Oncology, Haematology and Palliative

Question 1

sclerosis radiological appearance

Answer 1

increased density

Question 2

Renal cancer Paraneoplastic syndromes

Answer 2

Polycythaemia (RCC secretes unregulated erythropoietin)
Renin - raised BP
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome (abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)

Question 3

Refer people using a suspected cancer pathway referral for renal cancer if they are aged 45 and over and have:

Answer 3

Unexplained visible haematuria without urinary tract infection or
Visible haematuria that persists or recurs after successful treatment of urinary tract infection.

Question 4

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are aged 60 and over and have

Answer 4

unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.

Question 5

Courvoisier’s law

Answer 5

Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

Question 6

pancreatic cancer tumour marker

Answer 6

CA19-9

CA19-9 is also tumour marker for cholangiocarcinoma, a bile duct cancer.

Question 7

Whipple’s procedure

Answer 7

removal of the head of the pancreas, the antrum of the stomach, the 1st and 2nd parts of the duodenum, the common bile duct, and the gallbladder.

Question 8

oesophageal squamous cell risk factors

Answer 8

smoking, XS alcohol, Plummer vinson syndrome ,Deficiencies in zinc and selenium,Achalasia

Question 9

Oesophageal adenocarcinoma risk factors

Answer 9

GORD ,Barrett’s oesophagus adenocarcinoma, obesity, Hiatus hernia , Achalasia ,medications that relax the lower oesophageal sphincter

Question 10

most common cancers to metastasize to bone are

Answer 10

breast, bronchus, thyroid, kidney and prostate.

Question 11

commonly metastasise to the brain.

Answer 11

Breast cancer, lung cancer and melanoma

Question 12

2WW breast cancer

Answer 12

Aged 30 or older who have an unexplained breast lump with or without pain, or
Aged 50 years and over with any of the following symptoms in one nipple only:
Discharge.
Retraction.
Other changes of concern.

Question 13

2WW lung cancer

Answer 13

have chest X‑ray findings that suggest lung cancer or
are aged 40 and over with unexplained haemoptysis.

Question 14

2WW colorectal cancer

Answer 14

≥60 years with iron deficiency anaemia or change in bowel habit
Positive occult test
≥50yrs with unexplained rectal bleeding and another symptom
≥40yrs with unexplained weight loss and abdominal pain

Question 15

Features of breast cancer

Answer 15

hard irregular, typically painless, fixed lesions, skin dimpling, nipple retraction, discharge

Question 16

Breast screening

Answer 16

All women aged 50-70 years
invited every 3 years

Question 17

Cervical screening

Answer 17

Every three years aged 25 – 49
Every five years aged 50 – 64

Question 18

Tumour lysis syndrome electrolyte abnormalities

Answer 18

hyperuricaemia
hyperkalaemia
hyperphosphatemia
hypocalcaemia
increased blood urea nitrogen
precipitating renal failure.

Question 19

2WW oesophageal cancer

Answer 19

Offer urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people:
With dysphagia, or
Aged 55 years and over with weight loss and any of the following:
Upper abdominal pain.
Reflux.
Dyspepsia.

Question 20

2WW pancreatic cancer

Answer 20

if they are aged 40 years and over and have jaundice.

Question 21

2ww suspected malignant melanoma of the skin

Answer 21

suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more.
checklist:
Major features of the lesions (scoring 2 points each):
Change in size.
Irregular shape.
Irregular colour.
Minor features of the lesions (scoring 1 point each):
Largest diameter 7 mm or more.
Inflammation.
Oozing.
Change in sensation

or if dermoscopy suggests melanoma of the skin.
or in people with a pigmented

Question 22

Antiemetics
persistent nausea–>
motion related/food –>
multifactorial/unknown cause –>

Answer 22

persistent nausea–> metaclopramide
motion related/food –>cyclizine
multifactorial/unknown cause –> levomepromazine

Question 23

A Krukenberg tumour refers to

Answer 23

a metastasis in the ovary, usually from a gastrointestinal tract cancer, particularly the stomach. Krukenberg tumours have characteristic “signet-ring” cells on histology,

Question 24

Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch Syndrome

Answer 24

genetic mutation in the DNA mismatch repair genes (MSH1/MSH2) and predisposes individuals to colorectal, endometrial and ovarian cancers. It is inherited in an autosomal dominant fashion, and genetic testing is indicated in all suspected individuals (those with 3+ family members known carriers, or affected by these cancers).

HNPCC confers a 60% lifetime risk of colorectal cancer, and a 40% risk of endometrial cancer in carriers of the gene mutation.

Question 25

(HNPCC) Lynch Syndrome is the CEO of cancers

Answer 25

Colon
Endometrial
Ovarian

Question 26

Factors that stop ovulation or reduce the number of lifetime ovulations, reduce the risk of ovarian cancer

Answer 26

Combined contraceptive pill >10 years
Breastfeeding
Pregnancy (have about half the risk of ovarian cancer of women without children) > 3 pregnancies
Hysterectomy, tubal ligation
Exercise
Aspirin

Question 27

Tumours that metastasise to bone

Answer 27

P: prostate
B: breast
K: kidney
T: thyroid
L: lung

Question 28

Familial adenomatosis polyposis coli

Answer 28

autosomal dominant pattern
caused by mutations within the APC gene which lead to the formation of hundreds of polyps within the colon and patients will inevitably develop carcinoma.

Question 29

Peutz–Jeghers syndrome

Answer 29

leads to the growth of hamartomatous polyps within the gastrointestinal tract. It increases the risk of gastrointestinal tract, pancreatic, cervical, ovarian and breast cancers

Question 30

Li Fraumeni syndrome

Answer 30

rare autosomal dominant disorder. It is the result of germ line mutation of the p53 tumour suppressor gene. It leads to an increased risk of sarcoma and cancer of the breast, brain and adrenal glands.

Question 31

MEN 1 Syndrome

Answer 31

Causes neoplastic mutations of the pituitary, parathyroid and the pancreas.
caused by mutations in the MEN1 gene

Question 32

MEN 2A Syndrome

Answer 32

Caused by mutations within the RET oncogene. Results in medullary thyroid cancer, phaechromocytoma and parathyroid adenoma.

Question 33

MEN 2B Syndrome

Answer 33

Caused by mutations within the RET oncogene. Results in medullary thyroid cancer, phaechromocytoma, mucosal neuroma, gastro-intestinal complaints, craniosynostosis

Question 34

Patients at high risk of hepatocellular carcinoma

Answer 34

alcoholic liver disease, hepatitis B, hepatitis C, haemochromatosis and alpha-1 antitrypsin deficiency

Question 35

WHO performance status 0

Answer 35

able to carry out all normal activity without restriction

Question 36

WHO performance status 1

Answer 36

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

Question 37

WHO performance status 2

Answer 37

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

Question 38

WHO performance status 3

Answer 38

symptomatic and in a chair or in bed for greater than 50% of the day but not bedridden

Question 39

WHO performance status 4

Answer 39

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

Question 40

Malignancies associated with EBV infection

Answer 40

Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma
HIV-associated central nervous system lymphomas

Question 41

Mostly lytic

Answer 41

Multiple myeloma
Thyroid cancer
Renal cell cancer
Melanoma

Question 42

Mostly sclerotic ( white and increased density )

Answer 42

Prostate
Mucinous cancer of the bowel

Question 43

Definition of cord compression

Answer 43

neurological symptoms and signs caused by the mechanical pressure over the spinal cord from metastases of any part of vertebra
causes an upper motor neuron (UMN) pattern of weakness