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MCQOPTIONS
This section includes 396 Mcqs, each offering curated multiple-choice questions to sharpen your Uncategorized topics knowledge and support exam preparation. Choose a topic below to get started.
| 301. |
A patient with non-metastatic gestational trophoblastic disease can be treated with weekly intramuscular injections of which of the following agents? |
| A. | Cyclophosphamide |
| B. | Carboplatin |
| C. | Etoposide |
| D. | Actinomycin D |
| E. | Methotrexate |
| Answer» F. | |
| 302. |
Least effective for identifying an unknown primary |
| A. | Axillary lymphadenopathy adenocarcinoma |
| B. | Secondary hepatic metastases adenocarcinoma |
| C. | Mediastinal undifferentiated carcinoma |
| D. | Bone blast secondary |
| Answer» D. Bone blast secondary | |
| 303. |
What number of axillary lymph nodes removed for sampling during a level I/ II node dissection for breast cancer most likely would require postoperative radiation therapy to the axilla? |
| A. | 02 |
| B. | 06 |
| C. | 08 |
| D. | 10 |
| Answer» B. 06 | |
| 304. |
According to the FIGO staging of gestational trophoblastic tumors, a lady with choriocarcinoma having lung metastasis will belong to which stage |
| A. | l |
| B. | ll |
| C. | lll |
| D. | lV |
| Answer» D. lV | |
| 305. |
An older woman with breast cancer with bony metastases who was on aminoglutamethonine. Picture of rash which covered right breast and covered left breast a little, small nodules, some dead skin and a few scaly bits. Most likely cause of rash? |
| A. | fungal |
| B. | radiation |
| C. | aminoglutamethonine reaction |
| D. | skin recurrence |
| E. | zoster |
| Answer» E. zoster | |
| 306. |
What is the most common histology of tumors involving the terminal ileum? |
| A. | Sarcoma |
| B. | Carcinoid |
| C. | Lymphoma |
| D. | Adenocarcinoma |
| Answer» C. Lymphoma | |
| 307. |
Primary surgery is most appropriate for patients with which of the following types of squamous cell carcinoma? |
| A. | Stage T1N0 of the oropharyngeal portion of the posterior pharyngeal wall |
| B. | Stage T1N0 of the floor of mouth |
| C. | Stage T1N0 of the soft palate |
| D. | Stage T2N0 of the base of tongue |
| Answer» C. Stage T1N0 of the soft palate | |
| 308. |
Most common mode of spread of epithelial ovarian tumors occurs to |
| A. | Para aortic lymph nodes |
| B. | Adnexae |
| C. | Bone |
| D. | Lungs |
| E. | Liver |
| Answer» C. Bone | |
| 309. |
A 47-year-old woman is recovering from surgery for stage III ovarian cancer (spread to the peritoneal cavity but without parenchymal liver involvement). Not all of the visible cancer could be resected; the largest residual tumor was 3 cm in diameter. Her performance status is excellent. She is interested in pursuing aggressive therapy and wishes to be treated as soon as possible in her local community. The proposed systemic therapy will involve cisplatin or carboplatin and paclitaxel. What further treatment is appropriate for this patient? |
| A. | No further treatment beyond the proposed standard therapy |
| B. | Another drug that has a different mechanism of action |
| C. | Regional peritoneal therapy |
| D. | High-dose therapy with peripheral or bone marrow stem cell rescue |
| E. | A second-look laparotomy |
| Answer» B. Another drug that has a different mechanism of action | |
| 310. |
According to Intergroup Trial 0116, adjuvant chemotherapy and radiation therapy after gastrectomy were more likely than gastrectomy alone to: |
| A. | result in an unacceptable level of toxicity in the majority of patients. |
| B. | result in a statistically significant decrease in the rate of distant metastases. |
| C. | result in a statistically significant improvement in overall patient survival. |
| D. | be most beneficial after D2 lymph node dissections. |
| Answer» D. be most beneficial after D2 lymph node dissections. | |
| 311. |
Which of the following characterizes the biologic nature of carcinoid tumors (argentaffinomas)? |
| A. | benign but produce systemic symptoms |
| B. | production of systemic symptoms when they metastasize to the liver |
| C. | especially malignant when primary in the appendix |
| D. | production of jejunal ulceration due to gastrin elaboration |
| Answer» C. especially malignant when primary in the appendix | |
| 312. |
Carcinoid tumors of the lung (bronchial adenomas) originate from which of the following cell types? |
| A. | Ciliated cell |
| B. | Clara cell |
| C. | Kulchitsky (K) cell |
| D. | Mucus (goblet) cell |
| E. | Type 2 Alveolar cell |
| Answer» D. Mucus (goblet) cell | |
| 313. |
What is the most common site of metastatic disease in patients with Ewing sarcoma? |
| A. | Lung |
| B. | Bone |
| C. | Bone marrow |
| D. | Lymph nodes |
| Answer» B. Bone | |
| 314. |
Which of the following statements about desmoid tumors is true? |
| A. | They commonly metastasize to the lungs. |
| B. | They commonly metastasize to the bones. |
| C. | Surgical excision is the most common treatment of choice. |
| D. | Definitive radiation therapy can achieve local control in 25% of cases. |
| Answer» D. Definitive radiation therapy can achieve local control in 25% of cases. | |
| 315. |
Carcinoid tumors (argentaffinomas) are characterized by all of the following except: |
| A. | many are multiple especially in the ileum |
| B. | can occur in alimentary, biliary and respiratory tracts |
| C. | may produce systemic symptoms when accompanied by liver metastases |
| D. | appendix is the most common site |
| E. | appendiceal types have greatest malignant potential |
| Answer» F. | |
| 316. |
Which of the following statements about unknown primary head and neck tumors is true? |
| A. | PET imaging is able to detect the primary tumor in 60% of cases. |
| B. | Random biopsies will reveal the primary lesion in 40% of cases. |
| C. | Chest imaging will reveal a primary lung tumor in 20% of cases. |
| D. | Tonsillectomy may reveal the occult primary tumor in 20% of cases. |
| Answer» E. | |
| 317. |
Which of the following factors is the most important predictor of disease-free survival and overall survival in patients with breast cancer? |
| A. | Tumor size |
| B. | Mitotic index |
| C. | Axillary lymph node status |
| D. | Histopathologic tumor grade |
| Answer» D. Histopathologic tumor grade | |
| 318. |
Based on the results of SWOG 8797 (Peters), which of the following pathologic findings after a radical hysterectomy and pelvic lymph node dissection is an indication for adjuvant chemotherapy with radiation therapy for patients with high-risk cancers of the cervix? |
| A. | Tumor size >5 cm |
| B. | Lymphovascular space invasion |
| C. | Depth of invasion into the deep third of the cervical stroma |
| D. | Microscopic involvement of the parametrium |
| Answer» E. | |
| 319. |
A 45 years old female with right sided breast cancer with no family history suggesting familial cancer. The most likely genetic mutation for this patient is/are |
| A. | BRAC1 |
| B. | BRCA2 |
| C. | ATM |
| D. | APC |
| E. | Answer A and B are correct |
| Answer» C. ATM | |
| 320. |
A 45-year-old woman noticed tinnitus in her left ear which progressed over some weeks to hearing loss in that ear. On physical examination she is found to have a marked decrease in hearing on the left, with Rinne test indicating air conduction better than bone conduction. The other cranial nerves I - VII and IX - XII are intact. A brain MRI scan revealed a solitary, fairly discreet, 3 cm mass located in the region of the left cerebellopontine angle. Which of the following statements is most appropriate to tell the patient regarding these findings? |
| A. | A test for HIV-1 is likely to be positive |
| B. | Other family members should undergo MR imaging of the brain |
| C. | Remissions and exacerbations are likely to occur in coming years |
| D. | The lesion can be resected with a good prognosis |
| E. | You are unlikely to survive for more than a year |
| Answer» E. You are unlikely to survive for more than a year | |
| 321. |
Which of the following factors most adversely affects patients receiving radiation therapy for squamous cell carcinoma of the head and neck? |
| A. | Concurrent HPV infection |
| B. | Concurrent tobacco use |
| C. | Gender of the patient |
| D. | Grade of the cancer |
| Answer» C. Gender of the patient | |
| 322. |
According to GOG 99 (Keys), which of the following sites is most likely to be associated with cancer recurrence in a patient who has early-stage endometrial cancer and undergoes TAH-BSO without adjuvant irradiation? |
| A. | Liver |
| B. | Vaginal vault |
| C. | Pelvic lymph nodes |
| D. | Paraaortic lymph nodes |
| Answer» C. Pelvic lymph nodes | |
| 323. |
In RTOG 8501, what was the 5-year overall survival rate for patients who had esophageal cancer and received radiation therapy alone? |
| A. | 00% |
| B. | 10% |
| C. | 25% |
| D. | 35% |
| Answer» B. 10% | |
| 324. |
Which of the following survival times is most likely to be associated with a patient who has a class II brain metastasis, based on the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA)? |
| A. | 10.2 months |
| B. | 07.1 months |
| C. | 04.2 months |
| D. | 02.3 months |
| Answer» D. 02.3 months | |
| 325. |
Which of the following side effects is NOT associated with long-term hormonal therapy combined with radiation therapy for prostate cancer? |
| A. | Decreased sexual libido and hot flashes |
| B. | Osteoporosis and muscle weakness |
| C. | Increased late GU toxicity |
| D. | Increased late GI toxicity |
| Answer» D. Increased late GI toxicity | |
| 326. |
Which of the following primary bone tumors is most common? |
| A. | Ewing sarcoma |
| B. | Malignant giant cell tumor |
| C. | Chondrosarcoma |
| D. | Osteosarcoma |
| Answer» E. | |
| 327. |
Five-year survival rates of patients with low-risk, non-metastatic gestational trophoblastic disease approaches? |
| A. | 100% |
| B. | 75% |
| C. | 50% |
| D. | 25% |
| E. | 5-10% |
| Answer» B. 75% | |
| 328. |
Which of the following studies compared surgery alone versus surgery plus external-beam pelvic irradiation in patients with early-stage endometrial cancer and required all patients to undergo surgical staging with pelvic lymphadenectomy? |
| A. | GOG 99 (Keys) |
| B. | GOG 33 (Morrow) |
| C. | PORTEC (Creutzberg) |
| D. | Norwegian (Aalders) |
| Answer» B. GOG 33 (Morrow) | |
| 329. |
Which of the following pathological findings is associated with patients who have meningioma? |
| A. | Verocay bodies |
| B. | Psammoma bodies |
| C. | Small, round blue cells |
| D. | Flexner-Wintersteiner rosettes |
| Answer» C. Small, round blue cells | |
| 330. |
Which of the following types of cancer was associated with a statistically significant improvement in survival for patients who had one to three solitary brain metastases and received whole brain radiation therapy with the addition of stereotactic radiosurgery, according to results of the RTOG 9508 phase III trial? |
| A. | Breast cancer |
| B. | Renal cell cancer |
| C. | Non-small cell lung cancer |
| D. | Melanoma |
| Answer» D. Melanoma | |
| 331. |
Which of the following results is associated with concurrent chemoradiation therapy versus radiation therapy alone for patients with locally advanced laryngeal cancer, based on the RTOG 91-11 study? |
| A. | Same rate of distant metastases |
| B. | Improved swallowing function |
| C. | Improved overall survival |
| D. | Improved local control |
| Answer» E. | |
| 332. |
According to GOG 122 (Randall), the survival rate of patients who have surgical stage III-IV endometrial cancer and receive adjuvant abdominopelvic irradiation compared to adjuvant chemotherapy is: |
| A. | worse. |
| B. | similar. |
| C. | improved. |
| D. | not able to be analyzed. |
| Answer» B. similar. | |
| 333. |
A 45 years old male with bilateral breast cancer with his mother developed breast cancer when aged 34 years and his sister developed ovarian cancer at age 50 years. The most likely genetic mutation for this patient is/are |
| A. | BRAC1 |
| B. | BRCA2 |
| C. | ATM |
| D. | APC |
| E. | Answer A and B are correct |
| Answer» C. ATM | |
| 334. |
Which of the following factors is NOT typically associated with improved overall survival for patients who present with unknown primary tumors of the head and neck region? |
| A. | Radiation doses of >50 Gy |
| B. | Complete resection of the involved lymph nodes |
| C. | Subsequent presentation of the primary tumor |
| D. | Stage N1 versus stage N2 lymph node involvement |
| Answer» D. Stage N1 versus stage N2 lymph node involvement | |
| 335. |
A 58-year-old postmenopausal woman has been taking hormone replacement therapy with combined estrogen and progestin for the past 4 years because she was told it would decrease her risk for heart disease. Her father died at age 65 years of heart disease, and she is concerned that she is also at risk. Recently, her sister has been diagnosed with breast cancer. Her mother died of breast cancer. Three years ago, the patient had a breast biopsy that showed atypical hyperplasia. She has not had a hysterectomy. The patient is considering chemoprevention for breast cancer, but is nonetheless concerned about heart disease. Her calculated risk of breast cancer is 10.4% over the next 5 years. Which of the following options is reasonable to consider for this patient? |
| A. | Continue hormone replacement therapy alone for primary prevention of heart disease |
| B. | Continue hormone replacement therapy and add tamoxifen |
| C. | Discontinue hormone replacement therapy and start tamoxifen |
| D. | Change her hormone replacement therapy to estrogen alone and add tamoxifen |
| Answer» D. Change her hormone replacement therapy to estrogen alone and add tamoxifen | |
| 336. |
A 64-year-old woman has the following family history: One sister, who was a smoker, had lung cancer at the age of 63 years; another sister had breast cancer at the age of 70 years. Her father had prostate cancer at 82 years of age, and her mother had breast cancer at age 71 years. She has three other sisters, now aged 58, 60, and 65 years who have no history of cancer. She has two daughters and two sons between the ages of 25 and 39 years, who have no history of cancer. Her ancestry is European in general, and she is not of known Ashkenazi Jewish descent. She is concerned that cancer runs in the family and would like to have one of those gene tests she has read about. What is the best advice to give her and her family? |
| A. | Have blood testing for abnormalities in known germ-line tumor suppressor genes (such as BRCA-1 and BRCA-2). |
| B. | Encourage her children to have genetic counseling and testing for abnormalities in known germ-line tumor suppressor genes. |
| C. | Advise her children to start routine cancer screening tests immediately, including mammography, colonoscopy or sigmoidoscopy, and prostate-specific antigen testing. |
| D. | Advise her that genetic testing is unnecessary, and recommend that she and her family continue screening and risk-reduction strategies as recommended for the general population. |
| E. | Recommend bilateral prophylactic mastectomies and oophorectomies for her and her daughters. |
| Answer» E. Recommend bilateral prophylactic mastectomies and oophorectomies for her and her daughters. | |
| 337. |
A 50-year-old menstruating woman has a 1 .5-cm moderately differentiated breast cancer. The lesion is completely excised, and the margins of the excision are negative. Axillary node sampling shows that she has three positive nodes. The tumor is negative for estrogen and progesterone receptors and is highly positive for HER2. She is otherwise healthy. Her mother had breast cancer at 62 years and was treated by mastectomy; she is alive and healthy at the age of 80 years. The patients sister had breast cancer at 54 years and was treated by breast conservation therapy; 4 years later she died of a recurrence of breast cancer. The patient has seen two different surgeons with opposing viewpoints regarding the best treatment, and she has been reading extensively on the Internet and has become confused about her options. Which of the following represents the best treatment for this patient? |
| A. | Modified radical mastectomy, followed by tamoxifen and chemotherapy |
| B. | Chemotherapy with no further treatment to the breast |
| C. | Chemotherapy and tamoxifen, with no further treatment to the breast |
| D. | Chemotherapy and radiation therapy to the breast and axillary regions |
| E. | Chemotherapy, tamoxifen, and radiation therapy to the breast and axillary regions |
| Answer» E. Chemotherapy, tamoxifen, and radiation therapy to the breast and axillary regions | |
| 338. |
A 62-year-old postmenopausal woman with a family history of breast cancer in two first-degree relatives wishes to consider taking tamoxifen to reduce her risk of breast cancer. Her baseline risk of breast cancer qualifies her for consideration of tamoxifen (i.e., an absolute risk of at least 1.66% over the next 5 years). She has had a prior hysterectomy, but her ovaries are intact. Which of the following effects of tamoxifen are relevant to the decision? |
| A. | Decreased risk of myocardial infarction or ischemic heart disease |
| B. | Increased risk of deep venous thrombosis |
| C. | Increased risk of ovarian cancer |
| D. | Increased risk of major depression |
| E. | Increased risk of colorectal cancer |
| Answer» C. Increased risk of ovarian cancer | |
| 339. |
A 40-year-old woman has a routine gynecologic examination. At the age of 32 years, she gave birth to twins after receiving fertility drugs. She has just seen a television program on ovarian cancer, and is concerned because previous use of fertility drugs and a family history of ovarian cancer were mentioned as possible risk factors. Her mother developed endometrial cancer at 56 years, and a paternal uncle was diagnosed with a type of lymphoma at 60 years. She has one older sister with hypertension and one younger brother who is healthy. Results of her pelvic examination are unremarkable, but she asks what additional tests she should have to look for ovarian cancer in the early stages that cannot be detected by physical examination. What is the most appropriate management for this patient? |
| A. | Blood test for CA-125 |
| B. | Rectovaginal pelvic examination in 1 year |
| C. | Transvaginal ultrasound |
| D. | Screening test for BRCA-1 and BRCA-2 |
| Answer» C. Transvaginal ultrasound | |
| 340. |
Which of the following treatment outcomes is associated with patients who have DCIS, according to prospective randomized trials? |
| A. | In NSABP B-17, the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery only was 24%. |
| B. | In NSABP B-17, the actuarial rate of breast cancer recurrence after 12 years in patients who received surgery plus breast irradiation was 16%. |
| C. | In NSABP B-24, breast irradiation reduced the risk of breast cancer recurrence in all subgroups except for the patients with positive surgical margins. |
| D. | In EORTC 10853, the subtype of DCIS histology had no effect on patients' risk for breast cancer recurrence. |
| Answer» C. In NSABP B-24, breast irradiation reduced the risk of breast cancer recurrence in all subgroups except for the patients with positive surgical margins. | |
| 341. |
A 57-year-old man has tried to stop smoking unsuccessfully for the past year. He has tried smoking cessation counseling and use of nicotine gum. Although he has no new symptoms, the smokers cough that he has had for years is a constant reminder that he is at risk of dying of lung cancer. He wants to know what measures he can take that have been shown to reduce that risk. In addition to a smoking cessation program, what is the best recommendation for this patient? |
| A. | Daily dietary supplementation with the antioxidantl3-carotene |
| B. | Daily isotretinoin, titrated to limit skin toxicity |
| C. | Daily bupropion |
| D. | An annual low-dose spiral CT scan of the chest |
| E. | Sputum cytology every4 months |
| Answer» D. An annual low-dose spiral CT scan of the chest | |
| 342. |
A 44-year-old woman has a lumpectomy and radiation therapy for stage II breast cancer. She receives 6 months of chemotherapy. Her periods cease while she is receiving chemotherapy, and she remains amenorrheic. Her tumor was found to be rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back and her energy is returning, but she is having severe hot flushes that keep her awake at night. She is so tired during the day that she is unable to perform her job in a satisfactory manner. She also relates that she and her husband have been unable to have satisfying sexual relations because intercourse is painful for her. What would be the most appropriate treatment for this patient? |
| A. | A selective serotonin reuptake inhibitor and use of nonhormonal vaginal lubricating preparations |
| B. | Reassurance that these normal physiologic responses to menopause will resolve in time |
| C. | Estrogen replacement therapy with a progesterone supplement |
| D. | Work-up for endometrial cancer because she is taking tamoxifen |
| Answer» B. Reassurance that these normal physiologic responses to menopause will resolve in time | |
| 343. |
A 45-year-old woman has recently undergone lumpectomy and radiation therapy for a stage II breast cancer. She received chemotherapy for 6 months. Her periods ceased while she was receiving chemotherapy, and she remains amenorrheic. Her tumor was rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back, her energy is returning, and she has no specific complaints, but she is worried about recurrence. In addition to routine follow-up, what is the most appropriate management of this patient? |
| A. | Positron emission tomography now and annually |
| B. | No further management |
| C. | Routine tumor marker evaluation every 3 to 4 months (serum CAl 5-3, carcinoembryonic antigen) |
| D. | Bone scan and annual CT of the chest, abdomen, and pelvis |
| E. | Estrogen replacement therapy |
| Answer» C. Routine tumor marker evaluation every 3 to 4 months (serum CAl 5-3, carcinoembryonic antigen) | |
| 344. |
A 42-year-old woman is evaluated because she has noticed a thickening in her left breast over the past few weeks. She noticed it a few months ago, but because it seems to come and go, she put off seeking medical attention. She is premenopausal. She had menarche at age 13 years. When she was 35 years, she had one child (whom she breast-fed) after a normal first full-term pregnancy. She took oral contraceptives for 10 years before her pregnancy. She has no known radiation exposure and no family history of breast cancer. On physical examination, there appears to be some asymmetry in breast tissue density in the upper outer quadrant of the left breast compared with the right one, but no discrete mass. There are no palpable lymph nodes. Results of a mammogram are negative. What would be the most appropriate next step in this patients management? |
| A. | Breast ultrasound; consultation with a surgeon experienced in breast diagnosis |
| B. | Reassurance that because her family history is negative and the mammogram is negative, no additional studies or treatment is required |
| C. | MRI of the breast |
| D. | Measurement of circulating tumor markers, including CA15-3 and carcinoembryonic antigen A 68-year-old woman is |
| Answer» B. Reassurance that because her family history is negative and the mammogram is negative, no additional studies or treatment is required | |
| 345. |
A 32-year-old woman is evaluated because of a painless swelling in her lower neck. She noted the swelling about 3 weeks ago and now thinks it is getting larger. She has no history of foreign travel. She smokes but does not drink alcohol. She owns a cat. She has not had fever or unexplained weight loss, but has had night sweats twice in the past week. She has been feeling fatigued lately and has noted dyspnea on exertion. On physical examination, a 3 X 5-cm left supraclavicular lymph node is palpable. It is firm but not rock-hard and is nontender. The remainder of her physical examination and results of a complete blood count are normal. What is the best next step in this patient s management? |
| A. | Observe for 2 weeks |
| B. | Refer her to an otolaryngologist for a thorough search for a primary lesion of the oropharyngeal mucosa |
| C. | Administer oral antibiotics and observe the course of the node |
| D. | Perform a needle aspiration of the node |
| E. | Perform a chest radiograph |
| Answer» F. | |
| 346. |
A 76-year-old man was diagnosed with prostate cancer 8 years ago. At that time he had a serum prostate-specific antigen (PSA) level of 12 ng/mL, a Gleason score of 6, and a clinical stage of T2b (organ-confined on digital rectal examination but involving both lobes of the prostate gland). He was treated with external-beam radiation therapy, and his PSA level dropped to a low of 1.4 ng/mL. Four years later, his PSA level began to rise and now is 14.1 ng/mL. A recent bone scan and CT scans revealed no metastatic disease. His urologist has suggested initiating a course of leuprolide. Which of the following is a potential side effect of leuprolide that the patient should be informed about before commencing therapy? |
| A. | Impaired urinary flow |
| B. | Bone thinning |
| C. | Weight loss |
| D. | Increased hair growth |
| Answer» C. Weight loss | |
| 347. |
Four years ago, a 67-year-old man had a serum prostate-specific antigen (PSA) level of 16 ng/mL. Biopsy specimen showed adenocarcinoma of the prostate gland. His Gleason score was 7. He was treated with external-beam radiation therapy. One month ago, the patient noted fatigue and rib pain. His PSA was found to be 87 ng/mL, and bone scan revealed diffuse metastatic disease. What is the best treatment for this patient? |
| A. | Chemotherapy with docetaxel |
| B. | Chemotherapy with mitoxantrone and prednisone |
| C. | Androgen ablation (medical or surgical) |
| D. | Radiation therapy with strontium-89 |
| Answer» D. Radiation therapy with strontium-89 | |
| 348. |
A 65-year-old man has a routine screening examination, and his serum prostate- specific antigen (PSA) level is found to be 6.7 ng/mL. Digital rectal examination reveals a mildly enlarged prostate gland, but no discrete nodules. One year ago, his PSA was 2.1 ng/mL. The patient is referred to a urologist who performs a biopsy of the gland. Biopsy specimen shows adenocarcinoma of the prostate with a Gleason score of 9. Which of the following best describes his prognosis on the basis of his Gleason score? |
| A. | The Gleason score is not reproducible and should not be used as a prognostic variable. |
| B. | Because the patient is asymptomatic, the Gleason score will not be predictive of outcome. |
| C. | The Gleason score indicates that the patient would have a high risk of recurrence after a radical prostatectomy. |
| D. | The Gleason score indicates that the patient would have a very low risk of recurrence after radiation therapy. |
| Answer» D. The Gleason score indicates that the patient would have a very low risk of recurrence after radiation therapy. | |
| 349. |
A 57-year-old man is found to have a rectal mass 3 cm from the anal verge on digital rectal examination. Subsequent colonoscopy and biopsy confirm rectal adenocarcinoma. EUS examination demonstrates penetration of the tumor into, but not through, the muscularis propria, but shows significant perirectal lymph nodes. CT scan of chest/abdomen/pelvis demonstrates no metastases. The patient is staged as T2N1M0. What procedure should be attempted to remove the primary lesion in this patient? |
| A. | Endoscopic mucosal resection (EMR) to remove the lesion |
| B. | Endoscopic argon plasma coagulation (APC) therapy to cauterize and ablate the lesion |
| C. | Surgical transanal excision of the lesion |
| D. | Neo-adjuvant chemoradiation followed by transanal excision |
| E. | Neo-adjuvant chemoradiation followed by abdominoperineal resection (APR) |
| Answer» F. | |
| 350. |
A 29-year-old man was diagnosed with stage II (that is, spread from the primary tumor to retroperitoneal lymph nodes) nonseminomatous germ cell tumor 1 year ago. Treatment included orchiectomy and retroperitoneal lymph node dissection. He now presents with an elevated level of -human chorionic gonadotropin hormone and multiple pulmonary lesions ranging in size from 0.61 to 3.22 cm. Needle biopsy specimen of the largest lesion reveals a germ cell tumor consistent with the initial diagnosis. He is asymptomatic. What is the best treatment for this patient? |
| A. | Surgical resection of the lung lesions |
| B. | Combination chemotherapy with bleomycin, etoposide, and cisplatin |
| C. | Radiation therapy to the chest |
| D. | Watchful waiting |
| Answer» C. Radiation therapy to the chest | |