- Email: [email protected]
Test yourself: MCQ and extended matching
MULTIPLE CHOICE QUESTIONS
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
3 The role of endocrine therapy in cancer treatment
1 The principles of cancer treatment by chemotherapy
A
The three cancers for which endocrine therapy is most commonly used are breast, endometrial and prostatic.
When considering the principles of cancer treatment by chemotherapy
B
Approximately 75% of breast cancers in postmenopausal and 50% of cancers in pre-menopausal women will be hormone receptor-positive.
For patients receiving endocrine therapy for cancer treatment
A
All cytotoxic chemotherapy agents exert their effects by disrupting the cell cycle by one or more processes.
C
B
Chemotherapy drugs are classified by their cell cycle effects.
Tamoxifen’s main use is in the adjuvant setting in pre-menopausal women.
D
C
The National Cancer Institute in the USA has devised a standardized way of reporting toxicities using a graded scale, the Common Toxicity Criteria.
Progestins are the commonest type of endocrine therapy used for recurrent or metastatic endometrial cancer.
E
Non-steroidal anti-androgens are the commonest type of anti-androgen used in the management of prostate cancer.
Non-Hodgkin’s lymphoma and acute myeloid leukaemia have been reported as a late complication in patients treated for Hodgkin’s disease with chemotherapy.
4 The principles of cancer treatment by immunotherapy
D
E
For patients treatment
Tumours can possess transport proteins that actively pump drugs out of cells, resulting in resistance.
receiving
immunotherapy
for
cancer
A
The cytotoxic T cell lymphocyte has a critical role in an immunological cascade that ultimately results in the lysis of tumour cells in an antigen-specific manner.
When considering the role of the surgeon in cancer management
B
Interferon has been used in a range of haematological malignancies and in renal cancer and advanced melanoma.
A
For genetic mutation carriers, the lifetime risk of developing the corresponding cancer is approximately 40%.
C
Monoclonal antibodies are monophasic specific treatments aimed at specific cancer antigens and thereby mount a specific immunological response.
B
BRCA1/2 mutation carriers have a lifetime risk of between 60 and 80% of developing breast cancer and a 20e40% risk of developing ovarian cancer.
D
Radio-immunotherapy has become established in the treatment of Hodgkin’s lymphoma with high response rates.
E
Clinical trials of ipilimumab in combination with cytotoxic chemotherapy have shown no improvement in response rates and survival in metastatic melanoma.
2 The role of the surgeon in cancer management
C
Surgical intervention for familial adenomatous polyposis should only be performed following malignant transformation of the adenomatous polyps.
D
Patients carrying the CDH1 germ line mutations have a 70% lifetime risk of developing diffuse gastric cancer, and should be considered for prophylactic total gastrectomy.
5 Pathology of tumours of the central nervous system
In incurable cancer patients, palliative surgery should not be utilized to reduce the severity of symptoms or improve the quality of life.
A
E
Theme: pathology of tumours of the central nervous system The ability of a drug to elicit a response, once bound to its target and in terms of the doseeresponse curve it defines the maximum response. see next page
SURGERY 30:4
207
Ó 2012 Published by Elsevier Ltd.
MULTIPLE CHOICE QUESTIONS
Questions cont. B
A measure of the efficiency with which a substance is removed from the systemic circulation.
C
The proportion of an administered dose that reaches the systemic circulation.
D
Refers to the amount of drug required to produce a response of a certain magnitude.
E
Describes the fate of a drug after absorption and comprises distribution, metabolism and elimination.
Answers to incorrect statements
F
The measure of a drug’s ability to bind to a particular receptor.
B Chemotherapy drugs are classified in one of two ways e by their cell cycle effects, or by their biochemical properties.
G
A characteristic that is measured and evaluated as an indicator of normal biological or pathological processes or pharmacological responses to a therapeutic intervention.
Answers 1 2 3 4 5
Question 1
Question 2 A For genetic mutation carriers, the lifetime risk of developing the corresponding cancer is approximately 70e80%. C Surgical intervention for familial adenomatous polyposis should be prophylactic, given the risk for malignant transformation of adenomatous polyps. E In incurable cancer patients, palliative surgery can be justified to reduce the severity of symptoms and improve the quality of life.
When considering the clinical pharmacology terminologies listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all 1
Biomarker
2
Affinity
3
Efficacy
4
Potency
5
Bioavailability
6
Clearance
7
Disposition
SURGERY 30:4
A, C, D, E B, D All A, B, C 1-G, 2-F, 3-A, 4-D, 5-C, 6-B, 7-E
Question 4 D Radio-immunotherapy has become established in the treatment of non-Hodgkin’s lymphoma with high response rates. E Clinical trials of ipilimumab in combination with cytotoxic chemotherapy have shown an improvement in response rates and survival in metastatic melanoma.
208
Ó 2012 Published by Elsevier Ltd.
Test yourself
MCQ and extended matching
The MCQ and extended matching section in Surgery is designed to test your knowledge of selected topics in this issue of the journal.
Michael G Wyatt MSc MD FRCS FRCSEd (ad hom) Consultant Surgeon, Freeman Hospital, Newcastle upon Tyne; Honorary Reader, Newcastle University; Clinical Editor, SURGERY; Honorary Secretary, The Vascular Society of Great Britain and Ireland, and Member of the Court of Examiners for the Intercollegiate MRCS
For questions 1e4, select the statements which are true and which are false. The correct answers are given below.
3 The role of endocrine therapy in cancer treatment
1 The principles of cancer treatment by chemotherapy
A
The three cancers for which endocrine therapy is most commonly used are breast, endometrial and prostatic.
When considering the principles of cancer treatment by chemotherapy
B
Approximately 75% of breast cancers in postmenopausal and 50% of cancers in pre-menopausal women will be hormone receptor-positive.
For patients receiving endocrine therapy for cancer treatment
A
All cytotoxic chemotherapy agents exert their effects by disrupting the cell cycle by one or more processes.
C
B
Chemotherapy drugs are classified by their cell cycle effects.
Tamoxifen’s main use is in the adjuvant setting in pre-menopausal women.
D
C
The National Cancer Institute in the USA has devised a standardized way of reporting toxicities using a graded scale, the Common Toxicity Criteria.
Progestins are the commonest type of endocrine therapy used for recurrent or metastatic endometrial cancer.
E
Non-steroidal anti-androgens are the commonest type of anti-androgen used in the management of prostate cancer.
Non-Hodgkin’s lymphoma and acute myeloid leukaemia have been reported as a late complication in patients treated for Hodgkin’s disease with chemotherapy.
4 The principles of cancer treatment by immunotherapy
D
E
For patients treatment
Tumours can possess transport proteins that actively pump drugs out of cells, resulting in resistance.
receiving
immunotherapy
for
cancer
A
The cytotoxic T cell lymphocyte has a critical role in an immunological cascade that ultimately results in the lysis of tumour cells in an antigen-specific manner.
When considering the role of the surgeon in cancer management
B
Interferon has been used in a range of haematological malignancies and in renal cancer and advanced melanoma.
A
For genetic mutation carriers, the lifetime risk of developing the corresponding cancer is approximately 40%.
C
Monoclonal antibodies are monophasic specific treatments aimed at specific cancer antigens and thereby mount a specific immunological response.
B
BRCA1/2 mutation carriers have a lifetime risk of between 60 and 80% of developing breast cancer and a 20e40% risk of developing ovarian cancer.
D
Radio-immunotherapy has become established in the treatment of Hodgkin’s lymphoma with high response rates.
E
Clinical trials of ipilimumab in combination with cytotoxic chemotherapy have shown no improvement in response rates and survival in metastatic melanoma.
2 The role of the surgeon in cancer management
C
Surgical intervention for familial adenomatous polyposis should only be performed following malignant transformation of the adenomatous polyps.
D
Patients carrying the CDH1 germ line mutations have a 70% lifetime risk of developing diffuse gastric cancer, and should be considered for prophylactic total gastrectomy.
5 Pathology of tumours of the central nervous system
In incurable cancer patients, palliative surgery should not be utilized to reduce the severity of symptoms or improve the quality of life.
A
E
Theme: pathology of tumours of the central nervous system The ability of a drug to elicit a response, once bound to its target and in terms of the doseeresponse curve it defines the maximum response. see next page
SURGERY 30:4
207
Ó 2012 Published by Elsevier Ltd.
MULTIPLE CHOICE QUESTIONS
Questions cont. B
A measure of the efficiency with which a substance is removed from the systemic circulation.
C
The proportion of an administered dose that reaches the systemic circulation.
D
Refers to the amount of drug required to produce a response of a certain magnitude.
E
Describes the fate of a drug after absorption and comprises distribution, metabolism and elimination.
Answers to incorrect statements
F
The measure of a drug’s ability to bind to a particular receptor.
B Chemotherapy drugs are classified in one of two ways e by their cell cycle effects, or by their biochemical properties.
G
A characteristic that is measured and evaluated as an indicator of normal biological or pathological processes or pharmacological responses to a therapeutic intervention.
Answers 1 2 3 4 5
Question 1
Question 2 A For genetic mutation carriers, the lifetime risk of developing the corresponding cancer is approximately 70e80%. C Surgical intervention for familial adenomatous polyposis should be prophylactic, given the risk for malignant transformation of adenomatous polyps. E In incurable cancer patients, palliative surgery can be justified to reduce the severity of symptoms and improve the quality of life.
When considering the clinical pharmacology terminologies listed below, select the single most likely true statement from the list above. Each option may be used only once, more than once or not at all 1
Biomarker
2
Affinity
3
Efficacy
4
Potency
5
Bioavailability
6
Clearance
7
Disposition
SURGERY 30:4
A, C, D, E B, D All A, B, C 1-G, 2-F, 3-A, 4-D, 5-C, 6-B, 7-E
Question 4 D Radio-immunotherapy has become established in the treatment of non-Hodgkin’s lymphoma with high response rates. E Clinical trials of ipilimumab in combination with cytotoxic chemotherapy have shown an improvement in response rates and survival in metastatic melanoma.
208
Ó 2012 Published by Elsevier Ltd.