TUESDAY, NOVEMBER 26, 1996
1. BE SURE TO FILL IN YOUR CORRECT ID NUMBER, LAST NAME, FIRST INITIAL AND MIDDLE INITIAL.
2. USE NO. 2 PENCIL ONLY - READ MARKING INSTRUCTIONS
ON TEST ANSWER FORM!!!
3. READ EACH QUESTION CAREFULLY. HOW IT IS ASKED
COULD BE AS IMPORTANT AS WHAT IS ASKED.
4. WRITE YOUR NAME AND BOX NUMBER ON YOUR PAPER.
INSTRUCTIONS: SELECT THE SINGLE BEST ANSWER FOR EACH QUESTION.
1. The most common malignancy of childhood is:
1. glioblastoma
2. lymphoma
3. leukemia
4. neuroblastoma
5. Wilm's tumor (nephroblastoma)
2. Childhood cancers differ from those in adults in all of the following ways EXCEPT:
1. Many childhood cancers are blastemal tumors (small round blue cell tumors).
2. Childhood malignancies may cytodifferentiate or undergo spontaneous regression.
3. Childhood cancers are frequently associated with specific chromosomal abnormalities.
4. Are almost never fatal due to improved multimodality therapeutic regimens.
5. Childhood cancers have characteristic age distributions, related to the type of tumor.
The following scenario applies to questions 3 and 4.
A 2 day old girl has a markedly enlarged abdomen. CT scan shows a mass involving the right adrenal and kidney, and a massively enlarged liver without discrete masses. Fine needle aspiration of the liver yields a small round blue cell tumor.
3. The most likely diagnosis is:
1. Wilm's tumor (nephroblastoma).
2. hepatoblastoma.
3. leukemia.
4. neuroblastoma.
5. adrenal cortical carcinoma with liver metastases.
4. Which chromosomal abnormality is associated with this tumor?
1. t(8;14)(q24;32)
2. t(11;22)(q24;q12)
3. N-myc amplification
4. 11p13 deletion
5. 13q14 point mutations
5. The single most important parameter for predicting the deposition efficiency of inhaled
fibrous and non-fibrous particles in the respiratory tract is their:
1. Gravimetric density
2. Aerodynamic diameter
3. Geometric diameter
4. Aspect ratio
5. Particle surface area
6. Particle volume
6. A smoker occupationally-exposed to asbestos fibers is more likely than a non-smoker to
develop:
1. Lung fibrosis
2. Pleural mesothelioma
3. Impairment of mucociliary clearance
4. Peritoneal mesothelioma
5. Bronchogenic carcinoma
7. Low doses of inhaled particles deposited in the alveolar region of humans are eliminated:
1. Within 24 hours via the mucociliary escalator
2. Slowly with a retention halftime of > 100 days
3. Not at all since they are translocated to the pulmonary interstitium
4. To the regional thoracic lymph nodes
8. Lung tumors induced in rats by high inhaled concentrations of non-fibrous particles
(e.g. carbon black: Ti02: talc) are mechanistically most likely caused by:
1. A direct genotoxic effect of particles after their uptake by target cells
2. Particle-induced loss of tumor suppressor genes of alveolar-epithelial target cells
3. Release of pro-inflammatory cytokines from alveolar macrophages
4. A secondary toxic particle effect mediated by oxidants released from inflammatory
cells
5. Oncogene activation by particles in alveolar-epithelial target cells
9. The highest mortality caused by cigarette smoking is due to:
1. Chronic obstructive pulmonary disease
2. Myocardial infarction
3. Lung cancer
4. Cerebral vascular lesions
10. Length and diameter of asbestos fibers are crucial determinants of their pathogenicity
in the lung. The concern that a glass fiber with similar dimensions - marketed as
replacement for asbestos - may be carcinogenic as asbestos has been lessened
particularly by one of the following arguments:
1. No lung tumors or fibrosis have developed in workers since the new fiber was
introduced 5 years ago.
2. Work place exposure concentrations are below the permissible occupational level.
3. The new fiber has a very low biopersistence in the lung.
4. Experimentally-exposed rats developed less pulmonary fibrosis than asbestos-
exposed rats.
11. A 55-year old male worker has been diagnosed with malignant pleural mesothelioma.
The likely cause for this disease is suspected to be previous occupational
asbestos exposure and this diagnosis can best be confirmed by demonstrating:
1. Hyperreactivity of the airways
2. TNFa increase in the worker's blood sample
3. Radiographic evidence of lung fibrosis
4. Ferruginous bodies in sputum and/or bronchial lavage
5. Decreased ventilatory lung function
6. Increase in inflammatory cells in bronchial lavage
12. Desmoplasia refers to:
1. Differentiation of the tumor
2. The change of one cell type to another
3. The host stromal response
4. Nuclear grade
13. A chondroma is a benign tumor comprised of:
1. Bone
2. Fibroblasts
3. Muscle
4. Cartilage
14. Sarcomas are malignant tumors arising from:
1. Glandular epithelium
2. Mesenchymal tissue
3. Bone only
4. Squamous epithelium
15. A woman has recently been diagnosed with a well-differentiated breast cancer.
Differentiation refers to:
1. The nuclear grade of the tumor.
2. The histologic subtype
3. The extent to which the tumor cells resemble normal cells.
4. The degree of anaplasia in the tumor
16. All of the following are features of anaplasia EXCEPT:
1. Mitotic activity
2. Lack of differentiation
3. Pleomorphism of nuclei
4. Hyperchromasia of nuclei
17. Benign tumors have all of the following characteristics EXCEPT:
1. Well-circumscribed mass
2. Slow growth
3. Destruction of surrounding tissue
4. Well-differentiated tumor cells
18. Features that characterize familial cancers include all of the following EXCEPT:
1. Early age at onset
2. Multiple tumors
3. Tumors in two or more close relatives
4. Expression of BRCA-1
19. Which of the following statements regarding cancer screening programs is correct?
1. The test should be easily implemented.
2. For the program to be effective, the disease must be of very high prevalence
in the population.
3. It is more important that the testing be specific rather than sensitive.
4. Cost of the program is irrelevant.
20. All of the following statements regarding the Papanicolaou screening program for cervical cancer are true EXCEPT:
1. Cervical cancer develops through a series of non-invasive precursor lesions.
2. Each Papanicolaou smear is approximately 90% sensitive for the detection of
abnormality.
3. Cervical cancer screening by the Papanicolaou smear method is inexpensive.
4. The Papanicolaou method is the most successful cancer screening program yet
devised.
5. The Papanicolaou method is widely accessible to the female population.
21. Which of the following statements regarding cervical cancer is CORRECT:
1. 90% of all cervical dysplasias will progress to invasive cancer if untreated.
2. Cervical squamous cancer is associated with infection by human papillomavirus
in a minority of cases.
3. Cervical cancer mortality is the highest of any gynecologic malignancy.
4. Cells of adenocarcinoma of the cervix often contain Human papillomavirus DNA.
5. Cervical dysplasia is difficult to treat effectively.
22. A 35 year old female enters your office complaining of an enlarging nodule in the left cheek. She reports that it is non-painful and that it has been steadily growing for
the past ten (10) weeks. Based on your examination of the patient, you are concerned
about a salivary gland neoplastic lesion. Which of the following would be the MOST
cost-effective manner to confirm your diagnostic impression, AND to provide proper
classification of any disease process present:
1. Send the patient to a surgeon to perform an open biopsy.
2. Aspirate the specimen in your office and send the slides to the cytopathology
laboratory for interpretation.
3. Refer the patient to a medical oncologist who will orchestrate the workup.
4. Watch the patient's nodule to see if it persists.
5. Order radiologic studies to evaluate the extent of the disease process.
23. Typical turnaround time for a diagnosis on a fine needle aspiration biopsy specimen
would be in which of the following ranges:
1. 1 - 2 hours
2. 1 day
3. 3 days
4. 1 week
5. 1 month
24. Which of the following cytologic features is most likely to indicate the neoplastic
biologic potential of a cell:
1. Nuclear configuration (size, shape, N:C ratio)
2. Cytoplasmic configuration (size, shape)
3. Cytoplasmic color
4. Presence of nucleolus
5. Presence of cytoplasmic vacuolizations
25. Which of the following statements regarding fine needle aspiration cytology is CORRECT:
1. Fine needle aspiration is always performed under radiologic guidance.
2. Retroperitoneal organs such as kidney are not amenable to the technique.
3. Complications such as acute hemorrhage are frequent.
4. The procedure is more cost effective than a surgical biopsy.
5. The specificity of the procedure is low (<70%).
26. Studies of oncogene and tumor suppressor gene products and the role they play in neoplastic transformation have shown that:
1. These proteins are primarily involved in cell signaling and cell cycle progress pathways .
2. These proteins are primarily introduced into cells through viral infection.
3. Most cells do not require these proteins and that is why their expression causes disease.
27. In the retroviral model for oncogene activation, deregulation of protein function occurs through:
1. Viral early gene products binding to and inactivating host cell cycle regulatory proteins.
2. Viral integration into host cell genes causing mutation of important functional parts of proto oncogenes.
3. Over expression of proto oncogene products due to the high level of transcriptional activity signaled from LTRs.
4. Amplification of proto oncogenes within the host cell chromosomes.
5. Both 2 and 3 could be correct.
28. Complete the following sentence. Signal transduction through ras can lead to the hydrolysis of inositol triphosphate which will lead to:
1. a cascade of tyrosine kinase-dependent phosphorylations.
2. activation of phospholipase C.
3. the release of two secondary messengers, diacylglycerol and inositol triphosphate.
4. a transient release of calcium from the endoplasmic reticulum.
5. 3 and 4 could complete the sentence.
29. Covalent interactions of proto oncogene proteins with fatty acids and farnesyl is thought to be mechanistically important because:
1. it makes proteins more hydrophobic and enables them to pass between membrane compartments within the cell.
2. it permits reversible protein dimer formation in signal transduction pathways.
3. it enables proteins to localize and function at membrane surfaces.
4. it prevents attenuation in cell signaling pathways by reducing protein degradation rates.
30. The progression of cancer from normal tissue to metastatic cells is:
1. typically attributable to the activation of a single oncogene.
2. typically going to involve alterations in the structure and function of multiple genes.
3. typically attributable to the loss of an allele for a tumor suppressor gene.
4. typically seen as mutations within genes coding for the differentiated phenotype.
31. It is frequently said that neoplastic transformation requires that multiple gene functions become deregulated. This statement is supported by which of the following observations?
1. benign neoplasias rarely have the same chromosomal abnormalities seen in metastatic disease.
2. chromosomal abnormalities in neoplasias only occur in the regions encoding oncogenes.
3. many neoplasias have a characteristic chromosomal abnormality which is diagnostic for the disease.
4. cell growth and differentiation are controlled at multiple cellular levels by both proto oncogene and tumor suppresser gene products.
5. the statement is supported by 1 and 2.
32. Select one of the choices below for the set of four terms or phrases whose order from left to right best fill in the blanks in the following sentence:
Activation of can result in an increase in _______ activity which will in turn activate _____________following the _______.
1. ras/phospholipase C/protein kinase C/release of calcium
2. src/tyrosine kinase/cell shape changes/release of actin bundles from adhesion plaques
3. c-erb B/tyrosine kinase/other kinases/internalization of erb B
4. 1, 2 and 3 all could be choices.
33. In the examples we discussed of oncogenes, situations can arise wherein:
1. cells completely lose hormone receptors and become transformed.
2. over-expression of peptide hormones can deregulate autocrine stimulation of
cellular growth.
3. these proteins are rarely found on the interior of the plasma membrane of
non transformed cells.
34. A silica granuloma is characterized by:
1. Collagen fibers
2. Large numbers of cells
3. An absence of giant cells
4. Both T and B cells
35. Pleural plaques have the following characteristics EXCEPT:
1. Bilateral and symmetric
2. Found on the membranous diaphragm
3. Predominantly on the visceral surface
4. Progress and calcify with time
36. Asbestos-induced lung disease includes:
1. Pulmonary lymphoma
2. Pulmonary granuloma
3. Interstitial fibrosis
4. Pulmonary sarcoma
37. Hypersensitivity pneumonitis is characterized by:
1. Immunologic reaction to organic dusts
2. Granulomas/interstitial/alveolar process
3. Local production of IgM
4. All of the above
38. All of the following are complications of silicosis EXCEPT:
1. Lung cancer
2. Tuberculosis
3. Rheumatoid disease
4. Pneumonia
39. Occupational asthma is characterized by:
1. Irreversibility
2. IgM antibodies
3. Response to low and high molecular weight compounds
4. Decreasing frequency in the population
40. Mechanisms of toxicity from inhaled gases include:
1. Simple asphyxia
2. Systemic uptake with no pulmonary toxicity
3. Tissue asphyxia
4. Direct cellular injury
5. All of the above
41. Regarding death certification, which of the following statements is TRUE?
1. New York State Health Department has announced the intention of moving towards
a system of electronic death certification with the next several years.
2. The death certificate should be filled out with great caution because it is legally
binding in disputes with insurance companies.
3. If a psychotic person kills him/herself because, according to a note found at the scene,
"demons compelled me to do this", the death certificate should not reflect suicide as
manner of death because in this situation true suicidal intent cannot be inferred.
4. If an injury sustained over 25 years ago results in death due to medical complications,
the "statute of limitations" has been exceeded, and it won't be strictly necessary to
infrom the Medical Examiner.
5. All of the above are laughable notions and manifestly FALSE.
42. Concerning asphyxial deaths, which of the following statements is TRUE?
1. Facial and subconjunctival petechial hemorrhages are a common but neither invariable nor pathognomonic finding in manual and ligature strangulation.
2. A carbon monoxide (Carboxyhemoglobin) saturation of 35% from which a healthy
individual would probably recover after temporary disability may be fatal in the
presence of a blood alcohol concentration of 0.25 gms per 100 ml.
3. Carbon dioxide may cause asphyxia by excluding oxygen but this cannot be
established by measuring blood gases post mortem.
4. Most victims of auto-erotic asphyxial deaths are best certified as ACCIDENTAL in
manner.
5. All of the above are TRUE.
43. Regarding gunshot wounds, which of the following statements is FALSE?
1. Exit wounds are usually larger in diameter than entrance wounds which are fired
from a distance and which do not strike intermediary targets.
2. In evaluating close to intermediate entrance wounds, the presence of soot and/or
powder stippling are important indicators of muzzle to target distance and can help
determine the range of fire.
3. The diameter of a rounded skin entrance defect with its typical marginal abrasion
establishes the caliber of the penetrating projectile.
4. All of the above are FALSE.
5. All of the above are TRUE.
44. Regarding vitreous humor, which of the following statements is FALSE?
1. It is a clear fluid which can usually be easily aspirated post mortem.
2. Vitreous (K+) decreases post mortem and this can be helpful in assessing the post mortem interval.
3. Vitreous electrolyte studies can be helpful in assessing any clinically significant
degree of dehydration that obtained at the time of death.
4. Vitreous glucose and acetone levels should be significantly elevated if death was
caused by diabetic ketoacidosis.
5. All of the above are TRUE.
45. Which of the following does NOT correlate reasonably with the value 0.15?
1. Typical percentage of live births which in many parts of the US go on to die of
S.I.D.S.?
2. Approximate peak level of blood ethanol in gms per deciliter in average size male
who consumes 6 to 8 12 oz. cans of beer?
3. Decrease in alcohol concentration in the blood in milligrams per deciliter per hour
after absorption in a living individual with little tolerance to ethanol?
4. None ot the above is reasonable.
5. All of the above are reasonable.
46. The single most diagnostic feature of a malignant tumor is:
1. The presence of metastases
2. Local infiltration
3. High mitotic rate
4. Cellular pleomorphism
47. The TNM system is a method for assessing tumor:
1. Grade
2. Stage
3. Necrosis
4. Differentiation
48. All of the following are cytologic features of a malignant tumor EXCEPT:
1. Hyperchromasia
2. Pleomorphism
3. Low nuclear/cytoplasmic ratio
4. Abnormal mitotic figures
49. Dysplasia is best defined as:
1. A precancerous change
2. An irreversible process leading to invasive cancer
3. A change in tissue type
4. All of the above
50. A sarcoma usually metastasizes via:
1. the blood stream
2. the lymphatic system
3. perineural invasion
4. peritoneal metastases
51. Gleason's system for grading prostate cancer is:
1. A cytologic grading system
2. An architectural grading system
3. A secretory product based system
4. None of the above
52. Benign neoplasms:
1. are all pre-malignant
2. are never pre-malignant
3. are sometimes pre-malignant
4. none of the above
53. Which of these disorders has little evidence for a strong genetic component?
1. Ankylosing spondylitis
2. Arthritis secondary to Yersinia or Salmonella bacterial infection.
3. Insulin-dependent diabetes mellitus
4. Lupus erythematosis and lupus-like diseases in mouse and man
5. None of the above
54. Which three typical clinical features are commonly found in both systemic lupus erythematosis (SLE) and serum sickness?
1. Skin rash, liver disease, arthritis
2. Pulmonary disease
3. Renal disease, arthritis, fibrosis in skin
4. Skin rash, arthritis, renal disease
55. Which of these statements regarding rheumatoid arthritis (RA) is most accurate?
1. Rheumatoid factor production is quite specific for RA.
2. Joint inflammation is severe, but fibrosis does not affect the joint due to inhibition of
fibrogenesis by protoglycans in the joint fluid.
3. Rheumatoid arthritis is an autoimmune disease restricted to the joints.
4. The diagnosis of RA is based on a constellation of clinical symptoms and
laboratory data.
56. Anti-nuclear antibodies...
1. are specific for SLE (systemic lupus).
2. may react with DNA itself or nuclear proteins.
3. are never found in normal individuals.
4. are not specific for a particular autoimmune disease, but when present, indicate the
presence of a pathologic autoimmune process.
57. Which of these explanations for HLA-B27 related autoimmune disease is the least
convincing possibility in light of current knowledge?
1. HLA-B27 shares epitopes with sacroiliac joint associated proteins and therefore
predisposes to an anti-self reactivity.
2. Arthritis in response to several bacterial infections suggests possible role of cross-
reactivity of self proteins with bacterial antigens.
3. HLA-B27 is associated with ankylosing spondylitis, but another inciting event
appears to be required to initiate clinical disease.
4. Most HLA-B27 positive individuals do not show symptoms of ankylosing
spondylitis.
58. Which of these statements regarding rheumatic fever is most accurate in light of current
knowledge?
1. Streptococcal infection is sometimes seen in these patients, but is not typically
present before the onset of symptoms.
2. The cardiac disease associated with rheumatic fever is acute and either results in
rapid cardiac failure or complete recovery.
3. Streptococcal antigens may induce an immune response which causes certain
normally present autoreactive T cells to recognize cross-reacting heart antigens
which they had previously "ignored."
4. T cells with potential anti-heart specificity should not enter the circulation because
of negative selection in the thymus, so that presence of these cells in the circulation
indicates a defect in tolerance.
59. In which of these immunopathologic events would one anticipate that complement
activation probably plays the least direct role?
1. airway obstruction minutes after a bee sting
2. lupus erythematosis
3. skin rash secondary to treatment with horse anti-human lymphocyte globulin
4. renal failure and shock following transfusion of type A blood to a type O patient
60. Which of these immunopathologic disorders is primarily characterized by abnormally
increased growth of the parenchymal (organ specific) cells in the affected tissues?
1. Hashimoto's thyroiditis
2. insulin-dependent diabetes mellitus
3. progressive systemic sclerosis
4. Graves disease
61. In a contact sensitivity reaction to poison ivy (rhus), what happens first?
1. Monocytes become activated by direct contact with rhus oils.
2. Rhus specific IgM forms immune complexes in the skin, which attract neutrophils
to dermal vessels and epidermis.
3. T cells bearing antigen receptors specific for rhus antigens are activated by contact
with antigen presented in antigen presenting cells in the skin.
4. Blood monocytes are recruited to the skin by cytokines released by T cells.
62. Which of these features is most likely to be shared by immunopathologic reactions in
progressive systemic sclerosis (scleroderma) and chronic renal transplant rejection?
1. Primarily antibody mediated responses.
2. Prominent anti-nuclear antibody response, particularly with specific antibody to
chromosome centromeres.
3. Dense lymphocyte and monocyte infiltration involving particularly small vessels.
4. Chronic overexpression of fibrogenic growth factors.
For the following malformations, choose the mechanism of malformation from the list provided:
1. Failure of anlage (primordium) to form
2. Failure to differentiate
3. Failure to involute
4. Failure to fuse
5. Failure to migrate properly
6. This isn't a malformation, it's a disruption
7. This isn't a malformation, it's a deformation
63. Cleft lip and palate in Trisomy 13 - 4
64. Cleft lip and palate after fetal Thalidomide exposure - 6
65. Imperforate anus in VATER association - 3
66. Cryptorchidism (undescended testes) - 5
67. Club foot in Oligohydramnios sequence - 7
68. Syndactyly (fused fingers) after amniotic band entanglement - 6
69. Absent spleen in Asplenia syndrome - 1
70. Multicystic renal dysplasia in Meckel-Gruber syndrome - 2
For each of the following questions choose the best answer.
71. Which of the following groups of tissues are arranged according to decreasing radiosensitivity?
1. lymphoid tissue, bone, brain
2. lymphoid tissue, heart, gastrointestinal epithelium
3. gastrointestinal epithelium, heart, lymphoid tissue
4. brain, bone, lymphoid tissue
5. brain, lymphoid tissue, heart
72. One to two weeks after a single large dose of irradiation to the hands, each of the following histologic changes would be expected except:
1. endothelial swelling
2. abnormal collagen fibrils
3. vascular congestion and edema
4. precancerous changes in the epidermis
5. sparse numbers of inflammatory cells
73. In general, which of the following types of cancer is most radiosensitive?
1. astrocytoma
2. adenocarcinoma
3. lymphoma
4. osteogenic sarcoma
5. squamous cell carcinoma
74. Which occurs months to years after therapeutic irradiation of a pelvic cancer?
1. diarrhea due to necrosis of small intestine mucosa
2. extensive fibrosis of colonic wall
3. both
4. neither
75. With a lethal dose of 300 cGy (300 rad) of whole-body irradiation, death is mainly the result of injury to the:
1. brain
2. small intestine
3. bone marrow
4. lung
5. heart
76. Tissues that are considered radioresistant include:
1. epidermis
2. liver
3. both
4. neither
77. Which microscopic features are attributable to radiation?
1. fibrosis with atrophy of parenchymal cells
2. abnormal mitotic figures and nuclear atypia
3. both
4. neither
78. The most nearly constant reaction to a sublethal dose of whole-body irradiation is:
1. acute brain syndrome
2. disseminated intravascular coagulation
3. lymphopenia
4. respiratory distress syndrome
5. skin burns
79. Total body irradiation in the range of the gastrointestinal syndrome causes:
1. leukocytopenia
2. mitotic arrest in crypts of Lieberkuhn
3. denudation of the intestinal mucosa
4. electrolyte imbalance
5. all of the above
80. Cells which are radioresistant are:
1. vegetative intermitotic and differentiating intermitotic cells
2. vegetative intermitotic and reverting postmitotic cells
3. vegetative intermitotic and fixed postmitotic cells
4. differentiating intermitotic and reverting postmitotic cells
5. differentiating intermitotic fixed postmitotic cells
6. reverting postmitotic and fixed postmitotic cells
81. Radiation is thought to induce neoplasia by:
1. releasing carcinogens from normal tissue
2. altering cell membranes causing decreased cohesiveness
3. interacting with DNA causing mutations
4. destroying specific antineoplastic intracellular enzymes
5. decreasing the immunologic "tumor surveillance" mechanism
82. The chronic effects of therapeutic radiation on bowel are predominantly due to changes in the:
1. crypt epithelium
2. mesothelium
3. muscularis
4. surface epithelium
5. microcirculation
83. One Gray (absorbed dose) of alpha particles equals a larger number of Seiverts (equivalent dose) than one Gray of Xrays because:
1. Alpha particles penetrate tissue more deeply
2. Alpha particles have higher linear energy transfer
3. Alpha particles act by causing indirect ionization
4. Alpha particles have higher velocity
5. Alpha particles cause more ionization in air (Roentgens)
84. Which type of malignancy was most often seen in atomic bomb irradiation survivors?
1. glioma
2. leukemia
3. adenocarcinoma of breast
4. osteogenic sarcoma
5. squamous cell carcinoma of skin
6. thyroid carcinoma
85. A forty-five year old Vietnamese male has recently immigrated to the U.S. He has a heavy smoking and drinking history, and has worked in a dye factory. He presents with abdominal distension and ascites. A chest radiograph shows clear lungs except for a right hilar mass. Liver ultrasound shows multiple masses. Liver biopsy is diagnosed as squamous cell carcinoma. The most likely etiology for this would be:
1. aflatoxin B1 from contaminated peanuts
2. cigarette smoke
3. ethanol
4. azo dye exposure
5. asbestos exposure
86. In the patient from the previous question, tumor initiation was most likely caused:
1. By direct reaction of a nucleophilic (acidic) carcinogen with DNA.
2. By direct reaction of an electrophilic (basic) carcinogen with DNA.
3. By metabolic activation of the carcinogen to a nucleophilic (acidic) ultimate carcinogen with reaction with DNA.
4. By metabolic activation of the carcinogen to an electrophilic (basis) ultimate carcinogen with reaction with DNA.
87. The process of carcinogenesis is characterized by which of the following statements?
1. somatic mutation is produced by the carcinogen
2. t issue proliferation must ensue, usually induced by a tumor promoter
3. the type of cancer produced depends on the mode of administration of the carcinogen
4. susceptibility to carcinogens is species dependent
5. all of the above
88. Specific chemical carcinogens have been implicated in all of the following except:
1. hepatic angiosarcoma
2. hepatocellular carcinoma
3. transitional carcinoma of the bladder
4. basal cell carcinoma of the skin
5. squamous cell carcinoma of the lung
89. A promoter differs from a carcinogen in that it:
1. will not induce cancer by itself
2. is mutagenic
3. binds to DNA
4. requires metabolic activation
90. Benzo(a) pyrene:
1. Is a major carcinogen in aniline dyes
2. Is a major carcinogen in cigarette smoke
3. Is a major carcinogen in betel nut juice
4. Is a major carcinogen in spoiled peanuts
5. Is a major carcinogen in asbestos
6. Is not a carcinogen
Kodachrome questions
91. A 35 year old man presents with a lump in his neck. A biopsy reveals a lymph node containing this tissue. His past medical history is likely to reveal:
1. Heavy smoking
2. Heavy drinking
3. Head and neck irradiation
4. Aggressive suntanning
5. Multiple skin tumors
Questions 92 and 93 refer to the same patient -
92. A 75 year old man complains of feeling weak. He is found to be anemic and his stool is guaiac positive. This cecal lesion was resected. With this information, his symptoms are most likely related to:
1. Bowel obstruction with decreased iron absorption
2. Hepatic metastases with decreased heme synthesis
3. Hepatic metastases with decreased bile acid synthesis
4. Tumor ulceration with malabsorption
5. Tumor ulceration with blood loss
93. He dies and autopsy is performed. This is the gross appearance of his liver. With this additional information, his symptoms were most likely related to:
1. Bowel obstruction with decreased iron absorption
2. Hepatic metastases with decreased heme synthesis
3. Hepatic metastases with decreased bile acid synthesis
4. Tumor ulceration with malabsorption
5. Tumor ulceration with blood loss
94. A 21 year old man presents with shortness of breath. He has the skin lesions shown. All of the following are likely diagnoses to consider except:
1. Mitral endocarditis
2. Pulmonary talc granulomas
3. Pneumcystis carinii pneumonia
4. Hepatitis
95. A 2 month old infant is brought in comatose and dies. He has no bruises or external markings. The parents state that he rolled off of the couch onto the floor. Autopsy reveals the lesion shown. To confirm your diagnosis you would also look for:
1. Pulmonary petechiae
2. Conjunctival petechiae
3. Retinal hemorrhages
4. Hepatic lacerations
5. Renal hematomas
Questions 96 and 97 apply to the same patient -
96. This 3 year old girl has abnormal facial appearence, short stature, hepatosplenomegaly, and developmental delays. To differentiate between the most likely conditions you want to measure serum levels of all of the following except:
1. chondroitin sulfate
2. heparan sulfate
3. dermatan sulfate
4. aminoglycin sulfate
5. keratan sulfate
97. This is what an electron micrograph of her chondrocytes would look like. The multiple spaces represent:
1. dilated mitochondria
2. dilated endoplasmic reticulum
3. dilated Golgi apparatus
4. dilated lysosomes
5. dilated peroxisomes
98. Which of the following is NOT a feature of the tumor shown in this slide?
1. Association with aniridia.
2. Deletions/mutations of 11p13 and 11p15.5.
3. Triphasic histologic appearance.
4. Association with genital anomalies.
5. Peak age in the second decade.
99. Which statement about the tumor shown in this slide is correct?
1. Most tumors are first detected after age 5.
2. Familial variants of this tumor are associated with second malignancies, especially osteosarcomas.
3. Familial variants of this tumor have two somatic mutations of a gene on
chromosome 13q14.
4. Sporadic variants of this tumor are associated with a germline mutation of a
gene on chromosome 1p.
5. Histologically, these tumors are composed of small round blue cells with
Homer-Wright pseudorosettes.
100. A 16 year old girl presents with left hip pain. Physical examination reveals a palpable mass antero-laterally. Ct and MRI show a 15 cm mass involving the ischium with cortical erosion and extension into the adjacent soft tissues. A CT guided core biopsy of the mass yields the small round blue cell tumor shown in this slide.
Which chromosomal abnormality is characteristic of this tumor?
1. t(8;14)(q24;32)
2. t(11;22)(q24;q12)
3. N-myc amplification
4. 11p13 deletion
5. 13q14 point mutations
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