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Example Questions
Example Question #11 : Conditions And Treatments
With what co-infection is Burkitt lymphoma associated?
Cytomegalovirus (CMV)
Hepatitis B
Epstein-Barr virus (EBV)
Herpes simplex
Epstein-Barr virus (EBV)
EBV infection is common in Burkitt lymphoma. In malaria-endemic areas, it is thought that the cancer is actually caused by chronic malarial infection increasing a person's susceptibility to chronic EBV infection. The same is assumed about HIV co-infection with EBV in the United States.
None of the other infections listed are associated with Burkitt lymphoma.
Example Question #16 : Tumors And Cancer
A 55-year-old client presents to clinic for a small slowly enlarging papular skin lesion on the right aspect of his nose that has been present for less than 6 months. The nurse is aware that sun exposed skin is susceptible to lesions that may become cancerous. The appearance of the lesion is consistent with a basal cell carcinoma.
What is the best initial treatment for this type of lesion?
Ultraviolet radiation
Radiation and systemic chemotherapy
Wide excision of tissue down to fascia
Excisional surgery with possible use of topical chemotherapy agents
No treatment is warranted at this time, the lesion should be observed for signs of overt changes.
Excisional surgery with possible use of topical chemotherapy agents
The proper intervention for a lesion on the nose should include complete excision of the lesion to send for biopsy to discover the extent and type of skin lesion. It may require additional treatment in the form of topical chemotherapy drugs or further surgery depending on the pathological findings. Wide excision to fascia may be reserved for more invasive skin cancers such as malgnant melanoma after an initial biopsy has been performed. Lesions that have been present for longer than 6 months should be biopsied as a general rule, although some practitioners may biopsy sooner with increased suspicion of omnious looking lesions.
Example Question #17 : Conditions And Treatments
A nurse is caring for a client newly diagnosed with chronic lymphocyctic leukemia (CLL). The nurse is aware that this type of malignancy is associated with certain factors and clinical manifestations.
Which of these is not associated with CLL?
Treatments mostly include combination therapy of various chemotherapy agents, as well as radiation and splenectomy.
Some diagnostic findings include thrombocytopenia, with the presence of lymphocytes within the bone marrow.
CLL is the most common leukemia in adults, mostly affecting men between the ages of 50-70 years of age.
There is usually no symptoms seen in early disease, with later manifestations such as fatigue, splenomegaly, and night sweats.
The affected cells contain a distinctive genetic abnormality, known as the Philadelphia chromosome, used as a marker of the disease.
The affected cells contain a distinctive genetic abnormality, known as the Philadelphia chromosome, used as a marker of the disease.
The Philadelphia chromosome is associated with chronic myelogenous leukemia.
Example Question #17 : Conditions And Treatments
A patient with a strong family history of cancer presents to your clinic with a new diagnosis of medullary thyroid cancer. You are concerned that the patient may have the familial cancer syndrome, MEN2A (Multiple Endocrine Neoplasia) Syndrome. Which of the following represents the malignancies encountered in MEN2A Syndrome?
Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma
Medullary thyroid cancer, head and neck cancer, esophageal cancer, anal cancer
Medullary thyroid cancer, pheochromocytoma, mucosal adenoma
Medullary thyroid cancer, colorectal cancer, uterine cancer, gastric cancer
Medullary thyroid cancer, parathyroid adenoma, islet cell tumor of the pancreas
Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma
The correct answer is "Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma," as these are the cancers most commonly associated with MEN2A (Multiple Endocrine Neoplasia) Syndrome, a familial cancer syndrome that predisposes to development of numerous cancers in patients generally at younger ages that would be expected. One should have an index of suspicion for such a familial cancer syndrome when evaluating a patient with a new cancer who has a family history of similar cancers that are known to be associated with familial cancer syndromes.
Medullary thyroid cancer, pheochromocytoma, and mucosal adenomas are seen in patients with MEN2B Syndrome, not MEN2A.
Medullary thyroid cancer, parathyroid adenoma, and islet cell tumors of the pancreas are not seen together in a particular cancer syndrome. Parathyroid adenomas, islet cell tumors of the pancreas, and pituitary adenomas are seen in patients with MEN1 Syndrome though.
Medullary thyroid cancer, colorectal cancer, uterine cancer, and gastric cancer are not seen together in a particular cancer syndrome. Colorectal cancer, uterine cancer, and gastric cancer are known to be associated with Lynch Syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer Syndrome though.
Medullary thyroid cancer, head and neck cancer, esophageal cancer, and anal cancer are not seen together in a particular cancer syndrome. Head and neck cancer, esophageal cancer (squamous cell carcinoma), and anal cancer are all known to be associated with alcohol and tobacco use among other risk factors.
Example Question #13 : Conditions And Treatments
You are the nurse taking care of a 20-year old patient who complains of palpitations, feelings of anxiety, headaches, and sweating for the last two months. You take the patient's vital signs, and find that they are tachycardic and hypertensive. Thyroid function tests and a urine drug screen are both within normal limits. 24-hour urine catecholamines and metanephrines are markedly elevated. Which of the following is the most likely diagnosis?
Amphetamine abuse
Pheochromocytoma
Generalized anxiety disorder
Cocaine abuse
Panic attack
Pheochromocytoma
The most likely diagnosis in this patient is pheochromocytoma. A pheochromocytoma is a rare neuroendocrine neoplasm that arises within the chromaffin cells of the adrenal medulla. Pheochromocytomas can secrete norepinephrine and/or epinephrine, which can lead to symptoms of sympathetic activation. Patients with pheochromocytomas may experience palpitations, hypertension, headaches, fatigue, flushing, sweating, nausea, anxiety, and flank pain, among other symptoms. The workup for pheochromocytoma includes 24-hour urine catecholamines and metanephrines, as these would be elevated in a patient with a pheochromocytoma.
For the patient in this vignette, he/she complains of a number of symptoms that are consistent with a pheochromocytoma, and the elevated 24-hour urine catecholamines and metanephrines has a high sensitivity and specificity for pheochromocytoma, so this is the most likely diagnosis.
Panic attacks and generalized anxiety disorder may present with similar symptoms to a pheochromocytoma, but would not account for the elevated urine catecholamines and metanephrines.
Amphetamine abuse and cocaine abuse may present with some similar symptoms to a pheochromocytoma, but would not account account for the elevated urine catecholamines and metanephrines, and also would have appeared in the urine drug screen. The urine drug screen in this patient was within normal limits.
Example Question #1 : Causes And Treatments Of Tumors
What muscle pathology is often linked to small cell lung cancer?
Rhabdomyosarcoma
Duchenne muscular dystrophy
Lambert-Eaton syndrome
Guillain–Barré syndrome
Lambert-Eaton syndrome
Approximately 60% of patients diagnosed with Lambert-Eaton syndrome have an underlying cancer, most often small cell lung cancer. Lambert-Eaton syndrome is an autoimmune disorder in which the release of neurotransmitter is not permitted due to antibodies against the presynaptic calcium channels. This results in muscle weakness in the limbs. The other conditions listed are not associated with any respiratory cancers.
Example Question #2 : Causes And Treatments Of Tumors
60% of cases of stomach cancer in the United States are associated with what infection?
Escherichia coli
Staphylococcus aureus
Salmonella enterica
Helicobacter pylori
Helicobacter pylori
Helicobacter pylori is present in the stomach of 60% of individuals with gastric cancer. Cancer in these cases may be caused by chronic inflammation at the site of infection, resulting in metaplasia.
Staphylococcus aureus, Salmonella enterica, and Escherichia coli are all common causes of gastroenteritis but are not associated with malignancy.
Example Question #23 : Conditions And Treatments
Which of the following is not a risk factor for renal cell carcinoma?
Obesity
Alcohol
Hypertension
Smoking
Alcohol
Smoking, obesity, and high blood pressure are among the most common risk factors for development of renal cell carcinoma. Other risk factors include genetic susceptibility, diuretic use, and male gender. Alcohol consumption has not been associated with increased rates of renal cell cancer.
Example Question #3 : Causes And Treatments Of Tumors
Renal cell carcinoma can cause what paraneoplastic syndrome?
Lambert-Eaton myasthenic syndrome
Hypercalcemia
Polymyositis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Hypercalcemia
Renal cell carcinoma can cause hypercalcemia, due to secretion of PTHrP (parathyroid hormone-related protein).
SIADH and Lambert-Eaton myasthenic syndrome are both associated with small-cell lung cancer, while polymyositis is associated with non-Hodgkin lymphoma.
Example Question #4 : Causes And Treatments Of Tumors
What cell line is metaplastic in multiple myeloma?
Neutrophils
T cells
Plasma cells (also known as memory B cells)
Natural killer cells
Plasma cells (also known as memory B cells)
Multiple myeloma is caused by metaplasia of plasma cells. No other white blood cell type is typically metaplastic, though abnormal plasma cell accumulation in bone marrow does interfere with the synthesis of all other blood cell types.
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