Medical Oncology RACP MCQs Flashcards
RACP 2022a Q3
PALB2 gene is implicated in which cancer?
a. Breast
b. Small cell lung cancer
c. Gastric
d. Prostate
A. Breast
PALB2 is a partner and localiser of BRCA2 and plays a role in BRCA2 DNA damage response functions. The cumulative breast cancer risk to age 80 for female carries is ~53%
Women with a faulty PALB2 gene have about a 55% chance of developing breast cancer and about a 5% chance of developing ovarian cancer over their lifetime.
Men with a faulty PALB2 gene have a 1% chance of developing breast cancer over their lifetime. Men with a faulty PALB2 gene also have an increased chance of developing prostate cancer over their lifetime, but the exact chance is unknown.
Both men and women with a faulty PALB2 gene have about a 3% chance of developing pancreatic cancer over their lifetime.
Not everyone who has a faulty PALB2 gene will develop cancer.
RACP 2022a Q11
11.A 59F is has a solitary plasmacytoma at T4 treated with irradiation. What is
the percentage risk of developing multiple myeloma?
a. 10%
b. 20%
c. 50%
d. 90%
C. 50%
Multiple myeloma develops in 50-60% of patients with solitary plasmacytoma of bone after initial radiation therapy. In contrast, MM only develops in 10-15% of patients with solitary extramedullary plasmacytomas.
RACP 2022 Q18
What is reduced by dose escalation during commencement of venetoclax?
a. Haematopoietic toxicity
b. Differentiation syndrome
c. Tumour lysis
C. TLS
Dose-escalation refers to a step-wise increase in treatment dose over a specified period of time. In the case of venetoclax, dose-escalation is performed to reduce the risk of developing life-threatening TLS.
Binds to and inhibits the B cell lymphoma 2 (BCL‑2) protein, which is an anti-apoptotic protein over-expressed in certain tumour cells, triggering cell death.
RACP 2022a Q24
A 24yo male with a history of pT1 seminomatous testicular cancer is
reviewed in clinic. In addition to LDH, which of the following tumour markers
would be elevated?
a. CEA
b. CA125
c. B-HCG
d. AFP
C - B-HCG
AFP, HCG, and LDH can be elevated in all testicular cancers. However, generally seminomas should be AFP negative and positive AFP in seminomas should raise suspicion for nonseminomatous lesions as well.
HCG is elevated in 10-15% of seminomatous tumours with synctiotrophoblastic cells.
RACP 2022a Q27
27.(Past question)Female patient with adenocarcinoma of unknown origin, presents with shortness of breath. RR 24, 94% RA and BP 100/40. CXR showed globular heart.
a. Lymphangitic carcinomatosis
b. Atypical pneumonia
c. Pericardial effusion
d. PE with infarct
C - Pericardial effusion
The water bottle sign (globular heart) refers to the shape of the cardiac silhouette on erect frontal chest x-rays in patients who have a very large pericardial effusion. Typically the effusion has accumulated over many weeks to months (e.g. in patients with malignancy) and the pericardium has gradually stretched. The fluid, often measuring a litre or more, causes the pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.
RACP 2022a Q45
45.A patient has a new diagnosis of diffuse large B cell lymphoma. He is about
to start chemo with RCHOP. As part of his initial work up, his hepatitis B
serology shows Hep B surface antigen negative, Hep B core antibody
positive, Hep B surface antibody positive. How would you manage this?
a. Do nothing as patient is immune
b. Check Hep B E antibody
c. Start antivirals
C
In patients who are HBsAg negative and anti-HBc positive the cancer therapy regimen determines the risk for HBV reactivation. Patients receiving:
Higher risk cancer therapy (blood and marrow transplantation (BMT), B-cell depleting/B-cell active/anti-CD20 monoclonal antibodies, acute leukaemia and high grade lymphoma therapy) should receive antiviral prophylaxis.
Lower risk cancer therapy (therapy which is not classified as higher risk) do not require antiviral prophylaxis.
RACP 2022a Q46
46.40yo female with gord and new diagnosis of SCLC develops a rash over her nose that spreads to her face chest and hands. Hands are cold in the
morning. There is no myalgia, arthragia and CK and renal function is normal.
(Photo provided of Gottron papules on bilateral hands)
a. Amyotrophic dermatomyositis
b. Limited scleroderma
c. Granuloma annulares
d. Cutaneous SLE
A - Amyotrophic dermatomyositis
Gottron papules are characteristic of dermatomyositis. Dermatomyositis is also a paraneoplastic syndrome associated with lung cancers.
RACP 2022a Q47
47.An ex-smoker with 30 pack year history has a right sided central lung mass on CXR. He has also experienced proximal weakness and hypokalemia -
what is most likely cause?
a. Squamous cell carcinoma
b. Small cell lung cancer
B - SCLC
Lung SCC and SCLC are the only two variants that are exclusively centrally located. The proximal muscle weakness and hypokalemia describes signs of paraneoplastic syndromes. Proximal muscle weakness could indicate myositis or Lambert-Eaton syndrome, the latter is strongly associated with SCLC. Hypokalaemia may be present in Cushing’s syndrome as a result of ectopic ACTH production from SCLC.
RACP 2022a Q56
56.Which cancer has the most neurological paraneoplastic symptoms?
a. Ovarian
b. Breast
c. Thymoma
d. Small cell
D - SCLC
SCLC is the most common cause for almost all the neurological paraneoplastic symptoms. This is followed by breast and then ovarian cancers.
RACP 2022a Q66
66.70yo male with Boney met prostate CA Ca 2.78 2.20-2.55 Pth 7.5 1.7-7.3
Urine ca to Cr 0.41 <0.61
a. Boney errosions
b. Hyperparathyroidism
c. Exogenous vit D production
d. PTHrP
B
urine calcium appropriately low given high PTH
PTH will not be elevated in A or C
Prostate cancer, multiple myeloma and breast cancer produce PTHrP. But in malignancy-associated hypercalcaemia secondary to PTHrP, PTH is suppressed.
RACP 2022a Q74
74.30M with orchectomy. The biopsy has come back and it shows seminoma.
Besides raised LDH, which tumour would you expect to be raised?
a. BHCG
b. AFP
c. CEA
d. CA125
C - B-HCG
AFP, HCG, and LDH can be elevated in all testicular cancers. However, generally seminomas should be AFP negative and positive AFP in seminomas should raise suspicion for nonseminomatous lesions as well.
HCG is elevated in 10-15% of seminomatous tumours with synctiotrophoblastic cells.
RACP 2022a Q77
77.68 year old man with 3 months of dyspnoea, cough and bloody sputum. Nil
weight loss or fevers. He has a 30 pack year smoking history. CT chest
showed a 3 cm R sided central hilar mass with bilateral lymphadenopathy.
What is the most likely diagnosis?
a. Sarcoidosis
b. Lymphoma
c. Small call carcinoma
d. Squamous cell carcinoma
RACP 2022a Q78
78.For which thyroid cancer is calcitonin used to monitor for recurrence
a. anaplastic
b. follicular
c. medullary
d. papillary
C
Medullary thyroid cancer (MTC) is a neuroendocrine tumor of the parafollicular or C cells of the thyroid gland; it accounts for approximately 1 to 2 percent of thyroid carcinomas. The production of calcitonin is a characteristic feature of this tumor
RACP 2022a Q79
79.”A 64yo M is found to have large cell lymphoma, he is planned to commence
on cyclophosphamide, doxorubicin, vincristine(?), prednisone, and rituximab.
He was screened pre-treatment for hepatitis B, his results are as follows:
HbsAg negative
HbsAb positive
HbcAb positive
Viral load not detected
What is the most appropriate step before commencing chemotherapy?
a. antiviral medications
b. check hepatitis B e antibody
c. hepatitis B vaccine
d. no further treatment
A
https://www.eviq.org.au/getmedia/a957df52-3610-4b0c-a31e-e31db15b901d/1382-Preventing-reactivation-of-hep-B-algorithm.pdf
RACP 2022b Q3
- Which mutation and location does cetuximab provide the greatest survival
advantage in colorectal cancer?
A. RAS wild type and Left sided
B. RAS wild type and Right sided
C. RAS mutation and Left sided
D. RAS mutation and Right sided
A - wild type and left sided
Those that are RAS and BRAF wild-type, derive relatively more benefit from treatment with bevacizumab.
Whereas left-sided tumors that are RAS and BRAF-wildtype derive relatively more benefit from treatment with EGFR inhibitors (eg, cetuximab, panitumumab)
RACP 2022b Q21
- (Past question) Where does CDK4/6 work in the cell cycle?
A) G1 to S
B) S to G2
C) G2 to M
D) M to G1
A - G1 phase
https://www.nature.com/articles/s41388-020-1354-9
RACP 2022b Q36
- What cancer causes most deaths worldwide?
A. Lung
B. Colorectal
C. Breast
D. Prostate
A - lung
The most common causes of cancer death in 2020 were:
- lung (1.80 million deaths);
- colon and rectum (916 000 deaths);
- liver (830 000 deaths);
- stomach (769 000 deaths); and
- breast (685 000 deaths).
(from WHO)
Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020 (1). The most common in 2020 (in terms of new cases of cancer) were:
- breast (2.26 million cases);
- lung (2.21 million cases);
-colon and rectum (1.93 million cases);
- prostate (1.41 million cases);
- skin (non-melanoma) (1.20 million cases); and
- stomach (1.09 million cases).
RACP 2022b Q38
- “Two-hit hypothesis” is evident in which genetic condition?
A. Chromosomal microdeletion syndrome
B. Congential disorder of glycogen storage
C. Familal cancer syndromes
D. Inborn errors of metabolism
C - Familial cancer syndromes
Tumor suppressor genes may undergo a variety of mutations; however, most loss-of-function mutations that occur in tumor suppressor genes are recessive in nature. Thus, in order for a particular cell to become cancerous, both of the cell’s tumor suppressor genes must be mutated.
This idea is known as the “two-hit” hypothesis, and it was first proposed by geneticist Alfred Knudson in 1971. Today, this hypothesis serves as the basis for researchers’ understanding of how mutations in tumor suppressor genes drive cancer.
RACP 2021a Q19
Q19. A 52 year old man who is an ex-smoker presents to clinic with proximal muscle weakness and dysphagia. A
chest x-ray reveals a large anterior mediastinal pathology. He subsequently undergoes resection of the mass. Which histopathology would best explain his clinical findings and imaging?
A. Germ cell tumor
B. Lymphoma
C. Small cell lung cancer
D. Thymoma
This question and the answer options were well recalled.
??D
There are two clinical forms of myasthenia gravis (MG)
•Ocular MG – Weakness is limited to the eyelids and extraocular muscles.
•Generalized MG – Symptoms involve a variable combination of ocular, bulbar, limb, and/or respiratory muscles.
RACP 2021a Q36
Q36. A 60 year old man presents with a two week history of pruritis, jaundice, dark urine, pale stools, and 6kg
weight loss, but nil abdominal pain. In the month prior, he had a course of augmentin duo forte for a chest
infection. He has a background history of a caecal cancer treated with right sided hemicolectomy. He smokes 20
cigarettes per day and drinks 2 standard drinks per day. His observations are: HR 88, BP 125/88, RR 12, temp
36.8C.
An abdominal ultrasound shows a dilated gallbladder with nil stones, dilated CBD to the level of the duodenum,
and increased echogenicity throughout the liver. His LFTs are as follows:
Bilirubin 210
Albumin 34
ALT 40
ALP 610
GGT 340
What is the most likely diagnosis?
A. Drug induced liver injury related to Augmentin
B. Alcoholic liver disease
C. Widespread colorectal cancer
D. Head of pancreas cancer
?C
obstructive jaundice
b/g CRC
RACP 2021a Q43
Q43. A 65 year old female has a right hemicolectomy for colon cancer. Her brother was diagnosed with colon
cancer aged 60. The histopathology showed mucinous adenocarcinoma with high satellite Instability. Which of the
following mutations would support a sporadic disease mutation rather than familial lynch syndrome?
A. BRAF
B. EGFR
C. Kras
D. PI3K
RACP 2021 Q109
Q109. Minor elevations of which tumor marker could best be explained by cigarette smoking?
A. AFP
B. CA125
C. CEA
D. PSA
This question and the answer options were well recalled.
C - CEA
In a recent study of >700 apparently healthy volunteers, the median CEA values for male smokers and nonsmokers were 6.2 and 3.4 μg/L, respectively. The median concentrations for female smoker and nonsmokers were 4.9 and 2.5 μg/L, respectively (17). Thus, smoking appears to almost double the serum concentration of CEA.
https://academic.oup.com/clinchem/article/47/4/624/5639154?login=false
RACP 2021 Q118
Q118. A patient with ER positive metastatic breast cancer has failed first line therapy. What class of agent would
you add to aromatase to increase efficacy?
A. mTOR
B. HER2
C. VEGF
D. EGFR
RACP 2021 Q140
Q140. Oestrogen-sensitive metastatic breast cancer can be treated with cyclin dependent kinases (CDK) 4/6
inhibitors. These drugs interfere with cell cycle progression by inactivation of CDK 4/6 complexes resulting in cell
cycle arrest.
From the diagram above, where do the CDK 4/6 inhibitors exert their inhibitory effects?
A. G1 to S
B. S to G2
C. G2 to M
D. M to G1
This question and the answer options were well recalled.
RACP 2021 Oct Q1
53 M presents for routine colonoscopy screening for polyps. Nil PMHx, nil regular meds, normal examination, nil hx PR bleeding. Normal hb and MCV. Colonoscopy found angiodysplastic lesions. What treatment?
A. Observe
B. Argon plasma treatment
C. TTE
D. Rhubarb
RACP 2020a Q11
- A 38yoM presents to the emergency department with worsening shortness of breath and episodes of chest tightness for the past 2 weeks. Below are his CXR images. What is the most likely radiological diagnosis?
A) Anterior mediastinal mass
B) Bilateral hilar lymphadenopathy
C) Cardiomyopathy with left atrial enlargement
D) Right middle lobe collapse
RACP 2020a Q20
- Which of the following synthetic disease modifying agents predisposes to the development of SCC of the skin?
A. Azathiopurine
B. Leflunomide
C. Methotrexate
D. Mycophenalate
RACP 2020a Q40
- What complication can occur in the hormonal therapy for transgender males?
A) Cervical carcinoma
B) Acne
C) Osteoporosis
D) Prolactinoma
RACP 2020a Q61
- Which DNA repair pathway is targeted by PARP inhibitors for the treatment of advanced ovarian cancer which is BRCA positive?
A) Base excision repair (BER)
B) Double strand break replication repair (DSB)
C) Mismatch repair (MMR)
D) Nucleotide excision repair (NER)
RACP 2020a Q71
- What is the mechanism for somatic chromosomal translocation as causing cancer?
A. Gene Fusion
B. Non homolygous end joining
C. Haplotype
RACP 2020 Q11
- What form of thyroid cancer has the worst prognosis?
A) Anaplastic
B) Papillary
C) Follicular
D) Medullary
RACP 2020
- What pathway does PARP inhibitors act on?
A) Base excision repair
B) Double stranded repair recombinase pathway
C) Nucleotide Excision repair
D) CDK4/6
RACP 2020
- What high risk feature in breast cancer is most associated with a BRCA mutation?
A) Lymphovascular invasion
B) Triple negative disease
RACP 2020
- Mammography typically underestimates the size of which type of breast cancer?
A) Lobular
B) Ductal
C) Mucinous
RACP 2020
- An 87-year-old man presents for an outpatient appointment for 4 months history of poor appetite, eating only 1/4 of his meals and 5kg weight loss. He has a history of moderate-severe dementia with MMSE 10/30 and his wife makes his meals for him. He is on nutritional supplements. He weighs 55kg (BMI 19.5). What is the best management?
A) CT abdomen
B) Gastroscopy
C) Start olanzapine
D) Cease donepezil
RACP 2019 Q5
Question 5
Squamous cell carcinoma is most common with which immunosuppressive agent?
A. Mycophenolate mofetil
B. Methotrexate
C. Azathioprine
D. Leflunomide
RACP 2019 Q12
Question 12
What is the most common type of cancer associated with primary immunodeficiencies?
A. Melanoma
B. Sarcoma
C. Lymphoma
D. Carcinoma
RACP 2019 Q22
Question 22
Patient with non-Hodgkin’s lymphoma receiving R-CHOP. Which agent carries the highest risk of peripheral neuropathy?
A. Rituximab
B. Cyclophosphamide
C. Doxorubicin
D. Vincristine
RACP 2019 Q23
Question 23
A 72yo male with Burkitt’s lymphoma is to commence on chemotherapy. There is evidence of tumour lysis syndrome prior to commencement of therapy. What is the most appropriate method to reduce the risk of tumour lysis syndrome?
A. Intravenous fluids
B. Rasburicase
C. Frusemide
D. Allopurinol
Answer B Rasburicase
- Allopurinol suitable for prophylaxis, rasburicase indicated when TLS established.
- IV fluids - supportive - prevents precipitation of solutes in renal tubules - should be given along with rasburicase.
- Frusemide - no evidence for TLS management, used to manage fluid overload in hydrated patient.
RACP 2019 Q 25
Question 25
A 63 year old lady with cancer is still independent with all her activities of daily living. She is unable to do housework, but is able to walk around in her back yard. She is currently spending about 40 % of her waking hours in bed. What is her ECOG?
A. 1
B. 2
C. 3
D. 4
RACP 2019 Q73
Question 73
A 45 year old man presents with pruritus and scleral icterus, but no abdominal pain. He has recently received a course of Augmentin DF for an infection. He has a history of colorectal cancer with hemicolectomy several years ago. He also has a history of heavy alcohol use. Vital signs are normal, and he is afebrile.
Bloods show:
High bilirubin, GGT, ALP, normal AST.
Normal Hb, WCC, PLT
Cannot recall if CRP, INR was given.
Abdominal US showed empty but dilated gallbladder, dilated common bile duct to the level of the duodenum, and increased homogeneous echogenicity of the liver.
What is the most likely diagnosis?
A. Antibiotic-induced cholestasis
B. Common bile duct stone-induced cholestasis
C. Disseminated colorectal cancer
D. Head of pancreas cancer
RACP 2019 Q77
Question 77
A 54 year old man has stage 3 colorectal cancer on capcitabine and oxaliplatin. He is currently experiencing 8 episodes of diarrhoea a day, despite taking loperamide. There are no other infective symptoms. What medication would you add to manage his symptoms?
A. Methylprednisolone
B. Subcutaneous morphine
C. Metronidazole
D. Infliximab
RACP 2019 Q83
Question 83
What is the mechanism of action of rasburicase in tumour lysis syndrome?
A. Inhibits xanthine oxidase
B. Decreases tubular reabsorption of urate
C. Increases tubular secretion of urate
D. Increases the oxidation of uric acid to allantoin
Answer D
Increases the oxidation of uric acid to allantoin –> which is water soluble and can be excreted through urine
RACP 2019b Q28
Question 28
What is the indication for cetuximab in metastatic colorectal cancer?
A. Wild type KRAS
B. Mutant KRAS
C. Wild type EGFR
D. Mutant EGFR
RACP 2019b Q40
Question 40
Cyclin dependent kinase inhibitors are effective in which type of breast cancer?
A. Hormone positive, HER2 negative
B. Hormone negative, HER2 positive
C. Triple negative
D. High tumour burden
RACP 2019 Q45
Question 45
A rise in which of the following tumour markers can be attributed to smoking?
A. CA-125
B. AFP
C. CEA
D. PSA
RACP 2019b Q60
A 60yo male, non-smoker, presents with persistent cough and dyspnoea. His CT is shown below:
His CT demonstrates bulky hilar lymphadenopathy. What is the most likely diagnosis?
A. Small cell lung cancer
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Hodgkin’s lymphoma
RACP 2018 Q6
- At initial diagnosis, which factor is most predictive of reduced survival in patients with metastatic renal cell cancer?
A. Age < 60.
B. Chromophobe histology.
C. Eastern Cooperative Oncology Group (ECOG) performance status of 3.
D. Lung metastases.
E. Smoking history.
RACP 2018a Q21
- What is the most common form of thyroid cancer?
A. Anaplastic.
B. Follicular.
C. Medullary.
D. Papillary.
E. Squamous.
RACP 2018a Q27
- A patient with metastatic adenocarcinoma of unknown primary involving liver and bone
presents with back pain, urinary incontinence and altered sensation in the legs. Clinical
examination showed reduced sensation to pin prick and light touch in both legs and perineal region. The lower limb reflexes were reduced with down-going plantar reflex.
What is the most likely diagnosis?
A. Cauda equina syndrome.
B. Cerebral metastasis.
C. Leptomeningeal carcinomatosis.
D. Paraneoplastic peripheral neuropathy.
E. Spinal cord compression.
RACP 2018a Q51
- A 38-year-old woman treated for advanced melanoma with pembrolizumab (anti-PD1 antibody)
presents with new onset fatigue, generalised weakness, diarrhoea, anorexia and weight loss.
Supine blood pressure is 110/74 mmHg, standing blood pressure falls to 86/52 mmHg.
Initial investigations reveal:
Normal values
Sodium (Na) 124 mmol/L [135–145]
Potassium (K) 5.9 mmol/L [3.5–5.5]
Urea 13.2 mmol/L [3.1–8.1]
Creatinine 44 μmol/L [49–90]
Glucose 3.6 mmol/L [4.0–5.5]
What is the most likely cause for her acute presentation?
A. Adrenal metastasis.
B. Adrenalitis.
C. Increased glucocorticoid clearance.
D. Sellar metastasis.
E. Syndrome of inappropriate antidiuretic hormone (SIADH).
RACP 2018a Q64
64.A patient receiving treatment for her metastatic colon cancer developed pain in her hands and
diarrhoea. Her hands are shown on the photograph below:
Which of the following is the most likely treatment to have caused this problem?
A. Bevacizumab.
B. Capecitabine.
C. Erlotinib.
D. Irinotecan.
E. Oxaliplatin.
RACP 2018a Q74
- A 35-year-old man presented with a painless testicular lump and imaging revealed bulky
retroperitoneal lymph nodes.
Which tumour marker profile is most consistent with his diagnosis of pure seminoma testicular
cancer?AFP βHCG LDH Profile A Normal Elevated Elevated Profile B Elevated Normal Normal Profile C Elevated Normal Elevated Profile D Elevated Elevated Elevated Profile E Normal Normal Normal
A. Profile A.
B. Profile B.
C. Profile C.
D. Profile D.
E. Profile E.
RACP 2018b Q1
101.Treatment of oestrogen-receptor positive breast cancer with tamoxifen causes cells to accumulate in which cell cycle phase?
A. G0
B. G1
C. G2
D. M
E. S
RACP 2018b Q111
111.BCL-2 inhibitors have recently shown to have therapeutic efficacy in blood cancers.
What is the function of BCL-2 protein?
A. Activates cell death receptors.
B. Activates cell survival proteins.
C. Activates effector caspases.
D. Inhibits cell apoptotic proteins.
E. Inhibits cell survival proteins.
RACP 2018b Q132
132.In which of the following groups is the benefit of BRCA1/2 genetic testing most established?
A. Men ≤ 60 years of age with prostate cancer.
B. Men with breast cancer irrespective of age.
C. Women with breast cancer who have two relatives with diagnosis of breast cancer.
D. Women with epithelial ovarian cancer irrespective of grade.
E. Women ≤ 50 years of age with triple negative breast cancer.
RACP 2018b Q155
155.In cancer pathology what does Ki-67 expression reflect?
A. Cell proliferation.
B. Epithelial origin.
C. Invasive potential.
D. Mutational load.
E. Tumour-infiltrating lymphocytes.
RACP 2018b Q157
157.The pathophysiology of chemotherapy-induced nausea and vomiting involves activation of neurotransmitter receptors in the brain. What is the receptor for the neurotransmitter, substance P?
A. 5-Hydroxytryptamine-3.
B. Dopamine-2.
C. Gamma-aminobutyric acid A.
D. Histamine-1.
E. Neurokinin-1.
RACP 2018b Q158
158.Epidermal growth factor receptor (anti-EGFR) therapy (e.g. cetuximab) improves disease-free survival and overall survival in patients with which type of metastatic colorectal cancer?
A. Both EGFR and KRAS mutant.
B. EGFR mutant.
C. EGFR wild-type.
D. KRAS mutant.
E. KRAS wild-type.
RACP 2018b Q158
158.Epidermal growth factor receptor (anti-EGFR) therapy (e.g. cetuximab) improves disease-free survival and overall survival in patients with which type of metastatic colorectal cancer?
A. Both EGFR and KRAS mutant.
B. EGFR mutant.
C. EGFR wild-type.
D. KRAS mutant.
E. KRAS wild-type.
RACP 2017
In patients with Breast Cancer, bone metastases are more likely to occur in which subgroup?
A. ER positive
B. PR positive
C. HER 2 overexpressed
D. Triple negative
E. BRCA1 mutation positive
RACP 2017
A 38-year-old male presents with dyspnoea. He has a background of metastatic testicular cancer and is one week post his fourth cycle of BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy. He is saturating at 84% on room air.
What is the most likely cause of dyspnoea?
A. LV dysfunction
B. Pericardial effusion
C. Lymphangitis carcinomatosis
D. Pulmonary fibrosis
E. Coronary vasospasm
RACP 2017
Which is the most common form of lung cancer in Australia?
A. Squamous
B. Adenocarcinoma
C. Small cell
D. Large cell
E. Bronchoalveolar
RACP 2017
A 74-year-old male presents with progressive dyspnoea on a background of a 50-pack-year smoking history. CT Chest shows bulky mediastinal lymphadenopathy. What is the most likely diagnosis?
A. Lung Adenocarcinoma
B. Hodgkin’s Lymphoma
C. Small Cell Lung Cancer
D. Germ Cell Tumour
E .Thymic mass
RACP 2017
Which of the following tumour markers is known to increase with smoking?
Repeat from 2016 paper
A. CA-125
B. CEA
C. CA-19.9
D. β-hCG
E. αFP
RACP 2017
Match the clinical features below with the most likely hereditary cancer syndrome from the list above.
Recent pituitary surgery, abdominal pain and nephrolithiasis
A. Peutz-Jegher Syndrome
B. Multiple Endocrine Neoplasia Type 1 Syndrome
C. Multiple Endocrine Neoplasia Type 2 Syndrome
D. Familial Adenomatous Polyposis
E. Lynch Syndrome
F. Li Fraumeni Syndrome
Match the clinical features below with the most likely hereditary cancer syndrome from the list above. Gastric polyp and these oral lesions.
A. Peutz-Jegher Syndrome
B. Multiple Endocrine Neoplasia Type 1 Syndrome
C. Multiple Endocrine Neoplasia Type 2 Syndrome
D.Familial Adenomatous Polyposis
E. Lynch Syndrome
F. Li Fraumeni Syndrome
Chemotherapy induced nausea is a common clinical problem. What receptor does the neurotransmitter Substance P act on?
Similar question in 2016/2015 paper
A. GABA-A
B. Neurokinin-1
C. Dopamine
D. 5HT3
E. Histamine
RACP 2017
A 50-year-old male patient has received three doses of Ipilimumab for Melanoma. He presents to the emergency department with two days of large volume watery diarrhoea, abdominal cramps and moderate dehydration. There is no blood or mucus in the stool and he is afebrile. His blood pressure is 100/60 mm Hg with a heart rate of 100 bpm.
What is the most appropriate management strategy?
Repeat from 2016 paper
A. Supportive care
B. Oral Steroids
C. Broad Spectrum IV antibiotic therapy
D. High dose IV Steroids
E. G-CSF
Which of the following is the target of the monoclonal antibody Bevacizumab?
A. EGFR
B. TNF alpha
C. VEGF
D. PD-1
E. CD20
RACP 2016
Question 46
A 60 year old man with a history of prostate cancer treated with radiotherapy, presents with rectal bleeding causing hypotension requiring blood transfusion.
After initial resuscitation, continued bleeding would be best managed by which of the following measures?
A. Colonoscopic argon thermal coagulation
B. Radiological embolization
C. Surgical resection
D. Oral tranexamic acid
E. IV vasopressin
RACP 2016
Question 79
A man with prostate cancer and bony mets presents with nausea and abdo pain. He is usually on oxycontin 20mg bd. AXR shown below (constipation +++). What would be you management?
a) Ondansetron
b) Haloperidol
c) Macrogol Laxative
d) Fentanyl
e) Tramadol
RACP 2016
Question 8
On which receptor(s) does Aprepitant work?
A. Serotonin
B. Dopamine-2 receptors
C. Dopamine-4 receptors
D. NK-1
E. Serotonin and dopamine receptors
Question 28
What is the mechanism for increased efficacy of Trastuzumab-Emtansine (T-DM1)?
A. Increased half-life
B. Decreased efflux
C. Targeted delivery
D. Antibody dependent cell-mediated cytoxicity
E. Increased exposure to the tumour microenvironment
RACP 2016
Question 34
Mechanism of action of abiraterone in castrate resistant prostate ca?
A. Inhibits demineralisation of androgen receptor in prostate
B. Inhibits LH action on prostate
C. Inhibits conversion of dihydrotestosterone from testosterone
D. Inhibits conversion of testosterone from oestrogen
E. Inhibits testosterone production from prostate cancer cells
RACP 2016
Question 50
What is the change of a male of offspring of a female who is a carrier of the BRAC2 mutation inheriting that mutation?
A. 0%
B. 25%
C. 50%
D. 75%
E. 100%
RACP 2016
Question 56
A 65 year old female with a background of breast cancer which has undergone lumpectomy and radiology 4 year prior presents with shortness of breath with difficulty breathing. Her respiratory rate is 28 breaths/minute and oxygen saturation is 96% on room air. High resolution T chest shows features indicating extensive lymphangitis carcinomatosis.
Which of the following would be most useful for treating her shortness of breath?
A. Frusemide
B. Oxygen
C. Morphine
D. GTN
E. Sildenafil
RACP 2015a Q2
Question 2
A 75 year old man with squamous cell cancer of the lung presents with confusion. His
serum calcium is 3.85. Other bloods include GGT 308, ALP 218, AST 150, ALT 208 and
creatinine 150. He is commenced on IV fluids and the decision is made to also give
zolendronic acid.
Which of the following is most important to consider when dosing zolendronic acid?
A. Patient age
B. Degree of hypercalcaemia
C. Liver function
D. Renal function
E. Weight
RACP 2015a Q28
Question 28
A man has node positive colorectal cancer treated with resection and chemotherapy 12
months ago. Now followed up with CEA and serial CTs. What is the utility of these tests?
A. Testing for anastomotic recurrence
B. Testing if he needs further chemo
C. Testing for resectable liver / lung metastases
D. Testing for a new colorectal primary
E. Testing for pancreatic cancer
RACP 2015a Q73
Question 73
A 45 year old man has colon cancer with 3 adenomas on colonoscopy. No family history. Histology shows expression of mismatch repair genes MLH1, MSH2, MSH6 in tumour and also in surrounding normal tissue. What is the likely diagnosis?
A. HNPCC
B. FAP
C. Juvenile polyposis
D. Sporadic colon caner
E. Autosomal recessive adenomatous polyposis
RACP 2015b Q32
Question 32
What is single strongest factor for poor survival in invasive breast cancer?
A. Axillary lymph node involvement
B. High grade tumour
C. Large size of tumour
D. Oestrogen negative
E. Vascular invasion
RACP 2015b Question 53
Which combination has the worst prognosis in early breast cancer?
ER PR HER
A Positive Positive positive
B Positive Positive negative
C Positive Negative Negative
D Negative Negative positive
E negative negative negative
RACP 2015
Question
A 55 year old woman of Asian background presents with persistent cough and weight loss. She has a pleural effusion, and evaluation of this reveals a non-small cell lung cancer of adenocarcinoma type.
Which of the following tests would best direct her treatment?
A. CT chest, abdo, pelvis
B. MRI brain
C. EGFR status
D. EML-ALK status
E. Whole body PET scan
RACP 2015
Question
A 55 year old woman of Asian background presents with persistent cough and weight loss. She has a pleural effusion, and evaluation of this reveals a non-small cell lung cancer of adenocarcinoma type.
Which of the following tests would best direct her treatment?
A. CT chest, abdo, pelvis
B. MRI brain
C. EGFR status
D. EML-ALK status
E. Whole body PET scan
RACP 2015
Question
You are reviewing a 35 year old woman who is known to be positive for the BRCA1 gene.
What is the most sensitive test for detecting breast malignancy for her?
A. MRI
B. Ultrasound
C. Mammogram
D. CT
E. Regular clinician examination
RACP 2015
Which of the following factors predicts the worst prognosis in early breast cancer?
A. Axillary lymph node involvement
B. Large tumour size
C. High tumour grade
D. Age
E. Vascular invasion
RACP 2015
Question
What is the treatment for stage IIIA and IIIB non-small cell lung cancer who do not have
surgical resection?
A. Definitive chemotherapy
B. Chemoradiotherapy
C. Radiotherapy
D. Palliative chemotherapy
E. Rhubarb
RACP 2015 Q25
What is the primary use of PET scans in lung cancer?
A. Confirm a primary lung cancer
B. Confirm subcentrimere nodal metastases
C. Monitor treatment response
D. Determine metastatic disease before treatment of localised disease
E. Monitor metastatic disease
RACP 2015 Q48
Which of the following is the worst prognostic factor for NSCLC ?
A. Age over 80 years
B. BMI under 17
C. Poor performance status
D. Smoking
E. Bad breath
RACP 2015 Q15
Ipilimumab is used in the management of metastatic melanoma. Which of the following describes its mechanism of action?
A. BRAF
B. Cytokine
C. Cytotoxic T cell inhibitory antibody
D. Immune checkpoint inhibitor
E. Tumour specific antigen vaccine
RACP 2015 Q32
In the setting of breast cancer, whichof the following carries the worst prognosis?
A. Positive axillary lymph node
B. Large primary
C. Lymphovascular invasion
D. High grade
E. ER negative
RACP 2014 Question 3:
70 year old male with SCC is found to have hypercalcemia.
Bloods: Ca(corr): 3.42
Urea=8.1
Creatinine=135
What is the next step in management?
A. IV fluids
B. Dexamethsone
C. s/c denosumab
D. s/c calcitonin
E. IV bisphosphonate
RACP 2014 Q23
Which of the following is associated with a better prognosis in oropharyngeal cancer?
a. EBV positive
b. squamous cell carcinoma
c. HPV negative
d. p16 mutation positive
e. non smoker
RACP 2014 Q 75
Patient with sporadic colorectal cancer treated with resection 1 yr ago, is being monitored with CEA and CT chest/abdo/pelvis. By what curative intent does this monitoring offer?
A. Resection of solitary metastatic lung or liver lesion
B. Resection of pancreatic lesion
C. Low grade metastases for commencing chemotherapy
D. Detect Anastomotic site disease
E. Detect another primary tumour
RACP 2014 Q81.
A 58yo man with pancreatic cancer presents with acute shortness of breath and desaturation to 90% on room air. He is on Gemcitabine.
A CT of his lungs is shown.
What is the likely cause of his symptoms?
A) PE
B) Pulmonary oedema
C) Gemcitabine-induced penumonitis
D) Pneumonia due to febrile neutropaenia
E) Lymphangitis carcinomatosis
RACP 2013a Q11
Question 11
Which of the following factors has the most effect on CEA?
A. alcohol
B. exercise
C. obesity
D. smoking
E. depression
RACP 2013a Q13
Question 13
Which of the following chemotherapy agents carries the greatest risk of infertility?
A. Cyclophosphamide
B. Bleomycin
C. Methotrexate
D. Doxorubicin
E. Vincristine
RACP 2013a Q14
Question 14
A 76M has castrate resistant prostate cancer with bony metastases. Which of the following will help improve overall survival?
A. Docetaxel
B. Mitoxantrone
C. Zoledronic acid
D. Strontium
E. Radiotherapy
RACP 2013a Q30
Question 30
Which of the following incurs the greatest risk of tumour lysis syndrome?
A. Breast cancer
B. Colorectal cancer
C. Testicular cancer
D. Lymphoma
E. Renal cell cancer
Answer D
TLS is observed most frequently in patients with aggressive and highly aggressive lymphomas (particularly the Burkitt subtype) and acute lymphoblastic leukaemia following the initiation of cytotoxic therapy
RACP 2013a Q55
Question 55
Mechanism of aromatase inhibitors is:
A) Converts testosterone to oestradiol
B) Inhibits oestrogen at the receptor
C) Blocks production of oestrogen
D) Increases metabolism of oestrogen
E) Prevents aromatistion of oestradiol from testosterone
RACP 2013a Q60
Question 60
Which chemotherapy agent causes cold dysesthesias of the hands and feet?
A) Oxaliplatin
B) Vincristine
C) Doxorubicin
D) 5-Fluorouracil
E) Cyclophosphamide
RACP 2013b Q2
Question 2
What is the most likely non-SCC malignancy in renal transplant patients?
a) Colorectal Ca
b) Native kidney Ca
c) Lymphoma
d) Pancreatic ca
e) Lung ca
RACP 2013b Q9
Question 9
A 75yo male patient has metastatic colorectal cancer. He spends most of his day resting in bed or in his chair and requires assistance with his activities of daily living. What is his ECOG score?
A. 0
B. 1
C. 2
D. 3
E. 4
RACP 2013b Q13
Question 13
55 yr old female with a history of colorectal node positive cancer, managed with resection and chemotherapy. She is found to have a single 2cm liver lesion a few years later. What is the most appropriate next step in her management?
A. Chemotherapy
B. radiotherapy
C. lesion resection
D. TACE
E. RFA
RACP 2013b Q18
Question 18
A 69yo male patient of yours is found to have an elevated serum paraprotein level of 35g/L. BMAT reveals 30% monoclonal plasma cell infiltrate. He has no evidence of anaemia, renal impairment, hypercalcaemia or lytic lesions. What is the next step in management?
A. Observe and monitor
B. Arrange for autologous stem cell transplantation
C. Commence thalidomide
D. Commence dexamethasone
E. Commence combined therapy with prednisolone and thalidomide / bortezomib
RACP 2013b Q34
Question 34
A 25M with testicular cancer is receiving cisplatin based chemotherapy. He has been given dexamethasone, metoclopramide and aprepitant prior to receiving chemotherapy. He is now agitated, very anxious and complaining of abnormal eye movements. What is the best immediate treatment?
A. Aspirin
B. IV benztropine
C. Hydrocortisone and promethazine
D. Cease cisplatin
E. SL lorazepam
RACP 2013b Q44
Question 44
A 45yo male is found to have an adenocarcinoma of the sigmoid colon. The rest of his colonoscopy was normal. He has no other family or personal history of cancer. Immunohistochemistry of the tumour showed mismatch repair mutations in MLH1, MSH2, and MSH6 in the tumour and adjacent normal tissue. What would be the surveillance recommendations for his children?
A. FOBT yearly from age 50
B. Colonoscopy 5 yearly from age 35
C. No surveillance
D. Yearly colonoscopy from age 25
E. Second yearly colonoscopy from age 45
RACP 2013b Q56
Question 56
What is single strongest factor for poor survival in Breast cancer?
A) Lymph node involvement
B) High grade tumour
C) Large size of tumour
D) Oestrogen negative
E) Vascular invasion
RACP 2013b Q57
Question 57
What is the population attributable risk of malignancy to obesity?
A. 0.1
B. 0.3
C. 0.5
D. 0.7
E. 0.9
RACP 2013b Q60
Question 60
A 45yo male patient has a glioblastoma multiforme removed neurosurgically. Which of the following is the next step in his post-operative care?
A. Chemotherapy
B. Radiotherapy
C. Chemo-radiotherapy
D. No further therapy needed
E. Biological agents
RACP 2011b Q80
Question 80
Patients with non-small cell lung cancer with an EGFR receptor mutation are often responsive and have a better prognosis when treated with tyrosine kinase inhibitors. Which tumour phenotype is most predictive of having an EGFR receptor mutation?
RACP 2009a Q1
QUESTION 1
In Hereditary non poliposis colon cancer (HNPCC) which is the most typical phenotype
RACP 2008b Q9
QUESTION 9
A 60-year-old man, with a past history of hypertension, type 2 diabetes and a 20 pack year history of smoking, presents with sudden onset of headache and a mild left sided hemiparesis. His cranial computed tomography (CT) scan is shown below.
The most likely diagnosis is:
A. cerebral metastasis.
B. hypertensive haemorrhage.
C. amyloid angiopathy.
D. arteriovenous haemorrhage.
E. giant cerebral aneurysm.
RACP 2008b Q34
A 24-year-old man presented with a left testicular mass and a serum αfetoprotein (AFP) of 560 μg/L
[<10 μg/L] with a normal serum human chorionic gonadotrophin (HCG). An orchidectomy revealed embryonal testicular carcinoma. He received four cycles of chemotherapy with cisplatin, etoposide and bleomycin (BEP regime). His serum αfetoprotein is now normal. His post-completion chemotherapy abdominal computed tomography (CT) scan is shown below.
The most appropriate next step in his management is:
A. autologous stem cell transplant.
B. external beam radiotherapy.
C. ongoing observation.
D. continue BEP chemotherapy.
E. retroperitoneal lymph node dissection.
RACP 2007b Q54
QUESTION 54
A 55-year-old woman presents with vague abdominal pain. Her CT scan is shown below.
A biopsy of the lesion shows spindle shaped cells. The most likely diagnosis is:
A. adenocarcinoma of esophagus.
B. gastrointestinal stromal tumour.
C. linitis plastica.
D. adrenal tumour.
E. renal cell tumour (hypernephroma).
RACP 2007b Q73
A 62-year-old woman with history of breast cancer treated with surgery, chemotherapy and
radiotherapy three years earlier presents with the following abnormality.
The most likely diagnosis is:
A. cellulitis.
B. radiation recall.
C. tumour recurrence. 4-14% recurrence within 3 years time after mastectomy. Recurrence occur later after lumpectomy coz ppl requiring mastectomy have more advanced disease. Also recurrence picked up earlier when there is less breast cancer left
D. Inflammatory breast cancer. Rarely can occur as a secondary after a non-inflammatory breast cancer
E. Paget’s disease. Primary nipple disease
RACP 2007b Q95
A patient with known lung cancer presents with nausea and lethargy. His serum sodium is 119 mmol/L. Which of the following sets of results is most consistent with a diagnosis of the syndrome of inappropriate antidiuretic hormone (ADH) secretion?
RACP 2006a Q21
Which one of the following patterns of electrolyte changes is most consistent with tumour lysis?
Answer D
TLS releases intracellular contents - causing hyperkalaemia, hyperuricaemia (uric acid is a breakdown product of nucleic acids), hyperphosphatemia and hypocalcaemia (precipitates with phosphate to form calcium phosphate crystals).
RACP 2005b Q46
The photographs opposite are of the immunohistochemistry staining of breast tumour in a patient presenting with metastatic disease. The antigens used are human epidermal growth factor receptor 2 protein (Her2) (Figure 1), and oestrogen receptor (ER) and progesterone receptor (PR) (Figure 2).
A patient with this result is most appropriately treated with:
A. trastuzumab (herceptin) but not letrozole.
B. trastuzumab and letrozole.
C. letrozole but not trastuzumab.
D. trastuzumab and tamoxifen.
E. tamoxifen but not trastuzumab.
RACP 2005b Q85
A 50-year-old man presents with shortness of breath, facial swelling and chest tightness. The computed tomography (CT) scan of his chest is shown above. The malignancy most likely responsible for this presentation is:
A. lymphoma.
B. thymoma.
C. lung cancer.
D. germ cell tumour.
E. melanoma.
RACP 2004b Q31
A young woman with advanced ovarian cancer presents with nausea, vomiting and abdominal pain. Her abdominal X-rays are shown below.
Which of the following treatments is most likely to improve her symptoms?
A. Ondansetron.
B. Domperidone.
C. Octreotide.
D. Hyoscine.
E. Prochlorperazine.
RACP 2002b 74
A 40-year-old woman with breast cancer presents because of increasing back pain. Her neurological examination reveals pyramidal weakness and brisk reflexes in lower limbs and upgoing plantar reflexes. The magnetic resonance imaging (MRI) scan of her spine is shown below. She is given 16 mg dexamethasone as a loading dose. The most appropriate next step in management is:
A. radiotherapy.
B. chemotherapy.
C. surgical decompression.
D. high-dose intravenous methylprednis(ol)one.
E. pamidronate.
RACP 2002b QUESTION 80
A 76-year-old man with a history of prostate cancer treated with radiotherapy a year ago, presents with increasing bone pain and tenderness involving the right chest wall. His prostate-specific antigen is 766 ng/mL [<6]. His bone scan is shown below.
The most effective therapy would be:
A. corticosteroids.
B. androgen deprivation.
C. radiotherapy.
D. chemotherapy.
E. best supportive care.
RACP 2001b Q56
A 76-year-old man with a history of prostate cancer treated with radiotherapy a year ago, presents with increasing bone pain and tenderness involving the right chest wall. His prostate specific antigen is 766 ng/mL [<6]. His bone scan is shown below. The most effective therapy would be:
A. corticosteroids.
B. androgen deprivation.
C. radiotherapy.
D. chemotherapy.
E. best supportive care
RACP 2001b Q92
Question 92
A 63-year-old woman with metastatic breast cancer with skeletal metastases presents with dry cough and shortness of breath. Six weeks ago she completed palliative radiotherapy to her T5 vertebra because of painful metastatic involvement. She is currently receiving tamoxifen. On examination she is afebrile and her chest auscultation reveals fine crepitations in the left upper zone. Her chest X-ray is shown below.
The most appropriate next step in her management is to:
A. cease tamoxifen and commence aromatase inhibitor therapy.
B. cease tamoxifen and commence cytotoxic chemotherapy.
C. add antifungal treatment.
D. add intravenous antibiotics.
E. add corticosteroids.
RACP 2000b Q46
Question 46
A 71-year-old woman, who lives alone, presents to the Accident and Emergency Department with a history of increasing back pain over two months. The X-ray obtained is shown below.
What is the most likely diagnosis?
A. Myeloma.
B. Osteoporosis.
C. Breast cancer.
D. Lymphoma.
E. Paget’s disease.
RACP 1999b Q17
Question 17
A 55-year-old woman who had a right mastectomy for breast cancer three years ago develops progressive low back discomfort. Her pain increases despite anti-inflammatory treatment.
Examination reveals no evidence of recurrent or metastatic breast cancer. Neurological examination is normal except for an equivocal right plantar reflex. Bowel and bladder function are normal. X-rays show generalised increase in radiolucency and reduced height of two lumbar vertebrae. The magnetic resonance imaging (MRI) scan is shown.
Which one of the following is the most appropriate management?
A. Intrathecal methotrexate.
B. Combination chemotherapy.
C. Discectomy and vertebral fusion.
D. Surgical decompression and radiotherapy.
E. Oestrogen replacement therapy.
RACP 1999b Q76
A 55-year-old female smoker presents with cough and weight loss. Clinical examination reveals reduced air entry over the left hemithorax and signs compatible with pulmonary collapse. The liver is not enlarged but a small firm
lymph gland is found in the left supraclavicular fossa. The chest X-ray is shown below. Bronchoscopic biopsy of the left main bronchus shows an undifferentiated carcinoma, and the serum neurone specific enolase is elevated
at 23.5 U/L [<12.5].
Which one of the following treatment modalities would be most appropriate?
A. Surgery.
B. Bronchoscopic laser therapy.
C. Radiotherapy.
D. Chemotherapy.
E. Palliative care
