Description
In this collection, there will be a bunch of questions to help doctors to prepare for the Specialty Certificate Examination in Medical Oncology
Study Set Content:
Specialty Certificate
Examination
in Medical Oncology Sample Questions
Question 1.
A 28-year-old woman was found to have stage IV Burkitt’s lymphoma. Her renal function was
normal and a staging CT scan had shown no abnormality of the renal tract. Three days later,
when she was about to start chemotherapy, she developed a temperature of 39.0°C with
rigors and was treated with imipenem.
Investigations (the following day):
serum sodium
138 mmol/L (137–144)
serum potassium
6.2 mmol/L (3.5–4.9)
serum
creatinine
215
μ
mol/L (60–110)
serum corrected calcium
1.60 mmol/L (2.20–2.60)
serum phosphate
1.52 mmol/L (0.8–1.4)
serum lactate dehydrogenase
1238 U/L (10–250)
serum urate
0.69 mmol/L (0.19–0.36)
What is the most likely cause of the renal impairment?
A imipenem
toxicity
B intravenous
contrast
toxicity
C kidney
infiltration
D septic
shock
E tumour lysis syndrome
Question 2.
A 44-year-old woman presented with post-coital bleeding. Investigation revealed a 2-cm
grade 1, stage IB1 squamous cell carcinoma of the cervix. There was no evidence of
lymphovascular space invasion. She had completed her family.
What is the most appropriate treatment?
A brachytherapy
B chemo-radiotherapy
C excision cone biopsy only
D radical
hysterectomy
E vaginal
trachelectomy
Question 3.
A 43-year-old man presented with vomiting and 4-kg weight loss. His performance status was
1. He was found to have a pre-pyloric gastric carcinoma gastric outlet obstruction. A CT scan
showed no metastases.
What is the most appropriate next step?
A chemo-radiation
B neoadjuvant
chemotherapy
C palliative
bypass
D radical
resection
E self-expanding
stent
Question 4.
A 72-year-old man was found to have an anterior rectal cancer at 2 cm from the anal verge. A
CT scan of chest, abdomen and pelvis showed no evidence of metastatic disease. An MR
scan of pelvis showed an anterior tumour abutting the prostate gland, radiologically staged as
a T3, N1, M0 cancer.
What is the most appropriate next step in management?
A abdominoperineal
resection
B chemotherapy
C long-course
chemoradiation
D short-course
radiotherapy
E total mesorectal excision
Question 5.
A 42-year-old man presented with a 1-month history of altered personality and increased
seizure frequency. An MR scan of brain demonstrated an enhancing lesion in the right frontal
lobe. Histology revealed a grade 3 oligodendroglioma, with loss of heterozygosity of 1p/19q.
What is the most appropriate treatment?
A chemoradiation with temozolomide
B cranial
irradiation
C craniospinal irradiation
D procarbazine, vincristine and lomustine (PCV)
E temozolomide
Question 6.
A 50-year-old woman with early breast cancer presented with fatigue to the accident and
emergency department on day 7 of her first adjuvant chemotherapy cycle. On examination,
her temperature was 38.5°C, her pulse was 110 beats per minute and her blood pressure was
110/70 mmHg. A full blood count was requested.
What is the most appropriate next step?
A await full blood count result
B intravenous broad-spectrum antibiotics
C intravenous broad-spectrum antibiotics and granulocyte colony-stimulating factor (G-CSF)
D oral broad-spectrum antibiotics
E oral broad-spectrum antibiotics and G-CSF
Question 7.
A 35-year-old man sought advice about the increased risk of cardiac complications following
chemotherapy. Eight years previously, he had been successfully treated for Hodgkin’s
disease with six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine, and
mediastinal radiotherapy.
For how many years from the end of treatment will this increased risk persist?
A 1–5
B 6–10
C 11–15
D 16–20
E >20
Question 8.
A 52-year-old woman presented with hot flushes. Her last menstrual period had been 1 year
previously. She was treated with ethinylestradiol and medroxyprogesterone acetate.
Which potential consequence of oestrogen therapy is most reduced by co-prescription of a
progestogen?
A breast cancer
B breast pain
C endometrial cancer
D mood changes
E weight gain
Question 9.
A 59-year-old man was referred because of a change in bowel habit. He had noticed no
alteration in stool calibre, gastrointestinal bleeding or unintended weight loss. There was no
family history of colonic polyps or gastrointestinal malignancy.
Physical examination was normal. A rectal examination revealed no masses. A
sigmoidoscopy revealed a 4-mm polyp in the mid-rectum, which was removed with forceps,
and histology revealed a tubular adenoma.
What is the most appropriate next step in management?
A barium enema now
B colonoscopy in 3 years
C colonoscopy in 5 years
D colonoscopy now
E sigmoidoscopy in 1 year
Question 10.
A 58-year-old man presented with haemoptysis, weight loss and worsening breathlessness.
He was a lifelong heavy smoker. His chest X-ray was abnormal. A CT scan of chest and
abdomen demonstrated a large mass in the right lower lobe invading into the mediastinum
and pericardium, extensive mediastinal lymphadenopathy, and bone metastasis (T4, N3,
M1b). Bronchoscopy and biopsy confirmed a squamous cell carcinoma. Mutation analysis
revealed that EGFR and K-ras
genes were both wild type.
What is the most appropriate first-line therapy?
A docetaxel
B erlotinib
C gefitinib
D gemcitabine and cisplatin
E pemetrexed and cisplatin
Question 11.
A 55-year-old man underwent resection of a T2 clear cell renal carcinoma.
What is the most likely pathogenesis?
A activating mutations of the VHL gene
B MET oncogene activity
C mutation of p53
D up-regulated
expression
of HIF-controlled genes
E von Hippel–Lindau syndrome
Question 12.
A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed
the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm
seminomatous germ cell tumour without non-seminomatous components. There was
evidence of vascular invasion within the testis.
Investigations:
serum lactate dehydrogenase (LDH)
1250 U/L (10–250)
serum
α
-fetoprotein
normal
serum
β
-human chorionic gonadotrophin (HCG) 700 U/L (<5)
A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3-cm
mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver,
brain or bone metastases.
What is the most appropriate International Germ Cell Cancer Collaborative Group
classification?
A good prognosis because of the absence of liver, bone and brain metastases
B good prognosis because of the raised HCG and LDH
C intermediate prognosis because of the presence of lung metastases
D intermediate prognosis because of the raised serum HCG and LDH
E poor prognosis because of the raised serum HCG and LDH
Question 13.
A 29-year-old woman had a 2.5-mm Breslow thickness melanoma removed from her right
shin. She was referred for wide local excision of the scar and consideration of sentinel node
biopsy.
In what proportion of patients with a negative sentinel node biopsy does nodal recurrence
subsequently develop in the same lymph node basin?
A <1%
B 1–4%
C 5–9%
D 10–14%
E 15–25%
Answer keys:
1.
E
2.
D
3.
D
4.
C
5.
B
6.
B
7.
E
8.
C
9.
D
10.
D
11.
D
12.
A
13.
B
