MCQ Book Questions

Q60122. Which of the following potent carcinogens was most likely involved in the pathogenesis of lung cancer in the patient described in Question 8?

Q60123. A 33-year-old woman discovers a lump in her left breast on self-examination. Her mother and sister both had breast can- cer. A mammogram demonstrates an ill-defi ned density in the outer quadrant of the left breast, with microcalcifi cations. Needle aspiration reveals the presence of malignant, ductal epithelial cells. Genetic screening identifi es a mutation in BRCA1. In addition to cell cycle control, BRCA1 protein pro- motes which of the following cellular functions?

Q60124. A 60-year-old man who worked for 30 years in a chemi- cal factory complains of blood in his urine. Urine cytology discloses dysplastic cells. A bladder biopsy demonstrates transitional cell carcinoma. Which of the following carcino- gens was most likely involved in the pathogenesis of bladder cancer in this patient?

Q60125. A 50-year-old woman presents with a lump in her breast. A 4-cm fi rm and fi xed mass is noted on breast examination. Excisional biopsy reveals malignant cells that form gland- like structures and solid nests, surrounded by a dense col- lagenous stroma. A connective tissue stain (trichrome) of the biopsy is shown in the image. Which of the following descriptive terms best describes the blue areas observed in this specimen?

Q60126. A 65-year-old man complains of muscle weakness and a dry cough for 4 months. He has smoked two packs of cigarettes daily for 45 years. A chest X-ray shows a 4-cm central, left lung mass. Laboratory studies reveal hyperglycemia and hypertension. A transbronchial biopsy is diagnosed as small cell carcinoma. Metastases to the liver are detected by CT scan. Which of the following might account for the development of hyperglycemia and hypertension in this patient?

Q60127. A 58-year-old woman with colon cancer presents with 3 months of increasing shortness of breath. A chest X-ray reveals numerous, bilateral, round masses in both lungs. His- tologic examination of an open-lung biopsy discloses malig- nant gland-like structures, which are nearly identical to the colon primary. Which of the following changes in cell behav- ior was the fi rst step in the process leading to tumor metastasis from the colon to the lung in this patient?

Q60128. A 68-year-old man complains of recent changes in bowel habits and blood-tinged stools. Colonoscopy reveals a 3-cm mass in the sigmoid colon. Biopsy of the mass shows infi ltrat- ing malignant glands. These neoplastic cells have most likely acquired a set of mutations that cause which of the following changes in cell behavior?

Q60129. A 60-year-old man presents with an ulcerated, encrusted, and infi ltrating lesion on the sun-exposed dorsal aspect of a fi nger (shown in the image). A biopsy reveals squamous cell carcinoma. The metastatic potential of this neoplasm would be enhanced by upregulation of the gene for which of the fol- lowing proteins?

Q60130. A 45-year-old man presents with a 9-month history of a reddish nodule on his foot. Biopsy of the nodule discloses a poorly demarcated lesion composed of fi broblasts and endothelial-like cells lining vascular spaces. Further work-up identifi es similar lesions in the lymph nodes and liver. The tumor cells contain sequences of human herpesvirus-8 (HHV-8). This patient most likely has which of the following diseases?

Q60131. During a routine checkup, a 50-year-old man is found to have blood in his urine. He is otherwise in excellent health. An abdominal CT scan reveals a 2-cm right renal mass. You inform the patient that staging of this tumor is key to selecting treatment and evaluating prognosis. Which of the following is the most important staging factor for this patient?

Q60132. A 59-year-old woman presents with increasing pigmentation of the skin. Physical examination shows hyperkeratosis and hyperpigmentation of the axilla, neck, fl exures, and anogeni- tal region. Endocrinologic studies reveal normal serum levels of adrenal corticosteroids and glucocorticoids. If this patient’s skin pigmentation represents a paraneoplastic syndrome, the primary tumor would most likely be found in which of the following anatomic locations?

Q60133. A 65-year-old man dies after a protracted battle with meta- static colon carcinoma. At autopsy, the liver is fi lled with multiple nodules of cancer, many of which display central necrosis (umbilication). Which of the following best explains the pathogenesis of tumor umbilication in this patient?

Q60134. A 59-year-old man complains of progressive weakness. He reports that his stools are very dark. Physical examination demonstrates fullness in the right lower quadrant. Laboratory studies show iron defi ciency anemia, with a serum hemoglo- bin level of 7.4 g/dL. Stool specimens are positive for occult blood. Colonoscopy discloses an ulcerating lesion of the cecum. Which of the following serum tumor markers is most likely to be useful for following this patient after surgery?

Q60135. Laboratory studies of the surgical specimen obtained from the patient described in Question 24 demonstrate hypermethyla- tion of the p53 gene. Which of the following best characterizes this biochemical change in the neoplastic cells?

Q60136. A 20-year-old woman has an ovarian tumor removed. The surgical specimen is 10 cm in diameter and cystic. The cystic cavity is found to contain black hair and sebaceous material. Histologic examination of the cyst wall reveals a variety of benign differentiated tissues, including skin, cartilage, brain, and mucinous glandular epithelium. What is the diagnosis?

Q60137. A 35-year-old woman complains of nipple discharge and irregular menses of 5 months duration. Physical examination reveals a milky discharge from both nipples. MRI shows an enlargement of the anterior pituitary. Which of the following is the most likely histologic diagnosis of this patient’s pituitary tumor?

Q60138. A 52-year-old woman presents with a 1-year history of upper truncal obesity and moderate depression. Physical examination shows hirsutism and moon facies. A CT scan of the thorax dis- plays a hilar mass. A transbronchial lung biopsy discloses small cell carcinoma. Electron microscopy of this patient’s lung tumor will most likely reveal which of the following cytologic features?

Q60139. Cytogenetic studies in a 40-year-old woman with follicular lymphoma demonstrate a t(14;18) chromosomal translocation involving the bcl-2 gene. Constitutive expression of the pro- tein encoded by the bcl-2 gene inhibits which of the following processes in this patient’s transformed lymphocytes?

Q60140. A 60-year-old man presents with a 6-month history of increasing weight loss and fatigue. Physical examination reveals conspic- uous hepatomegaly. An abdominal CT scan reveals multiple “canon ball” nodules in the liver (shown in the image). A CT- guided biopsy reveals a mucous-secreting adenocarcinoma. This patient’s metastatic liver cancer most likely originated in which of the following anatomic locations?

Q60141. A 58-year-old woman undergoes routine colonoscopy. A 2-cm submucosal nodule is identifi ed in the appendix. Biopsy of the nodule shows nests of cells with round, uniform nuclei. Elec- tron microscopy reveals numerous neuroendocrine granules in the cytoplasm. This patient’s neoplastic disease is associated with which of the following clinical features?