Questions

Question 1

Roach Formula

Answer 1

PSA + ([Gleason score - 6] x 10)
If <13 = 7% Risk SV involvement
If ≥13 = 37% Risk SV involvement

Question 2

ICRU 50 criteria for PTV dose

Answer 2

V95% (dose) = 100% (volume)

D100%(volume) ≥ 95% (dose)

Question 3

Poor outcomes Myeloma

Answer 3

t(4;14)
t(14;16)
deletion 17p

Question 4

Burkitt’s Lymphoma genetics

Answer 4

t(8;14)

Question 5

Mantle cell lymphoma genetics

Answer 5

t(11;14)

Question 6

MALT genetics

Answer 6

t(11;18)

Question 7

Follicular lymphoma

Answer 7

t(14;18)

Question 8

Indications for avoiding lymph node dissection in vulva

Answer 8

Clinically absent disease with <2cm diameter and <1cm stromal invasion

Question 9

Treating Stage IA Endometrial

Answer 9

If adverse features >2 treat; >60, deep myometrial invasion or high grade

Question 10

When is pelvic lymph node dissection indicated in melanoma?

Answer 10

If ≥2 nodes positive

Question 11

When is chemotherapy indicated in spermatocystic seminoma?

Answer 11

If localised disease, no chemotherapy indicated as not associated with metastatic spread.

Question 12

Thy3 cytology from Thyroid lesion

Answer 12

Indicates diagnostic hemi-thyroidectomy. Suspiscious of neoplasm

Thy3f (follicular - majority), Thy3a (atypia)

Question 13

Where do the following originate primarily;
Glioma
Meningioma
Ependymoma
Choroid Plexus Papillomas
Schwannomas

Answer 13

Glioma - above the tentorium
Meningioma - from the dura peripherally
Ependymoma - from the ventricle lining
Choroid Plexus Papillomas - smaller than 4cm
Schwannomas - Eight nerve

Question 14

Lung:

Which mutations are associated with a good response to TKI therapy

Answer 14

Exon 19 deletion
Exon 21 missense L858R
associated with a good response to TKI therapy
Exon G719x mutations <5%, but also associated with TKI response

Question 15

Lung: Which mutations are associated with resistance to TKI therapy

Answer 15

Exon 20 T790M point mutation
Exon 20 insertions
KRAS mutations

Question 16

How to perform a melanoma biopsy

Answer 16

Excision with 2cm margin

Question 17

Indications for post-op radiotherapy for submandibular tumours

Answer 17

High grade tumours
Large >4cm
Adenoid cystic
Residual neck disease or microscopic ECS from lymph nodes
Following surgery for recurrent disease

Question 18

International Prognostic Score for Hodgkin’s disease

Answer 18

ALL MASH

Age ≥45
Leucocytosis >15x 10^9
Lymphopenia <8% or absolute <0.6x10^9
Male
Albumin <40
Stage IV
Haem <10.5

Good 0-1
Fair 2-3
Poor 4-7

Question 19

How to correct for stand off

Answer 19

Inverse square law

I/I2 = D^2/D2^2

Question 20

Indications for post-operative radiotherapy after hysterectomy for cervical cancer

Answer 20

Postive pelvic lymph nodes
Postive parametrial involvement
Close resection margins <5mm

Question 21

Chronic Myeloid Leukaemia Genetic and Morphological characteristics

Answer 21

95% with CML, chromosomal translocation involving Chromosome 9 and 22

Fusion gene created by juxtapositioning Abl1 gene on chromosome 9 (region q34) to a part of the BCR gene on chromosome 22 (region q11).

The truncated chromosome 22 is known as the Philadelphia chromosome.

Question 22

SCC genetics

Answer 22

CK6,7 and p63

Question 23

Adenocarcinoma genetics

Answer 23

CDX-2 and CK20

Question 24

RMI score

Answer 24

Predicts malignancy of ovarian mass based on ca125 (pre surgery), menopausal status and USS features

RMI = U x M x Ca125

U = 1
if; multilocular (septated) cyst, solid areas, bilateral lesions, ascites, intra-abdominal metastases.

U=3 if 2 or more features (RMI 1)
U=4 if 2 or more features (RMI 2)

M=1 if pre-menopausal
M=3 if post-menopausal (RMI 1)
M=4 if post menopausal (RMI 2)

RMI >200 Positive Predictive Value for malignancy of 70-80%

Question 25

Myeloma ROTI (myeloma-related organ or tissue impairment)

Answer 25

CRAB

Calcium (adjusted) > 2.75
Renal insufficiency, Creatinine > 173
Anaemia, Hb <10 or >2g drop from lower limit
Bone, lytic lesions

Also indicated by symptomatic hyperviscocity, amyloidosis, recurrent bacterial infections. (RAS)

Question 26

Myeloma ROTI (myeloma-related organ or tissue impairment)

Answer 26

CRAB

Calcium (adjusted) > 2.75
Renal insufficiency, Creatinine > 173
Anaemia, Hb <10 or >2g drop from lower limit
Bone, lytic lesions

Also indicated by symptomatic hyperviscocity, amyloidosis, recurrent bacterial infections. (RAS)

Question 27

BCC post op radiotherapy

Answer 27

only indicated with involved margins

Question 28

Melanoma Excision SLNB

Answer 28

SLNB indicated Stage IB and above

Question 29

International Staging System (ISS)

Answer 29

3 risk categories for myeolma by [ ] B2 microglobulin and albumin

Serum B2 microglobulin <3.5 (296) and Serum Albumin >35
Neither I or III
Serum B2 microglobulin >5.5 (465)

Question 30

Paraprotein level to differentiate MGUS and myeloma

Answer 30

<30g/l and <10% plasma cells in the bone marrow differentiate.

Question 31

Presentation of Lymphoma;
Intestinal Mantle Cell Lymphoma
Burkitt’s Lymphoma

Answer 31

Intestinal Mantle Cell Lymphoma (Lymphomatous polyposis) - numerous polyps through the colon
Burkitt’s Lymphoma - Lymph node mass near the caecum

Question 32

Ewing Sarcoma translocation

Answer 32

t(11;22)

Question 33

Neutoblastomas genetics

Answer 33

Poor prognosis
N-Myc amplification
17q gain (50%)
1p and 11q deletions
1q gain

Good Prognosis
Hyperdiploidy and triploidy

Question 34

Treatment of ifosfamide encephalopaty

Answer 34

Methylene Blue

Question 35

RF for oesophageal adenocarcinoma

Answer 35

predominantly GORD (rather than smoking and alcohol)

Question 36

Percentages of SCC and AC in oesophagus

Answer 36

65% adeno, 25% scc