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1. Which of the following best describes neuroendocrine tumors (NETs):

A. Result in functional symptoms related to the overproduction of insulin B. Most commonly occurs as a result of genetic syndromes such as von Hippel-Lindau disease, tuberous sclerosis complex, and neurofibromatosis C. Arise from neuroendocrine cells and can affect the secretion of various regulatory hormones or vasoactive peptides throughout the body D. The most common types arise from the parathyroid, adrenal, pituitary, and thyroid glands

2. Which of the following classification systems best allocates patients into different risk categories:

A. World Health Organization (WHO) 2000 classification system B. European Neuroendocrine Tumor Society (ENETS) classification system C. WHO 2010 classification system D. B and C

3. A patient presents with a dermatitis located on the perineum, thighs, and distal extremities. The health care provider suspects that this is a classic necrolytic migratory erythema caused by a glucagonoma. Which of the following biochemical analyses should be performed to confirm a diagnosis of glucagonoma:

A. Glucose, plasma insulin, C-peptide, and proinsulin levels B. Gastrin level after the use of antacids, histamine (H2) receptor blockers, and proton pump inhibitors (PPIs) are discontinued for 1 week C. Vasoactive intestinal peptide (VIP) level D. Glucagon level

4. A patient with an insulinoma complains about mild symptoms of hypoglycemia. She will be undergoing surgery in 2 weeks. In the meantime, which of the following should be tried to help manage these symptoms:

A. Octreotide LAR 20 mg intramuscular (IM) monthly B. Streptozocin 400 mg/m2 intravenous (IV) D1 - 5 every 4 weeks C. Eating frequent small meals D. Diazoxide 3 mg/kg/day orally in divided doses every 8 hours

5. Which of the following should be used to predict the utility of a somatostatin analog:

A. Metaiodobenzylguanidine (MIBG) scintigraphy B. Magnetic resonance imaging (MRI) C. Somatostatin receptor scintigraphy (SRS) D. Endoscopic ultrasound (EUS)

6. What constellation of symptoms best describes the clinical presentation of carcinoid syndrome?

A. Confusion, visual disturbances, diaphoresis B. Flushing, diarrhea, bronchial constriction, carcinoid heart disease C. Large volume watery diarrhea, dehydration, and hypokalemia D. Glucose intolerance, weight loss, anemia

7. Which of the following patients with carcinoid of the small intestine would be most likely to experience carcinoid syndrome:

A. Elevated chromogranin A (CgA) level, lymph nodes metastases, and a 2.4 cm tumor B. Elevated 5-hydroxyindoleacetic acid (5-HIAA) level, liver metastases, and a 2 cm tumor C. Elevated CgA level, lymph nodes metastases, and a 1.5 cm tumor D. Elevated 5-HIAA level, no metastases, and a 2.6 cm tumor

8. AH is a woman, 50 years of age, with a past medical history significant for hypertension and gastroesophageal reflux disease who was recently diagnosed with metastatic carcinoid tumor. She presents to the clinic with complaints of severe diarrhea and flushing. Which of the following is the best option to control her symptoms:

A. Loperamide 2 mg orally every 2 to 4 hours B. Octreotide LAR 20 mg IM every month C. Octreotide 100 mcg subcutaneous (SQ) 3 times daily D. Lansoprazole 120 mg by mouth daily

9. AH has been receiving Octreotide LAR 20 mg IM monthly for the treatment of her diarrhea for the last 9 months. Today she presents to the clinic with complaints that her diarrhea is significantly worse at the end of each month. Which of the following would you recommend:

A. Increase the dose to octreotide LAR 30 mg IM monthly B. Add short acting octreotide 100 mcg SQ 3 times daily C. Add loperamide 2 mg orally every 4 hours as needed D. Administer octreotide LAR 20 mg IM every 3 weeks

10. H0 is a man, 65 years of age, who was recently diagnosed with malignant gastrinomas after presenting with a past medical history of severe peptic ulcer disease, chronic diarrhea, and most recently, abdominal pain. HO arrives in clinic today to inquire about available options to help relieve his excessive gastric production symptoms. Which of the following is the best treatment option for these symptoms:

A. Ranitidine 150 mg by mouth twice daily B. Octreotide 100 mg SQ 3 times daily C. Everolimus 10 mg by mouth daily D. Lansoprazole 120 mg by mouth daily

11. RS is a man, 60 years of age, who was diagnosed with a poorly differentiated, malignant VIPoma about 1 year ago. Since then, his treatment has consisted of octreotide LAR 30 mg IM every month, then octreotide LAR 30 mg IM every 3 weeks, and most recently octreotide LAR 30 mg IM every 3 weeks, plus octreotide 200 mcg SQ 3 times daily. Despite the therapeutic changes, RS continues to present to the clinic with diffuse diarrhea, dehydration, and electrolyte disturbances. Which of the following is the best treatment option for RS at this time:

A. Streptozocin 400 mg/m2 IV D1 - 5 every 10 weeks, fluorouracil 400 mg/m2 IV D1 - 5, D36 - 40 every 10 weeks B. Sunitinib 37.5 mg by mouth daily C. Octreotide LAR 30 mg every 2 weeks plus octreotide 200 mcg SQ 4 times a day D. Everolimus 10 mg by mouth daily

12. TR is a woman, 58 years of age, diagnosed with a well-differentiated, low-grade PNET, who presents to the clinic for treatment options after treatment failure with octreotide. It is determined that TR will begin therapy with sunitinib 37.5 mg by mouth daily. Which of the following should TR be counseled about:

A. Diarrhea, nausea, fatigue, hand-foot syndrome, hypothyroidism B. Hyperglycemia, hyperlipidemia, diarrhea, and rash C. Hyperthyroidism, hand-foot syndrome, diarrhea D. Hypoglycemia, diarrhea, rash

13. PM presents to the pharmacy to pick up her prescription refill for everolimus for the treatment of her gastrinoma. During the encounter, the pharmacist reviews her medication profile which includes the following: Tylenol 500 mg orally as needed, metoprolol XL 50 mg by mouth daily, lisinopril 20 mg by mouth daily, and a new prescription for clarithromycin 500 mg orally twice a day for a sinus infection. Which of the following should the pharmacist recommend:

A. Change metoprolol extended release to diltiazem extended release 120 mg by mouth daily B. Change clarithromycin to levofloxacin 500 mg by mouth daily C. Change lisinopril to enalapril 10 mg by mouth daily D. Change clarithromycin to bactrim double strength (DS) 1 tablet by mouth daily