Oncology — MCQs
On this page
Tumor lysis syndrome is associated with all of the following laboratory features EXCEPT?
A 62-year-old man presents with dark tarry stools and light-headedness. Upper endoscopy finds an ulcerating lesion in his stomach and biopsies confirm gastric cancer. Which of the following is a risk factor for carcinoma of the stomach?
A 21-year-old woman presents with a 2-day history of abdominal pain, nausea, and vomiting. On examination, her blood pressure is 100/70 mmHg, pulse 100/min, JVP is below sternal angle, and abdomen is diffusely tender. Her urine output is low and electrolytes reveal elevated urea and normal creatinine. For the above patient with AKI, what are the characteristic urine electrolyte and microscopy findings?
A patient presents with a history of alcoholic cirrhosis. Imaging reveals a hypervascular lesion during the arterial phase of CT and portal vein thrombosis. What is the most likely diagnosis given these findings?
A 29-year-old man is seen in follow-up 1 year post-kidney transplant. He is doing well clinically and the transplant is functioning well, with no recent episodes of rejection or changes to his immunosuppressive medications. Which of the following complications of transplantation is the most likely cause of death?
Which natural element possesses anticancer properties?
Which of the following is NOT a paraneoplastic syndrome associated with renal cell carcinoma?
A 38-year-old woman presents with repeated episodes of sore throat. She is on no medications, does not use ethanol, and has no history of renal disease. Physical examination is normal. Hemoglobin is 9.0 g/dL, mean corpuscular volume is 85 fL, white blood cell count is 2000/mL, and platelet count is 30,000/mL. Which of the following is the best approach to diagnosis?
A 74-year-old man with a history of hypertension and benign prostatic hypertrophy presents with urinary retention. A Foley catheter is inserted, draining 1500 cc of urine. Subsequently, his urine output is 200 cc/h. Which of the following urine electrolyte values is most likely in keeping with post-obstructive diuresis?
A 15-year-old boy develops symptoms of renal colic. The stone eventually passes spontaneously, but it is not recovered. The urinalysis reveals hexagonal crystals, and a cyanide-nitroprusside test on the urine is positive. Which of the following is the most likely diagnosis?
Oncology Indian Medical PG Practice Questions and MCQs
Question 121: Tumor lysis syndrome is associated with all of the following laboratory features EXCEPT?
- A. Hyperkalemia
- B. Hypercalcemia (Correct Answer)
- C. Hyperuricemia
- D. Hyperphosphatemia
Explanation: **Explanation:** Tumor Lysis Syndrome (TLS) is an oncologic emergency caused by the rapid destruction of a large number of metabolically active neoplastic cells (most commonly in high-grade lymphomas and leukemias). When these cells rupture, they release their intracellular contents into the systemic circulation, leading to a predictable pattern of metabolic derangements. **Why Hypercalcemia is the Correct Answer (The Exception):** TLS is characterized by **Hypocalcemia**, not hypercalcemia. As intracellular phosphorus is released into the blood (Hyperphosphatemia), it binds to circulating calcium to form calcium phosphate crystals. This precipitation leads to a result in a rapid decline in serum ionized calcium levels. **Analysis of Incorrect Options:** * **Hyperkalemia (A):** Potassium is the primary intracellular cation. Rapid cell lysis releases massive amounts of potassium into the extracellular space, which can lead to life-threatening cardiac arrhythmias. * **Hyperuricemia (C):** The breakdown of nucleic acids (purines) from the tumor cells is metabolized by xanthine oxidase into uric acid. This can lead to acute uric acid nephropathy. * **Hyperphosphatemia (D):** Malignant cells contain significantly higher concentrations of intracellular phosphorus than normal cells. Their lysis causes a surge in serum phosphate. **High-Yield Clinical Pearls for NEET-PG:** * **Cairo-Bishop Definition:** Laboratory TLS is defined by two or more metabolic abnormalities (Uric acid >8, Potassium >6, Phosphate >4.5, or Calcium <7) occurring within 3 days before or 7 days after chemotherapy. * **Renal Failure:** The "Calcium-Phosphate product" (>60) leads to crystal deposition in renal tubules, causing Acute Kidney Injury (AKI). * **Management:** Aggressive hydration is the mainstay. **Rasburicase** (recombinant urate oxidase) is the drug of choice for established hyperuricemia, while **Allopurinol** is used for prophylaxis.
Question 122: A 62-year-old man presents with dark tarry stools and light-headedness. Upper endoscopy finds an ulcerating lesion in his stomach and biopsies confirm gastric cancer. Which of the following is a risk factor for carcinoma of the stomach?
- A. Helicobacter pylori infection (Correct Answer)
- B. High socioeconomic status
- C. High protein diet
- D. High alcohol consumption
Explanation: **Explanation:** **1. Why Helicobacter pylori is correct:** *H. pylori* is the most significant risk factor for non-cardia gastric adenocarcinoma [1]. It is classified as a **Group 1 Carcinogen** by the WHO. Chronic infection leads to a predictable histological progression known as the **Correa Pathway**: Chronic gastritis → Atrophic gastritis → Intestinal metaplasia → Dysplasia → Adenocarcinoma [1]. The chronic inflammation induced by the bacteria (specifically strains expressing **CagA** [1]) leads to DNA damage and the loss of acid-secreting parietal cells, creating an environment conducive to malignancy. **2. Why the other options are incorrect:** * **High socioeconomic status:** Gastric cancer is more prevalent in **low socioeconomic groups**, primarily due to overcrowding (increased *H. pylori* transmission) and poor access to fresh fruits/vegetables (refrigeration). * **High protein diet:** A high protein diet is not a recognized risk factor. However, diets high in **nitrates/nitrites** (found in smoked, salted, or cured meats) are strongly associated with gastric cancer as they are converted into carcinogenic nitrosamines. * **High alcohol consumption:** While alcohol is a major risk factor for esophageal and liver cancers, its link to gastric cancer is inconsistent and not as definitive as *H. pylori* or tobacco use. **3. NEET-PG High-Yield Pearls:** * **Blood Group A:** Associated with an increased risk of gastric cancer (specifically the diffuse type). * **Dietary Protective Factors:** High intake of Vitamin C and beta-carotene (fresh fruits/vegetables). * **Virchow’s Node:** Left supraclavicular lymphadenopathy indicating metastasis. * **Sister Mary Joseph Nodule:** Periumbilical metastasis. * **Krukenberg Tumor:** Metastasis to the ovaries (classically showing signet ring cells).
Question 123: A 21-year-old woman presents with a 2-day history of abdominal pain, nausea, and vomiting. On examination, her blood pressure is 100/70 mmHg, pulse 100/min, JVP is below sternal angle, and abdomen is diffusely tender. Her urine output is low and electrolytes reveal elevated urea and normal creatinine. For the above patient with AKI, what are the characteristic urine electrolyte and microscopy findings?
- A. Urinary osmolality < 100 mOsm/kg
- B. Oxalate crystals in the urine
- C. Urinary sodium < 20 mEq/L (Correct Answer)
- D. Fractional sodium excretion > 1%
Explanation: ### Explanation The patient presents with signs of **Prerenal Acute Kidney Injury (AKI)** secondary to volume depletion (nausea, vomiting, low JVP, abdominal tenderness, and tachycardia). The biochemical hallmark of prerenal AKI is a **BUN:Creatinine ratio > 20:1** (elevated urea with normal/near-normal creatinine), indicating that the kidneys are structurally intact but responding to decreased perfusion [1]. **1. Why Option C is Correct:** In prerenal states, the kidneys attempt to restore intravascular volume by maximizing sodium and water reabsorption. The intact tubular function allows for the activation of the Renin-Angiotensin-Aldosterone System (RAAS), leading to: * **Urinary Sodium < 20 mEq/L** (due to intense reabsorption) [1]. * **Fractional Excretion of Sodium (FeNa) < 1%**. * **High Urine Osmolality (> 500 mOsm/kg)** as the kidneys concentrate urine to conserve water [1]. **2. Why the Other Options are Incorrect:** * **Option A:** Urinary osmolality < 100 mOsm/kg is seen in Diabetes Insipidus or primary polydipsia. In prerenal AKI, urine is highly concentrated (> 500 mOsm/kg) [1]. * **Option B:** Oxalate crystals are characteristic of ethylene glycol poisoning or secondary to high-dose Vitamin C. They are not a feature of volume-depletion-induced prerenal AKI. * **Option D:** FeNa > 1% (and often > 2%) is characteristic of **Acute Tubular Necrosis (ATN)**, where tubular damage prevents the kidney from reabsorbing sodium. **Clinical Pearls for NEET-PG:** * **Prerenal AKI:** FeNa < 1%, UNa < 20, Urine Osmolality > 500, Hyaline casts [1]. * **Intrinsic AKI (ATN):** FeNa > 1%, UNa > 40, Urine Osmolality < 350, **Muddy brown granular casts** [2]. * **Exception:** FeNa can be < 1% in certain intrinsic causes like Contrast-induced nephropathy and Acute Glomerulonephritis.
Question 124: A patient presents with a history of alcoholic cirrhosis. Imaging reveals a hypervascular lesion during the arterial phase of CT and portal vein thrombosis. What is the most likely diagnosis given these findings?
- A. Cholangiocarcinoma
- B. Hepatocellular carcinoma (Correct Answer)
- C. Metastatic colorectal carcinoma
- D. Neuroendocrine tumors
Explanation: **Explanation:** The clinical presentation described is a classic textbook case of **Hepatocellular Carcinoma (HCC)**. **1. Why Hepatocellular Carcinoma is correct:** HCC typically arises in the setting of chronic liver disease, most commonly **alcoholic cirrhosis** or chronic Hepatitis B/C. The hallmark radiological feature of HCC on dynamic contrast-enhanced CT or MRI is **"Arterial Enhancement with Venous Washout."** Because HCC derives its blood supply primarily from the hepatic artery (unlike normal liver parenchyma which relies on the portal vein), it appears **hypervascular during the arterial phase** [1]. Furthermore, HCC has a high propensity for **vascular invasion**, specifically involving the **portal vein**, leading to portal vein thrombosis (PVT) [1]. **2. Why the other options are incorrect:** * **Cholangiocarcinoma:** This typically presents as a non-cirrhotic mass with **delayed enhancement** (due to fibrous stroma) rather than arterial hypervascularity. It rarely causes portal vein thrombosis. * **Metastatic colorectal carcinoma:** These are usually **hypovascular** lesions. While they are the most common liver tumors overall, they do not typically show arterial phase "washout" or occur specifically due to cirrhosis. * **Neuroendocrine tumors (NETs):** While NET metastases can be hypervascular, they are usually multiple (not a single lesion) and are not associated with cirrhosis or a high frequency of portal vein thrombosis. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** Alpha-fetoprotein (AFP) is the most common marker; levels >400 ng/mL are highly suggestive [1]. * **Screening:** USG + AFP every 6 months for cirrhotic patients. * **Milan Criteria:** Used to determine eligibility for liver transplantation (Single lesion <5cm or up to 3 lesions <3cm). * **Treatment of choice for PVT:** Sorafenib or Lenvatinib (Systemic therapy) is indicated when vascular invasion is present [2].
Question 125: A 29-year-old man is seen in follow-up 1 year post-kidney transplant. He is doing well clinically and the transplant is functioning well, with no recent episodes of rejection or changes to his immunosuppressive medications. Which of the following complications of transplantation is the most likely cause of death?
- A. atherosclerotic disease (Correct Answer)
- B. opportunistic infection
- C. metabolic bone disease
- D. lung cancer
Explanation: **Explanation:** The correct answer is **A. atherosclerotic disease**. **1. Why Atherosclerotic Disease is Correct:** Cardiovascular disease (CVD), primarily due to accelerated atherosclerosis, is the **leading cause of death** in patients following a solid organ transplant (especially kidney transplants). While the risk of rejection and infection is highest in the immediate post-operative period, long-term survival is dictated by cardiovascular health. Post-transplant patients have a high prevalence of traditional risk factors (hypertension, diabetes, dyslipidemia) which are often exacerbated by immunosuppressive medications: * **Corticosteroids:** Cause weight gain, hyperglycemia, and hypertension. * **Calcineurin Inhibitors (Cyclosporine/Tacrolimus):** Lead to hypertension, hyperlipidemia, and new-onset diabetes after transplant (NODAT). **2. Why the Other Options are Incorrect:** * **B. Opportunistic Infection:** While a major cause of morbidity and mortality in the first 6 months (due to peak immunosuppression), the risk stabilizes after one year [2]. It is the second most common cause of death, but lags behind CVD. * **C. Metabolic Bone Disease:** Common (e.g., osteopenia, avascular necrosis) due to steroid use and pre-existing renal osteodystrophy, but it is rarely a direct cause of death. * **D. Lung Cancer:** Transplant recipients have an increased risk of malignancies (especially Skin Cancer and Post-Transplant Lymphoproliferative Disorder - PTLD), but lung cancer is not the leading cause of mortality in this population [1]. [2]. **Clinical Pearls for NEET-PG:** * **Most common cause of death post-renal transplant:** Cardiovascular disease (Atherosclerosis). * **Most common malignancy post-transplant:** Squamous cell carcinoma of the skin [1]. * **Most common viral infection post-transplant:** Cytomegalovirus (CMV). * **NODAT (New-onset diabetes):** Most strongly associated with Tacrolimus [2].
Question 126: Which natural element possesses anticancer properties?
- A. Nitrosoamines
- B. Vitamin C (Correct Answer)
- C. Vitamin D
- D. Carotene
Explanation: Explanation: Vitamin C (Ascorbic Acid) is the correct answer because it acts as a potent antioxidant and a cofactor in several enzymatic reactions [2]. Its anticancer properties are attributed to its ability to scavenge free radicals, thereby preventing oxidative DNA damage that leads to malignant transformation [1]. Furthermore, at high pharmacological doses (often administered intravenously in clinical trials), Vitamin C can act as a pro-oxidant, generating hydrogen peroxide ($H_2O_2$) which is selectively toxic to cancer cells while sparing normal cells [1]. It also enhances the immune system’s surveillance capabilities. Analysis of Incorrect Options: * A. Nitrosoamines: These are potent carcinogens, not anticancer agents. Found in tobacco smoke and cured meats, they induce DNA mutations (specifically G-to-A transitions) and are strongly linked to esophageal and gastric cancers. * C. Vitamin D: While Vitamin D plays a role in cell differentiation and apoptosis, and its deficiency is linked to higher cancer risks, it is primarily classified as a hormone precursor [3]. In the context of "natural elements with direct antioxidant/anticancer properties" in standard medical curricula, Vitamin C is the more classic answer. * D. Carotene: While Beta-carotene is a precursor to Vitamin A and an antioxidant, large-scale clinical trials (like the CARET study) surprisingly showed that beta-carotene supplementation actually increased the risk of lung cancer in smokers. NEET-PG High-Yield Pearls: * Antioxidant Trio: Vitamins A, C, and E are the primary dietary antioxidants [1]. * Vitamin C & Collagen: It is essential for the hydroxylation of proline and lysine residues during collagen synthesis (deficiency leads to Scurvy) [2]. * Carcinogen Alert: Aflatoxin B1 (from Aspergillus) is a major risk factor for Hepatocellular Carcinoma (HCC), often tested alongside nitrosoamines.
Question 127: Which of the following is NOT a paraneoplastic syndrome associated with renal cell carcinoma?
- A. Polycythemia
- B. Hypercalcemia
- C. Malignant hypertension
- D. Cushing syndrome (Correct Answer)
Explanation: Explanation: Renal Cell Carcinoma (RCC) is often referred to as the "Internist’s Tumor" because it frequently presents with a wide array of paraneoplastic syndromes (PNS) due to the ectopic production of hormones or cytokines [1]. Why Cushing Syndrome is the Correct Answer: While RCC can produce many hormones, it is not typically associated with the ectopic production of ACTH [1]. Cushing syndrome as a paraneoplastic phenomenon is most classically associated with Small Cell Lung Cancer (SCLC) and bronchial carcinoid tumors [1],[2]. Analysis of Other Options: * Polycythemia (Option A): This is a classic PNS of RCC, occurring in about 1-5% of patients. It is caused by the ectopic production of Erythropoietin (EPO) by the tumor cells [1]. * Hypercalcemia (Option B): This is the most common metabolic complication of RCC. It occurs due to the secretion of Parathyroid Hormone-related Protein (PTHrP), which mimics PTH action, or via direct bone osteolysis from metastases [1]. * Malignant Hypertension (Option C): RCC can cause hypertension through two mechanisms: the ectopic production of Renin (activating the RAAS pathway) or by direct compression of the renal artery by the tumor mass. High-Yield Clinical Pearls for NEET-PG: 1. Stauffer Syndrome: A unique PNS of RCC characterized by reversible hepatic dysfunction (elevated ALP, low albumin) in the absence of liver metastases. 2. Classic Triad: Hematuria, flank pain, and a palpable mass (seen in only 10% of cases, usually indicating advanced disease). 3. Most Common Histology: Clear cell carcinoma (associated with VHL gene mutations on chromosome 3p). 4. Amyloidosis: Secondary (AA) amyloidosis can also occur as a paraneoplastic manifestation of RCC.
Question 128: A 38-year-old woman presents with repeated episodes of sore throat. She is on no medications, does not use ethanol, and has no history of renal disease. Physical examination is normal. Hemoglobin is 9.0 g/dL, mean corpuscular volume is 85 fL, white blood cell count is 2000/mL, and platelet count is 30,000/mL. Which of the following is the best approach to diagnosis?
- A. Erythropoietin level
- B. Serum B12
- C. Bone marrow biopsy (Correct Answer)
- D. Liver spleen scan
Explanation: ### Explanation **Concept:** The patient presents with **pancytopenia** (anemia, leukopenia, and thrombocytopenia) as evidenced by Hb 9.0 g/dL, WBC 2000/mL, and platelets 30,000/mL. In a young patient with no obvious external cause (drugs, alcohol, or renal failure), the primary goal is to differentiate between bone marrow failure (e.g., Aplastic Anemia), marrow infiltration (e.g., Leukemia, Myelofibrosis), or peripheral destruction. **Bone marrow biopsy** is the gold standard for evaluating the cellularity and architecture of the marrow to reach a definitive diagnosis [1]. **Why the Correct Answer is Right:** * **Bone marrow biopsy (Option C):** It allows for the assessment of marrow cellularity [1]. It can distinguish between "empty" marrow (Aplastic Anemia) and "hypercellular" marrow (MDS or Aleukemic Leukemia). It is essential to rule out malignancies or granulomatous diseases in cases of unexplained pancytopenia; a trephine biopsy is specifically superior for assessing marrow cellularity and infiltration by abnormal cells [1]. **Why Other Options are Incorrect:** * **Erythropoietin level (Option A):** This is used to differentiate causes of polycythemia or evaluate anemia in chronic kidney disease. It does not help diagnose the cause of pancytopenia. * **Serum B12 (Option B):** While B12 deficiency can cause pancytopenia, the **MCV is 85 fL (normocytic)**. B12 deficiency typically presents with macrocytosis (MCV >100 fL) and hypersegmented neutrophils. * **Liver spleen scan (Option D):** This is an outdated modality. While it might show splenomegaly (suggesting sequestration), it does not provide a tissue diagnosis for the underlying hematological pathology. **NEET-PG High-Yield Pearls:** * **Definition of Pancytopenia:** Hb <12 g/dL (women), WBC <4000/mm³, and Platelets <1.5 lakh/mm³. * **Most common cause of pancytopenia in India:** Megaloblastic anemia (however, always check MCV first). * **Aplastic Anemia:** Characterized by pancytopenia with **hypocellular marrow** where fat cells replace hematopoietic elements. * **Dry Tap on Aspiration:** Classically seen in Myelofibrosis and Hairy Cell Leukemia; requires a trephine biopsy for diagnosis [1].
Question 129: A 74-year-old man with a history of hypertension and benign prostatic hypertrophy presents with urinary retention. A Foley catheter is inserted, draining 1500 cc of urine. Subsequently, his urine output is 200 cc/h. Which of the following urine electrolyte values is most likely in keeping with post-obstructive diuresis?
- A. High sodium (Correct Answer)
- B. Low potassium
- C. High specific gravity
- D. Low pH
Explanation: **Explanation:** **Post-obstructive diuresis (POD)** is a clinical condition characterized by polyuria (typically >200 mL/h) following the relief of a chronic, bilateral urinary tract obstruction. [1] **Why High Sodium is Correct:** The primary mechanism behind POD is a combination of **solute diuresis** and **tubular dysfunction**. During chronic obstruction, the accumulation of urea and other solutes creates an osmotic gradient. Once the obstruction is relieved, these solutes are excreted, dragging water with them [1]. More importantly, the prolonged high pressure in the renal pelvis causes damage to the distal tubules and collecting ducts, leading to an **impaired responsiveness to aldosterone and ADH** [2]. This results in a "salt-wasting" state where the kidneys cannot effectively reabsorb sodium, leading to **high urinary sodium levels** (often >40 mEq/L) [1]. **Why Other Options are Wrong:** * **Low Potassium:** While potassium is lost during diuresis, the hallmark of POD is the significant loss of sodium and water. Potassium levels in the urine are typically elevated (high), not low, due to the high flow rate. * **High Specific Gravity:** POD results in the excretion of large volumes of dilute urine because the kidneys lose their concentrating ability [2]. Therefore, the **specific gravity is low** (typically <1.010). * **Low pH:** Urine pH is not a defining characteristic of POD; however, if there is associated distal renal tubular acidosis due to prior obstructive damage, the urine might actually be inappropriately alkaline. **Clinical Pearls for NEET-PG:** * **Definition:** Urine output >200 mL/h for two consecutive hours or >3 L/24 hours. * **Management:** Most cases are self-limiting. Replace only **50% of hourly losses** with 0.45% saline to avoid perpetuating the diuresis, unless the patient is hemodynamically unstable. * **Risk Factors:** Chronic obstruction, congestive heart failure, and azotemia (high BUN/Creatinine).
Question 130: A 15-year-old boy develops symptoms of renal colic. The stone eventually passes spontaneously, but it is not recovered. The urinalysis reveals hexagonal crystals, and a cyanide-nitroprusside test on the urine is positive. Which of the following is the most likely diagnosis?
- A. Cystinuria (Correct Answer)
- B. Thalassemia
- C. Hereditary glycosuria
- D. Primary hyperoxaluria
Explanation: ### Explanation **1. Why Cystinuria is the Correct Answer:** Cystinuria is an autosomal recessive defect in the **COLA** transporter (Cystine, Ornithine, Lysine, and Arginine) in the proximal convoluted tubule and GI tract. Since cystine is poorly soluble in acidic urine, it precipitates to form stones. * **Pathognomonic Finding:** The presence of **hexagonal (six-sided), flat, colorless crystals** on urinalysis is diagnostic. * **Screening Test:** The **Cyanide-nitroprusside test** is the classic screening tool. Sodium cyanide reduces cystine to cysteine, which then reacts with nitroprusside to produce a characteristic **magenta/purple color**. **2. Analysis of Incorrect Options:** * **B. Thalassemia:** While chronic hemolysis can lead to gallstones (pigment stones), it does not cause renal stones with hexagonal crystals or a positive nitroprusside test. * **C. Hereditary Glycosuria:** This is a benign condition involving a defect in the SGLT2 transporter. It presents with glucose in the urine despite normal blood glucose levels, not nephrolithiasis. * **D. Primary Hyperoxaluria:** This leads to calcium oxalate stones. These crystals are typically shaped like **envelopes (dihydrate)** or **dumbbells (monohydrate)**, not hexagons. **3. High-Yield Clinical Pearls for NEET-PG:** * **Stone Radiopacity:** Cystine stones are **radio-opaque** (due to sulfur content) but less dense than calcium stones. They often appear "ground-glass" on X-ray. * **Management:** Treatment focuses on high fluid intake, **urinary alkalinization** (pH > 7.5) to increase solubility, and chelating agents like **D-penicillamine** or Tiopronin for refractory cases [1]. Around 90% of stones of less than 4 mm diameter pass spontaneously [1]. * **Mnemonic:** Remember **"COLA"** for the involved amino acids and **"Six-sided Cystine"** for the crystal shape.
Practice by Chapter
Cancer Biology and Carcinogenesis
Practice Questions
Principles of Cancer Diagnosis and Staging
Practice Questions
Solid Tumor Management
Practice Questions
Hematological Malignancies
Practice Questions
Cancer Emergencies
Practice Questions
Principles of Chemotherapy, Immunotherapy and Targeted Therapy
Practice Questions
Radiation Oncology Basics
Practice Questions
Palliative Care in Oncology
Practice Questions
Cancer Screening and Prevention
Practice Questions
Paraneoplastic Syndromes
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free