Carcinogenesis

​Question

A 60-year-old man receives a bowel cancer screening kit in the post for the first time. He is asymptomatic with an unremarkable medical history and family history. In the next 10 years, how often will he be invited for screening?​

Subject | Subject

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Multiple Choice

A 60-year-old man receives a bowel cancer screening kit in the post for the first time. He is asymptomatic with an unremarkable medical history and family history. In the next 10 years, how often will he be invited for screening?

• Annually

• Every 2 years

• Every 3 years

• Every 5 years

​Question

Which one of the following clinical features would not warrant an urgent referral (i.e. within 2 weeks) to local colorectal services?​

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Unexplained iron-deficiency anaemia in a 68 year old man

3 month history of unexplained bleeding in a 62 year old woman

Palpable rectal mass in a 38 year old woman.

​A 57 year old woman with a 7 week history of looser stools.

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Subject | Subject

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Multiple Choice

Which one of the following clinical features would not warrant an urgent referral (i.e. within 2 weeks) to local colorectal services?​

• Unexplained iron-deficiency anaemia in a 68 year old man

• 3 month history of unexplained bleeding in a 62 year old woman

• Palpable rectal mass in a 38 year old woman.

• ​A 7-week history of looser stools in a 57 year old woman.

Multiple Choice

Which best describes Lynch syndrome?

• An autosomal recessive mutation in DNA mismatch repair genes

• An autosomal dominant mutation in DNA mismatch repair genes

• An autosomal recessive mutation in tumour repressor genes

• An autosomal dominant mutation in tumour repressor genes

Multiple Choice

A 72-year-old woman presents with a two day history of diarrhoea and pain in the left iliac fossa. Her temperature is 37.8ºC. She has a past history of constipation. What is the most likely explanation of her symptoms?

• Diverticulosis

• Diverticular disease

• Diverticulitis

• Colorectal cancer

Multiple Choice

A 26 year old lady comes in to see the GP with postcoital and intermenstrual bleeding for 6 months. She has no associated pain or changes in her vaginal discharge. On speculum examination, the cervix looks abnormal. On bimanual examination the uterus is anteverted, there are no masses and no adnexal tenderness or cervical excitation.

She has no other past medical history. She has never been pregnant and she is yet to have a smear.

What is the most appropriate course of action?

• Urgent (2 week wait) cervical smear

• Arrange a transvaginal ultrasound scan

• same day referral to inpatient gynaecology ward

• urgent (2 week wait) referral to gynaecology

• Urgent CT chest abdomen and pelvis

Question​

You review a 72-year-old man with metastatic bowel cancer who is in the terminal phase and has a syringe driver. Unfortunately he has developed intestinal obstruction and is suffering with bowel colic. What is the most appropriate drug to add to the syringe driver?​​

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Multiple Choice

You review a 72-year-old man with metastatic bowel cancer who is in the terminal phase and has a syringe driver. Unfortunately he has started to have noisy breathing and appears distressed. What is the most appropriate drug to add to the syringe driver to reduce secretions?

• Metoclopramide

• Morphine

• Haloperidol

• Hyoscine butylbromide

Multiple Choice

Which of the following ISN'T a risk factor for breast cancer?

• Late menarche

• Obesity

• Smoking

• Oral combined contraceptive pill use

Multiple Choice

Which one of the following women should be referred immediately under 2WW for breast cancer?

• A 29 year old woman with a new lump in her left breast.

• A 45 year old woman with new onset nipple discharge from her right breast.

• A 45 year old woman with a new lump in her right breast

• A 55 year old woman with a painful left breast.

​Questions

A 56-year-old lady initially presented with a hard painless lump in her left breast and was recently diagnosed with invasive ductal carcinoma following a core biopsy. Her last menstrual period was over 7 years ago and she has no history of ovarian/endometrial cancer. Hormone receptor studies from the biopsy came back as:​

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She had left mastectomy and axillary node clearance followed by radiotherapy. She is seen in breast clinic 1 month later and is making a good recovery, with no signs of recurrence. What mode of hormonal therapy should she be offered?​

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Subject | Subject

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Multiple Choice

What hormone therapy should she be offered?

• Tamoxifen

• Trastuzumab

• Anastrazole

• None

Multiple Choice

Which tumour marker is most suggestive of pancreatic cancer

• CAE

• CA 19-9

• CA 125

• CA 15-3

Multiple Choice

A 50 year old man presents to the GP with a 6 month history of progressive weight loss, fatigue and night sweats. He also reports abdominal discomfort.

On examination, he has splenomegaly and is cachectic but there are no other abnormalities.

Blood tests show a raised WCC and anaemia. Cytogenetic analysis of the patient's blood shows that he is positive for the Philadelphia chromosome.

What is the most likely diagnosis?

• Chronic Myeloid Leukaemia

• Chronic lymphocytic leukaemia

• Hodgkins lymphoma

• Non-Hodgkins lymphoma

• Acute haemolytic anaemia

Multiple Choice

A 65-year-old female presents to her GP with a 1 month history of weight loss and night sweats. She has been generally lethargic and noted early satiety at meal times and abdominal discomfort. On abdominal examination a firm mass in the left upper quadrant extending towards the umbilicus is palpated.

Blood results show a WCC 100 X10^9 (4-11)

Blood film revealed granulocytes at different stages of differentiation.

Given the likely diagnosis what is the most appropriate treatment?

• R-CHOP regimen

• Danorubicin

• VAD chemotherapy regimen

• All trans retinoic acit (ATRA)

• Imatinib

Multiple Choice

A 66 year old male presents to the GP with shortness of breath on exertion and fatigue for the last few weeks. On examination, he has petechiae and splenomegaly.

Blood tests are ordered which show ↓haemoglobin (Hb), ↑white cell count (WCC), ↓platelets

He is referred to a specialist where a bone marrow biopsy is performed which shows high numbers of blast cells and Auer rods.

What is the most likely diagnosis?

• Hodgkins Lymphoma

• Chronic myeloid leukaemia

• Myelofibrosis

• Acute myeloid leukaemia

• Acute lymphoblastic leukaemia

Multiple Choice

You are an FY2 on rotation in GP. A 73 year old man presents having noticed enlarged Lymph Nodes in his neck, axillae and groin. 

A blood film shows that 60% of the white cells are small mature lymphocytes 

What is the most likely diagnosis?

• Acute lymphoblastic leukaemia

• Acute myeloid leukaemia

• Hodgkin's lymphoma

• Chronic myeloid leukaemia

• chronic lymphocytic leukaemia

Multiple Choice

A 3 year old male patient presents with a 1 month history of lethargy and abnormal bruising.

On physical examination there is conjunctival pallor and multiple petechiae and ecchymoses on the trunk and limbs. There is cervical lymphadenopathy and moderate hepatosplenomegaly.

Which of the following blood film findings is consistent with the most likely diagnosis?

• Rouleaux formation

• leukaemic lymphoblastic cells

• Smudge cells

• Mature myeloid cells

• Auer rods

Multiple Choice

A 70-year-old African male presents to his GP with fatigue, headaches and back pain. He has noted he has been constipated, urinating more frequently and his mood has been low in the last month. Over the last few months he has several chest infections and UTIs.

Given the most likely underlying diagnosis, what is the most appropriate initial investigation?

• Serum ACE

• Blood film

• Beta 2 microglobin

• MRI spine

• Serum protein electrophoresis

Multiple Choice

A 20 year old male presents to his GP with progressive neck swelling. He says that it becomes painful when he drinks alcohol. He has unintentionally lost around 5kg in weight over the last few months.

On examination, he has unilateral non-tender cervical lymphadenopathy. There are no other significant findings.

The patient is referred to a specialist who biopsies the lymph node. Tissue analysis shows the presence of Reed Sternberg cells.

What is the most likely diagnosis?

• Hodgkins lymphoma

• Acute lymphoblastic leukaemia

• Chronic myeloid leukaemia

• viral infection

• Non-hodgkins lymphoma

Multiple Choice

A 6 year old boy who has recently emigrated with his parents from Nigeria is referred to the paediatric department with loss of appetite, jaw lymphadenopathy and unexplained fever. Following further investigation, he is diagnosed with Burkitt's lymphoma.

What virus is this child most likely to test positive for that would have made him more susceptible to developing Burkitt's lymphoma?

• Zika virus

• Herpes zoster virus

• SARS-CoV-2

• Dengue Virus

• Epstein-Barr Virus

Multiple Choice

A 20 year old male presents to his General Practice with persistent cervical lymphadenopathy and fever weight loss and night sweats. He is referred for a biopsy which show Reed-Sterberg cells. On further investigation it is noted that he has inguinal lymphadenopathy that also show Reed-Sterberg cells on biopsy. There is no evidence of liver, spleen or marrow involvement.

Given his likely diagnosis what stage is his disease?

• 2A

• 1B

• 4B

• 3B

• 3A

Multiple Choice

A 75-year-old man with a previous history of prostate cancer cured by external beam radiotherapy presents to A&E with a history of urinary retention. On further probing, he describes a two-month history of severe lower back pain. He describes the pain as being worse at night and while lying flat, which has significantly disturbed his sleep.

What is the most important investigation to arrange to confirm the most likely diagnosis?

Magnetic resonance imaging of the lumbar spine

Whole body positron emission tomography (PET) scan

Prostate specific antigen (PSA) serum level measurement

Computed tomography (CT) scan of the whole spine

Magnetic resonance imaging (MRI) of the whole spine

• MRI of the lumbar spine

• whole body PET scan

• PSA serum level measurement

• CT scan of whole spine

• MRI of whole spine

Multiple Choice

A 12 month old baby is brought to the GP practice by his mother as she is concerned that he cannot see well. On examination at the slit lamp, the patient has a large cream coloured mass in the fundus of both eyes.

The red reflex is absent.

The baby was adopted, and it is unknown whether either of the biological parents had similar symptoms as a baby.

What is the most likely diagnosis?

Sporadic retinoblastoma

Hereditary retinoblastoma

Retinopathy of prematurity

Congenital cataracts

Congenital glaucoma

• Sporadic retinoblastoma

• Hereditary retinoblastoma

• Retinopathy of prematurity

• Congenital cataracts

• Congenital glaucoma

Multiple Choice

A 56-year-old woman is admitted with a 4 day history of worsening shortness of breath and a significant decrease in her exercise tolerance. She has had no fevers and has not felt otherwise unwell. Her inflammatory markers are mildly raised. A chest X-ray is performed which shows a large-right sided pleural effusion. A diagnostic pleural tap is performed and the fluid is sent for analysis. The results are:

Pleural fluid protein: 29 g/L

Pleural fluid protein : serum protein ratio 0.78

Pleural fluid LDH : serum LDH ratio 0.81

Which of the following is the most likely cause of her pleural effusion?

• Malignancy

• Heart failure

• Bronchiectasis

• Pneumonia

• Liver cirrhosis