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Prevention
Lung Cancer/Tobacco Use
Genetics
Tests/Studies
Breast Cancer
100
We have made significant progress in reducing the incidence rates of a number of cancers. Which of the following incidence is continuing to rise? A) Lung Cancer B) Colon Cancer C) Gastric Cancer D) Melanoma
What is D. Melanoma Increasing due to migration of people to southern states and increased skin screening.
100
What is the prevalence of smokers in US adults?
What is 20%
100
Which of the following malignancies are associated with germ line mutations in the RET protooncogene? A) MEN 2A B) MEN 2B C) Sporadic medullary thyroid cancer D) All the above
What is D. All the Above.
100
A total of 100 patients are screened for cancer using a newly developed test with the results: 8 are true positives; one results is false positive, one result is false negative; and 90 are true negatives. What is the formula that calculates the sensitivity of the test?
What is 8 divided by (8+1) Sensitivity is the portion of people with the disease who have a positive result (true positive/ (true positive + false negative).
100
Women are at increased risk of breast cancer if they have: Choose one or more: A) Lobular carcinoma in situ B) Atypical ductal hyperplasia (ADH) C) A history of mantle radiation of Hodgkin's Lymphoma
What is A, B, and C. LCIS is associated with an annual risk of developing breast cancer of up to 1% per year. Recommend screening mammogram. ADH increases cancer risk four to five fold, or even higher in women with a family history of breast cancer or those with ADH at ages less than 30 years. A person history of mantle cell radiation (especially between ages 10 and 30) has been shown to elevated breast cancer risk. Begin screening 8 years after treatment.
200
Tamoxifen has an increased risk of ________ cancer , while Raloxifene has an increased risk of ________ (side effect).
What is Uterine; increased risk of venous thromboembolism and fatal stroke.
200
What is the best measurement for nicotine dependence? A) Number of cigarettes per day B) Age of smoking initiation C) Time from waking up to the first cigarette smoking
What is C. Its who smoke the first cigarette within 30 minutes of waking up have a high level of dependence and will likely need more intensive cessation therapy
200
True or False: Among patients with hereditary ovarian cancers, BCRA1 mutation is more common than BRCA2 mutation.
What is TRUE. BRCA1 develop ovarian cancer by their mid 40s, BRAC2 mutants develop ovarian cancer by mid 60s.
200
A study evaluated patients with stage III colon cancer who were randomly assigned to 2 different adjuvant chemotherapy regimens and followed for disease recurrence and death. The study further queried the use of multivitamins during adjuvant chemotherapy, and the use of MTV was not associated with disease free survival or overall survival. What kind of study is this?
What is Cohort Study Compares 2 groups on the basis of exposures.
200
True or False: Older Women are more likely to develop triple negative breast cancer.
What is FALSE. Older women have a higher risk for developing breast cancer but they are less likely than younger women to develop triple negative disease.
300
What is the best treatment of a patient with FAP presenting with approximately 300 colorectal polyps and 15 rectal adenomas?
What is Total colectomy and ileorectal anastomosis (IRA). IRA can be considers in patients with less than 1000 colorectal polyps and less than 20 rectal adenomas. If higher number of adenomas, adenomas larger than 3cm, or severe dysplasia-- should undergo proctectomy in addition to colectomy.
300
Tobacco is responsible for close to 1/3 of cancers in the US. What is considered the second most important cause of cancer in the US? A) Hepatitis B B) HPV C) Obesity D) Low intake of fruit and vegetables
What is Obesity. May experts consider obesity the second most important cancer risk factor in the US. It increases breast, endometrial, adenocarcinoma of the esophagus, and prostate cancers.
300
Low prevalence, high penetrance genes for cancer, such as BCRA1 and BCRA2, have what kind of genetic inheritance
What is Autosomal dominant. These are typically tumor suppressor genes, which are AD.
300
A study is conducted to determine the effect of familial aggregation of cancer on the risk of testicular cancer. Interviews are conducted and detailed family history of cancer are obtained from each. Of the 194 men with testicular cancer, 21 report report a family history of first degree relative, while 13 from he control (without cancer) report such a history. What kind of bias would this be?
What is Recall Bias
300
Which frequently mutated gene is present in 17q21? A) BRCA1 B) BRCA2 C) PTEN D) P53
What is BRCA1 BRCA2 (13q12.3) PTEN (10q23.3) P53 (17p13.1)
400
A healthy 48 y/o woman went to see her primary care physician because she found a breast lamp. The work up found a 1 cm invasive ductal carcinoma. This is an example of what: A) Primary Prevention B) Secondary Prevention C) Tertiary Prevention D) Case Finding
What is Case Finding. Primary prevention refers to the prevention of a disease, such as the removal of colon polyps to prevent the development of cancer. Secondary prevention refers to the identification of a disease at an early asymptomatic stage through screening. Case finding occurs when a patient with symptomatic disease presents to a physician for evaluation.
400
Lung Cancer remains the primary cause of cancer related mortality in the United States. True or False: Annual Chest X-rays screening for heavy smokers is likely to reduce mortality of this disease.
What is FALSE. No benefit has been shown for lung cancer screening with plain X-rays. The NLST study did show 20% reduction in lung cancer morality for heavy smokers who underwent annual screening.
400
Patient is diagnosed with Cowden Syndrome, which is a hereditary neoplastic syndrome with common cancers involving the breast and thyroid. What gene is associated with Cowden Syndrome
What is PTEN
400
Studies of screening for cancer are subject to several types of bias. If screening detects a cancer earlier (before symptoms), but treatment has no effect on the course of the disease, then the subject will seem to live longer, than if he or she had presented symptomatically. Cancer is known for a longer period of time, but the time of death is not altered. What type of bias is this?
What is Lead time bias Lead time bias is the interval between the diagnosis of disease at screening and when it would have been detected because of the development of symptoms.
400
A 28 y/o woman with bilateral ductal cancer presents to her oncologist. History is notable for intussusception at age 6. On PE, she has small blue/black hyper pigmented macule on her lips, buccal mucosa, and fingertips. What syndrome does she have?
What is Peutz Jeghers Syndrome characterized by hyperpigmented macule, increased cancer risk and gastrointestinal polyposis. Females are at increased risk for breast, colorectal, ovarian, gastric, and pancreatic cancers.
500
Regarding population screening for ovarian cancer, which of the following tests have been proven effective? Choose one or more. A) Annual pelvic examination B) Annual measurement of serum CA 125 C) Two stage screening: annual CA 125 then transvaginal ultrasound if elevated CA 125 D) None of the above
What is D) None of the above. No screening strategies have been shown to be effective for screening for ovarian cancer for several reasons.
500
A long delay in the decline of risk for lung cancer stems from the fact that cigarette smoke contains what?
What is tumor initiators. Initiators are carcinogens that affect the early stages of the carcinogenic process and hence have their effect years before malignancy actually appears.
500
Hereditary Nonpolyposis Colorectal Cancer is associated with tumors of the colorectal, endometrium, ovary, pancreas, and small bowel. Name 3 of the 5 associated genes in this syndrome.
What is MSH2, MLH1, PMS1, PMS2, MSH6
500
A new screening test for ovarian cancer has been developed. It was tested in a tertiary care center in a group of women with BRCA positive breast cancer and was found to have a sensitivity of 70%, specificity of 90%, and PPV of 10%. If a woman, in the study population is found to have a positive (abnormal test result), how would you interpret it: A) There is a 30% chance that this represents a false positive result. B) There is a 10% chance that this represents a false positive result. C) There is a 9 in 10 chance that this represents a false positive result. D) You can be 90% sure your patient has the disease.
What is C. There is a 9 in 10 chance that this represents a false positive result. The sensitivity of a test reflects its ability to detect a known disease, and the specificity reflects the ability of a test to give a normal result when the disease is known to be absent. A PPV of 10% means that 10% of positive test results are true positives, so 90% are false positives.
500
What syndrome is characterized by the presence of breast cancer, soft tissue sarcoma, leukemia, and prostate cancer? Name the syndrome and gene associated with this syndrome
What is Li-Fraumeni Syndrome and TP53