A 64 year old man has presented with, breathlessness, a non-productive cough for one year, with three stone weight loss in the past 6 months. He also has low mood and bone pain. On bone profile his corrected calcium is 2.68 (normal 2.25-2.5 mmol/L). On Chest X Ray he has a cavitating lesion in his left lung and on CT scan the tumour is identified as being located on the proximal bronchus. Which of the following types of lung malignancy is this lesion most likely to be caused by?

A Squamous Cell Carcinoma

B Large Cell Carcinoma

C Small Cell Lung Cancer

D Adenocarcinoma

E Carcinoid tumour

A 69 year old lady with a 40 pack year history of smoking has presented to clinic with truncal obesity, fatigue and hirsutism. 24-hour urinary free cortisol test shows levels four times the normal laboratory value on three occasions. On chest X ray, a lesion is identified in the proximal bronchus of the right lung. Which of the following types of lung malignancy is most likely to be present?

A Squamous cell carcinoma

B Large cell carcinoma

C Small cell lung cancer

D Adenocarcinoma

E Carcinoid tumour

A 55 year old woman presents to clinic with a six month history of abdominal pain and distention, urinary frequency and weight loss. Her menarche was at age 12 and menopause was at age 54. You are concerned that she may be at risk of ovarian cancer. Which is the most appropriate and specific initial test to undertake?

A CT abdomen & pelvis

B CA125

C Abdominal/pelvic ultrasound

D MRI pelvis

E Colonoscopy

A 29 year old gentleman has presented as he is concerned he has a lump in his left testicle. It is painless and has been there for around 4 months. On examination he also has gynaecomastia. Beta-hCG levels are elevated and you are suspicious of testicular cancer. Which of the following basic tests would be most appropriate to screen for metastases in this case?

A Urine dip

B AFP

C Prolactin levels

D Chest X Ray

E Abdominal X Ray

A 75 year old man has presented with constipation, occasional diarrhoea and 3 stone of unintentional weight loss in one year. He is a smoker of 60 pack years. His father died of bowel cancer. Colonoscopy identifies malignancy. Which of the following tumour markers would have most prognostic value?

A AFP

B Beta hCG

C Chromogranin

D CA 19-9

E CEA

A 75 year old man is an inpatient on an orthopaedic ward. He was admitted for a hemi-arthroplasty for a fractured left neck of femur two weeks ago and has been receiving physiotherapy since. He is normally fit and well. Today he is confused and disoriented. His chest is clear but his abdomen is mildly distended and tender. On PR examination on admission his prostate was of normal size and shape. He has not had any recent weight loss or any history of bony pain before the fall. He has bloods done and you note the FY1 on nights has added on a PSA to this gentleman’s bloods, which is 9 (normal 7.2). What is the most likely cause for this gentleman’s raised PSA?

A Benign prostate hyperplasia

B Prostate cancer

C Old Age

D Acute urinary retention

E Prostatitis

A 41 year old lady presents concerned about a lump on her left breast. It is mildly tender and irregularly shaped on examination. She is worried because her mother died of breast cancer when she was 45. What would be the most effective initial investigation for this lady’s breast lump?

A Breast ultrasound

B Mammography

C MRI

D Core needle biopsy

E Fine needle aspiration