Clinical oncology CCT Flashcards
Some cancers require precision delivery of a treatment modality, which of the following particles has the property of a Bragg’s peak?
A. Superficial X-ray
B. Electron
C. Photon
D. Proton
D. Proton
Head and neck cancers are now commonly treated with a combination of radiotherapy and chemotherapy. Which of the following treatment combinations has been shown to have the best efficacy in the treatment of head and neck cancer?
A. Neoadjuvant chemotherapy and radiotherapy
B. Concurrent chemotherapy and radiotherapy
C. Chemotherapy then followed by radiotherapy only (?)
D. Radiotherapy then followed by chemotherapy only (?)
Ans: B
Which of the following is the most common side effect of morphine?
A. Respiratory depression
B. Constipation
C. Nausea and vomiting
D. Xxx
B. Constipation (always given laxatives)
Which of the following is an adjuvant analgesic for neuropathic pain?
A. Gabapentin
B. xxx
C. Ondansetron
D. xxx
A. Gabapentin
6x male patient with gastric (?) cancer and multiple bone metastasis presented with abdominal colicky pain and constipation for a few days. He was admitted to the hospital and was confused. There is no fever. (add more pls) Which of the following is the most likely diagnosis?
A. Neutropenic fever
B. Hypercalcemia
C. Anemia
D. Urinary tract infection
B. Hypercalcemia
A chronic smoker was diagnosed with lung cancer and develops neck swelling and dilated veins. Which of the following is the MOST IMPORTANT investigation?
A. Lung function test
B. Urine dipstick for protein
C. Contrast CT thorax
D. Ultrasound of neck
C. Contrast CT thorax
Stomach CA met, failed treatment, on palliative care, on morphine syrup 10 mg QID (given 4 times a day), 20mg nocte. The patient developed intestinal obstruction and analgesic has to be given intravenously, what is the DAILY dose of morphine that should be given?(Might hv missed sth)
A. 10mg
B. 20mg
C. 45mg
D. 60mg
Ans: B (Conversion for morphine syrup: IV morphine 3:1)
Daily dose: 10mg x 4 +20mg = 60mg, 60mg/3 = 20mg per day
Patient with hypertension, diabetes mellitus, renal impairment. Which drug is contraindicated?
A. Buprenorphine
B. Oxycodone
C. Morphine
D. Pethidine
C. Morphine (contraindicated in all renal failure as toxic metabolite will accumulate
M/38, KRAS wild type metastatic CRC, develop non-urticarial pustular rash on face, likely culprit?
A. Bevacizumab
B. Gefitinib
C. Cetuximab
D. 5-FU
C. Cetuximab
52–year–old woman recently diagnosed with congestive heart failure. She is a non–smoker and a social drinker. History includes a right–sided breast cancer treated with mastectomy, Adriamycin and Cyclophosphamide, followed by radiotherapy and hormonal therapy. Which of the followings is the most likely cause of her heart failure?
A. Mastectomy
B. Chemotherapy
C.Radiotherapy
D. Hormonal therapy
B. Chemotherapy (e.g. daunorubicin)
60–year–old man diagnosed with small cell lung cancer is admitted for confusion and decreased urine output. He received Cisplatin and Etoposide for 2 days. Blood tests on admission show increased serum creatinine, urate, potassium and phosphate. Which of the following is the provisional diagnosis?
A. Cisplatin–induced nephrotoxicity
B. Metastasis to kidney
C. Tumour lysis syndrome
D. Neutropenic fever
C. Tumour lysis syndrome
Which of the following drug belongs to WHO pain ladder step 2?
A. Morphine
B. Paracetamol
C. Methadone
D. Dihydrocodeine
D. Dihydrocodeine
Patient with cholangiocarcinoma, and you would like give an immune checkpoint inhibitor. Which is the most important to check?
A. MSI-H (microsatellite instability)
B. FGRF
C. c-kit
D. PD-L1 score
A. MSI-H (microsatellite instability)
A 62-year-old gentleman with metastatic left CA ureter with extensive peritoneal, lung, liver and bone metastasis, who is mostly chair/bed bound with poor performance status now presents with progressive poor renal function of >200 Cr (2x of upper limit of normal). He otherwise was not septic or with electrolyte imbalatnce. Abdominal ultrasound reveals a left hydronephrosis. What are your next steps?
A. Urgent urologist consult for ureteric stenting
B. Urgent interventional radiologist consult for percutaneous nephrostomy
C. Perform a renal biopsy
D. Interview patient and family for comfort care
D. Interview patient and family for comfort care
A 55 year-old gentleman with chemotherapy refractory colorectal cancer with extensive lung and peritoneal metastasis. Later developed vomiting and colicky abdominal pain for one week. There was no bowel opening for 5 days. On examination, he was found to be bed bound (i.e. ECOG 4), cachexic with a weight of 41 kg only. Mild abdominal distension was noted. Which of the following is the most appropriate management?
A. Consider Colostomy
B. Consider NG tube feeding
C. Palliative care with anticholinergics
D. TPN
C. Palliative care with anticholinergics
A 60-year-old gentleman with metastatic colorectal carcinoma on bevacizumab, oxaliplatin and 5-fluorouracil complains of puffy face and bilateral leg swelling. On physical examination there was bilateral pitting oedema but no tenderness palpated. His central venous pressure was normal. Which investigation should be used to find the cause of the generalised oedema?
A. Echocardiogram
B. Ultrasound of the lower limbs
C. Urine dipstick for protein
D. Complete blood count
C. Urine dipstick for protein
A 55-year-old woman was diagnosed with left breast carcinoma. What are the mammographic features suggestive of carcinoma?
A. Coarse Calcifications
B. Hypodense
C. Oval in shape
D. Spiculated border
D. Spiculated border
Hypoechoic lesion, taller than wide, posterior acoustic shadowing and microcalcifications
A patient has a resected descending colon cancer, with positive regional LN but clear resection margins. There was no distant metastasis. He was referred to COD for management. Which is the next appropriate step?
A. Observe
B. Adjuvant chemotherapy
C. Adjuvant chemoRT
D. Adjuvant RT
B. Adjuvant chemotherapy
Female presents with left side motor weakness and seizure. Found to have 1 cm nodule in right frontal lobe on non-contrast CT. Then did a ??? further characterising it has a 1.5 cm tumour. Neurosurgery performed and resected the mass, biopsy showed glioblastoma multiforme. What is the suitable treatment after surgery?
A. Refer to palliative care
B. Adjuvant chemotherapy.
C. Dexamethasone 16mg divided dose
D. Combined chemotherapy and RT, followed by adjuvant chemotherapy
D. Combined chemotherapy and RT, followed by adjuvant chemotherapy
Maximal safe surgical removal where feasible followed by Concomitant TMZ+ERT, then adjuvant TMZ
Which cancer require molecular diagnosis rather than histological?
A. GIST
B. leiomyoma
C. leiomyosarcoma
D. Neurofibroma
A. GIST
● Gastrointestinal stromal tumors (GISTs) is a mesenchymal tumor arising from the smooth muscle pacemaker interstitial cell of Cajal in the GI tract
● They are defined as tumors whose behavior is driven by mutations in the KIT gene (85%), PDGFRA gene (10%)
● 95% of GISTs stain positively for KIT (CD117)
● The diagnosis of GIST is more molecular than by histopathology
Patient was diagnosed with metastatic colon cancer. She is receiving syrup morphine 4mg per day, but refractory to pain. She is admitted to palliative care. If methadone is given, what are the number of days required for methadone to reach static therapeutic level?
A. 12 hours
B. 2-3 days
C. 5-7 days
D. 14-21 days
C. 5-7 days
Beckwith-Wiedemann syndrome is an overgrowth syndrome. Surveillance is required for which of the following tumours?
A. Hepatoblastoma
B. medulloblastoma
C. teratoma
D. atypical teratoid tumour
A. Hepatoblastoma
35 -year old Chinese man present with neck lymph nodes, fine needle aspiration found undifferentiated carcinoma cell. Where is the origin? (refry)
A: Nose
B: Nasopharynx
C: Oropharynx
D:
E: Hypopharynx
B: Nasopharynx (whenever neck lymph node aspirate show undifferentiated squamous cells –> it is NPC until proven otherwise)
Patient receiving chemoradiation . What are the acute side effects of radiotherapy?
(1) Neck stiffness
(2) Odynophagia
(3) Oral mucositis
(4) Carotid stenosis
(5) Desquamation of neck skin
A. 1,3
B. 1,3,4
C. 2,3,4
D. 2,3,5
E. 3,4,5
D. 2,3,5
A 50 year-old lady with refractory ovarian cancer with extensive peritoneal metastasis. Previously on chemotherapy but tumor markers continue to rise so decided to stop treatment 2 weeks ago. Later developed vomiting and colicky abdominal pain for one week. There was no bowel opening for 5 days. On examination, she was found to be bed bound (i.e. ECOG 4), cachexic with a weight of 36 kg only, and abdominal distension was noted. Which of the following is the most appropriate management?
A. Consider Colostomy
B. Consider NG tube
C. OGD
D. TPN
E. Palliative care with anti-cholinergics
E. Palliative care with anti-cholinergics
50/M metastatic CA lung, with multiple site bone met. On syrup morphine 10mg q4h. Recent 2 weeks, pain deteriorate and pain score increases to 7/10 1 hour before next dose. Require 3 extra rescue doses to relieve breakthrough pain. Which of the following provides quickest relief of pain?
A. Increase syrup morphine to 15mg q4h
B. Change to long acting morphine (MST) 30mg q12h
C. Add gabapentin 300mg 3 times a day
D. Add bisphosphonate
E. Prescribe anxiolytics
A. Increase syrup morphine to 15mg q4h
Which of the following is not an antimetabolite?
A. 5-FU
B. Gemcitabine
C. Methotrexate
D. Docetaxel
E. Pemetrexed
D. Docetaxel