ITE Hematology and Oncology 3

Question 1

A 57-year-old man undergoes colonoscopy for a positive stool occult blood test. A 2 cm polyp is removed; pathology shows T2N0M0 invasive adenocarcinoma of the colon. What is the most appropriate next step?

Accepted Answer

Surgical resection of the involved colon segment

Answer

T2 colon cancer has invaded the muscularis propria and requires surgical resection; polypectomy alone is inadequate for disease that extends beyond the submucosa (T1).

Question 2

A 66-year-old man with 45 pack-year smoking history has a right upper lobe mass. Biopsy shows squamous cell carcinoma. He has serum calcium of 12.8 mg/dL with no bone metastases on imaging. What is the most likely cause of his hypercalcemia?

Accepted Answer

Ectopic PTHrP secretion by the tumor

Answer

Squamous cell carcinoma of the lung commonly secretes PTH-related protein (PTHrP), causing hypercalcemia of malignancy without bone metastases.

Question 3

A 48-year-old premenopausal woman undergoes lumpectomy for a 1.8 cm invasive ductal carcinoma; pathology shows ER+/PR+, HER2-, pT1cN0M0. Which systemic adjuvant therapy is most appropriate?

Accepted Answer

Tamoxifen (hormone receptor blockade)

Answer

ER+/PR+ breast cancer is treated with endocrine therapy such as tamoxifen in premenopausal women; HER2-targeted therapy is not indicated in HER2-negative tumors.

Question 4

A patient with Burkitt lymphoma develops oliguria, creatinine rising to 3.1 mg/dL, potassium of 6.8 mEq/L, phosphorus of 8.2 mg/dL, calcium of 7.1 mg/dL, and uric acid of 14 mg/dL 24 hours after starting chemotherapy. What is the most likely complication?

Accepted Answer

Tumor lysis syndrome

Answer

Tumor lysis syndrome occurs when massive tumor cell death releases intracellular contents, causing hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia with acute kidney injury.

Question 5

A 68-year-old woman with extensive-stage small cell lung cancer presents with serum sodium of 116 mEq/L, serum osmolality of 250 mOsm/kg, urine osmolality of 620 mOsm/kg, and urine sodium of 50 mEq/L. She appears euvolemic. What is the most likely cause?

Accepted Answer

Syndrome of inappropriate ADH secretion (SIADH)

Answer

Small cell lung cancer commonly secretes ADH ectopically, causing SIADH with euvolemic hyponatremia and inappropriately concentrated urine with elevated urine sodium.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Hematology and Oncology 3