Oncologic Surgery Principles Practice Questions

Question 1

An excisional biopsy is performed and the diagnosis of superficial spreading melanoma is confirmed. The lesion is 1.1 mm thick. Which of the following is the most appropriate next step in management?

Accepted Answer

Surgical excision with 1-2 cm safety margins and sentinel lymph node study

Answer

Surgical excision with 0.5-1 cm safety margins only

Answer

Surgical excision with 1 cm safety margins only

Answer

Surgical excision with 1-2 cm safety margins only

Answer

Surgical excision with 0.5-1 cm safety margins and sentinel lymph node study

Question 2

A 64-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of type 2 diabetes mellitus for which she takes metformin. Her surgical history is a total knee arthroplasty 7 years ago. Her family history is insignificant. Physical examination is notable for an irregular nodule near the surface of her right breast. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of a portion of a breast?

Accepted Answer

Lumpectomy

Answer

Arthroplasty

Answer

Vasectomy

Answer

Mastectomy

Answer

Laminectomy

Question 3

A 58-year-old man presents with lower back pain that started a couple of weeks ago and is gradually increasing in severity. At present, he rates the intensity of the pain as 6/10. There is no radiation or associated paresthesias. There is no history of trauma. Past medical history is significant for aggressive squamous cell carcinoma of the right lung status post surgical resection followed by adjunct chemotherapy and radiation therapy that was completed 6 months ago. A technetium bone scan reveals metastatic lesions in the lumbar vertebrae at levels L2–L4. The physician explains to the patient that these are likely metastatic lesions from his primary lung cancer. Which of the following best describes the mechanism that most likely led to the development of these metastatic lesions?

Accepted Answer

Hematogenous spread

Answer

Transcoelomic

Answer

Lymphatic spread

Answer

Collagenase produced by cancer cells dissolves the basement membrane and aids in cellular invasion

Answer

PTH (parathormone)-related protein production by tumor cells

Question 4

A 58-year-old male undergoes a surveillance colonoscopy in which a 2 cm adenoma is identified and removed. Had this adenoma not been excised, the patient would have been at risk of progression to carcinoma. Which of the following is the final mutational step in the progression from adenoma to carcinoma?

Accepted Answer

p53 inactivation

Answer

APC mutation

Answer

COX-2 overexpression

Answer

SMAD 2/4 loss

Answer

K-ras mutation

Question 5

Five days after undergoing an open colectomy and temporary colostomy for colon cancer, a 73-year-old man develops severe pain and swelling of the left calf. He was diagnosed with colon cancer 3 months ago. He has hypothyroidism and hypertension. His father died of colon cancer at the age of 68. He does not smoke. Prior to admission, his medications included levothyroxine, amlodipine, and carvedilol. Since the surgery, he has also been receiving unfractionated heparin, morphine, and piperacillin-tazobactam. He is 172 cm (5 ft 8 in) tall and weighs 101 kg (223 lb); BMI is 34.1 kg/m2. He appears uncomfortable. His temperature is 38.1°C (100.6°F), pulse is 103/min, and blood pressure is 128/92 mm Hg. Examination shows multiple necrotic lesions over bilateral thighs. The left calf is erythematous, tender, and swollen. Dorsiflexion of the left foot elicits pain behind the knee. The abdomen is soft and nontender. There is a healing midline incision and the colostomy is healthy and functioning. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 13.6 g/dL
Leukocyte count 12,100/mm3
Platelet count 78,000/mm3
Prothrombin time 18 seconds (INR = 1.1)
Activated partial thromboplastin time 46 seconds
Serum
Na+ 138 mEq/L
Cl- 103 mEq/L
K+ 4.1 mEq/L
Urea nitrogen 18 mg/dL
Glucose 101 mg/dL
Creatinine 1.1 mg/dL
Which of the following is the most appropriate next step in management?

Accepted Answer

Switch from unfractionated heparin to argatroban therapy

Answer

Switch from unfractionated heparin to warfarin therapy

Answer

Transfuse platelet concentrate

Answer

Administer vitamin K

Answer

Administer fresh frozen plasma

Question 6

A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?

Accepted Answer

Duty, breach, causation, and damages

Answer

Only duty and breach

Answer

Only breach and causation

Answer

Duty, breach, and damages

Question 7

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 8

An investigator studying targeted therapy in patients with gastrointestinal stromal tumors requires a reliable test to determine the spatial distribution of CD117-positive cells in biopsy specimens. Which of the following is the most appropriate test?

Accepted Answer

Immunohistochemistry

Answer

Northern blot

Answer

Flow cytometry

Answer

Fluorescence in-situ hybridization

Answer

Western blot

Question 9

A 16-year-old man presents to the emergency department with a 2-hour history of sudden-onset abdominal pain. He was playing football when his symptoms started. The patient’s past medical history is notable only for asthma. Social history is notable for unprotected sex with 4 women in the past month. His temperature is 99.3°F (37.4°C), blood pressure is 120/88 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is noted for a non-tender abdomen. Testicular exam reveals a right testicle which is elevated with a horizontal lie and the scrotum is neither swollen nor discolored. Which of the following is the most likely diagnosis?

Accepted Answer

Testicular torsion

Answer

Traumatic urethral injury

Answer

Seminoma

Answer

Appendicitis

Answer

Epididymitis

Question 10

A 47-year-old woman comes to the physician for a mass in her left breast she noticed 2 days ago during breast self-examination. She has hypothyroidism treated with levothyroxine. There is no family history of breast cancer. Examination shows large, moderately ptotic breasts. The mass in her left breast is small (approximately 1 cm x 0.5 cm), firm, mobile, and painless. It is located 4 cm from her nipple-areolar complex at the 7 o'clock position. There are no changes in the skin or nipple, and there is no palpable axillary adenopathy. No masses are palpable in her right breast. A urine pregnancy test is negative. Mammogram showed a soft tissue mass with poorly defined margins. Core needle biopsy confirms a low-grade infiltrating ductal carcinoma. The pathological specimen is positive for estrogen receptors and negative for progesterone and human epidermal growth factor receptor 2 (HER2) receptors. Staging shows no distant metastatic disease. Which of the following is the most appropriate next step in management?

Accepted Answer

Lumpectomy with sentinel lymph node biopsy, followed by radiation and hormone therapy

Answer

Lumpectomy with sentinel lymph node biopsy followed by hormone therapy

Answer

Nipple-sparing mastectomy with axillary lymph node dissection followed by hormone therapy

Answer

Nipple-sparing mastectomy with axillary lymph node dissection, followed by radiation and hormone therapy

Answer

Radical mastectomy followed by hormone therapy

Oncologic Surgery Principles

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Cytoreductive surgery principles

Lymph node sampling techniques

Metastasectomy indications

Minimally invasive oncologic surgery

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Neoadjuvant and adjuvant therapy timing

Palliative surgical procedures

Quality of life considerations in cancer surgery

Surgical margins and R0 resection

Surgical oncology emergencies

Survivorship issues after cancer surgery

Tumor biology and surgical planning

Tumor staging and TNM classification

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