ONCOLOGY MCQ

1. Regarding G-CSF - the best description of its mechanism of action and role in chemotherapy is

a. reduced PMN nadir when used as prophylaxis

b. reduced duration of neutropenia when used as prophylaxis
c. not useful unless already neutropenic
d. reduce thrombocytopenia severity
e. reduces mortality
f. potentiates effects of chemotherapy

2. Mutations in which gene are least likely to be associated with breast cancer if inherited in the germ-line?

a. ATM (ataxia-telangiectasia)
b. BRCAl
c. BRCA2
d. Bcl-2
e. p53

3. The least likely to be associated with bowel cancer is

a. Ataxia telangiectasia
b. Der-abl gene translocation
c. BRCA-1
d. BRCA-2
e. Pcl-2

4. 14 year old girl with Hodgkin's disease is treated with radiotherapy (mantle field). Which is the most likely
secondary carcinoma that could develop

a. breast
b. Lung
c. thyroid
d. NHL
e. AML

5. Young male with germ cell cancer. He is on bleomycin. etoposide and cisplatinum.
What side effect would make you stop the treatment?

a. peripheral neuropathy
b. neutropenic septicaemia
c. interstitial lung disease
d. high tone hearing loss

6. Most likely route of ovarian cancer spread:

a. peritoneal
b. direct spread to adnexae
c. lymphatic
d. direct spread to other organs

7. Man with medullary carcinoma of thyroid, worried about his son. What do you do?

a. yearly calcitonin
b. look for ret oncogene in the cancer
c. look for ret oncogene in blood
d. pentagastrin stimulation test
e. reassure

8. Metastatic renal cell carcinoma, symptomatic:

a. best supportive care

b. radiotherapy
c. surgery
d. interferon
e. Vinblastine

9. An older woman with CA breast with bony mets who was on aminoglutamethonine. Picture of rash which
covered right breast and covered left breast a little, small nodules, some dead skin and a few scaly bits. Most likely
cause of rash?

a. fungal
b. radiation
c. aminoglutamethonine reaction
d. skin recurrence
e. zoster

10. Male with bone pain from metastatic prostate ca will be started on LHRH antagonist. He refuses
orchidectomy. His illness will show:

a. immediate improvement
b. initially worse then improvement
c. immediate improvement then decline
d. slow improvement
e. no change

11. Which of the following proto-oncogenes is least likely to be associated with an increased risk of breast cancer?

a. ATM (ataxia telangiectasia)

b. BRCA-1
c. BRCA~2
d. Bcl 2
e. p53
f. HER-2neu
g. Wiskott Aldrich Syndrome

12. A 40-year-old male is operated on for a medullary carcinoma of the thyroid. He expresses concern about his
10 yo son getting the disease. The best test:

a. b. Yearly calcitonin in son

b. yearly pentagastrin-stimulated calcitonin in son
c. DNA analysis for RET proto-oncogene in tumour
d. DNA analysis for RET proto-oncogene in peripheral blood
e. Thyroid ultrasound in son

13. Patient with germ cell tumour receiving BEP. Which side-effect would necessitate cessation of the responsible
drug:

a. neutropenia
b. high-tone severe hearing loss
c. peripheral neuropathy
d. interstitial lung damage
14. Cisplatin induced neuropathy will have which of the following features on nerve conduction studies:

a. Variety of descriptions with inc/dec velocities, absence F waves, sensory vs motor,

b. One mentioned H wave, increased or decreased amplitude, etc.

15. A female presents with shortness of breath. CXR is shown with whiteout of L lung. Told neurone-specific
enolase +ve, next best step in management:

a. Bronchoscopy with laser

b. Radiotherapy
c. Chemotherapy
d. Best supportive care
e. Surgical resection

16. Which of the following best describes the incidence of colon cancer with age:

a. Linear increase with age

b. Linear increase with plateau after age 50
c. Parabolic
d. Exponential rise after age 50
e. Bimodal distribution with peaks at age 50 and 70

17. All of the following can occur in germ line leading to breast cancer except which one:

a. BRCA1
b. BRCA2
c. Bcl-2
d. p53
e. Ataxia telangiectasia gene

18. Which of the following is the least likely to be involved in hereditary colon cancer:

a. APC gene
b. DNA repair gene
c. Microsatellites
d. Deletion of a gene
e. Chromosomal translocation

19. A 50 yo patient presents with metastatic renal cell carcinoma. The best management would be:

a. IFN-α
b. IL-2
c. Vinblastine
d. Best supportive care
e. Progesterone

20. The genetic defect in hereditary non-polyposis coli lies in:

a. APC gene
b. DCC gene
c. DNA repair defect
d. proto-oncogene
21. A female with a history of breast cancer removed. Photo shown ? previous modified radical mastectomy scar.
Diffuse erythema, with nodules and plaquing over and around scar with some extension onto contralateral breast is
evident. The most likely diagnosis is:

a. Radiation recall
b. Fungal infection
c. Tumour recurrence
d. Herpes zoster

22. Which is the strongest predictor of an increased risk of breast cancer in a 40 yo woman:

a. Early menarche
b. Late first pregnancy > 30 yo
c. Previous breast carcinoma in contralateral breast
d. Mother with breast cancer at age 70
e. Hormone replacement therapy

23. A young male has non-Hodgkin's lymphoma. The LMO starts prednisone whilst awaiting a haematology
admission. He presents unwell with WCC previously 30, now 2, urate 2.3, K 8.0, phosphate 10, Cr .25. The most
likely diagnosis?

a. Urate nephropathy
b. Tumour lysis syndrome
c. Dehydration
d. Lymphoma infiltration of kidneys

24. A young female (30 yo) had mantle radiotherapy in her teens. The most likely cancer site in her now:

a. Thyroid
b. Breast
c. Bone marrow
d. Lung
e. Lymph nodes

25. The most common mechanism of spread of epithelial ovarian cancer is:

a. Haematogenous
b. Lymphatics
c. Adjacent structures
d. Trans-coelomic

26. A man with metastatic prostate cancer with increasing bone pain. The decision is made to start a GnRH
agonist Your advice regarding the likely effect of this:

a. Immediate resolution of symptoms

b. Initial worsening of symptoms over two weeks followed by gradual resolution
c. Delayed resolution of symptoms
d. Slow progressive improvement of symptoms
e. Initial resolution followed by severe worsening of symptoms

27. Concerning lung cancer:

a. In Australia, the incidence in women is falling.

b. The use of chemotherapy in combination with radiotherapy in patients with stage III non-small cell lung cancer
is associated with improved survival.
c. Chemotherapy for metastatic non-small cell lung cancer improves quality of life but not survival.
d. The optimal treatment for limited stage small cell lung cancer is with chemotherapy alone.
e. Paraneoplastic manifestations occur in the majority of patients.

28. Regarding familial breast cancer, which of the following statements is true?

a. the majority of cases are also associated with mutations of the p53 gene.
b. mutation of the BRCA1 gene may be associated with an increased risk of both breast and ovarian cancer.
c. chemoprevention with tamoxifen is of proven benefit.
d. most affected families share the same specific mutation of the BRCA1 gene.
e. about 75% of affected family members develop breast cancer before the age of 35 years

29. BRCA-1:

a. Type of oncogene
b. Associated with male breast cancer
c. Associated with breast and ovarian cancer
d. Associated with sporadic breast cancer
e. Produces a truncated protein

30. Oesophageal cancer is associated with:

a. Alcohol abuse
b. Corrosive-associated damage
c. Achalasia
d. Reflux
e. Smoking

31. Concerning dysplastic naevi:

a. Usually < 5 mm in diameter

b. Homogeneously tan or black
c. If positive family Hx of malignant melanoma, and individual has dysplastic naevus, > 50% chance of
melanoma in lifetime

32. Small cell lung cancer is ? more associated with (? than NSCLC)

a. calcium
b. Clubbing
c. Cushing’s
d. Eaton-Lambert syndrome
e. Hyponatraemia

33. Regarding cell kinetics of cancer:

a. 1 cm tumour = 109 cells

b. Cells in G0 are highly sensitive to chemotherapy
c. Common cancers have doubling times of 20 days
d. Intrinsic mutation rate in common cancers ~ 1 in 106 cells
e. Growth in primary cancer decreases in the later stages of development

34. 73 yo female with metastatic breast cancer, on tamoxifen for 6/12. 2/7 Hx of nausea and thirst. Na+ 155, K+
5.2, urine osm 137. Has multiple mets including sella turcica. Next most appropriate mgt:

a. Saline
b. Fluid restriction
c. Intranasal desmopressin
d. APD
e. Demeclocycline

35. Pre-menopausal woman found to have left axillary and supraclavicular nodes. Bx showed poorly
differentiated cancer, oestrogen receptor poor. She has no other Sx, examination is otherwise normal and CXR and
mammogram are normal. Next Ix:

a. Endoscopy
b. Bronchoscopy
c. Local XRT
d. Chemo and XRT
e. Hormonal Rx

36. A patient with known disseminated lymphoma is anaemic, with Hb = 100, MCV = 74, Fe = 4, Ferritin = 300.
This is best explained by:

a. Fe deficiency
b. impaired release of Fe from macrophages
c. reduced erythropoietin
d. reticulocytosis
e. increased plasma clearance of Fe

37. Radiotherapy has its most severe effects on which tissues?

a. liver
b. kidney
c. lung
d. bone marrow
e. spinal cord

38. Which of the following is least likely to result form the administration of bleomycin?

a. sodium urate
b. calcium pyrophosphate
c. calcium hydroxyapatite

39. Pt with metastatic bowel cancer is taking Codeine 30 mg q4h without adequate analgesia. What is the most
appropriate therapy?

a. continue Codeine and add Paracetamol 1g qid

b. stop Codeine, start MS Contin l0 mg bd and Paracetamol 1g qid
c. stop Codeine, start MS Contin 20 mg bd and Paracetamol 1g qid
d. stop Codeine, start MS Contin l0 mg bd and Panadeine ii qid

40. Concerning the prophylactic use of G-CSF during cancer chemotherapy:

a. it decreases the duration of neutropenia

b. it decreases the severity of the neutropenic nadir
c. it increases platelet numbers
d. it potentiates the effect of chemotherapy
e. it is only useful in established neutropenia

41. Regarding this condition (photo of multiple dysplastic naevi). Which of the following statements are
incorrect?
a. Some lesions have the clinical features of a melanoma
b. Individuals with this condition have an increased risk of melanoma when compared with the general
population
c. The risk of melanoma is less in sporadic than familial forms
d. Epiluminescent microscopy has not been shown to aid earlier clinical detection of melanoma
e. Regular photography may be of value as melanomas always arise within existing lesions