Cancers

Question 1

Young male testicular cancer - which one is more common?

Answer 1

Teratoma
- 20-30yo
- worse prognosis than seminoma

Question 2

Older male testicular cancer - which one is more common?

Answer 2

Seminoma
- 35-45yo
- better prognosis than teratoma

Question 3

Cancers that cause spinal metastases

Answer 3

Breast
Bronchus
Prostate
kidney (more common to metastasise to lung first than bone)
thyroid
Multiple myeloma
High grade non-Hodgkin’s lymphoma

Question 4

Cancer that spread to lungs

Answer 4

Osteosarcoma

Question 5

Cancer that spread to liver

Answer 5

Colorectal

Question 6

? diagnosis - young child. Afro-Carribean. fever, irritability, reduced feeding. fingers and toes are swollen/tense.

strawberry tongue, dry cracked lips, rashes that are peeling

Answer 6

Kawasaki disease

Question 7

Cancer of corpus uteri is known as

Answer 7

endometrial cancer

Question 8

what increases iron absorption?

Answer 8

vitamin C

Question 9

In ALL, what do the lymphocyte immature cells express?

Answer 9

they express a protein called TdT (terminal deoxynucleotide transferase)

Question 10

what is pott’s disease

Answer 10

most dangerous form of musculoskeletal TB as it causes bone destruction, deformity and parapleia

Question 11

poor prognostic factor of breast cancer

Answer 11

young patients

other prognosis factors: axillary nodal status, tumour type and grade, lymphatic/vascular invasion/proliferation markers, ethnicity and patient’s age of diagnosis, oestrogen/progesterone receptor status, HER2/neu overexpression

Question 12

first line tx for CLL with 17p deletion or TP53 mutation

Answer 12

acalabrutinib

(also use this if no 17p deletion or TP53 mutation, but patient is not tolerating FCR and BR treatment)

FCR: fludarabine and cyclophosphamide and rituximab
BR: bendamustine and rituximab

Question 13

best initial tx of AML

Answer 13

chemotherapy

Question 14

what is the monitoing regimen for someone with gene for HNPPCC?

Answer 14

colonoscopy beginning 20-25yo

Question 15

what is Hughes syndrome?

Answer 15

anti-phospholipid syndrome

Question 16

indications for mastectomy

Answer 16

large tumour in small breast
multifocal tumour
central tumour
DCIS >4cm
tumour at nipple
patient’s request

Question 17

what is the cytology stages for breast biopsy?

Answer 17

C1 (inadequtae)
C2 (benign)
C3 (atypia but probabbly benign)
C4 (suspicious of malignnacy)
C5 (malignant)

Question 18

Prognosis factors for multiple myeloma

Answer 18

beta-2 microglobulin

Question 19

?diagnosis - pregnant lady, AKI, confusion, fever, thrombocytopenia, microagiopathic haemolytic anaemia

Answer 19

Thrombotic thrombocytopenic purpura

Question 20

how soon can radiation enteritis occur post-radiation to pelvis?

Answer 20

acute (within 2 weeks of tx): anorexia, diarrhoea, foaecal urgency, bloating, colicky abdo pain

chronic (18 months to 6 years later!) : weight loss, steatorrhoea, small bowel obstruction, nausea, anorexia

Question 21

Tumour marker:
LDH
ALP
…used for what diseases?

Answer 21

LDH - testicular cancer
ALP - Paget’s disease, teratoma (not seminoma)

Question 22

patient recently diagnosed with colorectal cancer - what disease must this patient be screened for?

Answer 22

Lynch syndrome
- autosomal dominant
- also increases risk of cancer in endometrial, stomach, breast, ovarian, small bowel, pancreatic, prostate, urinary, kidney, liver.

Question 23

what does haptoglobin do?

Answer 23

bind to free Hb (released in haemolytic diseases)

THerefore, low levels of haptoglobin in haemolytic anaemias -> test to do is osmotic fragility test to look for RBC breaking down

Question 24

basophilic stippling in blood film ? cause

Answer 24

toxic - eg lead poisoning

Question 25

Types of hypersensitivity reaction

Answer 25

1 - allergic (IgE) 2 - antibody (complement, phagocytosis) 3 - immune complex 4 - Delayed (T-helper cells)

Question 26

Graft rejection - what happens: - Acute allograft reaction - Hyperacute allograft reaction - Chronic allograft reaction

Answer 26

Acute: lymphocyte, T-cell, cytokine activation. donor MHC 1 antigens react with host CD8 resulting in direct cytotoxic damage Hyperacute: class 1 HLA antibody activation, granulocyte adhesion, thrombosis Chronic: interstitial fibrosis

Question 27

metastasis to the brain comes from where?

Answer 27

breast lung melanoma

Question 28

what is paraneoplastic cerebellum disorder

Answer 28

rare non-metastatic immune mediated complication of cancers : ovarian, breast, uterus, SCLC, Hodgkin's lymphoma CSF: elevated protein and presence of anti-neuronal antibodies MRI may be normal in early stages

Question 29

treatment of oestrogen-positive breast cancer - what medication to give patients?

Answer 29

post-menopausal women: aromatase inhibitors (eg anastrozole and letrozole) - to prevent peripheral oestrogen synthesis pre-menopausal/young patients: tamoxifen - selective oestrogen receptor modulators (side effect: endometrial cancer, VTE, menstural disturbance)

Question 30

Risk factors for bladder cancer

Answer 30

Transitional cell carcinoma: smoking (most significant) x4 exposure to aniline dyes rubber manufacture cyclophosphamide Squamous cell carcinoma: schistosomiasis smoking

Question 31

how soon after xxxx can you do the PSA test? - prostatitis - prostate biopsy - ejaculation - vigorous exercise - UTI

Answer 31

prostatitis : 1 month prostate biopsy: ejac/exercise: 48hrs UTI: 4 weeks DRE: 1 week

Question 32

PSA test & sensitivity/specificty

Answer 32

low sensitivtiyt and specificity

Question 33

what type of cancers are more prevalent in the following: Chinese Indian White Afro-Caribbean Ashkenazi Jews

Answer 33

Chinese: nasopharyngeal? Indian: White: Afro-Carribean: prostate Ashkenazi Jews: breast and ovarian cancer (BRCA 1 and 2)

Question 34

positive predictive value of faecal occult blood test

Answer 34

5-15%

Question 35

Risk factor for ovarian cancer

Answer 35

Nulliparous subfertile women has a familial tendency hormone therapy post menopause fertility medication obesity

Question 36

Risk factor for breast cancer

Answer 36

female sex obesity lack of physical exercise regular consumption of alcohol ionising radiation early age of menstruation BRCA1, BRCA2 genes - 40% lifetime risk of breast/ovarian cancer 1st degree relative premenopausal relative with breast cancer (e.g. mother) nulliparity, 1st pregnancy > 30 yrs (twice risk of women having 1st child < 25 yrs) early menarche, late menopause combined hormone replacement therapy (relative risk increase * 1.023/year of use), combined oral contraceptive use past breast cancer not breastfeeding ionising radiation p53 gene mutations obesity previous surgery for benign disease (?more follow-up, scar hides lump)

Question 37

Risk factor for endometrial cancer

Answer 37

excess oestrogen nulliparity early menarche late menopause unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously metabolic syndrome obesity diabetes mellitus polycystic ovarian syndrome tamoxifen hereditary non-polyposis colorectal carcinoma