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-
a.Assuming that mammography is "diagnostic"
b.Assuming that a radiographic lesion seen on mammography is the same as a
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
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-
94. In a patient with multiple enlarged lymph nodes, which should be
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
96. Which of the following is not a major example of inherited suscepti-
bility to cancer?
b.Familial polyposis coli
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-
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
c.Cerebral vascular accident
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-
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)
c.Physical therapy techniques
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
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
a.Head and neck 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
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
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-
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
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.