Last ex

1- 5 fluorouracil based chemotherapy?

A) Is indicated for all Patients with Duke’s B tumours.

B) In combination with capecitabine improves survival to around 18 months in metastasis disease.

C) Is likely to impair quality of life when used in the metastatic setting.

D) Improves 5 year survival rates for patients with Duke’s C tumours by approximately 7%.

2- Progenitor cell for basophils is:

a. Monoblast

b. Lymphoblast

c. Myeloblast

d. Megakaryoblast

3- Which one of the following statements is true of small cell lung cancer (SCLC)?

A. Approximately 80% of patients respond to chemotherapy

B. Limited stage disease describes disease less than T2 N1 MO

C. Prophylactic cranial irradiation has been shown to prolong survival

D. Surgery is the most important treatment modality

4- WHO Criteria for ET diagnosis include all except:

a. Megakaryocyte proliferation in the bone marrow

b. Not meeting the criteria of other myeloproliferative disorders

c. Platelets count more than 450 000/cumm

d. Hemoglobin elevation more than 16.5 g/dl

5- Which of the following statements is true regarding adjuvant treatment for early breast cancer ?

a) No survival benefit has been demonstrated with use of trastuzumab ( herceptin ) in the adjuvant
setting.

b) Combination chemotherapy reduces recurrence and improves survival in selected patient groups .

c) Aromatase inhibitors are replacing tamoxifen in premenopausal women due to better outcomes and
greater tolerability .

d) Radiotherapy is indicated after breast conserving surgery only if > 4 nodes positive or tumour close to
the resection margin
6- T cells develop into several distinct type in:

A. Spleen

B. Bone marrow

C. Thymus

D. Lymph node

7- Mrs. Hanna is a 42-year-old woman who has breast cancer metastatic to bone and liver. Her pain has
been well controlled on sustainedrelease morphine, 120 mg PO bid, for 3 months. Which of the
following is most likely to occur as a result of this treatment? xxxxxx

A. pharmacologic tolerance.

B. physical dependence.

C. respiratory depression.

D. psychological dependence.

8- coagulation basic tests. which parameters indicate intrinsic pathways :

A. PT by quick method.

B. fibrinogen.

C. INR.

D. aPTT

9- low erythropoietin is characteristic for:

A- Policytemia Vera
B- B12 deficiency anemia
C- Secondary erythrocytosis
D- Iron deficiency anemia
10- which parametes are used for screening and monitoring of diabetes mellitus?
a. total cholesterol
b. INR
c. HbA1c
d. RBC
11- Which one of the following is true regarding lung cancer:

a) Adenocarcinomas tend to grow quickly.

b) 5% of patients with lung cancer present with, or develop complications of nonmetastatic

paraneoplastic syndromes.

c) Syndrome of inappropriate antidiuretic hormone (SIADH) is associated with hypernatraemia.

D) 80-90% of small cell carcinomas have spread beyond the thorax at the time of diagnosis.

12- Pharmacologic tolerance develops to all of the following side effects of opioid analgesics except:

a. respiratory depression

b. sedation

c. nausea

d. Constipation

13- MCV and RDW are indicating on pathology of:

A. PLT.

B. NEUTROPHILS.

C. RBC.

D. EOSINOPHILS.

14- what is the INR?

A. ACTIVATED PARTIAL THROMBOPLASTIN TIME.

B. Thrombin time.

C. International normalized ratio.

D. Prothrombin activity by index.

15- Which of the following is not necessary when a patient first presents with a breast lump

A. Examination of axillary lymph nodes

B. Chest x – ray.

C. Examination of breasts with patient supine

D. Fine needle aspiration ( FNA )

16- What is polyuria:

A. 1780 mL/day. B. 2500 mL/day. C. 200 mL/day. D. 560 mL/day.

17- in FBC got leukopenia with monocytosis, lymphocytosis, neutropenia. What process is
indicated?
a. fungal infection

b. virul infection
c. systemic disease
d. bacterial infection
18- The nonopioid analgesics that characterize step 1 of the WHO ladder (acetaminophen, NSAIDs) all h
moderate to maximal doses to achieve optimal efficacy quickly.

A. True for only for nociceptic pain

B. True for all cases

C. True, but not for geriatric cases

D. True for only for cases with mixed pain

19-- What you can be the cause….?

A. Clumps;

B. Increase number of large PLT;

C. Schistocytes or microcytic RBCs;

D. EDTA-induce thrombocytopenia;

20- Mr. Martin has locally advanced transitional cell cancer of the bladder with chronic pelvic and
abdominal pain. Which of in determining the maximum dose of oral morphine during dose titration?

A. respiratory depression

B. strength of pill

C. pain relief.

D. risk of overstepping regulatory limits

21-- Which of the following is a rare site of breast cancer metastases?

A. Liver

B. Brain

C. Kidney D. Bone
22- iron absorption is increased in the presence of

a. vitamin b

b. vitamin c

c. vitamin d

d. vitamin a

23- For each breakthrough dose:

A. offer 1% to 5% of the total 24-hour dose of opioid at a frequency equal to Cmax for the choser

B. offer 20% of the total 24-hour dose of opioid at a frequency equal to Cmax for the chosen route

C. offer 5% to 15% of the total 24-hour dose of opioid at a frequency equal to Cmax for the chosen route
of administration.

D. offer 25% of the total 24-hour dose of opioid at a frequency equal to Cmax for the chosen route

24- As regards prognosis of NSCLC:

A. stage II disease is associated with 5 year survival rates of 50%

B. stage IV disease is associated with 5 year survival rates of 8%

C. stage Illa disease is associated with 5 year survival rates of 40%

D. stage I disease is associated with 5 year survival rates of 60-80%

25-Mature T cells marker is :

A. CD20.

B. CD117.

C. CD4. Aw CD8 badal 4

D. CD30.

26- Neuropathic pain is:

A. Usually treated with anti- inflammatory agents.

B. A result of disorderd nerve function.

C.Due to direct stimulation of intact not.

D. Rarely responsive to opioid analgesics.

27- The mixed opioid agonist-antagonists, such as pentazocine, butorphanol, nalbuphine, and dezocine,
should not be used in the patient already taking a pure agonist opioid as there is a high risk they will
precipitate withdrawal.

A. only for delirious patients

B. not true

C. true

D. for moderate to severe pain

28- Specific symptom of AML is

a. Fatigue

b. No specific symptoms

c. Weight loss

d. Fever

29-There is no reason to delay the use of analgesics while diagnosing and treating the underlying cause
of the pain:

A. True only for chronic pain.

B. True.

C. False.

D. Not always.

30- Which one of the following statements is true of surgery for non - small cell lung cancer ( NSCLC ) ?

a) Pneumonectomy is the most commonly performed operation

b) Surgery offers the best chance of cure.

c) About 30 % of patients are suitable for resection at diagnosis.

d) Post - operative mortality rate is approximately 10 %.

31- The route of administration for strong opioids is preferable for chronic pain management is:

A. IV

B. PO

C.IM

D. SC
32- If pain remains uncontrolled after 24 hours:

A. never increase the routine dose, rescue medication used during the previous 24 hours by 10 to 15%;

B. increase the routine dose by an amount at least equal to the total dose of rescue medication used
during the previous 24 hours and rotate the medication another opioid;

C. never increase the routine dose, stop medications and try the non pharmacology intervention;

D. increase the routine dose by an amount at least equal to the total dose of rescue medication used
during the previous 24 hours, or by 25% to 50% for mild to moderate pain, and 50% to 100% for severe
to uncontrolled pain

33- In treatment of metastatic breast cancer ?

a) bisphosphonates are used to control hypocalcaemia .

b) chemotherapy is superior to endocrine therapy.

c) responses to endocrine therapy tend to occur within 2 months of starting treatment .

d) trastuzumab ( herceptin ) in combination with chemotherapy improves survival in patients who have
tumours that overexpress HER 2.

34- What parameters indicate anemia?

A. RBC;

B. RBC, Hb, Hct, PLT;

C. RBC, Hb, Hct;

D. WBC;

35- main function of basophil is:

a. releases clotting factor

b. carry out allergic reactions

c. carry out acquired immune response

d. carry out inherited immune response

36- what of sample type are used to determine the concentration of glucose:

a. whole blood

b. capillary blood

c. plasma

d. serum
37- Auer rods are characteristic for:

a. Acute Myeloblastic Leukemia

b. Acute Lymphoblastic Leukemia

c. Chronic Myeloid Leukemia

d. Chronic Lymophoid Leukemia

38- What the WBC (leukocytes) indicate:

A. control of platelet plug formation.

B. they release chemicals from their granules that destroy pathogens; they are also capable of
phagocytosis. The monocyte an agranular leukocyte, differentiates into a macrophage that then
phagocytizes the pathogens.

C. pick up inhaled oxygen from the lungs and transport it to the body's tissues.

D. secrete a variety of growth factors essential for growth and repair of tissue, particuraly connective
tissue.

39-Which of the following are good prognostic factors in breast cancer?

a. HER 2 receptor overexpression

b. Grade III tumour

c. Lymph node involvement

d. Oestrogen receptor positivity

40- aplastic anemia is a condition where:

a. there is deficiency of iron

b. red blood cells are destroyed very fast in the circulation

c. there is deficiency of vitamin B12

d. the bone marrow does not produce enough blood cells

41. which blood cell can be described as being a biconcave disc?

a.Erythrocyte

42. which parameter in urine test indicates infection?

a. leucocytes , nitrite
HEMATOLOGY
1- A high reticulocyte count with low RBCs, low haemoglobin and low hematocrit indicate:

a. Iron deficiency anemia

b. Bleeding or hemolysis

c. Bone marrow failure

d. Aplastic anemia

3- A lack of which of these will result in abnormally large red blood cells and a condition called
megaloblastic anemia

a. Oxygen

b. Carbon dioxide

c. Vitamin C

d. Vitamin B-12 and folic acid

4- Stage I Non - hodgkins lymphopma is :

a. Lymphoma either in organs outside the lymphatic system or in the bone marrow

b. lymph nodes affected on both sides of the diaphragm

c. Two or more groups of lymph nodes affected on the same side of the diaphragm

d. Only one group of lymph nodes affected anywhere in the body

4- Stage II Non – Hodgkin’s lymphoma is :

a. lymph nodes affected on both sides of the diaphragm ;

b. Only one group of lymph nodes affected anywhere in the body ;

c. Lymphoma either in organs outside the lymphatic system or in the bone marrow

d. Two or more groups of lymph nodes affected on the same side of the diaphragm

9- Stage IV Non - hodgkins lymphopma is :

a. Two or more groups of lymph nodes affected on the same side of the diaphragm

b. Only one group of lymph nodes affected anywhere in the body

c. Lymphoma either in organs outside the lymphatic system or in the bone marrow

d. lymph nodes affected on both sides of the diaphragm

11- Stage Ill Non - hodgkins lymphopma is:

a. lymph nodes affected on both sides of the diaphragm

b. Only one group of lymph nodes affected anywhere in the body

c. Two or more groups of lymph nodes affected on the same side of the diaphragm

d. Lymphoma either in organs outside the lymphatic system or in the bone marrow

5- Differential Diagnosis of Aplastic anemia should be done except :

a. Acute leukemias

b. Primary myelofibrosis

c. Iron deficiency anemia

d. Megaloblastic anemia

6- What may be felt in the neck or under the arms in a person with non - hodgkins lymphoma ?

a. Pain and stiffness

b. Muscle tension

c. Excessive sweating

d. Swollen lymph nodes

7-Hodgkin’s lymphoma can be except:

a. Lymphocyte rich

b. Follicular

c. Nodular sclerosis

d. Mixed cellularity

8- In the breakdown of RBC bilirubin is:

a. Oxidized to bilverdin

b. Excreted

c. Returned to the pool

d. Reused by new red cell

10- Where does non - Hodgkin lymphoma originate ?

a. In the colon

b. In the limbic system

c. In the alimentary canal d. In the lymphatic system

12- Megaloblastic anemia is suspected in anemic patients with:

a. Microcytosis and pancytopenia

b. Hypochromia and leukopenia

c. Macrocytosis and pancytopenia

d. Normochromia and thrombocytopenia

13- lymphoma belongs to:

a. Solid tumors

b. Membranopathies

c. Lymphoproliferative disease

d. Myeloproliferative disease

15- Which of the following is a possible sign or symptom of non - Hodgkin lymphoma?

a. fever

b. Night sweats

c. All of the answers are possible signs or symptoms

d. Fatigue

16- The cells that carry out acquired immune response are

a. Platelet

b. Granulocyte Neutrophils

c. B Lymphocytes

d. Eosinophils

17- Posthemorrhagic anemia can be:

a. Acute and Chronic

b. Regenerative

c. Autoimmune haemolytic d. Deficiency

18- Anemia by the color index can be:

a. Hypochromic

b. Microcytic

c. Normocytic

d. Regenerative
19- For iron deficiency anemia is not right:

a. Can cause neurological symptoms

b. Treatment is iron supplements

c. Is Hypochromic Microcytic anemia

d. It is absorbed in duodenum and small intestine

20- Diffuse large B cell lymphoma belongs to:

a. Aggressive lymphoma

b. Hodgkins lymphoma

c. Very aggressive lymphoma

d. Indolent lymphoma

21- Reed-Sternberg cells are present:

Select one

a. Hodgkin’s lymphoma

b. Non-Hodgkin’s lymphoma

23- Which translocation is typical for Chronic myeloid leukemia:

a. MLL-AF4

b. E2A-PBX1

c. PLM-RARA

d. BRC-ABL

24- If the patient has extremely low levels of B12 in the body, what could happen?

a. Severe rages

b. Liver cancer

c. Stomach cancer

d. Mental confusion and dementia

25- Isoimmune hemolytic anemia is caused by:

a. When antibodies from mother who is suffering from autoimmune haemolytic anemia passes fetus
blood stream b. Transfusion of no compatible blood group

c. Antibody is produced against foreign antigens, it can be chemical , virus , bacteria and so on

d. When antibodies are produced against own erythrocytes

27- Which of the following is a good prognostic indicator in acute lymphoblastic leukemia?

a. B-lineage immunophenotype

b. CNS involvement

c. Age ˂ 1

d. A WBC ˃ 20,000

28- Primary lymphoid organs are:

a. Thymus gland

b. Bone marrow

c. Both

d. None of them

29- A 60-year-old man presents with headaches and anaemia. Investigations reveal an IgM paraprotein
of 30 g/L . What is the most likely diagnosis?

a. Waldenstrem macroglobilinemia

b. Mycosis fungoides

c. Follicular lymphoma d. Burkitt’s lymphoma

30- Erythropoietin is secreted by:

a. Bone marrow

b. Hupophysis

c. Kidney

d. Adrenal gland

31- Granulocytes are all except:

a. Basophill b. Platelet c. Eosinophill d. Segmented Neurophils

32- Which of the following is a bad prognostic indicator in acute myeloid leukemia :

a. Normal cytogenetics

b. ˃3 clonal chromosomal abnormalities

c. Rapid response to therapy

d. No CNS involvement

33- Mature B cells are:

a. Plasma cell b. Cd4+ lymphocyte c . Mast cell d. Cd8+ lymphocyte

34- Tear-drop shaped erythrocytes are characterstics for:

a. Primary Myelofibrosis

b. Thalassemia

c. Multiple Myeloma

d. Hodgkin’s Lymphoma

35- Hiatus Leukemicus is typical for:

a. Multiple myeloma

b. Chronic Leukemias

c. Myeloprolypherative disorders

d. Acute leukemias

38- M0 type of AML by FAB classification is:

a. Acute promyelocytic leukemia

b. Undifferentiated acute myeloblastic leukemia

c. Myelomonocytic

d. Megacarioblastic

39- CML means

a. All above b. Chronic Myeloid Leukemia

c. Chronic Megacaryoblastic Leukemia d. Chronic Myeloblastic Leukemia

40- Myloprolypherative disorders include:

a. Essential Thrombocythemia for the platelets

b. Polycythaemia vera ‘PRV’ in RBC

c. Primary Myelofibrosis

d. All above

41- A person can develop iron-deficiency anemia despite eating food that contains adequate iron :

a. True

b. False

42- Lymphocytosis can be caused by:

a. Autoimmune disorders b. Myelodysplastic syndrome

c. Acute viral infections d. Immune deficiency

43- Non-Hodgkin lymphoma:

a. Mixed cellularity

b. Lymphocyte rich

c. Follicular

d. Nodular sclerosis

44- In warm antibody haemolytic anemia antibodies are mostly:

a. IgE

b. IgG

c. IgD

d. IgM

45- The hemoglobin types found in a normal adult are:

a. A , A2 ; F

b. A2 , F

c. A , A2 , C

d. S , A , F

47- Secondary lymphoid organs are:

A. Lymph nodes

B. Spleen

C. All above

D. Lymphoid tissues

49- Anemia due to deficiency of iron or vitamin B12 can be differentiated based on the examination of
the blood cells:

A. True.

B. False.
LABORTATORY MEDICINE
1- Hyperglycemia. At what concentration of glucose can we talk about hyperglycemia?

A. 4.89 mmol/L;

B. 5.1 mmol/L;

C. 3,5;

D. ≥ 6.1mmol/L;

2- which test is used for diagnosis of hiv infection in children younger than 18 months?

a.hiv western blot

b.hiv ag/ab

c.anti-hiv

d.hiv pcr

3- Which test is the new gold standard for diagnosis of viral infections?

A. viral antigen detection

B. viral culture

C. ELISA

D. Nucleic acid testing (PCR)

4- Reticulocytes are

A. immature red cell that contain RNA

B. immature monocytes that contain RNA

C. immature lymphocytes that contain RNA

D. immature eosinophils that contain RNA

5- The most commonly ordered and most specific marker of heart damage which is positive within a few
hours of damage and remains elevated for up to two weeks is

A. Creatine Kinase B. Cardiac troponin C. AST D. Myoglobine

6- What is pancytopenia?

A. Decreased RBCs

B. Decreased PLTS

C. Decreased WBCs, RBCs and PLTS

D. Decreased WBCs 34.

7- The preferred initial test for thyroid disorders is :

A. T4 test

B. TSH test

C. T3 test

D. Free T4

8- Erythropoietin stimulates production of

Select one: 2

A. Granulocyte;

B. Platelet

C. Lymphocyte

D. Red blood cell;

9- Which dietary component(s) is/are needed for DNA synthesis, and thus greatly influence the
production of red blood cells:

A. Calcium;

B. Vitamin B12 and folic acid;

C. Protein;

D. Iron;

10- Which test is considered to be the most specific test for identifying iron deficiency anemia, unless
infection or inflammation are present?

Select one:

A. ESR

B. CBC

C. Ferritin

D. Reticulocyte count

11- Anemia arises due to deficiency of:

A. Iron;

B. Folic acid;

C. All of the above;

D. Vitamin B12;
12- Full Blood Count (FBC) - test evaluates:

A. Kidney function;

B. Infectious disease;

C. Liver function;

D. The general condition of the body, with pathological changes in the blood, requires additional studies;

16- Which additional parameters will help us make a more accurate diagnosis?

A. Transferrin saturation,

B. Iron, serum

C. Vitamin B12

D. Glucose concentration."

E. C and D.

17- How to calculate INR?

A. (PT patient/PT control plasma) ISI.

B. PT patient-PT control plasma.

C. PT patient ISI.

D. PT patient/PT control plasma.

19- …..about what pathology we can think?

A. Pernicious anemia.

B. Iron deficiency anemia.

C. Aplastic anemia. D. Hemolytic anemia.

20- which of the following signifies anemia:

A. A low hemoglobin level.

B. A low platelet level.

C. A low white blood cell count.

D. A low sodium level.

21- what parameters indicate anisocytosis:

A. WBC. B. RDW. C. MCV. D. MCH.

22- what is oligouria:

A. 780 ml/day. B. 2200 ml/day. C. Less than 500 ml/day. D. Less than 100 ml/day.
24- a chosen concentration (mg/L) of an antibiotic which defines whether a species of bacteria is
susceptible or resistant to the antibiotic:

A. A breakpoint.

B. Cut off value.

C. Sensitivity. D. Minimum inhibitory concentration (MIC).

24- concentration of antibiotic that inhibits the visual growth of an organism in an vitro system is:

a. minimum inhibitory concentration(mic)

b. sensitivity

c. cut off value

d. a breakpoint

25- Variation in erythrocyte shape is called?

A. spherocytosis

B. anisocytosis

C. anisochromia

D. poikolocytosis.

25- The presence of hypochromic and normochromic cells in the same film is called :

A. spherocytosis.

B. anisocytosis.

C. anisochromia or dimorphic anemia.

D. poikolocytosis.

26- In which phase of laboratory testing do the most errors occur ?

A. postanalysis

B. all are correct

C. preanalysis. D. analysis

27- The yellow color of urine is due to:

A. transferin

B. hemoglobin

C. urobilin.

D. Bilirubin.
28- Normal pH range for urine is:

A. 5.4-7

B. 4.5-9

C. 4.6–8

D. 3.5-6

29- Which is the example of organism in BSL3?

A. Staphylococcus

B. HIV

C. Ebola.

D. TB.

35- Which is the example of organism in BSL 4 :

A. Staphylococcus

B. HIV.

C. TB.

D. Ebola.

30- The mean and normal range of Hemoglobin for an adult male ?

A. 15.7 ( 14.0-17.5 ) g / dL.

B. 13.0 ( 12.0-14.0 ) g / dL

C. 13.0 ( 11.0-15.0 ) g / dL

D. 17.0 ( 16.0-18.0 ) g / dL

31- Plasma is about 45 % of the total blood volume?

A. True.

B. False.

32- Patient with diabetes mellitus have urine with?

A. Increased volume and decreased specific gravity.

B. Decreased volume and decreased specific gravity.

C. Decreased volume and increased specific gravity.

D. Increased volume and increased specific gravity.

33- Select the statement about red blood cells that is incorrect:

A. Mature red blood cells lack nuclei

B. Red blood cells lack mitochondria

C. Deoxyhemoglobin carries oxygen.

D. Red blood cells contain hemoglobin.

34- The type of white blood cell that often arrives at the site of infection first, is a granulocyte, and
contains granules that stain light purple is a?

A. Monocytes.

B. Neutrophils.

C. Basophils.

D. Eosinophils.

36- Normal value for INR in healthy people is?

A. 2.5 or below.

B. 4.5 or below.

C. 1.1 or below.

D. 1.5 or higher.

36- Normal value of serum anion gap is about:

a.25mmol/L

b.12mmol/L

c.120mmol/L

d.4mmol/L

37- which test is used to screen for neural defects such as spina bifida ?

A. Hcg. B. AFP. C. progesterone. D. estradiol.

38- Which pattern is characteristic for hyperthyroidism?

A. T3-normal, T4-normal, TSH-low.

B. T3-high or normal, T4-high or normal, TSH-low.

C. T3-high, T4-high, TSH-high.

D. only T4-high.
82-which pattern is characteristic for hypothyroidism?

a.t3 normal, t4 normal, tsh low

b.t3 high, t4 high, tsh high

c.t3 low or normal, t4 low, tsh high

39- Positive results for both CCP antibody and RF, means ?

A. most likely a patient has lupus.

B. a patient has osteoarthritis.

C. it is very likely that a patient has RA.

D. a patient does not have RA.

39- Negative results for both CCP antibody and RF, means ?

a. most likely a patient has lupus.

b. a patient has osteoarthritis.

c. it is less likely that the person has RA.

d. it is very likely that a patient has RA.

40- In MTB testing culture Negative is reported after?

A. six weeks.

B. four weeks.

C. two weeks.

D. one week.

41- Normal range of hematocrit (Hct) for an adult male is ?

a. 41-51%

b. 61-71%

c. 51-61%

d. 71-81%

42- Hematocrit (Hct) is ?

a. the average concentration of HB in a given volume of packed red cell.

b. the ratio of the volume of erythrocytes to the whole blood.

c. the content of haemoglobin inside a single red cell.

d. the average volume of a single red cell.

43- Polyuria is ?

a. production of more than 2000 ml of urine in 24 hrs.

b. production of more than 1000 ml of urine in 24 hrs.

c. production of more than 800 ml of urine in 24 hrs.

d. production of more than 1500 ml of urine in 24 hrs.

44- Shortened aPTT tests may be due to ?

a. Von Willebrand disease.

b. Disseminated intravascular coagulation (DIC).

c. lack of vitamin K.

d. haemophilia A and B.

61- Prolonged aPTT tests may be due to ?

a. extensive cancer.

b. disseminated intravascular coagulation (DIC).

c. an acute phase reaction.

d. Von Wilebrand disease.

45- The term primary hemostasis refers to ?

a. all answers are correct.

b. platelet reactivity at the site of injury.

c. the cascade of enzymatic reactions that results in the conversion of fibrinogen to fibrin monomers.

d. all answers are wrong.

45-The term secondary hemostasis refers to ?

a. all answers are wrong. b. all answers are correct.

c. platelet reactivity at the site of vessel injury.

d. the cascade of enzymatic reactions that results in the conversion of fibrinogen to fibrin monomers.

46- Lymphopenia can be caused by?

a. acute viral infections.

b. lymphocytic leukemia.

c. HIV.

d. lymphoma.
47- the blood urea nitrogen or BUN test is primarily used ?

a. to evaluate heart injury.

b. to evaluate liver function.

c. to evaluate kidney function.

D. to rule out diabetes.

48- Hemoglobin A1c (HbA1c) test evaluates ?

A. haemoglobin concentration over the past 6 monthes.

b. haemoglobin concentration over the past 1 month.

c. the average amount of glucose in the blood over the past 2 to 4 months.

d. the average amount of glucose in the blood over the past 1 month.

50- Mean cell haemoglobin concentration (MCHC) is ?

a. the average volume of a single red cell.

b. the average concentration of Hb in a given volume of packed red cells.

c. the ratio of the volume of erythrocytes to that of the whole blood.

d. the content (weight) of Hb inside a single red cell.

51- Mean cell volume (MCV) is ?

a. the average volume of a single red cell.

b. the ratio of the volume of erythrocytes to that of the whole blood.

c. the average concentration of Hb in a given volume of packed red cells.

d. the content (weight) of Hb inside a single red cell.

52- The mean normal range for platelet count is ?

a. 311 (172-450) × 1012/L.

b. 250 (150-350) × 109/L.

c. 311 (172-450) × 109/L. d. 250 (150-350) × 1012/L.

54- Initial screening for coronary risk panel may involve ?

A. only a LDL test and not a full lipid profile.

b. only a single test for total cholesterol and not a full lipid profile.

c. only a HDL test and not a full lipid profile.

d. full lipid panel should be used.

55- Reference intervals or "normal range" are defined as the range of values into which ?

a. 100% of nondiseased ("normal") individuals will fall.

b. 95% of nondiseased ("normal") individuals will fall.

c. 75% of nondiseased ("normal") individuals will fall.

d. 50% of nondiseased ("normal") individuals will fall.

56- Refractory periodontitis?

a. develops due to a complete remission after therapy, followed by recurrence of the disease as a result
of reformation of plague, and calculus.

b. periodontitis unresponsive to any treatment provided.

57- Which is the lipid profile test ?

a. creatinine.

b. cholesterol total, HDL-cholesterol, LDLcholesterol, VLDL-cholesterol, triglycerides.

c. HbA1c.

d. total bilirubin.

59- the ability of a test to discriminate disease from no disease is described by ?

a. positive predictive value.

b. sensitivity and specificity of the test.

c. specificity of the test.

d. sensitivity of the test.

62- excretion of more than 4 g/day protein in urine is ?

a. minimal proteinuria.

b. heavy proteinuria.

c. normal value.

d. moderate proteinuria.

63- "Schuffner's granules" are characteristics of ?

a. malaria.

b. megaloblastic anemia.

c. iron deficiency anemia.

d. pernicious anemia.
64- a normal eGFR for adults is ?

a. greater than 90 mL/min/1.73m2

b. greater than 70 mL/min/1.73m2

c. greater than 50 mL/min/1.73m2

d. greater than 35 mL/min/1.73m2

65- creatinine is a waste product produced by ?

a. liver.

b. kidneys.

c. muscles.

d. heart.

65- Urea is a waste product formed in

A. muscles

B. liver

C. heart

D. Kidneys

66- Fasting plasma glucose level < 100 mg/dl (< 5.6 mmol/L) ?

a. is a normal value.

b. indicates diabetes mellitus.

c. indicates prediabetes.

d. indicates gestational diabetes in pregnant women.

66- fasting plasma glucose level more than 126 mg/dL (more than 7mmol/L) indicates ?

a. indicates diabetes mellitus.

b. is a normal value.

c. indicates prediabetes. d. indicates gestational diabetes in pregnant women.

67- healthy adults with no other risk factors for heart disease should be tested with a fasting lipid panel :

a. there is no need for lipid testing in this population.

b. once every four to six years.

c. once every two years.

d. once a year.
68- In hypochromia :

a. MCH and MCHC are usually decreased.

b. MCH and MCHC do not change.

c. MCH decreases but MCHC does not change.

d. MCH and MCHC are usually increased.

69- the mean and normal range for white blood cell count is :

A. 11.5 (8.5-14.5) x 1012/L

B. 11.5 (8.5-14.5) x 109/L

C. 7.8 (4.4-11.3) x 109/L

D. 7.8 (4.4-11.3) x 1012/L

70- circle the correct answer :

A. precipitation immunoassays use radioisotopes as labels.

B. precipitation immunoassays provide the simplest method for antigens and antibodies to react with
each other using inert particles as labels.

C. precipitation immunoassays provide the simplest method for antigens and antibodies to react with
each other without involving the detection of any labels.

D. precipitation immunoassays use inert particles as labels.

71- In congenital viral infection :

A. maternal IgA and IgM antibodies passively transfer across the placenta into the fetal circulation.

B. maternal IgG antibodies do not passively transfer across the placenta into the fetal circulation.

C. maternal IgM antibodies passively transfer across the placenta into the fetal circulation.

D. maternal IgG antibodies passively transfer across the placenta into the fetal circulation.

72- A very high level of ALT is frequently seen with :

A. people with blocked bile ducts. B. liver cancer. C. cirrhosis. D. acute hepatitis.

73- Gross hematuria is :

A. presence of an increased number of red blood cells in urine visible to the naked eye.

B. presence of free hemoglobin in urine.

C. presence of 3 or greater red blood cells in urine per high-powered field.

D. all answers are wrong.

75- Based on cytochemistry myeloblasts are positive for :

A. glycogen.

B. acid phosphatase.

C. MPO.

D. nonspecific esterase.

78- Nocturia is:

A. excretion of more than 400 mL of urine at night with specific gravity <1.010

B. excretion of more than 1500 mL of urine at night with specific gravity <1.018

C. excretion of more than 500 mL of urine at night with specific gravity <1.018.

D. excretion of more than 1000 mL of urine at night with specific gravity <1.018

79- The specific gravity of a specimen indicates:

A. both answers are wrong.

B. both answers are correct.

C. the number of particles of solute per unit of solution.

D. the relative proportions of dissolved solid components to total volume of the specimen.

80- Osmolality of a specimen indicates:

A. the relative proportions of dissolved solid components to total volume of the specimen.

B. both answers are correct.

C. both answers are wrong.

D. the number of particles of solute per unit of solution.

81- Which is the most accurate "gold standard" test in diagnosing MTB:

A. serology.

B. molecular testing.

C. AF staining. D. culture.

82- Circle the correct statement:

A. up to 2 mg/dL acetoacetic acid in urine is normal.

B. up to 20 mg/dL acetoacetic acid in urine is normal.

C. up to 50 mg/dL acetoacetic acid in urine is normal.

D. normally there is no acetoacitic acid in urine.

83- Measuring potassium is especially important:

A. in diabetic patients.

B. when a patient has jaundice.

C. all answers are wrong.

D. when there are symptoms involving the heart.

84- in FBC got leukocytosis with neutrophilia, left shift. what process is indicated:

A. acute bacterial infection.

B. hepatitis of C.

C. viral infection.

D. diabetes mellitus.

86- A relative increase of leukocytes is:

A. an increase in percentage and absolute concentration.

B. an increase only in lymphocyte concentration.

C. an increase in absolute concentration.

D. an increase in percentage only

86- If the platelet count is normal:

A. about 10 platelets are found per 10-30 red cell.

B. about one platelet is found per 10-30 red cell.

C. no single platelets is found per 10-30 red cell.

D. about one platelet is found per 100 red cells.

88- Microbes in BSL 1 :

A. pose a moderate hazard to personnel and the environment.

B. are not known to consistently cause disease in healthy adults and present minimal potential hazard to
personnel and the environment.

C. are very easily transmitted and cause serious or fatal disease for which there are no vaccines or
treatments.

D. can cause serious or potentially fatal disease through inhalation.

Microbes in BSL 2 :

A. pose a moderate hazard to personnel and the environment.

B. are not known to consistently cause disease in healthy adults and present minimal potential hazard to
personnel and the environment.

C. are very easily transmitted and cause serious or fatal disease for which there are no vaccines or
treatments.

D. c. can cause serious or potentially fatal disease through inhalation.

Microbes in BSL 3 :

A. are not known to consistently cause disease in healthy adults and present minimal potential hazard to
personnel and the environment.

B. pose a moderate hazard to personnel and the environment.

C. can cause serious or potentially fatal disease through inhalation.

D. are very easily transmitted and cause serious or fatal disease for which there are no vaccines or
treatments.

Microbes in BSL 4 :

A. are not known to consistently cause disease in healthy adults and present minimal potential hazard to
personnel and the environment.

B. pose a moderate hazard to personnel and the environment.

C. can cause serious or potentially fatal disease through inhalation.

D. are very easily transmitted and cause serious or fatal disease for which there are no vaccines or
treatments.

89- Differential leukocyte count is:

A. ratio of leukocytes to thrombocytes.

B. percentage distribution of the different types of leukocytes.

C. all answers are wrong.

D. ratio of leukocytes to erythrocytes.

90- eGFR should be calculated:

A. every time a creatinine blood test is done.

B. only in patients on dialysis.

C. every time basic examination of urine is done.

D. with CBC test

91- red blood cells survive around ______days :

A. 10.

B. 120.

C. 360.

D. 240.

92- Patient has HBsAg (-), anti-HBc (-), anti-HBs (+). Patient is:

A. chronically infected.

B. acutely infected. C. immune due to natural infection. D. immune due to hepatitis B vaccination.

93- Specific IgM is usually found in blood within the:

A. few hours after infection.

B. first week of primary infection and typically becomes undetectable within 1 to 3 monthes.

C. all answers are wrong.

D. after 6 months of primary infection.

96- How do transferring level and total iron binding capacity (TIBC) change in iron deficiency anemia?

A. transferring level and TIBC are high.

B. transferring level and TIBC do not change.

C. all answers are wrong.

D. transferring level and TIBC are low.

98- Progenitor cell for platelets is:

A. Megalocyte.

B. Erythroblast.

C. Megakaryocyte.

D. Megaloblast.

99- How to use glycohemoglobin parameters:

A. Gestational diabetes.

B. Further evaluation of borderline elevations of fasting or post prandial blood sugar.

C. The amount of glycosylation is determined by glucose concentration present over the two or three
months before obtaining the plasma sample.

D. Oral glucse tolerance test.

ONCOLOGY
2- Which one of the following best describe follicular carcinoma of the thyroid?

a. High risk spread to liver

b. Associated with poor prognosis

c. Best treated with surgery and radioisotope therapy

d. Rapidly growing

3- a 45 years old man has a positive stool guaiac test during a routine physical examination. A
colonoscopy is performed and a 0.9 cm circumscribed, pedunculated mass on a short stalk is found in
the upper rectum. Which of the following terms best describes this lesion?

A. Hamartoma.

B. Adenoma.

C. Choristroma.

D. Hyperplasia.

4- Which of the following is associated with the highest risk of breast cancer?

A. Nulipanty

B. Dense breasts on mammogram

C. Postmenopausal estrogen plus progestin therapy

D. Postmenopausal obesity

5- A 53-year-old woman presents with a palpable mass in the upper outer quadrant of her left breast.
Breast imaging confirms the presence of a 2.0-cm mass, and a core needle biopsy finds invasive ductal
carcinoma, grade 3, ER < 5%, PR < 5%, HER2 IHC 0. She proceeded with breast conserving surgery and a
sentinel lymph node biopsy. Pathology showed a 2.2-cm invasive cancer with negative margins. A total
of two sentinel lymph nodes were recovered, one of which contained a 0.8-cm macrometastasis.
Adjuvant chemotherapy and radiotherapy are planned. What is the preferred next step in locoregional
management?

A. Completion axillary lymph node dissection

B. Completion mastectomy with axillary lymph node dissection

C. Completion mastectomy

D. No further axillary surgery

E. Ultrasound of the axilla to evaluate for residual disease

6- in cancer of the ovary which of the following is true?

A. The level of CEA is used to monitor response

B. Teratomas are usually malignant

C.Common types are cystic

D. The common histology is a squamous carcinoma

E.Blood-borne spread is an early feature

7- Which of the following statements is/are CORRECT regarding molecular abnormalities observed in
lung cancer?

A. C-Kit expression is seen in most NSCLCS

B. Chromosome 3p allele loss is one the most common events in lung cancer pathogenesis

C. all given options are correct

D. Chromosomal translocations seen in NSCLC

8- Which of the following statements is correct regarding pulmonary carcinoid tumors?

A. Adjuvant chemotherapy is the standard of care following complete surgical resection

B. Surgery has a curative potential for resectable localized tumors.

C. Most pulmonary carcinoids are atypical carcinoids

D. Patients usually present with carcinoid syndrome.

9- Which of the following is true of cancer of the cervix?

A. Surface ulceration is common

B. Lymph node spread is rare

C.The common form is an adenocarcinoma

D. The usual path of spread is into the uterine cavity

E.Squamous cancers typically arise from the endocervical canal

10- A 55-year-old man with a 30 pack-year history of smoking, presents to the emergency room with
shortness of breath. Chest radiograph demonstrates a right upper lobe opacity. Computed tomography
scan reveals a 3.5-cm spiculated mass in the peripheral right upper lobe, which is suspicious for
malignancy, without any hilar or mediastinal lymphadenopathy. What is the next best step in
management?

A. Brain MRI B. Refer to thoracic surgeon for resection.

C. CT-guided biopsy of the mass D. Bronchoscopy and biopsy of the mass

11- Which of the following parts of pancreas is most common site for cancers?

A. Head of pancreas

B. Body of pancreas

C. Tail of pancreas D. Diffuse

12- Which three of the following are true in the treatment of endometrial cancer?

A. Hormone replacement therapy should be encouraged after treatment

B. Radiotherapy is not useful as the cancer is radioresistant

C. Advanced disease may respond to antioestrogen therapy

D. Most cases are cured after radical hysterectomy

E. Chemotherapy is effective for advanced disease

13- Which of the following increases the risk of a woman developing ovarian cancer?

A. Nulliparity

B. Use of oral contraceptives for >5 consecutive years

C. Tubal ligation

D. Breastfeeding

13- CA-125 is most useful in what aspect of ovarian cancer management?

A. Screening

B. Monitoring treatment

C. Diagnosis

D. Prediction of metastasis

15- A 28-year-old woman presented to her primary care doctor with a right breast mass that persisted
through three menstrual cycles. A mammogram was not interpretable due to dense breast tissue, and
an ultrasound showed a 2.5-cm breast mass with associated left axillary lymphadenopathy. A core
biopsy of the breast mass was obtained, showing invasive ductal carcinoma, grade 3, ER/PR negative,
HER2 2+ by immunohistochemistry, with a FISH ratio of 4.3 and a HER2 copy number of 9.5. She reports
a family history of breast cancer in a paternal aunt at age 35, a history of a brain tumor in that aunt's
child at age 10, and a history of a bone cancer in a paternal grandmother. She is referred for genetic
testing. What is the most likely genetic abnormality identified?

A. PALB2 mutation

B. BRCA2 mutation

C. P53 mutation D. APC mutation

16- Colorectal cancer:

A. most commonly occurs in the caecum.

B. is the most common cancer in the US and Western Countries.

C. is more common in males.

D. commonly arises from pre-existing adenomas.

17- Risk factors associated with colorectal cancer include which one of the following?

A. Chronic aspirin therapy

B. Low intake of dietary fibre

C. Low intake of red meat

D. Irritable bowel syndrome

18- Which one of the following is true regarding the management of NSCLC?

A. NSCLC is more chemosensitive than SCLC

B. 5 year survival rates of 15-20% have been reported in selected patients treated with chemo- and
radiotherapy

C. Adjuvant radiotherapy should be used in patients following surgical resection

D. Palliative radiotherapy is rarely used

19- Which one of the following statements is true of lung cancer?

A. Screening has proved beneficial

B. Most are small cell in type

C. Approximately 25% of lung cancers are large cell anaplastic in histological type

D. 80% are due to smoking

25- Characteristic presenting features of left sided colorectal tumours include:

A. foul smelling stools which are difficult to flush.

B. iron deficiency anaemia.

C. painless abdominal mass.

D. acute large bowel obstruction.

26- Which one of the following statements is true of systemic treatment of NSCLC?

A. Adjuvant platinum-based chemotherapy confers no survival benefit

B. EGFR-TKI have a higher chance of response in male smokers

C. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) such as erlotinib have proven
active in previously treated patients with advanced NSCLC

D. Chemotherapy has no effect on survival in advanced NSCLC

27- Which of the following statements is INCORRECT regarding large cell neuroendocrine tumors
(LCNEC)?

A. Paraneoplastic syndromes are commonly associated with LCNEC

B. LCNEC are treated in the same manner as NSCLC (non-small cell lung cancer), with the same
treatment algorithm, stage for stage

C. LCNEC are less chemosensitive than SCLC

D. Like SCLC (small cell lung cancer), LCNEC have an aggressive natural history and propensity to
metastasize

28- All of the following statements regarding ovarian cancer are true,EXCEPT

A. Mucinous tumor types are resistant to chemotherapy

B. Clear cell variant is associated with hypocalcema

C. Endometroid variants are sometimes associated with endometriosis

D. Immunostains on ovarian cancers positivee typical cytokerate 7 and cytokeratin 20 negative

29- Which of the following statements about HER2 is FALSE?

A. The addition of trastuzumab to chemotherapy in the adjuvant setting reduces the rate of recurrence
by over 50%.

B. All given options are false

C.Lapatinib is a strong HER inhibitor

D. HER2 signaling is effected through homodimer formation

30- Risk factors for the development of NSCLC (non small cell lung cancer) include:

A. Obesity.

B. Diet.

C. Occupational radon exposure.

D. Family hx. E. Genetic susceptibility.

31- which syndrome is characterized by the presence of breast cancer, soft tissue sarcoma, leukemia
and prostate cancer?

A. Ataxia telangiectasia.

B. Peutz-jeghers syndrome.

C. Li- fraumeni syndrome.

D. Cowden syndrome

33- Which of the following is the most common site of distant metastasis from head and neck cancers :

A. Bone

B. Liver

C. Lung.

D. Thyroid

34- Which one of the following symptoms is rare in patients with progressive lung cancer ?

a) Headache

b) Urinary retention

c) Haemoptysis d) Hypercalcaemia

38- Which of the following is true about head and neck lymph node levels :

a) Levels II to IV : internal jugular vein lymph nodes.

b) All of the above.

c) Level V : posterior triangle

d) Level I : submental and submandibular areas.

42- Which of the following is not an effective treatment of breathlessness associated with lung cancer?

a) Pleurodesis

B) Nebulised opioids

C) Regular doses of short acting oral morphine

D) Endobronchial stenting

43- Which one of the following statements is true of mesothelioma?

A. Incidence is decreasing, reflecting the ban on use of asbestos. B. The disease is more common in
females.

C. All deaths due to mesothelioma should be discussed with the coroner D. Radical surgery is the
treatment of choice.
46- features associated with poor prognosis in colorectal cancer Include?

A) Adenocarcinoma cell type.

B) Rectal bleeding at presentation.

C) Presence of involved lymph nodes.

47- Surgery for liver metastasis from colorectal cancer is?

A) Associated with a 10% mortality.

B) Contraindicated if more than 1 lesion is present.

C) Associated with 16-40% 5 year survival.

D) Usually followed with consolidation radiation.

49- which of the following is a feature of colorectal cancer?

A) In Duke’s A disease >90% patients are cured by surgery alone.

B) Distant metastasis are present in less than 5% of patients at presentation.

C) Chemotherapy has no effect on survival.

D) In Duke’s C disease.

50- Bevacizumab:

A) Is a monoclonal antibody that targets vascular endothelial growth factor (VEGF).

B) Is a monoclonal antibody that targets epidermal growth factor receptor (EGFR).

C) Has no proven survival benefit in the metastatic setting.

D) Is standard treatment for metastatic colorectal cancer in UK.

51- regarding metastasis from colorectal cancer and symptomatic management of them:

A) Liver metastasis are a rare feature.

B) Hyperproteinemia is common.

C) Liver capsular pain usually responds well to non-steroidal anti-inflammatory drugs.

D) Cerebral metastasis are common.

52- acute bowel obstruction in advanced colorectal cancer:

A) Is usually managed by surgery. B) Is usually caused by obstruction at a single site in the bowel.

C) Should be treated with regular oral antiemetics, analgesics and antispasmodics.

D) Should be treated with using a syringe driver containing a mixture of anti-emetics, analgesics and
anti-spasmodics.
53- which of the following are true of breast cancer?

A) The life time risk for a woman of developing breast cancer is 1/9.

B) For most women a specific cause of their breast cancer is known.

C) Prognosis is worse for affluent women.

D) Incidence of breast cancer is decreasing.

54- 30- risk factors for breast cancer Include?

A) Young age.

B) Young age at menopause.

C) Young age at first birth.

D) Young age at menarche.

55- the following statements regarding screening for breast cancer are correct?

A) Mammography is offered to all women between the ages of 50 and 75 years in the UK.

B) Studies have shown an approximately 30% reduction in mortality with screening using
Mammography.

C) Most radiographically suspicious lesions are subsequently confirmed as malignant.

D) Mammography is less sensitive in postmenopausal women.

57- which of the following statements is true of breast cancer treatment?

A) Mastectomy is superior to breast conserving surgery.

B) Chemotherapy can be used safely in the first trimester of pregnancy.

C) Radiotherapy should be given to all male breast cancer patients after Mastectomy.

D) Paget’s disease of the nipple should be treated with wide local excision.

58- which of the following statements is true of palliative treatment of metastatic breast cancer?

A) Hypercalcemia should be treated with increased oral fluids and oral bisphosphonates.

B) Increased back pain and weak legs requires prompt investigation.

C) Bisphosphonates are used in treatment of liver metastasis.

D) Neuropathic pain usually responds quickly to opioid analgesics.

59- Which of the following may lead to oral tongue cancers in individuals younger than 40 years of age:

A) TP53 (Li-Fraumeni syndrome). B) Fanconi anemia.

C) Familial atypical multiple mole melanoma (FAMMM) syndrome. D) All of the above
60- HPV-positive oropharyngeal cancers show improved response to therapy when compared to HPV-
negative cancers of the same site. HPV16 is responsible for what fraction of these patients.

a) 90%

b) 80%

c) 70%

d) 60%

61- HPV-positive cancers show improved response to therapy when compared to HPVnegative cancers
of which sites:

a) Oral cavity

b) Oropharynx

c) Nasopharynx

d) All of the above

63- Which of the following is a variant of squamous cell carcinoma of the head and neck region:

a) Lymphoepithelioma

b) Spindle cell carcinoma

c) Verrucous carcinoma

d) Undifferentiated carcinoma

e) All of the above

64- All of the following cancers have the tendency to spread to bilateral neck nodes except :

a) Tongue base

b) Soft palate

c) Nasopharynx

d) Hard palate

65- Which of the following head and neck region cancer has the highest risk of lymph node metastasis:

a) Salivary gland tumors

b) Sarcomas

c) Squamous cell carcinoma

d) All have similar risk

67- Panendoscopy is recommended for head and neck cancers because the risk of synchronous primary
cancers is the upper aerodigestive tract is:

a) 20%

b. <1%

c. 1- 10%

68- In the treatment of head and neck cancers, all of the following are advantages of surgery compared
with radiotherapy except:

a) More amount of tissue can be addressed with surgery

b) Surgery takes considerably less time

c) The toxicities inherent to radiation therapy can be circumvented

d) Radiation may salvage tumor recurrences not amenable to surgery

69- In the treatment of head and neck cancers, all of the following are advantages of radiation therapy
compared with surgery except:

a) Post procedural surgical complications may be avoided with radiation therapy

b) Radiation may result in better cosmetic outcomes as no tissue is actually removed

c) Elective radiation of neck is potentially a less morbid procedure than surgery

d) Salvage of a surgical failure with radiation is easier than salvaging a radiation therapy failure with
surgery.

70- Conventional radiation therapy in head and neck cancer primary site is once-daily fractionation, 66
to 70 Gy per fraction, 5 days a week. There are alternatives schedules available too, which of the
alternative schedules leads to survival benefit compared with conventional schedule:

a) Hyperfractionation

b) Concomitant boost schedule

c) Both of the above

d) Neither 1 nor 2.

71- Intensity-modulated RT (IMRT) provides a more conformal does distribution compared to

conventional techniques of RT and it reduces the does to the normal tissues. Which of the following is
not a disadvantage of IMRT:

a) It is more time consuming

b) Risk of late complications is increased on “hot spots”

c) The risk of marginal miss may be higher

d) The “beam on” time is decreased

72- Radical neck dissection is potentially a very morbid procedure. To avoid the complications associated
with it, while maintaining the good ontological outcome, modified radical neck dissections (MRND) are
performed. Which of the following is a type of MRND:

a) Type I : cranial nerve (CN) XI is spared

b) Type II : CN XI and internal jugular vein are spared

c) Type III : CN XI, the internal jugular vein, and the sternocleidomastoid muscles are spared

d) All of the above

73- Which of the following modality is more effective in the management of clinically node negative (N0)
neck :

a) Radiation

b) Surgery

c) Both are equally effective

d) Neither radiation nor surgery is recommended in management of clinically N0 neck.

74- Which of the following immunotherapy molecules are approved in platinum refractory, recurrent or
metastatic head and neck cancer

a) Pembrolizumab

b) Nivolumab

c) Both of the above

d) Neither 1 nor 2

75- Radiation therapy is combination with surgery is indicated in many head and neck cancer subsites.
All of the following clinical situations are indications for pre-operative rather than postoperative RT,
except:

a) Mobile-neck nodes

b) Expected delayed initiation of postoperative RT by > 8 weeks

c) Gastric pull-up for reconstruction

d) Open biopsy of a positive neck node

76- Which of the following are indications of postoperative RT in head and neck cancers:

a) Close (< 5 mm) or positive margins

b) Extracapsular extension (ECE)

c) N2a or greater cervical node classification

d) Invasion of the soft tissues of the neck i) all of the above

77- Chemotherapy in combination with radiation is employed in the management of various head and
neck cancer sites. This approach when used without surgery leads to organ preservation and good
oncological outcomes. Which of the following are methods of delivering chemotherapy with radiation:

a) Concurrent chemotherapy and radiation

b) Induction chemotherapy followed by radiation therapy

c) Induction chemotherapy followed by concurrent chemoradiation

d) All of the above Answer : all of the above

78- Which of the following is the most accepted management protocol advanced nasopharyngeal
cancers:

a) Concurrent chemoradiation

b) Induction chemotherapy followed by concurrent chemoradiation

c) Concurrent chemoradiation followed by maintenance chemotherapy

d) Surgery followed by concurrent chemoradiation

79- In larynx cancer management, organ preservation is desired by both patients and physicians. The
seminal trials done on this subject like VA trail and EORTC trail have shown feasibility and good
oncological outcomes of radiation with or without chemotherapy in the management of larynx cancers.
Which of the following is false regarding organ preservation approaches in the management of larynx
cancer:

a) Over 60% of patients in the CRT arm avoided total laryngectomy in the VA trail

b) Patients in the combination chemoradiation arm in the VA trail showed better emotional well being
and freedom from pain compared with those being treated surgically

c) In a meta analysis of VA, EORTC and GETTEC trials of larynx cancer, there was a non-significant trend
towards improved survival in the chemoradiation arm

d) In the RTOG 91 – 11 trial long term mortality, not related to larynx cancer was highest in the
concurrent chemoradiation arm compared with induction chemo followed by RT and RT aloe groups

80- All of the following are true regarding squamous cell cancers of lips except :

a) Vermillion border of lower lip is the most common site of origin

b) Surgery or radiation can both be used for their management, surgery is preferable for lesions larger
than 2 cm in size

c) Upper lip cancers have worse prognosis

d) For small lesions interstitial brachytherapy may provide excellent outcomes

81- Which of the following is not true regarding cancers of the floor of mouth:

a) Majority of cancers occurs in the anterior part of FOM

b) Mandible invasion is a fairly early feature

c) For T1 and superficial T2 tumors the risk of occult neck node mets is 10-15%

d) If the lesion is invading mucosa is adherent to mandible but not grossly invading it then marginal
mandibulectomy is to be done

82- All of the following are true regarding cancers of oral tongue except:

a) Granular cell myoblastoma is a rare by highly malignant tumor involving oral tongue

b) Occult cervical lymph node mets occur in around 30% of patients

c) Elective nodal dissection is indicated in lesions of oral tongue with a depth of invasion ≥ 4 mm

d) The PENTOCLO protocol is used in the management of osteoradionecrosis

83- Which of the following the therapeutic modality of choice for discrete early lesions of retromolar
trigone:

a) Surgery

b) Radiation

c) Surgery followed by radiation

d) Combined chemoradiation

84- Which of the following is not anatomically a part of oropharynx :

a) Tonsillar pillars and tonsillar fossae

b) Pyriform fossa

c) Base of tongue

d) Soft palate and posterior pharyngeal wall

85- For early lesions of oropharynx, which of the following provides the best oncological outcome:

a) RT

b) Open surgery

c) TORS/TLM

d) All of the above

86- The treatment of choice for BOT squamous cell carcinoma is:

a) RT

b) Surgery

c) TORS

d) TLM

87- Which of the following is the treatment of choice for soft palate carcinoma :

a) RT

b) Surgery

c) TORS d) TLM

88- Which of the laryngeal cancer subsite has the highest propensity for cervical lymph node spread :

a) Glottis

b) Subglottis

c) Supraglottis

d) All have almost the same probability

89- In which of the following situation in larynx cancer, hemilaryngectomy which is potentially a voice
preserving surgery, can not be done:

a) Involvement of one cord and up to 5 mm of the opposite cord

b) Partial fixation of one cord

c) Up to 9 mm of subglottic extension anteriorly and 5 mm posteriorly

d) Extension to the supraglottic or interarytenoid area

90- Which of the following cancers of supraglottis are better suited for surgery by partial or total
laryngectomy (what should be their volume) :

a) > 6 mL b) < 6 mL

c) None of the above

91- Which of the following is not anatomically a part of hypopharynx

a) Pharyngeal walls

b) Pyriform sinus

c) Post cricoid pharynx

d) Valleculae
92- Retropharyngeal lymph node involvement is frequent in pharyngeal wall tumors, which of the
following is the preferred modality of treatment for these tumors:

a) RT

b) Surgery

c) TLM d) TORS.

93- Nasopharyngeal carcinoma affects individuals slightly younger age than other head and neck
squamous cell carcinoma. Which of the following is not a type of nasopharyngeal carcinoma :

a) Keratinizing

b) Nonkeratinizing

c) Undifferentiated

d) Basaloid Answer

e) all of the above

94- For cancers of the nasal vestibule, which is the preferred treatment :

a) Surgery

b) Radiation

c) Robotic surgery

d) None of the above

95- For cancers of the nasal cavity, which is the preferred curative modality :

For cancers of maxillary sinus which is the preferred curative modality :

a) Surgery

b) Radiation

c) Robotic surgery

d) None of the above

96- Which of the following is not true regarding malignancies of salivary glands :

a) One fourth of parotid tumors and half of submandibular tumors are malignant

b) Warthin Tumor generally occurs in older men who are smokers

c) Perineural invasion and local recurrences are hallmarks of adenoid cystic carcinoma

d) In the management of parotid gland tumors, facial nerve needs to be sacrificed often
97- c-kit is commonly expressed in :

a) Pleomorphic adenoma

b) Adenoid cystic cancer

c) Lymphoepithelioma

d) Eskimoma

98- Minor salivary gland tumors are most commonly found on :

a) Buccal mucosa

b) Hard palate

c) Soft palate

d) Nasopharynx

99- Which of the following is goal of oral cavity reconstruction :

a) Obliteration of the oral cavity

b) Maintaining premaxillary contact

c) Maintaining the finger function of the tongue

d) Facilitate retention and movement of sections within the oral cavity

e) Optimize sensation of the remaining native tissue and the revascularized free tissue transfer

F) all of the above.

100- Which of the following is true of ovarian cancer?

a) It is the most common gynaecologicalcancer in the UK

b) It is the second commonest cancer in females

c) Approximately 10% are familial

d) Median age of diagnosis is 53 years.

101- Risk factors for ovarian cancer include which of the following?

a) Young age

b) Nulliparity

c) Multiple pregnancies

d) Prolonged use of oral contraceptive pill.

102- Which one of the following statements regarding screening for ovarian cancer is correct?

a) Screening using CA-125 is offered to all women between the ages of 50 and 75 years in the UK

b) Studies have shown an approximate 40% reduction in mortality with screening

c) Serum CA-125 has a sensitivity of 50% and a specificity of 20%

d) Trials of potential screening methods for ovarian cancer are ongoing.

103- Which one of the following symptoms is an uncommon presentation of ovarian cancer?

a) Abdominal pain

b) Chest pain

c) Weight loss

d) Abdominal distension

104- Which of the following is true of staging of ovarian cancer?

a) Stage III describes disease which has spread to the peritoneum beyond the pelvis

b) Stage I tumours are common

c) Any pleural effusion equals stage IV disease

105- Which of the following statements is true regarding prognosis of ovarian cancer?

a) Stage I disease has a median 5 year survival of

b) Stage II disease has a median 5 year survival of 60%

c) Stage III disease has a median 5 year survival of 20%

d) Stage IV disease has a median 5 year survival of 10%

106- In treatment of ovarian cancer:

a) Germ cell ovarian tumours require total abdominal hysterectomy (TAH), bilateral salpingo-
oopherectomy (BSO), omentectomy and lymph node biopsies

b) Chemotherapy is the most important modality in the treatment of epithelial ovarian cancer

c) Optimal debulking describes surgery where no tumour remains which measures >2cm

d) Optimal debulking surgery has been demonstrated to significantly improve survival

107- Which of the following statements is true of first line chemotherapy for epithelial ovarian cancer?

a) Following platinum/taxane chemotherapy 5 year survival is >40%

b) Response rates to platinum/taxane chemotherapy are approximately 50%

c) Median survival following platinum/taxane chemotherapy is 2-3 years

108- Which of the following is true of treatment for relapsed epithelial ovarian cancer?

a) Platinum chemotherapy is the optimum therapy for patients who relapse less than 6 months after
completion of platinum based chemotherapy

b) The response rate to platinum chemotherapy is approximately 60% in those who relapse more than 2
years after completion of platinum based first line chemotherapy

c) Most patients can be cured with further chemotherapy

d) Most patients can be cured with further surgery

109- In metastatic epithelial ovarian cancer:

a) ascities usually responds well to diuretics

b) bowel obstruction is common and is usually managed medically using subcutaneous medication given
via a syringe driver

c) opioid analgesics should be avoided

d) lymphoedema is rare and treatment of it is generally ineffective

110- Risk factors for prostate cancer include which one of the following?

a) Castration before age 40 years

b) Black race

c) Asian race

d) Young age

111- Which of the following is true regarding prostate cancer?

a) The lifetime risk of developing it is 10%

b) It is the most common cause of cancer death in men

c) Incidence is falling

d) It accounts for approximately 30% of all cancers in men

112- In diagnosis of prostate cancer:

a) all patients should have a digital rectal examination (DRE)

b) most patients with a PSA>4ng/ml will have prostate cancer

c) urinary obstructive symptoms are highly suggestive

d) biopsy is usually by fine needle aspiration (FNA)

113- Which one of the following statements is true of prostate cancer?

a) Gleason score 3 describes a poorly differentiated tumour

b) 65% of patients with Gleason score 5-7 will die from prostate cancer within 15 years

c) PSA >50ng/ml is often associated with distant bone metastases

d) T2 describes a tumour that has extended through the capsule

114- Which of the following statements is true in management of prostate cancer which is confined to
the prostate gland?

a) Active surveillance is a valid approach

b) Prostatectomy has been shown to be superior to radiotherapy

c) Radiotherapy causes impotence in 50% of patients

d) Prostatectomy leads to long term incontinence in 5% of patients

115- In metastatic prostate cancer:

a) median survival is 18 months

b) hormone therapy will produce responses in around 70% of men with bone metastases

c) the median response duration of hormone therapy is 8 months

d) chemotherapy is the most commonly used systemic treatment used

116- Side effects of hormone treatment rarely include which one of the following?

a) Hot flushes

b) Loss of libido and potency

c) Osteoporosis

d) Myelopsuppression

117- In treatment of hormone refractory prostate cancer:

a) docetaxel and prednisolone have been shown to increase median survival by 2 months

b) mitoxantrone and prednisolone have been shown to increase median survival by 1 month

c) withdrawing anti-androgen therapy confers no benefit

d) intravenous radio-isotope therapy has been shown to increase median survival by 3 months
118- Which one of the following statements is true of prostate bone metastases and their
complications?

a) Most fractures occur as the result of trauma

b) Spinal cord compression is usually managed surgically

c) Prophylactic orthopaedic intervention may be required for bone lesions at high risk of fracture

d) Bisphosphonates may help to reduce bone pain but do not reduce the number of cancer-associated
skeletal events

119- Which one of the following symptoms is rare in patients with progressive prostate cancer?

a) Symptomatic anaemia

b) Urinary retention

c) Sexual dysfunction

d) Haematemesis.

120- Which of the following is true of endometrial cancer?

A. It is related to infection with the HPV virus.

B.It can be prevented by cervical smear screening programs.

C. It is most common in premenopausal women.

D. It can be caused by treatment for breast cancer.

121- Cancer staging has several purposes. All statements are correct regarding cancer staging except?

A. It defines the regional and distant extend of disease.

B. All given statements are true.

C. Staging may be clinical, non clinical and pathological.

D. It helps to determine optimum treatment and provides prognostic information.

122- Which of the following statements is true about the pathology of breast cancer?

A. Most are squamous carcinomas.

B. Paget's disease of the nipple is always associated with an underlying cancer.

C. Inflammatory cancers account for 10 per cent of cases.

D. LCIS is frequently detected by mammogram.

E. Lobular carcinomas are more commn than ductal.

123- Which one of the following is not a presenting feature of oesophageal cancer:

A. Dysphagia.

B. Weight loss.

C. Acid reflux.

D. Regurgitation of food.

E. Pulmonary aspiration.

124- In the above 76 year old gentleman, a PET scan does not reveal any other sites of metastatic
disease and a mediastinoscopy does not reveal the presence of carcinoma cells in the mediastinal or
hilar lymph nodes. What stage is the patient's lung cancer with 3 cm in diameter?

A. Stage IIB.

B. Stage IV.

C. Stage I.

D. Stage IIA.

E.Stage III.

125- A 35 year old postmenopausal woman of Ashkenazi jewish ancestry presents to you because her
60-year-old paternal aunt was recently diagnosed with ovarian cancer, and she is concerned about her
own risk for ovarian cancer. She has no siblings, and there is no other family history of cancer. She has
two living children and is in good health, and her pelvic examination is unremarkable. You should advise
her that:

a. She should visit a genetic counselor.

b. Annual transvaginal ultrasound and CA-125 screening can reduce her risk of mortality.

126- a 58-year-old man with a 700-packperyear smoking history presents to the emergency department
with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass
centrally located within the left lung field. The serum calcium is 13.0 mg/dl (normal 8.5 to 10.2). the
metabolic abnormality described here is likely due to elaboration of which substance:

a. carcinoembryonic antigen.

b. Adrenocorticotropic hormone-like substance.

c. Parathyroid-related hormone.

d. Antidiuretic hormone.
127- Brachytherapy is type of radiotherapy which uses several types of source besides:

a. Enteral treatment with radioactive capsules.

b. Radioactive source placed directly over superficial tumor of the skin.

c. Interstitial brachytherapy this uses radioactive needles or wire inserted directly in the tumor.

d. Intracavity treatment this uses radioactive sources (tubes or containers) placed within a body cavity.

128- Which one of the following statements is true about the prognosis of lung cancer?

a. Non-small cell lung cancer cannot be cured by radiotherapy.

b. 10-20 per cent will be cured.

c. Small cell histology is a poor prognostic factor.

d. The median survival of untreated small cell lung cancer is 12 months.

e. Adenocarcinomas have a particularly poor prognosis.

129- Which one of the following is true about the treatment of colorectal cancer:

a. Preoperative radiotherapy for rectal cancer substantially increases the risk of operative complications.

b. Those having a colostomy have a worse prognosis.

c. Advanced stages of the disease responds to VEGF (vascular endothelial growth factor) inhibitors.

d. Surgery alone is not curative. e. Platinum compounds have no significant activity in this disease.

130- Surgical management of malignant primary tumors have several components besides:

A. Tissue biopsy to establish morphological diagnosis.

B. Control of hemorrhage, control of obstructive symptoms, fracture reduction and fixation.

C. Removal of malignant tumor with a clear margin of normal tissue.

D. Repair, reconstruction and restoration of function.

131- External beam radiotherapy is the most common of treatment in clinical use. There are several
types of external beam machines besides:

A. Orthovoltage machine.

B. Superficial voltage machine.

C. Macrovoltage machine.

D. Megavitage machine.
132- Which of the following is true of the treatment of ovary cancer?

A. Chemotherapy with cisplatin And paclitaxil is standard in stage III.

B. Radical surgery is usually curative.

C. Unilateral salpingo-oophorectomy is the usual operation for stage I.

D. Hormone replacement therapy is contraindicated.

E. Postoperative radiotherapy is indicated for high-risk stage I disease.

133- Which of the following tumors of the liver is most common hepatic tumor of childhood?

A. Cavernous hemangioma.

B. Hepatocellular carcinoma.

C. Hepatoblastoma.

D. Hepatic adenoma.

134- A 50-year-old woman has a stage 2 HER2-positive breast cancer and will recieive a trastuzumab-
based regimen. She asks you about the toxicity profile. You reply that trastuzumab is generally safe, but
rare adverse effects can include:

A. Lower seizure threshold, rash, long QT interval.

B. Renal impairment, lowering of cardiac ejection fraction, infusion reaction.

C. Infusion reaction, lowering of cardiac ejection fraction interstitial pneumonitis.

D. Hypertention, vomiting, renal impairment.

E. Rash diarrhea stomatitis.

135- Which of the following applies to cancer of the ovary:

A. It is common in japan and the far east.

B. It is usually diagnosed with symptoms at an early age.

C. There is 50 per cent risk in patients with the BRCA1 gene.

D. It is most common in women under 40 years of age.

D. Chemotherapy is mainstay of treatment.

137- Which of the following liver tumors is benign?

A. Cavernous hemangiomas.

B.Angiosarcoma.

C. All given options are benign. D. Hepatocellular carcinomas.

138- Which of the following is true of choriocarcinoma:

A. Future pregnancy is contraindicated.

B. It typically occurs in women aged 20-40 years.

C. Surgical excision is the best treatment.

D. Metastases are present in a third of women at presentation.

139- Which one of the following statements is true about the staging of lung cancer?

a. PET imaging is of value in those being considered for curative surgery

b. Staging is only undertaken in those being considered for surgery

c. Pulmonary angiography should be performed in all cases

d. Bone marrow trephines are routinely performed CT imaging is performed inselected cases

140- Which of the following statements are true about mesothelioma?

a. There is associated with asbestos

b. Presents with heamoptysis

c. Chemotherapy is mainstay of treatment

d. Distant metastases are uncommon

PALLIATIVE CARE
8- All of the following are key elements of palliative care EXCEPT:

A. Pain and symptom management.

B. Psychological and spiritual support.

C.Getting the patient to be DNR.

D. Coordination of care.

9- The single MOST IMPORTANT feature defines opioid drug addiction (psychological dependence) is :

A. An increasing need for the drug over time.

B. Complaint of pain exceeding that expected for a given medical problem.

C.Development of withdrawal when the drug is stopped.

D. Evidence of adverse life consequences from drug use.

10- Every 12 hours, Mr. Kelly has been taking 60 mg of long-acting morphine. The best initial order for
breakthrough short-acting morphine is:

A. 10 mg q4

B. 15 mg q4

C.30mg q4

D. 45mg q4

11- The single MOST IMPORTANT supplemental therapy to consider at the time of starting patients on
opioids for pain is:

A. NSAIDs for adjuvant pain.

B. Laxatives for constipation.

C.Anti depressants to supplement pain relief.

D. Anti emetic to treat nausea.

12- You are completing a family meeting for a patient with moderately advanced Alzheimer’s type
dementia in which you have been describing the nature and likely course of the disease. The patient is
unable to participate. In concluding the meeting, it is MOST IMPORTANT to:

A. Summarize the plan for care.

B. Tell the family all is gonna be okay.

C.Make them feel strong.

D. None of these

13- Mrs. DeGilio is an 84-year-old woman with rheumatoid arthritis affecting her hands, feet, and knees.
Today she notes increased swelling and pain in her knees.An important question in pain assessment is:

A. Have you noticed a fever?

B. How does it affect your life?

C.Have you lost weight?

D. How are you feeling overall?

16- In case of respiratory depression caused by 1 opioid:

a. Inhibition of consciousness precedes inhibition of respiration

b. Pharmacological tolerance is rapidly formed

c. If vital signs are unstable, use naloxone 0.1-0.2 mg i / v every 1-2 minutes

d. All are correct

2. When prescribing regular (basic) and additional (PRN) doses of opioids, all but one ofthe following
provisions apply:

a. Due to the presence of basic pain and pain attacks, it is necessary toprescribi regular (basic) and
auxiliary (additional) doses;

b. prolonged-acting forms should be used as an PRN dose;

c. it is recommended to continue analgesia with prolonged-acting forms ofopioids after adjusting the
basic dose for the management of basal pain;

d. The adjuvant dose is 10-15% of the daily basal dose and can be used asneeded, taking into account
the time to reach the maximum concentration irits plasma, until the desired effect is achieved

3. All opinions regarding transdermal fentanyl ("fentanyl" patch) are correct except forone:

a. Transdermal fentanyl is prescribed when the patient experiences pain ofunstable strong intensity;

b. Transdermal fentanyl is prescribed when the patient has difficulty swallowingor uncontrolled nausea
and vomiting

d. the fentanyl patch is changed every 48 hours and no subcutaneous depot(stock) remains after its
removal;

e. Contraindications to the appointment of transdermal fentanyl are heavysweating and skin rash.

4. From the principles of opioid prescription is correct:

a. The recommended dose is the dose needed to relieve the patient's painregardless of side effects

b. Opioid titration and selection of the optimal dose should be performed assoon as possible to obtain
the effect;

c. The initial dose of opioid can be determined only by slow-acting forms;

d. 13 Stable plasma opioid concentrations are reached after 8 half-lives.

5. Mention the most appropriate definition of a breakthrough pain:

a. Nociceptive crisis

b. Newly emerging acute pain

c. Transient acute attack of moderate to severe pain manifested against thebackground of controlled
chronic pain

d. a stinging sensation in the affected area

6. Describe neuropathic pain: a. Central or peripheral nerves are damaged b. Nerve damage is caused
by compression, transection, infiltration, ischemia ometabolic damage

c. can be of different types - peripheral, deferential, complex regional syndromes

d. All of the above are correct

7. Opioids reach their maximum concentration (max when administeredsubcutaneously /
intramuscularly:

a. In 10-15 minutes

b. In half an hour

c. Upon input

d. 1 hour

8. Oral prolonged-release formulas are available:

a. Once in 2-3 hours

b. Once in 5-6 hours

c. Once in 8, 12 or 24 hours (depending on the medication)

d. All is correct

9. An additional dose during a pain attack is:

a. Arithmetic mean of daily doses taken last week

b. 24-hour dose ½ part

c. 5-15% of 24-hour dose

d. 24-hour dose ¼ part

10. During the rotation of the opioid form:

a. Cross-tolerance may develop

b. To avoid cross-tolerance we should start with 50-75% of the hexavalentanalgesic dose of the new
drug

c. Increase the dose if the pain still persists and reduce if there are adverse sideeffects in the case of
methadone, we should start with 10-25% of thehexavalent analgesic dose

d. All are correct

11. Which of the following is a second step in a WHO three-step pain managementscheme?

a. Acetylsalicylic acid

b. Morphine

c. Fentanyl

d. Othydrocodeine
12. Definitions of Acute Pain According to the National and InternationalRecommendation (Chronic Pain
Management) and Guidelines:

a. Pain lasting less than 1 month

b. pain lasting less than 3 months

c. pain lasting less than 1 week

d. Pain that begins acutely and is characterized by recurrent episodes

13. In addition, non-medical approaches need to be used to manage pain, namely:

a. Psychological approach

b. Correction of pathological process (radiation therapy, hormone therapy)

c. Temporary relive of pain (local anesthesia, neurolytic agents)

d. All listed

14. The pain assessments should include:

a. Physical impact (effects) - types of pain

b. Functional Impact (Effects) - Disruption of daily activities

c. Psychosocial and spiritual aspects

d. All of the above

15. Are international tools for assessing pain intensity

a. Visual analogy scale

b. Numerical evaluation scale

c. Verbal assessment scale

d. All of the above

16. Is it advisable to use two non-steroidal anti-inflammatory drugs (NSAIDs) at the sametime for
chronic pain?

a. in most cases it is possible;

b. it is advisable if the instructions are followed and measures are taken to prevent the development of
side effects;

c. it is not expedient;

d. only the following combinations are recommended - oral and injection;Injection and suppository; Oral
and suppository.
17. When using nonsteroidal anti-inflammatory drugs (NSAIDs), gastrointestinal toxicity is most common
caused by all but one of the following:

a. age (&gt; 65 years);

b. a history of peptic ulcer disease, especially with complicated bleeding or perforation;

c. Cancer with mild to moderate pain when the patient undergoes a course of chemotherapy;

18. All of the following statements for the appointment of morphine in severe chronic pain are correct
except for one:

a. Morphine can be prescribed for the first time when there is severe.(unbearable) pain;

b. morphine is prescribed only when there is a strong chronic pain and the patient has already taken a
nonsteroidal anti-inflammatory drug and to noavail;

c. Oral morphine - recommended as a first-line therapeutic drug for the 7 8treatment of severe pain in
patients with cancer;

d. The recommended dose of morphine is the dose needed to relieve the patient's pain without
undesirable side effects;

19. One of the following statements is correct for the onset of action of short-acting or almorphine and
the duration of its therapeutic effect:

a. short-acting oral morphine takes effect in about 30 minutes, drug level reaches an C-max in an
average of 3 hours, and the therapeutic effect lasts for about 6 hours;

b. short-acting oral morphine takes effect in about 45 minutes, drug level reaches an C-max in an
average of 1 hour, and the therapeutic effect lasts for about 8 hours;

c. short-acting oral morphine takes effect in about 20 minutes, the drug leveayreaches an C-max in 60
minutes and the therapeutic effect lasts for about hours;

d. short-acting oral morphine takes effect in about 25 minutes, drug level reaches an C-max in an
average of 2 hours, and the therapeutic effect last for about 3 hours;

20. For long-acting morphine formulations, one of the following statements is valid:

a. long-acting morphine is characterized by slow onset of action and the effect of premature peak;

b. long-acting morphine is characterized by rapid onset of action and late peak effects.

c. long-acting morphine is characterized by rapid onset of action and the effect of premature peak.

d. long-acting morphine is characterized by a slow onset of action and &late-peak effect.

21. characteristic features of BRCA-1-assosciat cancers include the following except:

a. aggressive features b. estrogen receptor (ER) positive c. HER 2 negative d. young age of presentation