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  • Question 1 - A 35-year-old male patient (undergoing chemotherapy treatment for Hodgkin’s lymphoma) complains of severe...

    Incorrect

    • A 35-year-old male patient (undergoing chemotherapy treatment for Hodgkin’s lymphoma) complains of severe mouth pain. On examination, you see white plaques over his tongue.
      Which of the following treatments is most appropriate?

      Your Answer: Oral mycafungin for 7–14 days

      Correct Answer: Oral fluconazole for 7–14 days

      Explanation:

      Treatment Options for Oral Candida Infection During Chemotherapy

      During chemotherapy, patients may experience immunosuppression, which can lead to oral candida infection. There are several treatment options available for this condition, including oral fluconazole, nystatin mouthwash, and oral mycafungin. However, the most appropriate choice for mild to moderate oral candida infection is oral fluconazole, as it is more likely to prevent or delay recurrence than nystatin. Intravenous amphotericin B and oral voriconazole are not recommended for this condition, as they are used for systemic fungal infections and other types of fungal infections, respectively. It is important for healthcare providers to consider the patient’s individual needs and medical history when selecting a treatment option.

    • This question is part of the following fields:

      • Oncology
      20.9
      Seconds
  • Question 2 - A 70-year-old man undergoing chemo-radiotherapy treatment for prostate cancer complains of poor appetite...

    Incorrect

    • A 70-year-old man undergoing chemo-radiotherapy treatment for prostate cancer complains of poor appetite and nausea secondary to his treatment. He is finding it difficult to cope with his illness and has become depressed.
      Which of the following may be the most suitable appetite stimulant for him?

      Your Answer: Trazodone

      Correct Answer: Mirtazapine

      Explanation:

      Medications for Appetite Stimulation and Mood Improvement in a Patient with Anorexia

      Mirtazapine is an antidepressant that can also stimulate appetite, making it a suitable option for a patient with anorexia who needs both mood improvement and increased food intake. Dexamethasone can also be used to boost appetite in the short term. However, metoclopramide is not effective for mood improvement and would require dual therapy with another medication. Megestrol, a progestin, is indicated for anorexia, cachexia, or significant weight loss, but it does not address mood issues. Trazodone, on the other hand, is an antidepressant but may not be the first choice for a patient with anorexia as it can cause weight loss and anorexia as side effects.

    • This question is part of the following fields:

      • Oncology
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      Seconds
  • Question 3 - A 56-year-old male presents with a history of a sore area on his...

    Incorrect

    • A 56-year-old male presents with a history of a sore area on his tongue, which has failed to heal for over three months and is becoming increasingly bothersome. The patient is otherwise well, with a history of mild osteoarthritis of the knees, but nil else of note. He is a builder, and smokes 30 cigarettes a day for the past 30 years. He drinks around 30 units of alcohol a week.
      Following examination, the patient is referred urgently as a case of suspected cancer of the tongue.
      Which one of the following statements is correct about tongue cancer?

      Your Answer: Adenocarcinoma is most common

      Correct Answer: It may be associated with human papillomavirus (HPV)

      Explanation:

      Myth-busting: Tongue Cancer Risk Factors

      Tongue cancer is a rare form of oral carcinoma, accounting for only 2% of overall cancers. While it can be associated with human papillomavirus (HPV), there are several misconceptions about its risk factors. Contrary to popular belief, smoking and alcohol are known risk factors, while coconut ingestion is not. Betel nut ingestion, on the other hand, is associated with an increased risk of tongue cancer. It is important to note that tongue cancer usually metastasises to the upper cervical and submandibular nodes, not the lower cervical nodes. However, early detection and treatment with a combination of surgery and chemoradiotherapy can often lead to a cure.

    • This question is part of the following fields:

      • Oncology
      31.3
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  • Question 4 - A 68-year-old retired banker is referred to the Urology Clinic with a 4-month...

    Correct

    • A 68-year-old retired banker is referred to the Urology Clinic with a 4-month history of poor stream when passing urine. Over the past few weeks, the patient has also noticed some blood in his urine.
      He is normally fit and well. The only medical history of note is type 2 diabetes, which is well controlled with diet alone.
      On rectal examination, the patient is noted to have an enlarged, irregularly shaped prostate.
      A raised level of which of the tumour markers below would be most commonly associated with carcinoma of the prostate?

      Your Answer: Prostate specific antigen (PSA)

      Explanation:

      Tumour Markers: PSA and Other Commonly Used Markers

      Prostate cancer is the most common cancer in men in the UK. It is a slow-growing cancer, which means that it may be present for a long time before symptoms appear. Symptoms of prostate cancer include increased urinary frequency, urgency, hesitancy, weak flow, sensation of incomplete emptying of the bladder post-voiding, and blood in the urine or semen. PSA is the most commonly used tumour marker for prostate cancer. However, PSA can also be elevated in non-malignant conditions of the prostate, such as benign prostatic hyperplasia. A normal PSA level ranges from 0 to 4 ng/ml, although the upper level of normal can vary according to age and race. If a patient’s PSA is 3.0 or higher, they should be referred urgently to a specialist using a Suspected Cancer Pathway referral for an appointment within two weeks. Serial PSA measurements are also used to monitor disease progression, to measure response to treatment and to check for remission in patients with carcinoma of the prostate.

      Other commonly used tumour markers include AFP, which is associated with liver and testicular tumours, CEA, which is a non-specific tumour marker associated with colorectal cancer, lung cancer, and breast cancer, Ca-125, which is associated with ovarian cancer, and Ca 15-3, which is associated with carcinoma of the breast.

    • This question is part of the following fields:

      • Oncology
      28.8
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  • Question 5 - Which bone is an uncommon location for metastatic spread? ...

    Incorrect

    • Which bone is an uncommon location for metastatic spread?

      Your Answer: Skull

      Correct Answer: Tibia

      Explanation:

      Bone Metastasis and its Common Sites

      Bone metastasis is a common cause of pain in cancer patients. It can also lead to pathological fractures and hypercalcaemia. The spine is the most commonly affected part of the skeleton, followed by the pelvis, hip, femurs, and skull. However, the tibia is rarely involved in bone metastasis.

      In summary, bone metastasis is a significant concern for cancer patients, as it can cause pain and other complications. It is important for healthcare professionals to monitor patients for signs of bone metastasis, especially in the commonly affected sites such as the spine, pelvis, hip, femurs, and skull.

    • This question is part of the following fields:

      • Oncology
      0.8
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  • Question 6 - A 65-year-old woman presents to the Emergency Department feeling generally unwell, with fever...

    Incorrect

    • A 65-year-old woman presents to the Emergency Department feeling generally unwell, with fever and a cough. She had chemotherapy for her breast cancer 4 days ago. There are no known drug allergies. On examination:
      Investigation Result Normal value
      Blood pressure (BP) 108/70 < 120/80 mmHg
      Heart rate (HR) 101 60–100 beats/min
      Respiratory rate (RR) 26 12–18 breaths/min
      Sats 96% on air 94–98%
      Temperature 38.7ºC 36.1–37.2°C
      There is some scattered crepitations at the right lung base. You check on the system and see that bloods were done 2 days ago, and showed:
      Investigation Result Normal value
      Haemoglobin 120 g/l 115–155 g/l
      White cell count (WCC) 3.1 × 109/l 4–11 × 109/l
      Neutrophils 0.8 × 109/l 1.7–7.5 × 109/l
      Lymphocytes 1.5 × 109/l 1.0–4.5 × 109/l
      Eosinophils 0.6 × 109/l 0.0–0.4 × 109/l
      Which of the following is the most appropriate next-step management?

      Your Answer: Start IV meropenem

      Correct Answer: Start IV piperacillin with tazobactam (Tazocin)

      Explanation:

      Management of Neutropenic Sepsis in a Post-Chemotherapy Patient

      When a patient presents with neutropenic sepsis post-chemotherapy, it is crucial to start a broad-spectrum antibiotic immediately, without waiting for blood results or investigations. Tazocin is the first-line antibiotic recommended by NICE, but local hospital guidelines should be consulted if there is a known penicillin allergy. The Sepsis 6 protocol should be initiated promptly, and antibiotics should be administered within an hour of presentation. Once the patient is stabilized, an urgent chest X-ray can be performed. While granulocyte-colony stimulating factor (G-CSF) administration may have a role in selected patients, it is not routinely used in neutropenic sepsis. Consultation with the haematology team is also recommended.

    • This question is part of the following fields:

      • Oncology
      20.4
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  • Question 7 - A 68-year-old man with oesophageal cancer has completed two cycles of neo-adjuvant cisplatin...

    Incorrect

    • A 68-year-old man with oesophageal cancer has completed two cycles of neo-adjuvant cisplatin and 5-fluorouracil (5FU) and is scheduled for his third cycle of chemotherapy in a week. He complains of pain, discharge, and redness around the site of his jejunostomy and has a fever of 38.5 °C. Upon examination, he is stable, with a clear chest and soft abdomen, but shows signs of infection around the jejunostomy. His renal function is normal, and he has no known drug allergies. A full blood count taken yesterday reveals a neutrophil count of 0.5 × 109/l.
      What is the best course of action for managing this patient's condition?

      Your Answer:

      Correct Answer: Obtain iv access, take full blood count and blood cultures and commence iv piperacillin–tazobactam (as per local policy) as soon as possible

      Explanation:

      Management of Neutropenic Sepsis in a Patient Receiving Chemotherapy

      Neutropenic sepsis is a life-threatening condition that can occur in patients receiving chemotherapy. It is defined as pyrexia in the presence of a neutrophil count of <0.5 × 109/l. Prompt administration of broad-spectrum iv antibiotics is crucial in improving outcomes. Therefore, obtaining iv access, taking full blood count and blood cultures, and commencing iv piperacillin–tazobactam (as per local policy) should be done as soon as possible. In cases where there is suspicion of a collection around the jejunostomy, further imaging and surgical consultation may be required. It is important to discuss the management of chemotherapy with the patient’s oncologist. Delaying chemotherapy is necessary in cases of active infection and worsening neutropenia. The National Institute for Health and Care Excellence (NICE) guidelines advise treating suspected neutropenic sepsis as an acute medical emergency and offering empiric antibiotic therapy immediately. It is important to note that NICE guidelines recommend offering β-lactam monotherapy with piperacillin with tazobactam as initial empiric antibiotic therapy to patients with suspected neutropenic sepsis who need iv treatment, unless there are patient-specific or local microbiological contraindications. However, this should be reviewed with the result of cultures at 48 hours. In summary, the management of neutropenic sepsis in a patient receiving chemotherapy requires prompt and appropriate administration of antibiotics, delaying chemotherapy, and close collaboration with the patient’s oncologist.

    • This question is part of the following fields:

      • Oncology
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  • Question 8 - A 22-year-old male patient presents to the Emergency department after ingesting an unknown...

    Incorrect

    • A 22-year-old male patient presents to the Emergency department after ingesting an unknown quantity of paracetamol tablets. What is the ideal time to evaluate his paracetamol level to determine if treatment with n-acetylcysteine is necessary?

      Your Answer:

      Correct Answer: Four hours after overdose

      Explanation:

      Treatment of Paracetamol Overdose

      Paracetamol overdose is a serious condition that requires prompt treatment. The nomograms used for the treatment of paracetamol overdose are based on assessing paracetamol levels four hours or later after an overdose has occurred. This is because measuring levels earlier may be unpredictable and lead to inappropriate omission of N-acetylcysteine. If a significant overdose is suspected or the patient presents more than four hours after overdose, treatment should be started expectantly.

      The treatment of paracetamol overdose begins with a loading dose of N-acetylcysteine over one hour, followed by four-hour and 16-hour infusions. Less than 5% of patients suffer an allergic reaction to N-acetylcysteine, and in those patients, slowing the infusion rate, giving IV corticosteroids and/or antihistamines are all potential options. Patients who do not tolerate N-acetylcysteine even after these measures should be given oral methionine.

      In summary, the treatment of paracetamol overdose is time-sensitive and requires careful monitoring of paracetamol levels. N-acetylcysteine is the primary treatment option, but alternative options are available for patients who cannot tolerate it.

    • This question is part of the following fields:

      • Oncology
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  • Question 9 - A 75-year-old man comes to the Cancer Outpatient Department complaining of severe back...

    Incorrect

    • A 75-year-old man comes to the Cancer Outpatient Department complaining of severe back pain. He reports that the NSAIDs and opioids he has been taking are not providing relief. The patient has been diagnosed with CRPC that is advancing rapidly. He has completed a full course of taxane chemotherapy and imaging has revealed metastases in his vertebrae and organs.
      What is the most appropriate course of action for managing this patient?

      Your Answer:

      Correct Answer: External beam radiation therapy (EBRT)

      Explanation:

      Treatment Options for Pain Relief in Metastatic Prostate Cancer Patients

      External beam radiation therapy (EBRT) is the preferred treatment for pain relief in men with castration-resistant prostate cancer (CRPC). It has a success rate of 60-80% in providing complete or partial pain relief in palliative care management. Bisphosphonates can also be prescribed in combination with other agents for mild to moderate pain relief in hormone-resistant prostate cancer patients. Enzalutamide, an antineoplastic, antiandrogen systemic drug, is not preferred in rapidly progressing cases of CRPC. Radium-223, an alpha-particle-emitting radiopharmaceutical agent, is contraindicated in cases with visceral metastases. Stereotactic body radiotherapy (STBRT) is the preferred modality for pain relief in metastatic prostate cancer patients with longer survival times, using targeted irradiation to minimize damage to adjacent normal tissues.

    • This question is part of the following fields:

      • Oncology
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  • Question 10 - A 55-year-old man with known squamous-cell lung cancer presents with facial swelling, shortness...

    Incorrect

    • A 55-year-old man with known squamous-cell lung cancer presents with facial swelling, shortness of breath and a headache. On examination, he has a raised jugular venous pressure (JVP) and inspiratory stridor when he raises his hands above his head for one minute. Chest X-ray and computed tomography (CT) scan of the chest confirm superior vena cava (SVC) obstruction.
      Which of the following treatments will provide the best long-term symptom relief?

      Your Answer:

      Correct Answer: Superior vena cava (SVC) stenting

      Explanation:

      Treatment Options for Superior Vena Cava Obstruction in Lung Cancer Patients

      Superior vena cava (SVC) obstruction is a common complication in patients with lung cancer. While dexamethasone infusion is the immediate treatment to reduce swelling, it only provides short-term relief. The best option for long-term symptom relief is SVC stenting, which prevents any obstruction. However, it is not always successful, and symptoms may reoccur if the tumour re-compresses the SVC. Inhaled daily steroids and inhaled beta-agonists are not effective in treating SVC obstruction. Brachytherapy is used to treat prostatic cancer and not squamous cell lung cancer. Therefore, SVC stenting remains the best option for long-term symptom relief in lung cancer patients with SVC obstruction.

    • This question is part of the following fields:

      • Oncology
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  • Question 11 - An older gentleman with prostate cancer is beginning treatment with morphine elixir for...

    Incorrect

    • An older gentleman with prostate cancer is beginning treatment with morphine elixir for painful bone metastases. What would be the most suitable advice to give to his caregiver?

      Your Answer:

      Correct Answer: A laxative will need to be used

      Explanation:

      Managing Pain in Terminally Ill Patients

      Managing pain in terminally ill patients can be challenging, but there are several strategies that can be employed to provide relief. When prescribing narcotics, it is important to start a laxative regimen to prevent constipation. Sedation may occur in the first few days, but this typically wears off. If pain relief is inadequate, the dose should be increased, although it is important to note that cocaine may produce hallucinations. It is also important to note that addiction is not a concern in terminally ill patients. Injections are typically three times more effective than oral medication. By employing these strategies, healthcare providers can help alleviate pain and improve the quality of life for terminally ill patients.

    • This question is part of the following fields:

      • Oncology
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  • Question 12 - A 67-year-old man visits his primary care clinic after being diagnosed with metastatic...

    Incorrect

    • A 67-year-old man visits his primary care clinic after being diagnosed with metastatic prostate cancer. He reports experiencing widespread pain, even though he is taking 30 mg of morphine tablets twice daily. Upon examination, his lungs are clear, and he does not display any neurological abnormalities. He denies having any headaches.
      What is the most probable site of metastasis in this patient?

      Your Answer:

      Correct Answer: Bone

      Explanation:

      Metastasis in Prostate Cancer: Common Sites and Symptoms

      Prostate cancer can spread to other parts of the body, a process known as metastasis. The most common site for metastases in prostate cancer is the bone, accounting for 84% of cases. Symptoms of bone metastases include bone pain, which can be managed with analgesics and palliative radiotherapy. Bisphosphonates may also be used. Brain metastases are rare in prostate cancer and typically present with headaches and neurological symptoms. Metastases to the pancreas are also uncommon, accounting for only 2% of cases. Lung metastases occur in about 9.1% of cases, while liver metastases are reported in 10.2% of cases and may present with jaundice, loss of appetite, and abdominal swelling. Understanding the common sites and symptoms of metastases in prostate cancer can aid in early detection and management.

    • This question is part of the following fields:

      • Oncology
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  • Question 13 - An 80-year-old woman has been suffering from Paget's disease of bone for over...

    Incorrect

    • An 80-year-old woman has been suffering from Paget's disease of bone for over a decade. Lately, she has been experiencing increased pain in her lower back and hip region even when at rest. Upon conducting an X-ray, a destructive mass is observed in her bony pelvis. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Osteosarcoma

      Explanation:

      Paget’s Disease of Bone

      Paget’s disease of bone is a condition that typically affects individuals in their later years. It is characterized by a disruption in the normal process of bone repair, resulting in the formation of weak bones that are prone to fractures. Specifically, the repair process ends at the stage of vascular osteoid bone, which is not as strong as fully mineralized bone.

      Unfortunately, Paget’s disease of bone can also lead to complications such as osteogenic sarcoma, which occurs in approximately 5% of cases. As such, it is important for individuals with this condition to receive appropriate medical care and monitoring to prevent further complications.

    • This question is part of the following fields:

      • Oncology
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  • Question 14 - A 56-year-old man presents to his general practitioner with proximal muscle weakness. He...

    Incorrect

    • A 56-year-old man presents to his general practitioner with proximal muscle weakness. He has noticed difficulty in trying to get up out of a chair. There is a past history of obstructive airways disease and a 35-pack-year cigarette history. On examination, you notice that he has marked weakness of the pelvic and shoulder girdle and decreased tendon reflexes.
      Investigations:
      Investigation Result Normal value
      sodium (Na+) 137 mmol/l 135–145 mmol/l
      Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
      Creatinine 95 μmol/l 50–120 µmol/l
      Haemoglobin 115 g/l 135–175 g/l
      White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
      Platelets 320 × 109/l 150–400 × 109/l
      Erythrocyte sedimentation rate (ESR) 80 mm/hr 0–10mm in the 1st hour
      You suspect that he may have an underlying malignancy with a paraneoplastic syndrome. Which of the following is most likely to be associated with this clinical picture?

      Your Answer:

      Correct Answer: Carcinoma of the bronchus

      Explanation:

      Paraneoplastic Syndromes: Neurological Manifestations in Different Types of Cancer

      Lambert-Eaton syndrome is a rare neurological manifestation that affects around 6% of cancer patients, particularly those with bronchial and ovarian tumors. This syndrome is characterized by proximal muscle weakness, impotence, and peripheral neuropathy. The cause of Lambert-Eaton is unknown, but it may be due to anti-tumor antibodies that cross-react with calcium channels involved in neuromuscular function. Resection of the primary tumor or use of immunosuppressive agents may lead to an improvement in symptoms for some patients.

      In contrast, neurological manifestations are rare in colorectal carcinoma, with only a few case reports of patients presenting with neurological symptoms as a paraneoplastic syndrome secondary to colorectal carcinoma. Bronchial carcinoid is more likely to cause endocrine paraneoplastic syndromes, such as Cushing’s syndrome. Renal cell carcinoma is also more likely to cause an endocrine picture rather than neurological manifestations. Similarly, pancreatic tumors are more commonly associated with endocrinological manifestations than neurological presentation.

    • This question is part of the following fields:

      • Oncology
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  • Question 15 - What is a typical characteristic seen in the display of myeloma? ...

    Incorrect

    • What is a typical characteristic seen in the display of myeloma?

      Your Answer:

      Correct Answer: Hypercalcaemia

      Explanation:

      Clinical Features of Multiple Myeloma

      Multiple myeloma is a type of cancer that commonly affects older adults, with a median age of 60 years, and is more prevalent in males than females. Patients with multiple myeloma may present with various clinical features, including anaemia, bone pain, and infections. Bone pain is the most common symptom and is often felt in the back or ribs. In some cases, it may lead to a pathologic fracture, especially in the femoral neck, following minimal trauma. Patients with multiple myeloma are also at risk of infections, particularly with encapsulated organisms such as Streptococcus pneumoniae and Haemophilus influenzae, due to suppression of antibody production and neutropenia.

      Hypercalcaemia is another common feature of multiple myeloma, which can cause nausea, fatigue, confusion, polyuria, and constipation. This occurs due to the release of osteoclast activating factors, which stimulate bone resorption and lead to an increase in serum calcium levels. Weight loss is also a common symptom in patients with multiple myeloma. In some cases, patients may develop hyperviscosity, which can cause symptoms such as blurred vision, headache, and dizziness.

      In summary, multiple myeloma is a complex disease with various clinical features. Early diagnosis and management are crucial to improve patient outcomes. Healthcare professionals should be aware of these clinical features and consider multiple myeloma in the differential diagnosis of patients presenting with bone pain, anaemia, infections, hypercalcaemia, and weight loss.

    • This question is part of the following fields:

      • Oncology
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  • Question 16 - A 78-year-old man with advanced dementia and oesophageal cancer is rushed to the...

    Incorrect

    • A 78-year-old man with advanced dementia and oesophageal cancer is rushed to the hospital from a nursing home due to sudden onset of complete dysphagia. He cannot tolerate any food or drink and immediately vomits. He had a stent placed two weeks ago which initially provided relief. Physical examination shows no abnormalities. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Bolus obstruction

      Explanation:

      Common Complications of Stenting

      Stenting is a common procedure used to treat blockages in the body’s vessels. However, despite providing detailed instructions on post-stenting diet, patients often forget the rules and are readmitted due to obstruction. The most likely cause of obstruction is bolus obstruction, which occurs when a large piece of food is inadvertently ingested.

      Stent displacement is another common complication, especially with metal stents that have not been fully deployed. This tends to occur early on after the procedure. On the other hand, tumour overgrowth is a longer-term complication that can occur with stenting. It is important for patients to follow the post-stenting diet and to be aware of the potential complications that may arise.

    • This question is part of the following fields:

      • Oncology
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  • Question 17 - A 6-year-old girl is brought to the Paediatric Outpatient Department by her father...

    Incorrect

    • 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:

      Correct 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 18 - A 65-year-old woman has been diagnosed with non-small-cell bronchial carcinoma during a bronchoscopy....

    Incorrect

    • A 65-year-old woman has been diagnosed with non-small-cell bronchial carcinoma during a bronchoscopy. Despite her diagnosis, she is in good health. CT imaging for staging did not show any signs of metastatic disease. Her surgeon has suggested a pneumonectomy but wants to conduct a PET scan. How will this test aid in managing the patient?

      Your Answer:

      Correct Answer: Demonstrates any metastatic disease not found at CT

      Explanation:

      PET Imaging in Cancer Diagnosis and Treatment

      PET imaging is a diagnostic tool that uses radiolabelled molecules to identify areas of high metabolic activity, such as cancerous tumors. When combined with CT, PET can be more sensitive in detecting metastatic disease. However, PET has limitations in identifying blood supply and primary tumor masses, which may require other imaging techniques such as angiography or MRI. PET also cannot label tumors for easier identification during surgery, but newer techniques using fluorescent labeling are emerging. Finally, PET does not have any therapeutic effect on the tumor itself, but can be used to guide neoadjuvant therapy.

    • This question is part of the following fields:

      • Oncology
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  • Question 19 - 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:

      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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  • Question 20 - A 53 year old female presents with a breast lump and is referred...

    Incorrect

    • A 53 year old female presents with a breast lump and is referred to the 2 week wait suspected cancer breast clinic. Biopsy confirms the presence of a HER-2 positive breast carcinoma. Which immunological therapy is appropriate for treatment?

      Your Answer:

      Correct Answer: Trastuzumab

      Explanation:

      Immunological Therapies for Breast Cancer: A Comparison of Trastuzumab, Infliximab, and Rituximab

      Breast cancer is a prevalent disease among women, and HER-2 receptor positive breast cancers have a worse prognosis. Trastuzumab, a monoclonal antibody therapy, has improved the treatment and survival of HER-2 positive breast cancers. On the other hand, Infliximab, a monoclonal antibody against tumour necrosis factor alpha, is used to treat autoimmune diseases and has no role in breast carcinoma treatment. Rituximab, another immunological therapy, is primarily used in the management of rheumatoid disease. Tamoxifen, a hormonal therapy, is used in the treatment of breast cancer when the carcinoma is confirmed as oestrogen receptor positive (ER+). Doxorubicin, a chemotherapy agent, is used in the treatment of advanced breast cancer. Understanding the differences between these therapies is crucial in determining the best treatment plan for breast cancer patients.

    • This question is part of the following fields:

      • Oncology
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  • Question 21 - A 42-year-old teacher is referred to the Breast Clinic for further investigation after...

    Incorrect

    • A 42-year-old teacher is referred to the Breast Clinic for further investigation after finding a lump on her right breast one week earlier. She has well-controlled hypertension, but no other medical history of note. The patient does not smoke and is a keen runner.
      The patient is especially concerned that she may have breast cancer, as her grandmother and maternal aunt both died from the condition. She is very upset that she did not find the lump sooner, as she thinks that it is at least 1 cm in size.
      With regard to tumour kinetics, which one of the following is correct?

      Your Answer:

      Correct Answer: Tumour growth obeys Gompertzian kinetics

      Explanation:

      Misconceptions about Tumour Growth

      Tumour growth is a complex process that is often misunderstood. Here are some common misconceptions about tumour growth:

      Common Misconceptions about Tumour Growth

      1. Tumour growth obeys Gompertzian kinetics
      While the rate of tumour growth does slow down from the initial exponential pattern, the assumption that it follows a sigmoidal shape is not always accurate.

      2. The clinical phase of tumour growth is long compared with the pre-clinical phase
      In reality, the clinical phase of a tumour is short in comparison to the pre-clinical phase. By the time a tumour is detected, it has already completed a significant portion of its life cycle.

      3. The smallest clinically detectable tumour is 1000 cells
      This is far too few cells to be clinically detectable. The usual number required to be clinically detectable would be 109 cells.

      4. In most tumours, the growth fraction is >90%
      The growth fraction is usually 4–80%, with an average of <20%. Even in some rapidly growing tumours, the growth fraction is only about 20%. 5. Tumour growth is characterised by contact inhibition
      Contact inhibition is a mechanism that is lost in cancer cells. Tumour growth is actually characterised by uncontrolled cell growth and division.

      It is important to have a clear understanding of tumour growth in order to develop effective treatments and improve patient outcomes.

    • This question is part of the following fields:

      • Oncology
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  • Question 22 - What is the most frequent location for an osteoclastoma? ...

    Incorrect

    • What is the most frequent location for an osteoclastoma?

      Your Answer:

      Correct Answer: Lower end of femur

      Explanation:

      Distribution and Characteristics of Giant Cell Tumours

      Giant cell tumours, also known as osteoclastomas, are most commonly found around the knee at the distal femur, accounting for approximately 50% of cases. The next most common site is the proximal tibia, followed by the proximal humerus and distal radius. These tumours are typically solitary, with less than 1% being multicentric.

      Overall, giant cell tumours are relatively rare and tend to occur in young adults between the ages of 20 and 40. They are characterized by the presence of numerous multinucleated giant cells, which are responsible for the destruction of bone tissue. While most cases are benign, some may become malignant and spread to other parts of the body. Treatment typically involves surgical removal of the tumour, although radiation therapy and other treatments may also be used in certain cases.

    • This question is part of the following fields:

      • Oncology
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  • Question 23 - A 75-year-old woman comes in with weight loss and a serum calcium concentration...

    Incorrect

    • A 75-year-old woman comes in with weight loss and a serum calcium concentration of 3.22 mmol/l (normal range 2.1-2.8 mmol/l). Her skeletal survey shows no abnormalities. The doctors suspect non-metastatic hypercalcaemia. What is the probable substance being produced by the tumor?

      Your Answer:

      Correct Answer: Parathyroid hormone-related peptide (PTHrP)

      Explanation:

      Causes of Hypercalcaemia in Cancer Patients

      Hypercalcaemia is a common occurrence in cancer patients, affecting around 10-20% of cases. It is caused by increased bone resorption and release of calcium from bone. The most common cancers associated with hypercalcaemia are breast and lung cancers, as well as multiple myeloma.

      One of the most common causes of hypercalcaemia in patients with non-metastatic solid tumours is the secretion of parathyroid hormone-related peptide (PTHrP), also known as humoral hypercalcaemia of malignancy. This should be suspected in any patient with a solid tumour in the absence of bony metastases or in patients with unexplained hypercalcaemia and low serum PTH concentration. PTHrP is related in function to PTH and is most commonly secreted by breast and lung tumours.

      Osteoclast-activating cytokines can also cause osteolytic metastases and release of calcium. Calcitonin is used to lower plasma calcium concentration in patients with hypercalcaemia associated with malignancy. Calcitriol is the cause of almost all cases of hypercalcaemia in Hodgkin’s disease and approximately one-third of cases in non-Hodgkin’s lymphoma. Secretion of PTH as a cause is rare, and serum PTH concentrations are typically low.

      In conclusion, hypercalcaemia in cancer patients can have various causes, and it is important to identify the underlying cause to provide appropriate treatment.

    • This question is part of the following fields:

      • Oncology
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  • Question 24 - A pre-med student is preparing for her oncology rotation and is studying the...

    Incorrect

    • A pre-med student is preparing for her oncology rotation and is studying the use of tumour markers in the diagnosis and monitoring of cancer.
      Which of the following tumour markers is accurately matched with the cancer it is linked to?

      Your Answer:

      Correct Answer: Alphafetoprotein (AFP) and hepatocellular carcinoma

      Explanation:

      Tumor Markers and Their Association with Specific Cancers

      Tumor markers are substances produced by cancer cells that can be detected in the blood. These markers can be used to screen for and monitor certain types of cancer. Here are some examples of tumor markers and their association with specific cancers:

      – Alphafetoprotein (AFP) and hepatocellular carcinoma: AFP is raised in 80% of patients with hepatocellular carcinoma. High-risk patients should be offered 6-monthly screening with a combination of hepatic ultrasound and AFP level.
      – CA 15-3 and breast cancer: CA 15-3 is associated with breast cancer.
      – CA 19-9 and pancreatic and biliary tract cancers: CA 19-9 is associated with pancreatic and biliary tract cancers.
      – CA 125 and ovarian cancer: CA 125 is associated with ovarian cancer.
      – Prostate-specific antigen (PSA) and prostatic cancer: PSA is associated with prostatic cancer and benign prostatic hypertrophy.
      – Testicular cancer: Testicular cancer can be associated with AFP, human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH), depending on the tumor type.

      It is important to note that tumor markers are not always specific to one type of cancer and can also be elevated in non-cancerous conditions. Therefore, tumor markers should always be interpreted in conjunction with other diagnostic tests and clinical findings.

    • This question is part of the following fields:

      • Oncology
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  • Question 25 - A 30-year-old man visits the outpatient urology clinic with a lump in his...

    Incorrect

    • A 30-year-old man visits the outpatient urology clinic with a lump in his left testicle. He reports no other symptoms. During his examination, a 5 mm firm and painless lump is detected. Following an ultrasound of the testicle and tumour markers, testicular cancer is suspected. What combination of tumour markers were likely requested for this patient?

      Your Answer:

      Correct Answer: Alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG)

      Explanation:

      Tumour Markers Associated with Testicular Cancer: AFP and hCG

      Testicular cancer is often characterized by the presence of a lump, and the most common tumour markers associated with this type of cancer are alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG). Germ cell tumours are the most common type of testicular cancer, with seminomas and non-seminomas being the most prevalent subtypes. Mixed germ cell tumours may also occur. Stromal tumours and metastasis from other organs are less common.

      The age range and tumour markers associated with each type of germ cell tumour are as follows: seminomas are associated with an increase in hCG, embryonal carcinoma with an increase in both hCG and AFP, yolk sac carcinoma with an increase in AFP, choriocarcinoma with an increase in hCG, and teratoma without specific markers.

      While it would be appropriate to request hCG and AFP, carcinoembryonic antigen (CEA) and prostate-specific antigen (PSA) are not typically elevated in testicular cancer. CEA is more commonly associated with adenocarcinomas, particularly colorectal, while PSA is associated with prostate cancer. Similarly, PSA and CA-125 are not typically elevated in testicular cancer, but rather in prostate cancer and ovarian cancers, respectively.

      In summary, AFP and hCG are the most common tumour markers associated with testicular cancer, and their levels can help diagnose and monitor the disease. Other tumour markers, such as CEA and PSA, are not typically elevated in testicular cancer and may be more indicative of other types of cancer.

    • This question is part of the following fields:

      • Oncology
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  • Question 26 - What is the origin of Ewing's tumor? ...

    Incorrect

    • What is the origin of Ewing's tumor?

      Your Answer:

      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 27 - What is the most common way in which a child with Wilms' tumour...

    Incorrect

    • What is the most common way in which a child with Wilms' tumour presents?

      Your Answer:

      Correct Answer: An asymptomatic abdominal mass

      Explanation:

      Wilms’ Tumour in Children

      Wilms’ tumour, also known as nephroblastoma, is a type of kidney cancer that is commonly found in children. It is usually detected when a parent notices a lump while bathing or dressing their child, typically around the age of three. Unlike other types of cancer, Wilms’ tumour rarely presents with symptoms such as abdominal pain, vomiting, or hypertension.

      It is important for parents to be aware of the signs and symptoms of Wilms’ tumour, as early detection can greatly improve the chances of successful treatment. Regular check-ups with a pediatrician can also help in identifying any potential issues. If a parent does notice a lump or any other unusual symptoms in their child, they should seek medical attention immediately. With prompt diagnosis and treatment, many children with Wilms’ tumour can go on to live healthy, normal lives.

    • This question is part of the following fields:

      • Oncology
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  • Question 28 - A 36-year-old patient with breast carcinoma is discovered to have a 1.5 cm...

    Incorrect

    • A 36-year-old patient with breast carcinoma is discovered to have a 1.5 cm tumour in the upper outer quadrant (OUQ) of her left breast. One local axillary node is positive, and no metastases are detected on imaging.
      What is the accurate TNM (Tumour, Nodes, and Metastases) staging for her?

      Your Answer:

      Correct Answer: T1, N1, M0

      Explanation:

      TNM Staging and Examples

      TNM staging is a system used to describe the extent of cancer in a patient’s body. It takes into account the size of the tumor (T), whether it has spread to nearby lymph nodes (N), and whether it has metastasized to distant organs (M). The categories are further subdivided to provide more detailed information. Based on the TNM categories, cancers are grouped into stages, which help determine the most appropriate treatment options.

      Examples of TNM staging include:

      – T1, N1, M0: The tumor is ≤2 cm in size (T1), one local axillary node is positive (N1), and there are no distant metastases (M0).
      – T0, Nx, M0: The tumor is ≤2 cm in size (T1), and there was one positive axillary lymph node (N1). Nx would mean that spread to local lymph nodes was not assessed.
      – T1, N0, M1: There was one positive axillary lymph node (N1), and there are no distant metastases (M0).
      – T2, N1, M0: The tumor is ≤2 cm in size (T1), and there was one positive axillary lymph node (N1).
      – T1, N1, Mx: There are no distant metastases (M0).

    • This question is part of the following fields:

      • Oncology
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  • Question 29 - A 51-year-old woman presents with a 5-month history of abdominal discomfort and bloating....

    Incorrect

    • A 51-year-old woman presents with a 5-month history of abdominal discomfort and bloating. She reports feeling fatigued and has lost around 5 kg in weight during this time. An ultrasound scan of the abdomen and pelvis reveals a solid mass with multiple compartments and high vascularity originating from the left ovary. Which tumour marker is expected to be elevated in this patient?

      Your Answer:

      Correct Answer: Ca-125

      Explanation:

      Tumour Markers for Ovarian Cancer: Understanding Ca-125 and Other Tests

      Ovarian cancer is a serious condition that can be difficult to diagnose. However, there are several tumour markers that can help healthcare professionals identify the presence of ovarian cancer and monitor its progression. One of the most well-established tumour markers for epithelial ovarian cancer is Ca-125. This marker is likely to be elevated in patients with ovarian malignancies, particularly those over the age of 50 who present with symptoms such as abdominal distension, pain, early satiety, loss of appetite, urinary frequency and urgency, unexplained weight loss, fatigue, or change in bowel habit.

      While Ca-125 is not specific to ovarian cancer, a raised level of 35 iu/ml or greater should prompt an urgent ultrasound scan of the abdomen and pelvis. If the scan is suggestive of ovarian cancer, the patient must be referred to Gynaecology on an urgent basis. Other tumour markers, such as SCC antigen, Ca 19-9, calcitonin, and CEA, may also be used to aid in the management of advanced cervical cancers, gastrointestinal malignancies, thyroid malignancies, and other types of cancer, respectively. However, these markers are not commonly associated with ovarian tumours.

      It is important to note that tumour markers should not be used in isolation to diagnose or monitor ovarian cancer. They should be used in conjunction with other diagnostic tests, such as imaging studies and biopsies, to ensure accurate diagnosis and appropriate treatment. With proper use and interpretation, tumour markers can be a valuable tool in the fight against ovarian cancer.

    • This question is part of the following fields:

      • Oncology
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  • Question 30 - A patient with rectal cancer in their 60s is seen by the colorectal...

    Incorrect

    • A patient with rectal cancer in their 60s is seen by the colorectal nurse specialist and is told about a special blood test to monitor their disease.
      Which of the following is this most likely to relate to?

      Your Answer:

      Correct Answer: Carcinoembryonic antigen (CEA)

      Explanation:

      Tumour Markers: Types and Uses

      Tumour markers are substances produced by cancer cells or normal cells in response to cancer. They can be used to diagnose cancer, monitor treatment response, and detect recurrence. Here are some common tumour markers and their uses:

      Carcinoembryonic antigen (CEA): This glycoprotein is found in normal mucosal cells but increases in adenocarcinoma, particularly colorectal cancer. It is used to monitor disease, rather than as a diagnostic tool.

      CA-19-9: This intracellular adhesion molecule is highly specific for pancreatic and biliary tract cancers but may also be elevated in other cancers. It has a role in predicting metastatic disease.

      Alpha fetoprotein (AFP): This tumour marker is used for hepatocellular carcinoma and non-seminomatous germ cell tumours. It can be used to screen for hepatocellular carcinomas, especially in high-risk patients.

      C-reactive protein (CRP): This marker indicates acute inflammation and is not specific to cancer.

      CA-125: This glycoprotein is a marker for ovarian cancer but can also be elevated in other intra-abdominal cancers and non-malignant conditions. It is mainly used for monitoring after treatment and if ovarian cancer is suspected.

      In conclusion, tumour markers have various uses in cancer diagnosis and management. However, they should always be interpreted in conjunction with other clinical and imaging findings.

    • This question is part of the following fields:

      • Oncology
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  • Question 31 - A 35-year-old woman has a solitary thyroid nodule that is confirmed to be...

    Incorrect

    • A 35-year-old woman has a solitary thyroid nodule that is confirmed to be a medullary thyroid tumour on histology. Which type of cells secrete the biochemical tumour marker used to monitor for recurrence?

      Your Answer:

      Correct Answer: Parafollicular cells

      Explanation:

      Tumor Markers and Thyroid Cells

      Thyroid cancer can be detected and monitored through the use of tumor markers, which are substances produced by cancer cells. Different types of thyroid cells produce different tumor markers.

      Parafollicular cells, also known as clear cells or C cells, produce calcitonin, which is a tumor marker for medullary thyroid carcinoma (MTC). Elevated levels of calcitonin in the blood can indicate the presence of MTC and can also be used to monitor for recurrence after treatment.

      Follicular cells produce thyroglobulin, which is a tumor marker for papillary and follicular thyroid tumors. Monitoring thyroglobulin levels can help detect the presence of these types of thyroid cancer and monitor for recurrence.

      Pericytes, colloid cells, and endothelial cells do not produce any tumor markers and therefore cannot be used for cancer detection or monitoring.

    • This question is part of the following fields:

      • Oncology
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  • Question 32 - A 79-year-old man comes to you with a complaint of weight loss and...

    Incorrect

    • A 79-year-old man comes to you with a complaint of weight loss and fatigue that has been going on for 3 months. He reports upper abdominal discomfort that worsens after eating and lying down. He has also noticed that his stool has become pale in color and his son has observed that he appears very yellow. Additionally, he has had high blood glucose levels on two separate occasions. What tumour marker would you order next?

      Your Answer:

      Correct Answer: CA 19–9

      Explanation:

      Tumour Markers and their Associated Cancers

      Tumour markers are substances produced by cancer cells that can be detected in the blood. They are used to aid in the diagnosis and monitoring of cancer. Here are some common tumour markers and the cancers they are associated with:

      – CA 19-9: This marker is associated with pancreatic cancer.
      – CEA: This marker is associated with colorectal cancer.
      – PSA: This marker is associated with prostate cancer.
      – CA 125: This marker is associated with ovarian cancer.
      – AFP: This marker is associated with hepatocellular carcinoma.

      It is important to note that tumour markers are not always specific to one type of cancer and can also be elevated in non-cancerous conditions. Therefore, they should always be used in conjunction with other diagnostic tests and clinical evaluations.

    • This question is part of the following fields:

      • Oncology
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  • Question 33 - What is the most frequent location for a carcinoid tumor? ...

    Incorrect

    • What is the most frequent location for a carcinoid tumor?

      Your Answer:

      Correct Answer: Small bowel

      Explanation:

      Carcinoid Tumours and Neuroendocrine Tumours

      Carcinoid tumours are a type of neuroendocrine tumour that originates from endocrine cells. These tumours can be found in various organs, but the most common location is the gastrointestinal tract, particularly the small intestine. The pancreas and lungs are also potential sites for carcinoid tumours. While some carcinoid tumours may not cause any symptoms, larger tumours and those located in the small intestine can lead to carcinoid syndrome. This occurs when the tumour cells release bioactive substances such as serotonin and bradykinin into the bloodstream, causing symptoms such as bronchospasm, diarrhoea, flushing, and heart damage.

      Other types of neuroendocrine tumours are derived from different endocrine cell types and may secrete different hormones. Examples include insulinoma, gastrinoma (Zollinger-Ellison syndrome), VIPoma, and somatostatinoma. Not all neuroendocrine tumours are functional, meaning they may not secrete hormones even if they originate from an endocrine cell.

      Treatment for carcinoid tumours typically involves surgical resection and/or somatostatin analogues such as octreotide, which can reduce the secretion of serotonin by the tumour. Most carcinoid tumours do not metastasize, but those that do may not be suitable for surgical resection depending on the extent of metastasis. However, some patients may benefit from octreotide and chemotherapy agents to manage symptoms.

    • This question is part of the following fields:

      • Oncology
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  • Question 34 - With which malignancy is HTLV-1 infection linked? ...

    Incorrect

    • With which malignancy is HTLV-1 infection linked?

      Your Answer:

      Correct Answer: Adult T cell leukaemia

      Explanation:

      Risk of Malignancy Associated with HTLV-1

      Between the time frame of 1:10 and 1:20, it is believed that individuals may develop malignancy associated with HTLV-1, specifically adult T cell leukaemia/lymphoma. This suggests that a small percentage of individuals infected with HTLV-1 may be at risk for developing this type of cancer. It is important for individuals who are infected with HTLV-1 to be aware of this potential risk and to regularly monitor their health for any signs or symptoms of malignancy. Early detection and treatment can greatly improve the chances of successful outcomes for those affected.

    • This question is part of the following fields:

      • Oncology
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  • Question 35 - A woman in her 40s has the BRCA2 mutation. What cancers are she...

    Incorrect

    • A woman in her 40s has the BRCA2 mutation. What cancers are she and her family members at higher risk of developing?

      Your Answer:

      Correct Answer: Breast, prostate, pancreatic, ovarian, melanoma

      Explanation:

      BRCA1 and BRCA2: Associated Cancers and Mechanisms of Action

      The BRCA1 and BRCA2 tumour suppressor genes are commonly associated with breast cancer, but they also predispose individuals to other types of cancer such as prostate, pancreatic, ovarian, and melanoma. Mutations in both copies of BRCA2 can lead to Fanconi anaemia and an increased risk of certain types of leukaemia.

      Both BRCA1 and BRCA2 play a role in repairing double-stranded DNA breaks, but through different mechanisms. BRCA2 is involved in homologous recombination, while BRCA1 is involved in non-homologous end-joining. This mechanism is utilized in the treatment of BRCA-associated cancers through the use of PARP inhibitors. PARP is a protein that repairs single-stranded DNA breaks, and inhibiting it creates multiple double-stranded breaks that cannot be fixed by BRCA-deficient cells, leading to cell death.

      While BRCA1 and BRCA2 mutations account for approximately 20% of familial breast cancer cases, they are also associated with other cancers such as prostate, pancreatic, ovarian, and melanoma. However, they are not associated with bladder cancer. Leukaemia, thyroid, and endometrial cancers are also not linked to BRCA1 and BRCA2 mutations.

    • This question is part of the following fields:

      • Oncology
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  • Question 36 - A 78-year-old man with advanced adenocarcinoma of the colon and extensive pulmonary metastases...

    Incorrect

    • A 78-year-old man with advanced adenocarcinoma of the colon and extensive pulmonary metastases reports experiencing breathlessness recently. He notices this when he takes just a few steps away from his bed. Despite trying controlled breathing techniques, he finds no relief from his breathing difficulties.
      What is the next appropriate course of action for managing dyspnoea in this patient?

      Your Answer:

      Correct Answer: Systemic opioids (oral/subcutaneous/intravenous)

      Explanation:

      Management Options for Dyspnoea in Palliative Care Patients

      Dyspnoea is a common complaint in palliative care patients and requires appropriate management. Short-acting systemic opioids have been shown to be effective in alleviating dyspnoea in terminally ill patients, but caution should be exercised in patients with certain conditions. Heliox® and benzodiazepines may also be used in certain cases, but require expertise and careful consideration. Continuous non-invasive ventilatory support may be considered if other options fail, but requires adequate support. Nebulised opioids may also be a viable option depending on the underlying cause of dyspnoea. Treatment should be tailored to the individual patient’s needs.

    • This question is part of the following fields:

      • Oncology
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  • Question 37 - 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:

      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 38 - A 44-year-old man presented to the hospital with complaints of hoarseness and unexplained...

    Incorrect

    • A 44-year-old man presented to the hospital with complaints of hoarseness and unexplained weight loss. Upon laryngoscopy, it was found that he had paralysis of the right vocal cord. A chest radiograph was ordered to further investigate the lesion. Which radiographic view would be most appropriate for this patient?

      Your Answer:

      Correct Answer: Lung apex

      Explanation:

      The Impact of Lesions on the Recurrent Laryngeal Nerve: A Guide by An AI Language Model

      The recurrent laryngeal nerve is a crucial nerve that innervates the vocal folds. Lesions along its course can cause dysfunction and lead to various symptoms. Here is a guide on how lesions in different regions of the body can impact the recurrent laryngeal nerve.

      Lung Apex:
      A lesion in the apex of the lung, known as a Pancoast tumor, can affect the right recurrent laryngeal nerve, which loops under the right subclavian artery at the apex of the right lung. This can cause dysfunction of the right vocal fold and may suggest malignancy, especially if accompanied by weight loss.

      Aortic Arch:
      The right recurrent laryngeal nerve branches off the vagus nerve at the right subclavian artery, and the left at the aortic arch. Therefore, lesions at the aortic arch can affect both the left and right recurrent laryngeal nerves.

      Basal Region of the Lung:
      Lesions at the base of the lungs would not affect the recurrent laryngeal nerve, as it branches from the vagus nerve at the level of the aortic arch and returns upwards.

      Hilar Region of the Right Lung:
      Lesions in the hilar region of the right lung would not affect the recurrent laryngeal nerve, as it branches off the vagus nerve at the right subclavian artery and the left at the aortic arch.

      Retrocardiac:
      Lesions in the retrocardiac region would be unlikely to impact the recurrent laryngeal nerve unless they are very large, as the nerve branches off the vagus nerve at the right subclavian artery.

    • This question is part of the following fields:

      • Oncology
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  • Question 39 - A 55-year-old individual who has been smoking for their entire life visits their...

    Incorrect

    • A 55-year-old individual who has been smoking for their entire life visits their GP with complaints of worsening breathlessness and symptoms of ptosis and constriction of the pupil. The GP refers them for a chest x-ray, which reveals the presence of an apical mass. What is the term used to describe the cause of this person's condition?

      Your Answer:

      Correct Answer: Pancoast tumour

      Explanation:

      Horner’s Syndrome and Pancoast Tumour

      Horner’s syndrome is a condition characterized by ptosis and constriction of the pupil. However, in some cases, it can be a consequence of a Pancoast tumour, which is a neoplasm located at the apex of the lung that invades the chest wall and brachial plexus. This lady is likely to have a Pancoast tumour as she presents with Horner’s syndrome. On the other hand, Holmes-Adie syndrome is a condition where the pupil is larger than normal and slow to react to direct light. Peyronie’s disease is a hardening of the corpora cavernosa of the penis caused by scar tissue, while Pott’s cancer is a scrotal cancer caused by coal tar exposure. Wilms’ tumour, on the other hand, is a malignant tumour of the kidney that usually occurs in childhood.

      In summary, Horner’s syndrome can be a consequence of a Pancoast tumour, which is a neoplasm located at the apex of the lung. Other conditions that present differently from Horner’s syndrome include Holmes-Adie syndrome, Peyronie’s disease, Pott’s cancer, and Wilms’ tumour. It is important to differentiate these conditions to provide appropriate management and treatment.

    • This question is part of the following fields:

      • Oncology
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  • Question 40 - A 65-year-old male with an inoperable oesophageal carcinoma has received a self-expanding metal...

    Incorrect

    • A 65-year-old male with an inoperable oesophageal carcinoma has received a self-expanding metal stent to relieve his malignant dysphagia. However, he has now presented with acute dysphagia to fluids that has lasted for four hours. What is the most appropriate initial approach to manage this situation?

      Your Answer:

      Correct Answer: Fizzy drink

      Explanation:

      Treatment Options for Malignant Dysphagia in Oesophageal Cancer Patients

      Patients with oesophageal cancer often present with symptoms such as progressive dysphagia, weight loss, and anaemia. Unfortunately, these symptoms tend to appear late in the disease’s progression, making treatment more challenging. Oesophagectomy, the surgical removal of the oesophagus, is typically reserved for early-stage cancers that have not yet invaded surrounding tissues. Traditionally, malignant dysphagia was treated with repeated endoscopic dilatations. However, self-expanding metal stents (SEMS) are now the preferred treatment option for patients with malignant dysphagia.

      While SEMS placement is generally safe and effective, there are some potential complications to be aware of. Early complications may include malposition, oesophageal perforation, bleeding, and stent migration. Late complications are more commonly related to eating, such as food bolus blockages or tumour overgrowth. If a food bolus blocks a stent, patients may be advised to consume a fizzy drink to help break it up. However, if this is unsuccessful, endoscopy may be required to dislodge the blockage.

      In summary, SEMS placement is a safe and effective treatment option for patients with malignant dysphagia caused by oesophageal cancer. While there are potential complications to be aware of, these are generally manageable with prompt medical attention. Early diagnosis and treatment are crucial for improving outcomes in patients with oesophageal cancer.

    • This question is part of the following fields:

      • Oncology
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  • Question 41 - A 66-year-old smoker visits his GP complaining of a persistent cough, difficulty breathing,...

    Incorrect

    • A 66-year-old smoker visits his GP complaining of a persistent cough, difficulty breathing, weight loss (5 kg), and night sweats that have been going on for 8 months. An urgent chest X-ray is ordered, which reveals multiple well-defined central opacities. A blood test shows the following abnormality:
      calcium: 3.7 mmol/l (2.1–2.6 mmol/l).
      What type of lung cancer is the most probable diagnosis based on these findings?

      Your Answer:

      Correct Answer: Squamous cell

      Explanation:

      Differentiating Lung Cancer Types Based on CXR Findings and Hypercalcemia

      When examining a patient with lung cancer and hypercalcemia, the CXR findings can help narrow down the potential types of cancer. Central opacities make adenocarcinoma and bronchoalveolar cancer less likely, as they typically present in the peripheral lung fields and with extensive widespread opacities, respectively. Squamous cell carcinoma is a possible culprit, as it is known to produce parathyroid hormone-related protein (PTHrP), which can cause hypercalcemia. Small-cell cancer is known for producing ADH and ACTH, not PTHrP. Large-cell cancer is unlikely to produce PTHrP, and adenocarcinoma usually presents peripherally and is unlikely to produce PTHrP. Therefore, considering CXR findings and hypercalcemia can aid in differentiating between lung cancer types.

    • This question is part of the following fields:

      • Oncology
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  • Question 42 - A 55-year-old man presented with non-specific abdominal discomfort lasting for 8 months. Physical...

    Incorrect

    • A 55-year-old man presented with non-specific abdominal discomfort lasting for 8 months. Physical examination revealed no lymphadenopathy, abdominal masses or organomegaly, and bowel sounds were present. A stool sample tested negative for occult blood. Imaging with abdominal CT revealed a 22-cm retroperitoneal soft tissue mass that was obstructing the left psoas muscle. What is the most probable neoplasm in this case?

      Your Answer:

      Correct Answer: Liposarcoma

      Explanation:

      Liposarcoma is a type of sarcoma that commonly affects adults in their 40s to 60s. It typically develops in the deep soft tissues of the proximal extremities and retroperitoneum and can grow into large tumors. There are different histological variants of liposarcoma, with varying degrees of malignancy. All types of liposarcoma have a high likelihood of recurring locally unless completely removed.

      Adenocarcinoma is a type of cancer that originates from glandular tissue in organs such as the oesophagus, pancreas, prostate, cervix, stomach, colorectal, and lungs. It does not arise in soft tissues.

      Melanoma is a type of skin cancer that can occur in younger patients and often arises from pre-existing moles. Suspicious signs include changes in size, shape, color, itching, crusting, bleeding, inflammation, or sensory changes. Melanomas can metastasize.

      Hamartoma is a benign neoplasm that consists of normal tissues in a disorganized mass. The most common type is pulmonary hamartoma, which grows at the same rate as surrounding tissue.

      Lymphoma is a type of cancer that results from the malignant proliferation of lymphocytes. It typically presents with lymphadenopathy and constitutional symptoms, and may also involve organs such as the liver and spleen. Matted nodes of this size are unlikely to be caused by lymphoma.

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      • Oncology
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  • Question 43 - A 28-year-old woman, who is receiving doxorubicin chemotherapy for breast cancer, presents with...

    Incorrect

    • A 28-year-old woman, who is receiving doxorubicin chemotherapy for breast cancer, presents with severe nausea and vomiting as a side effect of the treatment. Upon examination, the patient is afebrile with a blood pressure of 102/76 mmHg and a regular pulse rate of 90 bpm. The patient has a capillary refill time of 2 seconds and dry mucous membranes. Abdominal examination reveals a soft abdomen without palpable masses or tenderness. Bowel sounds are normal. What is the most appropriate management option for this patient?

      Your Answer:

      Correct Answer: Intravenous (IV) rehydration and IV ondansetron

      Explanation:

      Management of Chemotherapy-Induced Nausea and Vomiting: Treatment Options

      Chemotherapy-induced nausea and vomiting can be a distressing side-effect for patients undergoing cancer treatment. The use of antiemetics is an important aspect of patient care in managing these symptoms. In cases where the patient is actively vomiting, intravenous (IV) administration of antiemetics and fluids is preferred.

      Ondansetron, a 5-hydroxytryptamine 3 (5HT3) receptor antagonist, is a potent antiemetic that is generally effective and well-tolerated by patients. However, a single dose of IV ondansetron should not exceed 16 mg to avoid the risk of QT prolongation. Ideally, antiemetic therapy should be started before chemotherapy and continued at regular intervals for up to five days.

      Aggressive oral rehydration and oral antiemetics are not appropriate for patients who are actively vomiting. IV rehydration and IV ondansetron are the preferred treatment options in such cases.

      In rare cases where ondansetron cannot be used, metoclopramide, an antidopaminergic antiemetic, may be considered. However, it is not the first choice of antiemetic.

      IV omeprazole, a proton pump inhibitor, is not indicated in the management of chemotherapy-induced nausea and vomiting.

      Overall, the goal of treatment is to manage symptoms and provide relief to the patient. With appropriate treatment, symptoms will settle, and the patient can be discharged.

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      • Oncology
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  • Question 44 - 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:

      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.

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      • Oncology
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  • Question 45 - A 35-year-old woman visits her GP after her 38-year-old sister was diagnosed with...

    Incorrect

    • A 35-year-old woman visits her GP after her 38-year-old sister was diagnosed with breast cancer. She is worried about her own risk of developing the disease, especially since their mother passed away from breast cancer at age 41. The patient requests a referral for genetic testing to determine if she carries mutations commonly associated with inherited breast cancer.

      In which genes are these mutations most frequently found?

      Your Answer:

      Correct Answer: BRCA2

      Explanation:

      Genetic Mutations and Their Associated Risks

      Inherited genetic mutations can increase the risk of developing certain diseases, including cancer. The BRCA1 and BRCA2 genes are associated with an increased incidence of breast and ovarian cancers, with a 50% chance of inheritance from a parent. Mutations in these genes significantly increase the lifetime risk of developing these malignancies, with women with the BRCA1 mutation having a 72% risk of developing breast cancer and a 44% risk of developing ovarian cancer. The APC gene is associated with familial polyposis and an increased risk of colorectal cancer, while mutations in the PKD1 gene are associated with polycystic kidney disease. The delta F508 gene mutation causes cystic fibrosis, and mutations in the RAS gene are implicated in a wide range of malignancies. Understanding these genetic mutations and their associated risks can aid in early detection and prevention efforts.

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      • Oncology
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  • Question 46 - A 70-year-old woman comes to the clinic with a lump in her neck....

    Incorrect

    • 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:

      Correct 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.

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      • Oncology
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  • Question 47 - A 68-year-old woman with a history of stage III endometrial cancer and mucinous...

    Incorrect

    • A 68-year-old woman with a history of stage III endometrial cancer and mucinous pancreatic cancer presents to the Emergency Department with severe abdominal pain. The pain has been ongoing for the last four weeks but has worsened in the last three days as she has run out of her analgesia. She denies nausea or vomiting and she has been opening her bowels regularly. She has not been able to get an appointment with the general practitioner so that the pain medication could be prescribed. She was admitted to a hospice last week for end-of-life care.
      Examination reveals a distended abdomen. There is shifting dullness present. Bowel sounds are present. The abdomen is mildly tender to touch. Her legs are also oedematous.
      Which of the following is the most appropriate step in management?

      Your Answer:

      Correct Answer: Paracentesis

      Explanation:

      Appropriate Procedures for a Hospice Patient

      When a patient is admitted to hospice care, their medical treatment shifts towards end-of-life measures and comfort. In this context, certain procedures may not be appropriate or beneficial for the patient.

      Paracentesis is a procedure that may be helpful for a hospice patient experiencing pain due to ascites. This condition is often caused by low albumin levels, which can be due to malabsorption or liver disease.

      Colonoscopy and exploratory laparotomy are invasive procedures that require sedation and post-operative pain management. These procedures are unlikely to provide added benefit to a patient with a terminal diagnosis who is on comfort measures.

      Flexible sigmoidoscopy is a simpler procedure that may be used to investigate for colon masses in patients with iron deficiency anemia.

      Upper gastrointestinal endoscopy may be considered for symptom relief, but is not typically indicated for a hospice patient.

      In summary, the appropriateness of a medical procedure for a hospice patient should be carefully considered in the context of their end-of-life care plan.

      Appropriate Procedures for a Hospice Patient

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      • Oncology
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  • Question 48 - What is the most frequent primary cancer that leads to bone metastases? ...

    Incorrect

    • What is the most frequent primary cancer that leads to bone metastases?

      Your Answer:

      Correct Answer: Breast

      Explanation:

      Bone Metastases: Common Tumours, Symptoms, and Diagnosis

      Bone metastases are a common occurrence in patients with malignant disease, affecting approximately 30% of cases. The most frequent tumours that cause bone metastases are breast, prostate, bronchus, kidney, and thyroid, with breast and prostate cancers accounting for the majority. Symptoms of bone metastases typically include bone pain, the presence of a lump, pathological fractures, hypercalcaemia, or cord compression. Pathological fractures occur in about 10% of patients with bone metastases. Radiological changes usually occur late, and bone scintigraphy is the most sensitive diagnostic tool available to detect metastatic spread. Most metastases are osteolytic, but some tumours, such as prostate carcinoma, cause osteosclerotic lesions.

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      • Oncology
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  • Question 49 - A 72-year-old man with advanced prostate cancer is referred by his GP to...

    Incorrect

    • A 72-year-old man with advanced prostate cancer is referred by his GP to hospital as today’s blood test shows an elevated calcium level.
      Which of the following is the next most appropriate action?

      Your Answer:

      Correct Answer: IV 0.9% normal saline

      Explanation:

      Management of Electrolyte Imbalances: Fluids and Medications

      Electrolyte imbalances, such as hypercalcaemia and hyperkalaemia, can have serious consequences if left untreated. The following are some common treatments for these conditions:

      IV 0.9% normal saline: Rehydration is crucial in managing hypercalcaemia. Up to 3 liters of normal saline can be given daily to correct elevated calcium levels. Bisphosphonates may also be used after fluids are administered.

      Insulin dextrose: This is used to treat hyperkalaemia.

      Alendronic acid: While this medication can be given after fluids in patients with hypercalcaemia, fluid administration is the preferred management strategy.

      Calcium Resonium: This medication is used after the acute treatment of hyperkalaemia.

      Calcium gluconate: This medication is used to treat hyperkalaemia.

      Overall, a combination of fluids and medications may be necessary to effectively manage electrolyte imbalances.

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      • Oncology
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  • Question 50 - A 56-year-old retired man with a history of chronic hepatitis B infection presents...

    Incorrect

    • 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:

      Correct 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.

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      • Oncology
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  • Question 51 - What is the most frequent method of metastasis in osteogenic sarcoma? ...

    Incorrect

    • What is the most frequent method of metastasis in osteogenic sarcoma?

      Your Answer:

      Correct Answer: Haematogenous

      Explanation:

      Osteogenic Sarcoma: A Common Bone Cancer in Young Adults

      Osteogenic sarcoma is a type of bone cancer that primarily affects adolescents and young adults. It is the most prevalent form of bone cancer and is commonly found in the bones surrounding the knee in children. The cancer usually spreads through the bloodstream and is present in 10-20% of patients at the time of diagnosis. The lungs are the most common site of metastasis, but it can also spread to other bones.

      In summary, osteogenic sarcoma is a significant health concern for young adults and adolescents. It is crucial to detect the cancer early to prevent it from spreading to other parts of the body. Regular check-ups and early intervention can help improve the prognosis and increase the chances of successful treatment.

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      • Oncology
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  • Question 52 - The pathologist observed a lymph node biopsy under a microscope and found that...

    Incorrect

    • The pathologist observed a lymph node biopsy under a microscope and found that the lymph node morphology was completely effaced by scattered malignant cells. These cells were identified as Reed-Sternberg cells and were large and binucleated. Given these findings, what is the most probable pathological diagnosis?

      Your Answer:

      Correct Answer: Hodgkin lymphoma

      Explanation:

      Overview of Different Types of Lymphoma

      Lymphoma is a type of cancer that affects the lymphatic system, which is responsible for fighting infections and diseases. There are several types of lymphoma, each with its own unique characteristics and treatment options.

      Hodgkin Lymphoma: This type of lymphoma is diagnosed by the presence of Reed-Sternberg cells, which are large malignant B cells found in lymphoid tissue. It is staged using the Ann Arbor staging system and can be treated with cyclical chemotherapy and/or radiotherapy.

      Chronic Lymphocytic Leukaemia: This type of lymphoma is caused by the malignant transformation of B1 cells, a subset of B cells. It is a slow-growing cancer that may not require immediate treatment.

      Waldenström Macroglobulinemia: This neoplasm is characterized by a single clone of B cells and a mixture of lymphocytes, plasma cells, and lymphoplasmacytoid cells. Treatment options include chemotherapy, immunotherapy, and stem cell transplantation.

      Follicular Lymphoma: This type of lymphoma is a transformation of the B cells found in lymph node follicles. It is a slow-growing cancer that may not require immediate treatment.

      Burkitt Lymphoma: This type of lymphoma is not associated with Reed-Sternberg cells and can present as either a leukemia or lymphoma. Treatment options include chemotherapy and immunotherapy.

      Overall, the treatment and prognosis for lymphoma depend on the type and stage of the cancer, as well as the individual patient’s health and medical history.

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      • Oncology
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  • Question 53 - A young medical student is investigating the involvement of oncogenes in the formation...

    Incorrect

    • A young medical student is investigating the involvement of oncogenes in the formation of different types of cancers following an interview with a patient who has breast cancer linked to an oncogene. Which oncogene promotes the growth of breast cancer?

      Your Answer:

      Correct Answer: Human epidermal growth receptor 2 (HER2)

      Explanation:

      Genes and Proteins Associated with Cancer: HER2, p53, BRCA1, IgE, and CEA

      Cancer is a complex disease that can be caused by various genetic mutations and alterations. Some genes and proteins are associated with an increased risk of developing cancer, while others are used as markers to detect the presence of cancer. Here are some examples:

      HER2: A mutated HER2 gene is an oncogene that promotes the growth of breast cancer cells. HER2-positive breast cancers tend to be more aggressive and require targeted treatments such as trastuzumab.

      p53: The p53 gene produces a tumor suppressor protein that helps prevent the development of cancer. Loss of function or abnormal p53 is associated with an increased susceptibility to various malignancies.

      BRCA1: BRCA1 is a tumor suppressor gene that produces proteins that help repair damaged DNA. Mutations in BRCA1 increase the risk of breast and ovarian cancer in women.

      IgE: Immunoglobulin E is an antibody produced by plasma cells and is not associated with cancer development.

      CEA: Carcinoembryonic antigen is a tumor marker that may be elevated in various malignancies, including colorectal, lung, and breast cancer.

      Understanding the role of genes and proteins in cancer development and detection can help with early diagnosis and targeted treatments.

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      • Oncology
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  • Question 54 - A 47-year-old woman with primary sclerosing cholangitis presents with a 2 week history...

    Incorrect

    • A 47-year-old woman with primary sclerosing cholangitis presents with a 2 week history of pain under her right rib cage and 2 days history of yellow skin and pale stools. She has also experienced a weight loss of 2 stone over the last 6 months. What would be the appropriate tumour marker investigation for this likely diagnosis?

      Your Answer:

      Correct Answer: CA 19–9

      Explanation:

      Tumor Markers and Their Associated Cancers

      Tumor markers are substances produced by cancer cells that can be detected in the blood. They can be useful in diagnosing and monitoring certain types of cancer. Here are some common tumor markers and the cancers they are associated with:

      – CA 19-9: This marker is associated with cholangiocarcinoma, but can also be positive in pancreatic and colorectal cancer.
      – CA 15-3: This marker is associated with breast cancer.
      – AFP: This marker is associated with hepatocellular carcinoma (HCC) and teratomas.
      – CEA: This marker is associated with colorectal cancer.
      – CA 125: This marker is associated with ovarian, uterine, and breast cancer.

      It is important to note that tumor markers are not always specific to one type of cancer and should be used in conjunction with other diagnostic tests.

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      • Oncology
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  • Question 55 - 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:

      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.

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      • Oncology
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  • Question 56 - You review a pediatric patient with chronic myeloid leukaemia (CML) and are considering...

    Incorrect

    • You review a pediatric patient with chronic myeloid leukaemia (CML) and are considering starting them on imatinib. Imatinib is a kinase inhibitor.
      Which of the following best describes the mode of action of a kinase inhibitor?

      Your Answer:

      Correct Answer: Inhibits phosphorylation

      Explanation:

      Understanding the Mechanism of Tyrosine Kinase Inhibitors

      Tyrosine kinase inhibitors are a class of drugs that specifically target enzymes involved in the transfer of phosphate groups from ATP to proteins. Imatinib, for example, inhibits tyrosine kinase enzymes and is used to treat chronic myeloid leukemia (CML) by blocking the activity of the bcr-abl fusion protein. However, it is important to note that tyrosine kinase inhibitors do not inhibit other biochemical processes such as sulfonation, hydroxylation, dephosphorylation, or dihydroxylation. By understanding the mechanism of action of these drugs, researchers can develop more targeted and effective treatments for various diseases.

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      • Oncology
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  • Question 57 - A 67-year-old woman presented to the Oncology Clinic with chronic cough with haemoptysis,...

    Incorrect

    • A 67-year-old woman presented to the Oncology Clinic with chronic cough with haemoptysis, she has a long standing heavy smoking history. A bronchoscopy was performed which showed a tumour confined to the left main bronchus. A biopsy was taken and showed small cell lung cancer. She then had a staging computed tomography (CT) scan which showed a TNM grading of T2, N1, M0. She does not have any other medical co-morbidities and is usually independent in all daily activities.
      Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Chemotherapy and radiotherapy

      Explanation:

      Treatment Options for Small Cell Lung Cancer

      Small cell lung cancer is a type of lung cancer that is often treated with a combination of chemotherapy and radiotherapy. According to NICE guidelines, concurrent chemoradiotherapy is the recommended first-line treatment for limited-stage disease. Radiotherapy alone is less effective than combination therapy.

      Surgery is not routinely recommended for limited disease, but may be considered for patients with very early stage disease. Interferon-alpha is no longer recommended for small cell lung cancer.

      For patients with extensive metastatic disease, palliative chemotherapy may be offered. However, this decision should be discussed with the patient. In the case of a patient without significant co-morbidities and no metastases, other treatment options may be considered.

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      • Oncology
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  • Question 58 - A 42-year-old teacher is referred to the Breast Clinic after discovering a painless...

    Incorrect

    • 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:

      Correct 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).

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      • Oncology
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  • Question 59 - A 35-year-old patient came to his doctor with a lump in his neck....

    Incorrect

    • A 35-year-old patient came to his doctor with a lump in his neck. After evaluation, he was referred for a biopsy. The biopsy results revealed the presence of pleomorphic giant cells with binuclear cells. What is the most probable illness?

      Your Answer:

      Correct Answer: Hodgkin’s Lymphoma

      Explanation:

      Understanding Hodgkin’s Lymphoma: Symptoms, Diagnosis, and Management

      Hodgkin’s lymphoma is a type of cancer that typically affects individuals between the ages of 15 and 35 years and those above the age of 55. Common symptoms include unexplained fever, weight loss, fatigue, and lymphadenopathy in the neck, axilla, and groin. Diagnosis is made through fine needle aspiration of enlarged lymph nodes, which reveals the presence of Reed-Sternberg cells, giant cells with a multilobed or bilobed nucleus and prominent eosinophilic nucleoli. Risk factors for Hodgkin’s lymphoma include Epstein-Barr virus (EBV) infection, HIV infection, and a family history of the disease. Management involves radiation and chemotherapy, and survival rates have been improving, with 5-year survival reaching 85% in some recent studies.

      Other conditions that may present with similar symptoms include tuberculosis (TB), non-Hodgkin’s lymphoma, and acute lymphoblastic leukemia (ALL). TB typically presents with respiratory problems, a productive cough, and night fevers, but can also cause lymphadenopathy. Non-Hodgkin’s lymphoma is a collective term used to describe all lymphomas apart from Hodgkin’s lymphoma, and is characterized by the absence of Reed-Sternberg cells. ALL is a rapidly progressive acute leukemia associated with an increase in the number of immature lymphoid cells called lymphoblasts, and can present with general weakness, anemia, lymphadenopathy, weight loss, and hepatosplenomegaly.

      EBV is a virus that causes infectious mononucleosis, also known as glandular fever. It is transmitted through infected saliva and mostly affects young individuals, presenting with cervical lymphadenopathy, fever, tonsillar enlargement with white exudate, and palatal petechiae. EBV is also associated with some forms of lymphoma, predominantly Burkitt’s lymphoma, but also Hodgkin’s and diffuse large B cell lymphoma.

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      • Oncology
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  • Question 60 - A 67-year-old man has been diagnosed with transitional cell carcinoma of the bladder...

    Incorrect

    • A 67-year-old man has been diagnosed with transitional cell carcinoma of the bladder after presenting with haematuria. Are there any recognised occupational exposures that increase the risk of developing bladder cancer?

      Your Answer:

      Correct Answer: Aniline dye

      Explanation:

      Risk Factors for Bladder Cancer

      Bladder cancer is a type of cancer that affects the bladder, a hollow organ in the lower abdomen that stores urine. There are several risk factors that can increase the likelihood of developing bladder cancer. One of the most significant risk factors is smoking, which can cause harmful chemicals to accumulate in the bladder and increase the risk of cancer. Exposure to aniline dyes in the printing and textile industry, as well as rubber manufacture, can also increase the risk of bladder cancer. Additionally, the use of cyclophosphamide, a chemotherapy drug, can increase the risk of bladder cancer. Schistosomiasis, a parasitic infection that is common in certain parts of the world, is also a risk factor for bladder cancer, particularly for squamous cell carcinoma of the bladder. It is important to be aware of these risk factors and take steps to reduce your risk of developing bladder cancer.

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      • Oncology
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