Neoplasia Practice Questions

Question 1

A 33-year-old woman comes to the physician 1 week after noticing a lump in her right breast. Fifteen years ago, she was diagnosed with osteosarcoma of her left distal femur. Her father died of an adrenocortical carcinoma at the age of 41 years. Examination shows a 2-cm, firm, immobile mass in the lower outer quadrant of the right breast. A core needle biopsy of the mass shows adenocarcinoma. Genetic analysis in this patient is most likely to show a defect in which of the following genes?

Accepted Answer

TP53

Answer

BRCA1

Answer

KRAS

Answer

Rb

Answer

PTEN

Question 2

A 62-year-old woman presents to her physician with a painless breast mass on her left breast for the past 4 months. She mentions that she noticed the swelling suddenly one day and thought it would resolve by itself. Instead, it has been slowly increasing in size. On physical examination of the breasts, the physician notes a single non-tender, hard, and fixed nodule over left breast. An ultrasonogram of the breast shows a solid mass, and a fine-needle aspiration biopsy confirms the mass to be lobular carcinoma of the breast. When the patient asks about her prognosis, the physician says that the prognosis can be best determined after both grading and staging of the tumor. Based on the current diagnostic information, the physician says that they can only grade, but no stage, the neoplasm. Which of the following facts about the neoplasm is currently available to the physician?

Accepted Answer

The tumor cells exhibit marked nuclear atypia.

Answer

The tumor invades the pectoralis major.

Answer

The tumor has spread via blood-borne metastasis.

Answer

The tumor has not metastasized to the contralateral superior mediastinal lymph nodes.

Answer

The tumor has metastasized to the axillary lymph nodes.

Question 3

Patient 1 – A 26-year-old woman presents to her primary care physician for an annual exam. She currently does not have any acute concerns and says her health has been generally well. Medical history is significant for asthma, which is managed with an albuterol inhaler. Her last pap smear was unremarkable. She is currently sexually active with one male and consistently uses condoms. She occasionally smokes marijuana and drinks wine once per week. Her mother recently passed away from advanced ovarian cancer. Her sister is 37-years-old and was recently diagnosed with breast cancer and ovarian cancer. Physical examination is remarkable for a mildly anxious woman.

Patient 2 – A 27-year-old woman presents to her primary care physician for an annual exam. She says that she would like to be screened for breast cancer since two of her close friends were recently diagnosed. She noticed she has a small and mobile mass on her left breast, which increases in size and becomes tender around her time of menses. Family history is remarkable for hypertension in the father. The physical exam is significant for a small, well-defined, and mobile mass on her left breast that is not tender to palpation.

Which of the following is the best next step in management for patient 1 and 2?

Accepted Answer

Patient 1 – BRCA testing. Patient 2 – Breast ultrasound

Answer

Patient 1 – Breast ultrasound. Patient 2 – Return in 3 months for a clinical breast exam

Answer

Patient 1 – Reassurance. Patient 2 – Breast ultrasound

Answer

Patient 1 – CA-125 testing. Patient 2 – BRCA testing

Answer

Patient 1 – Breast and ovarian ultrasound. Patient 2 – Mammography

Question 4

An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

Accepted Answer

10

Answer

20

Answer

73

Answer

50

Answer

100

Question 5

A 39-year-old African American woman is admitted to the hospital following a seizure with a severe post-ictal headache. She was diagnosed with breast cancer 1 year ago when she presented with a hard, rock-like, immobile mass with irregular borders accompanied by changes in the breast skin, including erythema and dimpling. She had ipsilateral mobile axillary lymphadenopathy at that time. A biopsy confirmed the diagnosis of stage 2B invasive breast cancer. Her mother died at 42 years of age due to the same type of breast cancer. A CT scan done during this admission reveals multiple metastatic lesions in the brain and liver, along with the involvement of supra- and infra-clavicular lymph nodes. Which of the following molecular profile most likely characterizes this patient?

Accepted Answer

ER, PR, HER2 negative

Answer

PR, ER, HER2 positive

Answer

HER2 positive

Answer

Progesterone receptor (PR) positive

Answer

Estrogen receptor (ER) positive

Question 6

A 29-year-old woman presents to her gynecologist for a routine check-up. She is sexually active with multiple partners and intermittently uses condoms for contraception. She denies vaginal discharge, burning, itching, or rashes in her inguinal region. Pelvic examination is normal. Results from a routine pap smear are shown. The cellular changes seen are attributable to which of the following factors?

Accepted Answer

Inhibition of p53

Answer

Activation of p53

Answer

Activation of K-Ras

Answer

Inhibition of p16

Answer

Activation of Rb

Question 7

A 38-year-old man presents to his primary care practitioner for 2 months of rectal bleeding. He also reports occasional diarrhea and abdominal pain. His family history is relevant for his father and uncle, who died from complications of colorectal cancer. Colonoscopy shows more than 10 colorectal adenomas. Which of the following genes is most likely affected in this patient?

Accepted Answer

APC

Answer

RAS

Answer

TP53

Answer

hMLH1

Answer

PPAR

Question 8

You are currently employed as a clinical researcher working on clinical trials of a new drug to be used for the treatment of Parkinson's disease. Currently, you have already determined the safe clinical dose of the drug in a healthy patient. You are in the phase of drug development where the drug is studied in patients with the target disease to determine its efficacy. Which of the following phases is this new drug currently in?

Accepted Answer

Phase 2

Answer

Phase 4

Answer

Phase 1

Answer

Phase 0

Answer

Phase 3

Question 9

A researcher is investigating the behavior of two novel chemotherapeutic drugs that he believes will be effective against certain forms of lymphoma. In order to evaluate the safety of these drugs, this researcher measures the concentration and rate of elimination of each drug over time. A partial set of the results is provided below.

Time 1:
Concentration of Drug A: 4 mg/dl
Concentration of Drug B: 3 mg/dl
Elimination of Drug A: 1 mg/minute
Elimination of Drug B: 4 mg/minute

Time 2:
Concentration of Drug A: 2 mg/dl
Concentration of Drug B: 15 mg/dl
Elimination of Drug A: 0.5 mg/minute
Elimination of Drug B: 4 mg/minute

Which of the following statements correctly identifies the most likely relationship between the half-life of these two drugs?

Accepted Answer

The half-life of drug A is constant but that of drug B is variable

Answer

The half-life of drug A is always longer than that of drug B

Answer

The half-life of both drug A and drug B are constant

Answer

The half-life of both drug A and drug B are variable

Answer

The half-life of drug A is variable but that of drug B is constant

Question 10

A 27-year-old woman presents for her routine annual examination. She has no complaints. She has a 3-year-old child who was born via normal vaginal delivery with no complications. She had a Pap smear during her last pregnancy and the findings were normal. Her remaining past medical history is not significant, and her family history is also not significant. Recently, one of her close friends was diagnosed with breast cancer at the age of 36, and, after reading some online research, she wants to be checked for all types of cancer. Which of the following statements would be the best advice regarding the most appropriate screening tests for this patient?

Accepted Answer

“We should do a Pap smear now. Blood tests are not recommended for screening purposes.”

Answer

“Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”

Answer

“Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”

Answer

“Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”

Answer

“You need HPV (human papillomavirus) co-testing only.”

Neoplasia

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Characteristics of benign vs malignant tumors

Nomenclature of neoplasms

Carcinogenesis models

Oncogenes and proto-oncogenes

Tumor suppressor genes

DNA repair genes and cancer

Epigenetic mechanisms in cancer

Apoptosis and cancer

Tumor angiogenesis

Tumor invasion and metastasis

Carcinogenic agents

Paraneoplastic syndromes

Tumor immunology

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