Interview Questions.

Question 1. What Percentage Of All Breast Cancer Cases Is Related To Genetic Susceptibility?

Answer :

Genetic susceptibility to breast cancer money owed for about 25% of all breast cancer instances. In familial breast cancer, mutations in the BRCA1, BRCA2, CHEK2, TP53, and PTEN genes account for about 5% to ten% of breast and ovarian cancer instances normal. The occurrence of BRCA1 or BRCA2 mutations varies considerably among ethnic groups and geographical areas. In North America, 1 in every three hundred to 500 humans is anticipated to harbor BRCA germline mutations.

Question 2. Scenario: A sixty eight-yr-vintage Woman With A History Of Heavy Tobacco Use Is Found To Have A Solitary Lung Nodule On Chest Computed Tomography. Pathology From A Recent Bronchoscopy Reveals Adenocarcinoma. What Further Staging Work-up Is Necessary For This Patient Before Surgical Resection?

Answer :

FDG([18F]2-Fluoro-2-deoxy-glucose)-PET for baseline locoregional staging is now part of the usual work-up for non-small mobile lung cancer (NSCLC). The genuine energy of this take a look at for the mediastinum is its negative predictive price (NPV) whilst FDG uptake within the number one tumor is enough and a imperative tumor or essential hilar lymph node disease is absent. Two properly-designed, prospective research confirmed the high NPV (98%) of the mediastinum of sufferers with resectable NSCLC and that extensively fewer invasive tests (ie, mediastinoscopy) have been required inside the PET institution than inside the traditional work-up organization.

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Question 3. A 55-year-vintage Woman Recently Completed Induction Chemotherapy For Acute Myelogenous Leukemia (aml) With Evidence Of Complete Remission On Bone Marrow Biopsy. She Subsequently Was Found To Have A Platelet Count Of 25,000/microliter With No Clinical Evidence Of Bleeding. Is A Platelet Transfusion Necessary At This Time?

Answer :

No, Bleeding complications occur more regularly as the severity of thrombocytopenia increases, but handiest after the platelet be counted crosses a threshold of about 10 to 30 x 103. A regular platelet remember is not required to assist hemostasis. Clinically essential spontaneous bleeding does not arise unless the platelet depend is very low or other issues are present. In a study carried out at the National Cancer Institute to evaluate the danger for bleeding in sufferers with thrombocytopenia, the investigators were no longer capable of determine a threshold under which platelets should have prophylactic transfusion. However, following this observe prophylactic transfusion have become common practice for sufferers with a platelet be counted below 20 x 103. Several subsequent randomized research confirmed that using a platelet matter < 10 x 103 because the cause for prophylactic transfusion did not growth the danger for bleeding.

Question four. Obesity Is A Risk Factor For Which Types Of Cancer?

Answer :

Excess frame weight is turning into increasingly identified as an crucial chance component for most cancers. Renehan and colleagues conducted a scientific evaluate and meta-analysis of 141 articles that blanketed 282,137 instances of most cancers. Using data from those studies, they calculated the effect of gaining weight that was equivalent to an boom of five kg/m2 in body mass index (BMI). Such a weight benefit doubles the threat for esophageal adenocarcinoma in both sexes (relative risk [RR], 1.52; P < .0001). In ladies, it additionally slightly more than doubles the hazard for endometrial most cancers (RR, 1.59; P < .0001) and increases risk for renal cancer by about a 3rd (RR, 1.34; P < .0001).

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Question 5. Which Of The Following Is Not Among The Uses Of Pet Imaging In The Management Of Cervical Cancer?

Answer :

The use of functional imaging techniques, such as FDG-PET and PET-CT, to manage patients with cervical cancer is constantly increasing. Current roles include pretreatment staging and diagnosis of recurrent disease. Reports have also shown ability to predict survival based on pre- and posttherapy scans. Cervical cancer spreads primarily through direct extension, although lymphatic and hematogenous spread can result in distant metastases. Traditionally, clinical examination and cross-projectional imaging have been used to stage cervical cancer but are accurate in only 60% of cases. Detection of lymphatic metastases seems to be more successful with functional imaging techniques, such as FDG-PET or PET-CT.

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Question 6. A 63-year-old Man With A Remote History Of Tobacco Use Presents With Hematuria. He Undergoes A Transurethral Resection (tur), Which Reveals T1 Superficial Bladder Cancer. What Is His Risk For Bladder Cancer Recurrence In The Next 5 Years Without Further Therapy?

Answer :

TUR remains the surgical mainstay for the diagnosis and treatment of stages Ta and T1 bladder cancer. After this procedure, the 10-year disease-specific survival for Ta tumors is 85% and for T1 tumors it is 70%. The initial TUR provides pathologic material to determine the histologic type, grade, and depth of invasion. The findings help to direct additional therapy, dictate the follow-up schedule, and indicate prognosis. In a literature review of more than 600 cases of T1 bladder tumors treated only by TUR, 75% to 90% recurred by 5- and 10-year follow-up. A third of the cancers progressed to muscle invasion within 5 years, 39% had progressed by 10 years, and 53% by 15 years.

Question 7. A 35-year-old Woman Presents With Cervical Lymphadenopathy And Symptoms Of Fever, Night Sweats, And Weight Loss. An Excisional Biopsy Of A Supraclavicular Lymph Node Reveals Nodular Sclerosing Hodgkin's Lymphoma. Staging Pet-ct Shows Bulky Mediastinal Lymphadenopathy (mediastinal/thoracic Ratio > 1/three), And She Has A Baseline Erythrocyte Sedimentation Rate (esr) Of 50 Mm/h. What Favorable Prognostic Feature Does This Patient Have For Early-stage Hodgkin's Lymphoma?

Answer :

TUR stays the surgical mainstay for the diagnosis and remedy of tiers Ta and T1 bladder most cancers. After this method, the 10-yr ailment-unique survival for Ta tumors is 85% and for T1 tumors it's miles 70%. The initial TUR presents pathologic material to decide the histologic type, grade, and intensity of invasion. The findings assist to direct extra therapy, dictate the comply with-up schedule, and indicate diagnosis. In a literature evaluation of extra than 600 instances of T1 bladder tumors dealt with most effective by using TUR, 75% to 90% recurred by using 5- and 10-12 months follow-up. A 0.33 of the cancers improved to muscle invasion within five years, 39% had progressed via 10 years, and 53% by using 15 years.

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Question 8. Temozolomide Has Emerged As An Agent That Is Active Against Glioblastoma Multiforme (gbm). What Is The Mechanism Of Action Of This Chemotherapeutic Drug?

Answer :

Temozolomide (TMZ) is an orally administered alkylating agent of the imidazotetrazine magnificence this is chemically related to dacarbazine. It is unexpectedly and completely absorbed and passes through the blood-mind barrier, growing cerebrospinal fluid concentrations that are 20% to 40% of plasma tiers. The DNA restore protein MGMT gets rid of alkyl businesses from the O6 function of guanine, a target of alkylating agents, which include TMZ. In tumors, high expression of MGMT has been associated with resistance to remedy with alkylating agents. Inactivation of the MGMT gene by promoter methylation diminishes DNA repair interest and has been associated with longer basic survival in sufferers with GBM who are dealt with with alkylating agents.

Question 9. Treatment Options For Stage I Nonseminomatous Germ Cell Tumor (nsgct) Include All Of The Following, Except:

Answer :

Surveillance is preferred by way of many medical doctors and sufferers because the huge majority of patients may be cured after they relapse. However, a hit surveillance requires strict compliance on behalf of each physician and patient. RPLND is the most accurate manner to level sufferers, and cure rates in expert fingers approach a hundred%, however it's miles related to probably substantial morbidity. Chemotherapy, typically with 2 cycles of bleomycin, etoposide, and cisplatin, is likewise related to an wonderful outcome, however there are worries regarding longer-time period toxicities, such as infertility and 2nd cancers. High-dose chemotherapy with autologous stem mobile guide is possible and doubtlessly treatment plans a share of sufferers with resistant sickness. However, statistics on this treatment as preliminary therapy for better-risk patients are scarce.

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Question 10. The Primary Treatment For Locoregionally Advanced Head And Neck Cancer Consists Of:

Answer :

Historically, locoregionally advanced head and neck cancer (HNC) turned into treated with surgical treatment (without or with adjuvant radiotherapy) or radiotherapy on my own. Only a minority of sufferers with locoregionally superior disorder can go through ok surgical resection, however, and the outcomes had been terrible with recognize to survival and organ renovation. Furthermore, radiotherapy alone is not enough to efficaciously deal with most HNC at intermediate or advanced stages. Recently, chemoradiotherapy changed into shown to markedly improve survival and organ preservation.

Question eleven. Which Of The Following Targeted Agents Is Not A Tyrosine Kinase Inhibitor That Influences The Human Epidermal Growth Factor Receptor (her) Family Signaling Pathway By Binding To The Intracellular Domain Of The Receptors?

Answer :

Tyrosine kinase inhibitors, which include gefitinib and erlotinib (HER1 inhibitors) and lapatinib (a HER1/HER2 inhibitor), influence the signaling pathway by interacting with the intracellular domain of the receptors of HER1 and HER2. Trastuzumab is a humanized monoclonal antibody that goals the extracellular area of the HER2 receptor to save you dimerization with other HER family members and next downstream signaling activities.

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Question 12. Standard Treatment For Locally Advanced Epithelial Ovarian Cancer Includes All Of The Following, Except:

Answer :

Surgery and wellknown intravenous chemotherapy with a platinum-taxane mixture result in entire remission in most sufferers with newly identified ovarian most cancers. However, maximum sufferers sooner or later relapse and die from their disease. Interest is growing in the intraperitoneal delivery of chemotherapy to patients with ovarian most cancers who have minimum residual ailment following initial cytoreductive surgical treatment. Three randomized trials confirmed an improvement in overall survival with intraperitoneal cisplatin compared with intravenous chemotherapy by myself.

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Question thirteen. A 57-yr-antique, Obese White Man Has Symptoms Of Chronic Gastroesophageal Reflux Disease (gerd). Endoscopic Evaluation Reveals Evidence Of Barrett's Esophagus With High-grade Dysplasia. What Is The Recommended Management For This Disease?

Answer :

The American College of Gastroenterology hints state that "patients with chronic GERD signs are people who are maximum probable to have Barrett's esophagus and must undergo upper endoscopy." However, the grade of dysplasia determines the c program languageperiod for surveillance endoscopy. In sufferers without dysplasia on 2 consecutive endoscopies with biopsies, a three- to five-12 months interval has been proposed. For sufferers with low-grade dysplasia, annual surveillance is suggested. For patients with excessive-grade dysplasia, a mucosal resection must be attempted and the grade of dysplasia recognized cautiously through an expert gastrointestinal pathologist. Endoscopic ablation remedies may be taken into consideration as a viable opportunity to surgery in this affected person populace.

Question 14. Episodic Acute Overexposure To Ultraviolet (uv) Radiation (ie, Sunburn) Is An Important Risk Factor For Which Type Of Skin Cancer?

Answer :

Sunburn is an critical chance factor for two types of pores and skin cancer: basal mobile carcinoma and cancer. Melanoma is the most lethal kind of pores and skin most cancers. A meta-analysis of 57 research indicated that the relative chance for cancer among persons with sunburn history in comparison with those without sunburn history changed into 2.03 (95% confidence c programming language [CI], 1.Seventy three-2.37).

Question 15. Risk Factors For Anthracycline-prompted Cardiomyopathy Include?

Answer :

In addition to increasing cumulative doses of anthracyclines, older age, preexisting cardiac sickness, high blood pressure, irradiation to the mediastinum, simultaneous management of other antineoplastic retailers, bad dietary fame, previous treatment with anthracyclines, and diabetes mellitus have been recognized as the maximum critical hazard elements for anthracyclineinduced cardiotoxicity.

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Question 16. What Is A Possible Intervention To Treat Breathlessness In End-level Cancer Patients?

Answer :

It has been proven that facial cooling, with use of a small mechanical fan, within the areas subserved by using the second and third branches of the trigeminal nerve reduces the feeling of breathlessness and may be efficacious in cancer sufferers. It is an ideal, cheaper tool to incorporate into a "breathlessness/disaster plan." Opioids are an effective pharmacologic remedy for breathlessness; however, most proof so far comes from nonmalignant disease. A quantity of case reviews and out of control trials of inhaled furosemide have indicated that it can relieve dyspnea in terminal cancer patients.

Question 17. A fifty three-12 months-old White Man With No Family History Of Colorectal Cancer Had His First Screening Colonoscopy. He Was Found To Have A < 1 Cm Tubular Adenoma With Low-grade Dysplasia. When Should He Schedule His Next Colonoscopy?

Answer :

The current recommendations from the joint American Cancer Society/US Multisociety Task Force on Colorectal Cancer are that 5- to 10-yr durations are appropriate for comply with-up of sufferers at low threat for next superior adenomas. To deal with this problem, a set from the University of Pennsylvania diagnosed 1002 patients with 1 or 2 small adenomas at their first colonoscopy who had ≥ three colonoscopies achieved within a thirteen-12 months duration. Among 88 patients who had at least 1 adenoma at the third colonoscopy, three (3.Four%) had advanced adenomas. Although this look at become small, the authors concluded that it's miles reasonable to hold 5-year surveillance in patients with 1 to two small tubular adenomas determined at baseline exam.

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Question 18. What Is The Main Cause Of Hepatocellular Carcinoma (hcc) In The United States?

Answer :

The occurrence of HCC within the United States is increasing, and contamination with the hepatitis C virus is thought to be the fundamental reason. Indeed, HCC is the quickest-growing reason of cancer-associated demise in the United States. HCC is generally associated with cirrhosis, mainly because of hepatitis C, hepatitis B, alcohol abuse, hereditary hemochromatosis, and number one biliary cirrhosis. This malignancy is becoming diagnosed as an early complication and the maximum frequent cause of dying in humans with viral-associated cirrhosis. Effective therapy for hepatitis B and C has brought about extra patients with cirrhosis being diagnosed and screened.

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Question 19. Rituximab In Combination With Chop (r-chop) Was Approved In 2006 By The Fda For Treatment Of Diffuse Large B-cellular Lymphoma (dlbcl). The Addition Of Rituximab To Standard Chemotherapy Has Been Shown To Benefit Which Patient Population?

Answer :

Age is an essential issue within the treatment of sufferers with DLBCL due to the greater hazard for comorbid conditions. Therefore, techniques have been initiated to use the IPI chance factors and the age-adjusted IPI at the side of degree, serum lactate dehydrogenase, and performance score as stratification elements to layout therapeutic trials and appropriately choose sufferers.

These strategies have been observed inside the landmark R-CHOP trials, together with the Groupe d'Etude des Lymphomes de l'Adulte (GELA) and the US Intergroup Eastern Cooperative Oncology Group (ECOG) 4494/Cancer and Leukemia Group B (CALGB) 9793 trials. Results have proven that R-CHOP is effective in each older and more youthful sufferers and in low- and high-chance IPI businesses.

Question 20. The Annual Risk For Endometrial Cancer In Post-breast Cancer Patients After five Years Of Adjunctive Therapy With Tamoxifen Is 2 Cases Per_________?

Answer :

In a randomized trial conducted via the National Surgical Adjuvant Breast and Bowel Project (NSABP), tamoxifen (20 mg day by day) was compared with placebo as adjuvant breast cancer therapy. The relative hazard for endometrial most cancers after five years of tamoxifen use become 2.2; that is equal to an annual risk fee of about 2 instances in line with 1000 women. Of note, maximum women who develop uterine most cancers at some point of tamoxifen therapy gift with vaginal bleeding, have early-stage sickness, and generally (but not always) have properly-differentiated tumors.

Furthermore, the benefits of tamoxifen within the adjuvant breast cancer setting a ways outweigh the small danger for uterine most cancers. Currently, patients receiving tamoxifen must undergo a habitual pelvic examination with activate evaluation of peculiar vaginal bleeding by means of endometrial biopsy.

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Question 21. Which Of The Following Statements Concerning The American Cancer Society Nutrition And Exercise Guidelines For Cancer Survivors Is False?

Answer :

The position of soy meals and dietary supplements is uncertain. Soy may be an exceptional source of protein; however, high doses of supplemental soy isoflavones aren't advocated for women with estrogen-receptor-nice breast cancer due to the phytoestrogen content, which may additionally stimulate increase of hormone-touchy breast most cancers.

Question 22. Is Cytoreductive Nephrectomy Recommended For Patients With Metastatic Renal Cell Carcinoma (rcc) Before Cytokine Or Targeted Therapy?

Answer :

Approximately 30% of sufferers with RCC gift with level IV ailment. Two randomized trials tested nephrectomy observed through interferon vs immediate therapy with interferon in sufferers imparting de novo with metastatic kidney most cancers. Both trials confirmed good sized tendencies closer to survival favoring nephrectomy before interferon. Therefore, inside the cytokine era, cytoreductive nephrectomy earlier than the organization of cytokine therapy have become general. Clinical trials in patients who have received focused remedy have required that patients have nephrectomy earlier than enrollment, primarily based in large part at the cytokine consequences.

Question 23. The Immunomodulating Monoclonal Antibody Alemtuzumab Is Associated With Which Infectious Complication?

Answer :

Alemtuzumab is a humanized monoclonal antibody directed towards CD52, a surface antigen expressed in high tiers through B-cell continual lymphocytic leukemia (B-CLL) and T-prolymphocytic leukemia cells. Alemtuzumab has been proven to break target cells thru antibodydependent mobile cytotoxicity, complement-mediated cytolysis, and induction of apoptosis.

CD4 and CD8 T-mobile counts reach their nadir about 4 weeks after initiation of alemtuzumab. High rates of widespread and opportunistic infections, inclusive of PCP, invasive aspergillosis, candidiasis, disseminated varicella-zoster virus, mycobacterial infection, and CMV, and extraordinarily not on time recuperation of purposeful immune fame, had been stated with alemtuzumab use in salvage remedy of refractory or relapsed CLL.

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Question 24. What Is The five-yr Survival Rate For Patients Who Undergo Curative Hepatic Resection Of Colorectal Liver Metastases?

Answer :

In patients with unresectable metastatic colorectal cancer, modern-day systemic chemotherapy regimens offer median survival instances ranging from 12 to 24 months, and survival beyond five years is uncommon. In evaluation, historic five-year survival prices for sufferers undergoing hepatic resection with healing intent variety from 30% to forty%, with several extra current series reporting rates drawing close 60%.

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