NIZAM’S INSTITUTE OF MEDICAL SCIENCES Punjagutta, Hyderabad – 500 082, A.P., India.

Set A

2012 DM Medical Oncology

Question Booklet

Entrance Examination for Admission to

Subject Medical Oncology

24 June 2012 Marks 90 Time: 01 hr: 30 min

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Q1. Regarding development of tolerance to the effects of morphine A) tolerance develops to all effects in high doses B) tolerance can develop to all effects with chronic usage C) minimal or no tolerance develops to sedation D) minimal or no tolerance develops to miosis Q2. Which one of the following does not indicate high-risk myeloma

A) t (4;14) B) hyperdiploidy C) t (14;16) D) 13q deletion on conventional cytogenetics Q3. The tumor seen in the following image is associated with which neurocutaneous

syndrome

A) tuberous sclerosis B) neurofibromatosis type 1 C) neurofibromatosis type 2 D) von-HippelLindau disease

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Q4. BRCA1 gene is located on A) chromosome 9 B) chromosome 10 C) chromosome 17 D) chromosome 13 Q5. A patient's serological report reveals HBsAg +ve, HBeAg Negative, Anti HBe +ve, anti HBc IgM negative, HBV DNA quantitative 19,00,000 IU/ml. The diagnosis based on serology is

A) chronic HBsAg carrier wild type B) chronic HBsAg carrier with acute exacerbation C) chronic HBsAg carrier with pre core mutation D) HBV related acute viral hepatitis Q6. In a carcinoma with unknown primary the most common histology seen is A) squamous cell carcinoma B) neuroendocrine histology C) well differentiated adenocarcinoma D) poorly differentiated adenocarcinoma Q7. What % of data is covered within 2 standard deviations of the mean

A) 40% B) 68% C) 95% D) 99% Q8. Which of the following drugs has the highest emetogenic potential A) busulphan B) dacarbazine C) bleomycin D) rituximab Q9. Which of the following cytogenetic abnormalities are associated with good prognosis in a patient with acute myeloid leukemia A) trisomy 8 B) t (8;21) C) t (9;22) D) del 5q

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Q10. The cell of origin of the Reed- Sternberg cell in Hodgkin's Lymphoma is believed to be A) T cells B) macrophages C) NK cells D) B cells Q11. The cytogenetic abnormality seen in Ewings sarcoma is A) t (8;14) B) t (11;22) C) t (9;22) D) t (5;11) Q12. Of the following pairs, identify the pair of anticancer drugs that have a common mechanism of action A) Paclitaxel - Procarbazine B) Methotrexate - Cisplatin C) Teniposide - Irinotecan D) Etoposide - Idarubicin Q13. Voriconazole is ineffective in the treatment of A) candidiasis B) aspergillosis C) mucormycosis/zygomycetes D) fusarium infection Q14. Cox proportional hazard is A) used for calculation of relative risk B) used for calculating statistical sigificance of survival curves C) provides age adjusted incidence rates D) useful for comparing cancer data among various centres Q15. The treatment of choice for superior vena cava syndrome due to Burkitt's lymphoma is A) chemotherapy B) radiotherapy C) vascular stenting D) diuretics

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Q16. There are many biases in a screening test, one of the bias in which patient is merely diagnosed at an earlier date and survival appears increased, but life is not really prolonged, but it only prolongs the time the subject is aware of the disease and spends as a patient

A) length biased sampling B) lead time bias C) selection bias D) sample Q17. True statement regarding Mantle cell lymphoma A) it is a T cell lymphoma B) most are gastric in origin C) commonest association is with genetic translocations D) distant metastases at presentation is common Q18. The treatment of choice to prevent thrombosis in a patient with polycythemia vera and a haemoglobin of 18g/dL is A) low dose aspirin B) Jak 2inhibitor (ruxolitinib) C) periodic phlebotomy D) hydroxyurea

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Q19. In the diagram of a lymphnode shown below T lymphocytes are predominantly located in

A) primary lymphoid follicle B) medulla C) cortex D) paracortex Q20. Which of the following is not an observational study design A) case-control study B) cohort study C) randomised controlled Study D) ecologic study Q21. While compared to adult normal cells, cancer cells A) produce lactate in the presence of oxygen B) use greater fraction of nutrients for energy production C) have lower glucose uptake D) have lower rate of synthesis of amino acids

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Q22. Regarding use of Iridium192 in radiotherapy Assertion: It is a source used for brachytherapy Reason:It has a half life of 73.8 days A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q23. A 26 year old lady came with the complaints of fever with altered sensorium and reduced urine output of 1 week duration. On evaluation her hemoglobin was 7 gm/dl, platelet count of 30,000/cu.mm with peripheral smear showing schistocytes.Serum creatinine was 3mg/dl.Prothrombin time and activated partial thromboplastin time were normal. Enzyme most likely to be deficient in this situation is A) hexokinase B) pyruvate kinase C) ADAMTS 13 D) glucose-6 phosphate dehydrogenase Q24. Treatment of herpes zoster resistant to acyclovir A) penciclovir B) valaciclovir C) famciclovir D) foscarnet

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Q25. The following figure is from a diagnostic test for a congenital disorder. Which

malignancy is most commonly seen in this disorder

A) acute myeloid leukemia B) neuroblastoma C) Burkitts lymphoma D) Ewing's sarcoma Q26. Which of the following monitoring is repeatedly done in a patient of breast cancer on treatment with trastuzumab A) pulmonary function tests for vital capacity B) echocardiography for ejection fraction C) chest CT scans for pulmonary fibrosis D) ultrasound of the uterus for endometrial thickening

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Q27. The following is the family tree of a 18 year college student whose six family members were diagnosed with medullary cancer of thyroid and operated. He was found to have a normal thyroid profile and calcitonin. What do you advise the patient now

A) observation B) radio iodine ablation of thyroid C) prophylactic thyroidectomy D) mutation analysis for RET oncogene Q28. A resident doctor inserted central venous catheter for a patient with hypotension in the emergency medicine department. The cotton dressing stained with blood should then be placed into A) yellow plastic bag B) red plastic bag C) black plastic bag D) white translucent plastic bag Q29. Which of the following investigations when used for screening of high risk individuals has been found to reduce mortality from lung cancer A) sputum for occult blood B) PET-CT scan C) spiral CT scan D) digital chest radiograph

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Q30. Which of the following prehospital measures are acceptable in the care of a patient with snakebite

A) application of splint to the bitten extremity B) incision and application of suction to the bite site C) application of ice or poultices D) application of tourniquet Q31. Which of the following events is most commonly reported following the initial infusion of rituximab A) elevated transaminases B) bronchospasm C) prolonged APTT D) headache Q32. A 20 year old girl presented with a bony swelling in the distal femur. The biopsy revealed the following picture. The likely diagnosis is

A) osteosarcoma B) Ewing's tumor C) giant cell tumor D) tuberculous osteomyelitis

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Q33. The picture shown below depicts

A) high energy linear accelerator B) orthovoltage unit C) 60 Co teletherapy machine D) low energy linear accelerator Q34. Regarding carcinoids which of the following statements is correct A) bronchial carcinoids are associated with smoking B) most carcinoids occur in children C) most common presentation of intestinal carcinoid is GI bleeding D) diagnosis of carcinoid syndrome relies on measurement of urinary or plasma level of 5 HT or its metabolite , and urinary 5 - HIAA level

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Q35. Regarding second cancers in upper aerodigestive tract Assertion: Patients cured of squamous cell cancers of the lung, esophagus, oral cavity, and neck are at risk (as high as 50% per year) of developing second cancers of the upper aerodigestive tract Reason: "field carcinogenesis" hypothesis is smoking causes diffuse epithelial injury in the oral cavity, neck, esophagus, and lung. A) Both Assertion and Reason are True, and Reason is correct explanation for assertion B) Both Assertion and Reason are True, and Reason is not the correct explanation for assertion C) Assertion is True, but Reason is false D) Assertion is False, but Reason is true Q36. Regarding bleomycin lung toxicity Assertion : Patients with prior exposure to bleomycin should receive high flow oxygen during surgical procedures Reason: it causes pulmonary fibrosis. A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q37. Which of the following is the typical immunhistochemical pattern of the neoplastic cell in a patient with Nodular Lymphocyte predominant Hodgkin's Lymphoma A) CD15+, CD30+, CD20-ve, CD45 + B) CD15-, CD30-, CD20+, CD45+ C) CD15+. CD30+, CD20+, CD45+ D) CD15-, CD30-, CD20-, CD45+

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Q38. Change/changes included as epigenetic 1. methylation of cytosine residues in CpG islands 2. modification of nucleotide sequence by mutation 3. modification of histone by acetylation 4. single nucleotide polymorphisms A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q39. Ipilimumab is an inhibitor of

A) Ras B) CTLA-4 C) C-raf D) CD-30 Q40. Amplification of genomic material in which of the following chromosomes is associated with hepatocellular carcinoma A) 1q B) 16q C) 13q D) 4q Q41. A 50 year old man developed progressive increase of muscle stiffness, rigidity and painful spasms triggered by auditory, sensory or emotional stimuli. Regarding this clinical situation

A) it persists during sleep B) there maybe an underlying small cell lung cancer C) antibodies to acetylcholine receptor are present in most patients D) IV immunoglobulin provides benefit in the paraneoplastic syndrome Q42. The material used for absorbing neutrons in a nuclear reactor is A) cadmium B) radium C) uranium D) zinc

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Q43. Most common non ocular orbital tumor in young children presenting with proptosis is A) neuroblastoma B) non-Hodgkins lymphoma C) rhabdomyosarcoma D) PNET Q44. Preferred treatment of hairy cell leukemia A) bendamustine B) interferon alfa C) pentostatin D) cladribine Q45. Which of the following is uncommon in Waldenstrom's Macroglobulinemia A) elevated IgM B) bone marrow infiltration C) hypercalcemia D) positive direct Coomb's test Q46. Brentixumab vedotin a anti CD30 molecule has been found useful in phase 1 clinical trials for the treatment of which of the following A) diffuse large B cell lymphoma B) relapsed Hodgkin's Lymphoma C) cutaneous T cell lymphoma D) chronic myeloid leukemia Q47. Drug B is investigated in a meta-analysis for its effect on mortality after acute myocardial infarction. It is found that, when this drug is administered, the mortality drops from 11% to 3%. How many patients will have to be treated with drug B to prevent one death A) 3 B) 11 C) 12.5 D) 24

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Q48. A child aged one-and-half years presents with generalised rashes, lymphadenopathy and splenomegaly. The peripheral smear shows elevated leukocyte count, thrombocytopenia and erythroblasts. Bone marrow shows a myelodysplastic pattern with blasts less than 30% and philadelphia chromosome is absent. The most probable diagnosis is A) acute myelogenous leukemia B) juvenile chronic myelogenous leukemia C) hemo phagocytic syndrome D) acute lymphatic leukemia Q49. A 57 year old lady has pancytopenia: Hb- 8g/dl WBC - 3000/cmm, platelets 20000/cmm. Peripheral smear reveals macryocytic anemia. Bone marrow is hypocellular. Following is least likely possibility

A) aplastic anemia B) myelodysplastic syndrome C) megaloblastic anemia D) paroxysmal nocturnal hemoglobin urea (PNH) Q50. Identify the incorrect pair among the following preventive agents and their target in oncology trials

A) beta carotene : lung B) ascorbic acid: prostate C) aspirin: colorectal D) isotretinoin : head and neck Q51. The earliest second malignancy after an allogenic stem cell transplant is A) leukaemia B) post transplant lymphoproliferative disorder C) NHL D) solid tumours

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Q52. In patients with diabetes and kidney disease Assertion: Angiotensin converting enzyme blockers and angiotensin receptor antagonists are the preferred over calcium channel blockers antihypertensives in patients with diabetic nephropathy Reason: Angiotensin converting enzyme blockers and angiotensin receptor antagonists are more effective in lowering blood pressure in those with diabetes A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q53. To call a sequence variation in the genome a polymorphism, it should occur in the population at a frequency greater than A) 1% B) 0.1% C) 0.01% D) 0.001% Q54. The term "extensively drug-resistant tuberculosis (XDR-TB)" refers to isolates of M.tuberculosis resistant to A) streptomycin, rifampicin, pyrazinamide, ethambutol and cycloserine B) isoniazid, rifampicin, flouroquinolones and atleast one injectable second line drug C) pyrazinamide, isoniazid, ethambutol and atleast one injectable second line drug D) streptomycin, rifampicin, pyrazinamide, ethambutol and ethionamide

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Q55. The most common site of gastrointestinal stromal tumor is A) stomach B) small intestine C) large intenstine D) mesentry Q56. Which laser is most commonly used in the treatment of carcinomas of the upper aerodigestive tract A) carbondioxide B) argon C) Nd:YAG D) ruby Q57. Polyoma virus is linked to which of the following A) extra mammary Pagets ' Disease B) kaposis's sarcoma C) merkel cell carcinoma D) adenoid cystic carcinoma Q58. Characteristic histology of anthracycline toxicity is A) conduction system fibrosis B) pericardial fibrosis C) myofibrillar dropout D) myocardial necrosis Q59. Which of the following side effect is a distinct feature of dasatinib compared to imatinib A) cytopenias B) pleural effusion C) nausea D) muscle inflammation Q60. Regarding Malaria Assertion: plasmodium vivax malaria is characterized by long term relapses Reason: the latent erythrocytic stage lasts for several years

A) Both Assertion and Reason are true, and Reason is the correction explanation for the assertion B) Both Assertion and Reason are true, and Reason is not the correction explanation for the assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q61. The hallmark of serous borderline tumors with microinvasion is A) the presence of tumor cells identical to the adjacent noninvasive tumor in the stroma B) absence of destructive stromal invasion C) mitotic activity D) atypia Q62. Given below are schematic representation of radiographs of spine in normal and an abnormal condition. The abnormal condition represents that of

A) osteosclerosis B) osteolytic secondaries C) osteoblastic secondaries D) osteoporosis

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Q63. A 40 year woman presented with a mass in the left thigh of 2 months 10 x 8 cm size, firm to hard on palpation with engorged veins. Regional nodes were not enlarged. HPE was consistent with a high grade sarcoma. She was operated for a lump in the left breast 5years ago followed which she received chemo and radiotherapy. Her brother died of a brain tumor at the age of 20 years. The most probable mutation involved would be A) myc oncogene B) p53 C) RET oncogene D) p 16 Q64. A six year old child has presented with proptosis of 2 weeks duration. Biopsy reveals - Small round cell tumor. For further characterization following immuno-histochemistry (IHC) stains should be included

A) keratin, LCA, S-100 B) keratin, LCA, Myoglobin C) LCA, Myoglobin, S-100 D) LCA, S-100, Keratin Q65. Which of the following combinations of lung volume abnormalities are most likely in idiopathic pulmonary fibrosis A) decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) B) normal TLC, normal residual volume RV, normal FEV1/FVC ratio, normal MIP C) increased TLC, decreased VC, decreased FEV1/FVC ratio D) decreased TLC, increased residual volume RV, normal FEV1/FVC ratio, decreased MIP Q66. Prior to planning therapy with rasburicase in the setting of tumor lysis syndrome which of the following enzyme levels need to be measured A) glucose 6-phosphate isomerase B) glucose 6-phophate dehydrogenase C) glutathione synthase D) glyceraldehyde 3-phosphate dehydrogenase

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Q67. Regarding Cancer and Venous Thrombo Embolism (VTE) Assertion : Cancer increases the risk of VTE seven folds. Reason : Factor I is expressed by tumor cells. A) Both Assertion and Reason are True , and Reason is correct explanation for assertion B) Both Assertion and Reason are True , and Reason is not the correct explanation for assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q68. Galactomannan assay is used for the diagnosis of A) aspergillosis B) mucormycosis C) pneumocytsis Jercovii infection D) gram negative bacterial infection Q69. In which of the following group of patients is surveillance for hepatocellular carcinoma (HCC) recommended A) autoimmune hepatitis B) alcoholic cirrhosis C) non alcoholic steatohepatitis D) α-��� anti-trypsin deficiency Q70. Elements having same number of neutrons but having different mass numbers and different atomic numbers A) isotopes

B) isotones

C) isobars

D) isodiaphers Q71. Mechanisms of tumour associated hypoglycemia include/ includes 1. increased production of insulin by an islet cell tumour 2. hepatic dysfunction from liver metastases 3. increased production of insulin like growth factor 4. increased production of proinsulin A) only 1, 2, and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct

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Q72. Which one of the following subtypes of melanoma has the worst prognosis

A) acral lentiginous B) nodular C) lentigo maligna D) lentiginous Q73. Which among the following chemotherapy agent is the treatment of choice in patients with castration resistant prostatic cancer A) mitoxanterone B) estramustine C) sipuleucel-T D) docetaxel Q74. Infection /infections that occur in the first 2 weeks after allogeneic stem cell transplantation is/ are 1. gram positive bacterial sepsis 2. candida sepsis 3. herpes simplex virus disease 4. cytomegalovirus disease A) only 1, 2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q75. Leucocoria is a sign of A) neuroblastoma B) retinoblastoma C) rhabdomyosarcoma D) cataract

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Q76. Regarding cryptococcal infection 1. lifelong maintenance therapy is recommended to prevent a symptomatic clinical relapse in patients with HIV infection. 2. pulmonary cryptococccosis in an immunocompetent host always progresses to disseminated cryptococcosis if not treated. 3. complications of central nervous system cryptococcosis include cranial nerve deficits, vision loss and cognitive impairment. 4. the echinocandins , caspofungin and micafungin are highly effective against cryptococcus species A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q77. Which of the following processes does not occur during apoptosis A) shrinking of cytoplasm and condensation of nucleus B) presentation of phoshatidylserine on outer surface of the cell C) activation of cytoplasmic proteases, caspases D) lysis of the cell membrane and release of cytoplasm and nuclear material Q78. Which of the folowing drugs act by interfering with folate metabolism. 1. gemcitabine 2. pemetrexed 3. cytosine-arabinoside 4. methotrexate A) only 1,2 and 3 are correct B) only 1 and 3 are correct C) only 2 and 4 are correct D) only 4 is correct Q79. Regarding diagnosis of inflammatory carcinoma of breast Assertion: It is best done by biopsy of breast lump Reason: There is extensive involvement of dermal lymphatics A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true

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Q80. Bosentan used for treatment of Pulmonary arterial hypertension is A) selective ET-A receptor antagonist B) both ET-A and ET-B receptor antagonist C) phosphodiesterase inhibitor D) prostacyclin Q81. The following pedigree is an example of what pattern of inheritance

A) X-linked dominant B) X-linked recessive C) autosomal recessive D) autosomal dominant Q82. Given below are the common cancer susceptibility syndromes. Match the correct mutation most commonly involved with the syndrome 1 FAP (Familial adenomatosis polyposis) A MET gene 2 Hereditary breast ovarian cancer syndrome B P53 3 Li Fraumeni syndrome. C APC gene 4 Hereditary papillary renal cancer. D BRCA A) 1-D, 2-C, 3-A, 4-B B) 1-C, 2-D, 3-B, 4-A C) 1-A, 2-D, 3-C, 4-B D) 1-C, 2-D, 3- A, 4-B

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Q83. A 10 year old girl with her mother visited a pediatrician for a cervical cancer vaccination, Pediatrician explained that in Quadrivalent cervical cancer vaccine one of the following HPV strains is not included

A) 6 B) 10 C) 16 D) 18 Q84. Two important tumour suppressor genes inactivated by high risk Human Papilloma virus are

A) p53 and Cyclin D1 B) p53 and RB C) p53 and p21 D) Rb and p16 Q85. Multi drug resistant salmonella typhi infection is resistant to the following drugs

A) quinolones and chloramphenicol B) chloramphenicol, ampicillin and trimethoprim C) ciprofloxacin, ampicillin and ceftriaxone D) nalidixic acid and chloramphenicol Q86. Regarding use of tamoxifen in patients of ER positive metastatic breast cancer Assertion: patients with CYP2D6 polymorphisms that reduce its activity, are associated with higher risk of disease relapse. Reason: Tamoxifen is metabolized in liver by CYP2D6 into inactive metabolites, 4-OH Tamoxifen and endoxifen A) Both Assertion and Reason are true, and Reason is the correct explanation for Assertion B) Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion C) Assertion is true, but Reason is false D) Assertion is false, but Reason is true Q87. Chloride diuresis is recommended prior to cisplatin administration as it prevents

A) renal toxicity B) hearing loss C) tinnitus D) vomiting

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Q88. Which of the following parasitic infections is not associated with increased risk of malignancy A) clonorchis sinensis B) cryptosporidiosis C) schistosoma hematobium D) opisthorchis viverrini Q89. A 30 year old patient presented with 2 years history of anosmia followed by decreased visual acuity in both eyes of 1 year duration with mild memory disturbances and behavioural changes of apathy and irritability. On fundoscopic examination he had a pale white optic disc on left side with reduced vessels and on right side the optic disc showed blurred margins with engorged veins and haemorrhages.The most likely diagnosis is A) pituitary macroadenoma B) olfactory groove meningioma C) lymphoma D) optic nerve glioma Q90. The drug that causes mitotic spindle arrest is A) doxorubicin B) dactinomycin C) vincristine D) mitomycin