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  • Question 1 - A 56-year-old retired man with a history of chronic hepatitis B infection presents...

    Correct

    • A 56-year-old retired man with a history of chronic hepatitis B infection presents with jaundice and significant abdominal distention. The patient does not drink, and smokes ten cigarettes a day.
      On examination, the patient is found to have ascites and hepatomegaly. The patient is admitted for further investigations; the results of one tumour marker test is suggestive of a possible hepatocellular carcinoma (HCC).
      Which of the following tumour markers is usually raised in primary HCC?

      Your Answer: Alpha fetoprotein (AFP)

      Explanation:

      Understanding Tumour Markers: Types and Associated Cancers

      Tumour markers are compounds whose blood levels increase due to the presence of a particular malignant tumour. They are useful for diagnosis and detecting recurrence. However, they are not always specific, and different tumours may secrete the same marker. Here are some common tumour markers and the cancers they are associated with:

      Alpha fetoprotein (AFP): Associated with liver and testicular cancers.

      Prostate-specific antigen (PSA): Associated with prostate cancer.

      Chemical nature Name Associated tumour
      Enzyme PSA
      NSE
      LDH Prostate
      Small cell lung cancer
      Non-specific, mainly haematological
      Hormone HCG
      Calcitonin
      Parathormone Testes
      Medullary thyroid carcinoma
      Parathyroid carcinoma
      Immunoglobulin IgG, IgA, etc. Multiple myeloma
      Glycoprotein AFP
      CA-125
      CA-19-9
      CA-15-3
      CEA Liver, also testes
      Ovary
      Pancreas
      Breast
      Colon, stomach

      However, not all primary liver malignancies have AFP as a tumour marker. Certain types of liver malignancy, such as fibrolamellar carcinoma, hepatoblastoma, and hepatic angiosarcoma, do not secrete this protein. The first two usually occur in young persons. Hepatomas can occur de novo but are usually present because of an underlying disease such as hepatitis B infection (chronic) or cirrhosis of the liver. Alcoholism, aflatoxin, and obesity are also risk factors for hepatoma.

      CA-125 is associated with ovarian cancer, CA-19-9 with pancreatic cancer, and HCG with testicular cancer. Understanding tumour markers and their associated cancers can aid in early detection and treatment.

    • This question is part of the following fields:

      • Oncology
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  • Question 2 - A 42-year-old teacher is referred to the Breast Clinic after discovering a painless...

    Correct

    • A 42-year-old teacher is referred to the Breast Clinic after discovering a painless pea-sized lump in her left breast. Her grandmother passed away at age 46 due to breast cancer, and the patient is worried that she may have the same condition. What is the most accurate statement regarding breast cancer?

      Your Answer: Women with a history of ovarian cancer are at increased risk of breast cancer

      Explanation:

      Breast Cancer Myths and Facts

      Breast cancer is a complex disease that affects millions of women worldwide. Unfortunately, there are many myths and misconceptions surrounding breast cancer that can lead to confusion and anxiety. Here are some common breast cancer myths and facts to help you better understand this disease.

      Myth: Women with a history of ovarian cancer are not at risk for breast cancer.
      Fact: Women with a history of ovarian cancer are at increased risk of breast cancer because they share similar risk factors.

      Myth: All patients with the BRCA1 gene will develop breast cancer.
      Fact: Patients with the BRCA1 gene have an 80% lifetime risk for developing breast cancer, and 50% for ovarian cancer. It is a mutation on chromosome 17.

      Myth: Breast cancer is more common in women from low socioeconomic groups.
      Fact: Higher socio-economic groups are associated with increased risk of breast cancer.

      Myth: Malignant lumps are usually painful.
      Fact: Most breast cancers present with a painless lump and may be associated with nipple change or discharge, or skin contour changes. Mastalgia (breast pain) alone is a very uncommon presentation; <1% of all breast cancers present with mastalgia as the only symptom. Myth: Most breast cancers are lobular carcinomas.
      Fact: Breast cancer is most commonly ductal (arising from the epithelial lining of ducts) (90%). The second most common type is lobular (arising from the epithelium of the terminal ducts of lobules). They can be either intrusive or in situ. Paget’s disease of the breast is an infiltrating carcinoma of the nipple epithelium (1% of all breast cancers).

    • This question is part of the following fields:

      • Oncology
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  • Question 3 - What is the origin of Ewing's tumor? ...

    Incorrect

    • What is the origin of Ewing's tumor?

      Your Answer: None of these options

      Correct Answer: Mesenchymal cells

      Explanation:

      Ewing’s Tumour: A Younger Age Onset and Destructive Nature

      Ewing’s tumour is a type of bone cancer that typically occurs in individuals between the ages of 5 and 30 years old. Patients with this condition often experience fever and pain, and may have an elevated erythrocyte sedimentation rate. The tumour usually affects a long bone, particularly the diaphysis, and can be found in the axial skeleton, such as the pelvis, in 40% of cases. The tumour is primarily destructive and ill-defined, eroding the cortex of the bone. Its cellular origin is not well understood, but is believed to come from undifferentiated mesenchymal cells in the medulla of the bone.

      One of the characteristic features of Ewing’s tumour is an early periosteal reaction, which can be seen as a series of lamellated periosteal reactions with an onion skin appearance. This reaction occurs due to the elevation of the periosteum, which gives rise to the Codman’s triangle appearance. In cases where the tumour is large, the site of origin can be inferred from the centre of the radius of the mass.

      Overall, Ewing’s tumour is a serious condition that requires prompt diagnosis and treatment. Its destructive nature and younger age onset make it a particularly challenging form of bone cancer to manage.

    • This question is part of the following fields:

      • Oncology
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  • Question 4 - A 6-year-old girl is brought to the Paediatric Outpatient Department by her father...

    Correct

    • A 6-year-old girl is brought to the Paediatric Outpatient Department by her father with symptoms of bloating, mild fever, abdominal pain, lack of appetite, generalised feeling of being unwell and easy bruising for the past two weeks. On examination, hepatosplenomegaly, lymphadenopathy (non-tender, firm, rubbery) and patches of petechiae and purpura are noted on both lower limbs.
      The child is referred to the Oncology Department where complete laboratory investigations, including full blood count (FBC), differential count and a review of the peripheral smear, were performed. The findings are indicative of acute lymphocytic leukaemia (ALL).
      Which of the following would be the most likely finding with the suspected diagnosis?

      Your Answer: Positive staining for B-cell antibodies (CD19, cytoplasmic CD79a, CD22) and MPO-negative

      Explanation:

      Recognizing Leukemia and Lymphoma: Key Features and Diagnostic Tests

      Leukemia and lymphoma are types of blood cancers that can present with similar symptoms, making diagnosis challenging. However, certain features and diagnostic tests can help differentiate between them.

      For example, positive staining for B-cell antibodies (CD19, cytoplasmic CD79a, CD22) and MPO-negative suggest ALL/LBL, while an expanded population of myeloid cells with t(9;22) (Philadelphia chromosome) is characteristic of CML. Burkitt’s lymphoma is characterized by highly proliferative cells with a starry sky appearance, while hypocellular bone marrow with pancytopenia suggests aplastic anemia. Finally, AML is characterized by immature cells with large nucleoli that are MPO-positive.

      By recognizing these key features and utilizing appropriate diagnostic tests such as flow cytometry and cytochemistry, healthcare professionals can accurately diagnose and treat these blood cancers.

    • This question is part of the following fields:

      • Oncology
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  • Question 5 - A 70-year-old woman comes to the clinic with a lump in her neck....

    Correct

    • A 70-year-old woman comes to the clinic with a lump in her neck. She is anxious because her sister was diagnosed with a highly aggressive type of thyroid cancer that is prevalent in older adults and has a poor prognosis. What type of cancer is she talking about?

      Your Answer: Anaplastic carcinoma

      Explanation:

      Types of Thyroid Cancer: An Overview

      Thyroid cancer is a relatively rare malignancy that affects the thyroid gland. There are several types of thyroid cancer, each with its own unique characteristics and prognosis. Here is an overview of the most common types of thyroid cancer:

      1. Anaplastic carcinoma: This is a highly aggressive form of thyroid cancer that is typically found in elderly patients. It has a low survival rate and is usually treated palliatively.

      2. Papillary carcinoma: This is the most common type of thyroid cancer and typically affects younger patients. It tends to spread to local lymph nodes but rarely metastasizes via the bloodstream.

      3. Follicular carcinoma: This is the second most common type of thyroid cancer and is more aggressive than papillary carcinoma. It tends to spread via the bloodstream.

      4. Medullary carcinoma: This type of thyroid cancer originates from thyroid C cells and is associated with multiple endocrine neoplasia syndromes. It produces calcitonin, which is used as a tumor marker.

      5. Thyroid lymphoma: This is a rare type of thyroid cancer that is almost always a non-Hodgkin’s B-cell lymphoma. It is treated as a lymphoma rather than a thyroid cancer.

      In conclusion, understanding the different types of thyroid cancer is important for diagnosis and treatment. If you have concerns about your thyroid health, it is important to speak with your healthcare provider.

    • This question is part of the following fields:

      • Oncology
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  • Question 6 - A 25-year-old man has been referred to the Cancer Clinic for treatment after...

    Incorrect

    • A 25-year-old man has been referred to the Cancer Clinic for treatment after being diagnosed with acute myeloid leukaemia (AML) with favourable cytogenetic profiling. He reports experiencing fatigue, weight loss, reduced appetite, and easy bruising. What is the most suitable approach for achieving remission induction?

      Your Answer: Cyclophosphamide, doxorubicin and vincristine

      Correct Answer: Daunorubicin plus cytarabine

      Explanation:

      Chemotherapeutic Agents for Acute Myeloid Leukemia (AML)

      Remission induction therapy for AML patients with a favourable cytogenetic profile typically involves a combination of cytarabine and daunorubicin or idarubicin, known as the 7 plus 3 treatment. This involves a continuous infusion of cytarabine for seven days and daunorubicin or idarubicin on days 1-3. Infusion reactions such as nausea, vomiting, diarrhoea, alopecia, and stomatitis are monitored, and a bone marrow examination is performed after two weeks to determine the need for a second course of therapy. Complete clinical investigation profiling is performed after 4-5 weeks to assess remission.

      Asparaginase, dexamethasone, and vincristine are not used for remission induction in AML but are used for the treatment of acute lymphocytic leukemia/lymphoblastic leukemia (ALL/LBL). Cyclophosphamide, doxorubicin, and vincristine are mainly used for small cell carcinoma of the lung.

      Daunorubicin and idarubicin are not standalone drugs but are used in combination with cytarabine as part of the 7 plus 3 remission induction therapy for medically fit AML patients with favourable cytogenetics. Midostaurin, an FLT3 inhibitor, is only added as one of three agents for AML patients with FLT3 mutations and is not used as a standalone remission induction drug.

    • This question is part of the following fields:

      • Oncology
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  • Question 7 - A woman aged 57 presents with a unilateral ovarian mass, accompanied by a...

    Incorrect

    • A woman aged 57 presents with a unilateral ovarian mass, accompanied by a large omental metastasis.
      Which of the following postoperative treatments is the most appropriate?

      Your Answer: Bleomycin, cisplatin and etoposide

      Correct Answer: Carboplatin and Taxol®

      Explanation:

      Chemotherapy Options for Ovarian Cancer

      Platinum-based drugs, such as carboplatin and cisplatin, are the primary treatment for ovarian cancer. Carboplatin is preferred over cisplatin due to its lower risk of kidney and nerve damage. For germ cell tumors of the testicles or ovaries, a combination of bleomycin, cisplatin, and etoposide (BEP) may be used.

      While Taxol® can be used alone, it is not as effective as when combined with a platinum-based drug. In 2002, the National Institute for Health and Care Excellence (NICE) recommended the addition of Taxol® as a first-line drug for ovarian cancer treatment, based on large multicenter randomized trials. Overall, the choice of chemotherapy depends on the type and stage of ovarian cancer, as well as individual patient factors.

    • This question is part of the following fields:

      • Oncology
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  • Question 8 - A 55-year-old woman presents with symptoms of nausea and vomiting. She has been...

    Incorrect

    • A 55-year-old woman presents with symptoms of nausea and vomiting. She has been diagnosed with inoperable cancer and is experiencing pain from infiltration of the posterior abdominal wall. Currently, her pain is being managed effectively with Kapake (codeine 30 mg and paracetamol 500 mg), taken two tablets four times per day.

      What is the optimal approach for managing her pain?

      Your Answer: Fentanyl skin patch

      Correct Answer: Subcutaneous diamorphine by continuous infusion

      Explanation:

      Choosing the Best Analgesia for a Patient with Inoperable Carcinoma

      When a patient has inoperable carcinoma and requires opiate analgesia, it is important to choose the most effective method of administration. In the case of a patient who is vomiting, parenteral analgesia is necessary. Subcutaneous diamorphine administered through continuous infusion is the best option for achieving adequate analgesia while also allowing for effective dose titration.

      Other options, such as fentanyl patches, are not ideal for titration as they are used for 72 hours and are typically reserved for patients with stable opiate usage. Intramuscular pethidine has a delayed onset and prolonged effect, which is not ideal when the patient’s opiate requirements are unknown. Oral morphine is unlikely to be tolerated in a vomiting patient, and non-steroidal anti-inflammatory drugs are unlikely to provide sufficient pain relief in this case.

      In summary, subcutaneous diamorphine administered through continuous infusion is the most effective and appropriate method of analgesia for a patient with inoperable carcinoma who is vomiting and requires opiate pain relief.

    • This question is part of the following fields:

      • Oncology
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  • Question 9 - A child with leukaemia is given etoposide.
    What is the mechanism of action...

    Incorrect

    • A child with leukaemia is given etoposide.
      What is the mechanism of action of this medication?

      Your Answer: Microtubule inhibitor

      Correct Answer: Topoisomerase II inhibitor

      Explanation:

      Chemotherapy agents can be classified into different categories based on their mechanism of action. Topoisomerase II inhibitors, such as etoposide, prevent the re-ligation of DNA strands by forming a complex with the topoisomerase II enzyme, leading to cell cycle arrest and apoptosis. Microtubule inhibitors, like paclitaxel and vinblastine, block the formation of microtubules, which are essential for cell proliferation and signaling, resulting in cell death. Alkylating agents, such as cyclophosphamide, interfere with DNA replication by attaching an alkyl group to the guanine base of DNA. Antimetabolites, including base analogues, nucleoside analogues, nucleotide analogues, and antifolates, disrupt cell metabolism and inhibit DNA replication and repair. Topoisomerase I inhibitors, like irinotecan and topotecan, inhibit DNA transcription and replication by binding to the topoisomerase I-DNA complex. These chemotherapy agents have various side effects, including bone marrow suppression, hair loss, nausea, vomiting, and allergic reactions.

    • This question is part of the following fields:

      • Oncology
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  • Question 10 - A 58-year-old lady with multiple myeloma visits the Oncology Day Hospital for her...

    Incorrect

    • A 58-year-old lady with multiple myeloma visits the Oncology Day Hospital for her monthly infusion of intravenous zoledronic acid. She reports experiencing neck pain and new weakness and paraesthesiae in her left hand and arm.
      What is the most suitable initial approach for managing this woman?

      Your Answer: X-ray C-spine

      Correct Answer: Urgent magnetic resonance imaging (MRI) whole spine

      Explanation:

      Urgent Management for a Patient with Acute Neck Pain and Malignancy

      Explanation:

      When a patient with malignancy presents with acute neck pain and focal neurological deficits, urgent investigation is necessary. This is particularly important for patients with multiple myeloma, who are at risk for developing plasmacytomas, which can cause spinal cord compression or pathological fractures. In this case, an urgent magnetic resonance imaging (MRI) of the whole spine is needed to assess for spinal cord compression.

      While blood cultures may be important in other situations, they would not affect the management of this patient. Instead, the focus should be on obtaining a diagnosis and definitive treatment. Plasmacytomas are radiosensitive, so urgent radiotherapy is indicated for treatment.

      Although analgesia and pain assessment are necessary, they are not the top priority. Physiotherapy assessment for hand weakness may be beneficial, but it does not need to be done urgently. An X-ray of the cervical spine is not sensitive enough to detect all plasmacytomas, so an MRI of the whole spine is necessary to assess for multiple levels of disease.

      In summary, urgent management for a patient with acute neck pain and malignancy includes an urgent MRI of the whole spine to assess for spinal cord compression, followed by urgent radiotherapy for treatment.

    • This question is part of the following fields:

      • Oncology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Oncology (4/10) 40%
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