Question 1

Predisposing factors to oesophageal adenocarcinoma include the following except

Accepted Answer

Achalasia is a predisposing factor for oesophageal squamous cell carcinoma, not adenocarcinoma.

Question 2

Young woman with amenorrhoea & large uterus. CXR shows rounded opacities. What is the best test to monitor this condition?

Accepted Answer

C

Question 3

How would you treat metastatic Ca Breast in a postmenopausal woman?

Accepted Answer

A

Question 4

What is the best prognostic indicator of post op survival for Ca Breast?

Accepted Answer

Tumour grade/stage is the best prognostic indicator of post op survival for Ca Breast. It takes into account the size, number, and location of the tumors, as well as the presence of lymph node involvement and other factors.

Question 5

Which malignancy is least amenable to treatment?

Accepted Answer

The answer of Which malignancy is least amenable to treatment?
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Question 6

Associations for 1o Ca can be made for all of the following except

Accepted Answer

Mediastinal Adeno Ca in a young man is more likely to be a primary tumor rather than a metastasis, unlike the other options which are typical sites or presentations of metastatic cancer.

Question 7

Mechanism of drug resistance of chemotherapeutic drugs

Accepted Answer

P glycoprotein is a well-known efflux pump that can expel chemotherapeutic drugs from cancer cells, leading to drug resistance.

Question 8

A middle-aged man has a melanoma fully excised. What is the most important reason to follow him closely?

Accepted Answer

The most important reason to follow a patient closely after the excision of a melanoma is the risk of local and systemic recurrence. Melanoma has a significant risk of recurring both at the original site and in distant locations, making vigilant follow-up essential for early detection and management of any recurrence.

Question 9

A 68 year old man is admitted to the ER having had three large maroon colored stools. On arrival, he passes more bloody stools and clots. He is pale, orthostatic and tachycardic. NG aspirates are bilious. After resuscitation is begun, which of the following is the most appropriate initial test?

Accepted Answer

Rigid proctoscopy is the most appropriate initial test because it can quickly identify the source of bleeding in the lower gastrointestinal tract.

Question 10

The most common mode of spread of colon cancer is

Accepted Answer

Lymphatic spread is the most common mode of spread for colon cancer, as cancer cells typically first invade local lymph nodes before spreading to distant sites.

Question 11

The following is the most important prognostic determinant of survival after treatment for colorectal cancer?

Accepted Answer

Lymph node involvement is the most important prognostic determinant of survival after treatment for colorectal cancer. The presence or absence of cancer cells in the lymph nodes significantly influences the staging of the cancer, which in turn affects treatment decisions and outcomes.

Question 12

A 68-year-old man presents to his primary care physician for a routine physical examination. The patient"s medical history is significant for hypertension. The patient is found to have guaiac-positive stools and is subsequently referred for colonoscopy. Colonoscopy reveals a "golf ball"-size, near-obstructing tumor in the descending colon, not admitting the scope. The biopsy is positive for adenocarcinoma of the colon. Which of the following is the next step in the management of this patient?

Accepted Answer

Given the presence of a near-obstructing colon tumor, the priority is to plan for colon resection to prevent complete obstruction and manage the primary cancer. A metastatic workup is also important to stage the disease and guide further treatment, but the need for resection remains regardless of metastatic findings.

Question 13

For previous patients, after the appropriate evaluation, the patient undergoes surgery. No intraoperative evidence of metastases is identified. Postoperatively, the pathology report reveals that the tumor is an adenocarcinoma invading into the pericolonic fat, with 2 involved lymph nodes. After the patient recovers from surgery, which of the following is the most appropriate next step in his management?

Accepted Answer

Chemotherapy with a 5-fluorouracil (5-FU) based regimen is the most appropriate next step after surgery for a patient with colon cancer that has invaded into the pericolonic fat and with lymph node involvement. This indicates a more advanced stage of cancer (stage III), for which adjuvant chemotherapy has been shown to improve survival.

Question 14

A 65-year-old woman with no significant past medical history presents to the emergency department with a 2-day history of left lower quadrant abdominal pain. The patient denies nausea and vomiting, although she claims decreased oral intake. She also reports a low-grade fever and mild diarrhea. She describes a milder episode several years ago, which resolved on its own. On physical examination, the patient is found to have left lower quadrant tenderness with some mild guarding, but no rebound. She is hemodynamically stable, and her heart rate is 82 per minute. In the initial management of this patient, which of the following is the most sensitive diagnostic test?

Accepted Answer

Abdominal/pelvic CT with oral contrast is the most sensitive diagnostic test for evaluating left lower quadrant abdominal pain, especially when suspecting diverticulitis, as in this case scenario. It can provide detailed images of the colon and surrounding structures, helping to confirm the diagnosis and assess for complications.

Question 15

A 60-year-old man presents for an annual physical examination. The examination is normal except for a palpable mass in the rectum on digital rectal examination. The patient denies any change in bowel habits and feels well. Rectal cancer is suspected. What is the next best step in the evaluation of this patient?

Accepted Answer

A full colonoscopy with biopsy of the lesion is the next best step in the evaluation of a patient with a suspected rectal mass. This allows for direct visualization of the entire colon and rectum, identification of any additional lesions, and biopsy of the suspicious area for histopathological examination.

Question 16

A 78-year-old woman with coronary artery disease and severe chronic obstructive pulmonary disease is admitted to the hospital with painless jaundice. CT scan reveals the presence of multiple lesions in the liver, suggestive of metastases, and a nearly obstructing upper rectal mass. Colonoscopy demonstrates a large, ulcerated tumor in the proximal rectum and a residual lumen of less than 1 cm in diameter. While in the hospital, the patient develops a large bowel obstruction. What is the best treatment modality for this patient?

Accepted Answer

Given the patient's advanced age, comorbid conditions, and the presence of metastatic disease, a less invasive approach such as the placement of a rectal self-expanding metal stent is the best treatment modality. This option provides immediate relief of the obstruction with minimal risk compared to surgery or immediate radiation therapy, which could be more taxing on the patient's health and recovery.

Question 17

A 57-year-old man is found to have a rectal mass 3 cm from the anal verge on digital rectal examination. Subsequent colonoscopy and biopsy confirm rectal adenocarcinoma. EUS examination demonstrates penetration of the tumor into, but not through, the muscularis propria, but shows significant perirectal lymph nodes. CT scan of chest/abdomen/pelvis demonstrates no metastases. The patient is staged as T2N1M0. What procedure should be attempted to remove the primary lesion in this patient?

Accepted Answer

Given the staging of T2N1M0 for rectal adenocarcinoma, the appropriate treatment involves neo-adjuvant chemoradiation to shrink the tumor and address the lymph node involvement, followed by a more definitive surgical resection, in this case, abdominoperineal resection (APR), due to the tumor's proximity to the anal verge.

Question 18

A 70-year-old man is found to have distal rectal cancer during a screening colonoscopy. The patient undergoes preoperative staging and is found to have a 1.5-cm rectal mass that does not invade the muscularis propria of the rectal wall. There is no regional lymphadenopathy and no evidence of distant metastases. The patient is staged at T1N0M0. The patient is advised to undergo APR but refuses because it will lead to anal sphincter loss and permanent colostomy. Which of the following represents a viable alternate therapeutic option for this patient?

Accepted Answer

For a T1N0M0 rectal cancer that does not invade beyond the muscularis propria and with no evidence of regional lymphadenopathy or distant metastases, a less invasive option like full-thickness surgical removal of the tumor (transanal excision) can be considered. This approach can preserve the anal sphincter and avoid the need for a permanent colostomy, making it a viable alternative for patients refusing more radical surgery like abdominoperineal resection (APR).

Question 19

Which of the following may be appropriate initial therapy for a 4 cm cancer of the anal canal?

Accepted Answer

Combined chemotherapy and radiotherapy is considered an appropriate initial therapy for a 4 cm cancer of the anal canal. This approach is preferred because it can preserve anal function and avoid the need for a permanent colostomy, which is often required with more invasive surgical options like abdominoperineal resection.

Question 20

Which of the following processes is most likely to be associated with apoptosis?

Accepted Answer

Nucleosomal DNA laddering is a hallmark of apoptosis, characterized by the cleavage of chromosomal DNA into fragments by specific nucleases.

Quiz 11: Treatment Options for T1N0N0 Rectal Cancer