Oncology

Question 1

Answer 1

Paget’s disease of the bone

Excessive osteoclastic activity followed by osteoblastic activity –> increased rate of bone
turnover –> mosaic lamellar bone pattern

Question 2

Suspected testicular cancer. Ultrasound shows a hypoechoic intratesticular mass. Which investigation would be most appropriate to confirm the diagnosis?
a) Serial AFP (alpha feto-protein)
b) testicular core biopsy
c) testicular open biopsy
d) Inguinal orchidectomy
e) Review later
f) Surgical exploration

Answer 2

CONFIRM DIAGNOSIS?

AFP is a marker doesn’t really diagnose..

Think orchidectomy

Question 3

20 year old man with anechoic testicular mass with raised B-hCG. What type?
a) Choriocarcinoma
b) Seminoma
c) Ledig cell tumor
d) Sertoli tumour lol

Answer 3

VERY RAISED = choriocarcinoma

If just raised up to about ~50, this could be a seminoma

Question 4

Testicular mass. What investigation first?
a) Serial AFP (alpha feto-protein)
b) Testicular biopsy
c) USS
d) Inguinal orchidectomy

Answer 4

Umm, I think USS first.

Question 5

Guy with low back pain sore to touch with red flags like pain at night and at rest. Paracetamol and NSAIDs didn’t relieve it. Bloods: PSA <2, slightly raised total protein, raised Ca and poor renal function. Dx?
a) Multiple myeloma
b) Prostate cancer mets
c) Inflammatory arthritis
d) OA
e) Osteoporotic vertebral crush fracture

Answer 5

Multiple myeloma

• total protein up
  Raised Ca due to breakdown of brown
  Bence-Jones collecting in nephron –> poor renal function

Question 6

Person with back pain, waking at night. Bloods show anaemia, mildly high protein, high urea, high calcium and creatinine, reduced vit D. Dx?
a) Multiple myeloma
b) Osteoporotic crush fractures
c) Metastatic prostate cancer

Answer 6

Multiple myeloma

Question 7

Man with squamous cell lung cancer causing hypercalcaemia. Why?
a) PTHrP
b) Osteolytic bony metastasis
c) Calcitriol

Answer 7

Squamous cell carcinomas can cause PTHrP

Osteolysis mostly breast, multiple myeloma

Calcitriol in Hodgkins lymphoma

Question 8

Testicular cancer metastasises to which lymph nodes?

Answer 8

Paraaortic

Question 9

Kid with solid tumor arising from inside testicle, what do you do to diagnose it?
a) Inguinal orchidectomy
b) Scrotal approach biopsy
c) FNA

Answer 9

We do not use biopsy for testicles

INGUINAL ORCHIDECTOMY

Question 10

Old woman with trouble swallowing, originally to solids now to liquids as well. 15kg weight loss, LL neuro sx (areflexia both ankles, some sensory loss). Diagnosis?
a) Bulbar Palsy
b) Achalasia
c) GERD
d) Oesophageal Cancer

Answer 10

Oesophageal Cancer with spinal compression

Question 11

Dude with small cell lung cancer had a calcium of 3.2. What is this due to?
a) Bone mets
b) PTHrP

Answer 11

Bone mets

Small cell cx hypercalcaemia – bone mets
Squamous cell cx hypercalcaemia – PTHrP

Question 12

Lady with Non-Hodgkin’s lymphoma, bulky abdomen and hilar disease before treatment. Day 3 post 1st round of chemo. Now presenting with non-specific malaise. Blood results: low Hb and WCC, high urate, K+, phosphate and creatinine. Diagnosis?
a) Tumour lysis syndrome
b) Neutropenic sepsis/gram negative septicaemia
c) Aplastic crisis
d) Dehydration
e) Urate nephropathy

Answer 12

This is tumour lysis syndrome, where the tumour breaks down and all its contents are released (K+, urate, phosphate)

Question 13

Dude a) b) c) d)
with metastatic prostate cancer presents with back pain. First treatment? Anti-androgen therapy
Bisphosphates
External beam radiation therapy
Corticosteroids

Answer 13

I think anti-androgen

Question 14

Pathologist determines features of cancer using microscope. What is this called?
a) Grading
b) Staging

Answer 14

Grade = appearance of cells related to tissue of origin

Question 15

Male with colonic cancer. Best prognostic indicator?
a) Stage
b) Grade
c) CEA level
d) MSI mutations

Answer 15

Stage

Question 16

Patient with SOB, bilateral non-pulsatile (no wave) raised JVP up to 8cm (R >L) and mediastinal enlargement. Diagnosis?

Answer 16

SVCO

Non-pulsatile engorged veins

Prob give dexamethasome unless lymphoma

Question 17

65 year old man with palpable supraclavicular mass. Dx?
a) Gastric cancer
b) Lung cancer

Answer 17

This is Virchows node, suggestive of abdominal malignancy –> Gastric cancer

Question 18

Score used for prostate cancer staging. a) Gleason
b) Bethesda
c) Manchester

Answer 18

Gleason

Question 19

Which is not a risk factor for gastric cancer?
a) H pylori infection
b) Smoking
c) Older age
d) FHx
e) Pernicious anaemia
f) Male
g) Low salt diet

Answer 19

The pooled ORs showed a significantly positive association between high salt intake and gastric cancer compared with low salt intake

Question 20

Most likely investigation to confirm a diagnosis of prostate cancer?
a) Transurethral resection of prostate (TURP)
b) PSA
c) MRI prostate
d) Trans-rectal ultrasound (TRUS) needle biopsy
e) DRE

Answer 20

Do a TRUS for prostate cancer diagnosis

TURP is for treatment of BPH + diagnosis