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a) Infants
b) Children
c) Hospital workers
d) Adults
e) Elderly
4.2) How is lymphoma usually diagnosed?
a) Morphology in blood or bone marrow
b) Presence of T cell receptor genes
c) Abnormal monoclonal cells
d) Lymph node biopsy
e) Flow cytometry
4.3) How is chronic lymphocytic leukemia (CLL) distinguished?
a) Morphology in blood or bone marrow
b) Presence T cell receptor genes
c) Abnormal monoclonal cells
d) Lymph node biopsy
e) Flow cytometry
4.4) How is acute lymphocytic leukemia (ALL) usually diagnosed?
a) Morphology in blood or bone marrow
b) Presence T cell receptor genes
c) Abnormal monoclonal cells
d) Lymph node biopsy
e) Flow cytometry
4.5) How is lymphoid malignancy diagnosed?
a) Morphology in blood or bone marrow
b) Presence T cell receptor genes
c) Abnormal monoclonal cells
d) Lymph node biopsy
e) Flow cytometry
5) What type of tumor antigen is involved in tyrosinase-secreting melanocytes?
a) Developmental proteins
b) Lineage-specific proteins
c) Viral proteins
d) Proteins produced through translocations
e) None of the above
6) Which of the following tend to be the most immunogenic as they are not present in a
normal individual?
a) Developmental proteins
b) Lineage-specific proteins
c) Viral proteins
d) Proteins produced through translocations
e) None of the above
7) What immune cells are required to eradicate solid tumors?
a) Neutrophils
b) Lymphocyte B cells
c) Lymphocyte T cells
d) Lymphocyte NK cells
e) Macrophages
8) Tumors are able to evade the adaptive immune system by losing the ability to present
antigen to T cells or by decreasing the expression of major histocompatibility complex
(MHC). Cells expressing low levels of MHC may be targeted for destruction by what
type of immune cell, acting as a backup system?
a) Neutrophils
b) Lymphocyte B cells
c) Lymphocyte T cells
d) Lymphocyte NK cells
e) Macrophages
9) Infusions of anti-CD20 monoclonal antibodies (passive immunotherapy) can reduce or
cure up to 50% of which of the following?
a) B cell lymphoma
b) T cell lymphoma
c) NK cell lymphoma
d) Lymphomatoid papulosis
e) Sézary disease
10) An infusion of which of the following would activate T cells directly (active
immunotherapy), but has side effects including capillary leak syndrome?
a) Cytokine IL-2
b) Cytokine interferons (IFN)
c) Cytokine IL-10
d) Cytokines IL-1 and IL-18
e) Lymphokine-activated killer (LAK) cells
Hematology/Oncology #2 – Pathology
1.1) What is the most common type of non-Hodgkin lymphoma in the United States,
which have a characteristic t(14;18) and cells that are awry or with effacement?
a) Acute lymphoblastic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Small lymphocytic leukemia (SLL)
d) Follicular lymphoma
e) Diffuse large B-cell lymphoma
1.2) What is the type of the most common primary tumor arising in bone of adults?
a) Burkitt lymphoma
b) Mantle cell lymphoma (MCL)
c) Marginal zone lymphoma (MALToma)
d) Plasma cell neoplasms (e.g. multiple myeloma)
e) Lymphoplasmacytic lymphoma (Waldenström macroglobulinemia)
2) Which of the following type for Hodgkin Disease is the most common?
a) Nodular sclerosis
b) Mixed cellularity
c) Lymphocyte-rich
d) Lymphocyte-depletion
e) Lymphocyte predominance (NLPHL)
3) A patient is diagnosed with Hodgkin lymphoma that affects lymph node regions on
both sides of the diaphragm. What stage is this?
a) Stage I
b) Stage II
c) Stage III
d) Stage IV
4.1) Which of the following acute myelogenous leukemia (AML) classifications in the
French-American-British (FAB) system is the most common and is most associated with
a t(8;21) translocation?
a) M0: Minimally differentiated AML
b) M1: AML without differentiation
c) M2: AML with maturation
d) M3: Acute promyelocytic leukemia
e) M4: Acute myelomonocytic leukemia
f) M5: Acute monocytic leukemia
g) M6: Acute erythroleukemia
h) M7: Acute megakaryocytic leukemia
4.2) Which of the following has a high incidence of disseminated intravascular
coagulation (DIC) and a strong association with t(15;17)?
a) M0: Minimally differentiated AML
b) M1: AML without differentiation
c) M2: AML with maturation
d) M3: Acute promyelocytic leukemia
e) M4: Acute myelomonocytic leukemia
4.3) Which of the following has monoblasts with nonspecific esterases and a subset
associated with inv(16)?
a) M0: Minimally differentiated AML
b) M1: AML without differentiation
c) M2: AML with maturation
d) M3: Acute promyelocytic leukemia
e) M4: Acute myelomonocytic leukemia
4.4) Which of the following has specific antibodies against GP IIb/IIIa or vWF as well as
myelofibrosis or increased marrow reticulin?
a) M7: Acute megakaryocytic leukemia
b) M6: Acute erythroleukemia
c) M5: Acute monocytic leukemia
d) M4: Acute myelomonocytic leukemia
e) M3: Acute promyelocytic leukemia
5) Chronic myeloproliferative syndromes are neoplasms of multipotent progenitor cells,
which give rise to many mature cells and generally do not affect terminal differentiation.
Which syndrome is associated with splenomegaly (secondary hematopoiesis)?
a) Chronic myelogenous leukemia
b) Polycythemia vera
c) Essential thrombocytosis
d) Primary myelofibrosis
e) All of the above
6.1) A 60-year-old man presents with possible lymphoma. Lab testing reveals
hypogammaglobulinemia. Blood smear is shown, noting parachute smudge cells. Which
of the following is most likely?
a) Acute lymphocytic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Small lymphocytic leukemia (SLL)
d) Hairy cell leukemia (HCL)
e) Diffuse large B-cell lymphoma
6.2) Which of the following markers would NOT be present in CLL?
a) CD5
b) CD10
c) CD19
d) CD20
e) CD23
6.3) What is the approximate median survival time for patients with CLL?
a) 1-year
b) 3-years
c) 5-years
d) 10-years
e) 20-years
7) A middle-aged Caucasian male presents for a routine physical exam. History reveals
several short-term respiratory infections. Exam reveals massive splenomegaly. Lab test
show mild pancytopenia. Bone marrow reveals abnormal cells (shown). Which of the
following is most likely?
a) Acute lymphocytic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Small lymphocytic leukemia (SLL)
d) Hairy cell leukemia (HCL)
e) Diffuse large B-cell lymphoma
8.1) Which of the following is associated with Bence-Jones proteins, a monoclonal
immunoglobulin spike, “stacked coins” or “stacked poker chips” (rouleaux) formations of
red blood cells (shown), and amyloidosis?
a) Burkitt lymphoma
b) Hairy cell leukemia (HCL)
c) Multiple myeloma
d) Plasmacytoma (solitary myeloma)
e) Waldenström macroglobulinemia
8.2) Plasmacytoma affects the soft tissue and thus, unlike multiple myeloma, would not
have bone changes and the resultant:
a) Hypercalcemia
b) Hypocalcemia
c) Hypermagnesemia
d) Hypomagnesemia
e) Hypernatremia
8.3) Increased amounts of what cytokine are associated with poorer multiple myeloma
prognosis, as myeloma cells are dependent on that cytokine?
a) Interleukin-2 (IL-2)
b) Interleukin-4 (IL-4)
c) Interleukin-6 (IL-6)
d) Interleukin-8 (IL-8)
e) Interleukin-10 (IL-10)
9) A 60-year-old presents with fatigue, weight loss, vision disturbances, and chronic
oozing blood from the gums. Blood electrophoresis shows an M spike. Neoplastic cells
are found in many places including the spleen and lymph nodes. Electrolyte labs show no
increase in calcium. Bone aspiration shows Russell bodies (shown) and Dutcher bodies
(shown). Hyperviscosity syndrome is suspected. Which of the following is most likely?
a) Burkitt lymphoma
b) Hairy cell leukemia (HCL)
c) Multiple myeloma
d) Plasmacytoma (solitary myeloma)
e) Waldenström macroglobulinemia
10) A 4-year-old child presents with 30% blast cells, anemia, and petechiae. Which of the
following is most likely?
a) Acute lymphoblastic leukemia (ALL), B-cell
b) Chronic lymphocytic leukemia (CLL), B-cell
c) Acute lymphoblastic leukemia (ALL), T-cell
d) Chronic lymphocytic leukemia (CLL), T-cell
11) A teenager presents with 30% blast cells, anemia, and mediastinal thoracic pain.
Which of the following is most likely?
a) Acute lymphoblastic leukemia (ALL), B-cell
b) Chronic lymphocytic leukemia (CLL), B-cell
c) Acute lymphoblastic leukemia (ALL), T-cell
d) Chronic lymphocytic leukemia (CLL), T-cell
12) Which of the following is seen in adults, involves basophilic leukocytosis, and is
associated with Philadelphia chromosome t(9;22)?
a) Acute lymphoblastic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Acute myelogenous leukemia (AML)
d) Chronic myelogenous leukemia (CML)
e) Hairy cell leukemia
13) An elderly patient presents with persistent lymphocytosis. Testing reveals no blast
cells and possible Richter syndrome. Which of the following is most likely?
a) Acute lymphoblastic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Acute myelogenous leukemia (AML)
d) Chronic myelogenous leukemia (CML)
e) Hairy cell leukemia
14) An elderly patient presents with complains of early satiety. Examination reveals
splenomegaly. Testing reveals the patient is positive for tartate resistant acid phosphatase
(TRAP+). Which of the following is most likely?
a) Acute lymphoblastic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
a) Burkitt lymphoma
b) Mycosis fungoides
c) Follicular lymphoma
d) Chronic myelogenous leukemia
e) Waldenström macroglobulinemia
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b) Thymus-related peptides
c) Interferon (IFN) alpha
d) Interferon (IFN) beta
e) Interferon (IFN) gamma
28) Which of the following is FDA approved for relapsing-type multiple sclerosis (MS)?
a) Thymosin alpha-1
b) Thymus-related peptides
c) Interferon (IFN) alpha
d) Interferon (IFN) beta
e) Interferon (IFN) gamma
29) Which of the following is given in combination with fluorouracil for treating post-
surgical colorectal cancer?
a) Roquinimex
b) Levamisole
c) BCG (Bacille Balmette-Guerin)
d) Interleukin-2
e) Interferon (IFN) gamma
30) Which of the following may work by activating macrophages, is an immunization for
tuberculosis, and is used as an immunostimulant in cancer?
a) Roquinimex
b) Levamisole
c) BCG (Bacille Balmette-Guerin)
d) Interleukin-2
e) Interferon (IFN) gamma
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b) Mitosis
c) G1
d) G2
e) Non-specific
5) What phase of the cell cycle is affected by hydroxyurea and cytosine arabinoside?
a) Synthesis
b) Mitosis
c) G1
d) G2
e) Non-specific
6) What phase of the cell cycle is affected by alkylating agents and antitumor antibiotics?
a) Synthesis
b) Mitosis
c) G1
d) G2
e) Non-specific
7) What phase of the cell cycle is affected by paclitaxel?
a) Synthesis
b) Mitosis
c) G1
d) G2
e) Non-specific
8) What phase of the cell cycle is affected by procarbazine and cis-platinum?
a) Synthesis
b) Mitosis
c) G1
d) G2
e) Non-specific
9) What phase of the cell cycle is affected by methotrexate and 6-mercaptopurine?
a) Synthesis
b) Mitosis
c) G1
d) G2
e) Non-specific
10) Tumor growth characteristically exhibits a sigmoid-shaped curve where doubling
time varies with:
a) Patient age
b) Tumor age
c) Tumor location
d) Tumor size
e) Tumor origin
11) A chemotherapy agent that has a 1-log kill would destroy what percentage of cells?
a) 1%
b) 33%
c) 66%
d) 90%
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e) 99%
12) A patient is found to have 10^12 tumor cells in their body (neoplastic cell burden).
An effective drug is given which destroys 99.9% of clonogenic tumor cells, leading to
clinical remission. How many logs of tumor cells are still in the patient’s body?
a) Twelve (10^12)
b) Nine (10^9)
c) Six (10^6)
d) Three (10^3)
e) None
13) Which of the following chemotherapy treatment options would most likely increase
survival but not alleviate symptoms?
a) No treatment
b) Infrequent drug therapy
c) Combination drug therapy
d) Surgery and infrequent drug therapy
e) Surgery and combination drug therapy
14) Along with colon cancer, what form of cancer may exhibit primary resistance against
drug therapy?
a) Hodgkin disease
b) Childhood acute leukemia
c) Non-small cell lung cancer
d) Testicular cancer
e) Lymphoma
15) Which of the following would occur with increased expression of the normal MDR1
gene, which encodes for a cell surface glycoprotein (P-glycoprotein)?
a) Anti-tumor drug influx into tumor cells would increase
b) Anti-tumor drug influx into tumor cells would decreased
c) Anti-tumor drug efflux out of tumor cells would increase
d) Anti-tumor drug efflux out of tumor cells would decreased
16) A patient undergoing chemotherapy develops tumor resistance to anthracyclines.
Which of the following drug could be used to overcome this MDR-1-mediated drug
resistance?
a) Calcium channel blockers
b) Paclitaxel (Taxol)
c) Vinca alkaloids
d) Mitomycine (Mutamycine) or plicamycin (Mithramycin)
e) Etoposide
17) Which of the following cancer treatment options is used for systemic tumors?
a) Radiotherapy
b) Chemotherapy
c) Endocrine therapy
d) Immunotherapy
e) Thermotherapy
18) Along with cytopenia, what is the major side-effect of chemotherapy agents?
a) Sexuality impact
b) Weight loss
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c) Alopecia
d) Taste changes
e) Nausea and vomiting
19) Which of the following is NOT an effective drug in the management (prophylaxis) of
nausea seen with abdominal radiotherapy and with many chemotherapy agents?
a) Serotonin-receptor antagonists (ondansetron, granisetron, dolasetron)
b) Anti-dopaminergics (prochlorperazine, fluphenazine)
c) Metoclopramide (Reglan)
d) Lysergic acid diethylamide (LSD)
e) Dronabinol (Marinol, marijuana THC)
20) Which of the following drugs is the most effective available for the management of
nausea and vomiting associated with radiotherapy or chemotherapy?
a) Serotonin-receptor antagonists (ondansetron, granisetron, dolasetron)
b) Anti-dopaminergics (prochlorperazine, fluphenazine)
c) Metoclopramide (Reglan)
d) Lysergic acid diethylamide (LSD)
e) Dronabinol (Marinol, marijuana THC)
21) Anti-dopaminergics act as anti-emetics by depressing the:
a) Cerebral cortex
b) Vestibular apparatus
c) Chemoreceptor trigger zone (CTZ)
d) Area postrema (vomiting center)
e) Nucleus of the Solitary tract
22) A chemotherapy patient presents with extrapyramidal signs (acute dystonic reactions
and Parkinson-like symptoms). They are on an anti-emetic that increases the tone and
amplitude of gastric contractions. What drug are they taking?
a) Ondansetron (Zofran)
b) Prochlorperazine (Compazine)
c) Metoclopramide (Reglan)
d) Dronabinol (Marinol)
e) Dolasetron (Anzemet)
23) Which of the following cytopenias seen in cancer chemotherapy involves high fever
and increased risk of infection, and should be treated with G-CSF and antibiotics?
a) Anemia
b) Leukopenia
c) Neutropenia
d) Thrombocytopenia
e) All of the above
24) Activated Protein C (Drotrecogin-alpha, Xigris) is FDA approved in the treatment of
critically ill patients who have:
a) Intracranial hemorrhage
b) Pancytopenia
c) Malignant cancer
d) Cerebral cancer
e) Sepsis
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25) A 50-year-old patient is being treated for Hodkin Disease using the MOPP regimen.
Following three days of treatment, the patient develops severe nausea and vomiting. They
are put on ondansetron (Zofran), but develop severe dermatitis. What drug should they be
switched to?
a) Chlorpromazine (Thorazide)
b) Prochlorperazine (Compazine)
c) Metoclopramide (Reglan)
d) Dronabinol (Marinol)
e) Dolasetron (Anzemet)
Hematology/Oncology #5 – Nutrition
1) A colon carcinoma was detected in a 44-year-old woman. At the same site, an
adenoma had been endoscopically removed 5 years earlier. The same oncogene mutation
was detected in both tissue samples from the carcinoma and from the previously removed
adenoma, but not in healthy tissue from this patient. What is the most probably
explanation for the presence of the same mutation in the two tumor tissues?
a) Lack of regular fruit consumption often causes the same oncogene mutations
b) Continued exposure to the same carcinogen caused this mutation
c) Both adenomas and carcinomas typically harbor this kind of mutation
d) Adenoma and the later carcinoma are derived from the same mutated precursor
cell
e) The patient has a familial cancer syndrome caused by the oncogene mutation
2) Several colon polyps are detected in the colon of a 43-year-old man during
radiological examination for an unrelated illness. Why is cancer more likely to develop at
these sites than at non-affected sites?
a) With oncogene mutations already present in polyp cells, additional mutations
are more likely to generate a cancerous cell
b) Since polyps protrude into the interstitial lumen, they are more exposed to
carcinogens
c) Polyps are more cancer-prone because they reflect an accumulation of
carcinogens
d) As a colon polyp grows, all of its cells tend to break through organ barriers and
become more invasive in nature
e) Mutations in the polyp’s cells accelerate mucosal sloughing and interrupt
normal cell signaling
3) A 52-year-old man had a small cancerous colon polyp endoscopically removed several
years earlier, and has not had any recurrences since then. How will his diet most likely
affect his future cancer risk?
a) Eating fruits and vegetables slows the accumulation of DNA mutations
b) Dietary fiber binds and eliminates mutated DNA
c) Mucosal cells with cancer mutations are more likely to revert with a folate-rich
diet
d) Since he is likely to have cancer mutations already, diet will not affect his risk
e) His risk of cancer metastasis will be greatly reduced if he avoids flavonoid-rich
foods
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14) A middle-aged woman who has been smoking since her teenage years always has
liked broccoli with cheese and eaten generous amounts several times a week. How might
these eating habits influence cancer risk of a smoker?
a) Regular broccoli consumption increases phase I enzyme activity
b) The high fat content of cheese increases estrogen receptor activity which in
turn increases cancer risk
c) Substances in most vegetables enhance the catabolism of DNA adducts
d) Broccoli promotes the conjugation of carcinogens
e) Because broccoli has no direct effect on inhaled carcinogens, lung cancer risk
is unchanged
15) Phase I enzyme-dependent reactions include which of the following activities?
a) Alkylation of neucleotides
b) Glycosylation of oncogenes
c) Glucuronidation of aflatoxins
d) Hydroxylation of nitrosamines
e) Peroxidation of fatty acids
16) Which of the following activities are most likely enhanced by phase II enzyme
activators?
a) Aflatoxin deconjugation
b) Nitrosamine hydroxylation
c) Fatty acid peroxidation
d) Superoxide anion reduction
e) Benzpyrene glucuronidation
17) Which of the following is part of generally accepted guidelines for the dietary
reduction of cancer risk?
a) Prefer fat-free foods
b) Take a daily fiber supplement
c) Eat only organically grown vegetables
d) Use an antioxidant supplement with both vitamin C and E
e) Limit consumption of salt-cured and smoked foods
18) General recommendations for a cancer-preventive diet should include:
a) Achieve ideal body weight status and avoid soyfoods, meats, and alcohol
b) Do not eat barbecued vegetables and have raw vegetables with each meal
c) Avoid meats and refined sugar, and eat five servings of fruit a day
d) Avoid excess body fat, and eat several servings of green and vegetables a day
e) Avoid dietary polyphenols, nitrosamines, free radicals, and phytoestrogens
19) An anti-carcinogenic compound in citrus fruits is:
a) Magnesium
b) Zinc
c) Calcium
d) Riboflavin
e) Vitamin C
20) It has been proposed that a low omega-3 fatty acid intake increases risk of some
cancers. A study investigated this possible link by measuring adipose tissue composition
(a marker for past omega-3 fatty acid intake) in newly diagnosed patients. What
additional information is needed to make this a useful comparison?
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25) A study was undertaken to investigate the hypothesis that lower vitamin C intake
increases lung cancer risk in 40- to 50-year-old male smokers. Vitamin C intakes and
cancer status were assessed by questionnaire seven years after recruitment. Which
essential information is needed to make this a prospective cohort study?
a) Date on a control group of non-smokers
b) Dietary data from time of recruitment
c) Survival time of cancer patients
d) Intermediate marker of cancer
e) Family history of lung cancer
26) High cabbage consumption is associated with low colon cancer risk in many
populations. Which type of study is most suitable to rapidly test the practical relevance of
this initial observation?
a) Ecological study linking isothiocyanate content of cabbages to cancer incidence
b) Blinded cohort study with groups randomized to use isothiocyanate or placebo
c) Prospective cohort study relating isothiocyanate intake from cabbage to cancer
incidence
d) Controlled clinical trial of isothiocyanate using adenomatous polyps as end
point
e) Case-controlled study of cabbage in patients and matched controls
27) A journal article reports that healthy people consume green leafy vegetables about as
often as patients with newly diagnosed colon cancer. Seven-day dietary records were
used to assess food intakes. You know, however, that another study of cancer patients
found a relationship between consumption of green leafy vegetables and the risk of colon
cancer. This second study had used a questionnaire asking cancer patients and controls
about their customary food intakes ten years earlier. Does the second study contradict the
findings of the first one?
a) Yes, since a 7-day dietary record is more accurate than the food frequency
questionnaire used in the previous study
b) No, since the two diet assessment methods have targeted different time periods
c) The question cannot be answered, since dietary assessment methods are too
unreliable
d) No, since 7-day dietary records cannot assess the intake of individual foods
e) Yes, since people know much better what they currently eat than what they are
ten years earlier
28) Mr. Jones has lung cancer and has completed his chemotherapy; he has been losing
weight. What do you think the FIRST recommendation for dietary treatment should be
for him?
a) Increase his protein and calorie intake with regular foods
b) Supplement with high calorie/high protein commercial supplements
c) Prescribe appetite stimulants
d) Provide him with intravenous feeding or tube-feeding
e) None, since his chemotherapy is complete; eventually he will start eating better
29) For the treatment of disseminated bone and liver metastases, a 48-year-old woman
now is undergoing palliative chemotherapy. Which are relevant criteria that should
influence selection of diet?
a) Anti-carcinogenic properties of foods
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7) Prognostic factors requiring chemotherapy include trisomy 12, deletion of 11q and
17p, and Rai stage III or IV. Which of the following would NOT be included in the
standard chemotherapy regimen for those patients?
a) Fludarabine (Fludura)
b) Cyclophosphamide (Cytoxan)
c) Rituximab (Rituxan)
d) Vinblastine (Velbe)
e) All are used initially
8) A peripheral blood smear is shown with tartrate-resistant acid phosphates (positive
TRAP stain). Which of the following is most likely?
a) Acute lymphocytic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Small lymphocytic leukemia (SLL)
d) Hairy cell leukemia (HCL)
e) Hodgkin lymphoma
9) Which of the following is NOT characteristic of hairy cell leukemia (HCL)?
a) Splenomegaly
b) More common in males
c) Cytopenia and infections
d) Dry tap on bone marrow aspiration
e) Biopsy specimens are hypocellular
10) Which of the following infections are seen most commonly in hairy cell leukemia?
a) Toxoplasmosis
b) Bacterial pneumonia and urinary tract infections
c) Atypical mycobacterium
d) Viral infections
e) Histoplasmosis and coccidiodes
11) Which of the following drugs produces complete remission rates in about 85% of
patients with hairy cell leukemia after a 7-day continuous IV infusion?
a) Cladribine (Leustatin)
b) Cyclophosphamide (Cytoxan)
c) Vinblastine (Velbe)
d) Rituximab (Rituxan)
e) Fludarabine (Fludura)
12) A 25-year-old man with a history of mononucleosis presents with low hemoglobin
and low serum albumin. After detecting the presence of Reed-Sternberg “owls-eyes”
cells, Hodgkin lymphoma is diagnosed. Which of the following are the most common
infections that this patient is predisposed to?
a) Histoplasmosis and toxoplasmosis
b) Bacterial pneumonia and urinary tract infections
c) Herpes VZV and CMV
d) Herpes EBV and KSHV
e) Legionella and mycoplasma pneumonia
13) An elderly man presents with pruritis, cytopenia, and low
serum albumin. A peripheral blood smear is shown. Which of the
following is most likely?
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c) Stage III-1
d) Stage III-2
e) Stage IV
19) What is currently the initial treatment of choice for Hodgkin lymphoma?
a) ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine)
b) BEACOPP (bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin,
procarbazine, prednisone)
c) MOPP (Mechlorethamine, Oncovin, procarbazine, prednisone)
d) ChlVPP/EVA (chlorambucil, vincristine, procarbazine, prednisone, etoposide,
vinblastine, Adriamycin)
20) Which of the following chemotherapy options is the preferred treatment for advanced
stages of Hodgkin lymphoma as it results in improved disease-resurvival and overall
survival?
a) ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine)
b) BEACOPP (bleomycin, etoposide, Adriamycin, cyclophosphamide, Oncovin,
procarbazine, prednisone)
c) MOPP (Mechlorethamine, Oncovin, procarbazine, prednisone)
d) ChlVPP/EVA (chlorambucil, vincristine, procarbazine, prednisone, etoposide,
vinblastine, Adriamycin)
e) Stanford V (doxorubicin, mechlorethamine, bleomycin, vinblastine, vincristine,
etoposide, prednisone)
21) Which of the following is the recommended treatment for Hodgkin disease patients
who relapse after initial chemotherapy?
a) Radiation therapy
b) ABVD therapy
c) MOPP therapy
d) BEACOPP therapy
e) Stem cell or bone marrow transplant
22) Which of the following is NOT a complication of Hodgkin disease?
a) Alopecia
b) Infertility
c) Amenorrhea
d) Pneumococcal sepsis
e) Hypothyroidism and thyroid carcinoma
23) Which of the following regarding non-Hodgkin lymphoma (NHL) is correct?
a) Low grade NHL: potentially curable, short survival without treatment
b) Low grade NHL: potentially curable, long survival without treatment
c) High grade NHL: potentially curable, short survival without treatment
d) High grade NHL: not curable, short survival without treatment
e) High grade NHL: not curable, long survival without treatment
24.1) What is the treatment of choice for asymptomatic high grade (Stage III and IV)
non-Hodgkin lymphoma?
a) No treatment exists
b) Observation (initially)
c) Oral chlorambucil daily
d) CVP (cyclophosphamide, vincristine, prednisone)
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e) Waldenström macroglobulinemia
30) A 65-year-old African American man presents with weakness, fatigue, and bone pain.
Lab tests show anemia, renal insufficiency, and hypercalcemia. Serum and urine are
positive for paraprotein. Radiographs show “punched out” lytic lesions with osteoporosis
and possible fractures. Which of the following is most likely?
a) MGUS
b) Smoldering myeloma (SMM)
c) Multiple myeloma (MM)
d) Plasmacytoma (solitary myeloma)
e) Waldenström macroglobulinemia
31) A patient undergoes testing which finds M protein > 3g/dL and more than 10%
plasma cells in bone marrow. No lytic bone lesions are found. Treatment for this patient
is observation. Which of the following is most likely?
a) MGUS
b) Smoldering myeloma (SMM)
c) Multiple myeloma (MM)
d) Plasmacytoma (solitary myeloma)
e) Waldenström macroglobulinemia
32) What is the recommended treatment for multiple myeloma in patients over age 70?
a) Melphalen and prednisone
b) Lenolinomide
c) Dexamethasone and thalidomide
d) Peripheral stem cell transplant
e) Pallitive radiotherapy
33) What is the initial treatment for multiple myeloma in patients under age 70?
a) Melphalen and prednisone
b) Lenolinomide
c) Dexamethasone and thalidomide
d) Peripheral stem cell transplant
e) Pallitive radiotherapy
34) A patient presents with fatigue, dizziness, blurred vision, and bleeding from the
gums. Retinal venous congestion (“sausage formation”) is found on examination.
Electrophoresis shows IgM paraprotein > 3g/dL as well as Bence-Jones proteinuria.
Which of the following is most likely?
a) MGUS
b) Smoldering myeloma (SMM)
c) Multiple myeloma (MM)
d) Plasmacytoma (solitary myeloma)
e) Waldenström macroglobulinemia
35) What is the treatment for a patient with only an IgM MGUS?
a) Stem cell transplant
b) Observation (initially)
c) Melphalen and prednisone
d) Dexamethasone and thalidomide
e) Palliative radiotherapy
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36) Which of the following is the recommended treatment of choice for hyperviscosity
syndrome?
a) Plasmapheresis
b) Chlorambucil
c) Cladribine (2-CDA)
d) Fludarabine
37) Although many therapies exist for Waldenström macroglobulinemia, which of the
following should be used initially in an emergency situation?
a) Plasmapheresis
b) Alkylating agents
c) Interferon alpha
d) Purine neucleoside analogs
e) High-dose chemotherapy
38) What histological staining technique is used to identify amyloidosis?
a) Prealbumin
b) Periodic acid schiff (PAS)
c) Congo red stain
d) Mallory trichrome stain
e) Hematoxylin and eosin (H&E)
39) Which of the following is NOT associated with amyloidosis?
a) Macroglossia
b) Carpal tunnel syndrome
c) Splenomegaly
d) Congestive heart failure
e) Nephrotic syndrome
40) What is the most important screening test used for suspected amyloidosis?
a) CBC with differential
b) Kidney function tests
c) Prealbumin and calcium level
d) Serum or urine M protein
e) Creatinine clearance
41) A patient presents with suspected amyloidosis. Bone marrow shows plasma cells with
clonal predominance of a light chain isotope. A fat biopsy of the abdominal wall is
performed. If an ECG were performed, which of the following is most likely to be seen?
a) No electrocardiographic abnormalities
b) Narrow QRS complexes with increased PR interval
c) Drastically increased QT interval and possible Torsade de Pointes
d) Low voltage pattern consistent with myocardial infarction
e) Diffuse ST elevation and PR depression, mimicking pericarditis
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3) Which of the following treatment strategies is specific for MDS patients older than 55
years of age?
a) Allogeneic bone marrow transplant
b) Supportive with RBC transfusion, erythropoietin, and antibiotics
c) 5-azacytidine, antithymocyte globulin, and amifostine
d) Antileukemia chemotherapy
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b) Vinblastine (Velbe)
c) Imatinib (Gleevec)
d) Paclitaxel (Taxol)
e) Hydroxyurea (Hydrea)
7) What is the treatment of choice for CML with high blast counts and leukostatic
lesions, with safety in thrombocytopenia?
a) Vincristine (Oncovin)
b) Vinblastine (Velbe)
c) Imatinib (Gleevec)
d) Paclitaxel (Taxol)
e) Hydroxyurea (Hydrea)
8) When CML is in the accelerated phase, patients often have fever, poor appetite, weight
loss, and new chromosome changes. Which of the following is diagnostic of the blast
phase (“blast crisis”) in CML?
a) Immature WBCs < 10%
b) Mature WBCs < 10%
c) Immature WBCs > 30%
d) Mature WBCs > 30%
e) Decrease in LAP score
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e) 1 in 20
2) Which of the following is a low risk factor (relative risk 1.0-2.0) for breast cancer in
women?
a) Old age
b) Family history of breast cancer
c) Proliferative disease on breast biopsy
d) Menarche before age 12
e) Homosexuality
3) What is the risk of breast cancer in women with the genes BRCA1 and BRCA2?
a) 20%
b) 40%
c) 60%
d) 80%
e) 100%
4) Annual clinical breast examination and mammography is recommended for all females
older than 50 years. If a patient has risk factors for breast cancer, when should they be
screened?
a) Age 18
b) Age 21
c) Age 30
d) Age 40
e) Age 50
5) A female patient presents to the primary care clinic for a routine examination. Breast
examination reveals a suspicious palpable lump. Mammography is negative. What is the
next course of action?
a) Return for exam in 1 year
b) MRI scan of the breast
c) PET scan of the breast
d) Complete lump excision
e) Lump biopsy
6) What is the recommended treatment for ductal/intraductal carcinoma in situ (DCIS)?
a) Radiotherapy to prevent metastasis
b) Chemotherapy to treat possible metastasis
c) Complete excision including axillary lymph nodes
d) Bilateral mastectomy
e) Local therapy only
7) What is the most common type of invasive breast cancer, seen in 70% of all breast
cancers?
a) In situ breast cancer
b) Invasive ductal carcinoma (IDC)
c) Invasive lobular carcinoma (ILC)
d) inflammatory breast cancer
e) Paget disease of the breast
8) What is the most important prognostic factor for invasive breast cancer?
a) Bilateral involvement
b) Involvement of the superior lateral quadrant (tail)
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15) The most common combination chemotherapy regimens for breast cancer include all
of the following drugs EXCEPT:
a) Cyclophosphamide
b) Vinblastine
c) Methotrexate
d) Doxorubicin
e) 5-Fluorouracil
16) Which of the following drugs is associated with thromboembolic risk and vaginal
dryness, acts as an anti-estrogen in select tissues, such as the breast, and acts as an
estrogen in other tissues?
a) Tamoxifen
b) Trastuzumab
c) Imatinib
d) Vincristine
e) Palitaxel
17) Aromatase inhibitors (anastrozole, exemestrane, letrozole) increase the risk of:
a) Endometrial cancer
b) Hot flashes and bleeding
c) Thrombocytopenia
d) Osteoporosis
e) Diabetes
18) Aromatase inhibitors are useful in reducing the risk of breast cancer reoccurance,
especially in post-menopausal women, and are beneficial when compared to tamoxifen as
they do NOT have the risk of:
a) Endometrial cancer
b) Hot flashes and bleeding
c) Thrombocytopenia
d) Osteoporosis
e) Diabetes
19) Which of the following drugs, marketed as Herceptin, has activity against HER2/neu,
which is overexpressed in about 25% of breast cancers?
a) Tamoxifen
b) Trastuzumab
c) Imatinib
d) Vincristine
e) Palitaxel
20) Pamidronate (Aredia) can reduce the need for palliative radiation and pain medication
in women with what form of breast cancer metastasis?
a) Lymph
b) Lung
c) Bone
d) Liver
e) Spinal cord
f) Spleen
g) Brain/CNS
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a) Patient history
b) Physical exam
c) Liver function tests
d) Carcinoembryonic antigen (CEA)
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a) Radiation
b) Dual-drug chemotherapy
c) Combination chemotherapy
d) Chemotherapy and radiation
e) No treatment is available
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e) Pallitive treatment
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e) Complete prostatectomy
3) Which of the following therapies is reserved for advanced D2 (M1) prostate disease?
a) Radiotherapy
b) Chemotherapy
c) Androgen deprivation
d) Prostatectomy
e) Vasectomy
4) Which of the following is the preferred method of androgen deprivation as it affects
95% of the androgen production?
a) Orchiectomy
b) Leuprolide
c) Buserelin
d) Goserelin
5) What is the mechanism of action for flutamine, bicalutamide, and nilutamide?
a) LHRH agonists
b) LHRH antagonists
c) Androgen receptor agonists
d) Androgen receptor antagonists
6) Prostate cancer had previously been considered refractory to most chemotherapy
regimens. However, improved response and increased surival have been shown with
regimens containing prednisone and:
a) Vincristine (Oncovin)
b) Vinblastine (Velbe)
c) Imatinib (Gleevec)
d) Paclitaxel (Taxol)
e) Hydroxyurea (Hydrea)
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a) Stage 0
b) Stage I
c) Stage II
d) Stage III
5) Which of the following is always true for a pure seminoma?
a) Increased BhCG and increased aFP
b) aFP will not be increased
c) BhCG will not be increased
d) aFP will be increased
e) BhCG will be increased
6) What is the procedure of choice for pathologic diagnosis of testicular cancer?
a) Peripheral blood smear
b) Testicular biopsy
c) Seminal fluid examination
d) Radical orchiectomy
e) Inguinal lymph node biopsy
7.1) What is the treatment of choice for stage I and nonbulky stage II seminomas?
a) Close follow-up
b) Infradiaphragmatic lymphatic irradiation
c) Platinum-based chemotherapy
d) Radical orchiectomy
e) No treatment is needed
7.2) What is the treatment of choice for bulky stage II or III seminomas as well as stage II
or III non-seminomas?
a) Close follow-up
b) Infradiaphragmatic lymphatic irradiation
c) Platinum-based chemotherapy
d) Radical orchiectomy
e) No treatment is needed
8) What is the treatment of choice for stage I non-seminomas?
a) Close follow-up
b) Infradiaphragmatic lymphatic irradiation
c) Platinum-based chemotherapy
d) Radical orchiectomy
e) No treatment is needed
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d) Discuss the pain with a spouse or relative so they can give a new and possibly
better perspective to the clinician
e) Create a personal pain diary
8) Which of the following best describes the major goal(s) of pain management?
a) To relieve pain and suffering
b) To return the patient to their occupation
c) To relieve pain and improve function
d) To extend the patient’s lifetime
e) To improve the patient’s average quality of life (QOL) years
9) Which of the following patients would benefit the most from psychological
intervention in pain management?
a) Adolescents with moderate pain
b) Adults with acute back pain
c) Males with work stress who have bone fractures
d) Young females who are pregnant for the first time
e) Patients with chronic or recurrent pain
10) Physical rehabilitation is most useful in what type of patient?
a) Acute cancer pain
b) Acute non-cancer pain
c) Chronic cancer pain
d) Chronic non-cancer pain
e) It has not been shown to be cost effective or useful in pain management
11.1) Which of the following is NOT considered a non-opioid analgesic, which are used
for mild to moderate pain or in conjunction with opiates for severe pain?
a) NSAIDs
b) Anti-depressants
c) Acetaminophen
d) Salicyclates
11.2) Which of the following is NOT considered a non-steroidal anti-inflammatory drug
(NSAID) as it does not provide sufficient anti-inflammatory action?
a) Acetylsalicylic acid (Aspirin, Econtrin)
b) Acetaminophen (Tylenol, Paracetamol)
c) Naproxen sodium (Aleve, Naprosyn)
d) Ibuprofen (Advil, Motrin)
e) Indometacin (Indocin, Indomethacin)
12) According to the American Pain Society, which of the following patients should use a
non-opiate analgesic as part of their pain regimen?
a) Children with moderate pain
b) Adults with mild to moderate pain
c) Adults with intense pain
d) Elderly with intense pain
e) All patients with pain should use non-opiate analgesics
13) Which of the following effects is seen both in aspirin and acetaminophen?
a) Anti-platelet activity
b) Anti-inflammatory activity
c) Analgesic activity
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23.7) NSAIDs reduce the clearance of which of the following drugs, leading to increased
plasma concentration of that drug?
a) Atropine
b) Antihistamines
c) Oral contraceptives
d) Diazepam
e) Methotrexate
23.8) Hypoglycemia can occur when NSAIDs are combined with:
a) Phenytoin
b) Antiarrhythmics
c) Oral anticoagulants
d) Sulfonylureas
e) Methotrexate
23.9) Which of the following occurs when NSAIDs are combined with aminoglycoside
antibiotics?
a) Enhanced NSAID clearance
b) Inhibited NSAID clearance
c) Enhanced aminoglycoside clearance
d) Inhibited aminoglycoside clearance
e) None of the above
24) Opioid analgesics are very useful for moderate to severe chronic and cancer-related
pain. The most effective opioid analgesics are:
a) Full delta-receptor agonists
b) Full kappa-receptor agonists
c) Full mu-receptor agonists
d) Partial delta- & kappa-receptor agonists
e) Full mu-receptor antagonists
25) Which of the following is true of the recommendation for IV opioid administration?
a) The IV route is nearly always preferred over PO (oral)
b) Transdermal administration is relatively ineffective
c) They can be administered via rectal, intrathecal, and subcutaneous routes
d) Oral and transdermal routes are easy, effective, and relatively inexpensive
e) Oral route is prefered in the postoperative setting or if rapid effect is desired
26.1) A typical 10mg IV dose of morphine sulfated used for severe pain would be
equivalent to what oral dose?
a) 1mg
b) 3mg
c) 10mg
d) 30mg
e) 100mg
26.2) What is the time to peak analgesia for oral opioids?
a) Immediately
b) 4-10 minutes
c) 15-30 minutes
d) 45-60 minutes
e) 60-120 minues
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27) What is the prototype opioid drug to which the potency of all other opioid drugs is
compared?
a) Fentanyl (Sublimaze)
b) Codeine sulfate (Codeine)
c) Morphine sulfate (Morphine)
d) Oxycodone (Oxycontin)
e) Diacetylmorphine (Heroin)
28) Which of the following opioid forms is recommended for chronic pain patients?
a) High-dose
b) Low-dose
c) Long-acting
d) Short-acting
29) What is a typical opioid rescue dose for a patient with break-through pain?
a) Full 24-hour dose
b) 65-75% of a 24-hour dose
c) 45-55% of a 24-hour dose
d) 25-35% of a 24-hour dose
e) 5-15% of a 24-hour dose
30.1) Prophylactic treatment should be given for what opioid side-effect, which most
patients do not develop a tolerance to?
a) Respiratory depression
b) Constipation
c) Nausea/Vomiting
d) Somnolence
e) Reye syndrome
30.2) A child presents with lethargy, confusion, history of nightmares, and bouts of
severe vomiting. After a physical exam, Reye syndrome is suspected. This can occur in
children who are given aspirin when they have which of the following viral infections?
a) HHV-1: Herpes simplex virus 1 (HSV-1)
b) HHV-3: Varicella zoster virus (VZV)
c) HHV-4: Epstein-Barr virus (EBV)
d) HHV-5: Cytomegalovirus (CMV)
e) HHV-6/7: Roseolovirus
31.1) Which of the following drugs would be useful as an anti-emetic for patients who
develop opioid nausea due to reduced gastric motility?
a) Prochlorperazine (Compazine)
b) Dronabinol (Marinol)
c) Scopolamine (Hyoscine)
d) Midazolam (Versed)
e) Metoclopramide (Reglan)
31.2) Which of the following drugs would be useful as an anti-emetic for patients who
develop opioid nausea due to chemoreceptor activation of the medulla trigger zone?
a) Prochlorperazine (Compazine)
b) Dronabinol (Marinol)
c) Scopolamine (Hyoscine)
d) Midazolam (Versed)
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e) Metoclopramide (Reglan)
32) Patients with impaired renal function who are taking the opioid meperidine
(Demerol) are at increased risk for:
a) Nephrotoxicity
b) Hepatotoxicity
c) Neurotoxicity
d) Ototoxicity
e) Optic neuropathy
33) Increased sedation can occur when opioids are given with any of the following
EXCEPT:
a) Metoclopramide
b) Butyrophenones
c) Phenothiazides
d) Corticosteroids
e) Antihistamines
34) Which of the following is NOT considered an adjuvant analgesic?
a) Anti-depressants
b) Anti-convulsants
c) Local anesthetics
d) Muscle relaxants
e) NSAIDs
35) Gabapentin (Neurontin) is used to treat pain as a better alternative to certain anti-
convulsants. What is the important side-effect seen in elderly patients?
a) Splenomegaly
b) Ataxia
c) Renal insufficiency
d) Increased libido
e) Complete peripheral neuropathy
36) Which of the following is NOT a reason that many terminally ill patients, according
to a 1,000 patient survey, do not request additional pain medications?
a) Fear of addiction
b) Side effects
c) Pain already controlled
d) Unwillingness to take more pills
37) Addiction, a primary chronic neurobiological disease, is most influenced by which of
the following?
a) Genetic factors
b) Psychosocial factors
c) Environmental factors
d) All of the above
e) None of the above
38) A chronic pain patient presents to the Emergency Room for “pain relief.” They were
not given their opioid pain medication at their primary care office due to “clock-
watching” and were flagged as a “drug-seeker.” Which of the following would
distinguish addiction to under-treated pain (pseudoaddiction)?
a) Behaviors becoming more violent with time
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43) What is the most reliable indicator for patient pain assessment?
a) Neurological examination
b) Musculoskeletal examination
c) Patient self-reported pain
d) Pain reported by close relatives
e) Occupational disability (e.g. sick days)
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e) NSAIDs
7) Up to 50% of EM cases may involve mucous membranes. About what percentage of
EM cases re-occur after treatment?
a) 0%
b) 20%
c) 40%
d) 60%
e) 80%
8) Although EM treatment is mainly supportive, which of the following treatment may
shorten the duration of the rash?
a) Oral antihistamines
b) IV antihistamines
c) Topical corticosteroids
d) Systemic corticosteroids
e) Wet compress with bland emollients
9) Which of the following has been shown to prevent subsequent EM outbreaks?
a) Macrolide antibiotics
b) Chlorhexidine rinse
c) Diphenhydramine elixir
d) Viscous lidocaine
e) Oral anti-virals
10) How are SJS and TEN usually distinguished from each other?
a) Nature of lesions
b) Areas involved
c) Lesion size
d) Duration of illness
e) Body surface area affected
11) Toxic epidermal necrolysis (“dusky coalescent lesions”) is usually defined as
covering how much body surface area (BSA)?
a) < 10%
b) > 10%
c) < 30%
d) > 30%
e) < 50%
12) What is the Nikolsky sign?
a) Dusky erythematosus lesions
b) Lesions covering 10-30% BSA
c) Target-like lesions with surrounding edema
d) Lesions that denude with slight pressure
e) Lesions that bleed with slight pressure
13) An adult presents with target-like lesions on their face, arms, and abdomen. Some
lesions appear dusky. Lab tests show electrolyte imbalance. The patient complains of
nausea and vomiting. Which of the following is most likely?
a) EM
b) SJS
c) TEN
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James Lamberg
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