Oncology Practice Questions

Q: What is the most common type of bronchogenic carcinoma?

Adenocarcinoma. **Explanation:** **Adenocarcinoma** is currently the most common histological type of bronchogenic carcinoma worldwide [1], accounting for approximately 40% of all lung cancer cases. Historically, squamous cell carcinoma was the most frequent; however, due to changes in cigarette composition and smoking patterns, adenocarcinoma has surpassed it [1]. It is the most common type found in **non-smokers, women, and younger adults** [1]. It typically presents as a **peripheral lesion** and is associated with scarring (scar carcinoma) [1]. **Analysis of Incorrect Options:** * **Oat cell carcinoma (Small Cell Lung Cancer):** This is the most aggressive form of lung cancer, strongly associated with smoking [2]. It usually presents as a central mass and is notorious for causing various paraneoplastic syndromes (e.g., SIADH, ectopic ACTH). * **Squamous cell carcinoma:** Formerly the most common type, it is now the second most frequent. It is strongly linked to smoking and typically presents as a **central/hilar mass** [1] with a tendency for **cavitary lesions** and hypercalcemia (due to PTHrP secretion). * **Large cell carcinoma:** A diagnosis of exclusion, these are undifferentiated malignant epithelial tumors. They represent a smaller percentage of cases and typically present as large peripheral masses with a poor prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Location Mnemonic:** **S**quamous and **S**mall cell are **S**entral; Adenocarcinoma and Large cell are Peripheral [1]. * **Most common lung cancer in smokers:** Adenocarcinoma (though Squamous has a stronger *relative* association with smoking, Adenocarcinoma is more common in absolute numbers). * **Driver Mutations:** EGFR mutations and ALK rearrangements are most frequently seen in Adenocarcinomas, especially in non-smokers. * **Pancoast Tumor:** Most commonly caused by Squamous cell carcinoma or Adenocarcinoma.

Q: A 69-year-old woman presents with left flank pain and hematuria. Physical examination reveals a blood pressure of 165/96 mmHg, heart rate of 104/min, and left costovertebral angle tenderness. An abdominal CT scan shows a 5-cm left kidney mass. Which of the following laboratory abnormalities might also be present?

polycythemia. The clinical presentation of a flank mass, hematuria, and hypertension in an elderly patient is highly suggestive of **Renal Cell Carcinoma (RCC)** [1]. ### **Explanation of the Correct Answer** **Polycythemia (Option A)** is a classic paraneoplastic syndrome associated with RCC. It occurs due to the ectopic production of **Erythropoietin (EPO)** by the tumor cells, which stimulates the bone marrow to increase red blood cell production. While anemia is actually more common in RCC (due to chronic disease), polycythemia is a high-yield diagnostic clue. ### **Analysis of Incorrect Options** * **Thrombocytopenia (B):** RCC is more likely to cause thrombocytosis (as an acute phase reactant) rather than a low platelet count. * **Hypocalcemia (C):** RCC is famously associated with **Hypercalcemia**, not hypocalcemia. This occurs either due to bone metastasis or the secretion of **Parathyroid Hormone-related Protein (PTHrP)**. * **Leukocytosis (D):** While non-specific inflammation can occur, it is not a classic paraneoplastic hallmark of RCC compared to erythrocytosis. ### **NEET-PG High-Yield Pearls: RCC Paraneoplastic Syndromes** * **The "Internist's Tumor":** RCC is known by this name because it presents with diverse systemic symptoms. * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs, alkaline phosphatase) in the absence of liver metastases. * **Hypertension:** Caused by increased **Renin** production or direct compression of the renal artery by the tumor. * **Classic Triad:** Flank pain, hematuria, and palpable abdominal mass (seen in only 10% of cases, usually indicating advanced disease) [1]. * **Most Common Histology:** Clear cell carcinoma (originates from the proximal convoluted tubule) [1].

Q: All of the following are good prognostic factors for seminoma testis except?

Nonpulmonary visceral metastases. This question is based on the **IGCCCG (International Germ Cell Cancer Collaborative Group) Classification**, which is the gold standard for prognosticating germ cell tumors (GCTs). ### **Explanation of the Correct Answer** For **Seminomas**, the IGCCCG classification only recognizes two categories: **Good Prognosis** and **Intermediate Prognosis**. There is no "Poor Prognosis" category for seminoma. * **Non-pulmonary visceral metastases** (e.g., liver, bone, or brain) automatically upgrade a seminoma from "Good" to **"Intermediate" prognosis**. Therefore, it is not a good prognostic factor. ### **Analysis of Incorrect Options** * **A & B (Primarily Gonadal/Retroperitoneal):** For a seminoma, the primary site can be either the testis (gonadal) or the retroperitoneum to be classified as **Good Prognosis**. This differs from Non-Seminomatous Germ Cell Tumors (NSGCT), where a mediastinal primary indicates a poor prognosis. * **D (AFP more than 10,000 ng/mL):** This is a "trick" option. By definition, **pure seminomas do not produce AFP**. If AFP is elevated, the tumor is treated as a Non-Seminoma. Therefore, an elevated AFP is not a prognostic factor for seminoma; it changes the diagnosis itself. ### **NEET-PG High-Yield Pearls** 1. **Seminoma IGCCCG Criteria:** * **Good Prognosis:** Any primary site (Testis/Retroperitoneum) AND No non-pulmonary visceral metastases. (Normal AFP, any hCG/LDH). * **Intermediate Prognosis:** Any primary site AND **Presence of non-pulmonary visceral metastases**. 2. **Markers:** LDH is the most common marker elevated in seminoma; hCG may be elevated in 10-15% (due to syncytiotrophoblasts), but **AFP is never elevated in pure seminoma**. 3. **Radiosensitivity:** Seminomas are highly radiosensitive and chemosensitive (Cisplatin-based therapy).

Q: Beta-2-microglobulin is a tumor marker for which of the following conditions?

Multiple myeloma. **Beta-2-microglobulin (B2M)** is a low-molecular-weight protein that forms the light chain subunit of the **MHC Class I molecule**, found on the surface of almost all nucleated cells. 1. **Why Multiple Myeloma is correct:** In plasma cell dyscrasias like Multiple Myeloma, there is a high turnover of lymphoid cells, leading to increased shedding of B2M into the serum [1]. In clinical practice, B2M is the **most important prognostic marker** for Multiple Myeloma and is a core component of the **International Staging System (ISS)**. Higher levels correlate with a higher tumor burden and renal impairment. 2. **Why other options are incorrect:** * **Lung Cancer:** While non-specific markers like CEA or NSE may be elevated, B2M is not used for diagnosis or staging [2]. * **Colonic Neoplasm:** The primary tumor marker is **Carcinoembryonic Antigen (CEA)**, used mainly for monitoring recurrence [2]. * **Choriocarcinoma:** The definitive tumor marker is the **beta subunit of Human Chorionic Gonadotropin (β-hCG)** [2]. **High-Yield Clinical Pearls for NEET-PG:** * **B2M in Renal Failure:** Since B2M is excreted by the kidneys, its levels rise in renal failure. It is the precursor protein for **Dialysis-related Amyloidosis** (presents as Carpal Tunnel Syndrome in long-term dialysis patients). * **Other B2M associations:** It is also elevated in Chronic Lymphocytic Leukemia (CLL) and B-cell Lymphomas. * **ISS Staging for Myeloma:** * Stage I: B2M < 3.5 mg/L and Albumin ≥ 3.5 g/dL. * Stage III: B2M ≥ 5.5 mg/L.

Q: In tumor lysis syndrome, all of the following are seen except:

Hypercalcemia. **Explanation:** Tumor Lysis Syndrome (TLS) is an oncologic emergency caused by the rapid destruction of a large number of tumor cells, typically following chemotherapy in high-grade malignancies (e.g., Burkitt lymphoma, ALL). When these cells rupture, they release their intracellular contents into the systemic circulation, leading to a specific constellation of metabolic derangements. **Why Hypercalcemia is the Correct Answer:** In TLS, **Hypocalcemia** (low calcium) is seen, not hypercalcemia. This occurs because the massive release of intracellular phosphorus leads to **Hyperphosphatemia**. The excess phosphate binds to circulating ionized calcium, forming calcium phosphate crystals that precipitate in soft tissues and the kidneys (metastatic calcification). This "precipitation effect" rapidly depletes serum calcium levels. **Analysis of Incorrect Options:** * **Hyperuricemia (A):** Nucleic acids from the destroyed cell nuclei are catabolized into purines and then into uric acid by xanthine oxidase. * **Hyperkalemia (C):** Potassium is the primary intracellular cation. Rapid cell lysis dumps massive amounts of potassium into the blood, posing a risk for fatal arrhythmias. * **Hyperphosphatemia (D):** Malignant cells contain significantly higher concentrations of intracellular phosphorus than normal cells; their rupture leads to a profound rise in serum phosphate. **NEET-PG High-Yield Pearls:** * **Cairo-Bishop Criteria:** Used for the diagnosis of laboratory and clinical TLS. * **Renal Failure:** Caused by the precipitation of uric acid and calcium phosphate crystals in the renal tubules. * **Prophylaxis/Treatment:** Aggressive hydration is the mainstay. **Allopurinol** (prevents new uric acid formation) or **Rasburicase** (recombinant urate oxidase that breaks down existing uric acid) are used to manage hyperuricemia.

Q: A 44-year-old woman presents with symptoms of muscle weakness and fatigue. Her laboratory findings include serum potassium of 2.5 mEq/L, bicarbonate of 18 mEq/L, and a normal anion gap. Urine potassium is 40 mEq/L. What is the most likely diagnosis for this patient's hypokalemia?

Renal tubular acidosis (RTA). ### Explanation The patient presents with a triad of **hypokalemia**, **metabolic acidosis** (low bicarbonate), and a **normal anion gap**. The key to differentiating the cause lies in the urinary potassium excretion. **1. Why Renal Tubular Acidosis (RTA) is Correct:** In a patient with metabolic acidosis, the kidneys should ideally conserve potassium. However, in RTA (specifically Type 1 and Type 2), there is significant **renal potassium wasting**. A urine potassium level >20 mEq/L in the presence of hypokalemia indicates a renal cause of loss. The combination of a normal anion gap metabolic acidosis (NAGMA) and high urinary potassium (40 mEq/L) is classic for RTA. **2. Why the other options are incorrect:** * **Lower GI losses (e.g., Diarrhea):** While diarrhea causes NAGMA and hypokalemia [1], the kidneys would respond by conserving potassium. Therefore, urine potassium would typically be **<20 mEq/L** [1]. * **Prior use of diuretics:** While diuretics cause hypokalemia, they typically result in metabolic **alkalosis** (contraction alkalosis), not acidosis. * **Current use of diuretics:** Similar to prior use, this would present with metabolic alkalosis. Additionally, while urine potassium would be high, the acid-base status does not fit the NAGMA seen in this patient. **Clinical Pearls for NEET-PG:** * **NAGMA + Hypokalemia:** Think RTA or Diarrhea. Check Urine Potassium [1]. * **Urine Anion Gap (UAG):** In RTA, the UAG is usually **positive** (reflecting decreased NH4+ excretion), whereas in diarrhea, it is **negative**. * **Type 1 RTA (Distal):** Associated with high urine pH (>5.5) and hypokalemia. * **Type 2 RTA (Proximal):** Associated with Fanconi syndrome and hypokalemia. * **Type 4 RTA:** The only RTA associated with **hyperkalemia**.

Question 1

Which feature is common to carcinoma of the pancreas, lungs, and stomach?

Accepted Answer

Migratory thrombophlebitis

Answer

Retinoblastoma

Answer

Ascites

Answer

Disseminated intravascular coagulation (DIC)

Question 2

What is the most common type of bronchogenic carcinoma?

Accepted Answer

Adenocarcinoma

Answer

Oat cell carcinoma

Answer

Squamous cell carcinoma

Answer

Large cell carcinoma

Question 3

A 69-year-old woman presents with left flank pain and hematuria. Physical examination reveals a blood pressure of 165/96 mmHg, heart rate of 104/min, and left costovertebral angle tenderness. An abdominal CT scan shows a 5-cm left kidney mass. Which of the following laboratory abnormalities might also be present?

Accepted Answer

polycythemia

Answer

thrombocytopenia

Answer

hypocalcemia

Answer

leukocytosis

Question 4

All of the following are good prognostic factors for seminoma testis except?

Accepted Answer

Nonpulmonary visceral metastases

Answer

Primarily gonadal

Answer

Primarily retroperitoneal

Answer

AFP more than 10,000 ng/Ml

Question 5

Beta-2-microglobulin is a tumor marker for which of the following conditions?

Accepted Answer

Multiple myeloma

Answer

Lung cancer

Answer

Colonic neoplasm

Answer

Choriocarcinoma

Question 6

In tumor lysis syndrome, all of the following are seen except:

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Hyperkalemia

Answer

Hyperphosphatemia

Question 7

A 44-year-old woman presents with symptoms of muscle weakness and fatigue. Her laboratory findings include serum potassium of 2.5 mEq/L, bicarbonate of 18 mEq/L, and a normal anion gap. Urine potassium is 40 mEq/L. What is the most likely diagnosis for this patient's hypokalemia?

Accepted Answer

Renal tubular acidosis (RTA)

Answer

Lower gastrointestinal losses

Answer

Prior use of diuretics

Answer

Current use of diuretics

Question 8

A 60-year-old man with a 20-year smoking history presents with altered behavior over the past week, personality changes, and a productive cough for the past month. He is not a known drug addict, diabetic, or hypertensive. Physical examination reveals multiple bruises, hyper-pigmented spots on the buccal mucosa and the back of his neck. His blood pressure is 160/90 mmHg, and pulse is 70/mm. Laboratory studies show random blood sugar of 224 mg/dL, serum sodium of 140 mEq/L, serum potassium of 2.0 mEq/L, and serum bicarbonate of 27 mEq/L. Which of the following tests is most likely to be abnormal in this patient?

Accepted Answer

CT chest

Answer

MRI brain

Answer

Plasma metanephrine levels

Answer

Renal Doppler

Question 9

Which of the following is not a characteristic of Tumor Lysis Syndrome?

Accepted Answer

Hypercalcemia

Answer

Hyperkalemia

Answer

Hyperuricemia

Answer

Hyperphosphatemia

Question 10

In the case of CNS relapse in AML, what chemotherapy agent(s) would be administered intrathecally?

Accepted Answer

None of the above

Answer

Methotrexate

Answer

Methotrexate + Cytosine Arabinoside

Answer

Prednisolone

Oncology — MCQs

Oncology — MCQs

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