General

Question 1

What are the clinical features of SVCO?

Answer 1

Dyspnoea, facial plethora, orthopnoea, dilated/engorged veins, pembertons sign

Question 2

What is pembertons test?

Answer 2

When a patient is asked to raise their arms above their head for over 1 minute and this should cause facial plethora and cyanosis in someone with SVCO

Question 3

Which type of lung cancer is most likely to cause pleural effusion?

Answer 3

Adenocarcinoma

Question 4

Which type of lung cancer is most common in non-smokers?

Answer 4

Adenocarcinoma

Question 5

Where in the lung are adenocarcinomas most often found?

Answer 5

Peripherally

Question 6

Which carcinomas are most likely to spread to the bone?

Answer 6

Lung, thyroid, renal, prostate, breast

Question 7

What are the indications for G-CSF in neutropenia sepsis?

Answer 7

If initial treatment with sepsis six fails and there is persistent neutropenia +/- haemodynamic instability

Question 8

What are risk factors for neutropenia sepsis?

Answer 8

Clinically unstable, persistent and significant neutropenia, receiving chemotherapy, significant co-morbidities

Question 9

In a 62 year old woman who has had radiotherapy for breast cancer and is now presenting with dysphagia, hoarseness and cough- what could be the cause?

Answer 9

Radiotherapy induced laryngeal oedema

Question 10

How does hepatocellular carcinoma present?

Answer 10

Features of cirrhosis (jaundice, deranged LFTs, ascites and oedema) along with a raised serum AFP

Question 11

What does a WHO performance score of 0 mean?

Answer 11

Able to carry out all normal activity without restriction

Question 12

What does a WHO performance score of 1 mean?

Answer 12

Restricted in strenuous activity but ambulatory and able to carry out light work

Question 13

What does a WHO performance score of 2 mean?

Answer 13

Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours

Question 14

What does a WHO performance score of 3 mean?

Answer 14

Symptomatic and in a chair or in a bed for more than 50% of waking hours, but not bedridden

Question 15

What does a WHO performance score of 4 mean?

Answer 15

Completely disabled; cannot carry out any self-care; totally confined to bed or chair

Question 16

What can cause elevated AFP levels?

Answer 16

Hepatocellular carcinoma, germ cell tumours, GI cancers, metastatic lung cancer, pregnancy

Question 17

What diagnosis is most likely in a patient with elevated AFP levels and persistent cough, breathlessness and unexplained weight loss?

Answer 17

Metastatic lung cancer

Question 18

What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, weight loss and jaundice?

Answer 18

Hepatocellular carcinoma

Question 19

What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, unexplained weight loss and change in bowel habit?

Answer 19

GI cancer

Question 20

Orphan Annie cells are pathognomonic of what cancer?

Answer 20

Papillary thyroid cancer

Question 21

Reed stern berg cells are a feature of what cancer?

Answer 21

Hodgkins lymphoma

Question 22

What would be the prophylactic treatment for someone at high risk of tumour lysis syndrome?

Answer 22

Intravenous hydration- promotes urinary excretion of electrolytes and prevents AKI
Allopurinol- reduce production and accumulation of uric acid

Question 23

How is neutropenic sepsis defined?

Answer 23

A neutrophil count of <0.5 in a patient with a temperature greater than 38 or other signs/symptoms of clinically significant sepsis

Question 24

What are the most common causative organisms in neutropenic sepsis? Why is this?

Answer 24

Coagulase negative, gram positive bacteria- particularly staph epidermidis
Due to use of indwelling lines

Question 25

What prophylactic treatment is offered to patients with neutropenia for neutropenic sepsis?

Answer 25

A fluoroquinolone

Question 26

When would it be suggested to order investigations for fungal infections in a patient with neutropenic sepsis?

Answer 26

If patient not responding after 4-6 days

Question 27

What is tumour lysis syndrome?

Answer 27

A serious metabolic disorder where rapid tumour cell death leads to massive release of intracellular contents into the blood

Question 28

What is associated with tumour lysis syndrome?

Answer 28

Aggressive, rapidly proliferating tumours like acute leukaemia and high-grade lymphoma. Often occurs following chemotherapy but may be caused by other treatments

Question 29

What electrolyte abnormalities are seen in tumour lysis syndrome?

Answer 29

Hypocalcaemia, hyperphosphataemia, hyperuricaemia, hyperkalaemia

Question 30

Why does hypocalcaemia occur in tumour lysis syndrome?

Answer 30

Because of increased phosphate released from tumour cells acting as a calcium chelating agent

Question 31

Why does hyperuricaemia occur in tumour lysis syndrome, what is the main complication of this?

Answer 31

The breakdown of DNA bases from tumour cells into uric acid Uric acid then crystallises and gets deposited in kidney causing AKI

Question 32

What are signs and symptoms seen in tumour lysis syndrome?

Answer 32

Hypocalcaemia: Arrhythmias, seizures, muscle cramps, tingling and numbness in hands and feet Hyperuricaemia: gout/joint swelling, dysuria/oliguria Hyperkalaemia: arrhythmias, muscle weakness, palpitations Hyperphophataemia: itching, muscle cramps, peri oral tingling/numbness

Question 33

What are key investigations to do for suspected tumour lysis syndrome?

Answer 33

U+Es (shows high K+ and phosphate and creatine), calcium, uric acid, ECG

Question 34

What is involved in the management of tumour lysis syndrome?

Answer 34

Correction of electrolyte imbalances (may require temporary dialysis) IV fluids Prophylaxis in those at high risk with allopurinol or rasburicase

Question 35

When is rasburicase given?

Answer 35

In individuals at high risk of tumour lysis syndrome, allopurinol given to lower risk or those with G6PD. Rasburicase also used in acute treatment whereas allopurinol only prophylaxis

Question 36

What are indications for dialysis in tumour lysis syndrome?

Answer 36

Intractable fluid overload, hyperkalaemia, hyperphosphataemia, hyperuricaemia or hypocalcaemia

Question 37

Why can gynaecomastia occur with germ cell and leydig cell testicular tumours?

Answer 37

Germ cell: HCG causes leydig dysfunction causing an increase in oestradiol production Leydig cell: directly secrete more oestradiol

Question 38

What tumour marker is raised in around 20% of seminomas?

Answer 38

HCG

Question 39

What tumour markers can be raised in non-seminoma testicular tumours?

Answer 39

AFP and b-HCG

Question 40

What is elevated in around 40% of germ cell tumours?

Answer 40

LDH

Question 41

what is richter's transformation?

Answer 41

when chronic lymphocytic leukaemia cells enter the lymph node and change into high grade non-hodgkins lymphoma

Question 42

What investigation should women undergo before having breast cancer surgery if there is no palpable axillary lymphadenopathy?

Answer 42

USS of the axilla, if negative they should have sentinel lymph node biopsy rather than axillary node clearance

Question 43

how do anastrazole medications work?

Answer 43

they inhibit the peripheral synthesis of oestrogen

Question 44

what type of cancer does achalasia increase the risk of?

Answer 44

squamous cell carcinoma of the oesophagus

Question 45

what is the first line imaging that should be conducted in a patient with suspected multiple myeloma?

Answer 45

whole body MRI scan

Question 46

in which chronic leukaemia is lymphadenopathy more marked?

Answer 46

CLL

Question 47

what is a characteristic finding of CLL on blood film?

Answer 47

smear/smudge cells

Question 48

HNPCC increases the risk of which cancers?

Answer 48

Bowel, pancreatic and endometrial

Question 49

what are the three components of the risk malignancy index in ovarian cancer?

Answer 49

Ca125, menopausal status and ultrasound findings

Question 50

what are poor prognostic factors for ALL?

Answer 50

male sex, presenting age <2 years or >10years, having B or T cell surface markers and WCC >20 at diagnosis

Question 51

what are riskfactors for developing cervical cancer?

Answer 51

HPV 16, 18, 33 smoking, HIV, many sexual partners, high parity, COCP, lower socioeconomic status

Question 52

what are some complications of CLL?

Answer 52

anaemia, hypogammaglobulinaemia,warm autoimmune haemolytic anaemia, transformation to high-grade lymphoma

Question 53

who is offered genetic testing for BRCA1 and BRCA2 mutations?

Answer 53

women under 50 with triple negative breast cancer

Question 54

what is the staging of ovarian cancer?

Answer 54

1- tumour confined to ovary 2- tumour outside ovary but within pelvis 3- tumour outside pelvis but within abdomen 4- distant metastasis

Question 55

what is the main ECG abnormality seen with hypercalcaemia?

Answer 55

short QT interval

Question 56

which type of lung cancer is associated with hypertrophic pulmonary osteoarthropathy?

Answer 56

squamous cell carcinoma

Question 57

radiotherapy for prostate cancer can increase the risk of which other cancers?

Answer 57

bladder, colon and rectal

Question 58

which cancers does the COCP increase the risk of? which is it protective for?

Answer 58

risk of breast and cervical protective for endometrial

Question 59

what chemotherapy regime is used for breast cancer that is node +ve and which regime is used for node -ve?

Answer 59

node +ve = FEC-D chemotherapy node -ve = FEC chemotherapy

Question 60

what is first line investigation for suspected endometrial cancer?

Answer 60

transvaginal ultrasound to measure endometrial thickness if lining is thickened then a hysteroscopy is carried out with biopsy

Question 61

what is the treatment for endometrial cancer?

Answer 61

laproscopic hysterectomy with bilateral salpingo-oopherectomy, with or without radiotherapy

Question 62

which type of lung cancer is associated with gynaecomastia?

Answer 62

adenocarcinoma