Devita, Hellman, and Rosenberg's Cancer

LWBK1006-27 LWW-Govindan-Review December 12, 2011 19:32

378 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 27.14. A 65-year-old man with metastatic Merkel cell carcinoma is referred to

you for evaluation. CT imaging reveals bilateral pulmonary metastases.

What is the MOST appropriate initial therapy?

A. High-dose interleukin-2

B. Platinum-based chemotherapy

C. Imatinib

D. Referral to a surgical oncologist

Question 27.15. Which statement regarding actinic keratosis (AK) is NOT TRUE?

A. AKs are caused by ultraviolet (UV) B.

B. AKs may progress to invasive squamous cell carcinomas.

C. Cure rates for cryosurgery in solitary lesions are 98%

D. None of the above.

Question 27.16. Which statement regarding basal cell carcinoma is NOT TRUE?

A. It is a slow growing neoplasm.

B. Most common human cancer.

C. The most common subtype is the superficial.

D. May occur in areas not exposed to the sun.

Question 27.17. A 45-year-old woman was recently diagnosed with metastatic melanoma.

The CT examination reveals bilateral lung metastases and a 2-cm solitary

liver metastasis. The brain MRI examination is normal. The tumor is

negative for the BRAF V600E mutation. You recommend ipilimumab

(anti-CTLA-4 antibody) as the initial treatment. Two weeks after the

second dose, the patient reports 4 loose stools per day. After imodium,

the frequency decreases to twice a day. The patient receives the third

dose of ipilimumab on schedule. Three days later, she calls complaining

of abdominal cramping, subjective fever, and eight loose stools per day.

What is the most appropriate management for this patient?

A. Increase the imodium dose and have her call you back in 2 days.

B. A clinical evaluation is necessary to rule out infectious etiology and

bowel perforation.

C. Observation for 7 days. If no improvement, the patient should call

back with an update.

D. Check CBC and CMP. If normal, prescribe lomotil.