Question 1 : What is the prevalence of Barrett esophagus in the general population and what is the absolute risk of development of adenocarcinoma in a year in Barrett esophagus, respectively :
a) 1.5% and 0.12 – 0.33%
b) 0.5% and 1.5%
c) 5% and 23%
d) 2.7% and 0.33-1.77%
Answer : 1.5% and 0.12 – 0.33%
Question 2 : H.pylori is a class I carcinogen according to the WHO. The infection with this bacterium, especially the cagA+strain, is associated with the increased risk of adenocarcinoma of esophagus :
a) True
b) False
Answer : False
Question 3 : Which of the following statement regarding the epidemiology of esophagus carcinoma is not true :
a) Squamous cell carcinomas account for approximately 40% of esophageal malignancies diagnosed in the United States and the majority of cases arising in high-incidence areas throughout the world
b) Approximately 60% of esophagus carcinoma are located in the middle third of the esophagus, whereas 30% and 10% arise in the distal third and proximal third of the intrathoracic esophagus, respectively
c) Leiomyosarcoma is the most common mesenchymal tumor that affects the esophagus
d) The survival outcomes in squamous cell carcinoma of the esophagus are much better than in adenocarcinoma
Answer : The survival outcomes in squamous cell carcinoma of the esophagus are much better than in adenocarcinoma
Question 4 : Which of the following is the best modality for determining the T and N stage of esophagus cancer :
a) CT scan
b) EUS
c) PET-CT scan
d) MRI with dedicated coil
Answer : EUS
Question 5 : Which of the following are methods of management of high-grade dysplasia and T1a cancers of esophagus :
a) Surveillance
b) Photodynamic therapy (PDT)
c) Laser ablation
d) Multipolar electrocoagulation
e) Argon plasma coagulation
f) Cryotherapy
g) Radiofrequency ablation
h) Endoscopic mucosal resection (EMR)
Answer : all of the above
Question 6 : Preoperative chemotherapy is frequently used in esophagus cancers. What percentage of patients don’t respond to current chemotherapy regimens :
a) 10
b) 20
c) 30
d) 50
Answer : 50%
Question 7 : Which of the following is not true about the results of the US Intergroup Trial 113 (INT-0113) done in resectable esophageal cancer:
a) Preoperative cisplatin and 5-FU resulted in better curative resection rates than immediate surgery
b) Giving 2 cycles of adjuvant cisplatin and 5-Fu after resection resulted in no additional benefits
c) Median overall survival was similar regardless of the strategies employed in this trial
d) None of the above
Answer : Preoperative cisplatin and 5-FU resulted in better curative resection rates than immediate surgery
Question 8 : In the practice changing MAGIC trial, which of the following findings were observed with preoperative ECF chemotherapy in gastric, GEJ and distal esophagus adenocarcinoma patients :
a) Chemotherapy led to improved PFS
b) Chemotherapy led to improved complete resection rates
c) Chemotherapy did not lead to improved overall survival
d) All of the above
Answer : Chemotherapy led to improved PFS
Question 9 : A new standard of care was set for esophagus cancers by the CROSS trial by van Hagen, which of the following is true about the results of this trial:
a) Improved overall survival with preoperative chemoradiation followed by surgery compared to immediate surgery alone
b) Preoperative chemoradiation resulted in higher PFS
c) Preoperative chemoradiation was well tolerated
d) All of the above
Answer : all of the above
Question 10 : Postoperative chemoradiation is esophagus cancer results in :
a) Improved overall survival
b) Improved local control rates
c) Increased toxicity
d) all of the above
Answer : all of the above
Question 11 : Which of the following is/are the trials that studied the role of definitive chemoradiation as a method of treatment of esophagus cancer :
a) RTOG 85-01
b) FFCD 9102
c) German Oesophageal Cancer Study Group trial
d) all of the above
Answer : all of the above
Question 12 : The MUNICON trial studied the role of molecular imaging, such as FDG-PET imaging, in esophagus cancer. Which of the following is not true about this trial :
a) Patients were given induction chemo and metabolic responders were immediately switched to surgery
b) Metabolic responders had better event free survival outcomes compared with nonresponders
c) Nonresponders who went directly to surgery had improved recurrence-free periods and median survival times compared to the same group of patients who continued preoperative chemotherapy
d) This trial suggested the feasibility of using metabolic imaging as a treatment selection tool
Answer : Patients were given induction chemo and metabolic responders were immediately switched to surgery
Question 13 : The right artery most of the times arises from :
a) Hepatic artery proper
b) Left hepatic artery
c) Common hepatic artery
d) None of the above
Answer : Hepatic artery proper
Question 14 : Gastric cancer may spread to :
a) Left supraclavicular fossa (Virchow node)
b) Left axilla (Irish node)
c) Subcutaneous periumbilical tumor deposits (Sister Mary Joseph node)
d) all of the above
Answer : all of the above
Question 15 : Gastric cancer is classified by using
a) Borrmann classification
b) Lauren classification
c) Both of the above
d) Neither 1 nor 2
Answer : both of the above
Question 16 : Which of the following are used as screening methods for gastric cancer :
a) Upper endoscopy
b) Contrast radiography
c) serum trefoil factor 3, microRNAs, and multi-analysis blood tests
d) all of the above
Answer : all of the above
Question 17 : Which of the following is not a risk factor for gastric cancer :
a) Type A blood
b) Lack of refrigeration
c) Cigarette smoking
d) Type O blood
Answer : Type O blood
Question 18 : Which of the following is not true about the Siewert and Stein classification of adenocarcinomas of EGJ :
a) It is used for classification of tumors within 2 cm of the ECJ
b) Type I arises in the distal esophagus and may infiltrate the ECJ from above
c) Type II arises in the cardia or the EGJ
d) Type III arises in the subcardial stomach and may infiltrate the EGJ from below
Answer : It is used for classification of tumors within 2 cm of the ECJ
Question 19 : Which of the following is/are the subtypes of early gastric cancer (EGC) as per the Japanese classification :
a) Protruded, type 0I
b) Superficial elevated, type 0IIa
c) Flat, type 0IIb
d) Superficial depressed, type 0IIc
e) Excavated, type 0III
f) all of the above
Answer : all of the above
Question 20 : Which of the following is not true about the management of early gastric cancers :
a) Endoscopic Mucosa Resection and Endoscopic Submucosal Dissection are frequently used modalities
b) Patients with < 3 cm intramucosal tumors and those with nonucleated intramucosal tumors of any size may be candidates for endoscopic resection or limited resection
c) Gastrectomy with D1 lymph node dissection should be considered for patients with EGC who cannot be treated with ER or limited surgical resection
d) none of the above
Answer : none of the above
Question 21 : For mid and distal gastric adenocarcinomas, usually how much should be the grossly negative margin around the tumor :
a) 3 cm
b) 5 cm
c) 5 mm
d) 1 cm
Answer : 5 cm
Question 22 : The latest AJCC TNM staging system requires what minimum number of lymph nods to properly assign a pathologic N stage :
a) 15
b) 16
c) 17
d) 18
Answer : 16
Question 23 : Which of the following trials studied the role of postoperative radiation in gastric cancer following a D2 resection :
a) The Intergroup Trial (INT) 0116
b) ARTIST
c) CRITICS
d) TOPGEAR
Answer : ARTIST
Question 24 : Which of the following statements is true :
a) Metastatic gastric cancer have a dismal prognosis and palliative care is as good as systemic chemotherapy in these patients
b) In metastatic gastric cancer patients systemic chemotherapy results improved overall survival, hence its indicated
Answer : In metastatic gastric cancer patients systemic chemotherapy results improved overall survival, hence its indicated
Question 25 : What were the results of REAL-2 trial done in advance gastric cancer patients :
a) ECF was better than EOX and EOF
b) ECF had lower efficacy than EOF
c) Capecitabine may be substituted for 5-FU
d) None of the above
Answer : Capecitabine may be substituted for 5-FU
Question 26 : In what percentage of gastric cancer patients HER2 is overexpressed or amplified :
a) 20%
b) 50%
c) 13%
d) 90%
Answer : 20%
Question 27 : Which of the following is the greatest risk factor for pancreatic cancer :
a) Family history
b) Smoking
c) Alcohol consumption
d) Obesity
Answer : family history
Question 28 : Which is the most common tumor suppressor gene mutation in pancreatic cancer :
a) KRAS
b) CDKN2A/p16
c) BRCA2
d) TGFBR
Answer : CDKN2A
Question 29 : Which of the following is not true about the histology of pancreatic ductal adenocarcinoma :
a) The desmoplastic component comprises nearly 30% of the tumor mass
b) PDAs have characteristically hypodense appearance
c) It may rise from pancreatic intraepithelial neoplasia (PanIN) lesions (PanIN-1 to PanIN-3)
d) none of the above
Answer : The desmoplastic component comprises nearly 30% of the tumor mass
Question 30 : Which of the following rare pancreatic malignancies doesn’t have a KRAS mutation :
a) Pancreatoblastoma
b) Acinar cell tumors
c) NET of pancreas
d) All of the above
Answer : all of the above
Question 31 : Which is the screening modality approved by the FDA for pancreatic cancer in high risk individuals :
a) Serial CA19-9 monitoring
b) Annual CT scan of abdomen and CA19-9 every 6 monthly
c) Annual CT scan of abdomen and CA19-9 every 3 monthly
d) none of the above
Answer : none of the above
Question 32 : Which are the phases of the triphasic pancreas protocol study :
a) Early arterial
b) Late arterial
c) Venous
d) All of the above
Answer : all of the above
Question 33 : Which of the following is not true regarding surgical decision making in ca pancreas :
a) A resectable lesions should not contact the SMA, celiac axis, or common hepatic artery
b) A resectable lesion should not distort the SMV-PV and contact this vis-ceral vein by < 180 degrees
c) Locally advanced and unresectable lesions encase (i.e., > 270 degree invasion) any of the abovementioned arteries occulde the SMV-PV such that no reconstructive options remain
d) Borderline resectable lesions involve the visceral vessles to a lesser extent; they can about the viseral arteries and veins (< 180-degree invasion) or even occlude the SMV-PV, but venous reconstruction remains still technically feasible
Answer : Locally advanced and unresectable lesions encase (i.e., > 270 degree invasion) any of the abovementioned arteries occulde the SMV-PV such that no reconstructive options remain
Question 34 : HCV and HBV infections combined, account for how many cases of HCC world-wide :
a) 50%
b) 24%
c) 75%
d) 90%
Answer : 75%
Question 35 : All of the following are risk factors for the development of HCC :
a) Nonalcoholic Fatty Liver Disease
b) Hereditary hemochromatosis
c) α1-Antitrypsin deficiency
d) Hereditary tyrosinemia
Answer : all of the above
Question 36 : A diagnosis of HCC can be made in the absence of a biopsy :
a) True
b) False
Answer : true
Question 37 : The component of Child-Pugh score are :
a) Bilirubin
b) Albumin
c) Ascites
d) PT/INR
e) Encephalopathy
Answer : all of the above
Question 38 : Liver resection can be considered in all the following situations except :
a) In noncirrhotic patients with HCC who have normal liver function, no portal hypertension, and can tolerate major liver resections
b) In noncirrhotic patients with HCC if >40% functional liver can be preserved
c) In cirrhotic patients with Child-Pugh class A
d) An ICG retention rate of <14% is a safe indicator for major hepatectomy in cirrhotic patients
Answer : In noncirrhotic patients with HCC if >40% functional liver can be preserved
Question 39 : Which of the following is not true about the UCSF criteria for liver transplantation in HCC :
a) Single lesion 5 cm or less
b) No more than 3 lesions and none larger than 4.5 cm
c) In case of upto 3 lesions the total diameter of 8 cm or less
d) none of the above.
Answer : Single lesion 5 cm or less
Question 40 : Which of the following is the recommended adjuvant therapy for curatively resected, high risk HCC patients :
a) SBRT
b) TACE
c) Sorafenib
d) none of the above
Answer : none of the above
Question 41 : Which of the following is not a feature of the classic RILD, associated with radiation therapy to liver in HCC :
a) Typically occurs within 4 months of therapy
b) It is caused by directed hepatocyte injury
c) anicteric ascites is characteristic
d) it’s a type of veno-occlusive disease
Answer : It is caused by directed hepatocyte injury
Question 42 : Which of the following trial led to approval of soranfenib in advanced HCC :
a) SMURF
b) SMART
c) SHARP
d) SHIELD
Answer : SHARP
Question 43 : Which of the following is not true about fibrolamellar HCC :
a) It occurs mostly in the third decade of life
b) It predominantly affects females
c) The chances of lymph node metastasis are higher in it compared to normal variant HCC
d) Resection is the treatment of choice
Answer : It predominantly affects females
Question 44 : Which is the most common type of cholangiocarcinoma :
a) Perihilar
b) Intrahepatic
c) Distal extrahepatic
d) All occurs with same frequency
Answer : perihilar
Question 45 : Which of the following are classified as group I carcinogens by IARC for cholangiocarcinoma :
a) Opisthorchis viverrini
b) Clonorchis sinensis
c) both of the above
d) neither 1 nor 2
Answer : both of the above
Question 46 : Most of the times, Klatskin tumor is a variant of :
a) Perihilar CCA
b) Intrahepatic CCA
c) Periampullary carcinoma
d) Distal extrahepatic CCA
Answer : Perihilar CCA
Question 47 : Which is the incidence of gallbladder cancer (GBC) in patients with cholecystolithiasis :
a) 0.5-3%
b) 5.7%
c) 9.3-14.7%
d) 25-37%
Answer : 0.5-3%
Question 48 : GBC occurs most commonly at :
a) Fundus
b) Body
c) Neck
Answer : fundus
Question 49 : In which of the following high-risk situations a prophylactic cholecystectomy could be considered :
a) Porcelain gallbladder
b) Pancreaticobiliary maljunction
c) both of the above
d) neither 1 nor 2
Answer : both of the above
Question 50 : Which of the following is true about GBC :
a) Liver metastases without full-thickness invasion of the gallbladder wall occurs in < 10% of cases
b) For completely resected GBC patients the 5 year survival is 15 – 16%
c) For metastatic, unresectable GBC patients the 5 year survival is < 5%
d) all of the above
Answer : all of the above