1-A 20 years old woman asks for your advice

regarding her risk of developing breast cancer. Her

mother, maternal aunt, and grandmother all have
developed breast cancer. She would like to know if
she has a genetic predisposition. Laboratory tests
for mutations in which of the following genes
would be most likely to answer your patient's
question?
a- BRCA1. b-C-myc.
c-Estrogen receptor. d-HER2/neu. e-Rb-1.
2-Which one of the following oncogene families
includes a member for which testing for its activity
is routinely carried out in breast cancer patients
because a specific drug therapy can be initiated
when this oncogene is overexpressed through
amplification?
a.Ras b.Her2/neu c.Myc d. p53
e.Bcl2

3-P53 oncogene is :

A-Growth promoting gene. B- DNA repair gene.

C- Tumour suppressor gene. D- Apoptosis regulating gene.

E- Growth factor receptor.

4- It is observed that some neoplasms appear to develop from viral
oncogenesis, with serologic confirmation of past viral infection. Which
of the following neoplasms is most likely to arise in this manner?
 A-Retinoblastoma. B-T-cell leukemia. C-Prostatic adenocarcinoma.

D-Hepatic angiosarcoma. E-Plasma cell myeloma.

5-A study is performed to analyze characteristics of malignant

neoplasms in biopsy specimens. The biopsies were performed on
patients who had palpable mass lesions on digital rectal
examination. Of the following microscopic findings, which is most
likely to indicate that the neoplasm is malignant?
A-Pleomorphism B-Atypia

C-Invasion D-Increased nuclear/cytoplasmic ratio

E-Necrosis

6-A 44-year-old woman notes a lump in her left breast while

taking a shower. Her physician palpates a 3 cm firm, irregular,
non-movable mass in the upper outer quadrant of her left breast
on physical examination. A fine needle aspiration of this mass is
performed, and cytologically the cells are consistent with
infiltrating ductal carcinoma. The mass is removed with
lumpectomy along with an axillary lymph node dissection. Which
of the following findings will best predict a better prognosis for this
patient?
a-Tumor cells strongly estrogen receptor positive

b-No metastases in the sampled lymph nodes

c-Flow cytometric analysis with aneuploidy and a high S-phase

d-One relative who had a similar type of breast cancer

e-High cytologic tumor grade

7-A change in bowel habits prompts a 53-year-old woman to see her physician. On
physical examination there are no lesions noted on digital rectal examination, but her
stool is positive for occult blood. A colonoscopy is performed and reveals a 6 cm friable
exophytyic mass in the cecum. A biopsy of this mass is performed and microscopic
examination shows a moderately differentiated adenocarcinoma. Which of the following
laboratory findings is most likely to be present in this patient?

a-K-RAS mutation in the neoplastic cells

b-Neoplastic cells positive for vimentin

c-Stool culture with Shigella flexneri

d-Presence of HIV-1 RNA

e-DNA topoisomerase I autoantibody

8-A child is born with a single functional allele of a tumor

suppressor gene. At the age of five the remaining normal allele is
lost through a point mutation. As a result, the ability to inhibit cell
cycle progression until the cell is ready to divide is lost. Which of
the following neoplasms is most likely to arise via this
mechanism?

a-Breast ductal carcinoma b-Pulmonary small cell anaplastic

carcinoma

c-Ocular retinoblastoma d-Cerebral astrocytoma

e-Chronic myeloid leukemia

9-A 22-year-old woman goes to her physician for a routine examination. A palpable
nodule is found in the right lobe of her thyroid gland. No lymphadenopathy is noted. A
chest x-ray shows no masses. A fine needle aspirate of the nodule is performed and
cytologic examination reveals cells present consistent with a papillary carcinoma of the
thyroid. There are no other family members affected by this disorder. She works as a
secretary for an accounting firm part time and is earning a college degree. Which of the
following findings would you consider most relevant in her past history to indicate a risk
factor for this neoplasm?

a-Chronic alcoholism b-Radiation therapy in childhood

c-Ataxia telangiectasia d-Blunt trauma from a fall

e-Exposure to arsenic compounds

10-A 14-year-old healthy girl has a 0.3 cm reddish, slightly raised nodule on the skin of
the upper part of her chest found on a routine physical examination. She states that this
lesion has been present for years and has not appreciably changed in size or color.
Which of the following neoplasms is this nodule most likely to be?

a-Hemangioma b-Melanoma

c-Carcinoma d-Lymphoma

e-Glioma f-Sarcoma

11- A 60-year-old man who has a 90 pack year history of cigarette smoking has had a
chronic cough for the past 10 years. He has begun to lose weight (3 kg) during the past
year. No abnormal findings are noted on physical examination. He has a chest
radiograph that reveals a right hilar mass. A sputum cytology shows atypical,
hyperchromatic squamous cells. What is the most common initial pathway for
metastases from this lesion?

A-Bloodstream B-Pleural cavity

C-Contiguous spread to chest wall D-Lymphatics

E-Bronchi
12-A 55-year-old man has had malaise and a 4 kg weight loss over the past 6 months.
On physical examination his stool is positive for occult blood. An abdominal CT scan
shows his liver contains multiple tumor masses from 2 to 5 cm in size with central
necrosis. The surrounding hepatic parenchyma appears normal. Which of the following
characteristics of neoplasia is best illustrated by these findings?

a-Multicentric origin b-High tumor grade

c-Primary neoplasm in the stomach d-Exposure to a carcinogen

e-Advanced stage

13- A 60-year-old woman has a firm mass with irregular borders felt in her left breast on
a routine physical examination. A fine needle aspiration is performed and microscopic
examination shows malignant cells. A left mastectomy with axillary lymph node
dissection is performed. A tissue sample of this neoplasm is submitted for analysis by
flow cytometry. Which of the following does flow cytometric analysis most likely provide?

A-Analysis of the karyotype B-Detection of gene mutations

C-Determination of aneuploidy D-Distinguishing carcinoma from sarcoma

E-Quantitation of RNA content

14- A 35-year-old woman had a firm nodule palpable on the dome of the uterus six
years ago recorded on routine physical examination. The nodule has slowly increased
in size and now appears to be about twice the size it was when first discovered. By
ultrasound scan it is solid and circumscribed. She remains asymptomatic. Which of the
following neoplasms is she most likely to have?

a-Adenocarcinoma b-Leiomyosarcoma c-Hemangioma

d-Leiomyoma e-Metastasis

15- A lymph node is biopsied and on microscopic examination shows many lymphocytes
that are large, with clumped chromatin and occasional mitoses. The characterization of
this population of lymphocytes as a neoplasm is best accomplished by which of the
following methods?

a-Immunohistochemical staining identifying leukocyte common antigen

b-Gene rearrangement studies demonstrating clonality

c-Flow cytometry indicating high S-phase

d-Differential white blood count showing a lymphocytosis

e-Light microscopy demonstrating fibrosis

16-Benign tumor usually shows:

a-Many mitotic figures b-Vascular invasion
c-Mature cell proliferation d-Local invasion
e-No capsulation

17-All are nuclear features of malignancy EXCEPT:

a-Hyperchromatism b-Prominent nucleoli
c-Decreased nuclear cytoplasmic ratio
d-Anisonucleosis e-Abnormal mitoses

18-Irradiation of a malignant tumour results in the loss of individual

neoplastic cells through fragmentation of individual cell nuclei and
cytoplasm. What is the effect of this irradiation?
a-Coagulative necrosis b- Liquefactive necrosis
c- Phagocytosis d- Apoptosis e-Pinocytosis
19-Benign tumor usually shows:
a-Encapsulation b-Necrosis c-Lymphatic spread
d-Hyperchromatism e-Metastasis

20-Spread of sarcoma occurs mainly through:

a-Lymphatic spread b-Blood spread
c-Transcoelomic spread d-All of the above
e-None of the above

21-Some routes of spread of malignant tumors are:

a-Lymphatic embolism b-Lymphatic permeation
c-Perineural spread d-All of the above
e-Non of the above

22-A 52-year-old woman feels a lump in her right breast. On physical examination there
is a 3 cm right breast mass fixed to the chest wall. This mass is biopsied and on
microscopic examination shows nests of cells with marked hyperchromatism and
pleomorphism. These cells are estrogen receptor positive. Flow cytometry is performed.
Compared with surrounding non-neoplastic stromal cells, the neoplastic cells are more
likely to be in which of the following phases of the cell cycle?

a-G0 b-G1 c-S d-G2 e-M

23-A 49-year-old man complains of pain in his left thigh for 3 months. On physical
examination his thigh is increased in size, compared to the right. A plain film radiograph
reveals the presence of a 15 cm solid mass that does not appear to arise from bone, but
it does have infiltrative margins. A biopsy of this mass is taken, and on microscopic
examination the mass is composed of highly pleomorphic spindle cells. Which of the
following immunohistochemical markers is most likely to be demonstrated in the cells of
this mass?

a-Cytokeratin b-Factor VIII c-Alpha fetoprotein

d-Lambda light chain e-Vimentin

24-a womanhas an abnormal Pap smear with cytologic changes suggesting human
papillomavirus (HPV) infection. Without treatment, she is most likely to develop which of
the following lesions?

a-Squamous cell carcinoma b-Non-Hodgkin's lymphoma

c-Kaposi sarcoma d-Adenocarcinoma e-Leiomyoma

25-Cells with marked hyperchromatism and increased nuclear/cytoplasmic ratio

involving the full thickness of the epithelium. However, these changes are confined to
the epithelium above the basement membrane. Which of the following terms best
describes these biopsy findings?

a-Metaplasia b-Minimal dysplasia c-Microinvasion

d-Hyperplasia e-Carcinoma in situ