Medical Oncology RACP MCQs

Question 1

RACP 2022a Q3

PALB2 gene is implicated in which cancer?
a. Breast
b. Small cell lung cancer
c. Gastric
d. Prostate

Answer 1

A. Breast

PALB2 is a partner and localiser of BRCA2 and plays a role in BRCA2 DNA damage response functions. The cumulative breast cancer risk to age 80 for female carries is ~53%

Women with a faulty PALB2 gene have about a 55% chance of developing breast cancer and about a 5% chance of developing ovarian cancer over their lifetime.
Men with a faulty PALB2 gene have a 1% chance of developing breast cancer over their lifetime. Men with a faulty PALB2 gene also have an increased chance of developing prostate cancer over their lifetime, but the exact chance is unknown.
Both men and women with a faulty PALB2 gene have about a 3% chance of developing pancreatic cancer over their lifetime.
Not everyone who has a faulty PALB2 gene will develop cancer.

Question 1

RACP 2022a Q11

11.A 59F is has a solitary plasmacytoma at T4 treated with irradiation. What is
the percentage risk of developing multiple myeloma?
a. 10%
b. 20%
c. 50%
d. 90%

Answer 1

C. 50%

Multiple myeloma develops in 50-60% of patients with solitary plasmacytoma of bone after initial radiation therapy. In contrast, MM only develops in 10-15% of patients with solitary extramedullary plasmacytomas.

Question 2

RACP 2022 Q18

What is reduced by dose escalation during commencement of venetoclax?

a. Haematopoietic toxicity
b. Differentiation syndrome
c. Tumour lysis

Answer 2

C. TLS

Dose-escalation refers to a step-wise increase in treatment dose over a specified period of time. In the case of venetoclax, dose-escalation is performed to reduce the risk of developing life-threatening TLS.

Binds to and inhibits the B cell lymphoma 2 (BCL‑2) protein, which is an anti-apoptotic protein over-expressed in certain tumour cells, triggering cell death.

Question 3

RACP 2022a Q24

A 24yo male with a history of pT1 seminomatous testicular cancer is
reviewed in clinic. In addition to LDH, which of the following tumour markers
would be elevated?

a. CEA
b. CA125
c. B-HCG
d. AFP

Answer 3

C - B-HCG

Seminomatous testicular cancer is LDH and BHCG positive.

AFP, BHCG, and LDH can be elevated in all testicular cancers. However, generally seminomas should be AFP negative. A positive AFP in seminomas should raise suspicion for nonseminomatous lesions as well.
HCG is elevated in 10-15% of seminomatous tumours with synctiotrophoblastic cells.

Question 4

RACP 2022a Q27

27.(Past question)Female patient with adenocarcinoma of unknown origin, presents with shortness of breath. RR 24, 94% RA and BP 100/40. CXR showed globular heart.

a. Lymphangitic carcinomatosis
b. Atypical pneumonia
c. Pericardial effusion
d. PE with infarct

Answer 4

C - Pericardial effusion

The water bottle sign (globular heart) refers to the shape of the cardiac silhouette on erect frontal chest x-rays in patients who have a very large pericardial effusion. Typically the effusion has accumulated over many weeks to months (e.g. in patients with malignancy) and the pericardium has gradually stretched. The fluid, often measuring a litre or more, causes the pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

Question 5

RACP 2022a Q45

45.A patient has a new diagnosis of diffuse large B cell lymphoma. He is about
to start chemo with RCHOP. As part of his initial work up, his hepatitis B
serology shows Hep B surface antigen negative, Hep B core antibody
positive, Hep B surface antibody positive. How would you manage this?

a. Do nothing as patient is immune
b. Check Hep B E antibody
c. Start antivirals

Answer 5

C
In patients who are HBsAg negative and anti-HBc positive the cancer therapy regimen determines the risk for HBV reactivation. Patients receiving:
Higher risk cancer therapy (blood and marrow transplantation (BMT), B-cell depleting/B-cell active/anti-CD20 monoclonal antibodies, acute leukaemia and high grade lymphoma therapy) should receive antiviral prophylaxis.
Lower risk cancer therapy (therapy which is not classified as higher risk) do not require antiviral prophylaxis.

Question 6

RACP 2022a Q46

46.40yo female with gord and new diagnosis of SCLC develops a rash over her nose that spreads to her face chest and hands. Hands are cold in the
morning. There is no myalgia, arthragia and CK and renal function is normal.
(Photo provided of Gottron papules on bilateral hands)

a. Amyotrophic dermatomyositis
b. Limited scleroderma
c. Granuloma annulares
d. Cutaneous SLE

Answer 6

A - Amyotrophic dermatomyositis

Gottron papules are characteristic of dermatomyositis. Dermatomyositis is also a paraneoplastic syndrome associated with lung cancers.

Question 7

RACP 2022a Q47

47.An ex-smoker with 30 pack year history has a right sided central lung mass on CXR. He has also experienced proximal weakness and hypokalemia -
what is most likely cause?

a. Squamous cell carcinoma
b. Small cell lung cancer

Answer 7

B - SCLC

Lung SCC and SCLC are the only two variants that are exclusively centrally located. The proximal muscle weakness and hypokalemia describes signs of paraneoplastic syndromes. Proximal muscle weakness could indicate myositis or Lambert-Eaton syndrome, the latter is strongly associated with SCLC. Hypokalaemia may be present in Cushing’s syndrome as a result of ectopic ACTH production from SCLC.

Question 8

RACP 2022a Q56

56.Which cancer has the most neurological paraneoplastic symptoms?

a. Ovarian
b. Breast
c. Thymoma
d. Small cell

Answer 8

D - SCLC

SCLC is the most common cause for almost all the neurological paraneoplastic symptoms. This is followed by breast and then ovarian cancers.

Question 9

RACP 2022a Q66

66.70yo male with bony met prostate CA
Ca 2.78 (2.20-2.55)
Pth 7.5 (1.7-7.3)
Urine ca to Cr 0.41 (<0.61)

a. Bony erosions
b. Hyperparathyroidism
c. Exogenous vit D production
d. PTHrP

Answer 9

Answer B: Hyperparathyroidism

Blood tests reveal a PTH dependent hypercalcaemia

Options A and C are causes of PTH independent hyperCa

Prostate cancer, multiple myeloma and breast cancer produce PTHrP. But in malignancy-associated hypercalcaemia secondary to PTHrP, PTH is suppressed.

Urine Ca : Cr is WNL - not FHH

Question 10

RACP 2022a Q74

74.30M with orchectomy. The biopsy has come back and it shows seminoma.
Besides raised LDH, which tumour would you expect to be raised?

a. BHCG
b. AFP
c. CEA
d. CA125

Answer 10

C - B-HCG

AFP, HCG, and LDH can be elevated in all testicular cancers. However, generally seminomas should be AFP negative and positive AFP in seminomas should raise suspicion for nonseminomatous lesions as well.
HCG is elevated in 10-15% of seminomatous tumours with synctiotrophoblastic cells.

Question 11

RACP 2022a Q77

77.68 year old man with 3 months of dyspnoea, cough and bloody sputum. Nil
weight loss or fevers. He has a 30 pack year smoking history. CT chest
showed a 3 cm R sided central hilar mass with bilateral lymphadenopathy.
What is the most likely diagnosis?

a. Sarcoidosis
b. Lymphoma
c. Small call carcinoma
d. Squamous cell carcinoma

Answer 11

Answer C or D

Both SCLC and squamous cell carcinoma are centrally located and are strongly associated with smoking

Question 12

RACP 2022a Q78

78.For which thyroid cancer is calcitonin used to monitor for recurrence

a. anaplastic
b. follicular
c. medullary
d. papillary

Answer 12

Answer: C
Medullary thyroid cancer (MTC) is a neuroendocrine tumor of the parafollicular or C cells of the thyroid gland; it accounts for approximately 1 to 2 percent of thyroid carcinomas. The production of calcitonin is a characteristic feature of this tumor

Question 13

RACP 2022a Q79

79.A 64yo M is found to have large cell lymphoma, he is planned to commence
on cyclophosphamide, doxorubicin, vincristine(?), prednisone, and rituximab.
He was screened pre-treatment for hepatitis B, his results are as follows:
HbsAg negative
HbsAb positive
HbcAb positive
Viral load not detected
What is the most appropriate step before commencing chemotherapy?

a. antiviral medications
b. check hepatitis B e antibody
c. hepatitis B vaccine
d. no further treatment

Answer 13

A

https://www.eviq.org.au/getmedia/a957df52-3610-4b0c-a31e-e31db15b901d/1382-Preventing-reactivation-of-hep-B-algorithm.pdf

Question 14

RACP 2022b Q3

3. Which mutation and location does cetuximab provide the greatest survival
   advantage in colorectal cancer?

A. RAS wild type and Left sided
B. RAS wild type and Right sided
C. RAS mutation and Left sided
D. RAS mutation and Right sided

Answer 14

A - wild type and left sided

Those that are RAS and BRAF wild-type on the RIGHT colon, derive relatively more benefit from treatment with bevacizumab.
Whereas LEFT-sided tumors that are RAS and BRAF-wildtype derive relatively more benefit from treatment with EGFR inhibitors (eg, cetuximab, panitumumab)

Question 15

RACP 2022b Q21

21. (Past question) Where does CDK4/6 work in the cell cycle?

A) G1 to S
B) S to G2
C) G2 to M
D) M to G1

Answer 15

A - G1 phase

https://www.nature.com/articles/s41388-020-1354-9

Question 16

RACP 2022b Q36

36. What cancer causes most deaths worldwide?

A. Lung
B. Colorectal
C. Breast
D. Prostate

Answer 16

A - lung

The most common causes of cancer death in 2020 were:
- lung (1.80 million deaths);
- colon and rectum (916 000 deaths);
- liver (830 000 deaths);
- stomach (769 000 deaths); and
- breast (685 000 deaths).
(from WHO)

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020 (1). The most common in 2020 (in terms of new cases of cancer) were:
- breast (2.26 million cases);
- lung (2.21 million cases);
-colon and rectum (1.93 million cases);
- prostate (1.41 million cases);
- skin (non-melanoma) (1.20 million cases); and
- stomach (1.09 million cases).

Question 17

RACP 2022b Q38

38. “Two-hit hypothesis” is evident in which genetic condition?

A. Chromosomal microdeletion syndrome
B. Congential disorder of glycogen storage
C. Familal cancer syndromes
D. Inborn errors of metabolism

Answer 17

C - Familial cancer syndromes

Tumor suppressor genes may undergo a variety of mutations; however, most loss-of-function mutations that occur in tumor suppressor genes are recessive in nature. Thus, in order for a particular cell to become cancerous, both of the cell’s tumor suppressor genes must be mutated.
This idea is known as the “two-hit” hypothesis, and it was first proposed by geneticist Alfred Knudson in 1971. Today, this hypothesis serves as the basis for researchers’ understanding of how mutations in tumor suppressor genes drive cancer.

Question 18

RACP 2021a Q19

Q19. A 52 year old man who is an ex-smoker presents to clinic with proximal muscle weakness and dysphagia. A
chest x-ray reveals a large anterior mediastinal pathology. He subsequently undergoes resection of the mass. Which histopathology would best explain his clinical findings and imaging?

A. Germ cell tumor
B. Lymphoma
C. Small cell lung cancer
D. Thymoma
This question and the answer options were well recalled.

Answer 18

??D

There are two clinical forms of myasthenia gravis (MG)

•Ocular MG – Weakness is limited to the eyelids and extraocular muscles.

•Generalized MG – Symptoms involve a variable combination of ocular, bulbar, limb, and/or respiratory muscles.

Question 19

RACP 2021a Q36

Q36. A 60 year old man presents with a two week history of pruritis, jaundice, dark urine, pale stools, and 6kg
weight loss, but nil abdominal pain. In the month prior, he had a course of augmentin duo forte for a chest
infection. He has a background history of a caecal cancer treated with right sided hemicolectomy. He smokes 20
cigarettes per day and drinks 2 standard drinks per day. His observations are: HR 88, BP 125/88, RR 12, temp
36.8C.
An abdominal ultrasound shows a dilated gallbladder with nil stones, dilated CBD to the level of the duodenum,
and increased echogenicity throughout the liver. His LFTs are as follows:
Bilirubin 210
Albumin 34
ALT 40
ALP 610
GGT 340
What is the most likely diagnosis?

A. Drug induced liver injury related to Augmentin
B. Alcoholic liver disease
C. Widespread colorectal cancer
D. Head of pancreas cancer

Answer 19

?C

obstructive jaundice
b/g CRC

Question 20

RACP 2021a Q43

Q43. A 65 year old female has a right hemicolectomy for colon cancer. Her brother was diagnosed with colon
cancer aged 60. The histopathology showed mucinous adenocarcinoma with high satellite Instability. Which of the
following mutations would support a sporadic disease mutation rather than familial lynch syndrome?

A. BRAF
B. EGFR
C. Kras
D. PI3K

Answer 20

Answer: A

BRAF V600E mutation is commonly found in sporadic colorectal cancers, particularly those with microsatellite instability (MSI), but it is rarely found in Lynch syndrome-associated cancers.
Lynch syndrome (hereditary non-polyposis colorectal cancer) is associated with mutations in mismatch repair (MMR) genes such as MLH1, MSH2, MSH6, and PMS2. These cancers tend to have high microsatellite instability (MSI-H), but they typically do not have the BRAF mutation. Instead, they are more often associated with germline mutations in MMR genes without BRAF mutations.
In contrast:

KRAS, EGFR, and PI3K mutations can be seen in both sporadic and Lynch syndrome-associated colorectal cancers and are not as definitive in differentiating between sporadic and familial causes.

Question 21

RACP 2021 Q109

Q109. Minor elevations of which tumor marker could best be explained by cigarette smoking?

A. AFP
B. CA125
C. CEA
D. PSA
This question and the answer options were well recalled.

Answer 21

C - CEA

In a recent study of >700 apparently healthy volunteers, the median CEA values for male smokers and nonsmokers were 6.2 and 3.4 μg/L, respectively. The median concentrations for female smoker and nonsmokers were 4.9 and 2.5 μg/L, respectively (17). Thus, smoking appears to almost double the serum concentration of CEA.
https://academic.oup.com/clinchem/article/47/4/624/5639154?login=false

Question 22

RACP 2021 Q118

Q118. A patient with ER positive metastatic breast cancer has failed first line therapy. What class of agent would
you add to aromatase to increase efficacy?

A. mTOR
B. HER2
C. VEGF
D. EGFR

Answer 22

Answer A mTOR

For initial therapy for patients with metastatic hormone receptor-positive, HER2-negative breast cancer, we suggest a cyclin-dependent kinase (CDK) 4/6 inhibitor in combination with an aromatase inhibitor (AI) rather than an AI alone
ESR1 wild-type — For patients with PIK3CA and ESR1 wild-type tumors who have experienced progression on an aromatase inhibitor (AI) plus cyclin-dependent kinase (CDK) 4/6 inhibitor, we suggest the selective estrogen receptor degrader (SERD) fulvestrant, with or without the mechanistic target of rapamycin (mTOR) inhibitor everolimus.
In rare instances, breast cancers have HER2 mutations (not gene amplifications) on genomic sequencing. For ER positive tumors with HER2 mutations, fulvestrant in combination with anti-HER2 therapy with trastuzumab and neratinib is another treatment option.

Question 23

RACP 2021 Q140

Q140. Oestrogen-sensitive metastatic breast cancer can be treated with cyclin dependent kinases (CDK) 4/6
inhibitors. These drugs interfere with cell cycle progression by inactivation of CDK 4/6 complexes resulting in cell
cycle arrest.

From the diagram above, where do the CDK 4/6 inhibitors exert their inhibitory effects?
A. G1 to S
B. S to G2
C. G2 to M
D. M to G1
This question and the answer options were well recalled.

Answer 23

Answer A
G1 to S phase

Question 24

RACP 2021 Oct Q1

53 M presents for routine colonoscopy screening for polyps. Nil PMHx, nil regular meds, normal examination, nil hx PR bleeding. Normal hb and MCV. Colonoscopy found angiodysplastic lesions. What treatment?

A. Observe
B. Argon plasma treatment
C. TTE
D. Rhubarb

Answer 24

B. Argon plasma coagulation (APC).

Angiodysplasia is a common vascular abnormality found in the gastrointestinal tract, often presenting as asymptomatic or with intermittent gastrointestinal bleeding.
Argon plasma coagulation is an effective treatment used for cauterizing and controlling bleeding from these vascular lesions. It is a non-contact method that uses ionized argon gas to deliver electrical current and coagulate the tissue. This treatment helps prevent future bleeding from these lesions.
Observation might be considered if the lesions are completely asymptomatic and no history of bleeding is present, but given the nature of angiodysplasia and the potential for future bleeding, treatment with APC is typically recommended.

Question 25

RACP 2020a Q11

11. A 38yoM presents to the emergency department with worsening shortness of breath and episodes of chest tightness for the past 2 weeks. Below are his CXR images. What is the most likely radiological diagnosis?

A) Anterior mediastinal mass
B) Bilateral hilar lymphadenopathy
C) Cardiomyopathy with left atrial enlargement
D) Right middle lobe collapse

Answer 25

Answer A
Anterior mediastinal mass

Question 26

RACP 2020a Q20

20. Which of the following synthetic disease modifying agents predisposes to the development of SCC of the skin?

A. Azathiopurine
B. Leflunomide
C. Methotrexate
D. Mycophenalate

Answer 26

A. Azathioprine.

Azathioprine is an immunosuppressive medication commonly used in various autoimmune diseases. It has been shown in studies to increase the risk of skin cancers, particularly squamous cell carcinoma, due to its effects on DNA repair mechanisms and its capacity to enhance UV-induced damage to skin cells. Long-term use, especially in combination with other immunosuppressive agents, increases this risk

Question 27

RACP 2020a Q40

40. What complication can occur in the hormonal therapy for transgender males?
    A) Cervical carcinoma
    B) Acne
    C) Osteoporosis
    D) Prolactinoma

Answer 27

B) Acne.

Testosterone therapy, which is commonly used for transgender males (female-to-male transition), can lead to increased oil production in the skin, which can result in acne. This is one of the more common side effects associated with testosterone therapy.

Other complications from testosterone therapy in transgender males may include changes in lipid levels, increased risk of cardiovascular disease, polycythemia, and mood changes, but acne is one of the more frequent and early side effects due to the androgenic stimulation of sebaceous glands.

The other options like Cervical carcinoma, Osteoporosis, and Prolactinoma are less commonly associated with testosterone therapy in transgender males.

Explanation of the other options:
* Cervical carcinoma: Not typically a complication of testosterone therapy, though transgender men with intact cervixes may still require routine screening for cervical cancer.
* Osteoporosis: This can be a risk in transgender males if they stop hormonal therapy, leading to low testosterone levels, but testosterone therapy itself generally helps maintain bone density.
* Prolactinoma: There is no strong association between testosterone therapy and prolactinoma.

Question 28

RACP 2020a Q61

61. Which DNA repair pathway is targeted by PARP inhibitors for the treatment of advanced ovarian cancer which is BRCA positive?

A) Base excision repair (BER)
B) Double strand break replication repair (DSB)
C) Mismatch repair (MMR)
D) Nucleotide excision repair (NER)

Answer 28

Answer A: Base excision repair

Question 29

RACP 2020a Q71

71. What is the mechanism for somatic chromosomal translocation as causing cancer?

A. Gene Fusion
B. Non homolygous end joining
C. Haplotype

Answer 29

A. Gene Fusion.

Explanation:
Gene Fusion occurs when a chromosomal translocation brings together two genes that are not normally adjacent to one another. This often results in the creation of a fusion gene, which can encode an abnormal protein with oncogenic potential. A classic example of this is the BCR-ABL fusion seen in chronic myeloid leukemia (CML), where parts of the BCR gene from chromosome 22 and the ABL gene from chromosome 9 are fused, leading to continuous activation of the ABL tyrosine kinase and uncontrolled cell proliferation.

Non-homologous end joining (B) is a DNA repair mechanism that joins broken DNA ends, but it does not directly explain how chromosomal translocations lead to cancer. However, errors in non-homologous end joining can contribute to chromosomal rearrangements.

Haplotype (C) refers to a group of genes inherited together from a single parent and does not directly explain the cancer-causing mechanism of chromosomal translocations.

Question 30

RACP 2020 Q11

11. What form of thyroid cancer has the worst prognosis?

A) Anaplastic
B) Papillary
C) Follicular
D) Medullary

Answer 30

A

Question 31

RACP 2020

13. What pathway does PARP inhibitors act on?

A) Base excision repair
B) Double stranded repair recombinase pathway
C) Nucleotide Excision repair
D) CDK4/6

Answer 31

Answer A: Base excision repair

Question 32

RACP 2020

28. What high risk feature in breast cancer is most associated with a BRCA mutation?

A) Lymphovascular invasion
B) Triple negative disease

Answer 32

B

Question 33

RACP 2020

31. Mammography typically underestimates the size of which type of breast cancer?
    A) Lobular
    B) Ductal
    C) Mucinous

Answer 33

Answer A Lobular

Question 34

RACP 2020

37. An 87-year-old man presents for an outpatient appointment for 4 months history of poor appetite, eating only 1/4 of his meals and 5kg weight loss. He has a history of moderate-severe dementia with MMSE 10/30 and his wife makes his meals for him. He is on nutritional supplements. He weighs 55kg (BMI 19.5). What is the best management?

A) CT abdomen
B) Gastroscopy
C) Start olanzapine
D) Cease donepezil

Question 35

RACP 2019 Q5

Question 5
Squamous cell carcinoma is most common with which immunosuppressive agent?

A. Mycophenolate mofetil
B. Methotrexate
C. Azathioprine
D. Leflunomide

Answer 35

C

Question 36

RACP 2019 Q12

Question 12
What is the most common type of cancer associated with primary immunodeficiencies?

A. Melanoma
B. Sarcoma
C. Lymphoma
D. Carcinoma

Answer 36

C

The most common type of cancer associated with primary immunodeficiencies is C. Lymphoma.

Explanation:
Individuals with primary immunodeficiencies have an impaired immune response, which significantly increases their risk of developing certain types of cancers, particularly lymphomas. This includes Hodgkin lymphoma and non-Hodgkin lymphoma. The risk is associated with the inability of the immune system to effectively surveil and eliminate malignant cells.

For example, in conditions like Common Variable Immunodeficiency (CVID), the incidence of lymphoproliferative disorders is notably higher compared to the general population .

In addition to lymphomas, patients with primary immunodeficiencies are also at increased risk for other malignancies, including certain carcinomas and sarcomas, but lymphomas are the most frequently observed.

Question 37

RACP 2019 Q22

Question 22
Patient with non-Hodgkin’s lymphoma receiving R-CHOP. Which agent carries the highest risk of peripheral neuropathy?

A. Rituximab
B. Cyclophosphamide
C. Doxorubicin
D. Vincristine

Answer 37

D. Vincristine.

Explanation:
Vincristine is a vinca alkaloid known for its neurotoxic effects, leading to peripheral neuropathy. This can present as sensory disturbances, motor weakness, and autonomic dysfunction. The mechanism of action involves disrupting microtubule formation, which is crucial for neuronal transport.

Rituximab (A) is a monoclonal antibody targeting CD20 on B cells and does not typically cause peripheral neuropathy.

Cyclophosphamide (B) is an alkylating agent that primarily causes side effects related to myelosuppression and bladder toxicity rather than peripheral neuropathy.

Doxorubicin (C), an anthracycline, has its own set of side effects, including cardiotoxicity, but is not primarily associated with peripheral neuropathy like vincristine.

Clinical Evidence:
Vincristine is frequently cited in literature as causing dose-dependent peripheral neuropathy, which is a common complication in patients receiving this agent in chemotherapy regimens (e.g., R-CHOP for non-Hodgkin lymphoma) .
Studies have demonstrated that the cumulative dose of vincristine correlates with the severity of neuropathic symptoms, making it essential to monitor for signs of peripheral neuropathy during treatment .

Question 38

RACP 2019 Q23

Question 23
A 72yo male with Burkitt’s lymphoma is to commence on chemotherapy. There is evidence of tumour lysis syndrome prior to commencement of therapy. What is the most appropriate method to reduce the risk of tumour lysis syndrome?

A. Intravenous fluids
B. Rasburicase
C. Frusemide
D. Allopurinol

Answer 38

Answer B Rasburicase

• Allopurinol suitable for prophylaxis, rasburicase indicated when TLS established.
• IV fluids - supportive - prevents precipitation of solutes in renal tubules - should be given along with rasburicase.
• Frusemide - no evidence for TLS management, used to manage fluid overload in hydrated patient.

Question 39

RACP 2019 Q 25

Question 25
A 63 year old lady with cancer is still independent with all her activities of daily living. She is unable to do housework, but is able to walk around in her back yard. She is currently spending about 40 % of her waking hours in bed. What is her ECOG?

A. 1
B. 2
C. 3
D. 4

Answer 39

B. 2.

Explanation:
The Eastern Cooperative Oncology Group (ECOG) performance status scale is used to assess a patient’s level of functioning in terms of their ability to perform daily activities.
An ECOG score of 2 indicates that the patient is up and about more than 50% of the day, but they are unable to perform their normal work activities. They may be capable of self-care but require assistance for work and other activities. Given that this patient is independent in activities of daily living but unable to do housework and spends about 40% of her waking hours in bed, she fits the criteria for an ECOG 2.
ECOG Scale Summary:
0: Fully active, no restrictions.
1: Restricted in strenuous activity but ambulatory and able to carry out light work.
2: Up and about more than 50% of the day, but unable to perform normal work activities.
3: Capable of only limited self-care; confined to bed or chair more than 50% of waking hours.
4: Completely disabled; cannot perform any self-care.

Question 40

RACP 2019 Q73

Question 73
A 45 year old man presents with pruritus and scleral icterus, but no abdominal pain. He has recently received a course of Augmentin DF for an infection. He has a history of colorectal cancer with hemicolectomy several years ago. He also has a history of heavy alcohol use. Vital signs are normal, and he is afebrile.

Bloods show:
High bilirubin, GGT, ALP, normal AST.
Normal Hb, WCC, PLT
Cannot recall if CRP, INR was given.

Abdominal US showed empty but dilated gallbladder, dilated common bile duct to the level of the duodenum, and increased homogeneous echogenicity of the liver.

What is the most likely diagnosis?

A. Antibiotic-induced cholestasis
B. Common bile duct stone-induced cholestasis
C. Disseminated colorectal cancer
D. Head of pancreas cancer

Question 41

RACP 2019 Q77

Question 77
A 54 year old man has stage 3 colorectal cancer on capcitabine and oxaliplatin. He is currently experiencing 8 episodes of diarrhoea a day, despite taking loperamide. There are no other infective symptoms. What medication would you add to manage his symptoms?

A. Methylprednisolone
B. Subcutaneous morphine
C. Metronidazole
D. Infliximab

Question 42

RACP 2019 Q83

Question 83
What is the mechanism of action of rasburicase in tumour lysis syndrome?

A. Inhibits xanthine oxidase
B. Decreases tubular reabsorption of urate
C. Increases tubular secretion of urate
D. Increases the oxidation of uric acid to allantoin

Answer 42

Answer D

Increases the oxidation of uric acid to allantoin –> which is water soluble and can be excreted through urine

Question 43

RACP 2019b Q28

Question 28
What is the indication for cetuximab in metastatic colorectal cancer?

A. Wild type KRAS
B. Mutant KRAS
C. Wild type EGFR
D. Mutant EGFR

Question 44

RACP 2019b Q40

Question 40
Cyclin dependent kinase inhibitors are effective in which type of breast cancer?

A. Hormone positive, HER2 negative
B. Hormone negative, HER2 positive
C. Triple negative
D. High tumour burden

Answer 44

Answer A Hormone positive and HER2 negative

Question 45

RACP 2019 Q45

Question 45
A rise in which of the following tumour markers can be attributed to smoking?

A. CA-125
B. AFP
C. CEA
D. PSA

Question 46

RACP 2019b Q60

A 60yo male, non-smoker, presents with persistent cough and dyspnoea. His CT is shown below:

His CT demonstrates bulky hilar lymphadenopathy. What is the most likely diagnosis?

A. Small cell lung cancer
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Hodgkin’s lymphoma

Question 47

RACP 2018 Q6

6. At initial diagnosis, which factor is most predictive of reduced survival in patients with metastatic renal cell cancer?

A. Age < 60.
B. Chromophobe histology.
C. Eastern Cooperative Oncology Group (ECOG) performance status of 3.
D. Lung metastases.
E. Smoking history.

Question 48

RACP 2018a Q21

21. What is the most common form of thyroid cancer?
    A. Anaplastic.
    B. Follicular.
    C. Medullary.
    D. Papillary.
    E. Squamous.

Question 49

RACP 2018a Q27

27. A patient with metastatic adenocarcinoma of unknown primary involving liver and bone
    presents with back pain, urinary incontinence and altered sensation in the legs. Clinical
    examination showed reduced sensation to pin prick and light touch in both legs and perineal region. The lower limb reflexes were reduced with down-going plantar reflex.
    What is the most likely diagnosis?

A. Cauda equina syndrome.
B. Cerebral metastasis.
C. Leptomeningeal carcinomatosis.
D. Paraneoplastic peripheral neuropathy.
E. Spinal cord compression.

Question 50

RACP 2018a Q51

51. A 38-year-old woman treated for advanced melanoma with pembrolizumab (anti-PD1 antibody)
    presents with new onset fatigue, generalised weakness, diarrhoea, anorexia and weight loss.
    Supine blood pressure is 110/74 mmHg, standing blood pressure falls to 86/52 mmHg.
    Initial investigations reveal:

Normal values
Sodium (Na) 124 mmol/L [135–145]
Potassium (K) 5.9 mmol/L [3.5–5.5]
Urea 13.2 mmol/L [3.1–8.1]
Creatinine 44 μmol/L [49–90]
Glucose 3.6 mmol/L [4.0–5.5]
What is the most likely cause for her acute presentation?

A. Adrenal metastasis.
B. Adrenalitis.
C. Increased glucocorticoid clearance.
D. Sellar metastasis.
E. Syndrome of inappropriate antidiuretic hormone (SIADH).

Answer 50

Answer B - Adrenalitis

Question 51

RACP 2018a Q64

64.A patient receiving treatment for her metastatic colon cancer developed pain in her hands and
diarrhoea. Her hands are shown on the photograph below:

Which of the following is the most likely treatment to have caused this problem?
A. Bevacizumab.
B. Capecitabine.
C. Erlotinib.
D. Irinotecan.
E. Oxaliplatin.

Question 52

RACP 2018a Q74

76. A 35-year-old man presented with a painless testicular lump and imaging revealed bulky
    retroperitoneal lymph nodes.
    Which tumour marker profile is most consistent with his diagnosis of pure seminoma testicular
    cancer?

                AFP      βHCG     LDH Profile A  Normal Elevated Elevated Profile B  Elevated Normal Normal Profile C  Elevated Normal Elevated Profile D Elevated Elevated Elevated Profile E   Normal Normal Normal

A. Profile A.
B. Profile B.
C. Profile C.
D. Profile D.
E. Profile E.

Question 53

RACP 2018b Q1

101.Treatment of oestrogen-receptor positive breast cancer with tamoxifen causes cells to accumulate in which cell cycle phase?

A. G0
B. G1
C. G2
D. M
E. S

Answer 53

Answer ??? A or B

Question 54

RACP 2018b Q111

111.BCL-2 inhibitors have recently shown to have therapeutic efficacy in blood cancers.
What is the function of BCL-2 protein?

A. Activates cell death receptors.
B. Activates cell survival proteins.
C. Activates effector caspases.
D. Inhibits cell apoptotic proteins.
E. Inhibits cell survival proteins.

Question 55

RACP 2018b Q132

132.In which of the following groups is the benefit of BRCA1/2 genetic testing most established?

A. Men ≤ 60 years of age with prostate cancer.
B. Men with breast cancer irrespective of age.
C. Women with breast cancer who have two relatives with diagnosis of breast cancer.
D. Women with epithelial ovarian cancer irrespective of grade.
E. Women ≤ 50 years of age with triple negative breast cancer.

Question 56

RACP 2018b Q155

155.In cancer pathology what does Ki-67 expression reflect?

A. Cell proliferation.
B. Epithelial origin.
C. Invasive potential.
D. Mutational load.
E. Tumour-infiltrating lymphocytes.

Question 57

RACP 2018b Q157

157.The pathophysiology of chemotherapy-induced nausea and vomiting involves activation of neurotransmitter receptors in the brain. What is the receptor for the neurotransmitter, substance P?

A. 5-Hydroxytryptamine-3.
B. Dopamine-2.
C. Gamma-aminobutyric acid A.
D. Histamine-1.
E. Neurokinin-1.

Question 58

RACP 2018b Q158

158.Epidermal growth factor receptor (anti-EGFR) therapy (e.g. cetuximab) improves disease-free survival and overall survival in patients with which type of metastatic colorectal cancer?

A. Both EGFR and KRAS mutant.
B. EGFR mutant.
C. EGFR wild-type.
D. KRAS mutant.
E. KRAS wild-type.

Question 58

RACP 2018b Q158

158.Epidermal growth factor receptor (anti-EGFR) therapy (e.g. cetuximab) improves disease-free survival and overall survival in patients with which type of metastatic colorectal cancer?

A. Both EGFR and KRAS mutant.
B. EGFR mutant.
C. EGFR wild-type.
D. KRAS mutant.
E. KRAS wild-type.

Question 59

RACP 2017

In patients with Breast Cancer, bone metastases are more likely to occur in which subgroup?

A. ER positive
B. PR positive
C. HER 2 overexpressed
D. Triple negative
E. BRCA1 mutation positive

Answer 59

Answer A: ER positive

Question 60

RACP 2017

A 38-year-old male presents with dyspnoea. He has a background of metastatic testicular cancer and is one week post his fourth cycle of BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy. He is saturating at 84% on room air.

What is the most likely cause of dyspnoea?

A. LV dysfunction
B. Pericardial effusion
C. Lymphangitis carcinomatosis
D. Pulmonary fibrosis
E. Coronary vasospasm

Question 61

RACP 2017

Which is the most common form of lung cancer in Australia?

A. Squamous
B. Adenocarcinoma
C. Small cell
D. Large cell
E. Bronchoalveolar

Answer 61

Answer B Adenocarcinoma

Question 62

RACP 2017

A 74-year-old male presents with progressive dyspnoea on a background of a 50-pack-year smoking history. CT Chest shows bulky mediastinal lymphadenopathy. What is the most likely diagnosis?

A. Lung Adenocarcinoma
B. Hodgkin’s Lymphoma
C. Small Cell Lung Cancer
D. Germ Cell Tumour
E .Thymic mass

Question 63

RACP 2017

Which of the following tumour markers is known to increase with smoking?

Repeat from 2016 paper

A. CA-125
B. CEA
C. CA-19.9
D. β-hCG
E. αFP

Question 64

RACP 2017

Match the clinical features below with the most likely hereditary cancer syndrome from the list above.

Recent pituitary surgery, abdominal pain and nephrolithiasis

A. Peutz-Jegher Syndrome
B. Multiple Endocrine Neoplasia Type 1 Syndrome
C. Multiple Endocrine Neoplasia Type 2 Syndrome
D. Familial Adenomatous Polyposis
E. Lynch Syndrome
F. Li Fraumeni Syndrome

Question 65

Match the clinical features below with the most likely hereditary cancer syndrome from the list above. Gastric polyp and these oral lesions.

A. Peutz-Jegher Syndrome
B. Multiple Endocrine Neoplasia Type 1 Syndrome
C. Multiple Endocrine Neoplasia Type 2 Syndrome
D.Familial Adenomatous Polyposis
E. Lynch Syndrome
F. Li Fraumeni Syndrome

Question 66

Chemotherapy induced nausea is a common clinical problem. What receptor does the neurotransmitter Substance P act on?

Similar question in 2016/2015 paper

A. GABA-A
B. Neurokinin-1
C. Dopamine 
D. 5HT3
E. Histamine

Question 67

RACP 2017

A 50-year-old male patient has received three doses of Ipilimumab for Melanoma. He presents to the emergency department with two days of large volume watery diarrhoea, abdominal cramps and moderate dehydration. There is no blood or mucus in the stool and he is afebrile. His blood pressure is 100/60 mm Hg with a heart rate of 100 bpm.

What is the most appropriate management strategy?

Repeat from 2016 paper

A. Supportive care
B. Oral Steroids
C. Broad Spectrum IV antibiotic therapy
D. High dose IV Steroids
E. G-CSF

Answer 67

Answer D High dose IV steroids

Question 68

Which of the following is the target of the monoclonal antibody Bevacizumab?

A. EGFR
B. TNF alpha
C. VEGF
D. PD-1
E. CD20

Answer 68

Answer C VEGF

Question 69

RACP 2016

Question 46

A 60 year old man with a history of prostate cancer treated with radiotherapy, presents with rectal bleeding causing hypotension requiring blood transfusion.

After initial resuscitation, continued bleeding would be best managed by which of the following measures?

A. Colonoscopic argon thermal coagulation
B. Radiological embolization
C. Surgical resection
D. Oral tranexamic acid
E. IV vasopressin 

Question 70

RACP 2016

Question 79
A man with prostate cancer and bony mets presents with nausea and abdo pain. He is usually on oxycontin 20mg bd. AXR shown below (constipation +++). What would be you management?

a) Ondansetron
b) Haloperidol
c) Macrogol Laxative
d) Fentanyl
e) Tramadol

Question 71

RACP 2016

Question 8

On which receptor(s) does Aprepitant work?

A. Serotonin
B. Dopamine-2 receptors
C. Dopamine-4 receptors
D. NK-1
E. Serotonin and dopamine receptors

Question 72

Question 28

What is the mechanism for increased efficacy of Trastuzumab-Emtansine (T-DM1)?

A. Increased half-life
B. Decreased efflux
C. Targeted delivery
D. Antibody dependent cell-mediated cytoxicity
E. Increased exposure to the tumour microenvironment

Question 73

RACP 2016

Question 34
Mechanism of action of abiraterone in castrate resistant prostate ca?

A. Inhibits demineralisation of androgen receptor in prostate
B. Inhibits LH action on prostate
C. Inhibits conversion of dihydrotestosterone from testosterone 
D. Inhibits conversion of testosterone from oestrogen
E. Inhibits testosterone production from prostate cancer cells

Question 74

RACP 2016

Question 50

What is the change of a male of offspring of a female who is a carrier of the BRAC2 mutation inheriting that mutation?

A. 0%
B. 25%
C. 50%
D. 75%
E. 100%

Question 75

RACP 2016

Question 56

A 65 year old female with a background of breast cancer which has undergone lumpectomy and radiology 4 year prior presents with shortness of breath with difficulty breathing. Her respiratory rate is 28 breaths/minute and oxygen saturation is 96% on room air. High resolution T chest shows features indicating extensive lymphangitis carcinomatosis.

Which of the following would be most useful for treating her shortness of breath?

A. Frusemide
B. Oxygen
C. Morphine
D. GTN
E. Sildenafil

Question 76

RACP 2015a Q2

Question 2
A 75 year old man with squamous cell cancer of the lung presents with confusion. His
serum calcium is 3.85. Other bloods include GGT 308, ALP 218, AST 150, ALT 208 and
creatinine 150. He is commenced on IV fluids and the decision is made to also give
zolendronic acid.
Which of the following is most important to consider when dosing zolendronic acid?

A. Patient age
B. Degree of hypercalcaemia
C. Liver function
D. Renal function
E. Weight

Question 77

RACP 2015a Q28

Question 28
A man has node positive colorectal cancer treated with resection and chemotherapy 12
months ago. Now followed up with CEA and serial CTs. What is the utility of these tests?

A. Testing for anastomotic recurrence
B. Testing if he needs further chemo
C. Testing for resectable liver / lung metastases
D. Testing for a new colorectal primary
E. Testing for pancreatic cancer

Question 78

RACP 2015a Q73

Question 73
A 45 year old man has colon cancer with 3 adenomas on colonoscopy. No family history. Histology shows expression of mismatch repair genes MLH1, MSH2, MSH6 in tumour and also in surrounding normal tissue. What is the likely diagnosis?

A. HNPCC
B. FAP
C. Juvenile polyposis
D. Sporadic colon caner
E. Autosomal recessive adenomatous polyposis

Question 79

RACP 2015b Q32

Question 32
What is single strongest factor for poor survival in invasive breast cancer?

A. Axillary lymph node involvement
B. High grade tumour
C. Large size of tumour
D. Oestrogen negative
E. Vascular invasion

Question 80

RACP 2015b Question 53
Which combination has the worst prognosis in early breast cancer?
ER PR HER
A Positive Positive positive
B Positive Positive negative
C Positive Negative Negative
D Negative Negative positive
E negative negative negative

Question 81

RACP 2015

Question
A 55 year old woman of Asian background presents with persistent cough and weight loss. She has a pleural effusion, and evaluation of this reveals a non-small cell lung cancer of adenocarcinoma type.
Which of the following tests would best direct her treatment?

A. CT chest, abdo, pelvis
B. MRI brain
C. EGFR status
D. EML-ALK status
E. Whole body PET scan

Question 82

RACP 2015

Question
A 55 year old woman of Asian background presents with persistent cough and weight loss. She has a pleural effusion, and evaluation of this reveals a non-small cell lung cancer of adenocarcinoma type.
Which of the following tests would best direct her treatment?

A. CT chest, abdo, pelvis
B. MRI brain
C. EGFR status
D. EML-ALK status
E. Whole body PET scan

Question 83

RACP 2015

Question
You are reviewing a 35 year old woman who is known to be positive for the BRCA1 gene.
What is the most sensitive test for detecting breast malignancy for her?

A. MRI
B. Ultrasound
C. Mammogram
D. CT
E. Regular clinician examination

Question 84

RACP 2015

Which of the following factors predicts the worst prognosis in early breast cancer?

A. Axillary lymph node involvement
B. Large tumour size
C. High tumour grade
D. Age
E. Vascular invasion

Question 85

RACP 2015

Question
What is the treatment for stage IIIA and IIIB non-small cell lung cancer who do not have
surgical resection?

A. Definitive chemotherapy
B. Chemoradiotherapy
C. Radiotherapy
D. Palliative chemotherapy
E. Rhubarb

Question 86

RACP 2015 Q25

What is the primary use of PET scans in lung cancer?

A. Confirm a primary lung cancer
B. Confirm subcentrimere nodal metastases
C. Monitor treatment response
D. Determine metastatic disease before treatment of localised disease
E. Monitor metastatic disease

Question 87

RACP 2015 Q48

Which of the following is the worst prognostic factor for NSCLC ?

A. Age over 80 years
B. BMI under 17
C. Poor performance status
D. Smoking
E. Bad breath

Question 88

RACP 2015 Q15

Ipilimumab is used in the management of metastatic melanoma. Which of the following describes its mechanism of action?

A. BRAF
B. Cytokine
C. Cytotoxic T cell inhibitory antibody
D. Immune checkpoint inhibitor
E. Tumour specific antigen vaccine

Question 89

RACP 2015 Q32

In the setting of breast cancer, whichof the following carries the worst prognosis?

A. Positive axillary lymph node
B. Large primary
C. Lymphovascular invasion
D. High grade
E. ER negative

Question 90

RACP 2014 Question 3:

70 year old male with SCC is found to have hypercalcemia.
Bloods: Ca(corr): 3.42
Urea=8.1
Creatinine=135

What is the next step in management?
A. IV fluids
B. Dexamethsone
C. s/c denosumab
D. s/c calcitonin
E. IV bisphosphonate

Question 91

RACP 2014 Q23

Which of the following is associated with a better prognosis in oropharyngeal cancer?

a. EBV positive
b. squamous cell carcinoma
c. HPV negative
d. p16 mutation positive
e. non smoker

Question 92

RACP 2014 Q 75

Patient with sporadic colorectal cancer treated with resection 1 yr ago, is being monitored with CEA and CT chest/abdo/pelvis. By what curative intent does this monitoring offer?

A. Resection of solitary metastatic lung or liver lesion
B. Resection of pancreatic lesion
C. Low grade metastases for commencing chemotherapy
D. Detect Anastomotic site disease
E. Detect another primary tumour

Question 93

RACP 2014 Q81.
A 58yo man with pancreatic cancer presents with acute shortness of breath and desaturation to 90% on room air. He is on Gemcitabine.
A CT of his lungs is shown.

What is the likely cause of his symptoms?
A) PE
B) Pulmonary oedema
C) Gemcitabine-induced penumonitis
D) Pneumonia due to febrile neutropaenia
E) Lymphangitis carcinomatosis

Question 94

RACP 2013a Q11

Question 11
Which of the following factors has the most effect on CEA?

A. alcohol
B. exercise
C. obesity
D. smoking
E. depression

Question 95

RACP 2013a Q13

Question 13
Which of the following chemotherapy agents carries the greatest risk of infertility?

A. Cyclophosphamide
B. Bleomycin
C. Methotrexate
D. Doxorubicin
E. Vincristine

Question 96

RACP 2013a Q14

Question 14
A 76M has castrate resistant prostate cancer with bony metastases. Which of the following will help improve overall survival?

A. Docetaxel
B. Mitoxantrone
C. Zoledronic acid
D. Strontium
E. Radiotherapy

Question 97

RACP 2013a Q30

Question 30
Which of the following incurs the greatest risk of tumour lysis syndrome?

A. Breast cancer
B. Colorectal cancer
C. Testicular cancer
D. Lymphoma
E. Renal cell cancer

Answer 97

Answer D

TLS is observed most frequently in patients with aggressive and highly aggressive lymphomas (particularly the Burkitt subtype) and acute lymphoblastic leukaemia following the initiation of cytotoxic therapy

Question 98

RACP 2013a Q55

Question 55
Mechanism of aromatase inhibitors is:

A) Converts testosterone to oestradiol
B) Inhibits oestrogen at the receptor
C) Blocks production of oestrogen
D) Increases metabolism of oestrogen
E) Prevents aromatistion of oestradiol from testosterone

Question 99

RACP 2013a Q60

Question 60
Which chemotherapy agent causes cold dysesthesias of the hands and feet?

A) Oxaliplatin
B) Vincristine
C) Doxorubicin
D) 5-Fluorouracil
E) Cyclophosphamide

Question 100

RACP 2013b Q2

Question 2
What is the most likely non-SCC malignancy in renal transplant patients?

a) Colorectal Ca
b) Native kidney Ca
c) Lymphoma
d) Pancreatic ca
e) Lung ca

Question 101

RACP 2013b Q9

Question 9
A 75yo male patient has metastatic colorectal cancer. He spends most of his day resting in bed or in his chair and requires assistance with his activities of daily living. What is his ECOG score?

A. 0
B. 1
C. 2
D. 3
E. 4

Question 102

RACP 2013b Q13

Question 13
55 yr old female with a history of colorectal node positive cancer, managed with resection and chemotherapy. She is found to have a single 2cm liver lesion a few years later. What is the most appropriate next step in her management?

A. Chemotherapy
B. radiotherapy
C. lesion resection
D. TACE
E. RFA

Question 103

RACP 2013b Q18

Question 18
A 69yo male patient of yours is found to have an elevated serum paraprotein level of 35g/L. BMAT reveals 30% monoclonal plasma cell infiltrate. He has no evidence of anaemia, renal impairment, hypercalcaemia or lytic lesions. What is the next step in management?

A. Observe and monitor
B. Arrange for autologous stem cell transplantation
C. Commence thalidomide
D. Commence dexamethasone
E. Commence combined therapy with prednisolone and thalidomide / bortezomib

Question 104

RACP 2013b Q34

Question 34
A 25M with testicular cancer is receiving cisplatin based chemotherapy. He has been given dexamethasone, metoclopramide and aprepitant prior to receiving chemotherapy. He is now agitated, very anxious and complaining of abnormal eye movements. What is the best immediate treatment?

A. Aspirin
B. IV benztropine
C. Hydrocortisone and promethazine
D. Cease cisplatin
E. SL lorazepam

Question 105

RACP 2013b Q44

Question 44
A 45yo male is found to have an adenocarcinoma of the sigmoid colon. The rest of his colonoscopy was normal. He has no other family or personal history of cancer. Immunohistochemistry of the tumour showed mismatch repair mutations in MLH1, MSH2, and MSH6 in the tumour and adjacent normal tissue. What would be the surveillance recommendations for his children?

A. FOBT yearly from age 50
B. Colonoscopy 5 yearly from age 35
C. No surveillance
D. Yearly colonoscopy from age 25
E. Second yearly colonoscopy from age 45

Question 106

RACP 2013b Q56

Question 56
What is single strongest factor for poor survival in Breast cancer?

A) Lymph node involvement
B) High grade tumour
C) Large size of tumour
D) Oestrogen negative
E) Vascular invasion

Question 107

RACP 2013b Q57

Question 57
What is the population attributable risk of malignancy to obesity?
A. 0.1
B. 0.3
C. 0.5
D. 0.7
E. 0.9

Question 108

RACP 2013b Q60

Question 60
A 45yo male patient has a glioblastoma multiforme removed neurosurgically. Which of the following is the next step in his post-operative care?

A. Chemotherapy
B. Radiotherapy
C. Chemo-radiotherapy
D. No further therapy needed
E. Biological agents

Question 109

RACP 2012a Q7

QUESTION 7
A 54 year old male, smoker who is asymptomatic is found to have a single
nodule on chest CT. Which of the following is most suggestive of malignancy:

A. Doubling time greater than 500 days
B. Ground glass changes
C. Higher density (greater than 200 hounsfield units)
D. Size < 3mm
E. Smooth with round contours

Question 110

RACP 2012a Q19

QUESTION 19
What type of malignancy is most commonly associated with SIADH?

A. Brain
B. Duodenum
C. Lung
D. Pituitary
E. Pancreatic

Question 111

RACP 2012a Q30

QUESTION 30
A patient is treated for lymphoma with chemotherapy. Along with smoking, which
chemotherapy agent increases the risk of developing lung cancer?

A. Adriamycin
B. Bleomycin
C. Vinblastine
D. Carmustine
E. Dacarbazine

Question 112

RACP 2012a Q32

QUESTION 32
Bevacizumab used in colon cancer with chemotherapy what is mechanism of
action?

A. VEGF inhibitor
B. EGFR ihibitor
C. Her 2 inhibitor
D. Neurokinin 1 receptor antagonist
E. Platelet derived growth factor inhibitor

Question 113

RACP 2012a Q70

QUESTION 70
Cytotoxic chemotherapy is given in cycles to allow bone marrow recovery.
In a regimen of intravenous chemotherapy given on day one of a 21 day cycle;
which days will correspond to the neutrophil nadir?

A. 1 – 4 days
B. 5 – 9 days
C. 10 – 14 days
D. 15 – 18 days
E. 19 – 21 days

Question 114

RACP 2012b Q10

QUESTION 10
A 55 year old male with a past history of successful anterior resection for node
positive localised colonic adenocarcinoma presents for follow up 2 years later. He
remains independent and is otherwise well.
A recent CT scan has found a single 3cm lesion in the left lobe of the liver on CT
scan. A FDG-PET scan does not find any other lesions.
Repeat gastroscopy and colonoscopy is unremarkable and there is no evidence of
metastatic disease elsewhere.

What is the most appropriate treatment?
A. surgical resection of liver lesion
B. palliative chemotherapy
C. supportive care
D. arterial chemoembolization
E. radiotherapy

Question 115

RACP 2012b Q11

QUESTION 11
A 45 yr old man has colon cancer, and also has 3 adenomas on colonoscopy. No
family history. Histology shows mismatch repair genes MLH1, MSH2, MSH6 in the
tumour, and also in the surrounding normal tissue. What is the likely diagnosis?

A. Autosomal recessive adenomatous polyposis
B. HNPCC
C. FAP
D. Juvenile polyposis
E. sporadic colon cancer

Question 116

RACP 2012b Q30

QUESTION 30
A smoker presents with SOB and cough. CT chest shows evidence of a left lung
mass with collapse as well as left hilar and mediastinal lymphadenopathy.
Histopathology demonstrates evidence of small cell lung cancer.
PET scan and CT of brain/abdomen and pelvis shows no other evidence of
metastatic disease.
What would be the appropriate treatment?

A. Chemotherapy
B. Chemotherapy and chest radiotherapy
C. Surgical resection
D. Surgical resection followed by chemotherapy
E. Chest radiotherapy

Question 117

RACP 2012b Q86

QUESTION 86
A 63 year old man is sent to you by his GP. He presented with left sided abdominal
pain and the following blood results:
Hb 93
WCC 120
Plt 450
A blood film reveals leucocytosis with left shift but no blasts are seen. A cytogenetic
assay is performed which reveals a translocation (9;22).
He is diagnosed with chronic myeloid lekuemia, in the chronic phase.
What is the most appropriate management?

A. Busulphan
B. Leukopheresis
C. Interferon-alpha and cytarabine
D. Imatinib
E. Stem Cell Transplant

Question 118

RACP 2012b Q92

QUESTION 92
A patient has been diagnosed with Glioblastoma Multiforme and has had debulking surgery performed. What is the next best management step to maintain survival?

A. Temazolamide and Bevacizumab
B. Temazolamide and sterotactic radiotherapy
C. Interstitial localized brachytherapy
D. Repeat microsurgery
E. Temazolamide

Question 119

RACP 2011a Q12

Question 12
For which of the following malignancies does normalisation of the associated tumour marker predict the best overall prognosis?

A. Colorectal Ca and CEA
B. Pancreatic Ca and Ca19.9
C. Testicular Ca and alpha-fetoprotein
D. Breast Ca and Ca15.3
E. Ovarian Ca and Ca-125

Question 120

RACP 2011a Q19

Question 19
Breast mammography has a sensitivity of 90% and specificity of 95% for the detection of breast cancer. The incidence of breast cancer in the screened population is 5/1000. What proportion of those with an abnormal mammogram will have a false positive test?

A. 5%
B. 10%
C. 25%
D. 45%
E. 90%

Question 121

RACP 2011a Q35

Question 35
Worst prognostic factor in patient with metastatic breast cancer

A. Lack of response to 6 months of chemotherapy
B. 3 previous course of chemotherapy
C. Poor performance status (ECOG>3)
D. Recurrence within 2 years of diagnosis
Metastatic visceral disease

Question 122

RACP 2011a Q51

The target site for the action of bevacizumab is:
A. Epidermal growth factor receptor 1 (EGFR1)
B. Vascular endothelial growth factor (VEGF)
C. Neurokinin 1
D. HER2
E. Platelet derived growth factor (PDGF)

Question 123

RACP 2011a Q59

Question 59
Tamoxifen is a prodrug metabolised to its active metabolite by CYP2D6. Which anti depressant will interfere with its effect in breast cancer?

A. Citalopram
B. Mirtazapine
C. Moclobemide
D. Paroxetine
E. Venlafaxine

Question 124

RACP 2011b Q2

Question 2
40F presented with shortness of breath. Normal CXR and negative CTPA. 5 years prior to this presentation she had a Left sided breast cancer managed with mastectomy and chemotherapy with Doxorubicin and Cyclophosphamide. What is the most likely cause of her SOB.

A. Anthracycline cardiotoxicity
B. Constrictive pericarditis
C. Radiation cardiomyopathy
D. Pulmonary fibrosis
E. Pulmonary embolism

Question 125

RACP 2011b Q31

Question 31
45M with non small cell lung cancer (NSCLC) had a lobectomy. Histopathological examination showed involvement of the hilar lymph nodes. What is the most appropriate next step in his treatment?

A. Chemotherapy
B. Mediastinal radiotherapy
C. Completion pneumonectomy
D. Prophylactic cranial irradiation
E. No further treatment

Question 126

RACP 2011b Q35

Question 35
In a patient treated with chemotherapy for breast cancer, which of the following portends the poorest prognosis?

A. Time since first relapse
B. Relapse within 2 years
C. Axillary node involvement
D. ECOG 3 performance status
E. Tumour size > 1 cm

Question 127

RACP 2011b Q37

Question 37
A 35yr old man with advanced AIDS presents with a left hand motor seizure. CT brain with contrast reveals a 3cm enhancing lesion within the right frontal lobe. The most likely diagnosis is:

A. Glioma
B. Meningioma
C. Primary cerebral lymphoma
D. Secondary cerebral lymphoma
E. Secondary cerebral Kaposi’s sarcoma

Question 128

RACP 2011b Q50

Question 50
50. A 30yr old lady is concerned about her risk of ovarian cancer.
Her mother and grandmother both died in their forties of ovarian cancer.
Her examination is unremarkable.
What is the most appropriate next step in this lady’s management?

A. breast MRI
B. BRCA1/BRCA2 testing
C. oophorectomy
D. CA125 and transvaginal ultrasound
E. confirm the diagnosis of cancer in her family

Question 129

RACP 2011b Q78

Question 78
An elderly man urgent laparotomy for a large bowel obstruction at which point he is found to have a stenosing primary bowel cancer. He undergoes hemicolectomy with primary anastamosis. The main reason for doing a follow up colonoscopy afterwards is to:

A. Exclude synchronous cancer
B. Assess for colonic polyps
C. Assess for tumour at the anastamotic site
D. Assess for terminal ileitis
E. Assess for celiac disease

Question 130

RACP 2011b Q80

Question 80
Patients with non-small cell lung cancer with an EGFR receptor mutation are often responsive and have a better prognosis when treated with tyrosine kinase inhibitors. Which tumour phenotype is most predictive of having an EGFR receptor mutation?

Question 131

RACP 2011b Q84

Question 84

A patient presents unwell ten days post chemotherapy for bowel cancer. He is pale, has a systolic BP of 90 and is having a rigor. After physical examination, taking bloods and commencing IV therapy, what is the next step in his management?

A. ECG
B. CXR
C. Commence broad spectrum antibiotics
D. Commence GCSF
E. Await neutrophil count and continue IV therapy

Question 132

RACP 2011b Q86

A 36 year old female who smoke 30 cigarettes per day presents with left shoulder pain and left fourth and fifth digit numbness. Her CXR shows a left apical opacity and left hilar prominence.
What is the next investigative step?

A. PET scan
B. CT scan
C. Bronchoscopy
D. Nerve conduction studies
E. Sputum cytology

Question 133

RACP 2011b Q87

Question 87
After a genetic diagnosis of familial adenomatous polyposis, a 25 year old woman has a total colectomy and ileorectal anastamosis. Apart from monitoring the anastamotic site, which should be done as part of ongoing tumour surveillance?

A. Transvaginal ultrasound and CA125 level
B. Abdominal MRI for desmoid tumours
C. CEA level
D. Breast MRI
E. Gastroduodenoscopy

Question 134

RACP 2011b Q94

Question 94
A 45 year old pre-menopausal female is diagnosed with an 8mm grade II breast cancer for which she undergoes lumpectomy. Her lymph nodes are negative for disease. Her tumour is ER positive, HER2 negative. She does not undergo chemotherapy. The most appropriate adjuvant therapy to improve her prognosis is:

A. Aromatase inhibitor
B. Aromatase inhibitor plus tamoxifen
C. Aromatase inhibitor plus bisphosphonate
D. Tamoxifen
E. Tamoxifen plus bisphosphonate

Question 135

RACP 2011b Q100

Question 100
60 year old man with 55 pack year history of smoking presents with weight loss, malaise and cough. On examination he was found to have an enlarged left supra-clavicular lymph node. A CXR shows a left hilar mass. CT of the chest confirms the left hilar mass, and also shows a lung mass and mediastinal lymphadenopathy. What is the next investigational step?

A. Bronchoscopy and biopsy
B. CT guided biopsy of the hilar mass
C. Mediastinoscopy
D. PET scan
E. Needle biopsy of the supraclavicular lymph node

Question 136

RACP 2011b Q100

Question 100
60 year old man with 55 pack year history of smoking presents with weight loss, malaise and cough. On examination he was found to have an enlarged left supra-clavicular lymph node. A CXR shows a left hilar mass. CT of the chest confirms the left hilar mass, and also shows a lung mass and mediastinal lymphadenopathy. What is the next investigational step?

A. Bronchoscopy and biopsy
B. CT guided biopsy of the hilar mass
C. Mediastinoscopy
D. PET scan
E. Needle biopsy of the supraclavicular lymph node

Question 137

RACP 2010a Q3

Question 3
Which of the following cytotoxics is most likely to cause infertility?

A. Alkylating agents (eg cyclophosphamide)
B. Anthracyclines (eg doxorubicin)
C. Antimetabolites (eg 5-fluorouracil)
D. Taxanes (eg paclitaxel)
E. Vinca-alkyloids (eg vincristine)

Question 138

RACP 2010a Q6

Question 6
What is the lifetime risk of developing colorectal cancer in a person with genetically confirmed FAP who does not have a prophylactic colectomy.

A. 10%
B. 20%
C. 60%
D. 75%
E. 95%

Question 139

RACP 2010a Q24

Question 24
The percentage of bronchogenic cancers that are histologically classified as small cell are :

A. 5%
B. 15%
C. 50%
D. 75%
E. 90%

Question 140

RACP 2010a Q58

Question 58
A patient who is a long term smoker decides to quit smoking. What effect is abstinance of smoking likely to have on the risk of developing lung cancer in the future?

A. Will increase for the first 2 years then decrease
B. Will remain the same
C. Will decrease but never return to baseline level compared to non-smokers
D. Will decrease and be the same as nonsmokers after 5 years
E. Will decrease and be the same as nonsmokers after 10 years

Question 141

RACP 2010b Q7

Question 7
A 79 year old man presents with abdominal pain. He is found to have retroperitoneal
lymphadenopathy. WCC is 15 with 70% lymphocytes. There are several atypical lymphocytes.
What is the most appropriate diagnostic test?

A. Bone marrow Biopsy
B. Serum Cytogenetic analysis
C. PET scan
D. Retroperitoneal lymph node biopsy
E. PSA

Question 142

RACP 2010b Q64

Patients with HNPCC are most likely to have colonic tumours. What extra-colonic tumours are most likely?

A. endometrial ca
B. small bowel tumour
C. ovarian cancer
D. stomach cancer

Question 143

RACP 2010b Q73

Question 73
A 68 yo male had a large bowel resection due to a stenosing bowel cancer. A hemicolectomy with primary anastomosis was performed which revealed no evidence of spread. Following surgery, what
is the reason for follow-up colonoscopy?

A. Check for anastomotic integrity
B. check for colonic polyps
C. check for synchronous cancer
D. check for anastomotic cancer
E. check for terminal ileitis

Question 144

RACP 2009a Q1

QUESTION 1
In Hereditary non poliposis colon cancer (HNPCC) which is the most typical phenotype

Question 145

RACP 2009a Q5

QUESTION 5
Middle age man with metastatic colon cancer has resection of solitary hepatic met. Post op
has excessive bleeding from drains.
Platelets 90
INR 1.5
APTT slightly raised
Finbrinogen 0.6
D-dimer 0.75 (raised)
Which of the following agents would you use?

A. Platelets
B. Cryoprecipitate
C. Fresh frozen plasma
D. aprotinin
E. Recombinant Factor VII

Question 146

RACP 2009a Q17

QUESTION 17
Which class of chemotherapeutic agents is most likely to cause tissue damage if it
extravasates?
A. Taxanes (eg. Paclitaxel)
B. Vinka alkaloids (eg. Vincristine)
C. Anthecyclines (eg. Doxorubicin)
D. Antimetabolites (eg. Metothrexate)
E. Platinums (eg. Cisplatin)

Question 147

RACP 2009a Q23

QUESTION 23
Tumour suppressor genes are involved in the development of malignancy. What is the most likely result?

A. Missense mutation
B. Telomerase inactivation
C. Chromosome rearrangement
D. Increased gene amplification
E. Loss of heterozygosity

Question 148

RACP 2009a Q35

QUESTION 35
Streptococcus bovis endocarditis is most commonly associated with which type of cancer?

A. Lung
B. Pancreatic
C. Breast
D. Colon
E. Prostate

Question 149

RACP 2009a Q55

QUESTION 55
Which of the following best describes the consequences of inappropriate activation of receptor tyrosine kinases in cancer?

A. Silencing of tumour suppressor genes
B. Promotion of cell cycling
C. Efflux of cytotoxic agents
D. Stimulation of angiogenesis
E. recruitment of nuclear co-receptor complexes

Question 150

RACP 2009a Q63

QUESTION 63
What is the purpose of a phase III clinical trial in advanced cancer?

A. Gives patients access to experimental drugs
B. Compare standard therapy to placebo
C. Compare response rate of new therapy to standard therapy
D. Determine the rate of response
E. Decide the most effective regimen for the new therapy

Question 151

RACP 2009b Q49

QUESTION 49

Compared with tamoxifen, aromatase inhibitors increase the risk of-

A. hot flushes
B. osteoporosis
C. thromboembolism
D. endometrial cancer
E. local disease recurrence

Question 152

RACP 2009b Q59

QUESTION 59
44yo male, chronic smoker presents with 2 weeks history of SOB and cough. Walking distance now limited to 75m. Endobronchial biopsy shows small cell lung cancer.
CT scan given shows trachea compression.
What would be your next initial treatment?

A. Chemotherapy
B. Radiotherapy
C. Chemo-radiotherapy
D. Corticosteroids
E. Endobronchial stent

Question 153

RACP 2009b Q80

QUESTION 80
A 55 year old man on haemodialysis is on the waiting list for a transplant. He asks about his risk of cancer with the transplant. You note that he is of Anglo‐Saxon descent.
Which of the following cancers is he most at risk of?
A. Cancer of the prostate
B. Squamous cell carcinoma of the skin
C. Non‐hodgkin’s lymphoma
D. CML
E. Carcinoma of the colon

Question 154

RACP 2008a Q24

QUESTION 24
Which of the following tumours is the most chemo-resistant?
A. Breast carcinoma.
B. Renal cell carcinoma.
C. Testicular carcinoma.
D. Colon carcinoma.
E. Small cell lung carcinoma.

Question 155

RACP 2008a Q24

QUESTION 24
Which of the following tumours is the most chemo-resistant?
A. Breast carcinoma.
B. Renal cell carcinoma.
C. Testicular carcinoma.
D. Colon carcinoma.
E. Small cell lung carcinoma.

Question 156

RACP 2008a Q63

QUESTION 63
Tumour markers are often used indiscriminately to monitor therapy. For which of the following tumour
markers and associated tumours does normalisation with therapy best predict overall survival?
A. Ca 15-3 in breast carcinoma.
B. Carcinoembryonic antigen in bowel carcinoma.
C. Lactate dehydrogenase in lymphomas.
D. Alpha fetoprotein in testicular carcinoma.
E. Ca 19-9 in pancreatic carcinoma.

Question 157

RACP 2008b Q9

QUESTION 9
A 60-year-old man, with a past history of hypertension, type 2 diabetes and a 20 pack year history of smoking, presents with sudden onset of headache and a mild left sided hemiparesis. His cranial computed tomography (CT) scan is shown below.

The most likely diagnosis is:
A. cerebral metastasis.
B. hypertensive haemorrhage.
C. amyloid angiopathy.
D. arteriovenous haemorrhage.
E. giant cerebral aneurysm.

Question 158

RACP 2008b Q15

QUESTION 15
A 65-year-old male is reviewed following surgical resection of non-small cell lung cancer. Pathology reveals involvement of local hilar lymph nodes, in addition to the primary lung cancer. What is the most appropriate further management?

A. Radiotherapy.
B. Chemotherapy.
C. Regular radiological follow-up.
D. Combined chemo-radiation therapy.
E. Prophylactic cranial irradiation.

Question 159

RACP 2008b Q18

QUESTION 18
A 69-year-old lady presents with chest pain following a motor vehicle accident and is found on thoracic computed tomography (CT) scan to have multiple sclerotic lesions involving ribs and thoracic vertebrae. A technetium-99m-methylene diphosphonate (MDP) bone scan reveals multiple areas of radiotracer uptake throughout the skeleton. Physical examination and mammography are normal.
Which of the following is most likely to give a diagnosis?
A. Bone marrow biopsy.
B. Assay of tumour markers.
C. Serum protein electrophoresis.
D. Magnetic resonance imaging (MRI) scan of thorax.
E. Biopsy of vertebral lesion.

Question 160

RACP 2008b Q30

QUESTION 30
You are caring for a 55-year-old man on haemodialysis. He is on the transplant waiting list and asks about his risk of developing cancer if he has a transplant. You note he is of Anglo-Saxon descent.
Which of the following cancers is he most likely to develop over the ensuing ten years
post-transplantation?

A. Carcinoma of the prostate.
B. Squamous cell carcinoma of the skin.
C. Non-Hodgkin’s lymphoma.
D. Chronic myeloid leukaemia.
E. Carcinoma of the colon.

Question 161

RACP 2008b Q34

A 24-year-old man presented with a left testicular mass and a serum αfetoprotein (AFP) of 560 μg/L
[<10 μg/L] with a normal serum human chorionic gonadotrophin (HCG). An orchidectomy revealed embryonal testicular carcinoma. He received four cycles of chemotherapy with cisplatin, etoposide and bleomycin (BEP regime). His serum αfetoprotein is now normal. His post-completion chemotherapy abdominal computed tomography (CT) scan is shown below.

The most appropriate next step in his management is:
A. autologous stem cell transplant.
B. external beam radiotherapy.
C. ongoing observation.
D. continue BEP chemotherapy.
E. retroperitoneal lymph node dissection.

Question 162

RACP 2008b Q56

QUESTION 56
A 52-year-old man with no personal or family history of colon cancer, colonic polyps, or inflammatory
bowel disease underwent a colonoscopy for rectal bleeding that showed haemorrhoids and a 1.5 cm
pedunculated polyp at the hepatic flexure that was removed by means of a snare with cautery. The
polyp was a tubulovillous adenoma without high-grade dysplasia. What advice should be conveyed
about risks to close relatives?
A. He should encourage his first-degree relatives to discuss their family history and screening with their clinicians.
B. He should encourage his first and second-degree relatives to discuss their family history and
screening with their clinicians.
C. First-degree relatives should begin colonoscopic screening at 40 years of age.
D. First and second-degree relatives should begin colonoscopic screening at 50 years of age.
E. There is no increased risk of colorectal cancer among relatives, and they should undergo standard population screens.

Question 163

RACP 2008b Q64

A 37-year-old male is found to have some persistently enlarged lymph nodes (<2 cm diameter) in the left posterior triangle. A biopsy reveals follicular, Grade 1, B-cell non-Hodgkin lymphoma. Staging procedures including computed tomography (CT) scan, positron emission tomography (PET) scan and bone marrow biopsy confirm the disease is confined to a single lymph node region in the neck.
Which of the following management strategies is most appropriate?
A. Watch and wait.
B. Oral chlorambucil.
C. Radiotherapy.
D. Multiagent chemotherapy.
E. Combined modality therapy.

Question 164

RACP 2008b Q70

QUESTION 70
An 81-year-old female has had surgery for early stage breast cancer (node negative) and the tumour is ER+ (oestrogen receptor positive) and HER+ (herceptin receptor positive). She also has congestive
cardiac failure for which she takes frusemide and candesartan. Which of the following treatment approaches would most improve her life expectancy?
A. Trastuzumab.
B. Tamoxifen.
C. Letrozole (aromatase inhibitor).
D. Cyclophosphamide, methotextrate, 5-fluorouracil (CMF).
E. No treatment.

Question 165

RACP 2008b Q94

QUESTION 94
A 55-year-old male presents for antihypertensive medication. During the interview, you are told that
his 82-year-old father has recently been diagnosed with colon cancer. Which of the following is the most appropriate colon cancer screening for this patient?
A. One-off colonoscopy.
B. Five yearly colonoscopy.
C. Annual faecal occult blood testing.
D. Barium enema.
E. Computed tomography (CT) colonography.

Question 166

RACP 2008b Q99

QUESTION 99
A 42-year-old woman has recently had a mastectomy after being diagnosed with breast carcinoma. Her paternal grandmother had ovarian carcinoma in her early fifties. She has a 32-year-old well sister.
Apart from advising her on appropriate adjuvant therapy, the next most important issue you should also discuss with her is:
A. prophylactic oophorectomy.
B. radiation ovarian ablation.
C. prophylactic contralateral mastectomy.
D. screening her sister for a genetic mutation.
E. screening her for a genetic mutation.

Question 167

RACP 2008b Q100
QUESTION 100
A 64-year-old previously well smoker develops a cough and is found to have a lung mass. An
endobronchial biopsy reveals small cell lung carcinoma. He has lost 7 kg in weight, and is now 65 kg,
but he still has a good performance status. His liver function tests reveal:
Alkaline phosphatase 189 U/L [50 – 130 U/L]
Alanine transferase 70 U/L [<45 U/L]
Bilirubin 37 μmol/L [<20 μmol/L]
A computed tomography (CT) scan confirms multiple liver secondaries. In the last two days he has
developed some leg weakness, but is still able to walk. A magnetic resonance imaging (MRI) scan of
his spine is shown below.

The most appropriate next step in his management is:
A. systemic chemotherapy.
B. external beam radiotherapy.
C. best supportive care.
D. decompression laminectomy.
E. strontium.

Question 168

RACP 2007a Q14

PAPER 1

QUESTION 14

Adjuvant chemotherapy is given in many solid tumours. What is the main reason for doing this?

A. To shrink the primary tumour.

B. To improve survival by eradicating micrometastases.

C. To delay appearance of the secondary tumours.

D. To delay recurrence of primary tumour.

E. To reduce toxicity of the treatment regimen.

Question 169

RACP 2007a Q44

The main reason for bone loss in patients treated for metastatic prostate cancer with the luteinising hormone releasing hormone (LHRH) agonist goserelin and the antiandrogen flutamide is:

A. oestrogen deficiency due to goserelin.

B. androgen deficiency due to goserelin.

C. oestrogen deficiency due to flutamide.

D. androgen blockade due to flutamide.

E. multiple bony metastases.

Question 170

RACP 2007b Q40

QUESTION 40

Which of the following is the most common long-term side effect of radiation treatment of pituitary tumours?

A. Stroke.

B. Cranial nerve palsy.

C. Optic apparatus damage.

D. Second intracranial tumour.

E. Hypopituitarism.

Question 171

RACP 2007b Q54

QUESTION 54

A 55-year-old woman presents with vague abdominal pain. Her CT scan is shown below.

A biopsy of the lesion shows spindle shaped cells. The most likely diagnosis is:

A. adenocarcinoma of esophagus.

B. gastrointestinal stromal tumour.

C. linitis plastica.

D. adrenal tumour.

E. renal cell tumour (hypernephroma).

Question 172

RACP 2007b Q62

QUESTION 62

A “reasonably well” (normal performance status) patient with non-haemorrhagic cerebral metastases from breast carcinoma presents with spontaneous lower limb venous thrombosis and pulmonary embolism. Which of the following is the most appropriate long term management regime?

A. Dalteparin.

B. Inferior vena caval filter.

C. Warfarin.

D. Graduated compression stockings.

E. Aspirin.

Question 173

RACP 2007b Q67

A 60-year-old male with no significant past or family history presents for anti-hypertensive medication.

With regard to his risk of colon cancer, which of the following is the most appropriate strategy?

A. Dietary advice.

B. CT colography.

C. Annual digital rectal examination.

D. Annual faecal occult blood test. Over 50 years old age

E. Five yearly colonoscopy. Equivocal evidence as FOCT

Question 174

RACP 2007b Q68

QUESTION 68

The most common side effect of antiangiogenesis agent anticancer treatments is:

A. hypotension.

B. hypertension.

C. bleeding.

D. clotting.

E. cerebrovascular accidents.

Question 175

RACP 2007b Q73

A 62-year-old woman with history of breast cancer treated with surgery, chemotherapy and

radiotherapy three years earlier presents with the following abnormality.

The most likely diagnosis is:

A. cellulitis.

B. radiation recall.

C. tumour recurrence. 4-14% recurrence within 3 years time after mastectomy. Recurrence occur later after lumpectomy coz ppl requiring mastectomy have more advanced disease. Also recurrence picked up earlier when there is less breast cancer left

D. Inflammatory breast cancer. Rarely can occur as a secondary after a non-inflammatory breast cancer

E. Paget’s disease. Primary nipple disease

Question 176

RACP 2007b Q86

A 50-year-old woman undergoes breast conserving surgery for a breast cancer found on self- examination. Histology shows an invasive ductal carcinoma, moderately differentiated, 22mm in size, oestrogen receptor positive, progesterone receptor negative and HER-2 positive. Sentinel node biopsy is negative.

What further treatment will have the greatest impact on her survival probability?

A. Chemotherapy and tamoxifen.

B. Trastuzamab alone.

C. Aromatase inhibitor.

D. Chemotherapy and trastuzamab.

E. Tamoxifen followed by an aromatase inhibitor.

Question 177

RACP 2007b Q95

A patient with known lung cancer presents with nausea and lethargy. His serum sodium is 119 mmol/L. Which of the following sets of results is most consistent with a diagnosis of the syndrome of inappropriate antidiuretic hormone (ADH) secretion?

Question 178

RACP 2006a Q1

QUESTION 1

Of the following tumour markers, which has the highest specificity for the cancer indicated?

A. Beta-human chorionic gonadotrophin (β-hCG) and testicular cancer.

B. CA 125 and ovarian cancer.

C. CA 19-9 and pancreatic cancer.

D. CA 15-3 and breast cancer.

E. Carcinoembryonic antigen (CEA) and colon cancer.

Question 179

RACP 2006a Q5

QUESTION 5

In addition to ondansetron and dexamethasone, the most effective strategy to reduce delayed chemotherapy nausea for someone receiving highly emetogenic chemotherapy is to add:

A. tropisetron.

B. haloperidol.

C. lorazepam.

D. aprepitant.

E. droperidol.

Question 180

RACP 2006a Q17

For which of the following cancers is screening most strongly associated with improved survival?

A. Lung.

B. Prostate.

C. Ovarian.

D. Colon.

E. Melanoma.

Question 181

RACP 2006a Q19

A 40-year-old woman treated for Hodgkin’s disease in her early twenties with mantle radiotherapy is at highest risk of which of the following cancers?

A. Breast.

B. Lung.

C. Thyroid.

D. Lymphoma.

E. Sarcoma.

Question 182

RACP 2006a Q21

Which one of the following patterns of electrolyte changes is most consistent with tumour lysis?

Answer 182

Answer D

TLS releases intracellular contents - causing hyperkalaemia, hyperuricaemia (uric acid is a breakdown product of nucleic acids), hyperphosphatemia and hypocalcaemia (precipitates with phosphate to form calcium phosphate crystals).

Question 183

RACP 2006a Q36

Which of the following is the most appropriate tumour marker for follow-up of a person with medullary thyroid carcinoma?

A. Thyroglobulin.

B. Carcinoembryonic antigen.

C. Calcitonin.

D. Thyroid binding globulin.

E. Chromogranin

Question 184

RACP 2006b Q34

QUESTION 34

A patient with lung cancer receives chemotherapy with carboplatin and etoposide. He is given ondansetron and dexamethasone pre-chemotherapy and dexamethasone and metoclopramide postchemotherapy. On day two post-chemotherapy he complains of stiffness around his shoulders and feeling jittery and irritable.

The drug most likely to be responsible for these symptoms is:

A. carboplatin.

B. etoposide.

C. ondansetron.

D. dexamethasone.

E. metoclopramide.

Question 184

RACP 2006b Q34

QUESTION 34

A patient with lung cancer receives chemotherapy with carboplatin and etoposide. He is given ondansetron and dexamethasone pre-chemotherapy and dexamethasone and metoclopramide postchemotherapy. On day two post-chemotherapy he complains of stiffness around his shoulders and feeling jittery and irritable.

The drug most likely to be responsible for these symptoms is:

A. carboplatin.

B. etoposide.

C. ondansetron.

D. dexamethasone.

E. metoclopramide.

Question 185

RACP 2006b Q41

In which of the following is radiotherapy least likely to be of clinical benefit to the patient?

A. Bleeding malignant gastric ulcer.

B. Brain metastases with raised intracranial pressure.

C. Painful bone metastases from prostate cancer.

D. Intrahepatic metastases causing cholestasis.

E. Non small cell lung cancer causing bronchial obstruction.

Question 186

RACP 2006b Q44

In a 50-year-old man undergoing a computed tomography (CT) scan for investigation of abdominal pain, which of the following is the most likely cause of an incidentally discovered 3cm adrenal mass lesion?

A. Adrenal metastasis.

B. Cortisol secreting adrenal adenoma.

C. Phaeochromocytoma.

D. Non-functioning adrenal adenoma.

E. Adrenal carcinoma.

Question 187

RACP 2006b Q45

Of the following metastatic cancers, the one associated with the highest long term survival after treatment is:

A. breast cancer with bone metastases.

B. ovarian cancer with malignant ascites.

C. germ cell cancer with lung metastases.

D. prostate cancer with bone metastases.

E. lung cancer with brain metastases.

Question 188

RACP 2006b Q80

The most appropriate clinical scenario for the use of non-steroidal anti-inflammatory agents for management of cancer pain is which of the following?

A. Liver capsule pain in a patient with metastatic cancer.

B. Headache due to malignant meningitis.

C. Small bowel obstruction pain in a patient with ovarian cancer.

D. Bone pain due to metastatic lung cancer.

E. Neuropathic pain due to malignant nerve root infiltration.

Question 189

RACP 2006b Q89

Which of the following features in a patient with colon cancer is most suggestive of hereditary nonpolyposis colon cancer (HNPCC)?

A. Right-sided lesion.

B. Microsatellite instability in the tumour tissue.

C. Multiple synchronous polyps.

D. Brother with colon cancer at age 55.

E. Uncle with a germline MLH1 mutation.

Question 190

RACP 2005a Q3

QUESTION 3

With which of the following viruses is cancer of the cervix most strongly associated?

A. Epstein-Barr virus (EBV).

B. Cytomegalovirus (CMV).

C. Human papilloma virus (HPV).

D. Human immunodeficiency virus (HIV).

E. Herpes simplex virus (HSV).

Question 191

RACP 2005a Q23

Which one of the following is the most important consideration in optimising treatment outcome from combination chemotherapy?

A. Use drugs partially effective as single agents.

B. Use drugs with similar toxicity profiles.

C. Use drugs with similar schedules.

D. Use drugs with similar treatment free intervals.

E. Minimise interaction between drugs.

Question 192

RACP 2005a Q34

The most common mechanism for malignant ascites is:

A. cardiac failure.

B. hypoalbuminaemia.

C. obstruction of abdominal lymphatics.

D. portal hypertension.

E. portal vein thrombosis.

Question 193

RACP 2005a Q36

In a patient with unilateral facial weakness, which one of the following findings on physical examination most strongly suggests a peripheral cause for the facial weakness?

A. Frontalis weakness.

B. Associated lateral rectus weakness.

C. Loss of taste.

D. Facial numbness.

E. Nystagmus.

Question 194

RACP 2005a Q48

A 40-year-old woman treated for Hodgkin’s disease in her early twenties with mantle radiotherapy is at highest risk of which of the following cancers?

A. Breast.

B. Lung.

C. Thyroid.

D. Lymphoma.

E. Sarcoma.

Question 195

RACP 2005b Q 10
In addition to a 5HT3-receptor antagonist, the most effective agent used to prevent acute chemotherapy-induced nausea with a highly emetogenic drug (i.e. cisplatin) is:

A. lorazepam.

B. droperidol.

C. prochlorperazine.

D. metoclopramide.

E. dexamethasone.

Question 196

RACP 2005b Q28

A patient is diagnosed with brain metastases from large cell lung cancer. He had been started on steroids at diagnosis and completed his radiotherapy three weeks ago. He now complains of worsening weakness of his limbs. His leg strength had been normal at the time of diagnosis of brain metastases. Physical examination reveals weakness of hip flexion with intact reflexes and down going plantar responses. Sensory examination is normal.

The most likely diagnosis is:

A. tumour progression.

B. Eaton-Lambert syndrome.

C. hypercalcaemia.

D. steroid myopathy

E. paraneoplastic myopathy.

Question 197

RACP 2005b Q46

The photographs opposite are of the immunohistochemistry staining of breast tumour in a patient presenting with metastatic disease. The antigens used are human epidermal growth factor receptor 2 protein (Her2) (Figure 1), and oestrogen receptor (ER) and progesterone receptor (PR) (Figure 2).

A patient with this result is most appropriately treated with:

A. trastuzumab (herceptin) but not letrozole.

B. trastuzumab and letrozole.

C. letrozole but not trastuzumab.

D. trastuzumab and tamoxifen.

E. tamoxifen but not trastuzumab.

Question 198

RACP 2005b Q61

Among the following anti-cancer agents, the one most likely to cause acute respiratory distress is:

A. bleomycin.

B. all-trans-retinoic acid.

C. busulphan.

D. gemcitabine.

E. cyclophosphamide.

Question 199

RACP 2005b Q85

A 50-year-old man presents with shortness of breath, facial swelling and chest tightness. The computed tomography (CT) scan of his chest is shown above. The malignancy most likely responsible for this presentation is:

A. lymphoma.

B. thymoma.

C. lung cancer.

D. germ cell tumour.

E. melanoma.

Question 200

RACP 2004a Q25

QUESTION 25

Of the following cancer treatments, the one most likely to cause delayed (>24 hours after chemotherapy) nausea is:

A. cisplatin.

B. 5-fluorouracil (5-FU). Low

C. vincristine.

D. methotrexate.

E. capecitabine Low, oral equivalent of 5-FU

Question 201

RACP 2004a Q39

A 38-year-old woman presents with breast cancer and multiple liver metastases two years after resection of a left breast tumour. Which of the following is most likely to affect treatment decisions?

A. Tumour grade.

B. Presence of BRCA1 mutation.

C. Oestrogen receptor status.

D. HER-2 overexpression

E. Number of involved lymph nodes.

Question 202

RACP 2004a Q43

Which one of the following colonic polyps has the highest potential for malignant transformation?

A. Hyperplastic.

B. Tubular.

C. Villous.

D. Hamartomatous.

E. Peutz-Jegher

Question 203

RACP 2004a Q67

Long-term hormone replacement therapy (>5 years) in postmenopausal women results in the greatest increase in absolute risk of cancer of the:

A. lung.

B. ovary.

C. colon.

D. breast.

E. uterus.

Question 204

RACP 2004b Q12

A 22-year-old man is evaluated post resection of a stage I nonseminomatous testicular germ cell tumour with no vascular invasion (low risk).

The most appropriate next step in his management is:

A. regular surveillance.

B. carboplatin chemotherapy.

C. para-aortic radiotherapy.

D. hormonal therapy.

E. testicular radiotherapy

Question 205

RACP 2004b Q31

A young woman with advanced ovarian cancer presents with nausea, vomiting and abdominal pain. Her abdominal X-rays are shown below.

Which of the following treatments is most likely to improve her symptoms?

A. Ondansetron.

B. Domperidone.

C. Octreotide.

D. Hyoscine.

E. Prochlorperazine.

Question 206

RACP 2004b Q44

A 47-year-old woman with advanced cancer is admitted at 3 a.m. with a four-day history of weakness, nausea, vomiting and constipation. Her serum calcium is 3.8 mmol/L [2.2-2.6] and albumin is 32 g/L [31-44].

The most appropriate initial step in her management is:

A. intravenous rehydration.

B. diuretics.

C. steroids.

D. bisphosphonates.

E. calcitonin.

Question 207

RACP 2004b QUESTION 63

A 75-year-old man presents with progressive dysphagia. He is currently only able to ‘keep down’ liquids. He has lost 7 kg in weight over the last six weeks. Endoscopy shows a mass lesion in the distal oesophagus which does not allow passage of the endoscope into the stomach. Biopsies show adenocarcinoma. A computed tomography (CT) scan reveals thickening in the distal oesophagus as well as two liver lesions which prove to be metastatic on biopsy.

Which of the following is most appropriate to give him immediate and long lasting (>6 months) relief from dysphagia?

A. Oesophageal dilation.

B. External beam radiotherapy.

C. Percutaneous endoscopic gastrostomy (PEG) tube.

D. Self-expanding metal stent placement.

E. Ivor-Lewis procedure (distal oesophagectomy).

Question 207

RACP 2004b QUESTION 63

A 75-year-old man presents with progressive dysphagia. He is currently only able to ‘keep down’ liquids. He has lost 7 kg in weight over the last six weeks. Endoscopy shows a mass lesion in the distal oesophagus which does not allow passage of the endoscope into the stomach. Biopsies show adenocarcinoma. A computed tomography (CT) scan reveals thickening in the distal oesophagus as well as two liver lesions which prove to be metastatic on biopsy.

Which of the following is most appropriate to give him immediate and long lasting (>6 months) relief from dysphagia?

A. Oesophageal dilation.

B. External beam radiotherapy.

C. Percutaneous endoscopic gastrostomy (PEG) tube.

D. Self-expanding metal stent placement.

E. Ivor-Lewis procedure (distal oesophagectomy).

Question 208

RACP 2004b QUESTION 72

In assessment of cancer patients, the Karnofsky performance scale best correlates with:

A. treatment dose.

B. survival.

C. analgesic requirement.

D. rehabilitation needs.

E. cancer volume.

Question 209

RACP 2004b QUESTION 87

For pre-operative staging of oesophageal cancer, which one of the following provides the most accurate information on the T stage?

A. Endoscopy.

B. Computed tomography (CT) scanning.

C. Magnetic resonance imaging (MRI).

D. Endoscopic ultrasonography (EUS).

E. Positron emission tomography (PET) scanning.

Question 210

RACP 2003b QUESTION 11

The most important rationale for tumour debulking prior to initiation of cytotoxic chemotherapy is to:

A. increase rate of tumour kill.

B. decrease chemotherapy toxicity.

C. increase drug delivery to tumour sites.

D. decrease dose of chemotherapy.

E. reduce rate of tumour growth.

Question 211

RACP 2003a Q28

The most important application of carcinoembryonic antigen (CEA) measurements in patients with colon cancer is:

A. testing of relatives.

B. detection of resectable relapse.

C. determining prognosis of stage III disease.

D. identification of patients who require adjuvant chemotherapy.

E. monitoring during adjuvant treatment.

Question 212

RACP 2003a 45

A 45-year-old man undergoes bronchoscopy for investigation of haemoptysis. An endobronchial tumour is identified and cytology confirms carcinoma. Staging computed tomography (CT) scans of the chest and upper abdomen are shown opposite.

Based on these diagnostic studies, the stage of the tumour can be best described as:

A. T1N0M0.

B. T2N1M0.

C. T1N1M1.

D. T2N1M1.

E. T4N1M1.

Question 213

RACP 2003a Q54

QUESTION 54

Of the following, the most effective agent in reducing oestrogenic stimulation of the tumour in a premenopausal woman with hormone-responsive metastatic breast cancer is:

A. cytotoxic agent.

B. progestin.

C. aromatase inhibitor.

D. selective oestrogen receptor modulator.

E. luteinising hormone-releasing hormone (LHRH) analogue.

Question 214

RACP 2003b Q2

QUESTION 2

A 35-year-old mother with breast cancer reports that her aunt had developed breast cancer at 48 years of age. She is keen to clarify the risk of her young daughter developing breast cancer. A blood sample from the mother is submited for mutation analysis of the BRCA1 and BRCA2 genes, but no mutation is found.

What impact does the mutation analysis have on the estimate of the daughter’s risk of developing breast cancer?

A. The maternal studies place the daughter at low risk of developing breast cancer.

B. The maternal studies do not clarify the daughter’s risk.

C. The maternal studies place the daughter at high risk of developing breast cancer.

D. The daughter’s risk cannot be clarified without studies of her father’s BRCA1 and BRCA2 genes.

E. The daughter’s risk cannot be clarified without studies of her own BRCA1 and BRCA2 genes.

Question 215

RACP 2003b Q3

QUESTION 3

In assessment of cancer patients, the Karnofsky performance scale best correlates with:

A. treatment dose.

B. survival.

C. analgesic requirement.

D. rehabilitation needs.

E. cancer volume.

Question 216

RACP 2003a Q9

A 50-year-old man is receiving palliative care for advanced squamous cell carcinoma of the pharynx. He experiences persistent pain, has become increasingly distressed by his loss of independence and mentions thoughts of ending his life by suicide.

Which one of the following is likely to be the chief factor contributing to his suicidal ideation?

A. Major depression.

B. Unrelieved pain.

C. Personality disorder.

D. Normal grief reaction.

E. Delirium.

Question 217

RACP 2003a Q18

Hereditary non-polyposis colon cancer (HNPCC or Lynch syndrome) is associated with a number of extra- colonic malignancies.

Which one of the following extra-colonic malignancies is most strongly associated with this diagnosis?

A. Melanoma.

B. Sarcoma.

C. Leukaemia.

D. Endometrial cancer.

E. Renal cell cancer.

Question 218

RACP 2003a Q28

Among the following anti-cancer agents, the one most likely to cause acute respiratory distress is:

A. bleomycin.

B. all-trans-retinoic acid.

C. busulphan.

D. gemcitabine.

E. cyclophosphamide.

Question 219

RACP 2003a Q55

The cytotoxic agent most commonly associated with the skin abnormality shown above is:

A. doxorubicin.

B. methotrexate.

C. gemcitabine.

D. capecitabine.

E. irinotecan

Question 220

RACP 2003b Q71

QUESTION 71

A 48-year-old woman with advanced metastatic breast cancer is receiving palliative care. She is receiving morphine sulphate 120 mg/day, midazolam 20 mg/day and two weeks ago commenced dexamethasone 4 mg/day for the treatment of pain related to bone metastases. She has become increasingly agitated over a two-day period, is disruptive at night and has begun to experience visual and auditory hallucinations. She has become forgetful, uncooperative with staff and is refusing her treatments.

The most likely diagnosis is:

A. cerebral metastases.

B. delirium.

C. steroid-induced psychosis.

D. major depression.

E. acute schizophrenia.

Question 221

RACP 2023b Q73

QUESTION 73

A man is admitted to hospital with a diagnosis of medullary thyroid carcinoma. He has a family history of multiple endocrine neoplasia (MEN) type 2 and an inherited mutation in the RET proto-oncogene has been identified.

A thyroidectomy is performed. Samples of normal and malignant tissue are compared for alterations in the RET gene.

Which one of the following best describes the most likely genetic findings?

A. Deletion of the mutant RET allele in malignant tissue.

B. Deletion of the normal RET allele in malignant tissue.

C. No difference between normal and malignant tissue.

D. Amplification of the mutant RET allele in malignant tissue.

E. Amplification of the normal RET allele in malignant tissue

Question 221

RACP 2023b Q73

QUESTION 73

A man is admitted to hospital with a diagnosis of medullary thyroid carcinoma. He has a family history of multiple endocrine neoplasia (MEN) type 2 and an inherited mutation in the RET proto-oncogene has been identified.

A thyroidectomy is performed. Samples of normal and malignant tissue are compared for alterations in the RET gene.

Which one of the following best describes the most likely genetic findings?

A. Deletion of the mutant RET allele in malignant tissue.

B. Deletion of the normal RET allele in malignant tissue.

C. No difference between normal and malignant tissue.

D. Amplification of the mutant RET allele in malignant tissue.

E. Amplification of the normal RET allele in malignant tissue

Question 222

RACP 2003b Q80

QUESTION 80

For pre-operative staging of oesophageal cancer, which one of the following provides the most accurate information on the T stage?

A. Endoscopy.

B. Computed tomography (CT) scanning.

C. Magnetic resonance imaging (MRI).

D. Endoscopic ultrasonography (EUS).

E. Positron emission tomography (PET) scanning.

Question 223

RACP 2003a Q85

QUESTION 85

A 42-year-old woman presents with pain and bleeding on defecation. On investigation she is found to have squamous cell carcinoma of the anus.

The most appropriate management of her problem is:

A. radiotherapy followed by surgery.

B. concurrent chemoradiotherapy.

C. abdominoperineal resection.

D. brachytherapy.

E. chemotherapy.

Question 224

RACP 2002a Q53

QUESTION 53

The most important application of carcinoembryonic antigen (CEA) measurements in patients with colon cancer is that it allows:

A. testing of relatives.

B. detection of resectable relapse.

C. prognosis of stage III disease to be determined.

D. identification of patients who require adjuvant chemotherapy.

E. monitoring during adjuvant treatment.

Question 225

RACP 2002a Q63

A 75-year-old woman with breast cancer and bone metastases has been taking oral morphine for three months with good pain control until recently. She is admitted to hospital because of increasing pain in her hip.

Which one of the following is the most appropriate pharmacological management whilst awaiting investigation?

A. Change morphine to tramadol.

B. Change morphine to fentanyl.

C. Add amitriptyline to morphine.

D. Change morphine to oxycodone.

E. Increase the morphine dose.

Question 226

RACP 2002b Q11

QUESTION 11

The most important risk factor for development of anthracycline-related cardiac toxicity is:

A. concurrent chemotherapeutic agents.

B. cumulative dose.

C. age.

D. baseline ECG abnormalities.

E. gender.

Question 227

RACP 2002a Q23
QUESTION 23

A 28-year-old man is found to have a large mediastinal mass. Biopsy of the mass confirms undifferentiated carcinoma. His prognosis is likely to be better if he has elevation of serum:

A. CA 19-9.

B. CEA.

C. beta HCG.

D. CA 15-3.

E. CA-125.

Question 228

RACP 2002b Q37

A previously well 51-year-old man with a recent history of recurrent chest infections is found to have a right hilar mass on chest X-ray. Bronchoscopy and biopsy reveal small cell carcinoma of the lung. All staging investigations are normal.

Which one of the following treatment options is likely to provide the best outcome for this patient?

A. Radiotherapy.

B. Radiotherapy followed by pneumonectomy.

C. Chemotherapy followed by pneumonectomy.

D. Pneumonectomy.

E. Chemotherapy and radiotherapy

Question 229

RACP 2002b Q48

The major benefit of chest wall radiotherapy after lumpectomy and axillary clearance for a 2 cm node- negative, receptor-positive breast cancer is to:

A. improve survival.

B. reduce local recurrence.

C. reduce systemic recurrence.

D. avoid adjuvant chemotherapy.

E. improve cosmetic result.

Question 230

RACP 2002b Q66

A 62-year-old man presents with a chronic cough and haemoptysis. He has normal performance status. He is found on investigation to have non-small cell carcinoma of the lung. The primary lesion in the left main bronchus is 3 cm from the carina. Other investigations reveal that there is mediastinal involvement and his cancer is classified as stage IIIA.

Which one of the following is the best management option?

A. Palliative care.

B. Chemotherapy.

C. Radiotherapy.

D. Chemotherapy followed by surgery.

E. Chemotherapy and radiotherapy followed by surgery.

Question 231

RACP 2002b Q66

A 62-year-old man presents with a chronic cough and haemoptysis. He has normal performance status. He is found on investigation to have non-small cell carcinoma of the lung. The primary lesion in the left main bronchus is 3 cm from the carina. Other investigations reveal that there is mediastinal involvement and his cancer is classified as stage IIIA.

Which one of the following is the best management option?

A. Palliative care.

B. Chemotherapy.

C. Radiotherapy.

D. Chemotherapy followed by surgery.

E. Chemotherapy and radiotherapy followed by surgery.

Question 232

RACP 2002b 74

A 40-year-old woman with breast cancer presents because of increasing back pain. Her neurological examination reveals pyramidal weakness and brisk reflexes in lower limbs and upgoing plantar reflexes. The magnetic resonance imaging (MRI) scan of her spine is shown below. She is given 16 mg dexamethasone as a loading dose. The most appropriate next step in management is:

A. radiotherapy.

B. chemotherapy.

C. surgical decompression.

D. high-dose intravenous methylprednis(ol)one.

E. pamidronate.

Question 233

RACP 2002b QUESTION 32

A 75 year-old man with non-small cell lung cancer and mild chronic renal failure (his serum creatinine is usually 0.15 mmol/L [0.06-0.12]) is recovering from hip replacement surgery. He has been receiving intravenous pethidine via a patient-controlled analgesia device for the past three days. Over the past 24 hours, he has developed myoclonic twitching of all limbs and then has a grand mal seizure.

The most likely cause of his neurological signs is:

A. brain metastases.

B. uraemia.

C. hypercalcaemia.

D. pethidine metabolites.

E. stroke.

Question 234

RACP 2002b QUESTION 80

A 76-year-old man with a history of prostate cancer treated with radiotherapy a year ago, presents with increasing bone pain and tenderness involving the right chest wall. His prostate-specific antigen is 766 ng/mL [<6]. His bone scan is shown below.

The most effective therapy would be:

A. corticosteroids.

B. androgen deprivation.

C. radiotherapy.

D. chemotherapy.

E. best supportive care.

Question 235

RACP 2002b QUESTION 88

Suicidal ideation in a patient with cancer is most likely to be associated with:

A. advanced stage of disease progression.

B. a past psychiatric history.

C. a current major depression.

D. poor family support.

E. severe pain.

Question 236

RACP 2002b Q92

QUESTION 92

In a randomised controlled trial of a cancer screening program, the most important indicator of the program’s effectiveness is demonstration in the screened subpopulation of improved:

A. case detection.

B. case detection at an earlier stage.

C. cancer-specific survival.

D. cancer mortality.

E. cancer progression-free survival.

Question 237

RACP 2001b 18

Question 18

A 45-year-old man develops stage C cancer of the caecum. There is a strong family history of bowel cancer in the absence of polyps and there is no history of colitis.

The most likely underlying inherited genetic abnormality is in:

A. the ras gene.

B. the DNA mismatch repair (MMR) gene.

C. the p-glycoprotein (MDR1) gene.

D. the adenomatous polyposis coli (APC) gene.

E. the deleted in colon cancer (DCC) gene.

Question 238

RACP 2001a Q29

Question 29

The most important rationale for using adjuvant chemotherapy soon after surgery for cancer (rather than deferring chemotherapy until the cancer has recurred) is that after surgery:

A. cancer volume is smaller.

B. there is no resistance to cytotoxic agents.

C. there are fewer cells in cell cycle.

D. drug penetration into the tissues is reduced.

E. cancer growth is slower.

Question 239

RACP 2001a Q30

Which one of the following is the best predictor of outcome in a patient with colorectal cancer?

A. Tumour stage.

B. Degree of microsatellite instability.

C. Ethnic background.

D. Strong family history.

E. Sporadic occurrence.

Question 240

RACP 2001b Q37

Question 37

The principal aim of a phase 1 trial of a cytotoxic agent is to:

A. maintain the patient’s hope that treatment is possible.

B. determine the best schedule of administration.

C. define tumour response rate.

D. measure progression-free survival.

E. establish the maximum tolerated dose (MTD).

Question 241

RACP 2001a Q55

The most important application of carcinoembryonic antigen (CEA) measurements in patients with colon cancer is:

A. testing of relatives.

B. detection of resectable relapse.

C. determining prognosis of stage III disease.

D. identification of patients who require adjuvant chemotherapy.

E. monitoring during adjuvant treatment.

Question 242

RACP 2001a Q55

The most important application of carcinoembryonic antigen (CEA) measurements in patients with colon cancer is:

A. testing of relatives.

B. detection of resectable relapse.

C. determining prognosis of stage III disease.

D. identification of patients who require adjuvant chemotherapy.

E. monitoring during adjuvant treatment.

Question 243

RACP 2001b Q19

Question 19

Concerning carcinoma of unknown primary, which one of the following clinical situations is least likely to have a specific therapy?

A. Adenocarcinoma in an axillary lymph node in a 55-year-old woman.

B. Squamous cell carcinoma in a mid-cervical lymph node in a 60-year-old male smoker.

C. Adenocarcinoma in the liver in a 60-year-old man.

D. Poorly differentiated carcinoma in the mediastinum in a 38-year-old man.

E. Adenocarcinoma in sclerotic bony metastases in a 70-year-old man.

Question 244

RACP 2001b Q28

A 35-year-old woman seeks your advice about her risk of developing breast cancer. Which one of the following would place her at greatest risk of developing breast cancer?

A. Menarche less than 12 years.

B. Birth of first child after the age of 25.

C. Oral contraceptive use for more than 10 years.

D. Sister and aunt diagnosed with breast cancer.

E. Excision of a benign breast lump.

Question 245

RACP 2001b Q56

A 76-year-old man with a history of prostate cancer treated with radiotherapy a year ago, presents with increasing bone pain and tenderness involving the right chest wall. His prostate specific antigen is 766 ng/mL [<6]. His bone scan is shown below. The most effective therapy would be:

A. corticosteroids.

B. androgen deprivation.

C. radiotherapy.

D. chemotherapy.

E. best supportive care

Question 246

RACP 2001b Q69

Question 69

The least likely reason for shorter cancer-specific survival among the elderly is the finding that elderly patients:

A. present with more aggressive cancers.

B. undergo fewer investigations.

C. receive less treatment.

D. have co-morbidities which limit their tolerance of treatment.

E. undergo less cancer screening

Question 247

RACP 2001b 81

Question 81

The most important reason to carefully follow up a patient who has had a localised malignant melanoma adequately excised is for early detection of:

A. a new primary.

B. local recurrence.

C. in-transit metastases.

D. lymph node metastases.

E. systemic metastases.

Question 248

RACP 2001b 81

Question 81

The most important reason to carefully follow up a patient who has had a localised malignant melanoma adequately excised is for early detection of:

A. a new primary.

B. local recurrence.

C. in-transit metastases.

D. lymph node metastases.

E. systemic metastases.

Question 249

RACP 2001b Q86

Question 86

Abnormalities in which one of the following genes or proteins are most closely associated with the development of drug resistance during chemotherapy?

A. P-glycoprotein (MDR1).

B. p53.

C. bcl-2.

D. Cytochrome P450.

E. Thiopurine S-methyltransferase.

Question 250

RACP 2001b Q92

Question 92

A 63-year-old woman with metastatic breast cancer with skeletal metastases presents with dry cough and shortness of breath. Six weeks ago she completed palliative radiotherapy to her T5 vertebra because of painful metastatic involvement. She is currently receiving tamoxifen. On examination she is afebrile and her chest auscultation reveals fine crepitations in the left upper zone. Her chest X-ray is shown below.

The most appropriate next step in her management is to:

A. cease tamoxifen and commence aromatase inhibitor therapy.

B. cease tamoxifen and commence cytotoxic chemotherapy.

C. add antifungal treatment.

D. add intravenous antibiotics.

E. add corticosteroids.

Question 251

RACP 2000a Q3

Question 3

A 45-year-old man develops stage C cancer of the caecum. There is a strong family history of bowel cancer in the absence of polyps and there is no history of colitis.

The most likely underlying inherited genetic abnormality is in:

A. the ras gene.

B. the DNA mismatch repair (MMR) gene.

C. the p-glycoprotein (MDRI) gene.

D. the adenomatous polyposis coli (APC) gene.

E. the deleted in colon cancer (DCC) gene.

Question 252

RACP 2001b Q29

Question 29

In a post-menopausal patient, which one of the following is the best initial hormone therapy for metastatic breast cancer?

A. Androgen.

B. Anti-oestrogen.

C. Aromatase inhibitor.

D. Oestrogen.

E. Progesterone

Question 253

RACP 2000b Q46

Question 46

A 71-year-old woman, who lives alone, presents to the Accident and Emergency Department with a history of increasing back pain over two months. The X-ray obtained is shown below.

What is the most likely diagnosis?

A. Myeloma.

B. Osteoporosis.

C. Breast cancer.

D. Lymphoma.

E. Paget’s disease.

Question 254

RACP 2000a Q66

Question 66

The best prognostic indicator in operable breast cancer is:

A. oestrogen receptor (ER) status.

B. Her-2 / neu gene over-expression.

C. tumour size.

D. nodal status.

E. tumour grade.

Question 255

RACP 2000a Q66

Question 66

The best prognostic indicator in operable breast cancer is:

A. oestrogen receptor (ER) status.

B. Her-2 / neu gene over-expression.

C. tumour size.

D. nodal status.

E. tumour grade.

Question 256

RACP 2000b 75

Question 75

Concerning carcinoma of unknown primary, which one of the following clinical situations is least likely to have a specific therapy?

A. Adenocarcinoma in an axillary lymph node in a 55-year-old woman.

B. Squamous cell carcinoma in a mid cervical lymph node in a 60-year-old male smoker.

C. Adenocarcinoma in the liver in a 60-year-old man.

D. Poorly differentiated carcinoma in the mediastinum in a 38-year-old man.

E. Adenocarcinoma in sclerotic bony metastases in a 70-year-old man.

Question 256

RACP 2000b 75

Question 75

Concerning carcinoma of unknown primary, which one of the following clinical situations is least likely to have a specific therapy?

A. Adenocarcinoma in an axillary lymph node in a 55-year-old woman.

B. Squamous cell carcinoma in a mid cervical lymph node in a 60-year-old male smoker.

C. Adenocarcinoma in the liver in a 60-year-old man.

D. Poorly differentiated carcinoma in the mediastinum in a 38-year-old man.

E. Adenocarcinoma in sclerotic bony metastases in a 70-year-old man.

Question 257

RACP 2000b Q90

Abnormalities in which one of the following genes or proteins is most closely associated with the development of drug resistance during chemotherapy?

A. P-glycoprotein (MDRI).

B. p53.

C. BCL2.

D. Cytochrome P450.

E. Thiopurine S-methyltransferase.

Question 258

RACP 2000b Q94

Question 94

The most important reason to carefully follow up a patient who has had a localised malignant melanoma adequately excised is for early detection of:

A. a new primary.

B. local recurrence.

C. in-transit metastases.

D. lymph node metastases.

E. systemic metastases

Question 259

RACP 2000b 100

Question 100

A 52-year-old patient presents with indigestion. Upper endoscopy reveals extensive gastritis and a biopsy shows both mucosal-associated lymphoid tissue (MALT) lymphoma and Helicobacter pylori infection. Physical examination, computed tomography (CT) scan of the chest, abdomen and pelvis, gallium scan and bone marrow examination are all normal.

The most appropriate initial therapy is:

A. combination cytotoxic chemotherapy.

B. Helicobacter pylori eradication therapy.

C. single agent chemotherapy.

D. gastric irradiation.

E. gastrectomy.

Question 260

RACP 1999a Q19

Question 19

For which one of the following cancers is there the least evidence for a familial aggregation?

A. Breast cancer.

B. Germ cell tumours of testis.

C. Lung cancer.

D. Ovarian cancer.

E. Prostate cancer.

Question 261

RACP 1999b Q17

Question 17

A 55-year-old woman who had a right mastectomy for breast cancer three years ago develops progressive low back discomfort. Her pain increases despite anti-inflammatory treatment.

Examination reveals no evidence of recurrent or metastatic breast cancer. Neurological examination is normal except for an equivocal right plantar reflex. Bowel and bladder function are normal. X-rays show generalised increase in radiolucency and reduced height of two lumbar vertebrae. The magnetic resonance imaging (MRI) scan is shown.

Which one of the following is the most appropriate management?

A. Intrathecal methotrexate.

B. Combination chemotherapy.

C. Discectomy and vertebral fusion.

D. Surgical decompression and radiotherapy.

E. Oestrogen replacement therapy.

Question 262

RACP 1999b Q53

Question 53

Which one of the following is the most effective treatment for cytotoxic induced delayed (>24 hours) emesis?

A. Dexamethasone.

B. Tetrahydrocannabinol.

C. Ondansetron.

D. Metoclopramide.

E. Prochlorperazine.

Question 263

RACP 1999b Q57

Question 56

Concerning carcinoma of unknown primary, which one of the following clinical situations is least likely to have a specific therapy?

A. Adenocarcinoma in an axillary lymph node in a 55-year-old woman.

B. Squamous cell carcinoma in a mid-cervical lymph node in a 60-year-old male smoker.

C. Adenocarcinoma in the liver in a 60-year-old man.

D. Poorly differentiated carcinoma in the mediastinum in a 38-year-old man.

E. Adenocarcinoma in sclerotic bony metastases in a 70-year-old man.

Question 264

RACP 1999b Q57

Question 57

Which one of the following is least likely to be associated with familial colon cancer?

A. Mutations in the adenomatous polyposis coli gene.

B. Mutations in DNA repair genes.

C. Chromosomal translocations.

D. Microsatellite instability.

E. Loss of heterozygosity for tumour suppressor genes.

Question 265

RACP 1999b Q63

Question 63

The most common route of spread of epithelial ovarian cancer is via:

A. direct spread to adnexae.

B. direct spread to other pelvic organs.

C. haematogenous spread to lungs.

D. lymphatic spread to para-aortic lymph glands.

E. transcoelomic spread (peritoneal spread).

Question 266

RACP 1999b Q76

A 55-year-old female smoker presents with cough and weight loss. Clinical examination reveals reduced air entry over the left hemithorax and signs compatible with pulmonary collapse. The liver is not enlarged but a small firm

lymph gland is found in the left supraclavicular fossa. The chest X-ray is shown below. Bronchoscopic biopsy of the left main bronchus shows an undifferentiated carcinoma, and the serum neurone specific enolase is elevated

at 23.5 U/L [<12.5].

Which one of the following treatment modalities would be most appropriate?

A. Surgery.

B. Bronchoscopic laser therapy.

C. Radiotherapy.

D. Chemotherapy.

E. Palliative care

Question 267

RACP 2021a Q93

Q93/Q94 EMQ – Match the following genetic cancer syndromes from the list of options:
A. MEN1
B. RET
C. VHL
D. SDHA
E. SDHB
F. HPNCC
G. MLH1
H. PTEN
I. PKP2R*
J. NF1*
*Not sure if these two were options.
Q93. Patient presents with pancreatic cancer, pituitary adenoma and hyperparathyroidism

Question 268

RACP 2021a Q94

Q93/Q94 EMQ – Match the following genetic cancer syndromes from the list of options:
A. MEN1
B. RET
C. VHL
D. SDHA
E. SDHB
F. HPNCC
G. MLH1
H. PTEN
I. PKP2R*
J. NF1*
*Not sure if these two were options.

Q94. Patient presents with retinal angioblastoma, cerebellar hemangioma and a large renal mass.

Question 269

RACP Oct Q97

97. in the Hanahan and Weinberg classification of the hallmarks of cancer. Where is the effect of PARP inhibitors?
    a. Altered metabolism
    b. Genetic instability and mutations
    c. Evasion of growth suppression
    d. Immune invasion

Answer 269

Answer C