Copy of Medical Oncology Module 2

A patient with history of depression has breast cancer.

Which anti-depressant should be avoided when using Tamoxifen?

Which of the following is a known side effect effects effect of Aromatase inhibitor?

In early-stage breast cancer characterized by estrogen receptor positivity in postmenopausal women, which adjuvant therapy is most appropriate?

A 46-year-old female patient presents to the clinic with a diagnosis of stage IV breast cancer, characterized by supraclavicular and axillary lymph node involvement as well as liver metastases. The tumor is HER2 positive, and the patient maintains a good functional status.

What is the most appropriate initial treatment approach for this patient?

In premenoupausal women with estrogen receptor and progesterone receptor positive metastatic breast cancer, which of the following is the most effective agent in reducing estrogenic stimulation of the tumor?

While of the following tumor characteristics confers a poor prognosis in patients with breast cancer?

A breast cancer patient on chemotherapy and tamoxifen develops pulmonary embolism.

Which medication is most likely to have caused this?

A 55-year-old patient with a history of non-Hodgkin’s lymphoma undergoes high-dose chemotherapy as part of a preparative regimen for an autologous bone marrow transplant.

Within a week following the administration of the chemotherapy, the patient presents with acute onset of dyspnea, chest pain, and palpitations. The chest pain is described as sharp and worsens with deep breaths and when lying down, but slightly improves when sitting forward.

On physical examination, the patient exhibits signs of distress with tachypnea and tachycardia. A friction rub is audible on cardiac auscultation. The ECG shows diffuse ST-segment elevations, and an echocardiogram reveals a small-to-moderate sized pericardial effusion without signs of cardiac tamponade.

Laboratory findings include elevated cardiac biomarkers and inflammatory markers. The patient’s renal function and electrolytes are within normal limits, and there is no evidence of infection.

Given this clinical presentation, the patient is diagnosed with acute heart failure secondary to pericarditis and pericardial effusion following high-dose chemotherapy.

Based on the clinical scenario, which chemotherapeutic agent is most likely responsible for the patient’s acute heart failure, pericarditis, and pericardial effusion?

What is the mechanism of action of aprepitant?

A 23 year old man with non-Hodgkin’s lymphoma had just completed chemotherapy 10 days ago and now presents with neutropenic sepsis but without any features of systemic compromise. He has a history of anaphylaxis with penicillin.

What would be the antibiotic of choice?

What is the mechanism of action of ondansetron?

Which of the following serotonin antagonist has the highest affinity for the 5-HT3 receptor?

What is the rationale for reducing the dose of dexamethasone when given in combination with aprepitant in the treatment of chemotherapy induced nausea and vomiting(CINV)?

A cancer patient is planned to have intravenous vincristine for the first time.

What is the recommended anti-emetic regime before starting chemo?

The use of HRT increases the risk of which cancer?

A 50-year-old patient, with a history of receiving radiotherapy for head and neck cancer, presents to the oncology clinic with a new-onset rash.

The rash is localized to the area that previously underwent radiotherapy and appeared following the initiation of a new chemotherapy regimen. The patient reports no other new medications or changes in their routine. The physical examination reveals erythematous, desquamating skin changes confined to the irradiated region.

Which chemotherapy agent is most likely responsible for the development of the rash in this patient?

In certain type of cancer such as breast cancer, neoadjuvant chemotherapy is given prior to surgery.

What is the role of neoadjuvant chemotherapy?

A 17 year old man recently completed chemotherapy for rhabdomyosarcoma.

On routine testing the following results were obtained:

• Serum Sodium 134 mmol/L [135-145 mmol/L]
• Creatinine 39 mmol/L [18-58 mmol/L]
• Potassium 3.4 mmol/L [3.5-5.0 mmol/L]
• Calcium 2.46 mmol/L [2.20-2.70 mmol/L]
• Chloride 114 mmol/L [97 – 109 mmol/L]
• Phosphate 0.44 mmol/L [1.07 – 2.03 mmol/L]
• Bicarbonate 13.9 mmol/L [20.0 – 28.0 mmol/L]
• Magnesium 0.93 mmol/L [0.65 – 1.05 mmol/L]
• Urea 4.9 mmol/L [2.1 – 8.4 mmol/L] Albumin 42 g/L [33 – 49 g/L] Urinalysis: protein ++ glucose +++

The drug most likely to have caused these abnormalities is:

Which one of the following phases in the cell cycle is characterized by increased production of microtubules?

In assessment of cancer patients, the Karnofsky performance scale (KPS) best correlates with:

Which type of primary tumour is most commonly associated with the syndrome of inappropriate antidiuretic hormone (SIADH)?

The occurrence of gynaecomastia in patients with testicular cancer is most likely to arise through which one of the following mechanisms?

An adolescent 16 year old female has been treated successfully with radiotherapy for Hodgkin’s disease.

Which of the following tumour is most likely to occur when she reaches adulthood (After more than 10 years following treatment)?

A 57-year-old female, with a history of right mastectomy for breast cancer performed three years prior, reports to the clinic complaining of progressive discomfort in her lower back. Upon clinical evaluation, there are no detectable signs indicative of either a recurrence of the breast cancer or distant metastases. The neurological examination is largely unremarkable, with the exception of an ambiguous right plantar reflex. Functions of the bowel and bladder remain intact. Radiographic imaging reveals a generalized increase in bone lucency along with a diminished height in two of the lumbar vertebrae. Subsequent MRI imaging confirms the presence of spinal cord compression. The patient’s Eastern Cooperative Oncology Group (ECOG) performance status is classified as 1.

What is the most appropriate course of action for managing this patient’s condition?

Which of the following carries the best prognosis in operable breast cancer?

A 35-year-old woman seeks your advice about her risk of developing breast cancer.

Which one of the following would place her at greatest risk of developing breast cancer?

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:

Which one of the following would be a relative contraindication to the use of raloxifene (a selective oestrogen receptor modulator) in a perimenopausal woman?

What is the main advantage of chest wall radiotherapy following lumpectomy and axillary clearance of a 2 cm node-negative, receptor positive breast cancer?

A 36-year-old woman presents with breast cancer and multiple liver metastases one year after resection of a right breast tumour. The presence of which of the following would likely to confer a benefit of using Trastuzumab (Herceptin)?