1.
A 60-year-old man with a 90 pack-year history of smoking experiences an episode of hemoptysis. A chest x-ray reveals a 5 cm right upper lobe lung mass. An FNA yields cells consistent with small cell anaplastic ("oat cell") carcinoma. O/E -Puffiness of face, pedal edema, skin bruises, BP-165/100 mm Hg. A bone scan shows no metastases. Immunohistochemical staining of tumor cells is likely to be positive for:
A. 
Parathormone related peptide
B. 
C. 
D. 
2.
A 63-year-old chronic smoker presents with a 15 kg wt loss over past 3 months. Labs: Na+ 114 mmol/L, K+ 4.1 mmol/L, Cl- 86 mmol/L, CO2 22 mmol/L, glucose 78 mg/dL, creatinine 0.9 mg/dL, BUN 20 mg/dL, alk. phos. 38 U/L, total bil 0.8 mg/dL, alb. 3.3 g/dL. CBC shows Hb 13.9 g/dL, hematocrit 41.8%, MCV 92 fL, platelets 155,000/μL, WBC count 8300/ μL. Which of the following neoplasms is most likely to be present?
A. 
B. 
C. 
Small cell anaplastic carcinoma
D. 
E. 
3.
A young man from Sub-Saharan Africa with a history of Hepatitis B infection presented to the ER complaining of vague abdominal pain, intermittent fevers, and a 20-lb weight loss over the past 6 months. O/E- Diffuse abdominal tenderness, hepatomegaly, and yellow sclera. A CT scan showed a diffusely nodular liver with a dominant nodule mass. 3 cm. Which of the following serum markers is useful for monitoring the disease progression in this patient?
A. 
B. 
C. 
D. 
E. 
4.
Liver metastasis of a tumor that secretes carcinoembryonic antigen was found by biopsy. The lung, pancreas, gall bladder, and stomach were devoid of tumors. What is the most likely primary site of such a tumor?
A. 
B. 
C. 
D. 
E. 
5.
A neoplasm on biopsy is found to be composed predominantly of cells with spindle shape and a high N/C ratio with marked pleomorphism. These cells are vimentin-positive, cytokeratin negative, and CD45 negative by immunohistochemical staining. This neoplasm is most likely to have been diagnosed in which of the following patients:
A. 
A 35-year-old woman with a left breast mass and enlarged axillary lymph nodes
B. 
A 55-year-old woman with massive ascites and multiple peritoneal metastases
C. 
A 25-year-old man with an enlarged left testis
D. 
A 15-year-old man with a mass in left femur and lung metastases
E. 
A 55-year-old man with a right renal mass
6.
A 70-year-old healthy man is found to have a palpable firm nodule in the prostate gland on digital rectal examination. His serum prostate-specific antigen (PSA) is found to be elevated. The microscopic appearance seen on biopsy of the prostate will probably be most consistent with which of the following conditions:
A. 
B. 
Adenocarcinoma of prostate
C. 
D. 
Squamous cell carcinoma of lung
E. 
7.
A 64-year-old man has suffered and. pain for the past week. He has had a 20 kg wt loss along with withing fatigue over the past year. He has developed and. distention with lack of stools in the past 2 days. O/E, bowel sounds are reduced. An abdominal CT scan reveals a mass involving descending colon. At laparotomy, partial resection of the colon is performed, with the removal of an encircling mass in descending colon. Microscopically, the mass is found to be a moderately differentiated adenocarcinoma. Which of the following lab finding is most likely to be present in this patient?
A. 
Microcytic hypochromic anemia
B. 
Positive antinuclear antibody
C. 
D. 
E. 
8.
Smoking predisposes to which of the following tumors?
A. 
B. 
C. 
D. 
E. 
F. 
9.
Carcinoma of which organ has been linked to occupational exposure to aniline dyes?
A. 
Bone marrow (hematopoietic stem cells)
B. 
C. 
D. 
E. 
10.
A 51-year-old man has worked in a factory producing plastic pipe. He has weight loss, nausea, and vomiting. His serum alkaline phosphatase is 405 U/L with AST 67 U/L, ALT 55 U/L, total bilirubin 1.2 mg/dL. An abd. CT scan reveals a 12 cm right liver lobe mass. Liver biopsy reveals a neoplasm composed of spindle cells forming irregular vascular channels. The cells demonstrate vimentin positivity and cytokeratin negativity with IHC staining. Exposure to which of the following substances
A. 
B. 
C. 
D. 
E. 
11.
A 1.2 cm darkly pigmented skin lesion is excised from the dorsum of the right hand of a previously healthy 42-year-old man. He noted that this lesion had become larger and darker with more irregular outlines over the past 3 mths. Several non-tender enlarged lymph nodes are palpable in the right axilla. Which of the following risk factors is most important for the development of this neoplasm:
A. 
B. 
C. 
Inheritance of a faulty Rb gene
D. 
Prior job-related asbestos exposure
E. 
Chronic exposure to ultraviolet radiation
12.
A 56-year-old man has had a chronic cough for the past year. He is a non-smoker. He recently had an episode of hemoptysis. A chest x-ray demonstrates a 6 cm peri-hilar mass. A sputum sample is collected, and the sputum cytology report reads "Atypical cells present suggestive of squamous cell carcinoma." Which of the following environmental exposures is most likely to be associated with these findings?
A. 
B. 
C. 
D. 
E. 
13.
A 22-year-old woman has a palpable nodule in the right lobe of her thyroid gland. An FNA of the nodule reveals cells present consistent with papillary carcinoma of the thyroid. No LN noted. Chest x-ray – normal; no positive family history. 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:
A. 
B. 
Radiation therapy in childhood
C. 
D. 
Exposure to arsenic compounds
E. 
14.
A 26-year-old student incurs a needlestick injury while starting an IV on a combative patient in the ER. He thinks no more about it, but 25 yrs later, he has increasing malaise along with a 5 kg wt loss over 5 months. On examination, his liver edge is firm. An abdominal CT scan shows a 7 cm mass in the right lobe of his liver. Which of the following neoplasms, is the most likely to have?
A. 
B. 
C. 
D. 
E.