KFP – Oncology

Gillian Ward, aged 67, presents to your rural general practice with persistent right upper quadrant abdominal pain and a 3-month history of unexplained weight loss and anorexia. She reports intermittent nausea and early satiety. Over the past week, her husband has noticed yellowing of her eyes and dark urine. She denies fevers or recent overseas travel.

Medications: Rosuvastatin 10 mg daily, Perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia

Family history: Father died of bowel cancer at age 72, no known liver disease

Social history: Retired school teacher, non-smoker, drinks 1–2 glasses of wine most nights

Examination findings: Icteric sclerae, mild right upper quadrant tenderness without rebound or guarding, no palpable masses, no ascites

Investigations:

Liver function tests:

What is the most likely diagnosis, and what are the appropriate next steps? Select four (4) from the following list:

Timothy Huang, a 56-year-old truck driver, presents to your metropolitan GP clinic with a 4-month history of progressive hoarseness. He reports mild dysphagia to solids and has recently noticed unintentional weight loss of 6 kg. He denies smoking but reports daily alcohol use, drinking 4–5 standard drinks per night for over 20 years.

Medications: None

Allergies: Nil known

Past history: Hypertension, well controlled

Family history: Non-contributory

Social history: Lives alone, does not smoke, heavy alcohol use. No recent travel.

Examination findings: Hoarse voice, no lymphadenopathy, mild erythema of posterior pharynx. No masses palpable in the neck. Rest of systemic examination unremarkable.

Investigations: FBC, LFTs, and electrolytes all within normal limits.

What are the most appropriate next steps? Select three (3) from the following list:

Leila Koury, a 48-year-old woman, presents with a 2-month history of a painless lump in her left breast. She reports it was initially small but has become firmer and slightly larger. She denies nipple discharge, skin changes, or systemic symptoms. Her last mammogram was 4 years ago. She is premenopausal and has no history of hormonal therapy use.

Medications: None

Allergies: Nil known

Past history: G2P2, no major illnesses

Family history: Maternal aunt diagnosed with breast cancer at age 52

Social history: Non-smoker, works as a school librarian, drinks socially

Examination findings: 2.5 cm firm, non-tender mass in the upper outer quadrant of the left breast, mobile, with no skin tethering or nipple retraction. No palpable axillary or supraclavicular lymphadenopathy.

What are the most appropriate next steps in management? Select four (4) from the following list:

Samuel Idris, a 72-year-old man, presents to your suburban general practice with a 3-month history of increasing fatigue, early satiety, and unintentional weight loss. He also reports occasional left-sided abdominal discomfort. He has noticed easy bruising and recently developed night sweats. He denies fever or recent infections.

Medications: Aspirin 100 mg daily

Allergies: Nil known

Past history: Ischaemic heart disease, hypertension

Family history: Non-contributory

Social history: Retired builder, non-smoker, minimal alcohol use

Examination findings: Pale conjunctivae, palpable spleen 5 cm below the left costal margin, no hepatomegaly or lymphadenopathy

Investigations:

What are the most appropriate next steps? Select three (3) from the following list:

Aisha Mohamed, a 62-year-old woman, presents with a 3-month history of progressively worsening back pain, particularly at night and not relieved by rest. She also reports recent fatigue, frequent urination, and episodes of confusion. She denies trauma. She has lost 4 kg over the past 2 months without trying.

Medications: Ramipril 5 mg daily

Allergies: Nil known

Past history: Hypertension, osteoarthritis

Family history: Mother died of stroke, father had type 2 diabetes

Social history: Retired, lives with husband, non-smoker, drinks socially

Examination findings: Mild spinal tenderness at the thoracolumbar junction, no focal neurological signs, no lymphadenopathy

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Chi Nguyen, a 28-year-old woman, presents with a 2-month history of an enlarging, non-tender neck lump. She also reports intermittent night sweats, low-grade fevers, and recent unintentional weight loss of 5 kg. She denies sore throat, cough, or dysphagia. She works as a marketing executive, has no recent overseas travel, and has not been unwell recently.

Medications: Oral contraceptive pill

Allergies: Nil known

Past history: Mild asthma in childhood

Family history: Maternal grandfather had bowel cancer

Social history: Non-smoker, drinks socially, sexually active, monogamous relationship

Examination findings: 3 cm firm, rubbery, non-tender lymph node in the left supraclavicular fossa. No overlying skin changes. No hepatosplenomegaly. Vitals are stable.

What are the most appropriate next steps? Select four (4) from the following list:

Martin Godfrey, a 69-year-old retired mechanic, presents with persistent haematuria noted over the past 2 weeks. He describes the urine as red and without clots. He has no associated pain, fever, or dysuria. He denies trauma or recent strenuous activity. He has a 45-pack-year smoking history and stopped smoking 3 years ago.

Medications: Atorvastatin 20 mg daily, Amlodipine 5 mg daily

Allergies: Nil known

Past history: Hypertension, hypercholesterolaemia

Family history: No known malignancies

Social history: Lives alone, no recent travel

Examination findings: Normal vital signs. No abdominal or flank tenderness. No palpable masses. Digital rectal examination reveals a normal-sized, smooth prostate.

What are the most appropriate next steps? Select four (4) from the following list:

Thomas Vella, a 61-year-old man, presents with a persistent non-healing ulcer on the left side of his lower lip. He reports that it has been present for approximately 2 months, gradually enlarging and occasionally bleeding. He is a long-term smoker and retired builder who reports significant lifetime sun exposure. He denies weight loss, dysphagia, or cervical lumps.

Medications: Irbesartan 150 mg daily

Allergies: Nil known

Past history: Hypertension, actinic keratoses

Family history: Non-contributory

Social history: Smokes 15 cigarettes/day, drinks 2–3 standard drinks most nights

Examination findings: 1.2 cm ulcerated lesion on the vermillion border of the left lower lip with indurated edges and a firm base. No cervical lymphadenopathy. Cranial nerve examination is normal.

What are the most appropriate next steps? Select three (3) from the following list:

Jonathan Keyes, a 54-year-old lawyer, presents with a 4-week history of worsening headache, intermittent nausea, and new-onset difficulty finding words. His wife also notes occasional episodes where he seems confused or ‘zoned out’. He has no significant past medical history. He does not smoke or drink alcohol.

Medications: None

Allergies: Nil known

Past history: No chronic conditions or prior head trauma

Family history: Father died of myocardial infarction, no known cancers

Social history: Lives with wife and children, no recent travel

Examination findings: Alert and oriented. Cranial nerves intact. Mild expressive aphasia. No focal motor deficits. Fundoscopy shows mild papilloedema.

What are the most appropriate next steps? Select three (3) from the following list:

Sandra Felton, a 35-year-old woman, presents with increasing fatigue, bruising, and gum bleeding over the past 2 weeks. She has also had intermittent fevers and reports feeling generally unwell. She denies recent travel or known infections. She is not currently taking any medications and has no significant past medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil

Family history: Non-contributory

Social history: Works as a primary school teacher, non-smoker, drinks alcohol occasionally

Examination findings: Pale conjunctivae, petechiae on lower limbs, gingival hypertrophy. No hepatosplenomegaly or lymphadenopathy. Temperature 38.2°C

Investigations:

What are the most appropriate next steps? Select three (3) from the following list:

Jackie De Luca, a 63-year-old woman, presents with persistent right shoulder pain that has worsened over 3 months. The pain is dull, worse at night, and not relieved by simple analgesia. She has also noticed mild dyspnoea and a chronic dry cough. She is a retired nurse with a 35-pack-year smoking history and quit smoking 5 years ago. She denies any recent trauma.

Medications: Paracetamol as needed

Allergies: Nil known

Past history: COPD, hyperlipidaemia

Family history: Brother with prostate cancer, mother with COPD

Social history: Lives alone, independent with ADLs

Examination findings: Decreased breath sounds at the right apex, no wheeze or crepitations. No clubbing. No lymphadenopathy or bony tenderness. Neurological examination of the right upper limb reveals mild hand weakness and diminished sensation in the C8-T1 distribution.

What are the most appropriate next steps? Select four (4) from the following list:

Linda Monroe, a 59-year-old woman, presents with fatigue and post-menopausal vaginal bleeding for the past 2 weeks. She went through menopause at age 51 and has not had bleeding since then. She denies pelvic pain, urinary symptoms, or discharge. She is obese (BMI 34) and has type 2 diabetes mellitus, managed with oral hypoglycaemics. She has never used hormone replacement therapy.

Medications: Metformin XR 1 g daily, Atorvastatin 20 mg nocte

Allergies: Nil known

Past history: Type 2 diabetes, hypertension

Family history: Sister with breast cancer, mother with hypertension

Social history: Non-smoker, retired accountant, lives with husband

Examination findings: Normal vital signs. Bimanual examination reveals a slightly enlarged but non-tender uterus. No adnexal masses or cervical lesions noted.

What are the most appropriate next steps? Select four (4) from the following list:

Benjamin Tran, a 71-year-old retired engineer, presents with a 3-month history of progressively worsening back pain and fatigue. He also reports occasional constipation and polyuria. He has lost 5 kg unintentionally. His GP previously prescribed analgesics for presumed musculoskeletal back strain with minimal improvement. There is no history of trauma.

Medications: Aspirin 100 mg daily, Lisinopril 10 mg daily

Allergies: Nil known

Past history: Hypertension, osteoarthritis

Family history: Father died of prostate cancer

Social history: Non-smoker, moderate alcohol use, independent with ADLs

Examination findings: Appears pale, no lymphadenopathy. Spine tenderness over T12 and L1. No focal neurological deficits. Prostate smooth on DRE.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Aleksandra Petrovic, a 45-year-old woman, presents with right-sided abdominal fullness and dull ache for the past 3 months. She also reports early satiety and occasional bloating. She has no significant past history. Her menstrual cycles are regular, and she has had three children. On direct questioning, she reports a family history of breast and ovarian cancer.

Medications: None

Allergies: Nil known

Past history: Nil

Family history: Mother had breast cancer at 49, maternal aunt had ovarian cancer at 52

Social history: Works as an accountant, non-smoker, drinks 1–2 standard drinks/week

Examination findings: Palpable right adnexal mass, firm and non-tender. No ascites. Pelvic examination confirms mass separate from the uterus.

What are the most appropriate next steps? Select four (4) from the following list:

Daniel Wright, a 68-year-old retired plumber, presents with fatigue, anorexia, and right upper quadrant discomfort for the past 2 months. He has lost 6 kg unintentionally. He reports dark urine and pale stools for the last week. He has a history of heavy alcohol use in the past but quit drinking 10 years ago. He has no history of viral hepatitis or liver disease follow-up.

Medications: None

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia

Family history: Non-contributory

Social history: Former heavy alcohol use (ceased 10 years ago), ex-smoker

Examination findings: Icteric sclerae, hepatomegaly without tenderness, no ascites, spider naevi on chest

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Nathan Ellis, a 24-year-old man, presents with a 2-week history of a painless lump in his right testicle. He noticed it incidentally while showering. He denies trauma, fever, dysuria, or recent illness. He feels otherwise well and is sexually active in a monogamous relationship. He reports no weight loss, fatigue, or night sweats.

Medications: None

Allergies: Nil known

Past history: Nil

Family history: Uncle had testicular cancer at age 29

Social history: Non-smoker, drinks socially, works as a landscaper

Examination findings: 2.5 cm firm, non-tender mass at the lower pole of the right testicle. The mass is distinct from the epididymis and does not transilluminate. Left testicle is normal. No inguinal lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Rosie Ahmed, a 50-year-old woman, presents with a persistent non-healing lesion on the lateral border of her tongue. She first noticed it about 6 weeks ago. It has become slightly painful and occasionally bleeds. She is a current smoker and drinks 2–3 glasses of wine most evenings. She has no recent dental trauma and denies weight loss or dysphagia.

Medications: Esomeprazole 20 mg daily

Allergies: Nil known

Past history: Reflux oesophagitis

Family history: Father died from throat cancer at age 64

Social history: Smoker (15 cigarettes/day), regular alcohol use, no recent travel

Examination findings: 1.5 cm ulcerated lesion with indurated edges on the right lateral tongue. No cervical lymphadenopathy. No other oral mucosal lesions noted. Cranial nerves intact.

What are the most appropriate next steps? Select three (3) from the following list:

Julie O’Neill, a 64-year-old woman, presents with a 2-month history of increasing shortness of breath on exertion, dry cough, and vague chest discomfort. She has also experienced mild ankle swelling and weight loss of 4 kg. She is a lifelong non-smoker with no occupational exposure to asbestos or chemicals. She was treated for breast cancer 8 years ago with surgery and radiotherapy.

Medications: Letrozole 2.5 mg daily

Allergies: Nil known

Past history: ER+ breast cancer, hypertension

Family history: Sister with ovarian cancer

Social history: Retired nurse, non-smoker, moderate alcohol use

Examination findings: Mild pallor, reduced breath sounds and dullness to percussion at the left lung base. Mild bilateral ankle oedema. No lymphadenopathy or hepatosplenomegaly.

What are the most appropriate next steps? Select four (4) from the following list:

Andrew Milne, a 38-year-old man, presents with progressive headaches and visual disturbances over the past 4 weeks. He reports occasional vomiting in the mornings and recent difficulty concentrating at work. His partner has noticed he has become more irritable and forgetful. He has no history of trauma, seizures, or recent illness. No significant medical history.

Medications: None

Allergies: Nil known

Past history: Nil

Family history: Mother with Parkinson’s disease

Social history: Non-smoker, occasional alcohol use, IT consultant

Examination findings: Mild right-sided visual field defect, bilateral papilloedema on fundoscopy, no focal limb weakness, gait normal.

What are the most appropriate next steps? Select four (4) from the following list:

Margaret Shields, a 72-year-old woman, presents with progressive difficulty swallowing solids over the past 3 months, now also involving some liquids. She has unintentionally lost 7 kg during this time. She reports early satiety, occasional regurgitation of food, and a sensation of food ‘getting stuck’. She denies haematemesis or odynophagia. She has no significant past medical history.

Medications: Calcium carbonate for reflux (PRN)

Allergies: Nil known

Past history: Nil of note

Family history: Father died of stomach cancer at age 65

Social history: Lives alone, former smoker (quit 15 years ago), minimal alcohol use

Examination findings: BMI 19.2 kg/m², mild pallor, no lymphadenopathy, no abdominal masses or tenderness

What are the most appropriate next steps? Select four (4) from the following list:

Jacob Warner, a 47-year-old man, presents with a 3-month history of painless visible haematuria. He reports that the urine is consistently blood-stained but without clots. He denies urinary frequency, urgency, dysuria, or nocturia. He is otherwise well. He has a 25-pack-year smoking history and works as a commercial painter with long-standing exposure to industrial solvents and dyes.

Medications: None

Allergies: Nil known

Past history: Nil of note

Family history: Non-contributory

Social history: Current smoker, lives with wife and two children

Examination findings: Vital signs normal, abdomen soft, non-tender, no palpable masses. No flank or suprapubic tenderness. DRE reveals a smooth, non-enlarged prostate.

What are the most appropriate next steps? Select four (4) from the following list:

Sophie Langford, a 36-year-old woman, presents with a persistent pigmented lesion on her upper back that she noticed changing over the past 4 months. It has become darker, increased in size, and developed irregular borders. It occasionally itches but is not painful. She has a history of multiple childhood sunburns and worked as a lifeguard in her early 20s.

Medications: Combined oral contraceptive pill

Allergies: Nil known

Past history: Nil

Family history: Mother had a melanoma at age 49

Social history: Non-smoker, active, regular sun exposure, uses tanning beds occasionally

Examination findings: 1.1 cm asymmetrical pigmented lesion with irregular border and colour variation (brown to black), located on the right upper back. No regional lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Michael Ross, a 60-year-old man, presents with persistent hoarseness for the past 7 weeks. He describes his voice as raspy and weak. He denies sore throat, cough, dysphagia, or odynophagia. He has also noticed mild shortness of breath when climbing stairs. He is a former smoker with a 40-pack-year history and works as a retired radio technician.

Medications: Amlodipine 5 mg daily

Allergies: Nil known

Past history: Hypertension, gastroesophageal reflux disease (GERD)

Family history: Non-contributory

Social history: Former smoker, quit 10 years ago; no alcohol use

Examination findings: No cervical lymphadenopathy, no mouth ulcers or oropharyngeal lesions. Indirect laryngoscopy reveals right vocal cord immobility. Respiratory exam normal. No cranial nerve deficits.

What are the most appropriate next steps? Select four (4) from the following list:

Karen D’Souza, a 57-year-old woman, presents with left breast discomfort and nipple inversion noticed over the last 2 months. She also reports a small area of skin thickening near the nipple that she initially thought was eczema. She denies fever or trauma. There is no nipple discharge or obvious lump felt on self-examination. Her last mammogram was 18 months ago and was reported as normal.

Medications: None

Allergies: Nil known

Past history: G3P3, menopause at age 50

Family history: Mother had breast cancer at age 62

Social history: Lives with husband, works part-time as a librarian, non-smoker

Examination findings: Mild nipple inversion on the left, peau d’orange appearance over a 3×3 cm area of the areola. No palpable lump or axillary lymphadenopathy. Right breast unremarkable.

What are the most appropriate next steps? Select four (4) from the following list:

Patrick Lin, a 66-year-old man, presents with persistent lower back pain and a recent onset of left-sided sciatica. He reports the pain is worse at night and not relieved by rest. He also mentions unintentional weight loss of 5 kg over the last 2 months and difficulty initiating urination. He has a history of hypertension and benign prostatic hyperplasia (BPH).

Medications: Tamsulosin 400 mcg daily, Perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension, BPH

Family history: Father died of prostate cancer at 72

Social history: Retired accountant, former smoker, drinks occasionally

Examination findings: Tenderness over the lumbosacral spine, reduced power (4/5) in left ankle dorsiflexion, absent left ankle reflex. DRE reveals a firm, irregular prostate. No lymphadenopathy. Normal vital signs.

What are the most appropriate next steps? Select four (4) from the following list:

Emma Fraser, a 34-year-old woman, presents with increasing abdominal distension and early satiety over the past month. She also reports mild pelvic discomfort and has been feeling more fatigued than usual. Her periods are regular. She is nulliparous and has a history of endometriosis, managed conservatively. There is no history of bowel or urinary symptoms.

Medications: Naproxen PRN

Allergies: Nil known

Past history: Endometriosis

Family history: Maternal grandmother had ovarian cancer

Social history: Works as a pharmacist, non-smoker, moderate alcohol use

Examination findings: Abdomen distended with a fluid thrill, pelvic exam reveals a firm, non-tender adnexal mass. No hepatomegaly. No peripheral lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Richard Foley, a 52-year-old man, presents with new-onset jaundice and unintentional weight loss of 8 kg over the past two months. He also reports pale stools, dark urine, and intermittent right upper quadrant discomfort. He denies alcohol use, recent travel, or fever. He has no history of liver disease. He has been a smoker for 30 years and works as a logistics manager.

Medications: Nil

Allergies: Nil known

Past history: Hyperlipidaemia

Family history: Brother with colon cancer at 60

Social history: Smokes 10 cigarettes/day, occasional alcohol use

Examination findings: Icteric sclerae, non-tender palpable gallbladder (Courvoisier sign), mild right upper quadrant fullness, no lymphadenopathy

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Angela Tran, a 30-year-old woman, presents with a 2-week history of painless right neck swelling. She has also noticed intermittent fevers, drenching night sweats, and a 4 kg unintentional weight loss over the last month. She denies sore throat, dental issues, or recent infections. She works as a teacher and has no recent travel or known TB exposure.

Medications: None

Allergies: Nil known

Past history: Nil

Family history: Non-contributory

Social history: Non-smoker, drinks socially

Examination findings: 2.5 cm firm, non-tender, mobile lymph node in the right anterior cervical chain. No overlying skin changes. No hepatosplenomegaly. Vitals: T 37.8°C, HR 90 bpm, BP 118/72 mmHg.

What are the most appropriate next steps? Select four (4) from the following list:

Leonard Walker, a 74-year-old man, presents with fatigue, weight loss of 6 kg over 3 months, and generalised pruritus. He also reports vague abdominal discomfort and has recently noticed yellowing of his eyes. He is a retired carpenter with no history of liver disease. He is a non-smoker and drinks one glass of wine most nights.

Medications: Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Hyperlipidaemia

Family history: Non-contributory

Social history: Lives with wife, independent with ADLs

Examination findings: Icteric sclerae, scratch marks on limbs, palpable non-tender gallbladder, no hepatosplenomegaly. BMI 23.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Isla Matthews, a 45-year-old woman, presents with persistent pelvic discomfort and deep dyspareunia for the past 3 months. She also reports increasing bloating and a change in bowel habits, including alternating constipation and loose stools. She has experienced early satiety and unintentional weight loss of 3 kg. Her last cervical screening was normal. She has two children and no significant medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil

Family history: Mother diagnosed with bowel cancer at age 62

Social history: Non-smoker, works as a primary school teacher

Examination findings: Mild abdominal distension, vague left adnexal fullness on bimanual exam, bowel sounds normal. No rectal mass. No cervical lesions.

What are the most appropriate next steps? Select four (4) from the following list:

Thomas Bell, a 68-year-old retired boilermaker, presents with worsening dyspnoea and a persistent dry cough over the past 2 months. He also reports chest discomfort and has lost 4 kg without trying. He denies haemoptysis or fevers. He has a 50-pack-year smoking history and worked in shipyards for over 20 years.

Medications: Salbutamol inhaler PRN

Allergies: Nil known

Past history: COPD, hypertension

Family history: Non-contributory

Social history: Ex-smoker, quit 5 years ago; moderate alcohol intake

Examination findings: Decreased breath sounds and dullness to percussion at the right lung base. No clubbing. No palpable lymphadenopathy. SpO₂ 95% on room air.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Priya Nair, a 62-year-old woman, presents with persistent bone pain affecting her hips and lower back for the past 3 months. She describes it as dull and constant, worse at night. She has also felt increasingly fatigued and noticed increased thirst and constipation. She has lost 3 kg unintentionally over the past 2 months. She has a history of well-controlled type 2 diabetes.

Medications: Metformin XR 1 g daily, Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hyperlipidaemia

Family history: Sister with breast cancer, father with hypertension

Social history: Retired nurse, non-smoker, low alcohol intake

Examination findings: Mild tenderness over lumbar spine and pelvis. No lymphadenopathy. No hepatosplenomegaly. Neurological exam normal.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Matilda George, a 49-year-old school administrator, presents with intermittent rectal bleeding and a recent change in bowel habit, including alternating constipation and loose stools over the past 2 months. She has also experienced increasing fatigue and reports a 5 kg unintentional weight loss. There is no personal history of inflammatory bowel disease. Her last cervical screening was normal, and she has not had a colonoscopy before.

Medications: Iron supplement (self-initiated)

Allergies: Nil known

Past history: G3P3, hypertension

Family history: Father died from colorectal cancer at age 65

Social history: Non-smoker, occasional alcohol, regular exercise

Examination findings: Mild pallor, no abdominal masses. Digital rectal exam reveals no masses or haemorrhoids. No lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Alana Brooks, a 40-year-old woman, presents with a 3-month history of a persistent dry cough and mild breathlessness on exertion. She has also experienced fatigue and unintentional weight loss of 4 kg. She is otherwise well and denies fever, wheeze, or chest pain. She has no smoking history but has a strong family history of cancer. She works as a physiotherapist and lives with her partner and two children.

Medications: Nil

Allergies: Nil known

Past history: Nil

Family history: Mother died of lung cancer at age 52 (non-smoker)

Social history: Never smoked, no occupational exposure

Examination findings: Vitals normal, respiratory exam unremarkable. No clubbing, no lymphadenopathy. No signs of infection.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Dominic Hughes, a 59-year-old man, presents with persistent fatigue and new-onset abdominal fullness over the past 2 months. He also reports occasional night sweats and early satiety. He denies weight loss or fever. On questioning, he recalls having episodes of easy bruising. He works as a property manager and has not travelled recently.

Medications: None

Allergies: Nil known

Past history: Nil significant

Family history: Brother with lymphoma at age 64

Social history: Non-smoker, occasional alcohol, independent with ADLs

Examination findings: Mild pallor, splenomegaly palpable 5 cm below the left costal margin, no lymphadenopathy. No hepatomegaly or rash. Vitals stable.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Nina D’Souza, a 29-year-old woman, presents with a painless breast lump in the upper outer quadrant of her right breast, noticed 3 weeks ago. She is concerned as the lump has not changed with her menstrual cycle. She denies nipple discharge, skin changes, or systemic symptoms. She has no family history of breast or ovarian cancer. She has regular periods and is nulliparous.

Medications: Combined oral contraceptive pill

Allergies: Nil known

Past history: Nil significant

Family history: Nil of breast or ovarian cancer

Social history: Non-smoker, minimal alcohol

Examination findings: 2.2 cm firm, mobile, non-tender mass in the upper outer quadrant of the right breast. No skin tethering, nipple changes, or axillary lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Jonathan Elwood, a 70-year-old man, presents with persistent right hip pain that has progressively worsened over 3 months. He reports the pain is dull, worse at night, and not relieved by rest or paracetamol. He also mentions reduced appetite and recent constipation. He has a history of prostate cancer diagnosed 6 years ago, treated with prostatectomy and radiotherapy. His last PSA, 18 months ago, was 0.3 ng/mL.

Medications: None currently

Allergies: Nil known

Past history: Prostate cancer (Gleason 7), hypertension

Family history: Father had prostate cancer, mother had stroke

Social history: Retired teacher, non-smoker, low alcohol use

Examination findings: Tenderness over right iliac crest and proximal femur. No palpable masses. Neurologically intact. No lymphadenopathy.

What are the most appropriate next steps? Select four (4) from the following list:

Anna McIntyre, a 33-year-old woman, presents with a 3-week history of a painless lump in her left neck. She reports intermittent low-grade fevers and fatigue. She also mentions intense itching, especially after hot showers. She has not experienced any weight loss or night sweats. She denies recent infections, dental issues, or trauma. She is otherwise well.

Medications: None

Allergies: Nil known

Past history: Nil significant

Family history: Non-contributory

Social history: Non-smoker, works as a school counsellor

Examination findings: 2.8 cm firm, rubbery, non-tender lymph node in the left posterior cervical chain. No erythema or warmth. No hepatosplenomegaly. Vitals: Temp 37.6°C, HR 84 bpm, BP 122/76 mmHg.

What are the most appropriate next steps? Select four (4) from the following list:

Geoffrey Nolan, a 76-year-old man, presents with persistent fatigue, anorexia, and a dull ache in his right upper abdomen. He reports a 6 kg weight loss over 3 months and new-onset jaundice noticed by his wife. He denies fever or pruritus. He drinks 2–3 beers most nights and has a 40-pack-year smoking history, though he quit 5 years ago.

Medications: Atorvastatin 20 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension

Family history: Brother died of pancreatic cancer at age 72

Social history: Lives alone, ex-smoker, drinks daily

Examination findings: Icteric sclerae, palpable, non-tender gallbladder (Courvoisier sign), mild hepatomegaly. No ascites or peripheral stigmata of chronic liver disease.

Investigations:

What are the most appropriate next steps? Select four (4) from the following list:

Clare Robertson, a 37-year-old woman, presents with a new 1.5 cm pigmented lesion on her anterior thigh noticed by her partner. She states that it has darkened and increased in size over the past 2 months. She denies pain or bleeding. She has a history of multiple childhood sunburns and uses tanning beds occasionally. She has no personal or family history of skin cancer.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Nil melanoma or skin cancer

Social history: Works indoors, but frequently holidays in sunny locations

Examination findings: Asymmetrical, irregularly bordered, variegated pigmented lesion measuring approximately 1.5 cm with a slightly raised surface. Located on the left anterior thigh. No regional lymphadenopathy. No other suspicious lesions noted.

What are the most appropriate next steps? Select four (4) from the following list:

Christopher Yee, a 67-year-old man, presents with progressive dysphagia over 2 months. Initially, he had difficulty swallowing solids, but now also struggles with some liquids. He reports retrosternal discomfort after meals and a 7 kg unintentional weight loss. He denies odynophagia or haematemesis. He has a 40-pack-year smoking history and drinks three beers nightly.

Medications: Esomeprazole 20 mg daily

Allergies: Nil known

Past history: Hypertension, GERD

Family history: Father died of oesophageal cancer at 70

Social history: Retired, lives alone

Examination findings: BMI 20, no palpable lymphadenopathy, no abdominal masses, unremarkable oral examination

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Deborah Ashton, a 72-year-old woman, presents with postmenopausal bleeding that started two weeks ago. It is light but persistent. She denies pain, discharge, or urinary symptoms. She went through menopause at age 51 and has not had any vaginal bleeding since. She has never used hormone replacement therapy. She has a BMI of 33 and a history of type 2 diabetes.

Medications: Metformin XR 1 g daily, Amlodipine 5 mg daily

Allergies: Nil known

Past history: Type 2 diabetes, hypertension

Family history: Mother had uterine cancer at age 60

Social history: Retired librarian, widowed, non-smoker

Examination findings: External genitalia normal. Speculum examination reveals slight blood in the vault but no obvious cervical or vaginal lesions. Bimanual examination: uterus slightly enlarged, no adnexal masses or tenderness.

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Mark Halverson, a 62-year-old man, presents with a 4-month history of generalised fatigue, abdominal discomfort, and early satiety. He has also experienced an unintentional weight loss of 6 kg and occasional night sweats. He has no history of recent infections. He takes no regular medications and has no significant past medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Non-contributory

Social history: Retired mechanic, non-smoker, occasional alcohol

Examination findings: Splenomegaly extending 4 cm below costal margin. No hepatomegaly or lymphadenopathy. Vitals: T 37.4°C, HR 88 bpm, BP 132/76 mmHg.

Investigations:

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Alicia Romero, a 61-year-old woman, presents with increasing fatigue, abdominal bloating, and vague pelvic discomfort over the past 6 weeks. She also reports urinary urgency and early satiety. She has been postmenopausal for 10 years and has no history of hormone replacement therapy. She has not had any recent gynaecological exams. She is nulliparous and has a BMI of 35.

Medications: Atorvastatin 20 mg daily, Metformin XR 1 g daily

Allergies: Nil known

Past history: Type 2 diabetes, hyperlipidaemia

Family history: Maternal aunt had ovarian cancer at age 64

Social history: Lives with partner, retired, non-smoker

Examination findings: Abdominal distension with fluid thrill. On pelvic examination, a fixed, irregular mass is palpable in the left adnexa. No vaginal discharge. No hepatosplenomegaly or peripheral lymphadenopathy.

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Daniel Kerr, a 58-year-old man, presents with a 3-month history of a persistent non-healing ulcer on the scalp. He reports that the lesion bleeds easily and has slowly enlarged over time. He is a retired farmer with significant lifetime sun exposure. He has a history of treated actinic keratoses but no previous skin cancers.

Medications: Perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension, actinic keratoses

Family history: Father had basal cell carcinoma

Social history: Non-smoker, lives in rural NSW, continues to do occasional outdoor work

Examination findings: 1.8 cm ulcerated lesion with rolled pearly border and telangiectasia on the vertex of the scalp. No lymphadenopathy. No other suspicious lesions seen.

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Linda North, a 65-year-old woman, presents with persistent right upper quadrant discomfort and unintentional weight loss of 5 kg over the past 2 months. She has also developed pruritus and noticed yellowing of her skin. She denies fever, vomiting, or recent travel. She has a history of gallstones diagnosed 3 years ago but was managed conservatively. She is a non-smoker and drinks alcohol occasionally.

Medications: Rosuvastatin 10 mg daily, Metformin XR 1 g daily

Allergies: Nil known

Past history: Type 2 diabetes, cholelithiasis (no cholecystectomy)

Family history: Mother had gallbladder cancer at age 68

Social history: Retired nurse, lives with husband

Examination findings: Icteric sclerae, scratch marks on limbs, mild right upper quadrant tenderness. No palpable masses or hepatosplenomegaly.

Investigations:

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Hassan Farouk, a 44-year-old man, presents with a gradually enlarging, painless mass in his right thigh. He first noticed it 3 months ago, and it has steadily increased in size. He denies trauma, fever, or weight loss. He works as a courier and has no relevant past medical history. The mass does not interfere with his mobility but has become more noticeable in clothing.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Uncle with bowel cancer at age 68

Social history: Non-smoker, active lifestyle

Examination findings: 5 cm firm, deep, non-tender mass in the anterolateral thigh. Not fixed to skin but not clearly mobile over deeper structures. No skin changes or lymphadenopathy. Vitals normal.

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Patricia Wong, a 54-year-old woman, presents with persistent headache and recent onset of visual disturbances. She describes blurry peripheral vision and occasional double vision. She also reports fatigue, irregular periods over the past year, and reduced libido. There is no history of trauma. She is a non-smoker and has no significant family history.

Medications: None

Allergies: Nil known

Past history: Migraine (resolved), hypothyroidism (on thyroxine)

Family history: Nil endocrine or neurological conditions

Social history: Office manager, non-smoker, occasional alcohol use

Examination findings: Bitemporal hemianopia on visual field testing. No focal neurological deficits. No breast discharge or skin hyperpigmentation. Vitals normal.

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James Forrester, a 69-year-old man, presents with painless gross haematuria that began 5 days ago and has persisted daily. He denies dysuria, fever, urgency, or flank pain. He is otherwise well but mentions a 4 kg weight loss over the past few months. He has a 35-pack-year smoking history and retired as a chemical plant operator. He has no known family history of cancer.

Medications: Aspirin 100 mg daily

Allergies: Nil known

Past history: Hypertension

Family history: Nil malignancy

Social history: Ex-smoker, moderate alcohol intake

Examination findings: Abdomen soft, non-tender. No palpable masses. No costovertebral angle tenderness. DRE reveals normal-sized, smooth prostate. Vitals normal.

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Emily Sanderson, a 36-year-old woman, presents with a 2-month history of left breast pain and swelling. She describes a rapidly enlarging, firm area of fullness and heaviness in the lower outer quadrant of the breast. She also reports skin redness and warmth. She denies fever or nipple discharge. She has two children, both breastfed. No recent trauma or mastitis. No family history of breast or ovarian cancer.

Medications: None

Allergies: Nil known

Past history: G2P2, no significant medical history

Family history: Nil cancer

Social history: Non-smoker, occasional alcohol, teacher

Examination findings: Diffuse erythema and oedema of the left breast with a peau d’orange appearance. The breast is firm and tender. No discrete mass palpable. Axillary lymphadenopathy present on the left. No fever. Right breast normal.

What are the most appropriate next steps? Select four (4) from the following list: