1st Academic CME Quiz 2016

WB AROI

Date: 01/09/2016

R. G. Kar Medical College

Topic: Ovarian Cancer

Instructions

• There are total 20 questions

• Each slide contains one question.

• Slide will change in every 15seconds.

• Choose single best answer among 4 options.

• Put a “√” in the box against correct answer.

• Each correct answer will carry 4 marks.

• Each wrong answer will carry 1 negative marks.

Q1. Which of the following statement is TRUE?a) Cumulative lifetime risk of Epithelial Ovarian cancer

(EOC) in BRCA 2 mutation carrier is 5-8%.

b) >90% tumors in BRCA + patients are mucinous histology.

c) BRCA +ve patients have better OS,PFS &DFI than BRCA –ve cases after 1st line CT.

d) Olaparib is indicated as 1st line CT is advanced germ line BRCA mutated EOC.

Q2. According to 2014 FIGO staging of ovarian ca, metastasis in retroperitoneal lymph node (diameter>1cm) without peritoneal/visceral disease is staged as:

a) IIB

b) IIIA1(i)

c) IIIA1(ii)

d) IIIB

Q3. Which histological subtype is NOT included in Germ cell tumor variety:

a) Embryonal carcinoma

b) Choriocarcinoma

c) Polyembryoma

d) Gynandroblastoma

Q4. Which of the following gene mutation is NOT associated with Hereditary Breast-Ovary Cancer Syndromes (HBOC)?

a) PTEN

b) TP53

c) BRCA

d) STK4

Q5. Which is NOT a typical IHC picture of Germ Cell Tumor (GCT) of Ovary?

a) Salla4 +ve

b) OCT3/4 +ve

c) SOX 2 +ve

d) Inhibin +ve

Q6. Which of the following statement is WRONG?

a) Mucinous carcinomas often have normal CA125 levels.

b) Low grade Serous carcinomas are extremely chemo-sensitive.

c) Pseudomyxoma peritonei is most commonly associated with ovarian metastasis of intestinal cancers.

d) Papillary serous Carcinoma is typically CK7+/CK20-in IHC.

Q7.Which of the following statement is WRONG?

a) ROMA algorithm includes serum HE4 and CA125 levels.

b) 18FDG PET CT has no recommended/ proven role in diagnosis and follow up in ovarian cancer.

c) CA125 level is increased in majority of early EOCs.

d) USG and CT Scan have similar specificity and sensitivity for initial evaluation of ovarian tumors.

Q8. 34yrs nulliparous female with H/O abdominal pain, has 10.5cm X 9.5cm X 4.7cm right adnexal mixed cystic mass (with predominantly solid component ) on USG.CA 125 : 87.25U/ml, LDH: 172U/L,AFP 1.01ng/ml and B HCG < 0.1mIU/ml. What is the NEXT line of treatment?

a) 18-FDG PET CT

b) FNAC from the mass

c) Laparoscopic oophorectomy

d) Open oophorectomy, frozen section HP and decide about surgical staging procedure.

Q9. A 65yrs patient was referred from district tier hospital after right oophorectomy. HP shows serous cystadenocarcinoma. CECT whole abdomen shows gross residual disease in omentum adhered to colon.CA125 is 1584U/mL.What is the NEXT Line of management ?

a) 18FDG –PET CT evaluation

b) Refer to Gynae Oncologist for assessment of completion sx.

c) 6cycles of Pacli+ Carbo then reassess.

d) 3cycles of Pacli + Carbo then completion sx .

Q10. Which is WRONG statement regarding GCTs of ovary?

a) Majority of GCTs are diagnosed at advanced stage.

b) Fertility sparing Sx in advanced stage has a cure rate >90%.

c) BEPX3 is standard postop treatment .

d) Role of RT in Dysgerminoma is limited.

Q11. Which is a FALSE statement for EOCs?

a) Pacli+ carbo combination is standard chemo protocol.

b) Pacli + Cis is more toxic and less effective than Pacli+ Carbo.

c) Dose dense (weekly) Pacli+ Carbo has OS/PFS benefit over 3weekly regimen.

d) Doce + Carbo is also recommended as 1st line adjuvant Chemo.

Q12. Which is TRUE regarding Intra-peritoneal (IP) Chemo in EOCs?

a) IP has OS/PFS advantages over IV Chemo in patients with <1cm residual disease.

b) Paclitaxel is never given in IP route.

c) IP Chemo is not useful in tubal/Primary peritoneal Ca.

d) IP chemo has better S/E profile than IV Chemo.

Q13. In advanced EOC, NACT followed by Cyto-reductive Sx has the following outcome difference over debulking Sx and adjuvant CT:

a) Survival advantages in NACT.

b) No difference in survival.

c) More perioperative complications in NACT.

d) Improved Quality of Life in NACT.

Q14. Which of the following is a TRUE statement ?

a) Definition of “Optimum debulking” is <1cm residual disease/No residual Disease.

b) Interval debulking surgery is routinely recommended in III-IV EOC.

c) Fertility sparing Sx in Stage IA/IC disease has poorer outcome than comprehensive Surgical staging.

d) Secondary cyto-reductive Sx has no outcome benefit in post Chemo relapse.

Q15. Which is TRUE regarding use of Bevacizumab in advanced EOCs?

a) Routinely recommended in Neo-adjuvant setting with Pacli+ Carbo.

b) Has OS and PFS benefit in combination with Pacli +carboplatin.

c) Only PFS benefit in combination with Pacli+carbo.

d) Has OS benefit if used as maintenance therapy.

Stage III-IV EOC after Cyto-reduction

3weekly Pacli + Carbo X6Chemotherapy

Response

ProgressionWithin

4weeks of CT6

Treatment??

Q16. Which is NOT a preferred treatment option ?

a) Taxane Platin re-challangeb) Weekly taxane

monotherapyc) Re-Check renal/hepatic

function d) Liposomal Doxorubicin

Q17. What is the BEST treatment strategy in Platinum resistant recurrence ?

a) Sequential non-platin single agent CT

b) Taxane Platin re-challenge

c) Multi-agent non-platin CT

d) Bevacizumab monotherpy

Q18. Which drug has the HIGHEST response rate in Platinum resistant EOC ?

a) Liposomal doxorubicin

b) Gemcitabine

c) Weekly paclitaxel

d) Topotecan

Q19. During follow up, a patient (IIIC EOC) has gradually rising CA 125 level. She is asymptomatic and clinically normal. CECT Pelvis is normal. Which is NOT a preferred strategy in this situation?

a) Immediate active treatment

b) 18-FDG PET CT evaluation

c) Hormone therapy

d) Close follow-up

Q20. Which is a WRONG statement about drugs used in advanced EOCs?

a) Farletuzumab (Mab to Folate Receptor A) has no PFS benefit in platinum sensitive relapse.

b) Typhilitis and hand foot syndrome are major non-cardiac complications in Liposomal doxorubicin.

c) Pazopanib may be used as maintenance therapy after complete remission.

d) Olaparib has lower response rate in platinum sensitive population than resistant one.