A 50-year-old woman presents with a three-month history of discomfort in the lower right quadrant of her abdomen. She had her last menstrual period two weeks ago and has been experiencing regular menses. During a pelvic examination, fullness was noted in the right adnexal region. An ultrasound revealed a solid mass in the left adnexa, and a CT scan confirmed the presence of an 8 cm adnexal lesion, omental studding, and peritoneal carcinomatosis. What is the most appropriate management for this patient?
MRCP2-3673
A 45-year-old smoker comes in with chest pain, cough, dyspnoea and haemoptysis. An X-ray shows circular shadows in the left upper lobe of the lung with involvement of the ipsilateral hilar node. A biopsy confirms the presence of small cell carcinoma. CT and PET scans do not indicate distant metastases, either on the opposite side of the chest or beyond the thoracic cavity. What is the best course of treatment for this patient?
MRCP2-3648
An 80-year-old man presents with a four month history of weight loss, altered bowel habit and lethargy.
A subsequent colonoscopy reveals a large mass in the descending colon consistent with a colonic cancer. The patient undergoes a left hemicolectomy which is pathologically graded as Dukes’ C with evidence of metastatic adenocarcinoma in 2 of 15 lymph nodes.
A subsequent CT scan reveals no evidence of metastatic disease.
What is the estimated five year survival rate for a Dukes’ C adenocarcinoma in an 80-year-old patient?
MRCP2-3649
A 45-year-old premenopausal woman is worried about her chances of developing ovarian cancer after learning that one of her second cousins was diagnosed with the disease. She has no symptoms and her menstrual cycle is regular. She has undergone all necessary health screenings and there is no history of cancer in her family. During physical examinations, including pelvic exams, no abnormalities were found. What is the best screening recommendation for ovarian cancer in this patient?
MRCP2-3650
A 67-year-old man presents to the oncology team with a three-week history of progressive thoracic back pain. The pain is localised to a point between his shoulder blades and is worsened by movement and coughing. He also reports difficulty standing and walking, with intermittent tingling sensations in his lower legs. The patient has a history of prostate cancer and has been lost to urological follow-up for two years. Examination reveals metastatic invasion and collapse of T10 vertebral with spinal cord compression. What is the most appropriate first-line treatment for this patient’s condition?
MRCP2-3651
A 57-year-old patient presents to hospital with confusion. He is a long-term smoker. He has a past-medical history of chronic obstructive pulmonary disease, hypertension, bipolar disease and long-term muscular back pain.
On examination he is confused with a Glasgow Coma Scale score of 14 out of 15. He has a pulse rate of 97 beats per minute with a blood pressure of 145/97 mmHg. Respiratory rate is 14 per minute with oxygen saturations of 95% on room air. He has bilateral vesicular breath sounds on auscultation with normal percussion. His abdomen is soft and non-tender without masses. He has no focal neurology.
Chest X-ray Right perihilar opacification 3x4cm Lumbar Spine X-ray Normal
What is the likely underlying diagnosis?
MRCP2-3654
A 55-year-old Caucasian man presents to the Oncology Clinic with a PSA value of 15 ng/ml. He has no symptoms and no significant medical history, but requested the PSA test after hearing about the Prostate Cancer Risk Management Programme (PCRMP) from a friend. A digital rectal examination (DRE) was performed by his General Practitioner (GP) and revealed a normal-sized prostate with preserved midline sulcus and no palpable nodules. What is the best course of action for management?
MRCP2-3655
A 65-year-old woman presented to the emergency department with recurrent episodes of severe headache and vomiting over the past 5-6 days. She had a history of metastatic breast cancer and was receiving palliative chemotherapy. Additionally, she had type 2 diabetes mellitus and osteoarthritis of bilateral knee joints.
During examination, her pulse rate was 100/min, respiratory rate was 18/min, and blood pressure was 130/90 mmHg. Fundoscopy revealed early papilloedema.
A contrast-enhanced CT brain scan was performed, which revealed a solitary mass of 3.5 cm in the left cerebral hemisphere.
What would be the most appropriate course of action now?
MRCP2-3656
A 74-year-old man with ischaemic heart disease and chronic obstructive pulmonary disease has been diagnosed with a well-differentiated small bowel neuroendocrine tumour with liver metastases. He presented with a 6-month history of diarrhoea, abdominal cramps and flushing. His observations are within normal limits, but his blood results show low haemoglobin, high ALT and ALP, and elevated levels of serum 5-hydroxyindoleacetic acid and serum chromogranin A. What is the most appropriate treatment option to improve the patient’s symptoms at this stage?
MRCP2-3657
A 48-year-old woman presents to the emergency department with sudden onset of shortness of breath and pleuritic chest pain. Observations demonstrate marked hypoxia and she is given oxygen and analgesia and undergoes a chest X-ray followed by a CT pulmonary angiogram which shows a pulmonary embolism. There is also an incidental finding of a nodule suspicious of metastatic disease.
She is started on a treatment dose of low molecular weight heparin and admitted under the medical team for further assessment. During a more detailed history, she explains that she has lost one stone in weight over two months and been feeling progressively more tired as well. She denies any other symptoms. She has a past medical history of asthma and also underwent a caesarean section three years ago. She has two children, of which she breastfed both, and has a long history of use of oral contraceptive use. She is an ex-smoker of 5 pack-years and has minimal alcohol intake. Her grandfather died of prostate cancer, and her sister developed breast cancer at the age of 52.
A complete further examination was completed and no abnormalities were found. Routine blood tests are currently pending, and a flexible bronchoscopy for biopsy of the lung nodule has been arranged. How should this patient be further investigated?