Deck 9: Cancer and Management Scenarios

Question 1

Which of the following proto-oncogenes is least likely to be associated with an increased risk of breast cancer?

A)ATM (ataxia telangiectasia)
B)BRCA-1
C)Bcl 2
D)HER-2neu
E)Wiskott Aldrich Syndrome

Answer 1

Wiskott Aldrich Syndrome

Question 2

A 40-year-old male is operated on for a medullary carcinoma of the thyroid. He expresses concern about his 10 years son getting the disease. The best test:

A)Yearly calcitonin in son
B)yearly pentagastrin-stimulated calcitonin in son
C)DNA analysis for RET proto-oncogene in tumor
D)DNA analysis for RET proto-oncogene in peripheral blood
E)Thyroid ultrasound in son

Answer 2

DNA analysis for RET proto-oncogene in peripheral blood

Question 3

Patient with germ cell tumor receiving BEP. Which side-effect would necessitate cessation of the responsible drug:

A)neutropenia
B)high-tone severe hearing loss
C)peripheral neuropathy
D)interstitial lung damage
E)none of above

Answer 3

neutropenia

Question 4

A female presents with shortness of breath. CXR is shown with whiteout of Left lung. Told neurone-specific enolase +ve, next best step in management:

A)Bronchoscopy with laser
B)Radiotherapy
C)Chemotherapy
D)Best supportive care
E)Surgical resection

Question 5

Which of the following best describes the incidence of colon cancer with age:

A)Linear increase with age
B)Linear increase with plateau after age 50
C)Parabolic
D)Exponential rise after age 50
E)Bimodal distribution with peaks at age 50 and 70

Question 6

All of the following can occur in germ line leading to breast cancer except which one:

A)BRCA1
B)BRCA2
C)Bcl-2
D)p53
E)Ataxia telangiectasia gene

Question 7

Which of the following is the least likely to be involved in hereditary colon cancer:

A)APC gene
B)DNA repair gene
C)Microsatellites
D)Deletion of a gene
E)Chromosomal translocation

Question 8

A 50 year patient presents with metastatic renal cell carcinoma. The best management would be:

A)IFN-
B)IL-2
C)Vinblastine
D)Best supportive care
E)Progesterone

Question 9

The genetic defect in hereditary non-polyposis coli lies in:

A)APC gene
B)DCC gene
C)DNA repair defect
D)proto-oncogene
E)P53 gene

Question 10

A female with a history of breast cancer removed. Examination revealed previous modified radical mastectomy scar. Diffuse erythema, with nodules and plaquing over and around scar with some extension onto contralateral breast is evident. The most likely diagnosis is:

A)Radiation recall
B)Fungal infection
C)Tumor recurrence
D)Herpes zoster
E)None of above

Question 11

Which is the strongest predictor of an increased risk of breast cancer in a 40 ys woman:

A)Early menarche
B)Late first pregnancy > 30 years
C)Previous breast carcinoma in contralateral breast
D)Mother with breast cancer at age 70
E)Hormone replacement therapy

Question 12

A young male has non-Hodgkin's lymphoma. The LMO starts prednisone whilst awaiting a haematology admission. He presents unwell with WCC previously 30, now 2, urate 2.3, K 8.0, phosphate 10, Cr .25. The most likely diagnosis?

A)Urate nephropathy
B)Tumor lysis syndrome
C)Dehydration
D)Lymphoma infiltration of kidneys
E)Hyperleucocytosis

Question 13

A young female (30 years) had mantle radiotherapy in her teens. The most likely cancer site in her now:

A)Thyroid
B)Breast
C)Bone marrow
D)Lung
E)Lymph nodes

Question 14

The most common mechanism of spread of epithelial ovarian cancer is:

A)Haematogenous
B)Lymphatics
C)Adjacent structures
D)Trans-coelomic
E)Lepidic

Question 15

A man with metastatic prostate cancer with increasing bone pain. The decision is made to start a GnRH agonist Your advice regarding the likely effect of this:

A)Immediate resolution of symptoms
B)Initial worsening of symptoms over two weeks followed by gradual resolution
C)Delayed resolution of symptoms
D)Slow progressive improvement of symptoms
E)Initial resolution followed by severe worsening of symptoms

Question 16

Concerning lung cancer:

A)In Australia, the incidence in women is falling.
B)The use of chemotherapy in combination with radiotherapy in patients with stage III non-small cell lung cancer is associated with improved survival.
C)Chemotherapy for metastatic non-small cell lung cancer improves quality of life but not survival.
D)The optimal treatment for limited stage small cell lung cancer is with chemotherapy alone.
E)Paraneoplastic manifestations occur in the majority of patients.

Question 17

Regarding familial breast cancer, which of the following statements is true?

A)The majority of cases are also associated with mutations of the p53 gene.
B)mutation of the BRCA1 gene may be associated with an increased risk of both breast and ovarian cancer.
C)chemoprevention with tamoxifen is of proven benefit.
D)most affected families share the same specific mutation of the BRCA1 gene.
E)about 75% of affected family members develop breast cancer before the age of 35 years

Question 18

Oesophageal cancer is associated with:

A)Alcohol abuse
B)Corrosive-associated damage
C)Achalasia
D)Reflux
E)Smoking

Question 19

Small cell lung cancer is more associated with ( than NSCLC)

A)Hypercalcemia
B)Clubbing
C)Cushing"s
D)Eaton-Lambert syndrome
E)Hyponatraemia

Question 20

Regarding cell kinetics of cancer:

A)1 cm tumor = 109 cells
B)Cells in G0 are highly sensitive to chemotherapy
C)Common cancers have doubling times of 20 days
D)Intrinsic mutation rate in common cancers ~ 1 in 106 cells
E)Growth in primary cancer decreases in the later stages of development

Question 21

73 years female with metastatic breast cancer, on tamoxifen for 6/12. 2/7 Hx of nausea and thirst. Na+ 155, K+ 5.2, urine osm 137. Has multiple mets including sella turcica. Next most appropriate treatment:

A)Saline
B)Fluid restriction
C)Intranasal desmopressin
D)APD
E)Demeclocycline

Question 22

Pre-menopausal woman found to have left axillary and supraclavicular nodes. Biopsy showed poorly differentiated cancer, oestrogen receptor poor. She has no other Symptoms, examination is otherwise normal and CXR and mammogram are normal. Next step:

A)Endoscopy
B)Bronchoscopy
C)Local XRT
D)Chemo and XRT
E)Hormonal therapy

Question 23

A patient with known disseminated lymphoma is anaemic, with Hb = 100, MCV = 74, Fe = 4, Ferritin = 300. This is best explained by:

A)Fe deficiency
B)Impaired release of Fe from macrophages
C)Reduced erythropoietin
D)Reticulocytosis
E)Increased plasma clearance of Fe

Question 24

Radiotherapy has its most severe effects on which tissues?

A)liver
B)kidney
C)lung
D)bone marrow
E)spinal cord