A 59 year old male with metastatic prostate cancer continues to struggle with pain which is localised to his rib cage. He is currently taking Naproxen 500 mg BD and paracetamol 1g QDS. His recent liver and renal function tests were normal. You decide to make some changes to his medication. What is the SINGLE MOST appropriate NEXT treatment option?

A 60 year old man with lung cancer has recently been found to have brain metastasis. He is complaining of nausea and vomiting. Which of the following is the first line antiemetic for his symptoms?

Your patient is a 66 year old woman with hepatocellular carcinoma and chronic alcohol problems. Which tumour marker is most likely to be elevated?

A 76 year old male with metastatic prostate cancer is seen with his wife. He is currently on a syringe driver which consists of diamorphine and water. His pain has started to settle. His wife mentions that he has become more restless. Which ONE of the following medications can be added to his syringe driver to help control his restlessness?

Which ONE of the following medications must be mixed with water when administered by a syringe driver?

Which One of the following tumour markers is associated with hepatocellular carcinoma?

Your colleague asks you to have a look at an unsightly lesion on the left cheek of 46 year old female. Which ONE of the following features is MOST LIKELY to be consistent with a basal cell cancer?

You review a 58 year old man with metastatic colorectal carcinoma who is in severe pain. What is the most appropriate management option?

The mother of a 16 month old boy comes into see her GP, she has noticed his left pupil has a white reflection he also appears to have some difficulty focusing on that side. She first noticed this around 3 weeks ago. What would be the MOST APPROPRIATE next management step?

A 64 year old man attends your clinic stating that he has worked with paints and dyes for most of his life Which malignancy is most strongly associated with this risk factor?

During your morning session, you are reviewing a 71 year old male with myeloma. You also have a medical student sitting in with you. Once the patient lives the medical student has lots of questions about myeloma. She wants to know more about some of the risk factors for this condition. Which ONE ETHNICITY listed below has the highest rates of multiple myeloma?

Which one of the following best describes the mechanism of action of tamoxifen?

A 68 year old man with a background of metastatic prostate cancer is admitted to A&E following a 2 day history of vomiting and having not opened his bowels. On examination his abdomen is soft and distended, but he has tinkling bowel sounds. What is the most appropriate management to help his symptoms?

A 25 year old homosexual woman presents for her first cervical smear. What is the most likely risk factor for potential cervical cancer?

A 56 year old male presents to his GP after his wife has become concerned at how much weight he has lost over the last 2 months. He generally feels very tired and run down too. On examination you note a palpable left supraclavicular lymph node. What is the NAME given to this CLINICAL SIGN?

A 54 year old woman with bony metastases atends your clinic requesting pain relief. What is the most appropriate 1st line management option?

Which ONE of the following cancers is most likely to cause acanthosis nigricans?

A 67 year old man with prostate cancer complains that his breasts seem to be getting bigger. You note from his hospital records that he is having chemotherapy. Which drug is MOST LIKELY to be responsible for these adverse effects?

A 64 year old male with metastatic colorectal cancer is reviewed. He reports persistent respiratory tract secretions, which are beginning to effect his quality of life. Which ONE of the following medications can be used to help his respiratory tract secretions?

A 65 year old male with metastatic prostate cancer is reviewed. His pain appeared to be well controlled on morphine sulphate 30mg BD. The district nurse has noted a deterioration in the patient and he can no longer swallow effectively. You decide to start him on a diamorphine syringe driver. What dose of DIAMORPHINE should you prescribe for his syringe driver?

A 65 year old male is referred to his oncology team by his GP, as he has been struggling with recurrent vomiting in recent weeks despite being on regular cyclizine. He is under the oncology team for cerebral metastases. What would be the MOST APPROPRIATE NEXT MEDICATION to help relieve his nausea and vomiting?

A 75 year old female with metastatic lung cancer is reviewed, as she is no long able to tolerate oral medications. Which mode of drug administration should be AVOIDED in this patient?

A 59 year old female with breast cancer presents with worsening headaches, especially after coughing. Her husband also says that she has vomited each morning for the last week and her balance seems a little 'off' at the moment. What is the MOST LIKELY underlying diagnosis?

A 68 year old woman presents with painless jaundice and complains of weight loss. On examination you note signs of thrombophlebitis migrans. A CT abdomen later shows a mass in the pancreatic head. Which tumour marker is most likely to be elevated?

A 50 year old lady with a background of metastatic ovarian cancer attends your clinic for the results of her lumbar/sacral x-ray, following 6 weeks of lower back pain. The x-ray report shows evidence of metastatic bony deposits in the lumbar region. What is the most appropriate management to treat her bony metastases?

A 56 year old lady with metastatic lung cancer is struggling with shortness of breath. According to the current best practice, which ONE of the following SIMPLE MEASURES can be used to help improve her breathing?

A short time after chemotherapy for leukaemia, a 32 year old man develops heart block and atrial fibrillation. Which drug is most likely to be responsible for these adverse effects?

A woman develops pulmonary fibrosis after being treated for squamous cell lung cancer with chemotherapy. Which drug is most likely to be responsible for these adverse effects?

Which cancers listed below are associated with Alpha-feto protein (AFP)?

A 53 year old lady attends your clinic for a review. You are considering a diagnosis of ovarian cancer as part of your differential diagnosis. Which of the following symptoms is most likely to be seen in ovarian cancer?

A 41 year old male is worried about bowel cancer, after he has noted loose stools and vomiting for the last 7 days. His past medical history includes asthma, eczema and generalized anxiety disorder. Which ONE of the following scenarios would warrant a a 2 week wait colorectal cancer clinic referral?

A 23 year old woman attends your clinic complaining of pain on passing urine over the last 2 days. On further query she informs you that she had had unprotected sexual intercourse with a number of different partners over the last 3 months. Which malignancy is most strongly associated with this risk factor?

A 65 year old female with a background of metastatic breast cancer attends your clinic. She states that she has been constipated for the last 5 days despite trying various different oral laxatives. According to national guidance, which ONE of the following groups of palliative patients are at high risk and should NOT have an enema?

A 67 year old woman with a background of myeloma presents with blood in her urine and pain on passing urine. She informs you that she recently has had chemotherapy. Which drug is most likely to be responsible for these adverse effects?

A 48 year old man a background of coeliac disease attends your clinic. Which malignancy is most strongly associated with this risk factor?

Which ONE of the following TUMOUR MARKERS is linked with colorectal cancer?

Which ONE of the following tumour markers is associated with BREAST CANCER?

A 68 year old lady with a background of metastatic breast cancer attends your clinic, complaining of ongoing diarrhoea for the last 3 weeks. Which medication is most likely to be causing her symptoms?

A 73 year old man presents with a change in bowel habit and PR bleeding. You suspected colorectal cancer. Which tumour marker is most likely to be elevated?

A 35 year old lady with metastatic breast cancer asks for some advice regarding her pain control. She is currently taking a transdermal fentanyl 25 microgram patch. She is hoping for some better pain control. According to the CURRENT BNF advice, a transdermal fentanyl 25 microgram patch equates to approximately how much oral morphine?

A 70 year old lady with a background of metastatic breast cancer is currently on 60 mg BD of MST (morphine slow release tablet), but is no longer able to tolerate oral medications. You decide to start a continuous subcutaneous infusion. What dose of subcutaneous morphine over 24 hours would you prescribe?

A 65 year old female with ovarian cancer is struggling with mild abdominal pain. She has no other symptoms of note. What would be the most appropriate INITIAL option to help reduce her pain?

A 66 year old male with metastatic lung cancer is now taking oral tramadol 100 mg QDS, but still reports intense pain. The district nurse has asked if you can change him to an equivalent dose of oral morphine. What is the appropriate 24 hour EQUIVALENT dose of Morphine?

A 55 year old lady with non-small cell lung cancer has just completed chemotherapy 2 weeks ago. She is currently taking calcium supplements due to hypocalcaemia. Today her bloods show that her serum calcium is 2.03 mmol/l (low). Which ONE of the following additional tests may be used to investigate why her calcium remains low, despite treatment?

A 21 year old male attends your clinic for the results of his orchidectomy histopathology. What is the most likely diagnosis?

A 72 year old male is diagnosed with prostate cancer. His urologist is trying to find out if the patient has had any risk factors for prostate cancer. Which ONE of the following is a RISK factor for prostate cancer?

A 54 year old female with metastatic breast cancer is now taking oral tramadol 100 mg QDS, but still reports intense pain. You decide to change her to oral morphine. What is the appropriate 24 hour EQUIVALENT dose of Morphine?

Which ONE of the following tumour markers is most associated with breast cancer?

A 40 year old lady presents with several non-tender neck lumps that have been present over the last 2 months. She also reports some night sweats and weight loss. On examination you note several non-tender lymph nodes around her neck, which feel rubbery. You note splenomegaly on palpation of her abdomen. What is the MOST LIKELY diagnosis?

A 28 year old lady with a background of thyroid cancer attends your clinic for a review of her post-op bloods. She has had thyroid cancer treatment 3 months ago.

A 71 year old male with prostate cancer attends your clinic. Before leaving, you safety net about important signs and symptoms of metastatic spinal cord compression. Which ONE of the following features will usually be seen FIRST in a patient with metastatic spinal cord compression (MSCC)?

A 67 year old lady with breast cancer is suffering with localised pain in her left breast. She is currently taking 5 mg of oramorph (morphine solution) every 4 hours. Her Macmillan nurse calls you saying the patient is now struggling to swallow. You decide to switch her pain relief medications to a regular form. What would be the MOST APPROPRIATE NEXT option to control her pain?

A 35 year old lady with lung cancer is reviewed in your clinic after presenting with a 5 hour history of shortness of breath, orthopnoea and some mild swelling around her face. On examination you note mild stridor, oedema of her face/arms and a raised JVP. Her pulse is 90, her oxygen saturations are 90% on room air but rise to 99% on 15 litres of oxygen. Her chest is clear, and her calves are soft with no pain or swelling noted. What is the MOST LIKELY diagnosis?

A 65 year old male is seen in A&E after being referred by the out of hours GP. He has reported low back pains, and now feels he has lost control of his bowels and bladder, and legs feel weak too. You note he has recently received treatment for prostate cancer. On examination you note power of 4/5 in both legs, a loss of sensation on PR examination, exaggerated reflexes in the lower limb and up going plantars. Give the MOST LIKELY diagnosis, what is the most appropriate investigation to confirm the diagnosis?

A 53 year old woman comes into see her GP for some advice. She is worried about getting ovarian cancer as her younger sister was recently diagnosed with this. You discuss some of the risk factors with her. Which ONE of the following is thought to REDUCE the risk of developing ovarian cancer?

A 38 year old woman with metastatic ovarian cancer develops peripheral neuropathy. You note from her records that she was previously treated with alkylating chemotherapy agent Which drug is most likely to be responsible for this adverse effect?

A 78 year old man is being treated palliatively for advanced prostate cancer. He appears to be in the final days of life. He has been taking Morphine Sulphate Modified Release 30mg twice daily for the past few weeks and his pain has been well controlled. The distric nurse asks you to review his medication as he is now struggling to swallow oral medications. What is the next appropriate step in management?

A 64 year old woman is diagnosed with the Epstein-Barr virus infection. Which malignancy is most strongly associated with this risk factor?

A 48 year old lady with a background of Crohns disease attends your clinic for the results of her blood test. Her results are as follows:

A 61 year old female is found to have a low sodium and a raised urine osmolality. She is diagnosed with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which ONE of the cancers listed below is associated with this condition?

A 61 year old man complains of back pain, weight loss and poor stream. You perform a digital rectal examination and find a hard, irregular prostate gland. Which tumour marker is most likely to be elevated?

A 57 year old lady with metastatic breast cancer is currently taking 5 mg of Oxycodone every 6 hours. Unfortunately she is now deteriorating and a decision is made to switch her to a Diamorphine syringe driver. What would be the MOST APPROPRIATE Diamorphine dose?

Lung Cancer A 69 year old male is reviewed in the respiratory clinic for suspected lung cancer. The consultant asks the patient about possible risk factors for lung cancer. Which ONE of the following is a RISK FACTOR for lung cancer?

A 65 year old male with pancreatic cancer is now entering the palliative phase. At present he is troubled by a persistent dry cough and so far he has tried humidified air, simple codeine linctus and Morphine 10 mg QDS PRN, with minimal improvement noted so far. Which ONE of the following would be a suitable next option to help alleviate his dry cough?

A 30 year old man with testicular seminomas is referred to the Oncology team for discussion of possible radiotherapy. Which tumour marker is most likely to be elevated?

Approximately how many new cases of prostate cancer are diagnosed each year, in the UK?

A 54 year old male reports recurrent nocturia for the last 6 weeks, he has to pass urine around 2-3 times a night. He denies excess fluid intake later in the day. He does not report any other symptoms of note. He is worried today as one of his friends who is 55 was diagnosed with prostate cancer 4 weeks ago. What would be the MOST APPROPRIATE next step in his management?

A 72 year old male with metastatic prostate cancer to the bone, appears to be struggling with his pain control. He is currently taking Paracetamol 1g QDS. He asks for something stronger as he states his pain is moderate. Which ONE of the following options is the RECOMMENDED next medication to help manage his bone pain?

Immediately after undergoing chemotherapy for uterine cancer, a 29 year old lady begins to experience severe vomiting. What is the most appropriate management option?

You review a 65 year old lady with advanced stage ovarian cancer. She is currently taking Tramadol 100 mg QDS and 5 mg Oramorph every 6 hours. Her cancer nurse would like to change her to an equivalent oral morphine sulphate (MST) dose. What DOSE of MST would be EQUIVALENT to her current analgesia intake?

Which of the following palliative care medication is LEAST likely to cause local irritation when given subcutaneously?

A 57 year old male with lung cancer is currently taking codeine 60 mg QDS. You decide to switch him to an equivalent oral morphine dose. Which ONE of the following doses would be the correct MORPHINE CONVERSION dose?

A 45 year old lady presents with ongoing abdominal bloating. She has been reading about a blood test which can help to identify ovarian cancer. Which TUMOR MARKER is associated with ovarian cancer?

A 70 year old man with metastatic bladder cancer presents with pain and vomiting. He currently takes oral morphine sulphate MR 40mg twice daily. You decide to change his medication to subcutaneous morphine in a syringe driver. What is the most appropriate dose of subcutaneous morphine to give over a 24 hour period?

A 12 year old boy is seen with his mother, she has noticed a tender swelling over his left shin, which has gradually got worse over the last week. He denies any trauma or recent injuries. On examination you note a tender firm swelling over his left tibia and the bone is very tender to touch. He has no obvious surrounding bruises. You note he is unable to fully weight bare on his left leg. What would be the most appropriate investigation?

A 55 year old woman comes into see her GP, she would like to discuss the risk factors for ovarian cancer, as her sister was recently diagnosed with it and has just started treatment. Which ONE of the following is believed to REDUCE the risk of developing ovarian cancer?

A 23 year old female comes into see you, as she noted a small pea sized non tender lump in her left breast. She has no other signs or symptoms of note. She is worried about breast cancer and would like to be referred to the clinic. Which ONE of the following situations would warrant a NON URGENT REFERRAL to the breast clinic?

A 53 year old woman with metastatic cancer from an unknown primary presents with vomiting. What is the most appropriate management option?

For patients with severe renal impairment (Stage 4 or 5 chronic kidney disease), which of the following is the MOST APPROPRIATE choice of analgesia for palliative care?