Oncology — MCQs
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Which of the following is a good prognostic marker?
A 58-year-old man with a 700-pack-year smoking history presents with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass centrally located within the left lung field. The serum calcium is 13.0 mg/dL (normal 8.5 to 10.2). The metabolic abnormality described here is likely due to elaboration of which substance?
Which of the following is a risk factor for colorectal cancer?
For the following medical condition, select the associated acid-base disturbance: Chronic pulmonary disease on steroids.
Which of the following is the most effective treatment for ER-positive breast cancer?
A 25-year-old male presents with pigmented macules on the palms, soles, and oral mucosa. He also has anemia and abdominal pain. What is the most probable diagnosis?
A 26-year-old woman presents with diffuse abdominal pain and nausea, which began 1 day ago and is now at its maximum intensity. She denies fever but reports constipation and dark urine. She has a history of similar episodes, having undergone appendectomy and cholecystectomy on separate occasions. Physical examination reveals tachycardia, diffuse abdominal tenderness without rebound tenderness, and slightly sluggish bowel sounds. Neurological examination shows decreased sensation to fine and crude touch in both lower extremities up to the knees. Laboratory findings include normal hemoglobin, WBC, and platelet counts. She has mild transaminitis with ALT 123 IU/L, AST 160 IU/L, and ALP 122 IU/L. Urine is red, but a urine dipstick is negative for blood, leukocyte esterase, nitrite, glucose, or protein. Urine porphobilinogen and total porphyrin levels are elevated, while plasma porphyrin levels are normal. What is the most likely explanation for her recurrent symptoms?
A patient with Hodgkin's lymphoma presents with a single cervical lymph node. Biopsy shows the lymphocyte-predominant variant. Which of the following is the treatment of choice?
Which acid-base disturbance is most commonly associated with hepatic cirrhosis complicated by acute kidney injury?
A patient presents to the emergency room after a seizure. Laboratory investigations reveal SIADH, and a CT scan demonstrates a lung mass. Which of the following lung cancer subtypes is most likely to cause this electrolyte imbalance?
Oncology Indian Medical PG Practice Questions and MCQs
Question 111: Which of the following is a good prognostic marker?
- A. Age > 10 years
- B. Male sex
- C. Hyperploidy (Correct Answer)
- D. Translocation (9;22)
Explanation: This question pertains to the prognostic factors in **Acute Lymphoblastic Leukemia (ALL)**, which is a high-yield topic for NEET-PG. Prognosis in ALL is determined by age, initial white blood cell (WBC) count, and specific cytogenetic abnormalities [1]. ### **Why Hyperploidy is Correct** **Hyperploidy** (defined as >50 chromosomes per cell) is one of the most significant **favorable prognostic markers** in pediatric ALL [1]. It is often associated with the accumulation of methotrexate polyglutamates within leukemic blasts, making the cells highly sensitive to chemotherapy. Another favorable genetic marker is the **t(12;21)** translocation (ETV6-RUNX1). ### **Explanation of Incorrect Options** * **Age > 10 years:** The "Age Peak" for a good prognosis is between **1 and 9 years**. Children younger than 1 year (infants) or older than 10 years (adolescents) have a poorer prognosis. * **Male Sex:** Historically, males have a slightly worse prognosis than females, partly due to the risk of late relapses in sanctuary sites like the testes. * **Translocation (9;22):** Also known as the **Philadelphia Chromosome** (BCR-ABL1), this is a notorious **poor prognostic marker** in ALL [1]. It is more common in adults and requires treatment with Tyrosine Kinase Inhibitors (TKIs) like Imatinib. ### **NEET-PG High-Yield Pearls: ALL Prognosis** | Feature | Favorable Prognosis | Unfavorable Prognosis | | :--- | :--- | :--- | | **Age** | 1–9 years | <1 year or >10 years | | **WBC Count** | <50,000/µL | >50,000/µL | | **Cytogenetics** | **Hyperploidy**, t(12;21) | **t(9;22)**, t(4;11), Hypoploidy | | **Response** | Rapid (CR by day 14) | Slow response to induction | | **Immunotype** | Early Pre-B cell | Mature B-cell or T-cell |
Question 112: A 58-year-old man with a 700-pack-year smoking history presents with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass centrally located within the left lung field. The serum calcium is 13.0 mg/dL (normal 8.5 to 10.2). The metabolic abnormality described here is likely due to elaboration of which substance?
- A. Adrenocorticotropic hormone-like substance
- B. Antidiuretic hormone
- C. Carcinoembryonic antigen
- D. Parathyroid-related hormone (Correct Answer)
Explanation: The patient presents with a central lung mass, a heavy smoking history, and significant hypercalcemia (13.0 mg/dL). This clinical triad is classic for **Squamous Cell Carcinoma (SCC)** of the lung. [1] **1. Why Option D is Correct:** Hypercalcemia in lung cancer is most commonly a **paraneoplastic syndrome** caused by the secretion of **Parathyroid Hormone-related Protein (PTHrP)** [2]. PTHrP mimics the action of PTH by binding to the same receptors in the bone and kidney, leading to increased bone resorption and decreased renal calcium excretion. This is specifically associated with Squamous Cell Carcinoma (mnemonic: **S**quamous = **S**ecretion of PTHrP = **S**tones/Hypercalcemia) [2]. **2. Why the Other Options are Incorrect:** * **Option A (ACTH):** Ectopic ACTH production leads to Cushing Syndrome (hypokalemia, hypertension). This is a paraneoplastic syndrome associated with **Small Cell Lung Cancer (SCLC)**, not SCC [2]. * **Option B (ADH):** Ectopic ADH secretion causes SIADH (hyponatremia). This is also a classic feature of **Small Cell Lung Cancer** [2]. * **Option C (CEA):** Carcinoembryonic antigen is a tumor marker used for monitoring colorectal and some lung adenocarcinomas, but it does not cause metabolic abnormalities like hypercalcemia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Central Lung Tumors:** Squamous Cell Carcinoma and Small Cell Carcinoma (The "S" tumors are **S**moking-related and **S**entral) [1]. * **Peripheral Lung Tumors:** Adenocarcinoma (most common in non-smokers and females). * **Hypercalcemia of Malignancy:** PTHrP is the most common cause (80%); the second most common is local osteolytic hypercalcemia (bone metastases). * **Small Cell Lung Cancer (SCLC):** Associated with Lambert-Eaton Syndrome, SIADH, and ACTH [2]. * **Squamous Cell Carcinoma (SCC):** Associated with PTHrP (Hypercalcemia) and Pancoast tumors [2].
Question 113: Which of the following is a risk factor for colorectal cancer?
- A. Male sex
- B. Red meat consumption (Correct Answer)
- C. High intake of animal fat
- D. Use of NSAIDS
Explanation: ### Explanation **Correct Answer: B. Red meat consumption** The association between diet and colorectal cancer (CRC) is a high-yield topic for NEET-PG. **Red meat** (beef, lamb, pork) and **processed meats** (ham, bacon, salami) are classified by the IARC as Group 1 carcinogens. The underlying medical mechanism involves the formation of **N-nitroso compounds (NOCs)**, polycyclic aromatic hydrocarbons, and heterocyclic amines during cooking. These compounds cause DNA damage and promote colonic carcinogenesis. **Analysis of Options:** * **A. Male sex:** While the incidence of CRC is slightly higher in males, **age** is a much more significant non-modifiable risk factor than sex. Most cases occur after age 50. * **C. High intake of animal fat:** Historically, high fat was linked to CRC; however, recent large-scale prospective studies (like the Nurses' Health Study) have shown that the **type of food** (red/processed meat) is a more definitive risk factor than total animal fat intake alone. * **D. Use of NSAIDs:** This is a **protective factor**, not a risk factor. Regular use of Aspirin or other NSAIDs inhibits the COX-2 enzyme, which is overexpressed in 80-90% of colorectal adenocarcinomas. NSAIDs are known to reduce the size and number of polyps, especially in FAP patients. **High-Yield Clinical Pearls for NEET-PG:** 1. **Protective Factors:** High-fiber diet, Calcium, Vitamin D, Physical activity, and NSAIDs/Aspirin. 2. **Most Common Site:** Historically the rectum/sigmoid, but there is a rising trend of **right-sided (proximal) colon cancers** [1]. Over 65% occur in the rectosigmoid and a further 15% recur in the caecum or ascending colon [1]. 3. **Screening Gold Standard:** Colonoscopy every 10 years, starting at age 45 (updated guideline) for average-risk individuals. 4. **Streptococcus bovis (S. gallolyticus):** If found in blood culture (endocarditis), always perform a colonoscopy to rule out occult CRC.
Question 114: For the following medical condition, select the associated acid-base disturbance: Chronic pulmonary disease on steroids.
- A. Metabolic acidosis and respiratory acidosis
- B. Metabolic acidosis and respiratory alkalosis
- C. Metabolic alkalosis and respiratory acidosis (Correct Answer)
- D. Metabolic alkalosis and respiratory alkalosis
Explanation: This question tests the ability to recognize mixed acid-base disturbances in a clinical context. The patient has two distinct physiological processes occurring simultaneously: **1. Why Option C is Correct:** * **Respiratory Acidosis:** Chronic pulmonary disease (such as COPD) leads to alveolar hypoventilation and impaired gas exchange. This causes the retention of carbon dioxide ($CO_2$), leading to an increase in $PaCO_2$ and a decrease in pH [2], [4]. Specifically in severe COPD, the $PaCO_2$ may be persistently raised [5]. * **Metabolic Alkalosis:** Steroids (glucocorticoids) have inherent mineralocorticoid activity. This leads to increased sodium reabsorption and increased excretion of potassium ($K^+$) and hydrogen ions ($H^+$) in the distal renal tubules. The loss of $H^+$ ions results in a primary increase in serum bicarbonate, causing metabolic alkalosis. Corticosteroid therapy is a recognized cause of hypervolemic metabolic alkalosis [1]. **2. Why Incorrect Options are Wrong:** * **Option A & B:** Metabolic acidosis is incorrect because steroids promote $H^+$ loss, not retention. Conditions like renal failure or ketoacidosis would be required for metabolic acidosis. * **Option D:** Respiratory alkalosis occurs in hyperventilation (e.g., acute asthma or pulmonary embolism). In chronic obstructive disease, the baseline state is typically $CO_2$ retention (acidosis), not washout [2], [5]. **Clinical Pearls for NEET-PG:** * **Mixed Acid-Base Disorders:** Always look for two separate "hits" (e.g., a lung pathology + a drug or vomiting). Acid-base disorders can occur in combination [4]. * **Steroid Side Effects:** Remember the mnemonic **"Hypo-K-Alkalosis"**—steroids and diuretics are common culprits for metabolic alkalosis in clinical vignettes [1]. * **Compensation:** In chronic respiratory acidosis, the kidneys compensate by retaining $HCO_3^-$ over days and weeks [3]. In chronic type II respiratory failure from COPD, the kidneys retain bicarbonate to correct arterial pH toward normal [5]. However, when steroids are added, the elevation in $HCO_3^-$ is "primary" and often exceeds the expected compensatory range, confirming a mixed disorder [3].
Question 115: Which of the following is the most effective treatment for ER-positive breast cancer?
- A. Tamoxifen (Correct Answer)
- B. Exemestane
- C. Leuprolide
- D. Bicalutamide
Explanation: Explanation: In ER-positive (Estrogen Receptor-positive) breast cancer, the tumor cells depend on estrogen for growth. **Tamoxifen** is a Selective Estrogen Receptor Modulator (SERM) that acts as a competitive antagonist at the estrogen receptors in breast tissue, effectively blocking the proliferative signals. It is considered the gold standard and most widely used hormonal therapy for both pre-menopausal and post-menopausal women with ER-positive breast cancer. Analysis of Options: * **Tamoxifen (A):** The drug of choice for ER+ breast cancer across all age groups. It reduces the risk of recurrence and contralateral breast cancer. * **Exemestane (B):** This is an Aromatase Inhibitor (AI). While AIs are highly effective (and often preferred) in **post-menopausal** women, they are ineffective in pre-menopausal women unless combined with ovarian suppression, making Tamoxifen the more "universal" correct answer for general ER+ treatment. * **Leuprolide (C):** A GnRH agonist used for ovarian suppression. While used in breast cancer management to induce medical menopause, it is rarely used as a monotherapy and is usually an adjunct to Tamoxifen or AIs. * **Bicalutamide (D):** An anti-androgen used primarily in the treatment of **Prostate Cancer**, not breast cancer. High-Yield Clinical Pearls for NEET-PG: * **Tamoxifen Side Effects:** It acts as an agonist in the uterus and bone. This leads to an increased risk of **Endometrial Carcinoma** and thromboembolism (DVT/PE), but it helps prevent osteoporosis. * **Aromatase Inhibitors (Letrozole, Anastrozole):** These are the first-line choice specifically for **post-menopausal** ER+ patients but carry a risk of osteoporosis and joint pain. * **HER2/neu positive:** For these patients, **Trastuzumab** (a monoclonal antibody against ErbB2) is the treatment of choice.
Question 116: A 25-year-old male presents with pigmented macules on the palms, soles, and oral mucosa. He also has anemia and abdominal pain. What is the most probable diagnosis?
- A. Albright's syndrome
- B. Cushing's syndrome
- C. Peutz-Jeghers syndrome (Correct Answer)
- D. Incontinentia pigmenti
Explanation: The clinical presentation of **mucocutaneous pigmentation** (pigmented macules on palms, soles, and oral mucosa) combined with **anemia** and **abdominal pain** is classic for **Peutz-Jeghers Syndrome (PJS)**. **Why C is correct:** PJS is an autosomal dominant condition caused by a mutation in the **STK11 (LKB1)** gene. It is characterized by: 1. **Hamartomatous polyps:** Primarily in the small intestine, which can cause intussusception (leading to abdominal pain) and chronic occult bleeding (leading to iron-deficiency anemia). [1] 2. **Melanocytic macules:** Distinctive dark spots on the lips, buccal mucosa, palms, and soles. Unlike freckles, these do not fade with sun exposure. **Why the other options are incorrect:** * **A. Albright’s Syndrome (McCune-Albright):** Presents with "Café-au-lait" spots (large, irregular borders), polyostotic fibrous dysplasia, and precocious puberty. It does not involve oral mucosal pigmentation or intestinal polyps. * **B. Cushing’s Syndrome:** Characterized by weight gain, moon facies, striae, and hypertension. While hyperpigmentation can occur in ACTH-dependent causes, it is generalized and lacks the specific macules and GI symptoms seen here. * **C. Incontinentia Pigmenti:** An X-linked dominant skin disorder that evolves through stages (vesicular, verrucous, hyperpigmented). The pigmentation follows Blaschko’s lines and is associated with dental and CNS anomalies, not GI polyposis. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Autosomal Dominant (STK11 gene on Chromosome 19p). * **Cancer Risk:** Patients have a significantly increased risk of GI cancers and extra-intestinal malignancies (Breast, Pancreas, Ovary/Sertoli cell tumors). [1] * **Most common site of polyps:** Small intestine (Jejunum). * **Management:** Regular screening with upper/lower GI endoscopy and imaging for extra-intestinal tumors.
Question 117: A 26-year-old woman presents with diffuse abdominal pain and nausea, which began 1 day ago and is now at its maximum intensity. She denies fever but reports constipation and dark urine. She has a history of similar episodes, having undergone appendectomy and cholecystectomy on separate occasions. Physical examination reveals tachycardia, diffuse abdominal tenderness without rebound tenderness, and slightly sluggish bowel sounds. Neurological examination shows decreased sensation to fine and crude touch in both lower extremities up to the knees. Laboratory findings include normal hemoglobin, WBC, and platelet counts. She has mild transaminitis with ALT 123 IU/L, AST 160 IU/L, and ALP 122 IU/L. Urine is red, but a urine dipstick is negative for blood, leukocyte esterase, nitrite, glucose, or protein. Urine porphobilinogen and total porphyrin levels are elevated, while plasma porphyrin levels are normal. What is the most likely explanation for her recurrent symptoms?
- A. Variegate porphyria
- B. Thalassemia
- C. Acute intermittent porphyria (Correct Answer)
- D. Porphyria cutanea tarda
Explanation: **Explanation:** The patient presents with the classic triad of **Acute Intermittent Porphyria (AIP)**: abdominal pain, neuropsychiatric symptoms (peripheral neuropathy), and autonomic instability (tachycardia, constipation) [1]. **Why AIP is the correct answer:** AIP is an autosomal dominant disorder caused by a deficiency in **porphobilinogen (PBG) deaminase** [4]. * **Clinical Presentation:** Recurrent "surgical-like" abdominal pain without rebound tenderness (neurovisceral) is hallmark [1]. History of unnecessary surgeries (appendectomy/cholecystectomy) is a classic board-exam clue. * **Urine Findings:** The "dark/red urine" that is **dipstick-negative for blood** indicates the presence of porphyrins/porphyrin precursors rather than hemoglobin or myoglobin. * **Biochemical Marker:** Elevated urinary **PBG** and delta-aminolevulinic acid (ALA) during attacks are diagnostic [4]. Crucially, in AIP, **plasma porphyrins are normal**, and there are **no cutaneous photosensitivity** features, distinguishing it from other porphyrias [4]. **Why other options are incorrect:** * **Variegate Porphyria:** While it presents with similar neurovisceral attacks, it typically features **cutaneous photosensitivity** (blisters/erosions) and **elevated plasma porphyrins** (with a characteristic fluorescence peak) [4]. * **Thalassemia:** Presents with chronic anemia, splenomegaly, and characteristic peripheral smear findings (target cells); it does not cause acute neurovisceral attacks or porphobilinogenuria. * **Porphyria Cutanea Tarda (PCT):** The most common porphyria, but it presents **only with skin findings** (fragile skin, blisters on sun-exposed areas) and lacks acute abdominal or neurological symptoms [2]. **NEET-PG High-Yield Pearls:** * **Mnemonic (5 Ps):** **P**ainful abdomen, **P**ort-wine urine, **P**olyneuropathy, **P**sychological disturbances, **P**recipitated by drugs (e.g., Cytochrome P450 inducers like Barbiturates, Sulfonamides) [1]. * **Management:** Acute attacks are treated with **IV Hemin** (inhibits ALA synthase via feedback) and **high-dose glucose** (dextrose) to suppress heme synthesis [3].
Question 118: A patient with Hodgkin's lymphoma presents with a single cervical lymph node. Biopsy shows the lymphocyte-predominant variant. Which of the following is the treatment of choice?
- A. Chemotherapy with Radiotherapy
- B. Chemotherapy only
- C. Radiotherapy only (Correct Answer)
- D. No treatment needed
Explanation: ### Explanation **Concept:** The patient has **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)**. This is a distinct clinical entity from Classical Hodgkin Lymphoma (cHL) [1]. NLPHL is characterized by an indolent (slow-growing) course, a tendency to present in early stages (Stage I or II), and the presence of "Popcorn cells" (LP cells) that are CD20 positive. **Why Radiotherapy only is correct:** For **Early-stage (Stage IA or IIA)** NLPHL without risk factors, **Involved-Field Radiation Therapy (IFRT)** or Involved-Site Radiation Therapy (ISRT) is the standard of care [2]. Because the disease is localized and highly radiosensitive, radiotherapy alone achieves excellent long-term survival rates (>90%) and avoids the systemic toxicity of chemotherapy [2]. **Why other options are incorrect:** * **Option A & B:** Combined Modality Therapy (CMT) or chemotherapy alone (e.g., ABVD or CHOP + Rituximab) is generally reserved for advanced stages (III-IV) or early stages with bulky disease/B-symptoms. Using them for a single node is considered "over-treatment." * **Option D:** While NLPHL is indolent, it is not a "watch and wait" disease like some low-grade B-cell lymphomas; active localized treatment is required to prevent progression or transformation. --- ### NEET-PG High-Yield Pearls * **Immunophenotype:** NLPHL is **CD20+** and **CD45+**, but usually **CD15- and CD30-** (the opposite of Classical Hodgkin Lymphoma). * **Morphology:** Look for **"Popcorn cells"** (L&H cells) instead of the classic Reed-Sternberg cells [1]. * **Clinical Course:** It has a high risk of late recurrence but a very low mortality rate [2]. It can transform into Diffuse Large B-cell Lymphoma (DLBCL) in ~3-5% of cases. * **Treatment Note:** If the question mentions CD20 positivity, **Rituximab** is a highly effective targeted therapy often used in relapsed cases [3].
Question 119: Which acid-base disturbance is most commonly associated with hepatic cirrhosis complicated by acute kidney injury?
- A. Metabolic acidosis and respiratory acidosis
- B. Metabolic acidosis and respiratory alkalosis (Correct Answer)
- C. Metabolic alkalosis and respiratory acidosis
- D. Metabolic alkalosis and respiratory alkalosis
Explanation: The coexistence of **Metabolic Acidosis and Respiratory Alkalosis** is the most frequent mixed acid-base disorder seen in patients with cirrhosis and acute kidney injury (AKI). [1] 1. **Why the correct answer is right:** * **Metabolic Acidosis:** In the setting of cirrhosis, AKI (often Hepatorenal Syndrome or ATN) leads to the accumulation of fixed acids and decreased bicarbonate reabsorption, resulting in a **High Anion Gap Metabolic Acidosis (HAGMA)**. Additionally, advanced cirrhosis itself can cause lactic acidosis due to poor hepatic clearance. [1] * **Respiratory Alkalosis:** Patients with cirrhosis chronically hyperventilate. This is driven by increased levels of progesterone, ammonia, and vasoactive substances that directly stimulate the medullary respiratory center. This results in a primary decrease in $PCO_2$. 2. **Why the incorrect options are wrong:** * **Options A & C (Respiratory Acidosis):** Respiratory acidosis implies hypoventilation. In cirrhosis, the drive to breathe is typically increased, not decreased, unless the patient has co-existing COPD or severe hepatic encephalopathy leading to coma. * **Option D (Metabolic Alkalosis):** While metabolic alkalosis can occur in cirrhosis due to diuretic use or vomiting, the presence of **AKI** shifts the balance toward acidosis due to the failure of the kidneys to excrete organic acids. [2] **High-Yield Clinical Pearls for NEET-PG:** * **Triple Acid-Base Disorder:** Cirrhotic patients on diuretics who develop AKI and hyperventilate can actually present with a triple disorder: Metabolic Acidosis + Metabolic Alkalosis + Respiratory Alkalosis. * **Progesterone:** This is the key hormone responsible for the chronic hyperventilation and primary respiratory alkalosis seen in pregnancy and liver failure. * **Hepatorenal Syndrome (HRS):** Always suspect HRS in a cirrhotic patient with AKI who does not respond to volume expansion with albumin.
Question 120: A patient presents to the emergency room after a seizure. Laboratory investigations reveal SIADH, and a CT scan demonstrates a lung mass. Which of the following lung cancer subtypes is most likely to cause this electrolyte imbalance?
- A. Adenocarcinoma
- B. Bronchioloalveolar carcinoma
- C. Large cell carcinoma
- D. Small cell carcinoma (Correct Answer)
Explanation: **Explanation:** **1. Why Small Cell Carcinoma (SCLC) is correct:** Small cell lung carcinoma is a neuroendocrine tumor derived from **Kulchitsky cells**. These cells have the metabolic machinery to produce various ectopic hormones. **SIADH (Syndrome of Inappropriate Antidiuretic Hormone)** is the most common paraneoplastic syndrome associated with SCLC, occurring in approximately 7–10% of patients [1]. It results in water retention and dilutional hyponatremia, which can manifest clinically as seizures, confusion, or coma [1]. **2. Why the other options are incorrect:** * **Adenocarcinoma (Option A):** This is the most common lung cancer overall (especially in non-smokers). While it is associated with hypertrophic osteoarthropathy (clubbing), it rarely causes SIADH. * **Bronchioloalveolar carcinoma (Option B):** Now classified under Adenocarcinoma in situ, it typically presents with voluminous watery sputum (bronchorrhea) rather than endocrine disturbances. * **Large cell carcinoma (Option C):** This is a diagnosis of exclusion. It is more commonly associated with gynecomastia due to beta-hCG production, not SIADH. **3. High-Yield Clinical Pearls for NEET-PG:** * **Small Cell Carcinoma:** Associated with "The 3 S's": **S**IADH, **S**ubacute cerebellar degeneration, and Lambert-Eaton **S**yndrome (and ACTH/Cushing’s) [1]. * **Squamous Cell Carcinoma:** Associated with "The 3 P's": **P**THrP (Hypercalcemia), **P**erypheral (actually Central, but often mnemonicized for **P**arathyroid-like), and **P**earl formation (keratin pearls) [1]. * **Location:** SCLC and Squamous cell are typically **Central** (hilar), while Adenocarcinoma is **Peripheral**. * **Management of SIADH:** Fluid restriction is the first-line treatment; Vaptans (Vasopressin antagonists) or Demeclocycline are used in refractory cases.
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