Clinical oncology CCT

Question 1

Some cancers require precision delivery of a treatment modality, which of the following particles has the property of a Bragg’s peak?
A. Superficial X-ray
B. Electron
C. Photon
D. Proton

Answer 1

D. Proton

Question 2

Head and neck cancers are now commonly treated with a combination of radiotherapy and chemotherapy. Which of the following treatment combinations has been shown to have the best efficacy in the treatment of head and neck cancer?
A. Neoadjuvant chemotherapy and radiotherapy
B. Concurrent chemotherapy and radiotherapy
C. Chemotherapy then followed by radiotherapy only (?)
D. Radiotherapy then followed by chemotherapy only (?)

Answer 2

Ans: B

Question 3

Which of the following is the most common side effect of morphine?
A. Respiratory depression
B. Constipation
C. Nausea and vomiting
D. Xxx

Answer 3

B. Constipation (always given laxatives)

Question 4

Which of the following is an adjuvant analgesic for neuropathic pain?
A. Gabapentin
B. xxx
C. Ondansetron
D. xxx

Answer 4

A. Gabapentin

Question 5

6x male patient with gastric (?) cancer and multiple bone metastasis presented with abdominal colicky pain and constipation for a few days. He was admitted to the hospital and was confused. There is no fever. (add more pls) Which of the following is the most likely diagnosis?
A. Neutropenic fever
B. Hypercalcemia
C. Anemia
D. Urinary tract infection

Answer 5

B. Hypercalcemia

Question 6

A chronic smoker was diagnosed with lung cancer and develops neck swelling and dilated veins. Which of the following is the MOST IMPORTANT investigation?
A. Lung function test
B. Urine dipstick for protein
C. Contrast CT thorax
D. Ultrasound of neck

Answer 6

C. Contrast CT thorax

Question 7

Stomach CA met, failed treatment, on palliative care, on morphine syrup 10 mg QID (given 4 times a day), 20mg nocte. The patient developed intestinal obstruction and analgesic has to be given intravenously, what is the DAILY dose of morphine that should be given?(Might hv missed sth)
A. 10mg
B. 20mg
C. 45mg
D. 60mg

Answer 7

Ans: B (Conversion for morphine syrup: IV morphine 3:1)
Daily dose: 10mg x 4 +20mg = 60mg, 60mg/3 = 20mg per day

Question 8

Patient with hypertension, diabetes mellitus, renal impairment. Which drug is contraindicated?
A. Buprenorphine
B. Oxycodone
C. Morphine
D. Pethidine

Answer 8

C. Morphine (contraindicated in all renal failure as toxic metabolite will accumulate

Question 9

M/38, KRAS wild type metastatic CRC, develop non-urticarial pustular rash on face, likely culprit?
A. Bevacizumab
B. Gefitinib
C. Cetuximab
D. 5-FU

Answer 9

C. Cetuximab

Question 10

52–year–old woman recently diagnosed with congestive heart failure. She is a non–smoker and a social drinker. History includes a right–sided breast cancer treated with mastectomy, Adriamycin and Cyclophosphamide, followed by radiotherapy and hormonal therapy. Which of the followings is the most likely cause of her heart failure?

A. Mastectomy
B. Chemotherapy
C.Radiotherapy
D. Hormonal therapy

Answer 10

B. Chemotherapy (e.g. daunorubicin)

Question 11

60–year–old man diagnosed with small cell lung cancer is admitted for confusion and decreased urine output. He received Cisplatin and Etoposide for 2 days. Blood tests on admission show increased serum creatinine, urate, potassium and phosphate. Which of the following is the provisional diagnosis?

A. Cisplatin–induced nephrotoxicity
B. Metastasis to kidney
C. Tumour lysis syndrome
D. Neutropenic fever

Answer 11

C. Tumour lysis syndrome

Question 12

Which of the following drug belongs to WHO pain ladder step 2?
A. Morphine
B. Paracetamol
C. Methadone
D. Dihydrocodeine

Answer 12

D. Dihydrocodeine

Question 13

Patient with cholangiocarcinoma, and you would like give an immune checkpoint inhibitor. Which is the most important to check?
A. MSI-H (microsatellite instability)
B. FGRF
C. c-kit
D. PD-L1 score

Answer 13

A. MSI-H (microsatellite instability)

Question 14

A 62-year-old gentleman with metastatic left CA ureter with extensive peritoneal, lung, liver and bone metastasis, who is mostly chair/bed bound with poor performance status now presents with progressive poor renal function of >200 Cr (2x of upper limit of normal). He otherwise was not septic or with electrolyte imbalatnce. Abdominal ultrasound reveals a left hydronephrosis. What are your next steps?
A. Urgent urologist consult for ureteric stenting
B. Urgent interventional radiologist consult for percutaneous nephrostomy
C. Perform a renal biopsy
D. Interview patient and family for comfort care

Answer 14

D. Interview patient and family for comfort care

Question 15

A 55 year-old gentleman with chemotherapy refractory colorectal cancer with extensive lung and peritoneal metastasis. Later developed vomiting and colicky abdominal pain for one week. There was no bowel opening for 5 days. On examination, he was found to be bed bound (i.e. ECOG 4), cachexic with a weight of 41 kg only. Mild abdominal distension was noted. Which of the following is the most appropriate management?
A. Consider Colostomy
B. Consider NG tube feeding
C. Palliative care with anticholinergics
D. TPN

Answer 15

C. Palliative care with anticholinergics

Question 16

A 60-year-old gentleman with metastatic colorectal carcinoma on bevacizumab, oxaliplatin and 5-fluorouracil complains of puffy face and bilateral leg swelling. On physical examination there was bilateral pitting oedema but no tenderness palpated. His central venous pressure was normal. Which investigation should be used to find the cause of the generalised oedema?
A. Echocardiogram
B. Ultrasound of the lower limbs
C. Urine dipstick for protein
D. Complete blood count

Answer 16

C. Urine dipstick for protein

Question 17

A 55-year-old woman was diagnosed with left breast carcinoma. What are the mammographic features suggestive of carcinoma?
A. Coarse Calcifications
B. Hypodense
C. Oval in shape
D. Spiculated border

Answer 17

D. Spiculated border

Hypoechoic lesion, taller than wide, posterior acoustic shadowing and microcalcifications

Question 18

A patient has a resected descending colon cancer, with positive regional LN but clear resection margins. There was no distant metastasis. He was referred to COD for management. Which is the next appropriate step?

A. Observe
B. Adjuvant chemotherapy
C. Adjuvant chemoRT
D. Adjuvant RT

Answer 18

B. Adjuvant chemotherapy

Question 19

Female presents with left side motor weakness and seizure. Found to have 1 cm nodule in right frontal lobe on non-contrast CT. Then did a ??? further characterising it has a 1.5 cm tumour. Neurosurgery performed and resected the mass, biopsy showed glioblastoma multiforme. What is the suitable treatment after surgery?

A. Refer to palliative care
B. Adjuvant chemotherapy.
C. Dexamethasone 16mg divided dose
D. Combined chemotherapy and RT, followed by adjuvant chemotherapy

Answer 19

D. Combined chemotherapy and RT, followed by adjuvant chemotherapy

Maximal safe surgical removal where feasible followed by Concomitant TMZ+ERT, then adjuvant TMZ

Question 20

Which cancer require molecular diagnosis rather than histological?

A. GIST
B. leiomyoma
C. leiomyosarcoma
D. Neurofibroma

Answer 20

A. GIST

● Gastrointestinal stromal tumors (GISTs) is a mesenchymal tumor arising from the smooth muscle pacemaker interstitial cell of Cajal in the GI tract
● They are defined as tumors whose behavior is driven by mutations in the KIT gene (85%), PDGFRA gene (10%)
● 95% of GISTs stain positively for KIT (CD117)
● The diagnosis of GIST is more molecular than by histopathology

Question 21

Patient was diagnosed with metastatic colon cancer. She is receiving syrup morphine 4mg per day, but refractory to pain. She is admitted to palliative care. If methadone is given, what are the number of days required for methadone to reach static therapeutic level?
A. 12 hours
B. 2-3 days
C. 5-7 days
D. 14-21 days

Answer 21

C. 5-7 days

Question 22

Beckwith-Wiedemann syndrome is an overgrowth syndrome. Surveillance is required for which of the following tumours?

A. Hepatoblastoma
B. medulloblastoma
C. teratoma
D. atypical teratoid tumour

Answer 22

A. Hepatoblastoma

Question 23

35 -year old Chinese man present with neck lymph nodes, fine needle aspiration found undifferentiated carcinoma cell. Where is the origin? (refry)
A: Nose
B: Nasopharynx
C: Oropharynx
D:
E: Hypopharynx

Answer 23

B: Nasopharynx (whenever neck lymph node aspirate show undifferentiated squamous cells –> it is NPC until proven otherwise)

Question 24

Patient receiving chemoradiation . What are the acute side effects of radiotherapy?
(1) Neck stiffness
(2) Odynophagia
(3) Oral mucositis
(4) Carotid stenosis
(5) Desquamation of neck skin

A. 1,3
B. 1,3,4
C. 2,3,4
D. 2,3,5
E. 3,4,5

Answer 24

D. 2,3,5

Question 25

A 50 year-old lady with refractory ovarian cancer with extensive peritoneal metastasis. Previously on chemotherapy but tumor markers continue to rise so decided to stop treatment 2 weeks ago. Later developed vomiting and colicky abdominal pain for one week. There was no bowel opening for 5 days. On examination, she was found to be bed bound (i.e. ECOG 4), cachexic with a weight of 36 kg only, and abdominal distension was noted. Which of the following is the most appropriate management?
A. Consider Colostomy
B. Consider NG tube
C. OGD
D. TPN
E. Palliative care with anti-cholinergics

Answer 25

E. Palliative care with anti-cholinergics

Question 26

50/M metastatic CA lung, with multiple site bone met. On syrup morphine 10mg q4h. Recent 2 weeks, pain deteriorate and pain score increases to 7/10 1 hour before next dose. Require 3 extra rescue doses to relieve breakthrough pain. Which of the following provides quickest relief of pain?
A. Increase syrup morphine to 15mg q4h
B. Change to long acting morphine (MST) 30mg q12h
C. Add gabapentin 300mg 3 times a day
D. Add bisphosphonate
E. Prescribe anxiolytics

Answer 26

A. Increase syrup morphine to 15mg q4h

Question 27

Which of the following is not an antimetabolite?
A. 5-FU
B. Gemcitabine
C. Methotrexate
D. Docetaxel
E. Pemetrexed

Answer 27

D. Docetaxel

Question 28

Which of the following are not hormonal therapy for prostate CA?
A. Bicalutamide
B. LHRHa
C. Abiraterone
D. Enzalutamide
E. Fulvestrant

Answer 28

E. Fulvestrant (SERD for breast Ca)

Question 29

First symptom of spinal cord compression?
A. Backpain
B. Sensoryloss
C. Dermatomallevel
D. Lowerlimbweakness
E. Bowelorbladderdysfunction

Answer 29

A. Backpain

Question 30

A 60 year old man with lung cancer with bilateral adrenal metastasis. Received chemotherapy and 7 days later admitted for abdominal pain and fever. PE shows that abdomen is soft and nontender. Serum Na 125 mmol/L (low), K 5.3 mmol/L (high). Morning Cortisol 90 (low) before chemotherapy. What should be given?
A. Sodium chloride tablets1800mg B. Recheck morning cortisol
C. IV morphine 10mg stat
D. IM Haloperidol 5mg stat
E. IV hydrocortisone 100mgstat

Answer 30

E. IV hydrocortisone 100mg stat

Question 31

Patient developed shock, LOC and diffuse rash 15 minutes after starting carboplatin infusion. You decided to give adrenaline. The best dose is:
A. 0.5ml1in100IMevery5mins
B. 0.5ml1in1000IMevery5mins
C. 0.5ml1in10000IM
D. 500mcgintravenousbolus
E. 0.5mgbolusgivenintravenously

Answer 31

B. 0.5ml 1 in 1000IM every 5mins

Question 32

A 45-year-old was recently diagnosed with nasopharyngeal carcinoma, now on concurrent
chemoirradiation. Which of the following is NOT an acute side effect of his radiotherapy?
A. Odynophagia
B. Oral mucositis
C. Xerostomia
D. Desquamation of neck skin
E. Temporal lobe necrosis

Answer 32

E. Temporal lobe necrosis

Question 33

Frontal hypodensity, one sided weakness and dysphasia after RT for NPC 2x ago, what is the cause?
A. Hypopituitarism
B. ?
C. ?
D. Carotidpseudo-aneurysm
E. Internalcarotidstenosis

Answer 33

E. Internalcarotidstenosis

Question 34

Young man diagnosed with large B cell lymphoma. Chemotherapy given, well tolerated. On the third day after treatment, he developed oliguria and some other symptoms. Tumour lysis syndrome is suspected. Some lab tests are done. Which of the following is most likely be low?
A. Urate
B. Ca
C. K
D. Phosphate E. Hb

Answer 34

B. Ca

Question 35

metastatic lung cancer with chest infection. on morphine 10 mg syrup q4h with satisfactory pain control. later he developed confusion, hypersomnolence, jerky movement of limbs. no fever, no… ct brain is normal. what is the appropriate management.
A. Give IV naloxone.
B. Stop morphinepermanently
C. Withhold morphine 2 doses and reassess
D. Antibioticsandfluid
E. MRI brain for possible small brain metastases

Answer 35

C. Withhold morphine 2 doses and reassess

Question 36

50/M metastatic CA lung, with multiple site bone met. On syrup morphine 10mg q4h. Recent 2 weeks, pain deteriorate and pain score increases to 7/10 1 hour before next dose. Require 3 extra rescue doses to relieve breakthrough pain. Which of the following provides quickest relief of pain?
A. Increase syrup morphine to 15mg q4h
B. Change to long acting morphine (MST) 30mgq12h
C. Add gabapentin 300mg 3 times a day
D. Add bisphosphonate
E. Prescribe anxiolytics

Answer 36

A. Increase syrup morphine to 15mg q4h

Question 37

First station of lymphatic spread by testicular CA
A. Common iliac LN
B. External iliac LN
C. Inguinal LN
D. Internal iliac LN
E. Para aortic LN

Answer 37

E. Para aortic LN

Question 38

Which of the paediatric tumour most commonly gives rise to bone metastasis?
A. Ependymoblastoma
B. Hepatoblastoma
C. Nephroblastoma
D. Neuroblastoma
E. Retinoblastoma

Answer 38

D. Neuroblastoma

Question 39

Which is the most common complication of radical prostatectomy?
A. Cystitis
B. Erectile dysfunction
C. Intestinal Obstruction
D. Proctitis
E. Rectal perforation

Answer 39

B. Erectile dysfunction

Question 40

70-year old man with generalized bone pain. XR showed multiple sclerotic lesions.
Which of the following is the most likely primary site of the malignancy?
A. Breast cancer
B. Myeloma
C. Prostate cancer
D. Renal cell carcinoma
E. Thyroid cancer

Answer 40

C. Prostate cancer

Question 41

Elderly lady with Ca Breast on Chemotherapy presents with fever, chills and rigors. CBC = pancytopenia.
Which of the following should NOT be done?
A. Give abx
B. Give fluids
C. Support by G-CSF
D. Give steroids
E. None of the above

Answer 41

D. Give steroids (will cause immunosuppression)

Question 42

Which of the following factor(s) predict(s) the start of physical deterioration in patients with metastatic cancer?
A. Progressive weight loss
B. Drop in performance status from ECOG 1 to 2
C. Drop in performance status from ECOG 2 to 3
D. A+C
E. A+B

Answer 42

D. A+C

Question 43

A 69-year-old lady with right breast cancer had modified radical mastectomy and axillary dissection done. Histopathological results were confirmed to be ductal carcinoma with 0 out of 12 lymph nodes. Estrogen receptor (ER) was positive. Both progestogen receptor (PgR) and HER-2 receptor were negative. She then met her oncologist for consultation of further adjuvant therapy. Which of the following adjuvant therapy is most suitable for her conditions?
A. Aromatase inhibitor
B. Avastin
C. Cisplatin
D. Herceptin
E. Iressa

Answer 43

A. Aromatase inhibitor (post menopausal)

Anastrozole, letrozole

Question 44

50-year-old woman with breast cancer and multiple liver and brain metastasis, presented with malaise, colicky abd pain, constipation for one week. She is mildly confused and dehydrated. O/E: abd soft and non-tender Electrolytes: Na 130/K 3.2/adjusted Ca 3.78
Diagnosis?
A. Brain metastasis
B. Intestinal obstruction
C. Malignant hypercalcemia
D. Multiple myeloma
E. Tumor lysis syndrome

Answer 44

C. Malignant hypercalcemia

Question 45

A 50-year old man, who was newly diagnosed with locally advanced NPC, presented with tinnitus, epistaxis and left sided cervical lymphadenopathy. Nasoendoscopy biopsy showed poorly differentiated NPC. What is the blood test surrogate marker for treatment response and prognostic marker for newly diagnosed NPC?
A. EBV VCA / Ig A Ab titre
B. EBV DNA
C. HBV DNA
D. HPV DNA
E. MCV DNA

Answer 45

B. EBV DNA

Question 46

A patient couldn’t achieve adequate pain control with panadol. Opioid is added and he achieved adequate pain control. In the subsequent follow up he expressed he would like to down-step the drug back to panadol only, as the opioid is causing him constipation. What should you do next?
A. Switch back to panadol only
B. Reassure the patient that tolerance will develop eventually for constipation
C. prescribe sennokot and ask the patient to take it at night only if that day has constipation
D. prescribe sennokot to be taken daily
E. Prescribe Colace

Answer 46

D. prescribe sennokot to be taken daily (laxative)

Question 47

A 70-year-old woman is newly diagnosed with carcinoma of the colon. While waiting for definitive resection by the surgeons, she presented one day with abdominal pain and vomiting. Per rectal examination revealed empty rectum. Physical examination also revealed hyperactive bowel sounds. Which of the following is the most likely working diagnosis?
A. Gastroenteritis
B. Intestinal obstruction
C. Intestinal perforation
D. Malignant biliary obstruction
E. Septic shock

Answer 47

B. Intestinal obstruction

Question 48

A 58-year-old man with known carcinoma of the pancreas underwent pancreaticoduodenectomy 2 years ago. Now, the tumor has recurred with peritoneal metastases and the patient was started on palliative chemotherapy. The level of tumor marker dropped initially but is rising again recently. The patient complains of abdominal distension making him uncomfortable. He had bowel opening 1-2 times per day. Clinically shifting dullness was elicited. Which of the following treatments is most appropriate?
A. abdominal tapping
B. continue chemotherapy
C. emergency laparotomy
D. increase dosage of laxatives
E. give morphine

Answer 48

A. abdominal tapping

Question 49

A 45 year-old man presented with left cervical neck node for 3 weeks, with progressive diplopia and tinnitus. Physical examination revealed right CNVI palsy. Excisional biopsy of the lymph node showed poorly differentiated carcinoma. Which of the following investigation is appropriate in finding the origin of the cancer?
A. Bronchoscopy
B. MRI Brain X
C. PET-CT
D. Panendoscopy
E. Upper endoscopy

Answer 49

D. Panendoscopy (NPC until proven otherwise)

Question 50

F/52 breast CA multiple bone metastasis. Currently on tramadol (step 2 of WHO ladder) but no adequate pain control. Currently on laxatives for relieving constipation. X ray show multiple bone metastasis but no impending fracture of femur. What should be next step of management?
A. radiotherapy
B. doloxene (step 2 WHO ladder)
C. stop tramadol and start morphine
D. continue tramadol and start morphine
E. continue current therapy and don’t start morphine since patient is already on laxatives for relieving constipation

Answer 50

C. stop tramadol and start morphine

Question 51

A patient has pleural pain due to malignant pleural effusion. The pain is well controlled by tramadol QID. The patient can still go to work after switching to a part-time office job. What is his ECOG score?
A. ECOG 0
B. ECOG 1
C. ECOG 2
D. ECOG 3
E. ECOG 4

Answer 51

C. ECOG 2

Question 52

A 52-year-old man with metastatic colorectal cancer now receiving palliative chemotherapy with bevacizumab, oxaliplatin, 5-FU, irinotecan and folinic acid. He complainted of numbness in all four extremities after 6 cycles. Which of the chemotherapeutic drug is the MOST LIKELY causative agent?
A. Bevacizumab
B. Oxaliplatin
C. 5-FU
D. Irinotecan
E. Folinic acid

Answer 52

B. Oxaliplatin

Question 53

A 48-year-old gentleman with a 2-year history of non-small cell lung carcinoma, presented with dyspnea for 1 week. On physical examination, he has a swollen and red face with dilated and engorged veins on neck and upper chest. What is the appropriate next step of management?
A. High dose systemic steroids
B. Intravenous diuretics
C. Systemic chemotherapy
D. Targeted therapy
E. Intravenous antibiotics

Answer 53

A. High dose systemic steroids

Question 54

A 50-year-old woman has a peripherally inserted central catheter (PICC) inserted on the left side for chemotherapy of her metastatic breast cancer. The chemotherapy consists of three cycles. Six weeks since the start of chemotherapy she reported erythema, swelling and pain over her left arm. What is the most appropriate action to be done?
A. Systemic chemotherapy
B. Ultrasonography scan of the left arm
C. High dose systemic steroids
D. Duplex ultrasound of lower limbs to detect DVT
E. Systemic broad-spectrum antibiotics

Answer 54

B. Ultrasonography scan of the left arm

Question 55

What is the proper way of administering adrenaline in a patient with anaphylaxis?
A 0.5 mL of 1:100 adrenaline, IM every 5 minutes
B 0.5 mL of 1:1000 adrenaline, IM every 5 minutes
C 0.5 mL of 1:10000 adrenaline, IM every 5 minutes
D 500 mcg adrenaline, IV bolus every 5 minutes
E 0.5 mg adrenaline, IV bolus every 5 minutes

Answer 55

B 0.5 mL of 1:1000 adrenaline, IM every 5 minutes

Question 56

Which of the following drugs is the most likely to cause an immunological/allergic reaction?
A Rituximab
B Pembrolizumab
C Cyclophosphamide
D 5-fluorouridine
E Trastuzumab

Answer 56

A Rituximab

Question 57

Chemotherapeutic agents can be classified as phase non-specific and phase specific agents. Compared to phase non-specific agents, phase specific agents -
A Are active irrespective of the state of the cell cycle
B Are particularly effective in tumours with a low growth cell fraction
C Can achieve a greater cell kill if they are given in multiple repeated fractions
D Has a linear dose-response relationship
E Only works by covalently binding to DNA and disrupting DNA function

Answer 57

C Can achieve a greater cell kill if they are given in multiple repeated fractions

Question 58

In which of the following, aromatase inhibitor is the most preferable treatment for CA breast
A. 58/F post menopause ER pos her pos
B. 44/F pre menopause stage 3 ER pos her2 pos
C. 54/F ER neg, her2 neg
D. 70/F severe osteoporosis ER pos her2 neg
E. 62/ F post menopausal met CA ER pos her2 neg

Answer 58

E. 62/ F post menopausal met CA ER pos her2 neg

If ER +ve can use SERM (fulvestrant)

Question 59

Which chemo drug cannot be given concurrently with radiotherapy?
A. Vincristine
B. Cisplatin
C. Docetaxel
D. Epirubicin
E. Temozolomide

Answer 59

D. Epirubicin

Chemoradiation not for anthracyclines because of severe radio-sensitizing side effects (over-radiosensitizing)
Other anthracyclines: doxorubicin, daunorubicin

Question 60

SCLC complicated with SVCO but endovascular stenting not available, treatment mentioned in previous question already given. what is the definite treatment?
A. Radiotherapy
B. Chemotherapy
C. IV pulse dose steroid
D. Surgery

Answer 60

B. Chemotherapy

Chemosensitive tumors (SCLC, non hodgkins lymphoma)
Radiosensitive: NSCLC, lymphomas

Question 61

Which of the following side effect is more common in aromatase inhibitor than tamoxifen?
A. Endometrial malignancy
B. DVT
C. Vaginal dryness
D. Bone fractures
E. Retinopathy

Answer 61

D. Bone fractures

Aromatase inhibitor (inhibits peripheral conversion of estrogen)

Question 62

Which of the following benign conditions is BEST treated with stereotactic radiosurgery?
A. Vestibular schwannoma
B. Graves ophthalmopathy
C. Toxic nodular goitre
D. Keloid scar
E. Splenomegaly

Answer 62

A. Vestibular schwannoma

Question 63

72y/o man with past Hx of NPC treated with 2-D RT 20years ago. Otherwise no significant past medical hx. He was occasionally found to have low BP since 2 years ago. Sudden left-sided weakness 2 days ago. CT of his brain showed a hypodense area at right parietal region. What is the most likely cause for his left-side weakness?
A. Temporal lobe necrosis
B. Hypopituitarism
C. Hypothyroidism
D. Carotid pseudoaneurysm
E. Carotid stenosis

Answer 63

E. Carotid stenosis

Question 64

65/M, on cetuximab, oxaliplatin, leucovorin and 5-FU for metastatic CA colon. Imodium intermittently for diarrhea. ?Complain of finger pain, erythematous swelling over the base of nails. Which of the following agents is responsible for the current situation?
A. Cetuximab
B. Oxaliplatin
C. Leucovorin
D. 5-FU
E. Imodium

Answer 64

A. Cetuximab

Question 65

Old lady with recurrence of breast cancer. Multiple metastasis to bone and liver. Liver function normal. ER -/PR -/HER -. What is the most important treatment.
A. Systemic chemotherapy
B. Arterial chemotherapy to liver
C. Radiotherapy to breast
D. Systemic hormonal therapy
E. Bisphosphonate

Answer 65

A. Systemic chemotherapy

Question 66

A 85-year-old woman with multiple medical comorbidities was diagnosed to have right breast cancer, measured 6cm in size. Biopsy showed ER strongly +ve and HER2 -ve. The patient was found to have multiple asymptomatic bone metastases and no visceral metastasis. Which of the following is the MOST APPROPRIATE TREATMENT?
A. modified radical mastectomy
B. lumpectomy of right breast mass
C. radiotherapy
D. hormonal therapy
E. chemotherapy

Answer 66

D. hormonal therapy

Question 67

A 50 year-old lady, who has chemotherapy refractory ovarian cancer with extensive peritoneal metastasis, developed vomiting and colicky abdominal pain for one week. There was no bowel opening for 5 days. On examination, she was found to be bed bound (i.e. ECOG 4), cachexic with a weight of 36 kg only, and abdominal distension was noted. Which of the following is the the most appropriate management.
A. Consider Colostomy
B. Consider NG tube
C. OGD
D. TPN
E. Palliative care with anticholinergics

Answer 67

E. Palliative care with anticholinergics

Question 68

90/M, colorectal CA, bone metastasis involving T12. Given 5mg morphine q6h for pain relief. Suddenly developed AROU requiring Foley’s. One day later developed disorientation and agitation. What is the most appropriate management for this patient.
A. Withhold morphine
B. Switch to fentanyl patch
C. Give IV naloxone bolus 0.4mg
D. CT brain for investigation of confusion
E. Sedation for pain management

Answer 68

A. Withhold morphine

Question 69

Elderly man with metastatic prostate cancer treated with chemotherapy comes to follow up in the oncology clinic. He reported to have pain over the mid-thoracic spine recently. The pain is exacerbated by movement and cough. Which of the following is the best way of managing this patient?
A. Plain radiographs of spine
B. Magnetic resonance imaging (MRI) of spine
C. Prescribe analgesics for pain relief
D. Give chemotherapy
E. Reassurance

Answer 69

B. Magnetic resonance imaging (MRI) of spine