Download Exam 2 - Roswell Park Cancer Institute

ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Iyer
NAME:___________________________
12 POINTS
1.
The selection of a chemotherapeutic agent should be based on 3 separate but related
scientific disciplines. These are pharmacodynamics, pharmacokinetics, and ____________.
(1 point)
a.
b.
c.
d.
2.
DATE: March 25th, 2010
cytokinetics
histology
cytology
pharmaceutics
Which of the following statements are true about alkylating agents? (1 point)
a. Dissociate a positively charged, electrophilic alkyl group capable of attacking a
negatively charged nucleophilic site on biologic molecules.
b. Impair cell function by forming covalent bonds with amino, carboxyl, sulfhydryl and
phosphate groups in DNA, RNA, proteins.
c. Alter DNA structure and function and alter DNA base pairing, replication and
transcription.
d. Need cell proliferation to be active but not phase specific.
e. a and c
f. a,b,c and d
3.
Mitomycin C is an antitumor antibiotic that functions as an __________. (1 point)
a.
b.
c.
d.
4.
antimetabolite
immunotherapeutic
atypical alkylator
antitumor enzyme
What is dose intensity? (1 point)
a. DI= amt of drug delivered/ unit time expressed as milligrams per square meter per
week, regardless of schedule or route.
b. DI= amt of drug delivered/ unit time expressed as milligrams per square meter per
week, and varies by route- IV vs PO
c. DI= amt of drug delivered/ unit time expressed as milligrams per square meter per
week, compared to a standard regimen expressed in the same units.
5.
Doxorubicin is an anthracycline antibiotic, and is associated with cardiac toxicity. Patients
may be pretreated with _________ in an effort to limit or prevent cardiomyopathy. (1
point)
a.
b.
c.
d.
6.
Bacillus Calmette-Guerin (BCG) is an immunotherapeutic agent principally used against
_________. (1 point)
a.
b.
c.
d.
7.
porfimer sodium
denileukin difitox
dexrazoxane
tretinoin
non-small-cell lung cancer
bladder cancer
Hodgkin’s lymphoma
mycosis fungoides
A pharmacist friend of yours was recently diagnosed with CNS lymphoma and is receiving
methotrexate (MTX). He has read that the elimination of MTX from the body is well
characterized. Ninety percent of an administered dose of MTX is eliminated unchanged in
the urine. While the drug is excreted into the bile, enterohepatic recirculation is such that
little is excreted in the stool. Elimination in the urine is by glomerular filtration and
proximal renal tubular secretion. MTX is poorly soluble in acid urine. He asks you which
of the following statements about reducing the toxicity of MTX are true.
1. In the presence of renal failure, cholestyramine (Antidote, anion-exchange resin)
will increase stool MTX and potentially lower toxicity.
2. Patients on high dose schedules should be well hydrated and have their
urine alkalinized to prevent precipitation.
3. Many drugs may interfere with renal tubular secretory capacity and concomitant
administration of such drugs may lead to the delayed excretion of MTX and increased
toxicity.
4. Since the drug depletes cells of reduced folates, one way to overcome the block would
be to administer the reduced folates themselves i.e leucovorin rescue.
a.
b.
c.
d.
2 and 4
2, 3 and 4
4 only
All of the above
8.
You have decided to spend your summer volunteering in the local public library and the
librarian hears that you are a researcher. She then tells you she has breast cancer is going to
start chemo the next week with a taxane. She asks if you could tell her how the drug works
and what major side effects to expect as she can’t remember anything from her doctors
visit- it was all a “blur.” (1 point)
a. Taxanes are microtubule binding agents and can cause neuropathy and allergic
reactions.
b. Taxanes are antimetabolites with myelosupressive and nephrotoxic properties
c. Taxanes are anti-microtubule agents associated with severe treatment related nausea.
d. a and c
9.
Which of these statements is false? (1 point)
a.
b.
c.
d.
10.
All of the following require dose modification for liver dysfunction except. (1 point)
a.
b.
c.
d.
e.
11.
Paclitaxel
Doxorubicin
Vincristine
Topotecan
Irinotecan
All of the following are mechanisms of resistance to 5-Fluorouracil except: (1 point)
a.
b.
c.
d.
12.
Inactivation of the purine analogue 6-mercaptopurine is by enzyme xanthine oxidase.
Allopurinol inhibits this enzyme and is often used to prevent hyperuricemia
6-MP dose needs to be reduced when given concomitantly.
6-MP dose needs to be increased when given concomitantly.
Reduced activation (deletion of uridine kinase or uridine phosphorylase)
Increased catabolism (increased expression of acid and alkaline phosphatases)
Deficiency in N5-10-methynyl FH4 leading to decreased binding of FdUMP to TS
Decrease in target enzyme thymidylate synthase (increased binding affinity for
FdUMP)
Mechanisms of Imatinib mesylate (gleevec) action include all of the following except: (1
point)
a.
b.
c.
d.
Inhibits BCR-ABL
Promotes signal transduction in CML
Inhibits PDGFR
Inhibits c-kit
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Ms. Hutton
NAME:___________________________
13 POINTS
DATE: March 25th, 2010
13.
List two (2) characteristics associated with inherited susceptibility for cancer that you’d
look for when assessing a family history. (2 points)
14.
List two (2) situations in which DNA banking is a useful resource for a family. (2 points)
15.
True_____ False_____ Inherited susceptibility accounts for about 25-30% of most
common cancers, i.e. breast, colon, prostate. (1 point)
16.
True_____ False_____ Identification of a hereditary cancer syndrome in an
individual with cancer may impact their risk for recurrence. (1 point)
17.
True_____ False_____ Genetic testing for cancer susceptibility in children is only
appropriate if it will alter current medical management. (1 point)
18.
True_____ False_____ Hereditary risk for breast and ovarian cancer is only inherited
through the maternal side of the family. (1 point)
Matching: (1 point each/5 points total)
Cancer genetic syndromes often are associated with risk for more than one type of cancer. Thus,
more than one cancer syndrome may need to be considered in the differential diagnosis in an
individual/family. Match the cancer genetic syndrome (or genes) with the associated cancers or
features:
Cancer Genetic Syndrome [or genes]
Associated Cancers or Features
19.
_____ Familial Adenomatous Polyposis
a. Parathyroid, Pituitary, Pancreatic
20.
_____ Multiple Endocrine Neoplasia Type 1 b. Breast, Ovarian, Prostate
21.
_____ Von Hippel-Lindau
c. Colon Polyps, Colon Cancer, CHRPEs
22.
_____ BRCA1 and BRCA2
d. Breast, Thyroid, Endometrial
23.
_____ Cowden syndrome
Cancer, Pheochromocytomas,
hemangioblastomas
e. Renal
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Mhawech-Fauceglia
NAME:___________________________
13 POINTS
24.
DATE: March 25th, 2010
Which of the following disciplines are not handled by the clinical pathology lab? (1 point)
a.
b.
c.
d.
e.
25.
microbiology
hematology
cytology
a and b
all of the above
The Gleason grading system is used for which type of cancer? (1 point)
a.
b.
c.
d.
26.
endometrial cancer
prostate cancer
lung cancer
breast cancer
All these are characteristic cytologic features for malignancy except: (1 point)
a.
b.
c.
d.
e.
27.
nuclear contour
necrosis
prominent nucleoli
inflammation
b and d
Which of the following are not considered ancillary tools? (1 point)
a.
b.
c.
d.
e.
hematoxylin-eosin stain.
immunohistochemistry
cytogenetics
flow cytometry
both a and b
28.
What is the purpose of immunohistochemistry? (1 point)
a.
b.
c.
d.
e.
29.
defining the cell lineage
grading the tumor
prognostic factors
all of the above
a and b
What immunohistochemistry antibody do sarcomas never express? (1 point)
a.
b.
c.
d.
30.
vimentin
cytokeratin
both of the above
none of the above
A surgical pathology report should include all except: (1 point)
a.
b.
c.
d.
e.
f.
tumor size
tumor stage
tumor grade
resection margins
all of the above
b, c and c only
Match the corresponding (1 point each/ 3 points total)
Type
Tissue of Origin
31.
32.
33.
__________ fibrosarcoma
__________ adenocarcinoma
__________ acute lymphocytic leukemia
34.
True_____
35.
What is true about CK7 and CK20 immunohistochemistry? (1 point)
a.
b.
c.
d.
False_____
a. mesenchymal tumors
b. hematopoetic neoplasms
c. epithelial tumors
The definition of atypia always means cancer. (2 points)
they are useful as a panel to define the origin of cancer
Are rarely used in surgical pathology
Are used as prognostic factors
All of the above
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Lee
NAME:___________________________
12 POINTS
36.
DATE: March 25th, 2010
For many years, human clinical trials using vaccines against established cancers have been
called “unsuccessful” because they didn’t shrink the tumor (i.e. there were no responses).
All of a sudden, they are being called “successful” (for example, vaccines against prostate
cancer) – but they still don’t shrink tumors. Why are they now being regarded as
successful? Explain the underlying biology for this newfound success. (6 points)
37.
What are the essential components of an effective cancer vaccine? If it were the perfect
vaccine, how would it fulfill the 4 potential advantages of vaccine based therapy over
traditional cancer therapies (e.g. chemotherapy, radiation therapy)? (6 points)
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Brecher
NAME:___________________________
12 POINTS
38.
DATE: March 25th, 2010
The number of new pediatric cancer cases in the U.S. each year is approximately: (1 point)
a.
b.
c.
d.
39.
5,000
12,000
25,000
50,000
Approximately what percentage of childhood deaths in this country is a result of cancer? (1
point)
a.
b.
c.
d.
40.
1%
5%
10%
25%
Wilms tumor arises from the: (1 point)
a.
b.
c.
d.
41.
Brain
Liver
Kidney
Adrenal Gland
Sarcomas generally arise at the: (1 point)
a.
b.
c.
d.
Epithelium
Endothelium
Meseschyme
All germ layers
42.
True_____ False_____ Hyperdiploidy often confers a favorable prognosis in
childhood acute lymphoblastic leukemia: (1 point)
43.
Burkitts Lymphoma arises from: (1 point)
a.
b.
c.
d.
B lymphocyte
T lymphocyte
Natural killer cells
Dendritic cells
44.
True_____
point)
45.
The peak age for neuroblastoma is: (1 point)
a.
b.
c.
d.
46.
0 – 5 years
5 – 10 years
10 – 15 years
15 – 20 years
The t (11:22) is often found in: (1 point)
a.
b.
c.
d.
47.
Acute myeloid leukemia
Rhabdomyosarcoma
Osteogenic sarcoma
Ewings sarcoma
Bleomycin may cause damage to the: (1 point)
a.
b.
c.
d.
48.
Heart
Lungs
Liver
Kidneys
Auer Rods are seen in: (1 point)
a.
b.
c.
d.
49.
False_____ Brain tumors in children frequently present with seizures. (1
Acute Lymphocytic Leukemia
Acute Myeloid Leukemia
Lymphoblastic Lymphoma
Burkitts Lymphoma
True_____ False_____ Acute Myeloid Leukemia accounts for almost 80% of
childhood leukemias. (1 point)
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Jayaprakash
NAME:___________________________
12 POINTS
DATE: March 25th, 2010
The worldwide overall five-year relative survival rate from Oral Cancer is about: (1 point)
a.
b.
c.
d.
50%
20%
10%
79%
The most common histological type of Head and Neck Cancer is: (1 point)
a.
b.
c.
d.
Adenocarcinoma
Salivary gland carcinoma
Squamous cell carcinoma
Lymphoepithelial carcinoma
The virus that is considered a risk factor for nasopharyngeal carcinoma is: (1 point)
** in paper 3 very brief, but in stolers lectures
a.
b.
c.
d.
Human Papilloma Virus
Merkel cell polyomavirus
Human T-lymphotropic virus
Epstein-Barr virus
Which of the following lesions is NOT an oral premalignant lesion? (1 point)
a.
b.
c.
d.
Leukoplakia
Lichen planus
Hyperkeratosis
Erythroplakia
Which one of the following characteristics does NOT predict a greater risk of progression of
leukoplakias? (1 point)
a.
b.
c.
d.
If it is located in the floor of the mouth
Presence of nodular or red areas
Presence of epithelial dysplasia
Remains longer than 5 years
In the TNM classification system, what do T, N, and M stand for? (3 points)
The most common site of metastasis of Head and Neck Cancers is: (1 point)
a.
b.
c.
d.
Liver
Brain
Lung
Kidney
Most common site of oral cancer that accounts for 12% of all Head and Neck Carcinomas is: (1
point)
a.
b.
c.
d.
Buccal mucosa
Maxillary gingiva
Lip
Hard palate
The HPV strain commonly associated with oropharyngeal cancer is: (1 point)
a.
b.
c.
d.
HPV 5
HPV 16
HPV 27
HPV 1
Surgery, Radiotherapy and Chemotherapy (or a combination of these) are the available treatment
modalities for Head and Neck cancers. Factor(s) that influence the choice of treatment modality
for Head and Neck Cancers: (1 point)
a.
b.
c.
d.
e.
Site of the cancer
Stage of the cancer
General medical condition of the patient
All of the above
b&c
Possible questions to add in:
True_____
False_____
The US has the highest rates of HNSCC worldwide. (1 point)
True_____ False_____ The combined use of both alcohol and tobacco causes an increased
risk of Head & Neck cancer above that of either agent alone. (1 point)
True_____ False_____ The intensity and duration of tobacco use, but not alcohol use,
increases risk of head and neck cancer . (1 point)
True_____
point)
False_____
The majority of people who smoke will not go on to develop (1
((*question about alcohol and tobacco use…(prominent theme throughout papers) possibly a
short answer
- risk is related to both intensity and duration (for both)
-combined use increases the risk above that of either exposure alone
-If you smoke you WILL get H&N cancer (false, only a minority does)
* oral health (paper 1…poor oral health is associated with the risk of H&N cancer)
* incidence question, T/F it is #1 in incidence in US (F!) ))
ONCOLOGY FOR SCIENTISTS RPN 532
EXAM 2
Dr. Underwood
NAME:___________________________
12 POINTS
DATE: March 25th, 2010