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25.01.2022 Tamara is a 41F, who is premenopausal. She is seeing you in clinic to discuss endocrine therapy post completion of her adjuvant radiotherapy and chemotherapy. She asks of the side effects of tamoxifen, which of the following is not a common side effect of it? A) Reduction in bone mineral density B) DVT C) Endometrial adenocarcinoma D) Myalgias... E) Peripheral oedema. See more

25.01.2022 Which of the following is not an anticipated toxicity of Bevacizumab, a vascular endothelial growth factor monoclonal antibody, commonly used in treating metastatic colorectal cancer? A) proteinuria B) hypertension C) gastric perforation D) neutropenia... E) infusion reaction Answer will be posted tomorrow evening!!!

24.01.2022 Robert is a 48M with a nasty bladder cancer, who has been referred to you for consideration of neoadjuvant chemotherapy with dose dense MVAC (methotrexate, vincristine, doxorubicin and cisplatin). Which of the following is not a contraindication to this regimen? A) poor hearing B) peripheral neuropathy C) CKD... D) T2DM E) CCF See more

24.01.2022 A 24M with a history of meningioencephalitis as a child, with a subsequent hearing impairment has been referred to you by a Urologist, for consideration of adjuvant chemotherapy with BEP (bleomycin, etoposide and cisplatin). Which of the drugs is contraindicated and why? A) Bleomycin due to concerns fo pneumonitis B) etoposide due to concerns of a recall flare of his encephalitis C) cisplatin due to hearing impairment... D) cisplatin due to nephrotoxicity E) Bleomycin due to risk of tinnitus. See more

24.01.2022 Which of the following is a predictor of a response to cetuximab (an EGFR monoclonal antibody) in metastatic colorectal cancer? A) mismatch repair deficiency B) Presence of a BRAF V600E mutation C) Absence of a mutation in NRAS, KRAS or BRAF... D) a normal baseline CEA E) presence of pulmonary mets. See more

23.01.2022 Which of the following pathological features is predictive of recurrence of a resected NSCLC? A) PDL-1 status. B) Nodal status C) EGFR mutation... D) Lymphovascular invasion. E) Perineural invasion. See more

22.01.2022 Thanks to all our speakers, who helped make for a great two days on Haematology and Oncology for the Melbourne Cancer Course for 2019. Thanks also to all of you who travelled from far and wide, who helped make it a brilliant weekend. Hopefully you learnt from our fabulous speakers, and inspired your studies and careers. Good luck!

22.01.2022 You're treating Elena with adjuvant chemotherapy of doxorubicin, cyclophosphamide, a taxane and herceptin for her ER+PR+Her2+ breast cancer. She asks you why cant you give her doxorubicin, and Herceptin based treatment together, so that she can get to her surgery faster. You say they cannot, because of? A) The risk of heart failure B) The risk of febrile neutropenia C) The risk of chronic alopecia... D) To minimize the risk of transfusion dependent anaemia E) To minimize the risk of potentially fatal diarrhea. See more

21.01.2022 Which of the following suggests a sporadic dMMR deficient colorectal cancer? a) MLH1 def BRAF mt CRC b) MLH1 wt BRAF wt CRC c) MLH1 def KRAS mt CRC... d) MSH2 def NRAS mt CRC E) MSH6 def BRAF mt CRC. See more

21.01.2022 And were back for 2019! Share the news with your friends, the Melbourne Cancer Course will be on at the Victorian Comprehensive Cancer Centre on the 7th & 8th of September. More info on our website.

21.01.2022 A 75F with a curatively treated Her2+ node positive breast cancer presents to her local doctor some 4 years post treatment of her breast cancer. She complains of dyspnoea, orthopnea and paroxysmal nocturnal dyspnoea. Her GP is very resourceful, and orders a TTE. This shows global systolic dysfunction with an LVEF of 20%, a drop from 55% at the time of her receiving her adjuvant chemotherapy. You discuss the case with her oncologist, who informs you that she received chemother...apy with doxorubicin, cyclophosphamide, paclitaxel and herceptin. She also received adjuvant radiotherapy. Despite the best measures of her GP, and the intervention of a cardiologist, her LVEF deteriorates further, and she succumbs to cardiac failure. What is the likely cause of her cardiac failure? A) Herceptin B) radiotherapy C) Cyclophosphamide D) Doxorubicin E) Paclitaxel and herceptin in combination.

19.01.2022 With regards to glioblastoma multiforme (GBM - the most common primary CNS tumour), what is the best predictor of response to temozolamide (an oral alkylating agent with good CNS penetration)? A) MGMT methylation. B) IDH1 deficiency C) p53 mutation... D) MGMT wildtype E) EGFR amplification. See more

19.01.2022 A 72M receiving high dose methotrexate for primary CNS lymphoma develops a fever of 39.4c on the ward, with associated rigors Given he is receiving chemotherapy, you treat him emperically for febrile neutropenia. He has no allergies, and has tolerated penicillins well previously. What is the appropriate antibiotic(s) in this situation? A) Tazobactam & piperacillin (tazocin). B) Ciprofloxacin C) Cefepime... D) Gentamicin E) Tigecycline. See more

19.01.2022 You are reviewing a 65F in the breast oncology clinic for consideration of adjuvant endocrine therapy for her curatively treated, node positive, endocrine receptor positive, Her2- breast cancer, who has completed her adjuvant chemotherapy and radiotherapy, post wide local excision and sentinel node biopsy. Her past medical history is significant for a history of protein c deficiency, diagnosed after an unprovoked DVT in her teenage years, for which she takes no regular medic...ations. Which of the following therapies is contra-indicated? A) tamoxifen B) exemestane C) anastrozole D) zoledronic acid E) denosumab.

19.01.2022 Which of the following is not a predictor of poor prognosis in metastatic melanoma? A) Elevated LDH B) Poor performance status C) BRAF wt... D) KRAS wt E) Old age See more

17.01.2022 A 70F Asian never smoker presents with haemoptysis. Bronchoscopy reveals a tumour at the hilum, with a staging PET scan showing contralateral lung mets, and hepatic mets. Biopsy confirms adenocarcinoma. What is the next most important test that will inform treatment and prognosis? A) Next gen sequencing looking for the presence of an EGFR/ROS mutation. B) Tumour mutational burden on a blood test C) PDL-1 levels within tumour... D) PDL-1 levels within tumour infiltrating lymphocytes E) Bone scan. See more

15.01.2022 A 38M with metastatic melanoma presents to ED with colitis. He is receiving nivolumab & ipilumimab for metastatic melanoma. He presents with a 2 day history of watery, bloody diarrhoea, opening his bowels approximately 20 times per day. A CT of his abdomen is consistent with colitis. Having ruled out an infectious cause, he is treated with high dose IV methylprednisolone. After 4 days of treatment and a colonoscopy confirming immunotherapy related colitis, his colitis persist...s. What is the next step in treatment? A) surgical referral for consideration of colectomy B) IVIG C) Infliximab D) ATGAM E) tacrolimus.

14.01.2022 In a patient with metastatic NSCLC harbouring an exon 19 EGFR who progresses whilst on first line erlotinib(a tyrosine kinase inhibitor directed at the EGFR oncogenic mutation) the most appropriate next investigation is: A) biopsy of a progressive lesion to assess for the presence of a T790M mutation biopsy of a non-progressing lesion to assess for the presence of a C121Y lesion. C) biopsy of a lesion to assess for the presence of Her2+ amplification... D) an assessment of PDL-1 expression on the initial diagnostic biopsy E) serum analysis of circulating tumour mutation burden (TMB). See more

13.01.2022 Wendy, 74 has metastatic ER-/PR-/Her2+ breast cancer that you are treating with single agent Herceptin. Her most recent TTE shows a drop in her LVEF from 60 to 40%. She has no history of IHD or CCF What is the most reasonable course of action? A) Cease her Herceptin all together due to irreversible cardiomyopathy B) Withhold her Herceptin for four weeks, and reassess her LVEF, and consider reintroduction if her LVEF has improved C) Continue her Herceptin, as the LVEF is likel...y due to a previous anthracycline D) Urgent angiogram to assess for ischaemic cardiomyopathy E) Cease her tamoxifen and consider an aromatase inhibitor. See more

12.01.2022 Which of the following is not a side effect of PDL-1 targeting immunotherapy? A) pneumonitis B) hyperthyroidism C) hypothyroidism D) colitis... E) febrile neutropenia. See more

12.01.2022 Which of the following is not a BRCA associated cancer? A) Pancreatic cancer B) breast cancer C) gastric cancer... D) high grade serous ovarian cancer E) Prostate cancer. See more

11.01.2022 A man with node positive, sporadic colorectal cancer was treated 12 months ago with surgery and chemotherapy. He is currently being followed up with regular CEA and annual CT scans. Detecting which of the following would be the strongest reason for following this patient up in this way? A. Anastomotic recurrence B. A separate primary malignancy C. Minimal residual disease so that chemotherapy can be commenced... D. Pancreatic cancer E. Resectable secondaries to liver and lung See more

11.01.2022 Which of the following is not a side effect of nivolumab? A) febrile neutropenia B) hypothyroidism C) pneumonitis... D) adrenal insufficiency E) new T1DM. See more

10.01.2022 A 59M with metastatic pancreatic cancer is found to have an incidental pulmonary embolus on a restating CT chest/abdomen/pelvis. His cancer appears to be responding to treatment, and you would like to continue his current chemotherapy of gemcitabine and abraxane. With regards to his pulmonary embolus, the most appropriate management would be? A) Clot retrieval Thrombolysis C) Commencing warfarin, with an INR of 2-3 ... D) Commencing clexane @ 1.5mg/kg daily E) Commencing apixaban at 10mg BD followed by 5mg BD See more

10.01.2022 A patient receiving R-CHOP for Non-Hodgkins Lymphoma presents to the Emergency Dept with a fever of 38.3c, tachycardic, hypoxic and a CXR suggestive of a Right lower lobe pneumonia. Blood tests have been taken, but are not yet available for analysis. What is the most appropriate antibiotic(s) to commence treatment with immediately? A) Tazobactam & piperacillin & azithromycin B) Tazobactam & piperacillin C) Benzylpenicillin & doxycycline... D) Clindamycin & gentamicin E) Ceftriaxone & azithromycin. See more

09.01.2022 Aziz is a 69M who has just receiving his 6th cycle of nivolumab for metastatic NSCLC and has so far been having a good radiological response. He presents to ED with a non productive cough, and dyspnea that has been ongoing for the past 2 weeks. He is afebrile, and his inflammatory markers are normal. What test is the next most important to consider? A) RFT, as Aziz is likely to be a smoker, and subsequently he likely has undiagnosed COPD B) CTPA to find the dirty big PE he ha...s. C) CT brain, to find his new cerebral met. D) HRCT chest to rule out pneumonitis E) U/S of his lower limbs to rule out a DVT. See more

08.01.2022 Lina is a 67F with metastatic EGFR+ lung cancer, who you are prescribing gefitinib too. You note she is on pantoprazole for GORD, though she has had normal gscopes approximately 12 months ago, and has been on pantoprazole for 4 years. Why should she cease her pantoprazole? A) she no longer needs it given she has been asymptomatic for 4 years B) the potential for Steven Johnsons syndrome with gefitinib and pantoprazole combined C) reduction in gastric acid levels reduce gastr...ic absorption of gefitinib D) PPI inhibits p-glycoprotein ability to absorb the activated S-enatomor of gefitinib E) It potentiates the diarrhea that is commonly seen with gefitinib. See more

08.01.2022 In a patient with metastatic Her2+ breast cancer, receiving paclitaxel, trastuzumab and pertuzumab, presents with new dyspnoea and peripheral oedema. A trans thoracic echocardiogram shows a drop in her LVEF from 65->45%. What is the most appropriate course of action? A) Urgent angiogram to assess for the presence of an ischaemic cardiomyopathy. B) Withhold both drugs, until her LVEF improves to be within 10% of baseline. C) Cease all Treatment, as she now has an irreversibl...e cardiomyopathy andwil need to change cancer treatment. D) It is unrelated to her her2+ treatment, however we should caes her paclitaxel. E) it is a paraneoplastic phenomenon See more

07.01.2022 A MSH6 deficient colorectal cancer, in a patient with a past history of endometrial cancer is suggestive of what genetic/familial syndrome? A) BRCA 1 Lynch syndrome C) BRCA 2... D) Peutz Jeugher E) Li-Fraumeni. See more

06.01.2022 Which so the following is predictive of a poor prognosis in HCC? A) AFP >100 B) portal vein thrombus C) Presence of ascites D) Albumin <20... E) Haemoglobin 90 See more

05.01.2022 Which of the following confers a high risk of an adverse event to irinotecan? A) Asian ethnicity B) Concurrent metformin use C) Concurrent statin use D) Gilbert's syndrome... E) Coeliac disease See more

05.01.2022 Janine is a 44f with ER-/PR-/Her2+ T3N2 breast cancer who you are seeing to discuss neoadjuvant breast cancer. You discuss with her the combination of doxorubicin, cyclophosphamide, Herceptin and paclitaxel. She asks during which period will she be most susceptible to infection. What do you answer with? A) during her anthracycline based treatment B) during her cyclophosphamide treatment C) during the weekly paclitaxel... D) during her period of Herceptin E) a&b See more

04.01.2022 A 35 year old man presented with a painless testicular lump and imaging revealed bulky retroperitoneal lymph nodes. Which tumour marker profile is most consistent with his diagnosis of pure seminole testicular cancer? A - normal AFP, elevated bHCG, elevated LDH... B - elevated AFP, normal bHCG, normal LDH C - elevated AFP, normal bHCG, elevated LDH D - elevated AFP, elevated bHCG, elevated LDH E - normal AFP, normal bHCG, normal LDH. See more

03.01.2022 Which of the following is predictive of a newly diagnosed metastatic NSCLC- adenocarcinoma responding to pembrolizumab? A)ALK mutation status B)Smoking status C)Level of PDL-1 expression... D)Level of CTLA4 expression E)CRP See more

03.01.2022 Nicole is a 34F who you are seeing in clinic post completion of her adjuvant radio and chemotherapy, for which she had doxorubicin, cyclophosphamide and weekly ...paclitaxel for her ER+/PR+/Her2- breast cancer. Her primary tumour was a poorly differentiated grade 3, 23mm in size, with 7/14 axillary nodes positive. What is the most appropriate endocrine therapy for a premenopausal woman in this situation? A) Ovarian suppression with a GNRH analogue (ie, goserelin) and an aromatase inhibitor B) Ovarian suppression with a GNRH analogue (ie, goserelin) and tamoxifen C) Tamoxifen D) Fulvestrant E) Ovarian suppression with a GNRH analogue (ie, goserelin) and denosumab.

02.01.2022 Why are BRAF V600E mutated melanomas placed on both dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor), when they have one mutation? A) Both are BRAF inhibitors that work to stabilize the transmembrane protein and prevent oncogenesis B) The combination prevents use of the alternative MEK pathway and improves OS C) The combination prevent use of the EGFR pathway and improves OS... D) Trametinib improves CNS penetration of dabrafenib E) Both are prodrugs that bind together to create a super molecule See more

02.01.2022 Within metastatic colorectal cancer, which of following is the best predictor of response to pembrolizumab? A) RAS wt B) BRAF mutation C) Tumour infiltrating lymphocytes... D) mismatch repair deficiency E) Tumour mutation burden. See more

01.01.2022 Which of the following is not a side effect of cyclophosphamide? A) Secondary bladder TCC B) Premature ovarian failure C) Haemorrhagic cystitis... D) Hair thinning E) Peripheral neuropathy See more