily. He is allergic to lisinopril,

which caused angioedema. He is a former smoker

and drinks alcohol rarely.

On physical examination, he is obtunded and minimally

arousable. He is febrile with a temperature of 38.9°C. His

blood pressure is 159/96 mmHg, and heart rate is 98 beats/

min. He is breathing at a rate of 24 breaths/min with a room

air oxygen saturation of 95%. He has minimal scleral icterus.

The oropharynx reveals dry mucous membranes. His

cardiovascular, pulmonary, and abdominal examinations

are normal. There are no rashes. His neurologic examination

is difficult to obtain. There are no cranial nerve findings.

He resists movement of his extremities but has normal

strength. Deep tendon reflexes are brisk, 3+ and equal.

The laboratory values are as follows: hemoglobin 9.3 g/

dL, hematocrit 29.1%, white blood cell count 14,000/ μL,

and platelets 42,000/ μL. The differential demonstrates

83% neutrophils, 2% band forms, 6% lymphocytes, and

9% monocytes. The sodium is 145 meq/L, potassium 3.8

meq/L, chloride 113 meq/L, bicarbonate 19 meq/L, blood

urea nitrogen 68 mg/dL, and creatinine 3.4 mg/dL. The

bilirubin is 2.4 mg/dL, and lactate dehydrogenase is 450

U/L. A peripheral blood smear shows diminished platelets

and many schistocytes.What is the next most appropriate

step in this patient’s care?

A. Discontinue clopidogrel.

B. Discontinue clopidogrel and initiate plasmapheresis.

C. Initiate therapy with intravenous immunoglobulin.

D. Obtain a head CT scan and initiate treatment with

factor VIIa, if subarachnoid hemorrhage is seen.

E. Perform a lumbar puncture and start broad-spectrum

antibiotic coverage with ceftazidime and vancomycin.

Answer   B

Q 9 . A primary tumor of which of these organs is the

least likely to metastasize to bone?

A. Breast

B. Colon

C. Kidney

D. Lung

E. Prostate

Answer  B

Q 10 . The triad of portal vein thrombosis, hemolysis, and

pancytopenia suggests which of the following diagnoses?

A. Acute promyelocytic leukemia

B. Hemolytic-uremic syndrome (HUS)

C. Leptospirosis

D. Paroxysmal nocturnal hemoglobinuria (PNH)

E. Thrombotic thrombocytopenia purpura (TTP)

Answer    D