Specialty Certificate 

Examination 

in Medical Oncology Sample Questions 

Question 1. 
 
A 28-year-old woman was found to have stage IV Burkitt’s lymphoma. Her renal function was 
normal and a staging CT scan had shown no abnormality of the renal tract. Three days later, 
when she was about to start chemotherapy, she developed a temperature of 39.0°C with 
rigors and was treated with imipenem. 
 
Investigations (the following day): 
 
 

serum sodium 

138 mmol/L (137–144) 

serum potassium 

6.2 mmol/L (3.5–4.9) 

 serum 

creatinine 

215 

μ

mol/L (60–110) 

serum corrected calcium 

1.60 mmol/L (2.20–2.60) 

serum phosphate 

1.52 mmol/L (0.8–1.4) 

serum lactate dehydrogenase 

1238 U/L (10–250) 

serum urate 

0.69 mmol/L (0.19–0.36) 

 
What is the most likely cause of the renal impairment? 
 
A imipenem 

toxicity 

B intravenous 

contrast 

toxicity 

C kidney 

infiltration 

D septic 

shock 

E  tumour lysis syndrome