pre-formed antibodies against donor antigens, occasionally from passive infusion

of antibodies from atopic donor.

75.(D). Used for allergic transfusion reaction.

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SECTION 21 Oncology
QUESTIONS
HASANEIN GHALI
1. Malignancies and age; the LEAST likely association is
A. neuroblastoma peaks during the first two years of life
B. leukemia peaks during early childhood
C. retinoblastoma peaks during late childhood
D. osteosarcoma peaks during adolescence
E. Hodgkin disease peaks during late adolescence

2. The BEST screening radiographic study for a patient with suspicious cervical
lymphadenopathy, fever and weight loss is
A. chest x-ray
B. chest MRI
C. abdominal CT scan
D. neck x-ray
E. bone scan

3. Metaiodobenzylguanidine (MIBG) scans are useful in the workup of

A. retinoblastoma
B. Wilms’ tumor
C. acute leukemia
D. neuroblastoma
E. CNS tumors

4. Rb gene analysis is useful in the workup of

A. Wilms’ tumor
B. neuroblastoma
C. rhabdomyosarcoma
D. CNS tumors
E. retinoblastoma

5. Cutaneous manifestations are helpful in suspecting

A. osteogenic sarcoma
B. craniopharyngioma
C. retinoblastoma

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 D. neuroblastoma
E. rhabdomyosarcoma

6. Diarrhea is a possible manifestation of which malignancy?

A. Wilms’ tumor
B. rhabdomyosarcoma
C. CNS tumors
D. melanoma
E. neuroblastoma

7. Posterior mediastinal mass is found in

A. neuroblastoma
B. Wilms’ tumor
C. germ cell tumor
D. T- cell lymphoma
E. Hodgkin lymphoma

8. Anterior mediastinal mass is found in

A. rhabdomyosarcoma
B. Wilms’ tumor
C. CNS tumors
D. lymphoma
E. neuroblastoma

9. Leukocoria is a manifestation of
A. neuroblastoma
B. retinoblastoma
C. Wilms’ tumor
D. CNS tumors
E. leukemia

10. A 2-year- old girl presented with abdominal mass, periorbital ecchymoses and
ataxia.
Of the following, the MOST likely diagnosis is
A. Wilms’ tumor
B. neuroblastoma
C. leukemia
D. rhabdomyosarcoma
E. brain tumor

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11. A 5-year- old boy presented with abdominal mass, hematuria and hypertension.
Of the following, the MOST likely diagnosis is
A. Wilms’ tumor
B. neuroblastoma
C. leukemia
D. rhabdomyosarcoma
E. brain tumor

12. A 5-year- old girl presented with prolonged fever, progressive pallor, arthralgia,
and skin ecchymoses.
Of the following, the MOST likely diagnosis is
A. Wilms’ tumor
B. hepatoblastoma
C. leukemia
D. rhabdomyosarcoma
E. brain tumor

13. A 15-year- old boy presented with a 3-month history of cervical swelling, fever,
weight loss, and night sweating.
Of the following, the MOST likely diagnosis is
A. Wilms’ tumor
B. hepatoblastoma
C. Hodgkin lymphoma
D. rhabdomyosarcoma
E. brain tumor

14. A 10-year- old girl with newly diagnosed abdominal lymphoma was admitted to
the hematology ward with difficult breathing and poor urine output for the last
day, her biochemical renal indices (urea and creatinine) are high and the
electrolytes were disturbed (hyperkalemia, hyperuricemia and
hyperphosphatemia).
Of the following, the MOST likely diagnosis is
A. renal infiltration by lymphoma
B. hemolytic uremic syndrome
C. tumor lysis syndrome
D. leukostasis
E. superior vena cava syndrome

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15. Tumor lysis syndrome is associated with which of the following malignancies?
A. neuroblastoma
B. Wilms’ tumor
C. hepatoblastoma
D. lymphoma
E. Ewing sarcoma

16. A 3-year- old girl with newly diagnosed paravertebral neuroblastoma,

presented to the pediatric emergency department with rapid onset weakness of
both lower limbs following a 3-day history of severe back pain.
Of the following, the MOST possible diagnosis is
A. brain infiltration
B. paraneoplastic manifestation
C. spinal cord compression
D. hypokalemia
E. intracranial bleeding

17. A 5-year- old girl diagnosed recently with lymphoma, presented to the
emergency room with distended neck veins, plethora, and swollen head and neck.
Of the following, the MOST likely cause is
A. lung metastasis
B. superior vena cava syndrome
C. pleural effusion
D. tracheal compression
E. shock

18. Steroid could be of MINIMAL help in which of the following oncologic event?
A. neuroblastoma and spinal cord compression
B. lymphoma and superior vena cava syndrome
C. leukemia and hyper leukocytosis
D. Wilms’ tumor and diffuse lung metastasis
E. brain tumor and increased intracranial pressure

19. Disseminated intravascular coagulation as a consequence of chemotherapy

administration is LEAST likely to get benefit from
A. fresh frozen plasma
B. cryoprecipitate
C. antibiotics
D. intravenous fluids

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 E. leukapheresis

20. Radiation therapy is indicated in which of the following oncologic emergencies?

A. spinal cord compression
B. graft versus host disease
C. disseminated intravascular coagulation
D. tumor lysis syndrome
E. hyper leukocytosis

21. Biochemical abnormalities in tumor lysis syndrome include

A. hypokalemia
B. hyperuricemia
C. hypercalcemia
D. hypophosphatemia
E. hypernatremia

22. Which of the following tumors requires biopsy rather than complete surgical
resection?
A. neuroblastoma
B. Wilms’ tumor
C. lymphoma
D. hepatoblastoma
E. pheochromocytoma

23. Almost all the following pediatric malignancies require chemotherapy EXCEPT
A. high grade hepatoblastoma
B. low grade neuroblastoma
C. low grade soft tissue sarcoma
D. high grade lymphoma
E. low grade osteogenic sarcoma

24. Neo-adjuvant chemotherapy means

A. chemotherapy administered after resection of the tumor
B. chemotherapy administered after recurrence of the primary mass
C. chemotherapy administered while the primary tumor is still present
D. new chemotherapeutic agents administered along with the classical
therapy
E. supportive agents used in addition to the original chemotherapy

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25. Hemorrhagic cystitis is a complication of which of the following
chemotherapeutic agents?
A. vincristine
B. actinomycin
C. 6-mercaptopurine
D. doxorubicin
E. cyclophosphamide

26. Minimal myelosuppression is reported with which agent?

A. vincristine
B. cyclophosphamide
C. methotrexate
D. cisplatin
E. cytosine arabinoside

27. Which of the following agents can cause significant allergic reaction?
A. methotrexate
B. asparginase
C. 6-mercaptopurine
D. cytosine arabinoside
E. cyclophosphamide

28. Pulmonary fibrosis is a side effect of

A. vinblastine
B. cyclophosphamide
C. bleomycin
D. methotrexate
E. cytosine arabinoside

29. Of the long-term consequences of cancer therapy, cardiomyopathy may be

related to
A. anthracycline
B. methotrexate
C. corticosteroids
D. etoposide
E. cyclophosphamide

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30. A translocation between chromosomes 9 and 22 (BCR-ABL) plays an important
role in the development of
A. acute myeloid leukemia
B. chronic myeloid leukemia
C. chronic lymphoid leukemia
D. Hodgkin’s lymphoma
E. non-Hodgkin lymphoma

31. Which of the following genotypes can predispose a child to the development of
acute leukemia?
A. Turner syndrome
B. Neurofibromatosis type 2
C. Bloom syndrome
D. WAGR syndrome
E. Denys-Drash syndrome

32. Which of the following classes of chemotherapeutics carries a particular risk for
the development of future leukemia?
A. alkylating agents
B. corticosteroids
C. mitotic inhibitors
D. anti-tumor antibiotics
E. topoisomerase II inhibitors

33. The MOST common type of leukemia in childhood is

A. acute lymphoblastic leukemia
B. acute myeloid leukemia
C. chronic lymphoid leukemia
D. chronic myeloid leukemia
E. juvenile myelomonocytic leukemia

34. The incidence of pediatric acute lymphoblastic leukemia peaks at the age of
A. infancy
B. 2-5 years
C. 6-9 years
D. 10-13 years
E. 14-17 years

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35. An 11-year-old boy presented with a 1-month history of fever, pallor, and easy
skin bruising. His CBC showed: Hb 5.0 gm/dl, WBC 90.000/cmm, Plt 33.000 with
many blast cells in the peripheral film. His chest X-ray showed big mediastinal
mass. Physical examination showed pale, febrile, ill looking boy with generalized
lymph node enlargement, mild respiratory distress and hepatosplenomegaly.
Of the following, the MOST likely diagnosis is
A. precursor B-cell ALL
B. precursor T-cell ALL
C. acute promyelocytic leukemia
D. acute myelomonocytic leukemia
E. Burkitt’s leukemia

36. A common extramedullary site for acute lymphoblastic leukemia is

A. pancreas
B. kidneys
C. lungs
D. testes
E. vertebrae

37. The MOST common chromosomal translocation in pediatric acute

lymphoblastic leukemia is
A. t(12;21)
B. t(9;22)
C. t(4;11)
D. t(1;19)
E. t(10;14)

38. The commonest translocation in infantile acute lymphoblastic leukemia is

A. t(12;21)
B. t(9;22)
C. t(4;11)
D. t(1;19)
E. t(10;14)

39. CNS involvement should be excluded at the time of diagnosis of acute

lymphoblastic leukemia by
A. EEG
B. lumbar puncture
C. brain CT

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 D. brain MRI
E. funduscopic assessment

40. A 10-day-old newborn presented with pallor, poor oral intake and abdominal
distension, physical examination revealed stigmata of trisomy 21,
hepatosplenomegaly, and his peripheral blood film showed low hemoglobin, high
white cell count, low platelets and many blasts cells.
Of the following, the MOST likely diagnosis at this stage is
A. acute lymphoblastic leukemia
B. transient myeloproliferative syndrome
C. acute myeloid leukemia
D. chronic myeloid leukemia
E. juvenile myelomonocytic leukemia

41. Prophylaxis with oral trimethoprim-sulfamethoxazole is recommended during

treatment of acute lymphoblastic leukemia to prevent
A. Pneumocystis jiroveci pneumonia
B. pneumococcal pneumonia
C. gram negative sepsis
D. anaerobic sepsis
E. Mycobacterium tuberculosis infection

42. The major short term complication of chemotherapy treatment of childhood

leukemia is
A. cardiac dycfunction
B. secondary malignancy
C. bone marrow suppression
D. infertility
E. obesity

43. The LEAST effective factor in the prognosis of acute lymphoblastic leukemia is
A. gender
B. age
C. initial WBC count
D. cytogenetics
E. response to therapy

44. A boy with acute lymphoblastic leukemia is assigned to be of high risk group if
he had got which of the following features?

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 A. being 6-year- old
B. testicular disease at time of diagnosis
C. t(12;21)
D. initial WBC count of 40.000/cmm
E. good response to induction therapy

45. A boy with acute lymphoblastic leukemia is assigned to be of very high risk
group if he had got which of the following features?
A. being thirteen-year- old
B. hyperdiploid DNA index
C. t(12;21)
D. good response to induction therapy
E. t(9;22)

46. Which of the following features labels a patient with acute lymphoblastic
leukemia as a low risk patient?
A. being fourteen-year- old
B. initial WBC count of 72.000/cmm
C. failure to achieve remission after induction therapy
D. t(12;21)
E. CNS disease at time of diagnosis

47. The MOST common site of relapse of acute lymphoblastic leukemia is

A. testes
B. kidneys
C. bone marrow
D. brain
E. lungs

48. Which of the following viruses plays a role in the etiology of lymphoma?
A. Cytomegalovirus
B. Epstein-Barr virus
C. Rhinovirus
D. Rota virus
E. Herpes virus

49. The MOST common clinical presentation of Hodgkin disease in children is

painless lymph node enlargement of which region?
A. mediastinal

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 B. cervical
C. axillary
D. inguinal
E. abdominal

50. B symptoms in Hodgkin disease are

A. fever, drenching sweats and poor appetite
B. fever, skin rash and poor appetite
C. skin rash, drenching sweats and significant weight loss
D. fever, drenching sweats and significant weight loss
E. skin rash, drenching sweats and bone pain

51. A 6-year- old girl presented with a 3-week history of abdominal distension,
fever, and periorbital puffiness. Abdominal sonogram showed multiple intestinal
related masses suggestive of lymphoma.
Of the following, the BEST diagnostic procedure at this time is
A. bone marrow aspiration
B. urinalysis
C. fine needle aspiration from the mass
D. peripheral blood film
E. CT scan of abdomen

52. The LEAST likely presenting feature for a newly diagnosed 3-year-old girl with
non-Hodgkin’s lymphoma is
A. fever
B. pallor
C. abdominal distension
D. shortness of breath
E. jaundice

53. A 6-year- old girl presented with a 3-month history of cervical swelling, fever,
and excessive sweating. In the context of suspecting Hodgkin lymphoma.
Of the following, the BEST diagnostic procedure at this time is
A. bone marrow biopsy
B. lymph node biopsy
C. CT neck
D. Gallium scan
E. PET scan

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54. The MOST common histopathological subtype in childhood Hodgkin disease is
A. lymphocyte predominant
B. nodular sclerosis
C. mixed cellularity
D. lymphocyte depletion
E. undifferentiated

55. The MOST common solid tumors in children are

A. lymphomas
B. sarcomas
C. hepatoblastomas
D. renal tumors
E. CNS tumors

56. A unique symptom of slowly growing CNS tumors is

A. poor school performance
B. fever
C. weight loss
D. acute paralysis
E. convulsions

57. A common sign of increased intracranial pressure is

A. second nerve palsy
B. fifth nerve palsy
C. sixth nerve palsy
D. ninth nerve palsy
E. tenth nerve palsy

58. If an intracranial lesion is suspected, the examination of choice is

A. CT scan
B. CSF exam
C. MRI
D. PET scan
E. MIBG

59. During follow up of a surgically resected brain tumor, the examination of choice
to distinguish recurrent tumor from radiation necrosis is
A. computed tomography
B. magnetic resonance spectroscopy

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 C. cerebrospinal fluid analysis
D. positron emission topography
E. bone scan

60. Of the long-term adverse effects of brain tumor therapy, the one that carries
particular significance to infants is
A. endocrine sequelae
B. myelodysplasia
C. ototoxicity
D. neurocognitive deficits
E. renal insufficiency

61. Of the following, the MOST common brain tumor is

A. cerebellar astrocytoma
B. ependymoma
C. glioblastoma multiforme
D. craniopharyngioma
E. optic nerve glioma

62. After resection of a posterior fossa tumor in a 10-year- old boy, he became
mute suddenly and his family reported recent behavioral changes in form of
irritability and occasional apathy.
Of the following, the MOST likely diagnosis is
A. posterior fossa syndrome
B. middle cerebral artery syndrome
C. cerebellar mutism syndrome
D. somnolence syndrome
E. cerebral hyper perfusion syndrome

63. The MOST common malignancy in infancy is

A. Wilms’ tumor
B. neuroblastoma
C. rhabdomyosarcoma
D. Ewing sarcoma
E. hepatoblastoma

64. Which of the following malignant tumors has a remarkable broad spectrum
clinical prognosis ranging from spontaneous regression to death?
A. Wilms’ tumor

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 B. rhabdomyosarcoma
C. Ewing sarcoma
D. neuroblastoma
E. hepatoblastoma

65. The MOST common clinical presentation for a 2-year- old girl with
neuroblastoma is
A. abdominal mass
B. bone pain
C. fever
D. diarrhea
E. poor appetite

66. The LEAST likely presentation of neuroblastoma is

A. weakness of both lower limbs
B. Horner syndrome
C. secretary diarrhea
D. opsomyoclonus
E. vomiting

67. Which organ is rarely involved by metastatic neuroblastoma?

A. liver
B. bone marrow
C. lung
D. bone
E. lymph nodes

68. A 6-month- old infant presented with multiple skin nodules and pallor, his CBC
showed reduced blood elements with no abnormal cells. Abdominal sonogram
showed small right adrenal mass with diffuse liver hypoechoic lesions. The bone
marrow aspiration was highly suggestive of involvement by neuroblastoma.
Of the following, the MOST likely stage is
A. stage 1
B. stage 2
C. stage 3
D. stage 4
E. stage 4s

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69. Neuroblastoma associated diarrhea is likely to be due to
A. infectious organism
B. electrolyte disturbances
C. mechanical effect
D. catecholamine release
E. metabolic derangement

70. A strong mimicker of neuroblastoma is

A. Wilms’ tumor
B. lymphoma
C. rhabdomyosarcoma
D. hepatoblastoma
E. retinoblastoma

71. The initial treatment of choice for localized neuroblastoma is

A. radiotherapy
B. surgical excision
C. chemotherapy
D. watchful waiting
E. bone marrow transplantation

72. An oncologic emergency in neuroblastoma is

A. spinal cord compression
B. opsomyoclonus syndrome
C. pallor
D. Horner syndrome
E. bleeding tendency

73. A favorable prognostic factor in neuroblastoma is

A. lack of cell differentiation
B. amplification of the MYCN oncogene
C. lack of hyperdiploidy
D. metastatic disease at diagnosis
E. stage 4S

74. WAGR syndrome implies the following

A. Wilms tumor, aniridia, genitourinary malformation and mental retardation
B. Wilms tumor, aniridia, gigantism and renal failure
C. Wilms tumor, anisochromia, genitourinary malformation and rickets

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 D. Wilms tumor, anisochromia, gigantism and renal failure
E. Wilms tumor, asplenia, genitourinary malformation and rickets

75. The congenital anomalies that are associated with Wilms tumor are
A. heterochromia, skeletal dysplasia, and cardiac anomalies
B. cataract, genu varus, and gastrointestinal anomalies
C. sporadic aniridia, hemihypertrophy, and genitourinary anomalies
D. coloboma, syndactyly, and lung anomalies
E. glaucoma, polydactyly, and brain anomalies

76. The MOST common presentation of Wilms’ tumor is

A. fever
B. hypertension
C. hematuria
D. abdominal mass
E. abdominal pain

77. Evaluation of the inferior vena cava is crucial in the assessment of Wilms’ tumor
to detect
A. tumor vascularity
B. chemotherapy choice
C. tumor extension
D. lymphatic metastasis
E. portal hypertension

78. A 2-year- old girl presented with abdominal mass and irritability. The mother
reported change in the color of urine to red for the last few days. The examination
was notable for a flank mass with raised blood pressure.
Of the following, the MOST likely diagnosis is
A. neuroblastoma
B. Wilms’ tumor
C. lymphoma
D. rhabdomyosarcoma
E. hepatoblastoma

79. The MOST common soft tissue sarcoma in children is

A. fibrosarcoma
B. synovial sarcoma
C. myofibroma

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 D. rhabdomyosarcoma
E. extra osseous Ewing sarcoma

80. Individuals with hereditary retinoblastoma have an increased risk for

A. rhabdomyosarcoma
B. osteosarcoma
C. Wilms’ tumor
D. neuroblastoma
E. acute leukemia

81. The MOST common site for Ewing sarcoma is

A. pelvis
B. humerus
C. radius
D. tibia
E. metacarpals

82. A common site for osteosarcoma is

A. distal humerus
B. distal tibia
C. distal femur
D. proximal fibula
E. proximal ulna

83. A possible differentiating symptom between osteosarcoma and Ewing sarcoma

is
A. pain in osteosarcoma
B. swelling in Ewing sarcoma
C. fever in osteosarcoma
D. sweating in Ewing sarcoma
E. weight loss in Ewing sarcoma

84. Under light microscopy; small, round, blue cell tumors are the hallmark of
A. osteosarcoma
B. neurofibroma
C. acute leukemia
D. Ewing sarcoma
E. histiocytosis

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