oncology
Practice targeted AMC-style multiple-choice questions on oncology.
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A 68-year-old male with known Hepatitis B related cirrhosis and a history of alcohol excess presents for routine surveillance. His alpha-fetoprotein (AFP) level, which has been stable at 15 ng/mL for the past two years, is now noted to be 185 ng/mL. A screening ultrasound performed three months prior was reported as showing diffuse parenchymal changes consistent with cirrhosis but no focal lesions. Due to the elevated AFP, a repeat ultrasound was performed, which identified a 2.5 cm nodule in segment VIII. To further characterise this lesion, a contrast-enhanced ultrasound (CEUS) was performed, and the images provided are representative findings from this study. The patient has well-compensated cirrhosis (Child-Pugh A) and no significant comorbidities. His liver function tests are within normal limits except for a slightly elevated GGT. Given the clinical context and the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?
A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?
A 3-year-old presents with a 2-month history of increasing abdominal distension and intermittent pain. Physical examination reveals a firm, non-tender mass in the upper abdomen. Blood tests show mild anaemia. Vitals are stable. This CT scan was performed as part of the initial workup. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following investigations is the most critical next step for accurate staging and risk stratification to guide appropriate management in this paediatric patient?
A 58-year-old male with known alcoholic cirrhosis undergoes surveillance. AFP is 600 ng/mL. The provided image was obtained. What is the next step?
A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided, which of the following is the most appropriate next step in the management of this patient?
A 62-year-old male with a history of chronic hepatitis C presents to his general practitioner for a routine check-up. He reports no new symptoms. His liver function tests from 6 months ago were within normal limits. However, recent blood work reveals an elevated alpha-fetoprotein (AFP) level of 600 ng/mL (normal <10 ng/mL). The GP orders a contrast-enhanced ultrasound of the liver, the images from which are shown. Based on the ultrasound findings and the patient's history, what is the MOST appropriate next step in management?
A 70-year-old woman, post-mastectomy, presents with a chronic, pruritic lesion. What is the MOST likely underlying pathophysiology?
A 68-year-old woman presents with a persistent rash on her chest wall at the site of a previous mastectomy performed 8 years ago. She denies pain or itching. What is the MOST appropriate next step in management?
A 68-year-old former smoker with a 30 pack-year history presents to their GP with a 2-month history of persistent cough and increasing fatigue, noting a 3kg unintentional weight loss. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray reveals a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging is performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?
A 4-year-old boy presents with left flank pain and a palpable abdominal mass. His mother reports decreased appetite and recent weight loss. A CT scan of the abdomen is performed (image attached). What is the MOST likely diagnosis?
A 58-year-old woman presents for her scheduled screening mammogram. She denies any breast lumps, pain, or nipple discharge. She has no family history of breast cancer. Her physical examination is unremarkable. The image provided is a detail from her left craniocaudal view. Considering this finding, what is the most appropriate immediate next step in her clinical management?
A 3-year-old child presents with a 2-month history of increasing abdominal distension and intermittent pain. On examination, a firm, non-tender mass is palpable in the upper abdomen. Initial blood tests reveal mild anaemia. Vital signs are stable. The provided image was obtained as part of the diagnostic evaluation. Based on the findings in the image and the clinical context, which of the following imaging modalities is most likely to provide critical information regarding potential metastatic disease, which is essential for accurate staging and treatment planning in this paediatric patient?
A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The images are obtained. What is the MOST appropriate next step in management?
A 2-year-old with a palpable abdominal mass and periorbital ecchymoses has the shown CT. What is the MOST likely diagnosis?
A 62-year-old woman presents with a 4-month history of increasing abdominal distension, bloating, and a sensation of early fullness after eating. She has also noticed a gradual increase in her waist circumference and reports feeling more fatigued than usual. Her medical history includes well-controlled type 2 diabetes mellitus and hypercholesterolaemia, managed with metformin and atorvastatin respectively. She is post-menopausal, having completed menopause 10 years ago. On physical examination, her vital signs are stable: blood pressure 128/78 mmHg, heart rate 68 bpm, respiratory rate 14/min, and temperature 36.6°C. Abdominal examination reveals moderate distension and a firm, irregular mass is palpable extending from the pelvis into the lower abdomen. Bowel sounds are present and normal. A recent transvaginal ultrasound was inconclusive due to the size of the mass, prompting a CT scan of the abdomen and pelvis, an axial image from which is shown. Given the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?
A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?
A 28-year-old female presents with a chronic cough and fatigue. She has no significant past medical history. A chest PET-CT was performed as part of her workup. The axial view is shown. What is the MOST appropriate next step in management, considering the image and her presentation?
A 58-year-old male presents with iron deficiency anemia and a change in bowel habits. A colonoscopy was performed, and the image is shown. Biopsies were taken. Assuming the biopsies confirm malignancy, what is the next step?
A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The provided imaging was obtained. What is the MOST likely underlying cause of her presentation?
A 58-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated. A CT scan with contrast is performed (image attached). What is the MOST appropriate next step to determine definitive management?
A 72-year-old woman presents to her oncologist for follow-up. She underwent a left simple mastectomy for invasive ductal carcinoma 10 years ago. She reports a new, persistent skin change on her left chest wall over the past few months. Physical examination reveals the findings depicted. A recent biopsy of the affected area confirmed the presence of malignant cells consistent with Paget's disease. Considering the patient's history and the biopsy findings, which of the following investigations is the most appropriate next step in her management?
A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?
A 63-year-old man presents to his general practitioner with a several-year history of worsening symptoms. He describes significant heartburn and regurgitation, particularly when lying down, which is only partially relieved by high-dose proton pump inhibitors. He has also noticed increasing difficulty swallowing solid food and occasionally liquids, sometimes accompanied by coughing fits after eating. He reports feeling full very quickly after starting a meal and has lost approximately 5 kg unintentionally over the past year. His past medical history includes osteoarthritis and benign prostatic hyperplasia. He is a non-smoker and drinks alcohol occasionally. Physical examination is unremarkable. Routine blood tests, including full blood count, electrolytes, and liver function tests, are within normal limits. A CT scan of the chest and upper abdomen was performed as part of the workup for his symptoms, and a representative axial image is shown. Considering the clinical presentation and the findings demonstrated in the image, which of the following represents the MOST appropriate definitive management strategy for this patient?
A 70-year-old presents with iron deficiency anaemia and intermittent rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but malignancy is strongly suspected based on the endoscopic appearance. What is the MOST appropriate next investigation to guide definitive management?
A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?
A 55-year-old man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed. Considering the clinical context and the findings on imaging, which of the following represents the most appropriate next diagnostic step to guide management?
A 3-year-old presents with abdominal distension and vague pain. Vitals are stable. An abdominal CT is performed (image attached). Elevated levels of HVA and VMA are noted in the urine. What is the MOST likely origin of the primary lesion?
A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?
A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since. During the consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or systemic symptoms such as weight loss or fever. Her vital signs are stable, and physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history and the clinical presentation, what is the most appropriate initial diagnostic step?
A 62-year-old woman undergoes routine screening mammography. She is asymptomatic with no relevant family history of breast cancer. Physical examination is unremarkable. The provided image is a detail from her mammogram. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?
A 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue. Liver function tests are within his baseline (Child-Pugh A). Alpha-fetoprotein is 150 ng/mL. The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, which of the following treatment modalities is most likely to be considered first for this patient?
A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a representative image is shown. What is the MOST appropriate next step in management?
A 68-year-old woman presents to her general practitioner with a persistent, pruritic rash on her chest wall. She reports a history of left mastectomy for invasive ductal carcinoma 8 years ago, followed by adjuvant chemotherapy and radiation therapy. She denies any recent trauma or changes in soaps or detergents. Physical examination reveals the findings shown. A punch biopsy is performed. Which of the following immunohistochemical stains would most likely be positive in this patient's biopsy sample, supporting the suspected diagnosis?
A 58-year-old male with a 15-year history of chronic hepatitis B infection and established cirrhosis presents for a routine surveillance appointment. He reports feeling generally well, with no significant weight loss, abdominal pain, or jaundice. He denies alcohol use. On examination, his vital signs are stable. He has mild palmar erythema but no ascites or peripheral oedema. Liver span is normal. Recent blood tests show platelet count 120 x 10^9/L, albumin 35 g/L, INR 1.2, total bilirubin 20 µmol/L, ALT 40 U/L, AST 55 U/L, creatinine 80 µmol/L. Alpha-fetoprotein (AFP) has risen from 50 µg/L six months ago to 450 µg/L today. A triphasic CT scan of the abdomen was performed as part of the surveillance protocol, axial views of which are provided. Considering the patient's clinical history, laboratory trends, and the findings demonstrated on the provided imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?
A 35-year-old male presents with hemoptysis and weight loss. PET-CT is shown. Bronchoscopy with biopsy is MOST likely to reveal which of the following?
A 68-year-old woman presents with a persistent, pruritic rash on her chest wall at the site of a previous mastectomy performed 8 years ago for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation at that time. Examination reveals the area shown. What is the MOST appropriate next step in management?
A 72-year-old male presents with a 4-month history of increasing constipation and occasional streaks of blood on stool. He denies significant weight loss. Physical exam is unremarkable. A colonoscopy was performed, and the image is shown. Biopsies are taken from the lesion. Assuming the biopsy confirms adenocarcinoma, what is the MOST appropriate initial investigation to guide further management?
A 68-year-old woman presents with a persistent rash following a mastectomy 5 years prior. What is the MOST appropriate next step in management?
A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a concerning lesion was identified. What is the MOST appropriate next step in management?
A 35-year-old male presents with a two-month history of fatigue, unintentional weight loss, and a persistent dry cough. He denies fever or night sweats. A PET-CT scan of the chest was performed (image shown). What is the MOST appropriate next step in management?
A 55-year-old woman presents to her general practitioner with a 3-month history of increasing abdominal bloating, early satiety, and a vague, intermittent dull ache in her lower abdomen. She reports a 5 kg weight loss over the same period, which she attributes to reduced appetite. Her last menstrual period was 5 years ago. She has a past medical history of well-controlled hypertension and osteoarthritis. She is on perindopril and paracetamol as needed. On physical examination, her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Abdominal examination reveals mild distension and a firm, non-tender mass palpable in the suprapubic and left iliac fossa regions, estimated to be about 8 cm in size. Bowel sounds are normal. Pelvic examination is deferred due to patient discomfort and preference for imaging first. Routine blood tests, including full blood examination, urea and electrolytes, liver function tests, and C-reactive protein, are all within normal reference ranges. A CT scan of the abdomen and pelvis is performed to investigate her symptoms, an axial image from which is shown. Considering the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?
A 68-year-old man presents with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and fatigue. He denies significant weight loss. Physical examination is unremarkable. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy was performed, and the image provided is a representative view. Biopsies were taken from the observed lesion. Considering the clinical presentation and the endoscopic finding, what is the most appropriate next investigation to determine the extent of disease and inform definitive management planning?
A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since. During the consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or systemic symptoms such as weight loss or fever. Her vital signs are stable, and physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history and the clinical presentation, what is the most appropriate initial diagnostic step?
Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Assuming that subsequent investigation of the area highlighted in the image confirms a diagnosis of ductal carcinoma in situ (DCIS) and the patient undergoes breast-conserving surgery, which of the following factors is most important in determining the need for adjuvant radiotherapy?
A 70-year-old male with cirrhosis secondary to NAFLD presents for routine surveillance. A new 3 cm lesion was found in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?