Oncology

Question 1

vincristine, etoposide, oxaliplatin and paclitaxel are all recognised to cause neuropathy, oxaliplatin causes a classic acute sensory neuropathy that is aggravated by cold. It is thought to result from a specific interaction of oxaliplatin with voltage-gated sodium channels.

Question 2

What is the leading cause of death in testicular cancer survivors?

Answer 2

Second primary cancers
- atleast 2 x increase risk of developing solid tumours
- persists at least 30yrs post treatment

Question 3

Idosfamide

Answer 3

Synthetic structural isomer of Cyclophosphamide
- used in germ cell testicular cancer and some sarcomas

**Nephrotoxicity due to direct tubular injury **is a prominent complication

Tubular dysfunction:
- glucosuria
- Aminoaciduria
- proteinuria (LMW protein)
- increase in beta2microglobulin excretion
- DI –> polyuria

• Hypophosphatemia: reduced prox. tubular reabsorption
• Hypokalaemia due to wasting
• NAGMA

Can also:
- reduce GFR

Nephrotoxicity due to ifos is due cumulative dose, age <4

Question 4

Cetuximab

Answer 4

EGFR inhibitor
- beneficial with **BRAF/KRAS Wt and LEFT sided disease **

Question 5

p53 staining in BRCA1 can

Answer 5

all or nothing

patchy is uncommon

Question 6

role of VHL in normal physiology

Answer 6

suppression of HIF. HIF normally promotes angiogenesis and cell growth in hypoxic state

Question 7

Which phase does bleomycin act on

Answer 7

G2

Question 8

BRCA and ovarian ca

Answer 8

• All women diagnosed with non mucinous epithelial ovarian carcinoma before the age of 70 should be tested for BRCA1 and 2
• BRCA 2 confers a better prognosis with ovarian cancer, BRCA1 also likely does but the evidence is not as strong - this is also reflected in the effectiveness of novel PARP inhibitors.

Question 9

standard 5-fu treatment is not effective in patients with mismatch repair deficient Colorectal cancers

Answer 9

TRUE

Question 10

MMR colorectal cancer

Answer 10

commonly right-sided disease, mucinous Histology,
poor differentiation and lymphocytic infiltration

The majority cause MMR deficiency is due to methylation of that MLH1 gene as opposed to a germline mutations.

Question 11

BRAF mutation in melanoma

Answer 11

more common in younger people with limited sun exposure

80% of patients in BRAF inhibitors for melanoma will develop resistance due to MAPK reactivation. One way to avoid this resistance is to combine BRAF inhibitors with MEK inhibitors.

Question 12

“metinib”

Answer 12

MEK inhibtors

Question 13

What is the treatment for central and peripheral hiccups in palliative pt

Answer 13

Baclofen

Metoclopramide

Question 14

CTLA-4 inhibitors

Answer 14

Gastric toxicity

Question 15

PD-1 inhibitor

Answer 15

endocrine

Question 16

Gastric cancers, what’s the most commmon type?

Answer 16

Adeno

Question 16

Gastric cancers, what’s the most commmon type?

Answer 16

Adeno

Question 17

Most common location of gastric cancers

Answer 17

cardia then antrum

Question 18

Hiccups are a side effect of which antemetic?

Answer 18

Aprepitant

Question 19

Side effects of bevacizumab?

Answer 19

hypertension, proteinuria, arterial thromboembolic events and bleeding

Question 20

Which agents affect the S-phase

Answer 20

MTX, 5FU, Gemcitabine

Question 21

Majority of BRCA2 breast ca are

Answer 21

ER+ve

MRI screening is generally used in patients with prior radiotherapy/treatment for Hodgkin lymphoma as well as those with familial breast cancer syndromes.

Cyclin dependant kinases promote transition from G1 to S phase in cell cycle. CDK4 and 6 inhibitors such as palbociclib are used in the treatment of **hormone receptor positive metastatic breast cancer. **

The majority of breast cancer in males is estrogen receptor and androgen receptor positive.

Question 22

Anti Tr

Answer 22

Hodgkin’s disease

Question 23

Anti hu/zic4

Answer 23

SCLC

Question 24

Which factors worsens prognosis in Stage IV renal cell cancer?

Answer 24

* Karnofsky Performance Status (KPS) <80 * Time from original diagnosis to initiation of targeted therapy <1 year * Hemoglobin less than the lower limit of normal * Serum calcium greater than the upper limit of normal * Neutrophil count greater than the upper limit of normal * Platelet count greater than the upper limit of normal

Question 25

SE of crizotinib?

Answer 25

QT prolongation Neutropenia Visual changes Fluid retention Pulm. toxicity Change in bowel habit hepatotoxicity fatigue

Question 26

Enzalutamide

Answer 26

pure androgen receptor signalling inhibitor which is used and castrate resistant prostate carcinoma SE: HTN Fatigue Seizures SOB Cognitive impairment

Question 27

braf v600e mutation in colorectal cancers suggests

Answer 27

sporadic mutations

Question 28

What's the typical feature of breast cancer mets

Answer 28

Mostly lytic 25% can be mixed

Question 29

how does paroxetine and fluoxetine affect tamoxifen?

Answer 29

They are CYP2D6 inhibitors, thus reduces transformation of tamoxifen to active metabolite endoxifen.

Question 30

Which chemo may cause radiation recall reaction?

Answer 30

Daunorubicin

Question 31

RAdiation induced lung injury

Answer 31

radiation pneumonitis 4-12wks non productive cough, exertinal dypnsoea, low grade fever, chest pain, malaise, weight loss crackles or pleural rub

Question 32

Absolute CI to breast conservation surgery

Answer 32

1. Persistent positive resection margin after reasonable re-excision attempts 2. 2 or more primary tumour in separate breast quadrants 3. Diffuse malignant appearing mammographic microcalcification 4. A history of prior RT to the breast or chest wall 5. Pregnancy, although possible to perform BCT in 3rd trimester, deferring RT until after delivery

Question 33

RF for RCC

Answer 33

- Analgesic nephropathy - Leather tanners - Cadmium - Thorotrast - Acquired cystic disease - VHL - Smoking, HTN, Obesity

Question 34

Sunitinib

Answer 34

1st line for metastatic renal cell cancer - TKI inhibitor that inhibits VEDFR, PDGFR, c-Kit (CD117), FLT-3 - HTN is a good prognosticator for response to sunitinib

Question 35

women have higher risk for developing lung cancer for a given level of exposure to smoke than men true or false

Answer 35

true

Question 36

Lung adenocarcinoma - associated familial mutations

Answer 36

EGFR ALK

Question 37

Smoking increases the risk of mesothelioma True or false

Answer 37

False

Question 38

what does fixed inspiratory wheeze indicate?

Answer 38

bronchial obstruction by tumour

Question 39

which nerve palsy causes hoarseness?

Answer 39

REcurrent laryngeal

Question 40

Which lung cancers are implicated in SVC obstruction

Answer 40

Sq.CC SCLC

Question 41

Paraneoplastic endocrine sx with lung cancer

Answer 41

Sq. CC: PTHrP, insulin like activity SCLC: ADH, ACTH, Carcinoid sx, ELM Anti-hu

Question 42

Location and lung cancers

Answer 42

PEripheral - adeno Central lesion with obstructive pneumonitis: SqCC Mediastinal/Hilar mass: SCLC Alveolar infiltrate: bronchoalveolar Cavitation DOES NOT occur in SCLC

Question 43

What features on CT would suggest benign COIN LESION

Answer 43

Central or lamellar calcifications

Question 44

When are PET scan useful in lung ca

Answer 44

when lesion >1cm

Question 45

FEV1 requirement for pneumonectomy

Answer 45

FEV1 >1.5L DLCO >80% ## Footnote - <80% --> exercise testing --> Peak VO2 <35% --> resection not recommended Peak Vo2 >75 --> pneumonectomy

Question 46

what is the most common symptom of lung ca

Answer 46

persistent cough followed by breathlessness

Question 47

what do you do for immunotoxicity grade 3 that doesn't respond to methylpred?

Answer 47

Infliximab or vedolizumab

Question 48

cisplatin ototoxicity

Answer 48

second most common SE of cisplatin dose dependent high frequency sensorineural hearing loss with tinnitus - target outer hair cells in the organ of Corti and vascularised epithelium in the lateral wall of the cochlea

Question 49

which cancers contribute mostly to bone mets

Answer 49

Lung, breast, prostate Prostate is blastic

Question 50

how does calcitonin help yo improve hypercalcaemia in cancer

Answer 50

shift calcium out of the intravascular space

Question 51

RF associated with TLS

Answer 51

- rapidly dividing cells - bulk of disease is high - good response to tx - pre-exsiting renal impairment or dehydration - High serum LDH - high WCC

Question 52

which chemotherapy agents are associated with hand-foot syndrome?

Answer 52

5FU, docetaxel

Question 53

RF for developing prostate cancers

Answer 53

Age >50-65 Ethnicity: black >white, black: early and aggressive FHx BRCA1/BRCA2: more aggressive form Smoking