Oncology 🧬💊

A 51 year old man with metastatic colorectal cancer diagnosed 2 years ago is admitted to the hospital following severe abdominal colicky pain for the past 3 days. He is constantly vomiting faecal content for the past 2 days which is very distressing for him. He is usually mobile but has been in the bed for the past few days because of nausea and severe abdominal bloating. He has had a discussion with his oncologist 2 months ago and has decided not to proceed with chemotherapy for his cancer. His last CT scan shows diffuse intra-abdominal disease with ascites. On examination, his abdomen is distended with high-pitched bowel sounds. What is the most appropriate next management?

A 35 year old woman presents for her blood test results. She reports that she is constantly feeling tired and has heart palpitations. Three years ago she underwent a thyroidectomy for papillary carcinoma of the thyroid. The patient is taking levothyroxine. Her blood results are as follows:

Corrected calcium 2.6mmol/L (2.1-2.6)

Free T3 5.5 pmol/L (3.5-6.5)

Free T4 17.2 pmol/L (9-18)

Thyroid-stimulating hormone 0.1 (0.5-5.7)

Thyroglobulin 5.6 (1.50-38.5)

Which of the above laboratory values would be of most concern?

A 58 year old man is seen by the medical team in this hospital. He complains of shortness of breath and headaches which started several weeks ago. He has swelling of his arms and face, and distention of his neck and upper chest veins which have been worsening over a period of weeks. On examination, he has a facial plethora. He has no audible stridor or laryngeal oedema. What is the most appropriate immediate management?

A 77 year old man presents with a worsening headache over the past few weeks. He has been diagnosed with an inoperative glioblastoma a year ago. He feels nauseous. The head pain can wake him up in the morning. A recent brain CT shows an enhanced lesion with surrounding oedema. What is the SINGLE most appropriate management?

A 33 year old man with suspected testicular carcinoma attends your clinic for the results of the histopathology report. Gross examination shows greasy material which is comprised of hair. Microscopic examination reveals well differentiated hyaline cartilage and mature squamous epithelium with keratinisation. What is the most likely diagnosis?

A 59 year old man is followed up by his oncology team. He has a background of small cell lung cancer. Over the past few weeks, he has been experiencing headaches throught the day. He has been having nausea throughout the day with the loss of appetite. He has been vomiting several times a day for the past two days. His last neuroimaging shows brain metastasis with substantial surrounding oedema. His regular medications include cyclizine. What is the SINGLE most appropriate medication to prescribe?

A 61 year old man is admitted into the medical ward following face and arm swelling. difficulty breathing and headaches. He is known to have bronchogenic carcinoma which has metastasised to his vertebrae. On examination, there is distention of the veins on his neck. His oxygen saturation is 91%, heart rate is 70 beats/minute and respiratory rate is 26 breaths/minute. He is given oxygen by a face mask. A CT scan shows a well defined heterogeneously enhancing mass measuring 5 cm by 4.5 cm by 3.8 cm in the apical segment of the right upper lobe compressing the superior vena cava. What is the SINGLE most appropriate management?

A 58 year old lady with breast cancer has metastatic spread to her lower vertebrae. She describes the pain as being dull and constant and complains that the pain wakes her up at night. Her current medications include morphine sulphate, paracetamol, ibuprofen and senna. Despite taking her medications as prescribed, she still complains of moderate to severe pain in her back. A CT scan shows metastatic deposits at her fourth lumbar vertebra. What is the SINGLE best adjuvant to be added to manage her pain?

A 68 year old man is reviewed in the Oncology Department. He has metastatic colorectal cancer and has just started chemotherapy using capecitabine as monotherapy 7 days ago. He has also prescribed loperamide which he started a few days ago. He has been complaining of severe diarrhoea over the past few days with nausea. He passes around 6 watery stools a day. He has difficulty tolerating drinking a sufficient amount of fluids due to nausea. His medications also include allopurinol which he was prescribed as prophylaxis of hyperuricaemia associated with chemotherapy. He takes regular codeine for pain relief. He has been taking rivaroxaban for recurrent pulmonary embolisms for the past 15 years. What is the SINGLE most appropriate medication to stop?

A 66 year old man has developed pins and needles on his fingers and hands over the past week. He complains of increasing numbness on his hands with the feeling of heaviness. He was diagnosed with Hodgkin’s lymphoma 6 months ago and was recently started on vincristine. He drinks an average of 9 units of alcohol a week. He was diagnosed with type 2 diabetes mellitus a year ago and was started on metformin 9 months ago. His last HbA1c performed 2 months ago was 51 mmol/mol ( < 48). On examination, there is reduced pain and temperature sensation on both his hands and feet. There is a reduction of deep tendon reflexes. What is the SINGLE most likely diagnosis?

A 77 year old man is seen in the Oncology Department for a follow with his advanced prostate cancer. He has been on chemotherapy which had stopped 3 weeks ago. He has been suffering with worsening constipation over the past few weeks. He finds himself feeling depressed most of the day and extremely tired. His appetite is poor. He has noticed that he has been drinking more fluids over the past week. He drank 5 litres of water the day before. On examination, his abdomen is mildly distended with hypoactive bowel sounds. What is the SINGLE most appropriate investigation?

A 41 year old man presents to the GP with a swelling in his neck for the last 3 weeks. He is otherwise well and has not experienced any other symptoms since he noticed the swelling and prior to it as well. He does not smoke or drink alcohol. He is extremely anxious and is concerned that it may be something serious. On examination, the patient is afebrile. His heart rate is 77 beats/minute, respiratory rate is 15 breaths/minute and the blood pressure is 110/70 mmHg. On palpation, a mobile 2cm x 2cm fluctuant mass is palpated in the right submandibular region and there were no inflammatory signs on the skin above the swelling. What is the most appropriate initial investigation to perform?

A 48 year old woman attends the Emergency Department after feeling unwell with diarrhoea over the past 48 hours. She had chemotherapy 12 days ago for treatment of small cell lung cancer. She was treated with antibiotics for a lower urinary tract infection 3 days ago. On examination, she has generalised abdominal tenderness. She has a temperature of 39.5°C, heart rate of 95 beats/minute, blood pressure of 110/70 mmHg, respiratory rate of 25 breaths/minute and an oxygen saturation of 97%. Blood tests were taken. What is the SINGLE most appropriate next action?

A 59 year old man attends the GP surgery with extreme fatigue over the past 3 months. He has now been experiencing thirst and increased urinary frequency. He has lost significant weight over this period of time. The only medications that he takes are his multivitamins which he takes 4 times a day. His blood results show the following:

Sodium 139 mmol/L (135-145)

Potassium 3.8 mmol/L (3.5-5)

Creatinine 89 μmol/L (70-150)

eGFR >90 mL/min

Thyroid stimulating hormone 5.0 mU/L (0.5-5.7)

Serum corrected calcium 3.0 mmol/L (2.1-2.6)

Alanine transferase (ALT) 30 U/L (5-35)

Aspartate transaminase (AST) 32 U/L (5-35)

Alkaline phosphatase (ALP) 210 U/L (30-150)

Gamma glutamyl transferase (GT) 58 U/L (8-60)

Parathyroid hormone (PTH) 8.1 pmol/L (0.8-8.5)

What is the SINGLE most likely diagnosis?

A 75 year old man presents with a worsening headache over the past few weeks. He has been diagnosed with an inoperative high-grade glioblastoma 3 months ago. He feels nauseous and has been vomiting daily over the past week. The head pain can wake him up in the morning. He has been prescribed oral morphine but has very little pain relief from it. A recent brain CT shows an enhanced lesion with surrounding oedema. What is the SINGLE most appropriate management?