Oncology and Palliative Care
Answer grid
Question Answer Question Answer Question Answer
1
A
23
A
45
D
2
E
24
E
46
E
3
B
25
E
47
E
4
A
26
D
48
C
5
C
27
E
49
D
6
D
28
C
50
D
7
D
29
C
51
D
8
C
30
D
52
D
9
B
31
D
53
C
10
D
32
D
54
E
11
D
33
B
55
C
12
E
34
E
56
A
13
E
35
C
57
C
14
A
36
E
58
D
15
E
37
E
59
A
16
E
38
E
60
E
17
D
39
C
61
E
18
D
40
A
62
E
19
D
41
B
63
C
20
A
42
B
64
A
21
A
43
B
65
C
22
A
44
B
66
A
Questions and explanations
Question 1
Which of the following histological characteristics of cancer is NOT able to be detected by
immunohistochemical techniques ?
A.
B.
C.
D.
E.
Antibodies to Type IV collagen
Carcinoembryonic antigen
Prostate specific antigen
Desmin
Calcitonin
Answer: A
The following explanations were provided:
A. Type IV collagen can be detected in determining the intactness of basement membrane
in carcinoma in situ; but not an antibody to type IV collagen.
B. This is associated with colon cancer and other tumours.
C. This is associated with prostate cancer.
D. This is associated with muscle cell tumours.
E. This can be ectopic or in endocrine tumours.
10.02 Lecture 1: Diagnosis of cancer
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Question 2
Which of the following statement is NOT correct regarding the National Cervical Screening
Program (NCSP)?
A.
B.
C.
D.
E.
NCSP is responsible for quality control of Pap test taking, reading and histology.
NCSP provides epidemiological data about the effectiveness of cervical screening.
NCSP holds confidential records of pap test results and histology.
NCSP holds the results in the NSW Pap Test register.
NCSP has a reminder system to women for cervical screening every 3 years.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Screening is reminded for patients on a 2-year basis.
10.03 Lecture 1: A concerned GP - 10.03 - PBL 1
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Question 3
Which of the following has been shown to reduce the risk of transmission of human
immunodeficiency virus (HIV)?
A.
B.
C.
D.
E.
Unprotected sex
Infants born to mothers with HIV who received HIV therapy during pregnancy.
Intravenous drug use
Receiving blood transfusions
Breast-feeding from a HIV-positive mother.
Answer: B
The following explanations were provided:
A.
B. If the mother had proper HIV anti-retroviral therapy, the chances of HIV crossing the
placenta are significantly low; low enough not to considered as a risk factor.
C.
D.
E.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 4
Which of the following carries the greatest risk of transmission of human
immunodeficiency virus (HIV)?
A.
B.
C.
D.
E.
Perinatal infection
Intravenous needle sharing with a HIV positive individual
Anal receptive intercourse
Needlestick injury from viraemic patient
Vaginal receptive intercourse
Answer: A
The following explanations were provided:
A. Transfusion carries a risk of 75%, perinatal infection of 25%, ano-receptive intercourse
of 3.3% to 0.8%. The following activities carry a lower, but non-negligible risk: needle
sharing, needle stick injury from someone who is viraemic, receptive vaginal
intercourse, insertive vaginal intercourse and mucosal splash.
B.
C.
D.
E.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 5
Which of the following statements is TRUE regarding multi-disciplinary teams (MDTs)?
A. Time constraints are usually not an issue as MDT meetings are well-organised everyone
is present.
B. MDT meetings are a low-cost method of patient care, with regional centres benefiting
the most from their low-cost format.
C. Patients usually prefer a MDT approach over traditional approach.
D. Although MDTs have better outcomes for the patient, there is usually no time saved in
reaching a decision.
E. MDT meetings are heavily doctor based, with allied health playing a secondary role.
Answer: C
The following explanations were provided:
A. Time constraints are an issue normally, as not everyone can be present, and not every
issue is discussed.
B. MDT meetings are usually expensive and reliant on technology, especially in regional
centres where IT infrastructure has to make up for lack of experienced professionals.
C.
D. There usually is time saved in reaching a decision with an MDT.
E. Allied health play an important role in the MDT process.
10.01 Lecture 4: Multidisciplinary care in cancer
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Question 6
Which of the following is the BEST course of management for early stage cervical cancer
(FIGO stage 1A - microscopic cancer confined to the cervix)?
A.
B.
C.
D.
E.
Radical hysterectomy with adjuvant platinum-based chemotherapy.
Brachytherapy and external beam radiotherapy.
Platinum-based chemotherapy only.
Cone biopsy or hysterectomy only.
External beam raditherapy and platinum-based chemotherapy.
Answer: D
The following explanations were provided:
A.
B.
C.
D. There is a very low risk of metastasis so the patient only needs biopsy/hysterectomy.
No lymph node involvement means that no radiotherapy or chemotherapy is required.
E.
10.03 Lecture 5: Management of cervical cancer
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Question 7
p53 is a tumour suppressor protein, usually responsible for activating repair of damaged
DNA. Which of the following is TRUE in relation to p53?
A. The gene location for p53 is chromosome 10.
B. Inheriting only one functional copy of the p53 gene results in Familial Adenomatous
Polyposis.
C. Mutated or damaged p53 is found in around 90% of all cancers.
D. p53 is inducible by UV exposure and oxidative stress.
E. p53 has no effect on the cell cycle.
Answer: D
The following explanations were provided:
A.
B.
C.
D.
It is located on Chromosome 17.
This pattern of inheritance results in Li Fraumeni Syndrome.
p53 is found in around 50% of all cancers.
These things cause DNA damage to which p53 responds. In fact, p53 plays a role in
tanning.
E. p53 is able to induce a pathway by which the cell cycle is arrested while DNA is
repaired. This is key to its role in growth suppression.
10.01 Lecture 1: Epidemiology and molecular basis of carcinogenesis
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Question 8
Which of the following is NOT an acquired immunodeficiency syndrome (AIDS) defining
event or illness??
A.
B.
C.
D.
E.
Pneumosystis jirovecii pneumonia (PJP)
Cerebral toxomplasmosis
Hodgkin lymphoma
Cachexia in the form of wasting syndrome
Kaposi's sarcoma
Answer: C
The following explanations were provided:
A.
B.
C. Non-Hodgkin lymphoma is an AIDS-defining event.
D.
E.
10.05 Lecture 2: Pathology of AIDS: opportunistic infections and neoplasms
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Question 9
Which of the following statements regarding human immunodeficiency virus (HIV)
infection is FALSE?
A.
B.
C.
D.
E.
HIV-1 is the most common in North America, Europe, Asia and Central Africa.
The biggest contributor to its incidence is from sexual intercourse between men.
HIV-2 is the more common form found predominantly in West Africa and India.
It takes approximately 3 weeks to detect anti-HIV antibodies in the serum.
If you have an absence of CCR5, you have a natural resistance of HIV.
Answer: B
The following explanations were provided:
A.
B. The majority of the cases are through unprotected vaginal intercourse, especially in the
Sub-Saharan Africa.
C.
D.
E.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 10
Regarding p53, which of the following statements is FALSE?
A. It is located on chromosome 17.
B. It is a tumor suppressor gene that is affected in up to 50% of all human cancers.
C. It is activated by phosphorylation of its N-terminal domain in response to cell stress or
DNA damage.
D. Mutations in p53 give rise to familial adenomatous polyposis (FAP).
E. It initiates apoptosis (programmed cell death) if DNA damage is irreparable.
Answer: D
The following explanations were provided:
A.
B.
C.
D. Mutations in p53 give rise to Li Fraumeni syndrome. Familial adenomatous popyposis
(FAP) is associated with mutations in APC.
E.
10.01 Lecture 1: Epidemiology and molecular basis of carcinogenesis
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Question 11
Regarding human immunodeficiency virus (HIV) and acquired immunodeficiency
syndrome (AIDS), which of the following is TRUE?
A.
B.
C.
D.
The virus has a DNA genome.
In Australia, 67% of transmissions occur due to intravenous drug use.
The region of greatest prevalence is South East Asia.
Rates of infection are higher in Indigenous Australians compared to non-Indigenous
Australians.
E. Over 100,000 people in Australia are infected with HIV.
Answer: D
The following explanations were provided:
A.
B.
C.
D.
The virus has a diploid RNA genome.
67% of transmissions occurred among men who have sex with men
Sub-saharan Africa has the highest prevalence of HIV.
Aboriginal and Torres Strait Islander populations have rates of HIV similar to the
general population. However, Aboriginal and Torres Strait Islander people are named
as a priority population in Australia's Seventh National HIV Strategy. This is for a
number of reasons, including the potential for an acceleration of the HIV epidemic
among Indigenous communities.
E. Approximately 27,000 individuals are infected in Australia.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 12
Regarding the BRCA1 and BRCA2 genes, which of the following is TRUE?
A. They are responsible for the majority of breast cancers.
B. BRCA1 increases risk of breast and ovarian cancer, while BRCA2 only increases risk of
breast cancer.
C. Risk reducing options in affected individuals include taking the oral contraceptive pill
or having a mastectomy.
D. A mastectomy reduces the risk of breast cancer to zero.
E. There is a 50% chance of an affected individual of passing the gene fault on to each
child.
Answer: E
The following explanations were provided:
A. This is wrong because germline mutations account for 5-10% of breast cancers.
B. This is wrong because they both increase risk of breast and ovarian cancer
C. This is wrong because the oral contraceptive slightly increases risk of breast cancer.
Risk reducing measures include tamoxifen, mastectomy, salpingo-oopherectomy.
D. The risk post-mastectomy is not quite zero, but does decrease significantly.
E. This is the classical pattern of inheritance of autosomal dominant mutations, as in the
case of the BRCA mutations.
10.04 Lecture 3: Breast cancer genes: Implications for health care
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Question 13
The HPV vaccine Gardasil is effective against which strains of HPV?
A.
B.
C.
D.
E.
1, 5, 8 and 11
6, 8, 11 and 16
6, 8, 16 and 18
8, 11, 16 and 18
6, 11, 16 and 18
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. The vaccine is effective against serotypes 6 and 11 for genital warts; and 16 and 18 for
cervical cancer.
10.03 Lecture 3: Viruses and the cell cycle
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Question 14
Which of the following statements is FALSE about the treatment of cervical neoplasia?
A. Cyclophosphamide is used as a radio-sensitiser in conjunction with radiotherapy for
cervical cancer.
B. Radiation enteritis is a common side effect for radiotherapy for cervical cancer.
C. If biopsy is classified as CIN 1 (cervical intra-epithelial neoplasia), treatment is often not
required.
D. Radical trachelectomy in combination with lymphadenectomy is considered a s
treatment option for stage IIA patient wanting to perserve fertility.
E. Cone biopsy is an acceptable form of excision for biopsy classified as CIN II/III.
Answer: A
The following explanations were provided:
A. Cisplatin/Carboplatin can be used as a radio-sensitiser in conjunction with
radiotherapy. See Candelaria et al. (2006). Radiat Oncol. 1:15.
B.
C.
D.
E.
10.03 Lecture 1: A concerned GP - 10.03 - PBL 1
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Question 15
Which of the following is NOT a macroscopic appearance of a colorectal adenoma?
A.
B.
C.
D.
E.
Pedunculated
Sessile
Flat
Depressed
All of the answers are macroscopic appearances of colorectal adenomas.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. All of the answers are possible descriptions of the macroscopic appearance of colorectal
adenomas.
10.01 Lecture 2: Development, staging and prognosis of colorectal cancer
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Question 16
Which of the following options BEST describes the sequence of events mentioned
below?Damage to the APC locus produces a hyper proliferative epithelium. DNA
hypomethylation results in an early adenoma. Activation of the KRAS oncogene causes
progression from an intermediate to a late adenoma. Finally, loss or mutation of the p53
tumour suppressor gene produces carcinoma.
A.
B.
C.
D.
E.
Metastatic cascade
Complement cascade
Coagulation cascade
Radiation damage cascade
Volgestein's cascade
Answer: E
The following explanations were provided:
A. While the above cascade might fit into the first part of the metastatic cascade, the
metastatic cascade involves steps regarding distant invasion and tumour spread.
B. This cascade relates to immunity.
C. This cascade relates to blood coagulation.
D. This cascade relates to damage caused by radiation therapy.
E. Volgestein's cascade is a common pattern of cumulative genetic damage during
neoplastic transformation that has been well documented in colonic lesions. See
Essential Readings 10.01
10.01 Lecture 1: Like clockwork - 10.01 - PBL 1
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Question 17
Which of the following BEST describes how acquired immunodeficiency syndrome (AIDS)
is diagnosed or defined?
A. The patient has had one or more AIDS-defining illness.
B. The patient has a CD4-positive T cell count under 200 per μL.
C. The presence of an AIDS-defining illness in addition to current human
immunodeficiency virus (HIV) infection.
D. Both B and C.
E. All of A, B and C.
Answer: D
The following explanations were provided:
A.
B.
C.
D. AIDS is by definition a CD4-positive T cell count under 200 per μL. If the T cell count is
over this threshold, then an AIDS-defining illness in addition to HIV serology is
required.
E.
10.05 Lecture 2: Pathology of AIDS: opportunistic infections and neoplasms
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Question 18
Which of the following is NOT a reason that opiate administration for cancer pain relief
needs to be monitored?
A.
B.
C.
D.
E.
Constipation
Dosing in opiate-tolerant patients
Sedation
Dyspnoea
Nausea
Answer: D
The following explanations were provided:
A.
B.
C.
D. Opiates can cause respiratory depression, although the risk of this occurring is low
when treating severe cancer pain. Opiates can be used to treat dyspnoea in the
palliative care setting.
E.
10.02 Lecture 2: Treating cancer pain
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Question 19
In deciding whether patients are suitable for kidney transplants, they are grouped
according to their health, general well-being and other factors. Those that are less likely to
recover well from transplants are put onto dialysis. Research suggests that transplant
patients do better than patients that are dialysed. Is this research biased?
A.
B.
C.
D.
E.
No, because this is just how things have to be done.
Yes, because this is a form of information bias.
Yes, because this is a form of recall bias.
Yes, because patients have not been randomly grouped.
No, because this is likely to be unbiased research.
Answer: D
The following explanations were provided:
A.
B.
C.
D. This is a type of allocation or selection bias, whereby the healthier patients are given
transplants, and therefore the results may be skewed.
E.
10.03 Lecture 4: Clinical trials: methodology participation and attitudes
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Question 20
The following is an example of what phase of clinical trial?40 healthy volunteers take part
in the clinical trial. 10 are given 10 g doses per day, 10 are given 20 g doses per day, 10 are
given 30 g doses per day and 10 are given 40 g doses per day. Any side effects are
meticulously noted.
A.
B.
C.
D.
E.
Phase 1
Phase 2
Phase 3
Phase 4
Need more information
Answer: A
The following explanations were provided:
A. This is an example of a phase 1 trial - the safety of the drug is being tested. These trials
aim to understand doses safe for human use, and to target possible treatments.
B. Phase 2 trials target specific pathophysiologies and aim to determine if the treatment
actually works.
C. Phase 3 trials compare new treatments with the reference standard or placebo.
D. Phase 4 trials monitor new treatments in the community.
E.
10.03 Lecture 4: Clinical trials: methodology participation and attitudes
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Question 21
Which of the following BEST describes the cause of hypercalcaemia as a paraneoplastic
syndrome?
A. Parathyroid hormone-related protein (PTHrP) production stimulating bone resorption.
B. Destruction of bone by bony metastases.
C. Increased calcium uptake in the gastrointestinal tract due to cancer-related metabolism
changes.
D. Increases in parathyroid hormone production.
E. Decreases in Vitamin D production.
Answer: A
The following explanations were provided:
A. Hypercalcaemia in malignancy is due to cytokine/hormone (PTHrP) production causing
increased bone resorption and decreased renal elimination.
B.
C.
D.
E.
10.02 Lecture 3: Paraneoplastic effects
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Question 22
Which of the following is NOT one of the classical four principles of ethical practice in
medicine?
A.
B.
C.
D.
E.
Honesty
Beneficence
Non-malificence
Justice
Respect for autonomy
Answer: A
The following explanations were provided:
A. Honesty and informed consent are key in medical practice, but do not form one of the
'big four' principles of medical eithics.
B.
C.
D.
E.
10.02 Lecture 1: Ethics of decision making in cancer
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Question 23
A patient recently diagnosed with breast cancer arrives at her consultation with printouts
of websites and information about her particular type of breast cancer and wants to be
enrolled in any clinical trials for which she is eligible. Which of the following BEST
describes the role she will play in her own care?
A. Active: she would like to be the one in charge of making decisions about her own care.
B. Collaborative: she would like to be the one who has the final say in her own treatment.
C. Active: she would like to be the sole person responsible for managing her own care with
no assistance.
D. Passive: although she has come to the meeting prepared, it is likely she would prefer
you as the physician to make all the decisions about her care.
E. Collaborative: she is likely to want to work together with her managing team to best
treat her cancer.
Answer: A
The following explanations were provided:
A. While some of the other answers could be correct, the role of the "active patient" is best
illustrated by this patient and A is the most accurate description of an active patient.
B.
C.
D.
E.
10.04 Lecture 1: A matter of choice - 10.04 - PBL 1
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Question 24
Which of the following is NOT an appropriate supportive strategy for managing patients'
cancer pain, in addition to opiate use?
A.
B.
C.
D.
E.
Bisphosphonates for pain from bony metastases.
Corticosteroids for inflammatory processes.
Mindfulness techniques for relaxation.
Addressing spiritual needs for holistic patient care.
Alternating opiate use with periods without opioids to minimise side effects.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Opioids should be prescribed in regular doses to manage pain. The other options are
appropriate supportive strategies, if tailored to the patient, to help manage cancer pain
in addition to opioid use.
10.02 Lecture 2: Treating cancer pain
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Question 25
Who is MOST responsible for the care of a patient in a multidisciplinary team?
A.
B.
C.
D.
E.
The head of the ward to which the patient is admitted.
The surgeon.
The oncologist.
The general practitioner.
None of the above.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. One of the weaknesses of multidisciplinary teams is the legal and medical management
of the patient in cases of differing medical opinions.
10.01 Lecture 4: Multidisciplinary care in cancer
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Question 26
Modified radical mastectomy (MRM) when compared to radical mastectomy spares the
following structure/organ:
A.
B.
C.
D.
E.
Breast
Axillary lymph nodes
Areola
Pectoralis muscle
Nipple
Answer: D
The following explanations were provided:
A.
B.
C.
D.
The breast is removed in both procedures.
The axillary lymph nodes are removed in both procedures.
The areola is removed in both procedures.
A modified radical mastectomy is a procedure in which the entire breast is removed,
including the skin, areola, nipple, and most axillary lymph nodes; the pectoralis major
muscle is spared
E. The nipple is removed in both procedures.
10.01 Lecture 3: Surgery and the cancer patient
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Question 27
Which of the following statements is TRUE regarding neuropathic pain?
A.
B.
C.
D.
It is different from chronic pain in that it has no apparent tissue injury component.
It is described as a dull, throbbing pain.
It never responds to opioids, so non-opioid analgesics must always be considered.
Nerve blocks should never be considered, as this worsens the damage to the nerves
already causing the pain.
E. It can be caused by chemotherapy, radiotherapy or other diseases like diabetes.
Answer: E
The following explanations were provided:
A. Chronic pain even though is has no apparant tissue injury component, but neuropathic
pain is caused by a lesion in the peripheral or central nervous system.
B. It is often described as a sharp, burning, electrical pain.
C. It can respond to opioids, but non-opioid analgesics are often considered to improve
pain management.
D. Nerve block is a non-opioid analgesic option that is considered in some patients.
E.
10.02 Lecture 2: Treating cancer pain
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Question 28
Tumours arise because of clonal expansion of a single precursor cell. Which of the
following BEST describes the driving factor behind this expansion?
A. Inherited mutations which, after a period of time, activate and allow the clonal cell to
replicate uncontrollably.
B. Angiogenesis supplies the nutrients required to allow the cell to grow.
C. 6 to 20 key cell mutations which provide the cells with the necessary features to
expand.
D. Over 20000 mutations which are non-lethal to the cell and allow the cell to avoid
normal growth suppressors.
E. Environmental factors damage cell DNA and create mutations which allow the cell to
rapidly divide.
Answer: C
The following explanations were provided:
A. Partly true but not complete. Mutations may be inherited OR acquired.
B. Partially true, as this does occur, but this is not the driving factor of expansion, it is the
permitting factor.
C.
D. While it is possible that over 20,000 mutations can be found in cancer, many of them
are "passenger" mutations and do not drive the cancer expansion.
E. Partially true, but again, not complete. Mutations may be environmental, inherited or
spontaneous.
10.01 Lecture 1: Epidemiology and molecular basis of carcinogenesis
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Question 29
A clinical trial is underway examining the effectiveness of a new treatment that has been
developed to improve vision. Patients were allocated one of two groups - placebo or this
new treatment. They were allocated into groups randomly, and neither the patient, nor the
researchers were informed which group the patients were allocated. Which of the
following terms BEST describes this type of treatment allocation?
A.
B.
C.
D.
E.
Randomised allocation
Blinded allocation
Double-blind, random allocation
Biased allocation
None of the above.
Answer: C
The following explanations were provided:
A.
B.
C.
D.
E.
This is a form of randomised allocation.
This is a form of blinded allocation.
This is the most correct answer.
This is an attempt to reduce bias.
10.03 Lecture 4: Clinical trials: methodology participation and attitudes
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Question 30
Which of the following epidemiological facts is TRUE regarding lung cancer in the
Australian population?
A. Lung cancer is the third ranking cancer in terms of mortality in Australia.
B. 60% of smokers develop lung cancer in their life time.
C. Passive smoke inhalation does not deliver a large enough concentration of tobacco to
cause carcinogenic effects.
D. Over 90% of cases of lung cancer are due to tobacco use.
E. Gender patterns in smoking have no bearing on the patterns of lung cancer incidence
between genders.
Answer: D
The following explanations were provided:
A.
B.
C.
D.
E.
Lung cancer is the leading cause of cancer death in Australia, not the third.
20% of smokers develop lung cancer, not 60%.
Passive smoke inhalation can result in lung cancer
The opposite is true.
10.02 Lecture 1: What can I do - 10.02 - PBL 1
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Question 31
A patient with a cervical lesion undergoes colposcopy and the lesion is removed with loop
electrosurgical excision (LEEP). Biopsy shows that the lesion is a high grade squamous
intraepithelial lesion (HSIL). Which of the following is the BEST first course of action?
A. The woman should be referred to an oncologist for further investigation of the lesion as
it is likely to be malignant.
B. The woman should undergo pap-smears every 6 months for the next five years as HSILs
are likely to recur within several years. She should then go back to routine (two yearly)
screening.
C. The woman should undergo pap-smears every 12 months until at least two consecutive
pap-smears give a negative result. She should then go back to routine (two yearly)
screening.
D. The woman should undergo a repeat pap-smear and colposcopy in 4-6 months and a
pap-smear and HPV test at 12 months. She should then undergo yearly pap-smears
until at least two consecutive pap-smears give a negative result. She should then go
back to routine (two yearly) screening.
E. As the lesion was low grade the women requires no special management and should go
back to normal two yearly screening.
Answer: D
The following explanations were provided:
A. A HSIL is not malignant and does not require referral to an oncologist.
B. See option D for the correct approach.
C. See option D for the correct approach.
D.
E. The woman requires extra follow-up in the immediate future, however once there are
two subsequent negative yearly pap-smears she can co back to regular screening.
10.03 Lecture 1: Screening for cervical cancer
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Question 32
A pap smear has found a low-grade squamous intraepithelial lesion. Which of the following
is the MOST appropriate next course of action.
A.
B.
C.
D.
E.
Organise a colposcopy.
Refer the patient for immediate surgical assessment.
Take a biopsy.
Reassess with a pap smear in 1 year.
Do nothing.
Answer: D
The following explanations were provided:
A. This is indicated for a high-grade lesion, not a low grade lesion.
B.
C.
D. If follow up is normal, it should be repeated again in 1 year and then patients return to
normal 2 year screening.
E. The lesion still has risk of becoming invasive and should be monitored.
10.03 Lecture 5: Management of cervical cancer
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Question 33
A 56 year old woman recently-diagnosed with breast cancer asks that the information not
be communicated to her family. Which of the following is the BEST course of action
considering medical ethics if her husband asks to know about her condition?
A.
B.
C.
D.
E.
Tell him that his wife has breast cancer..
Discuss with the patient the benefits of sharing her diagnosis with her husband.
Tell the patient that she must disclose her diagnosis to her husband for her own benefit.
Organise a meeting with the patient and her husband to discuss her diagnosis.
Refuse to talk to him.
Answer: B
The following explanations were provided:
A. This would break confidentiality with your patient.
B.
C. This would not be respecting the patient's right to autonomy. It would be better to
encourage the patient by having a discussion with her about her concerns.
D. Without the patient's consent for a discussion, this is still breaking confidentiality.
E. This does not break confidentiality but is not helpful to the patient or her husband.
10.02 Lecture 1: Ethics of decision making in cancer
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Question 34
The risk of thrombotic events such as pulmonary embolism and deep venous thrombosis is
increased with malignancy. Which of the following BEST describes the reason for this
phenomenon?
A.
B.
C.
D.
E.
It is a side effect of chemotherapy and radiation treatment.
Loss of anticoagulant factors such as protein C and protein S.
Increased platelets stimulated by tumour cytokines.
The immune response to tumour cell causes thrombosis.
Circulating procoagulants are released by tumour cells.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. There is an increased risk of deep and superficial venous thrombosis, arterial
thrombosis, migratory thrombophlebitis and pulmonary embolus due to circulating
procoagulants released by the cancer.
10.02 Lecture 3: Paraneoplastic effects
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Question 35
Which of the following describes the BEST course of action following detection of a highgrade squamous intraepithelial lesion (HGSIL) on pap smear?
A.
B.
C.
D.
E.
Repeat the test in 1 year.
Refer for immediate surgical assessment.
Investigate with colposcopy.
Perform genetic testing for human papilloma virus.
Do nothing as this lesion will probably regress spontaneously.
Answer: C
The following explanations were provided:
A.
B. We require histogical confirmation of HGSIL by biopsy prior to surgical treatment.
C. All cervical lesions warrant colposcopic assessment. A biopsy is then performed if a
lesion is seen.
D.
E. There is a risk of progressing to cervical carcinoma, and so this lesion should be
investigated.
10.03 Lecture 5: Management of cervical cancer
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Question 36
Which of the following is NOT considered a paraneoplastic syndromes associated with lung
cancer?
A.
B.
C.
D.
E.
Hypertrophic pulmonary osteoarthropathy
Dermatomysositis
Cushing's syndrome
Erythema multiforme
Thrombotic thrombocytopaenic purpura
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Although thrombocytosis is associated with lung cancer, thrombotic
thrombocytopaenic purpura is not. It is a rare disease.
10.02 Lecture 1: Diagnosis of cancer
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Question 37
Which of the following is a barrier to managing pain in patients with cancer?
A.
B.
C.
D.
E.
Patient fear regarding the use of analgesics.
Failure of the treating team to ask the patient about pain.
Reluctance of patient to mention pain for fear of distraction from cancer treatment.
Patient perception that pain is indicative of disease progression.
All of the above
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. All of the above are barriers to managing pain in cancer patients.
10.02 Lecture 2: Treating cancer pain
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Question 38
Which of the following is NOT a risk factor for cervical cancer?
A.
B.
C.
D.
E.
Human papilloma virus (HPV) infection
Smoking
Long term use of the oral contraceptive pill
Co-infection with human immunodeficiency virus
Having no children
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Having no children is actually protective against cervical cancer. The risk of cancer
increases with increased parity.
10.03 Lecture 1: Screening for cervical cancer
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Question 39
Which of the following is NOT a known risk factor for cervical cancer?
A.
B.
C.
D.
E.
Human immunodeficiency virus (HIV) infection
Early onset of sexual activity (younger than 18)
Hormone replacement therapy
Multiple sexual partners
High parity
Answer: C
The following explanations were provided:
A.
B.
C. There is no correlation between hormone replacement therapy and cervical cancer. See
Gadducci et al. (2011). Gynecol Endocrinol. 27(8):597-604.
D.
E.
10.03 Lecture 1: A concerned GP - 10.03 - PBL 1
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Question 40
What level of evidence currently supports the fact that faecal occult blood screening
increases survival in cases of colorectal cancer?
A.
B.
C.
D.
E.
Level 1a
Level 1b
Level 1c
Level 2a
Level 2b
Answer: A
The following explanations were provided:
A. Level 1a refers to a systematic review with homogeneity of randomised controlled
trials.
B.
C.
D.
E.
10.02 Lecture 1: Diagnosis of cancer
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Question 41
Which of the following is FALSE about laparoscopic resection of the colon, compared to
open surgery in the treatment of colon cancer?
A.
B.
C.
D.
E.
The laparoscopic approach is associated with lower morbidity.
The laparoscopic approach is associated with shorter procedure time.
The laparoscopic approach is associated with less pain.
The laparoscopic approach is associated shorter hospital stay.
The laparoscopic approach is associated with faster recovery.
Answer: B
The following explanations were provided:
A.
B. The laparoscopic approach is associated with longer procedure time, not shorter
procedure time.
C.
D.
E.
10.01 Lecture 3: Surgery and the cancer patient
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Question 42
Which of the following genetic mutations are NOT correctly associated with their cancer?
A.
B.
C.
D.
E.
BCR-ABL with chronic myeloid leukemia.
RB1 with Von Hippel–Lindau disease.
B-RAF with melanoma.
BRCA with breast, ovarian and prostate cancer.
APC with familial adenomatous polyposis.
Answer: B
The following explanations were provided:
A.
B. RB1 is associated with retinoblastoma; VHLBP1 is associated with Von Hippel–Lindau
disease.
C.
D.
E.
10.01 Lecture 1: Epidemiology and molecular basis of carcinogenesis
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Question 43
Which of the following statements is TRUE regarding the management of breast cancer?
A. Mastectomy usually prevents recurrence more successfully than lumpectomy and
radiation.
B. Anazstrozole (an aromatase inhibitor) should be reserved for treatment of postmenopausal patients only.
C. Patients with triple negative cancers should be offered twelve month treatment with
trastuzumab (herceptin).
D. Her-2 positive breast cancers are usually less aggressive than Her-2 negative cancers.
E. Patients should undergo axillary clearance regardless of sentinel node status.
Answer: B
The following explanations were provided:
A. Mastectomy and lumpectomy with radiation have shown equal benefits post-treatment.
B. Aromatase inhibitors inhibit peripheral estrogen synthesis so are not used premenopause when estrogen is primarily made by the ovaries.
C. Herceptin is used in treatment for Her-2 positive cancers
D. Her-2 positive cancers tend to be more aggressive (Her-2 promotes cell growth).
E.
10.04 Lecture 1: A matter of choice - 10.04 - PBL 1
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Question 44
Which of the following does NOT increase the risk of developing breast cancer?
A.
B.
C.
D.
E.
Female gender
Late menarche
Hormone replacement therapy
Increasing age
Family history of breast cancer
Answer: B
The following explanations were provided:
A.
B. Breast cancer risk increases with increased exposure to oestrogen. Late menarchy
results in decreased exposure to oestrogen.
C.
D.
E.
10.04 Lecture 3: Breast cancer genes: Implications for health care
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Question 45
A 24-year-old female patient has a mother and three other family members previously
diagnosed with breast cancer. Which of the following BEST describes the initial step in
determining her risk of developing breast cancer.
A. A blood test to determine is there is a causative mutation.
B. Advising of the benefits of a preventative double mastectomy.
C. Advise yearly mammagrams starting immediately.
D. A blood test of a living, affected family member.
E. Advising Mary to monitor her breasts and present to the doctor if there are any
changes.
Answer: D
The following explanations were provided:
A.
B.
C.
D. Once a causative mutation is identified in a living, affected family member, then tests
can be commenced on this patient and the rest of the family (these tests are expensive!).
The family will then be advised on their options regarding future monitoring and
prevention.
E.
10.04 Lecture 3: Breast cancer genes: Implications for health care
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Question 46
Why might bisphosphonates be used in conjunction with chemotherapeutic treatment for
breast cancer?
A.
B.
C.
D.
E.
Women are more prone to bone metastases than men
Chemotherapy can significantly increase the risk of fractures in women
Some endocrine therapies can increase the risk of bone metastases
Bisphosponates aid in elevating serum calcium, which prevents osteopenia
Some endocrine therapies and chemotherapies can cause an increase in bone mineral
density loss
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. From the Cancer Australia guidelines: bisphosphonates can be used to manage
endocrine therapy and chemotherapy side effects, which include bone mineral density
loss
10.04 Lecture 1: A matter of choice - 10.04 - PBL 1
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Question 47
Why might bisphosphonates be used in conjunction with chemotherapeutic treatment for
breast cancer?
A.
B.
C.
D.
E.
Women are more prone to bone metastases than men.
Chemotherapy can significantly increase the risk of fractures in women.
Some endocrine therapies can increase the risk of bone metastases.
Bisphosponates aid in elevating serum calcium, which prevents osteopenia.
Some endocrine therapies and chemotherapies can cause an increase in bone mineral
density loss.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Bisphosphonates can be used to manage endocrine therapy and chemotherapy side
effects, which include bone mineral density loss.
10.04 Lecture 1: A matter of choice - 10.04 - PBL 1
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Question 48
Which of the following is NOT a principle of medical ethics?
A.
B.
C.
D.
E.
Honesty
Justice
Provision of highest standards of care
Confidentiality
Respect for autonomy
Answer: C
The following explanations were provided:
A.
B.
C. The patient has right to the best possible standard of care given current
protocol/practice–not necessarily the highest possible standard.
D.
E.
10.02 Lecture 1: Ethics of decision making in cancer
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Question 49
Which of the following is FALSE regarding the use of antibiotics?
A. The duration of use of antibiotics should be as short as possible, not exceeding 7 days
unless indicated otherwise.
B. A specimen should obtained where appropriate before commencing empirical therapy
with antibiotics.
C. Host factors such as renal and hepatic function must be taken into account when using
antibiotics.
D. The antimicrobial spectrum of the drug use for prophylactic or general therapy should
be the widest to cover likely pathogens.
E. Directed use of antibiotics should aim for a single drug with the narrowest range
possible.
Answer: D
The following explanations were provided:
A.
B.
C. Other host factors include site of infection, age, genetic (G6PD deficiency) & metabolic
(pregnancy and lactation) abnormalities.
D. There is a need to liaise with the local pathology providers to obtain up-to-date
information on local anti-microbial resistance patterns, which would allow you to use a
narrow spectrum antibiotic to cover the likely pathogen, even in prophylactic use.
E.
10.05 Lecture 3: Principles of antimicrobial therapy
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Question 50
Which of the following is FALSE regarding antibiotics?
A. The minimum inhibitory concentration (MIC) is the lowest concentration of antibiotic
that will inhibit growth of the organism.
B. Concentration-dependent killing is dependent on the concentration of MIC peak.
C. Antibiotics can be either bactericidal or bacteriostatic agents.
D. Effective killing of the organism only requires the concentration of the antimicrobial
agent at the infected site to be equal to the pathogen's MIC.
E. Time-dependent killing is dependent on the amount of time that the concentration of
the drug is above the MIC.
Answer: D
The following explanations were provided:
A.
B. Concentration dependent killing has a post-antibiotic effect: death of the organism still
occurs after the concentration of the drug is below the MIC.
C. Bactericidal drugs kill the bacteria directly. Bacteriostatic drugs do not kill the bacteria
but stop it from growing/replicating, allows the immune system a chance to attack it.
D. Effective killing of the organism requires concentration of the antimicrobial agent at the
infected site to be 3 to 5 times higher than the pathogen's MIC.
E. There is a negligible post-antibiotic effect of the drug on the organism in this case.
10.05 Lecture 3: Principles of antimicrobial therapy
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Question 51
Medical practice is generally guided by four basic ethical principles. Which of the following
is not one of these principles?
A.
B.
C.
D.
E.
Justice
Beneficence
Autonomy
Transparency
Non-maleficence
Answer: D
The following explanations were provided:
A.
B.
C.
D. Transparency is not one of the four ethical principles.
E.
10.04 Lecture 1: A matter of choice - 10.04 - PBL 1
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Question 52
Which of the following BEST describes the cause of paraneoplastic syndromes?
A.
B.
C.
D.
E.
Tumour invading and disrupting normal tissue function.
Host immune responses to cancer cells.
Cancer cells invading endocrine glands.
Cytokines, hormones and antibodies induced by the neoplasm.
Side-effects of chemotherapy and radiation
Answer: D
The following explanations were provided:
A.
B.
C.
D. This is the cause of paraneoplastic effects. The cytokines, hormones and antibodies
affect sites distant to the neoplastic growth.
E.
10.02 Lecture 3: Paraneoplastic effects
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Question 53
Which of the following is TRUE regarding the targets of antimicrobial drugs?
A.
B.
C.
D.
There are classes of antibiotics that will treat all classes of infecting pathogenic agents.
Resistance to quinolone drugs develops slowly due to its target in DNA.
β-lactam antibiotics do not affect human cells.
Aminoglycosides and macrolides act on separate targets, the bacterial ribosome and the
cell wall.
E. Anti-microbials only target bacteria.
Answer: C
The following explanations were provided:
A. No single antibiotic will treat ALL class of infecting agents.
B. Quinolone resistance develops rapidly due to its target DNA.
C. β-lactam antibiotics target the components of the cell wall, which is not present in the
human cells.
D. Macrolides and aminoglycosides act on the same target, the bacterial ribosome.
E. Other anti-microbials include anti-virals, anti-fungals, anti-parasitic etc. More are in
development.
10.05 Lecture 3: Principles of antimicrobial therapy
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Question 54
Which of the following is NOT a molecular change that contributes to the development of
carcinogenesis?
A. Upregulation of positive growth factors.
B. Increased expression of vascular endothelial growth factor and matrix
metalloproteinases.
C. Inactivation of genes which regulate the cell cycle and loss of DNA repair mechanisms.
D. Increased expression of telomerase.
E. Increased aerobic metabolism over anaerobic glycolysis.
Answer: E
The following explanations were provided:
A. There is increased positive growth signalling and dysregulation or loss of normal
negative signalling and growth control mechanisms in carcinogenesis.
B. There is increased expression of angiogenic factors such as vascular endothelial growth
factor and matrix metalloproteinase.
C. Dysregulation of the cell cycle and DNA repair are important contributors to
carcinogenesis.
D. Increased telomerase expression confers immortalization and resistance to senescence
and apoptosis.
E. There is a drive towards increased anaerobic glycolysis over aerobic metabolism - this
is an energy-inefficient process, but faster.
10.01 Lecture 1: Epidemiology and molecular basis of carcinogenesis
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Question 55
Which human papilloma virus protein binds to tumour suppressor gene p53 and inhibits
apoptosis?
A.
B.
C.
D.
E.
L1
L2
E6
E7
E8
Answer: C
The following explanations were provided:
A. This protein is targeted by Gardasil vaccine.
B.
C. E6 is responsible for inactivating p53.
D. This protein binds to the pRb protein and degrades it.
E.
10.03 Lecture 3: Viruses and the cell cycle
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Question 56
Which of the following proteins is expressed by human immunodeficiency virus (HIV) and
required for binding to CD4-positive T cells?
A.
B.
C.
D.
E.
gp120
CCR5
CXCR4
gp41
None of the above
Answer: A
The following explanations were provided:
A. This protein binds to the CD4 receptor on T cells.
B.
C. This protein is expressed by T cells.
D. This protein enables HIV fusion with the host cell membrane.
E.
10.05 Lecture 2: Pathology of AIDS: opportunistic infections and neoplasms
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Question 57
A 52 year old man was found to have a 2 cm lung mass on a routine chest x-ray for medical
insurance. Which of the following is LEAST likely to have caused the mass?
A.
B.
C.
D.
E.
Neoplasm
Pneumonic patch
Localised emphysema
Tuberculous granuloma
Calcified hydatid cyst
Answer: C
The following explanations were provided:
A.
B.
C. Emphysema is typically a diffuse disease and would not form a singular lesion.
D.
E.
10.02 Lecture 1: What can I do - 10.02 - PBL 1
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Question 58
Which of the following is not an acute manifestation of a human immunodeficiency virus
(HIV) seroconversion illness?
A. Fever and rash
B.
C.
D.
E.
Myalgia, arthralgia
Decreased CD4+ T cell count
Kaposi's sarcoma.
Meningo-encephalitis
Answer: D
The following explanations were provided:
A.
B.
C.
D. Kaposi's sarcoma is often a late manifestation of HIV disease particularly when the CD4
cell count is under 200 per μL
E.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 59
What type of virus is human papilloma virus?
A.
B.
C.
D.
E.
A double-stranded DNA virus
A single-stranded DNA virus
A double-stranded RNA virus
A single-stranded RNA virus
A satellite virus
Answer: A
The following explanations were provided:
A. The human papilloma virus contains double-stranded DNA.
B.
C.
D.
E.
10.03 Lecture 3: Viruses and the cell cycle
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Question 60
A patient was diagnosed with Stage 4 non-small cell lung cancer. Which of the following is
NOT a possible extra-pulmonary or paraneoplastic effect?
A. Pleural effusion
B. Hypercalcaemia
C. Superior vena cava obstruction
D. Thromboembolism
E. Diffuse abdominal ascites
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. Ascites is more likely to occur in liver disease than lung cancer.
10.02 Lecture 1: What can I do - 10.02 - PBL 1
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Question 61
Which of the following classes of healthcare worker is NOT part of a multi-disciplinary
team for the treatment of a cancer patient?
A.
B.
C.
D.
E.
General practitioners
Physiotherapists
Radiation oncologists
Social workers
All of A, B, C and D are involved in the multidisciplinary team.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. There are very few classes of healthcare worker which are not involved in the
multidisciplinary team.
10.01 Lecture 4: Multidisciplinary care in cancer
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Question 62
Which of the following statements BEST describes a barrier to effective pain management?
A. Patients frequently under report their pain, wanting to be the 'good' patient.
B. Due to a fear of unwanted side effects, patients often lie about their compliance.
C. There is a fear in the community of opioid addiction.
D. Some countries do not have the proper procedures to assess and manage pain.
E. All of the above are barriers to effective pain management.
Answer: E
The following explanations were provided:
A.
B.
C.
D.
E. All of the statements are true regarding pain management.
10.02 Lecture 2: Treating cancer pain
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Question 63
The average efficiency of human immunodeficiency virus (HIV) transmission with a single
episode of unprotected receptive vaginal intercourse with an untreated HIV infected source
is approximately?
A.
B.
C.
D.
E.
30%
3%
.03%
.003%
Not transmissible through vaginal receptive intercourse
Answer: C
The following explanations were provided:
A.
B.
C. This is the current estimated risk (as of 2014).
D.
E.
10.05 Lecture 1: Epidemiology and prevention of HIV
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Question 64
Which of the following options BEST describes equity and equality, respectively?
A.
B.
C.
D.
Fairness; Uniformity
Respect; Justice
Uniformity; Respect
Justice; Fairness
E. Uniformity; Fairness
Answer: A
The following explanations were provided:
A. Equity involves allocating resources to those in the most need while equality is
providing equal resources to each person regardless of their circumstances.
B.
C.
D.
E.
10.03 Lecture 2: Rationing and equity
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Question 65
Which of the following parts of the anatomy is removed in a right hemicolectomy?
A.
B.
C.
D.
E.
Small intestines
Most of the descending colon
Most of the ascending colon
Rectum
Most of the sigmoid colon
Answer: C
The following explanations were provided:
A.
B.
C. The ascending colon lies on the right side of the patient, so it would logically be
removed in a right hemicolectomy.
D.
E.
10.01 Lecture 3: Surgery and the cancer patient
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Question 66
Which of the following if FALSE regarding the procedure of colposcopy?
A. Acetic acid applied to the transition zone turns normal tissue white.
B. Colposcopy looks at the region between the squamocolumnar junction and the original
squamocolumnar junction.
C. Cells that take up lugol iodine are considered to be normal.
D. Colposcopy has a sensitivity of 50% to 80%.
E. Colposcopy always produces a biopsy of the abnormal lesion.
Answer: A
The following explanations were provided:
A. Acetic acid condenses the nucleolar material and reflects light, so cells with a high
turnover (eg abnormally replicating cells) turn white.
B.
C. Lugols iodine is taken up by glycogen rich cells (normal vaginal tissue).
D.
E. If the patient undergoes an ablative therapy (laser or rarely cryotherapy) no biopsy will
be produced.
10.03 Lecture 1: Screening for cervical cancer
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