1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Hypercalcaemia, low PTH, squamous lung cancer | Humoral hypercalcaemia (PTHrP) | IV saline, then a bisphosphonate (eviQ 2026). |
| Back pain, leg weakness, known prostate cancer | Metastatic spinal cord compression | Dexamethasone, urgent whole-spine MRI, then surgery or radiotherapy (eviQ 2025). |
| Fever of 38.0°C or more, neutrophils under 0.5 | Neutropenic fever | Piperacillin-tazobactam or cefepime, within 1 hour if septic (eviQ 2026). |
| High potassium, phosphate and urate after treating lymphoma | Tumour lysis syndrome | Hydration first; rasburicase if high risk, never in G6PD deficiency (eviQ). |
| Bloody diarrhoea on ipilimumab plus nivolumab | Immune-related colitis | Exclude C. difficile; prednisolone 1 mg/kg, IV methylprednisolone if severe; infliximab if refractory (eviQ 2026). |
| Dyspnoea, raised troponin on a checkpoint inhibitor | Immune myocarditis | Mortality about 50%: IV methylprednisolone within 24 hours; no rechallenge (eviQ 2026). |
| Ketoacidosis on a PD-1 inhibitor | Checkpoint inhibitor type 1 diabetes | Insulin; do not give steroids (eviQ 2026). |
| Severe toxicity after first fluorouracil or capecitabine | DPD deficiency (DPYD variants) | MBS 73322 (2025) funds DPYD genotyping; reduce or avoid fluoropyrimidines. |
| Falling LVEF on trastuzumab | Trastuzumab cardiotoxicity | Not dose-related and usually reversible, unlike anthracyclines. |
| Mediastinal mass and raised AFP in a young man | Non-seminomatous germ cell tumour | A raised AFP excludes pure seminoma; treat as non-seminoma. |
| Lung adenocarcinoma in a never-smoker | EGFR-mutant NSCLC | MBS 73437 gene panel; PBS lists osimertinib first line and adjuvant. |
2Australia-only high-yield (won't be in UK or US banks)
eviQ (Cancer Institute NSW). The free national protocol and toxicity reference; the table's eviQ rows are from its 2025 and 2026 documents. The national Optimal Care Pathways (on cancer.org.au) include one for Aboriginal and Torres Strait Islander people.
Checkpoint inhibitors (PBS, October 2026). Pembrolizumab, nivolumab and ipilimumab share one listing, "immunotherapy sensitive advanced or metastatic cancer" (Section 100, streamlined authority). Others include adjuvant pembrolizumab (resected stage IIIB to IIID melanoma) and durvalumab for unresectable stage III NSCLC.
Breast (PBS, October 2026). Palbociclib, ribociclib and abemaciclib for advanced disease; ribociclib and abemaciclib also early. Trastuzumab and pertuzumab for early and metastatic HER2-positive disease; trastuzumab deruxtecan for metastatic HER2-positive and HER2-low.
Prostate and ovary (PBS and MBS, 2026). Enzalutamide, apalutamide and darolutamide: castration-sensitive and non-metastatic castration-resistant; abiraterone and enzalutamide: metastatic castration-resistant. Lutetium-177 PSMA was not found in the PBS medicine index in October 2026; the MBS funds it. Olaparib and niraparib: first-line maintenance, stage III/IV high-grade ovarian cancer; MBS 73295 funds germline BRCA testing.
Screening. Bowel (Cancer Council Australia, 2026): free kit every two years, mailed at 50 to 74, on request at 45 to 49. Breast (BreastScreen NSW, 2026): two-yearly at 50 to 74; 40 to 49 eligible. Cervical (MBS 73070, 73071, 2026): five-yearly HPV test from 24 years 9 months, self-collection allowed, exit at 70 to 74. Lung (MBS 57410, July 2025): two-yearly low-dose CT. PSA (PCFA early detection guidelines, 2026): two-yearly at 50 to 69 after an informed discussion.
End of life. PBS palliative care listings (2026) cover active, progressive, far-advanced disease. Every state and the ACT has a voluntary assisted dying law; the Northern Territory's passed in 2026 (access expected early 2028). See Physify's Oncological Emergencies course.
3Sample questions (Physify format)
1. A 69 year old man has metastatic castration-resistant prostate cancer that has progressed after docetaxel and then enzalutamide. His PSMA PET meets the uptake thresholds for lutetium-177 PSMA therapy. How is this treatment funded in Australia?
- A. PBS Section 100, as a streamlined authority
- B. An MBS item, for up to six cycles in all
- C. Special Access Scheme, as it is not TGA registered
- D. An MBS item, but only before any taxane
- E. PBS General Schedule after abiraterone fails
Answer: B
B. Correct. MBS 16050 and 16055 (July 2025): PSMA-positive mCRPC after a taxane and an androgen receptor signalling inhibitor; 2 initial then up to 4 continuing cycles.
A. Lutetium-177 PSMA was not found in the PBS medicine index in October 2026.
C. It has TGA product information (Pluvicto), so no Special Access Scheme is needed.
D. The MBS item requires prior taxane chemotherapy, which he has had.
E. It is not a PBS medicine, and abiraterone failure is not the criterion.
2. A 58 year old woman on ipilimumab and nivolumab for metastatic melanoma has headache and fatigue. Sodium is 129 mmol/L, morning cortisol and ACTH are low, and TSH and free T4 are both low. She is haemodynamically stable. What is the most appropriate next step?
- A. Start levothyroxine now; add hydrocortisone if symptoms persist
- B. Start a corticosteroid now, then levothyroxine days later
- C. Start levothyroxine and a corticosteroid on the same day
- D. Stop immunotherapy for good and observe without replacement
- E. Give infliximab, then replace hormones once the pituitary recovers
Answer: B
B. Correct. Hypophysitis (eviQ 2026): start corticosteroids several days before levothyroxine, so thyroid hormone does not precipitate adrenal crisis.
A. Thyroxine first speeds cortisol clearance and can precipitate adrenal crisis.
C. A same-day start still risks crisis; eviQ advises steroids for several days first.
D. She needs hormone replacement; resuming immunotherapy can be considered once stable.
E. Infliximab has no role here; she needs replacement now.
3. Under the National Lung Cancer Screening Program (MBS, from July 2025), which of these asymptomatic people is eligible for a screening low-dose CT?
- A. 47 year old, current smoker, 35 pack-years
- B. 64 year old, quit 12 years ago, 40 pack-years
- C. 58 year old, quit 6 years ago, 32 pack-years
- D. 72 year old, current smoker, 50 pack-years
- E. 55 year old, current smoker, 20 pack-years
Answer: C
C. Correct. MBS 57410: aged 50 to 70, asymptomatic, at least 30 pack-years, and smoking now or quit within the past 10 years.
A. Too young: eligibility starts at 50.
B. Quit more than 10 years ago.
D. Too old: eligibility ends at 70 years and 364 days.
E. Fewer than 30 pack-years.