Internal-Medicine

Answers: 25–53 133
36. (F) Japanese Americans have a threefold
increase in stomach cancer rate compared to
White Americans, but this is lower than rates in
Japan. (Devita, pp. 228–240)
37. (C) The excess risk of cancers of the stomach,
esophagus, lung, and cervix among Black
Americans is diminished when socioeconomic
variations are factored in. (Devita, pp. 228–240)
38. (A) Alcoholic beverages combine with tobacco
smoking to increase cancer of the mouth and,
by causing cirrhosis, can lead to liver cancer.
(Devita, pp. 241–250)
39. (D) Asbestos exposure causes more deaths
from lung cancer (two-fold increase) than from
mesothelioma (hundredfold increase) because
the latter tumor is so rare. (Devita, pp. 241–250)
40. (F) Sun exposure severe enough to cause sunburn
is associated with increased risk of
melanoma, whereas other skin cancers are
more related to cumulative exposure. (Devita,
pp. 241–250)
41. (I) Although causation is not definite, a high
proportion of cervical cancers reveal HPV-16
and HPV-18 on biopsy. HPV has also been isolated
from vulvar, penile, and anal cancers.
(Devita, pp. 241–250)
42. (H) Cirrhosis, related to chronic HBV infection,
is a leading cause of HCC. (Devita, pp. 241–250)
43. (C) Adenocarcinoma is now the most common
form of lung cancer, accounting for 40% of the
total cases. (Devita, p. 928)
44. (B) Because of its tendency for early exfoliation
and obstruction, squamous cell cancer is
often detected at an earlier stage. Even correcting
for this, there is some suggestion that its
prognosis is still better, perhaps because of its
slow growth rate. (Devita, p. 928)
45. (B) Nonmetastatic hypercalcemia occurs in up
to 15% of all squamous cell cancers due to the
production of parathyroid hormone related
peptide (PTH-rP). This is a paraneoplastic phenomenon.
(Devita, p. 933)
46. (D) SIADH occurs in up to 10% of all small cell
cancers of the lung. SIADH, Cushing’s syndrome,
and neurologic paraneoplastic syndromes
usually occur with small cell lung cancer,
not nonsmall cell lung cancer. (Devita, p. 985)
47. (D) Eaton-Lambert syndrome is unusual, but
small cell lung cancer causes the majority of
cases that are paraneoplastic. (Devita, pp. 985, 2530)
48. (G) Cisplatin is used for the treatment of many
different cancers including testicular cancer. Its
major toxicities are renal, ototoxicity, myelosuppression,
and peripheral neuropathy. The
neuropathy is dose- and duration-dependent.
(Kasper, p. 475)
49. (A) Liver toxicity is most common when
methotrexate is used on a daily basis, such as for
psoriasis. Myelosuppression and GI mucositis
are the most common side effects in cancer
therapy. (Devita, p. 392)
50. (D) Although lung injury is the most serious
complication of bleomycin, this unusual skin
reaction is more frequent, occurring in almost
50% of patients. (Devita, pp. 453–454)
51. (E) Doxorubicin can cause a cumulative, dosedependent
cardiomyopathy that can result in
congestive heart failure. However, an acute,
non-dose-related myocarditis-pericarditis can
also occur. It can cause arrhythmias, heart failure,
or pericardial effusions. (Devita, pp. 425–427)
52. (I) Cyclophosphamide causes hemorrhagic cystitis
in up to 10% of patients because active
metabolites are excreted. Adequate hydration
and frequent urination can decrease the frequency
of this complication. (Devita, pp. 363–365)
53. (D) Papillary cancer has the best prognosis of
all thyroid cancers. Although it is seven times
more common than follicular cancer, fewer people
die from it. Even with follicular cancer, most
patients will die of other diseases. In common