Soal neoplasia

soal laennya http://checool.blogspot.com/2010/04/soal-ukdi-tentang-neoplasia-dan.html

Sumber : Pathophysiology PreTest Self-Assessment and Review Second Edition (Maurice A.Mufson,M.D.,M.A.C.P.)

 

91. A 48-year-old white woman has what she believes is a suspicious lump

in her breast, but a mammogram does not reveal any suspicious lesions.

Truthful statements concerning potential pitfalls in management and diag-

nosis include

a.Assuming that mammography is "diagnostic"

b.Assuming that a radiographic lesion seen on mammography is the same as a

palpable lesion

c.Letting a negative or nonsuspicious mammogram influence the judgment of

whether a palpable mass needs to be biopsied

d.Assuming that a benign aspiration cytology is definitive

 

92. A 55-year-old man has lung cancer in the right middle lobe. Which

paraneoplastic syndrome is associated with GHRH secretion and lung

cancer?

a.Hypocalcemia

b.Hypocortisolemia

c.Hypophosphatemia

d.Acromegaly

e.Gynecomastia

 

93. A 30-year-old man has pain in the left scrotum. What is currently valid

concerning types of tumor?

a.Alpha fetoprotein (AFP) is only elevated in seminomas.

b.The half-life of AFP is 24 to 36 h.

c.Lactate dehydrogenase (LDH) is an important marker to follow tumor progres-

sion or regression.

d.Human chorionic gonadotropin-ß subunit (ß-hCG) is only elevated in semi-

noma.

 

94. In a patient with multiple enlarged lymph nodes, which should be

biopsied?

a.Groin nodes

b.Nodes in the axilla

c.Superficial cervical nodes

d.Periaortic lymph node with CT guidance

 

95. The etiology of chronic lymphocytic leukemia (CLL) is

a.Due to radiation

b.Due to a retrovirus

c.A familial disease

d.Unknown

 

96. Which of the following is not a major example of inherited suscepti-

bility to cancer?

a.Li-Fraumeni syndrome

b.Familial polyposis coli

c.Familial retinoblastosis

d.Peutz-Jeghers syndrome

 

97. A 22-year-old man comes to the emergency room of your hospital

because he has a diffuse, erythematous rash involving nearly all of his

body. His total WBC count is greater than 100,000 cells/mm . He also com-

plains of bone pain, severe irritability, weakness, fatigue, nausea and vom-

iting, constipation, photophobia, and polyuria. His electrocardiogram

(ECG) shows shortening of the QT interval, prolongation of the PR inter-

val, and nonspecific T wave changes. The most likely cause of his symp-

toms is

a.Hypercalcemia

b.Hypocalcemia

c.Hypophosphatemia

d.Hyperkalemia

 

98. A 45-year-old white man with a limited small cell lung cancer presents

to the emergency room of a local hospital and exhibits agitation and con-

fusion, ataxia, nystagmus, peripheral sensory loss, and generalized weak-

ness. The most likely etiology of this disorder is

a.Hypercalcemia

b.Paraneoplastic syndrome

c.Cerebral vascular accident

d.Myasthenia gravis

 

99. A 52-year-old white woman with breast cancer receiving adjuvant

therapy presents with back pain that intensifies on movement and pain

over the L1 vertebral body when she coughs and that radiates down her left

lower extremity to her leg and foot. The most likely etiology of this dis-

order is

a.Paraneoplastic disorder

b.Trauma to the lumbar disk

c.Muscular spasm of the intercostal muscles

d.Possible spinal cord compression

 

100. In the aforementioned patient, the most effective initial treatment is

a.Intravenous Decadron (dexamethasone)

b.Orthopedic consultation

c.Physical therapy techniques

d.Intravenous narcotics

 

101. A 66-year-old white woman with a known history of small cell lung

cancer comes to your office because of engorgement of her neck veins on

the right side and over her chest wall. She also has cyanosis of the extrem-

ities, facial edema, and difficulty with her mentation. Her diagnosis is most

likely

a.Congestive heart failure

b.Lymphatic obstruction of the upper body

c.Superior vena cava syndrome

d.Deep venous thrombosis

102. The multistep theory of carcinogenesis can be applied to what form

of cancer?

a.Head and neck cancer

b.Breast cancer

c.Lung cancer

d.Colorectal cancer

 

 

dan jawabannya adalah….

 

 

91. The answer is c. (Fauci, 14/e, p 363.)Any suspicious palpable mass

should be biopsied despite a negative mammogram. Negative mammo-

grams can occur in 10 to 15% of instances of a palpable breast mass.

 

92. The answer is d. (Fauci, 14/e, p 620.)Ectopic acromegaly is a para-

neoplastic endocrine disorder related to small cell lung cancer and secre-

tion of growth hormone–releasing hormone (GHRH). Hypercalcemia is a

paraneoplastic endocrine syndrome associated with non-small cell can-

cers which is caused by secretion of parathyroid hormone–related pep-

tides (PTHrP); hypercortisolism caused by ACTH release occurs with

small cell lung cancers, and cellular release of phosphorus causes hyper-

phosphatemia associated with lung cancer; gynecomastia caused by

human chorionic gonadotropin secretion (hCG) also occurs with lung

cancers.

 

93. The answer is c. (Fauci, 14/e, p 603.) LDH is an important marker

to follow in any germ cell tumor. AFP elevation is seen only in nonsemi-

noma, whereas ß-hCG is seen in both nonseminoma and seminoma. The

half-life of AFP is 5 to 7 days.

 

94. The answer is c. (Fauci, 14/e, pp 346 and 347.) Cervical nodes are

more likely to yield an etiology of disease than those in the axillae and

supraclavicular region. Nodes in the inguinal/femoral (groin) area much

less often provide diagnosis of disease because they often are nonspecifi-

cally enlarged because of repeated infections of the lower extremities.

 

95. The answer is d. (Fauci, 14/e, p 699.) Chronic lymphocytic

leukemia (CLL), a common chronic leukemia, has no known etiology.

B cell CLL is the most common chronic leukemia/lymphoma. Often

itpresents as an asymptomatic lymphocytosis in patients about 60

yearsold.

 

96. The answer is d. (Fauci, 14/e, p 513.)Li-Fraumeni syndrome, famil-

ial polyposis coli, and familial retinoblastosis are known genetic disorders

associated with familial malignancies. Peutz-Jeghers syndrome, a familial

disorder of multiple gastrointestinal polyps, rarely occurs as a familial can-

cer disorder.

 

97. The answer is a. (Fauci, 14/e, pp 618–619.) Hypercalcemia of

malignancy is the most common paraneoplastic syndrome. It accounts for

about 40% of all hypercalcemia. The signs and symptoms of hypercalcemia

include bone pain, irritability, weakness, fatigue, constipation, nausea, and

vomiting, as this patient manifests. Symptoms begin at a serum calcium of

about 2.6 mmol/L. Hypercalcemia of malignancy is common in cancers

with squamous cell histology.

 

98. The answer is b. (Fauci, 14/e, pp 618–622.)The paraneoplastic syn-

dromes include endocrine syndromes and hematologic syndromes. The

paraneoplastic endocrine syndromes include hypercalcemia of malig-

nancy, inappropriate vasopressin secretion (SIADH), Cushing's syndrome,

acromegaly, and gynecomastia. The paraneoplastic hematologic disorders

include erythrocytosis, granulocytosis, thrombocytosis, eosinophilia, and

thrombophlebitis.

 

99. The answer is d. (Fauci, 14/e, pp 628–629.) Any back pain in a

patient with a known history of carcinoma should be evaluated for the pos-

sibility of spinal cord compression. It occurs in 5 to 10% of patients with

cancer. Lung cancer is the most common primary malignancy causing

spinal cord compression. Localized back pain and tenderness are the most

common initial complaints.

 

100. The answer is a. (Fauci, 14/e, pp 628–629.)Intravenous Decadron

is the choice for initial treatment in this situation because it will decrease

swelling of the tumor mass. It may provide some relief of the compression

by reducing the edema. It should be given immediately on making the diagnosis.

 

101. The answer is c. (Fauci, 14/e, p 627.) The definitive diagnosis is

superior vena cava syndrome until proven otherwise with scans. It means

that the superior vena cava is obstructed. Ninety percent of these cases are due to malignant tumors such as carcinoma of the lung, lymphoma, and

various metastatic tumors. The findings described in this patient are not

due to the other diagnoses.

 

102. The answer is d. (Fauci, 14/e, p 517.) Colon cancer is one cancer

in which the multistep theory of carcinogenesis has been studied. In the

multistep theory, the cancer develops from multiple somatic mutational

steps that change normal epithelium to adenoma to carcinoma. An accu-

mulation of somatic mutations is necessary for cancer to develop.