Rogo Qs (Y1 & 2) & (Copied to Cancer Qs)

Question 1

A 67-year-old woman with breast cancer is told by her oncologist that she will require chemotherapy after surgery

What is this type of treatment called?

Adjuvant
Curative
Neo-adjuvant
Palliative
Primary

Answer 1

Adjuvant

Question 2

A 67-year-old woman with ovarian cancer is told by her oncologist that she will require chemotherapy before surgery

What is this type of treatment called?

Adjuvant
Curative
Neo-adjuvant
Palliative
Primary

Answer 2

Neo-adjuvant

Question 3

There are certain histological features that are characteristic of neoplasia.

Which of the following are associated with a benign tumour?

High mitotic rate

High nuclear:cytoplasmic ratio

Irregular margins

Organised tissue

Presence of necrosis

Answer 3

Organised tissue

Question 4

Malignant and benign tumours have different clinical behaviours.

Which one of the following is a pathological sign of benign tumours?

More frequent and abnormal mitoses

Poorly cohesive and infiltrative

Regional and distant metastases

Slow progressive growth rate

Various degrees of anaplasia

Answer 4

Slow progressive growth rate

Question 5

Immunotherapy is the latest novel treatment for cancer.

Which immunotherapeutic technique has shown dramatic responses in acute lymphoblastic leukaemia (ALL)?

Cancer vaccines

CAR T-cells

PD1 checkpoint inhibitor

Pembrolizumab

Rituximab

Answer 5

CAR T-cells

Question 6

Erlotinib is an orally administered small molecule inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase used to treat

Small cell lung cancer
Non-small cell lung cancer
Adenocarcinoma
Squamous cell cancer

Answer 6

Erlotinib is an orally administered small molecule inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase used to treat

Small cell lung cancer
Non-small cell lung cancer
Adenocarcinoma
Squamous cell cancer

Question 7

Genetic alterations within cells can predispose to the formation of tumours and eventually cancers in the body.

Which of the following statements best describes an oncogene?

An altered gene that controls the cells structure and function

An altered gene that inhibits the growth of differentiated cells

An altered gene that promotes apoptosis and inhibits necrosis of cells.

An altered gene that promotes cell growth and division

An altered gene that regulates the metabolism of tumour cells

Answer 7

An altered gene that promotes cell growth and division

Question 8

Tumours are classified on the basis of their cell/tissue of origin.

What is a benign tumour arising from adipose tissue (fat) called?

Adipocyte adenoma

Adipoma

Leioangiomyoma

Leiomyoma

Lipoma

Answer 8

Lipoma

Question 9

;Diagnostic tests like biopsies and imaging are used to determine a cancer’s grade and its stage.

Which of the following is considered a staging criterion?

Cytological atypia

Mitotic activity

Necrosis

Resemblance/lack of resemblance to tissue of origin

Spread to distant organs

Answer 9

Spread to distant organs

Question 10

There are three checkpoints in the cell cycle which allow fidelity of DNA replication and cell division.

Which of the following proteins are most likely to be mutated if a damaged cell does not stop at the G2/M checkpoint?

B-cell lymphoma 2 (Bcl-2)

BRCA 1 (breast cancer 1)

Myc

p53

pRB (retinoblastoma protein)

Answer 10

BRCA 1 (breast cancer 1)

Question 11

Human blood contains chemical buffers which are able to neutralise a small amount of added acid or base.

Which of the following is the most important buffer system in the blood?

Ammonium buffer system

Carbonic acid-bicarbonate buffer system

Haemoglobin buffer system

Phosphate buffer system

Plasma proteins buffer system

Answer 11

Carbonic acid-bicarbonate buffer system

Question 12

DNA hypermethylation is observed in the 5’ untranslated region of the genome near to promoter regions of genes, resulting in transcriptional silencing.

On which DNA base is hypermethylation most likely to occur?

Adenosine

Cytosine

Guanine

Inosine

Thymine

Answer 12

Cytosine

Question 13

Abnormal epigenetic modifications can be observed in cancer cells. For example, hypomethylation is observed in the 3’ untranslated region of tumour suppressor genes.

What is the effect of this epigenetic modification?

Activate transcription factors

Enhance tumour suppressor gene expression

Increase the association between histones and the DNA

Promote gene silencing

Promote genomic instability

Answer 13

Promote genomic instability

Question 14

Cancers are initiated and progress by mutations in genes which result in either a gain or loss of function.

Which of the following best describes the gain of function mutation observed in lung adenocarcinoma?

Mutation in CDKN2A (cyclin dependent kinase inhibitor)

Mutation in Rb (retinoblastoma protein)

Mutation in EGFR (epidermal growth factor receptor)
Mutation in MYC

Mutation in TP53 (tumour protein 53)

Answer 14

Mutation in EGFR (epidermal growth factor receptor)

Question 15

DNA damage from ultra violet light results in the formation of pyrimidine dimers.

Which DNA repair mechanism can correct this mutation?

Base excision repair

Homologous double strand recombination

Mismatch repair

Non-homologous double strand end joining

Nucleotide excision repair

Answer 15

Nucleotide excision repair

Question 16

The levels of serum enzymes can be used to detect damage in specific tissues.

Elevated levels of which of the following enzymes specifically indicates prostatic carcinoma?

Acid phosphatase

Alkaline phosphatase

Aspartate transaminase

Creatinine kinase

Lactate dehydrogenase

Answer 16

Acid phosphatase

Question 17

TNM staging of a tumour provides information for diagnosis, prognosis and treatment.

If a breast tumour sample has been staged as TxN1M0 what would be the best description for this tumour?

It is 2cm across or less, there is nodal involvement and the tumour has not metastasised.

It is more than 2 centimetres but no more than 5 centimetres across, there is no nodal involvement and the tumour has not metastasised.
The tumour size can't be assessed, there is no nodal involvement and the tumour has not metastasised.
The tumour size can't be assessed, there is no nodal involvement and the tumour has metastasised.
The tumour size can't be assessed, there is nodal involvement and the tumour has not metastasised.

Answer 17

The tumour size can’t be assessed, there is nodal involvement and the tumour has not metastasised.

Question 18

Stem cells are continuously dividing cells that are required to maintain cell populations in a number of tissues.

What is the most common cause of cell senescence in stem cells?

Accumulation of point mutations

Changes in protein production

Epigenetic changes

Mitochondrial damage

Shortening of telomeres

Answer 18

Shortening of telomeres

Question 19

Caspases are proteins that initiate and execute the process of apoptosis in cells.

Which of the following caspase proteins is essential to initiate apoptosis through the extrinsic pathway?

Caspase 3
Caspase 6
Caspase 7
Caspase 8
Caspase 9

Answer 19

Caspase 8

Question 20

(i) The SI unit that ionizing radiation is measured in is the gray. What does the gray measure? (1 mark)

Answer 20

(i) The gray measures the absorbed dose of radiation.(1 mark)

Question 21

(ii) As with many cancer treatments side effects are common. List TWO common early/acute side effects of radiotherapy (1 mark)

Answer 21

(ii) Acute side effects:
* skin reaction (rash/redness/discolouration)
* fatigue
* pruritus
* hair loss

Question 22

(iii) List TWO late possible side effects of radiotherapy carried out in the head and neck region. (1 mark)

Answer 22

(iii) Late side effects: xerostomia, swallowing dysfunction/difficulty (1/2 mark each)

Question 23

GPs play an important role in identifying early presenting signs of cancer.

(i) What is the fast track cancer pathway? (½ mark)

(ii) Define its timeframe in the UK. (½ mark)

Answer 23

When a GP recognises certain ‘red flag’ symptoms for a potential diagnosis of cancer and refers the patient with urgency for further investigations (½ mark).

In the UK, an urgent referral means that the patient should see a specialist within 2 weeks (½ mark).

Question 24

Which red flag symptom carries the most positive predictive value for a lung cancer diagnosis when identified on its own? [1]

Answer 24

Haemoptysis (coughing blood)

Question 25

The NICE Guidelines for Urgent Referral in cases of a suspicion of a cancer diagnosis outline signs and symptoms that serve as red flags to GPs.

List TWO signs that would require urgent investigation under these guidelines but not immediate referral with regards to a suspicion of lung cancer in a 45-year old patient.

Answer 25

Cough, fatigue, shortness of breath, chest pain, weight loss, appetite loss (1/2 mark each)

Question 26

Define an oncogene [1]

Answer 26

An altered/mutated gene (1/2 mark) that promotes cell growth and division/proliferation (1/2 mark).

Question 27

What is the mechanism of action of pertuzumab? [1]

Answer 27

Its mechanism of action is to inhibit ligand-dependent HER2-HER3 dimerization (1/2 mark) AND reducing signalling via intracellular pathways OR suppressing ligand-dependent HER2 signalling (½ mark).

Question 28

Which group of drugs are used as first line treatment for lung adenocarcinoma with EGFR (epidermal growth factor receptor) mutations? [1]

Answer 28

small molecule kinase receptor inhibitor

Question 29

Why would this woman be given adjuvant chemotherapy AND when would it be given? [1]

Answer 29

She would be given adjuvant chemotherapy to prevent recurrence of the disease, particularly distant recurrence OR to eradicate or control micro-metastasis (1 mark)

She would be given adjuvant therapy after surgery or radiotherapy for the treatment of breast cancer.(1 mark)

Question 30

Identify TWO reasons why curative surgery may be unsuccessful [2]

Answer 30

Any two from: (1/2 mark each)
* Invasion of vital structures/organs so that resection OR surgery is not possible.
* There may be undetectable micrometastasis in distal organs
* Distal or distant metastasis which cannot be safely removed
* Seeding of the tumour in an area such as the peritoneal cavity

Question 31

A patient receiving chemotherapy phones the hotline number in the middle of the night to say they have a fever.

What advice should they be given? [1]

Answer 31

Go straight to hospital immediately as intravenous antibiotics may be required (1 mark)

Question 32

List the FOUR major cancer types that account for almost half (45%) of all cancer deaths in the UK.

Answer 32

Breast, lung, bowel (colorectal), prostate cancers (1/2 each)

Question 33

List the FOUR major cancer types that account for almost half (45%) of all cancer deaths in the UK.

Answer 33

Breast, lung, bowel (colorectal), prostate cancers (1/2 each)