EXAMINATION FOR CONTINUING MEDICAL EDUCATION CREDIT

*To obtain credit: 70% or more of the answers must be correct.*

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1. The mechanism(s) by which antibodies can have both a direct killing effect on a pathogen and stimulate a T cell response is:
1. Complement mediated lysis
2. Agglutination
3. Neutralization
4. Antibody dependent cell mediated cytotoxicity
2. Both CD4+ (T helper) and CD8+ (cytotoxic T cells) recognize immunogenic proteins in the context of MHC molecules presented on the surface of cells. When present in MHC molecules, these proteins are in the form of:
1. Enzymes
2. Peptides
3. Receptors
4. Toxins
3. The PRIMARY function of a CD4+ helper T cell is:
1. Binding to a pathogen and causing opsinization.
2. Directly phagocytizing foreign antigens for intercellular processing of proteins.
3. Cytokine secretion in response to antigen
4. Trigger apoptosis of a tumor cell
4. Which of the following statements is FALSE concerning what is know known about the human immune response to cancer:
1. Human tumors are immunogenic and human tumor antigen has been defined.
2. Human tumor antigens can be both foreign proteins such as HPV or EBV as well as self-proteins such as CEA and HER-2/neu
3. Most endogenous immunity detected in cancer patients is successful in eradicating tumors.
4. Immune responses in cancer patients can be quantified using newer molecular techniques.
5. An example of active immunotherapy is:
1. Administration of a melanoma specific vaccine to patients with Stage III melanoma
2. Treatment of a HER-2/neu positive breast cancer patients with Herceptin
3. Infusion of a cytotoxic EBV specific T cell clone into a patient with an EBV related lymphoma
4. Treatment of lymphoma patients with a monoclonal antibody such as Rituxan
6. Monoclonal antibodies are made by which of the following means?
1. By neutralizing growth factors and inhibiting tumor expansion
2. By injecting human cancer cells into mice and fusing murine antibody-producing cells with laboratory-grown cells
3. By targeting human cancer cells and binding to foreign antigens
4. By application of flow cytometry
7. Monoclonal antibodies are used in which of the following ways for cancer treatment?
1. Enhancing patient's immune response by reacting with specific antigens on cancer cells
2. Blocking cell growth
3. By linking with anticancer drugs, radioisotopes, or other biologic response modifiers
4. All of the above.
8. There are a number of antigens and corresponding monoclonal antibodies for the treatment of hematologic malignancies. Which of the following is one of the most widely used?
1. CD20
2. 17-IA
3. HER-2/neu
4. None of the above
9. In the US, the most commonly used monoclonal antibody for the treatment of solid tumors is trastuzumab, which targets the HER-2/neu antigen seen on 25% to 35% of breast cancers. Trastuzumab is thought to work in which of the following ways:
1. Down-regulation of angiogenesis factors
2. Inhibition of proliferation of tumor cells that overexpress HER-2/neu
3. Enhanced immune recruitment against tumor cells
4. All of the above
10. Important safety considerations of monoclonal antibody therapy include which of the following?
1. Impaired vision
2. Cardiac toxicity
3. Extrapyramidal symptoms
4. Fatigue
11. Which of the following statements about cytokines is true?
1. Cytokines are most effective as monotherapy for cancer.
2. Cytokines are the messengers of the central nervous system.
3. Cytokines are substances, either proteins or glycoproteins, secreted by immune cells.
4. Cytokines are not associated with significant adverse events.
12. Cytokines that have shown anticancer activity include which of the following?
1. Interferon gamma
2. Tumor necrosis factor (TNF)
3. IL-4
4. Interferon alfa
13. Toxicity of interferon, as standard adjuvant therapy for stage III resected melanoma, is an issue. Which of the following interventions are often necessary to manage toxicity?
1. Administration of antidepressant agent
2. Admission to the ICU
3. Administration of recombinant human epoetin alfa
4. None of the above.
14. Which of the following statements about interleukin-2 is true?
1. Treatment with IL-2 for cancer is not associated with significant toxicity.
2. IL-2 is active against renal cell cancer at high doses only.
3. IL-2 is a T cell growth factor that binds to a specific tripartite receptor on T cells.
4. IL-2 is indicated for treatment of advanced stage breast cancer.
15. Which of the following cytokines has shown promise as an adjuvant to vaccine therapy?
1. IL-2 and IL-12
2. IL-12
3. Interferon alfa
4. IL-4
16. Which of the following is a form of active immunotherapy:
1. The intravenous delivery of antibodies
2. The intravenous delivery of T cells
3. An intradermal injection of a peptide fragment of MART-1
4. All of the above
17. Most cancer vaccines stimulate an immune response by:
1. Directly causing T cells to proliferate
2. Causing IL-2 secretion
3. Directly causing B cells to make antibodies
4. Recruiting dendritic cells to the injection site where they take up, process, and present antigen to T cells
18. An example of a prime-boost strategy used in cancer vaccines is:
1. Injection of vaccinia virus encoding CEA followed by injections of fowl pox vector encoding CEA.
2. Injection of vaccinia virus encoding CEA followed by injections of 10 times the dose of the same viral vector.
3. Injection of dendritic cells loaded with CAP-1 peptide followed by dendritic cells loaded with full length CEA protein
4. Injection of a dendritic cell vaccine loaded with MART-1 followed 3 and 6 months later by the same vaccine at the same dose.
19. A potential hurdle to successful employment of cancer vaccines is:
1. Tumor cell upregulation of HLA class I expression
2. Low tumor antigen-specific T cell precursor frequency
3. Tumor cell expression of fas
4. All of the above

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