Cancer Studies MCQs Flashcards
A 65 year old woman has severe pain from metastatic liver disease from breast cancer. The pain is pleuritic in character. It is not controlled by oral co-codamol 30/500 tablets, taken as 2 tablets 4 times a day. She is constipated and has widespread itch.
What is the most appropriate next step in management?
A. Intramuscular morphine B. Oral dexamethasone C. Oral diazepam D. Oral gabapentin E. Oral morphine
B. Oral dexamethasone
This is liver capsule pain.
For cancer-related pain (e.g. liver capsule pain, nerve compression):
Dexamethasone 8-16mg a day orally in 1-2 doses.
A 75 year old man has haemoptysis and a non-small cell cancer in his right lower lober of his lung diagnosed at bronchoscopy. It is inoperable due to extensive mediastinal nodes. He is treated with palliative radiotherapy over one week. One week later he reports significant dysphagia and pain on swallowing hot liquids.
What is the most likely diagnosis?
A. Lymph node compression of oesophagus B. Oesophageal candidiasis C. Oesophageal stricture D. Radiation oesophagitis E. Trache-oesophageal fistula
D. Radiation oesophagitis.
A 70 year old woman has pain in her right hand which has increased over one month. She describes the pain as “burning” in character. She has COPD and has smoked 20 cigarettes daily for 50 years.
On examination she has reduced grip in the hand with reduced power in the small muscles of the hand. There is no objective sensory loss in the hand or arm. Her right pupil is smaller than the left pupil.
What is the most likely diagnosis?
A. Bone metastases B. Diabetic neuropathy C. Pancoast tumour D. Stroke E. Thoracic outlet syndrome.
C. Pancoast tumour
Horner’s syndrome:
- Ptosis
- Anhidrosis
- Miosis
- Pseudoendophthalmos (impression the eye is sunk in caused by narrow palpebral aperature)
A 66 year old woman attends for consideration of palliative chemotherapy for metastatic colon cancer. She is offered participation in a phase 3 clinical trial of a new agent.
What is the purpose of a phase 3 clinical trial?
A. To compare a new agent to an existing therapy
B. To determine the activity of the new agent
C. To determine the most appropriate dose for a new agent
D. To determine the most appropriate disease for a new agent
E. To evaluate the new agent after a formal approval for clinical use
A. To compare a new agent to an existing therapy
A 67 year old woman has a partial mastectomy and sentinel node biopsy for a T1N1M0 left breast cancer and completes adjuvant therapy.
She enquires regarding follow-up assessment of the affected breast.
What is the most appropriate management plan?
A. Annual mammogram for 5 years B. Annual MRI scan for 5 years C. Clinical examination only every 6 months D. Mammogram every 3 years E. MRI scan every 3 years
A. Annual mammogram for 5 years
*every 2-3 years thereafter
A 71 year old man with metastatic prostatic carcinoma is admitted to hospital with severe lower back pain, sudden loss of power in his legs and urinary retention.
What investigation is most likely to lead to a diagnosis?
A. CT scan of chest, abdomen, and pelvis B. MRI of whole spine C. Serum calcium measurement D. Serum PSA measurement E. X-ray of lubro-sacral spine
B. MRI of whole spine
Spinal cord compression symptoms and signs.
Tumours below L1/L2 may cause cauda equina:
- Sciatic pain - often bilateral
- Bladder dysfunction with retention and overflow incontinence
- Impotence
- Sacral anaesthesia
- Loss of sphincter tone
- Weakness and wasting of gluteal muscles
NB/ bilateral motor neurone signs –> assumed to be spinal cord compression until proven otherwise.
A 52 year old man with colon cancer, receiving adjuvant chemotherapy is admitted 10 days after chemotherapy with hypotension, hypothermia, and a 24 hour history of a sore throat.
What is the likely diagnosis?
A. Hypoadrenalism B. Hypoglycaemia C. Haemorrhage secondary to thrombocytopoenia D. Neutropenic sepsis E. Pulmonary embolism.
D. Neutropenic sepsis
- Neutrophil count <0.5 x 10^9/L
- Becomes febrile neutropenia when associated with a temp >38 degrees Celsius
- Assume fever is infection until proven otherwise
- Can quickly become life-threatening and requires prompt treatment
A 57 year old man with lung cancer is admitted with neutropenic sepsis 11 days following his first cycle of palliative chemotherapy.
What is the next most appropriate management step?
A. Catheterisation B. Chest X-ray C. IV broad spectrum antibiotics D. IV crystalloid fluids E. SC granulocyte colony stimulating factor (GCSF)
C. IV broad spectrum antibiotics
Mx:
- High flow O2
- IV access/fluids/blood cultures
- Monitor urinary output (ensure > 30 mL/hour
- Monitor BP
- IV broad spectrum antibiotics WITHIN one hour of hospital arrival usually piperacillin/tazobactam (TAZOCIN) +/- gentamicin
A 66 year old woman with metastatic breast cancer is found to have hypercalcaemia with a corrected serum calcium of 2.99 (normal range = 2.2-2.7).
What is the appropriate initial management?
A. IV fluid replacement B. IV zoledronic acid C. IV pamidronate D. IV albumin E. Palliative radiotherapy to bony metastases
A. IV fluid replacement
Mx:
- Immediate rehydration with IV 0.9% NaCl
- Promote high urine output
- 4-6 litres fluid rehydration in 24 hours
- IV bisphosphonate e.g. zoledronic acid
- Give after 24 hours
- Helps move calcium back into bones
- Discontinue any medication which may elevate calcium e.g. thiazide diuretics, Ca/vitamin supplements
A 49 year old woman who completed adjuvant chemotherapy for breast cancer 2 years previously, presents with altered mood, early morning nausea and blurred vision.
What is the likely diagnosis?
A. Brain metastasis B. Choroidal metastases C. Hypercalcaemia D. Intolerance to adjuvant tamoxifen E. Reactive depression
A. Brain metastasis
Symptoms of increased ICP:
- Headache is an early symptom (early morning/coughing and sneezing/positional)
- Nausea and vomiting (in morning)
- Seizures
- Behavioural changes (if frontal)
- Focal neurological changes
- Altered gait
- Papilloedema in 50% of cases usually associated with a neurological defect
An 83 year old woman has a left breast lump which is asymptomatic, but is increasing in size. She has multiple co-morbidities and is unfit for surgery. Investigations show a 3 cm left breast cancer which is ER-positive and HER2 positive.
What is the most appropriate management?
A. Anastrazole B. FEC chemotherapy C. Radiotherapy of the breast D. Radiotehrapy of the left breast, supraclavicular fossa and axilla E. Trastuzumab
A. Anastrazole
- Very unfit as 3cm and cannot tolerate lumpectomy
- Chemotherapy is hard going as co-morbidities
- HER2 positive –> receptors on the heart –> 83 years old and co-morbidities so this is NOT safe treatment for her cancer
- Only 3cm mass –> radiotherapy of the breast/SCF/axilla not necessary
- Anastrazole for ER +ve –> will respond –> stop metastasising and is only one tablet a day
A 73 year old man is dying peacefully in a side room in the hospice. He has lung cancer and emphysema and is receiving oxygen therapy via nasal specs at 2 L/min. His daughter is distressed in that his oxygen saturation measurements occassionally drop to 70% and then return to his normal baseline of around 92%. He has not been distressed during these episodes.
What is the most appropriate management?
A. Discontinue his opioids
B. Explain that their father is not distressed and make no changes
C. Explained that their father is not distressed and stop measuring oxygen saturations
D. Give midazolam and subcutaneous infusion
E. Withdraw oxygen therapy and stop measuring oxygen saturation
C. Explained that their father is not distressed and stop measuring oxygen saturations
A 46 year old woman with advanced ovarian carcinoma gives a history of vomiting moderate amounts of digested food without warning four to seven times a day. She has not been able to keep food or fluids down for 24 hours.
While investigating her for bowel obstruction, what is the most appropriate management?
A. IV fluids and cyclizine 150 mg over 24 hours subcutaneously by syringe driver
B. IV fluids and cyclizine 50 mg three times a day by mouth
C. IV fluids and laxatives by mouth
D. IV fluids and metoclopramide 10 mg three times a day by mouth
E. Oral fluids and cyclizine 150 mg 24 hours subcutaneously by syringe driver
A. IV fluids and cyclizine 150 mg over 24 hours subcutaneously by syringe driver
A terminally ill 65 year old man with prostate carcinoma has a metastatic deposit in his second lumbar vertebrae giving him moderate to severe back pain and a burning, painful sensation in his left anterior thigh.
Examination reveals loss of sensation in the L2 distribution in his left leg. His opioid breakthrough medication is helping his back pain but makes no difference to the pain in his thigh.
What is the most appropriate next step in his management?
A. Add paracetamol
B. Increase opioid background and breakthrough opioid doses
C. Increase opioid and start a neuropathic agent
D. Increase opioid doses and start a NSAID
E. Place a lidocaine patch on the thigh and do not change opioid doses
C. Increase opioid and start a neuropathic agent
A 60 year old woman has become extremely tired over six months and her family has noticed that she is very pale. Examination reveals a mass in the right side of her abdomen.
Hb 87 g/L (130-180 g/L) with a hypochromic, microcytic picture. Her serum CEA is 81 (NR = 0-4).
What is the most likely diagnosis to explain all these findings?
A. Caecal cancer B. Kidney cancer C. Liver cancer D. Ovarian cancer E. Rectal cancer
A. Caecal cancer
