Medical Oncology Module 3

Which biomarker is the most independent risk factor for the incidence of Immune check point inhibitor (ICI)-associated myocarditis?

CK-MB (CK isoenzyme-MB)

Correct Incorrect Correct answer

Cardiac troponin I

Correct Incorrect Correct answer

CK (creatine kinase)

Correct Incorrect Correct answer

N-terminal pro-B-type natriuretic peptide

Correct Incorrect Correct answer

Neutrophil-to-lymphocyte ratio

Correct Incorrect Correct answer

Among the following malignancies and its associated tumour markers, which one predicts the best overall prognosis with the normalisation of its tumour marker?

Testicular Ca and beta-HCG

Correct Incorrect Correct answer

Colorectal Ca and CEA

Correct Incorrect Correct answer

Pancreatic Ca and Ca19.9

Correct Incorrect Correct answer

Breast Ca and Ca15.3

Correct Incorrect Correct answer

Ovarian Ca and Ca-125

Correct Incorrect Correct answer

Which of the following tumour is least likely to respond to chemotherapy?

Renal cell carcinoma

Correct Incorrect Correct answer

Breast carcinoma

Correct Incorrect Correct answer

Testicular carcinoma

Correct Incorrect Correct answer

Colon carcinoma

Correct Incorrect Correct answer

Small cell lung carcinoma

Correct Incorrect Correct answer

A 78-year-old man presents with multiple sites of significant bone pain due to metastatic prostate cancer. He refuses bilateral orchidectomy. A decision is made to start a luteinising-hormone releasing-hormone (gonadotrophin-releasing hormone) agonist.

Which one of the following best describes the likely subsequent clinical events?

Increasing pain over two weeks followed by marked improvement

Correct Incorrect Correct answer

Rapid pain relief

Correct Incorrect Correct answer

Rapid pain relief followed by a rapid increase in pain.

Correct Incorrect Correct answer

Gradual pain relief

Correct Incorrect Correct answer

No pain relief

Correct Incorrect Correct answer

The normalization of which tumour marker predicts the best overall survival?

Alpha fetoprotein in testicular carcinoma.

Correct Incorrect Correct answer

Ca 15-3 in breast carcinoma

Correct Incorrect Correct answer

Carcinoembryonic antigen in bowel carcinoma

Correct Incorrect Correct answer

Lactate dehydrogenase in lymphomas

Correct Incorrect Correct answer

Ca 19-9 in pancreatic carcinoma

Correct Incorrect Correct answer

A 70 year old man has a diagnosis of castrate resistant metastatic prostate cancer with metastasis to the nodes and bones. He has been started on oral Abiraterone 1g daily along with prednisone 5mg twice daily.

What is the rationale for giving prednisone together with Abiraterone?

To reduce the severity of side effects of Abiraterone.

Correct Incorrect Correct answer

To provide synergy in reducing serum testosterone level.

Correct Incorrect Correct answer

To improve the efficacy of Abiraterone.

Correct Incorrect Correct answer

To prolong the half-life of Abiraterone.

Correct Incorrect Correct answer

To improve the absorption of Abiraterone.

Correct Incorrect Correct answer

What is the most common cell type in renal cell carcinoma?

clear cell

Correct Incorrect Correct answer

granular cell

Correct Incorrect Correct answer

sarcomatoid cell

Correct Incorrect Correct answer

spindle cell

Correct Incorrect Correct answer

mixed clear and granular

Correct Incorrect Correct answer

Which of the following is NOT a risk factor for renal cell carcinoma?

Analine dye

Correct Incorrect Correct answer

Smoking

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

von Hippel-Lindau syndrome

Correct Incorrect Correct answer

What is the median survival of metastatic renal cell carcinoma?

12 months

Correct Incorrect Correct answer

2 years

Correct Incorrect Correct answer

3 years

Correct Incorrect Correct answer

18 months

Correct Incorrect Correct answer

6 months

Correct Incorrect Correct answer

Where does the tumour cells in renal cell carcinoma arise from?

Proximal convoluted tubule

Correct Incorrect Correct answer

Distal tubule

Correct Incorrect Correct answer

Ascending limb of Loop of Henle

Correct Incorrect Correct answer

Collecting duct

Correct Incorrect Correct answer

Descending limb of Loop of Henle

Correct Incorrect Correct answer

What is the recommended first line treatment for metastatic renal cell carcinoma in patients with intermediate to poor risk disease?

Sunitinib

Correct Incorrect Correct answer

Sorafenib

Correct Incorrect Correct answer

Ipilimumab plus Nivolumab

Correct Incorrect Correct answer

Pazopanib

Correct Incorrect Correct answer

Interferon-alpha

Correct Incorrect Correct answer

A 45-year-old man with metastatic renal cell carcinoma is undergoing treatment with an immune checkpoint inhibitor. Two months into the therapy, he develops severe diarrhea and abdominal pain.

A colonoscopy reveals ulcerative lesions, and biopsies confirm the presence of immune-mediated colitis.

Which of the following is the most appropriate initial management for this patient?

High-dose systemic glucocorticoids

Correct Incorrect Correct answer

Broad-spectrum antibiotics

Correct Incorrect Correct answer

Antiviral therapy

Correct Incorrect Correct answer

Anti-TNFα therapy

Correct Incorrect Correct answer

Initiation of hemodialysis

Correct Incorrect Correct answer

In a patient on Sunitinib for metastatic renal cell cancer, which of the following is a good indicator of response to this medication?

Hypertension

Correct Incorrect Correct answer

Diarrhea

Correct Incorrect Correct answer

Pyrexia

Correct Incorrect Correct answer

Myalgia

Correct Incorrect Correct answer

Flu-like symptoms

Correct Incorrect Correct answer

A 54-year-old college professor with high-risk, resected renal cell carcinoma (RCC) has completed adjuvant therapy with pembrolizumab. During a routine follow-up visit, the patient inquires about the rationale behind choosing pembrolizumab over other agents for adjuvant therapy.

Which of the following best supports the use of pembrolizumab as adjuvant therapy in this clinical scenario?

Pembrolizumab is the only agent proven to prolong disease-free survival (DFS) in the adjuvant setting for high-risk, resected RCC.

Correct Incorrect Correct answer

Pembrolizumab has a lower incidence of immune-related adverse events compared to other immune checkpoint inhibitors.

Correct Incorrect Correct answer

Pembrolizumab directly targets VEGF, reducing the risk of RCC recurrence.

Correct Incorrect Correct answer

Pembrolizumab therapy is associated with a higher response rate in metastatic settings, implying efficacy in the adjuvant setting.

Correct Incorrect Correct answer

Pembrolizumab can be safely combined with VEGF-R TKIs, offering a synergistic effect in the adjuvant setting.

Correct Incorrect Correct answer

A 58-year-old male with metastatic renal cell carcinoma (RCC) has been receiving treatment with a vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGF-R TKI). He presents to the clinic with complaints of progressive fatigue, cold intolerance, and unintentional weight gain over the past two months.

His physical examination is notable for dry skin, bradycardia, and delayed ankle reflexes. Laboratory investigations reveal elevated serum thyroid-stimulating hormone (TSH) levels with low free thyroxine (T4).

Which of the following is the most likely complication of VEGF-R TKI therapy in this patient?

Hypothyroidism

Correct Incorrect Correct answer

Thyroiditis

Correct Incorrect Correct answer

Cushing's syndrome

Correct Incorrect Correct answer

Diabetic ketoacidosis

Correct Incorrect Correct answer

Hyperthyroidism

Correct Incorrect Correct answer

A 20-year-old man presents with 3-month history of progressive non-productive cough and increasing shortness of breath that has not improved despite 2 weeks course of antibiotics. There is no history of fever, chills, or weight loss. On physical examination, temperature is 37.1 C , blood pressure is 120/68 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. The lungs are clear. The remainder of the physical examination is normal.

His CXR shows multiple pulmonary nodules consistent with metastatic disease. CT scan of the chest confirms metastatic lesions in the lungs and retroperitoneal lymphadenopathy. Testicular ultrasonography shows a slightly enlarged right testicle.

Laboratory studies show a Lactate dehydrogenase of 310 U/L, α-Fetoprotein 1289 ng/mL and β-Human chorionic gonadotropin 6247 mU/mL.

Which of the following is the most appropriate treatment?

Right radical orchidectomy followed by BEP chemotherapy

Correct Incorrect Correct answer

Chemotherapy

Correct Incorrect Correct answer

Radiotherapy

Correct Incorrect Correct answer

Right radical orchiectomy followed by retroperitoneal lymph node dissection

Correct Incorrect Correct answer

Hospice referral

Correct Incorrect Correct answer

A 23-year-old man is seen in an outpatient clinic following a post resection of a stage I non-seminomatous testicular germ cell tumour with vascular invasion (High risk).

Since his surgery, he has been highly anxious and have been worried about the risk of recurrence and have been putting his job and marriage on-hold until he can know for sure that his cancer has been ‘cured’. He is open to the idea of undergoing chemotherapy if offered.

So in this situation, what would be the most appropriate next step in management?

BEP (Bleomycin, Etoposide, Cisplatin) chemotherapy

Correct Incorrect Correct answer

Active surveillance.

Correct Incorrect Correct answer

para-aortic radiotherapy

Correct Incorrect Correct answer

retroperitoneal lymph node dissection.

Correct Incorrect Correct answer

testicular radiotherapy

Correct Incorrect Correct answer

A 23-year-old man have just undergone a radical inguinal orchidectomy for a stage I nonseminomatous testicular germ cell tumour with no vascular invasion (low risk). As part of the active surveillance program, how frequent should he be followed up in clinic in his first year of surgery?

Monthly

Correct Incorrect Correct answer

Every 2 months

Correct Incorrect Correct answer

Every 3 months

Correct Incorrect Correct answer

Every 6 months

Correct Incorrect Correct answer

Yearly

Correct Incorrect Correct answer

Which of the following feature would strongly support the presence of a non-seminoma germ cell tumor compared to a seminoma?

Elevated alpha fetoprotein

Correct Incorrect Correct answer

Late relapses

Correct Incorrect Correct answer

Elevated B-HCG levels

Correct Incorrect Correct answer

More responsive to radiotherapy

Correct Incorrect Correct answer

Localized at presentation

Correct Incorrect Correct answer

A 25-year-old man is evaluated post resection of a stage I seminomatous testicular germ cell tumour with no vascular invasion (low risk).

The most appropriate next step in his management is:

active surveillance

Correct Incorrect Correct answer

carboplatin chemotherapy

Correct Incorrect Correct answer

para-aortic radiotherapy

Correct Incorrect Correct answer

testicular radiotherapy

Correct Incorrect Correct answer

hormonal therapy

Correct Incorrect Correct answer

A 38 year old man has been recently diagnosed with right testicular cancer that was found on self-examination. He had a right orchiectomy performed 2 weeks ago. Histology confirms this as seminoma, pT1bNx. The maximum dimension of the lesion is 54 x 48 x 35mm. The lesion appears to involve the rete testis. CT staging does not show any evidence of metastasis. His serum B-HCG and alpha-fetoprotein is within normal limits.

What would be the most appropriate next step in management?

Start adjuvant chemotherapy with carboplatin

Correct Incorrect Correct answer

Start adjuvant chemotherapy with 4 cycles of bleomycin, etoposide, cisplatin

Correct Incorrect Correct answer

Surveillance

Correct Incorrect Correct answer

Adjuvant radiotherapy

Correct Incorrect Correct answer

Start chemotherapy with cisplatin, etoposide and ifosfamide.

Correct Incorrect Correct answer

Which of the following cancers have the best chance of long term survival even with the presence of metastasis?

germ cell cancer with lung metastases.

Correct Incorrect Correct answer

breast cancer with bone metastases

Correct Incorrect Correct answer

ovarian cancer with malignant ascites.

Correct Incorrect Correct answer

prostate cancer with bone metastases

Correct Incorrect Correct answer

lung cancer with brain metastases.

Correct Incorrect Correct answer

A 15-year-old male presented with a history of successful treatment for a testicular germ cell tumor at the age of 12. The therapeutic regimen included cisplatin, etoposide (also known as VP-16), and bleomycin.

Three years following successful treatment for a testicular germ cell tumor with a regimen comprising cisplatin, etoposide, and bleomycin, a 15-year-old male is at increased risk for which of the following long-term complications?

high tone hearing deficit

Correct Incorrect Correct answer

pulmonary fibrosis.

Correct Incorrect Correct answer

renal failure.

Correct Incorrect Correct answer

secondary leukaemia

Correct Incorrect Correct answer

sterility.

Correct Incorrect Correct answer

What is the leading cause of death for survivors of testicular tumors following successful chemotherapy?

Second primary cancers

Correct Incorrect Correct answer

Lung fibrosis

Correct Incorrect Correct answer

Renal failure

Correct Incorrect Correct answer

Myocardial ischaemia

Correct Incorrect Correct answer

Thromboembolic event

Correct Incorrect Correct answer

Which of the following is the best diagnostic tool to detect early lung toxicity secondary to Bleomycin?

There is none.

Correct Incorrect Correct answer

High resolution CT

Correct Incorrect Correct answer

Diffuse lung capacity for carbon monoxide (DLCO)

Correct Incorrect Correct answer

Forced Vital Capacity (FVC)

Correct Incorrect Correct answer

Chest X ray

Correct Incorrect Correct answer

26 year old man has been treated with two previous chemotherapy regimens for metastatic sarcoma. On assessment, he appears tired and requiring regular opioid analgesia. He needs to rest more than half the day in bed.

What is the patient’s ECOG performance status?

ECOG 3

Correct Incorrect Correct answer

ECOG 0

Correct Incorrect Correct answer

ECOG 1

Correct Incorrect Correct answer

ECOG 2

Correct Incorrect Correct answer

ECOG 4

Correct Incorrect Correct answer

FDG-PET is least useful in the staging of which type of malignancy?

gastric cancer

Correct Incorrect Correct answer

colorectal cancer

Correct Incorrect Correct answer

melanoma

Correct Incorrect Correct answer

head and neck cancer

Correct Incorrect Correct answer

esophageal cancer

Correct Incorrect Correct answer

Which of the following gene mutation is associated with increased risk of breast cancer in males?

BRCA 2

Correct Incorrect Correct answer

BRCA 1

Correct Incorrect Correct answer

RET

Correct Incorrect Correct answer

CHEK 2

Correct Incorrect Correct answer

P53

Correct Incorrect Correct answer

The Human Papilloma Virus (HPV) is associated with which type of malignancy?

Anal carcinoma

Correct Incorrect Correct answer

Non small cell lung cancer

Correct Incorrect Correct answer

Hepatocellular carcinoma

Correct Incorrect Correct answer

Esophageal carcinoma

Correct Incorrect Correct answer

Cholangiocarcinoma

Correct Incorrect Correct answer

A 65-year-old man presents for a routine health check-up. He has no specific complaints but is interested in cancer screening due to his age.

Considering the epidemiological trends in Australia, which of the following cancers is he most at risk of being diagnosed with?

Prostate cancer

Correct Incorrect Correct answer

Lung cancer

Correct Incorrect Correct answer

Melanoma

Correct Incorrect Correct answer

Melanoma

Correct Incorrect Correct answer

Colorectal cancer

Correct Incorrect Correct answer

Which of the following does not have any role in the management of hypercalcemia caused by bony metastasis secondary to prostate cancer?

dexamethasone

Correct Incorrect Correct answer

normal saline

Correct Incorrect Correct answer

pamidronate

Correct Incorrect Correct answer

furosemide when the patient is euvolemic

Correct Incorrect Correct answer

calcitonin

Correct Incorrect Correct answer

In the management of metastatic castration-sensitive prostate cancer (mCSPC), which form of androgen deprivation therapy (ADT) is considered the mainstay of treatment with variable durability?

All options listed are considered mainstays of ADT with variable durability

Correct Incorrect Correct answer

Goserelin

Correct Incorrect Correct answer

Degarelix

Correct Incorrect Correct answer

Bilateral orchidectomy

Correct Incorrect Correct answer

Leuprolide

Correct Incorrect Correct answer

A 68-year-old man with de novo, high-volume metastatic castration-sensitive prostate cancer (mCSPC) is being considered for intensification of therapy. He has a performance status of 1 and no significant comorbidities.

In addition to androgen deprivation therapy (ADT), which of the following treatment strategies is most likely to improve his overall survival based on the recent advances in the management of mCSPC?

Triple therapy with docetaxel chemotherapy, apalutamide and goserelin

Correct Incorrect Correct answer

Six cycles of docetaxel chemotherapy alone

Correct Incorrect Correct answer

Addition of abiraterone acetate to goserelin

Correct Incorrect Correct answer

Addition of enzalutamide to goserelin

Correct Incorrect Correct answer

Doublet treatment with goserelin and apalutamide

Correct Incorrect Correct answer

Prostate-Specific Membrane Antigen (PSMA) plays a significant role in the diagnosis and treatment of prostate cancer.

Which of the following statements best describes the role of PSMA in prostate cancer management?

PSMA is a cell surface protein overexpressed in most prostate cancers, utilized for diagnostic imaging and targeted radionuclide therapy.

Correct Incorrect Correct answer

PSMA is predominantly expressed in benign prostatic hyperplasia and is therefore not a useful marker in prostate cancer.

Correct Incorrect Correct answer

PSMA expression is limited to prostate cancer cells, making it an unspecific target for diagnostic imaging or targeted therapy.

Correct Incorrect Correct answer

PSMA-targeted therapies are only effective in the early stages of localized prostate cancer and have no role in metastatic disease.

Correct Incorrect Correct answer

PSMA levels are inversely related to prostate cancer aggressiveness, with lower expression indicating more advanced disease.

Correct Incorrect Correct answer

When considering the treatment of metastatic castration-resistant prostate cancer (mCRPC), what is a potential benefit of using darolutamide over other androgen receptor inhibitors?

Darolutamide has a distinct chemical structure that may result in fewer central nervous system side effects and a lower risk of seizures compared to other androgen receptor inhibitors.

Correct Incorrect Correct answer

Darolutamide has been shown to significantly increase prostate-specific antigen (PSA) levels compared to other androgen receptor inhibitors.

Correct Incorrect Correct answer

Darolutamide is associated with a higher rate of severe cardiovascular events compared to other androgen receptor inhibitors.

Correct Incorrect Correct answer

Darolutamide can cross the blood-brain barrier more effectively, leading to improved outcomes in patients with central nervous system metastases.

Correct Incorrect Correct answer

Darolutamide is more effective in reducing bone metastases pain compared to other androgen receptor inhibitors.

Correct Incorrect Correct answer

A 72-year-old man with metastatic castration-resistant prostate cancer (mCRPC) presents for consideration of further treatment. He has previously received androgen deprivation therapy (ADT) with progression to mCRPC and has not received chemotherapy or novel androgen receptor targeted therapies during the castration-sensitive stage. He does not have a known BRCA1/BRCA2 mutation.

Which of the following treatment options is most appropriate for this patient?

Start chemotherapy with docetaxel, given the patient has not received chemotherapy in the mCSPC stage.

Correct Incorrect Correct answer

Initiate treatment with a poly-ADP ribose polymerase (PARP) inhibitor such as olaparib, regardless of BRCA mutation status.

Correct Incorrect Correct answer

Prescribe radium-223 as the first-line treatment for mCRPC, considering its radiopharmaceutical properties.

Correct Incorrect Correct answer

Begin novel androgen receptor targeted therapy with abiraterone acetate, as it has not been used in the mCSPC stage.

Correct Incorrect Correct answer

Proceed directly to cabazitaxel chemotherapy, bypassing first-line chemotherapy options for mCRPC.

Correct Incorrect Correct answer

Average score
Your score

Medical Oncology Module 3

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

34. Question

35. Question

36. Question