LINK

https://au-lti.bbcollab.com/recording/abc09cb131c14746bf10fd954125d7a7

PRETEST
1. Breast Panel showed Estrogen Receptor positive, Progesterone Receptor positive with No
Her2neu overexpression. Patient belongs to what subtype based on her tumor gene expression
profile?
A. Luminal A
B. Luminal B
C. Her2 Amplified
D. Basal-like

2. Patients with BRCA mutations fall within this molecular subtype

A. Luminal A
B. Luminal B
C. Her2 Amplified
D. Basal-like

3. A 53 year old female patient with metastatic breast cancer ER +, PR +, and Her2neu - with no
visceral involvement, what is the best treatment option?
A. Chemotherapy + Trastuzumab + No Endocrine Therapy
B. Chemotherapy, No Trastuzumab + No Endocrine Therapy
C. No Chemotherapy + Trastuzumab + Endocrine Therapy
D. No Chemotherapy + No Trastuzumab + Endocrine Therapy

4. It involves the administration of chemotherapy before definitive surgery and radiation

therapy
A. Adjuvant chemotherapy
B. Neoadjuvant chemotherapy
C. Palliative chemotherapy
D. Post-operative chemotherapy

5. Which of the following patient profile has the lowest risk of breast cancer?
A. A woman with menarche at 12 years, first child at 24 years, and menopause at 47
years
B. A woman with menarche at 14 years, first child at 17 years, and menopause at 52
years
C. A woman with menarche at 16 years, first child at 17 years, and menopause at 42
years
D. A woman with menarche at 16 years, first child at 32 years, and menopause at 52
years

6. Which of the following tumor characteristics confers a poor prognosis in patients with breast
cancer?
A. Estrogen receptor positive
B. Low proportion of cells in S-phase
C. Good nuclear grade
D. Overexpression of erbB2 (HER-2/neu)
7. A 50 year old female presented with an 8 cm solid nonmovable mass on the periareolar area
of the right breast. There were also palpable matted lymph nodes on the ipsilateral axilla. Core
needle biopsy revealed invasive ductal carcinoma with the following hormone receptor assay
results: ER-, PR-, HER2-. Metastatic work up was negative. What is the most appropriate
treatment for this patient?
A. Breast surgery followed by adjuvant chemotherapy and radiation therapy
B. Breast surgery followed by adjuvant chemotherapy
C. Neoadjuvant chemotherapy and radiation followed by breast surgery
D. Neoadjuvant chemotherapy followed by breast surgery and radiation therapy

8. The most common age group who are at risk for breast cancer is?
A. 10-19 years old
B. 20-29 years olds
C. 30-39 years old
D. Above 40 years old

9. Your 50 year old healthy aunt with no family history of breast cancer asked for your advice
regarding screening for breast cancer as part of her annual check-up. What imaging modality
would you recommend?
A. Breast MRI
B. Breast ultrasound
C. Chest CT Scan
D. Mammography

10. You are seeing a 55 year old woman with a family history of breast cancer. She is worried
about her future risk of breast cancer, since her sister was diagnosed of breast cancer at the age
of 39 and her mother at the age of 40. Which of the following feature increases her risk of
developing breast cancer?
A. Ductal or Lobular carcinoma in situ
B. Inherited genetic mutations (BRCA1 and/or BRCA2)
C. Personal history of early onset breast cancer
D. > or = 2 first degree relatives with breast cancer diagnosed at an early age
Febrile Neutropenia Dra Julie Tapispisan

PRETEST
1. A.F., 65 /o female diagnosed with Breast Cancer Stage IIIA and currently on her third
cycle of adjuvant chemotherapy, sought consult because of fever. CBC result as follows:
Hgb 134 mg/dL, Hct 0.45, plt 250, WBC 1.2, neutrophils 0.32, bands 0.05, lymphocytes
0.45. Compute for the ANC.
A. 284
 B. 384
C. 444
D. 544

2. Empirical anti-fungal therapy is

A. Initiation of antifungal agent at the first possible clinical evidence of fungal infection.
B. More targeted, less broad treatment.
C. Started within twenty four hours upon diagnosis of febrile neutropenia.
D. Treatment of patients who have additional findings, serologic or imaging, suggestive
of fungal infection.

3. This is considered as profound neutropenia

A. WBC 1.1, neutrophils 0.12, bands 0.02, lymphocytes 0.35
B. WBC 1.2, neutrophils 0.0.08, bands 0.05, lymphocytes 0.45
C. WBC 1.3, neutrophils 0.10, lymphocytes 0.55
D. WBC 1.4, neutrophils 0.07, lymphocytes 0.65

4. One of the recommendations for the use of WBC growth factors based on the American
Society of Clinical Oncology Practice Guideline
A. As adjunctive treatment for febrile neutropenia at low risk of infectious
complications.
B. As prophylaxis in patients >25 y/o with diffuse aggressive lymphoma undergoing
CHOP or more aggressive chemotherapy.
C. For patients undergoing nonmyelosuppressive therapy but who have risk factors for
febrile neutropenia due to bone marrow compromise or other comorbidities.
D. For reduction of neutropenia in patients with solid tumors with initial or repeat
induction chemotherapy.

5. M.F., 58 y/o female with controlled hypertension and diabetes, is diagnosed with
metastatic breast cancer currently receiving her 9th cycle of taxane-based chemotherapy.
She sought consult at your clinic because of 3-day history of dysuria and undocumented
fever with a CBC result done day before showing ANC of 1200. Pertinent findings: ECOG
0, stable VS, Temp 38 C, clear breath sounds. What will you do next?
A. Advise patient for admission
B. Check for the temperature after one hour
C. Discharge the patient
D. Start patient on antimicrobial

6. K.G., 35 y/o male, diagnosed with diffuse large B cell lymphoma was admitted because
of febrile neutropenia and pneumonia in the immunocompromised host. He is on his
fifth day of piperacillin-tazobactam, clinically stable, ECOG 0, ANC improving, but still
with febrile episodes (Tmax 38.3 C). What will be your management?
A. Observe.
B. Shift antimicrobial to carbapenem.
 C. Start vancomycin.
D. Start preemptive antifungal therapy.

7. M.K., 64 y/o male diagnosed with Non Small Cell Lung Cancer Stage IV on maintenance
chemotherapy was brought to the ER because of fever. What will you do in the initial
evaluation?
A. Do a focused physical examination
B. Ensure hemodynamic stability
C. Give GCSF
D. Start on antimicrobial therapy

8. P.B., 55 y/o female, nonhypertensive, nondiabetic, diagnosed with Ovarian Cancer Stage
III on adjuvant chemotherapy, was admitted because of febrile neutropenia and
complicated UTI. She had a history of candida infection where she was given
fluconazole. She is clinically improving on her 5th day of ceftriaxone but still has febrile
episodes (Tmax 38.5 C), ANC 650. Urinalysis, urine culture, and blood culture were done
pending results. What will be your management?
A. Shift antimicrobial
B. Start fluconazole
C. Start amphotericin B
D. Wait for the culture results

9. For febrile neutropenic patients who are low risk with no source of infection, once
afebrile and ANC >500 for 48 hrs
A. Can discontinue antimicrobial
B. Continue antimicrobial for five days
C. Continue antimicrobial for seven days
D. Continue antimicrobial for fourteen days

10. The Multinational Association for Supportive Care in Cancer (MASCC) risk index is a
validated tool for measuring the risk for neutropenic fever-related complications.
Patients are considered high-risk and should be initially admitted if they have an MASCC
score of
A. 20
B. 22
C. 24
D. 26