Oncology Practice Questions

Q: Management of acute lymphoblastic leukemia (ALL) in adults includes which of the following treatments?

High-dose chemotherapy. ***High-dose chemotherapy*** - **Adult ALL** requires intensive treatment due to its aggressive nature and propensity for relapse. [1] - **High-dose chemotherapy**, often involving **multi-agent regimens** and potentially followed by **hematopoietic stem cell transplantation**, is the cornerstone of inducing remission and preventing recurrence. [1] *Supportive care only* - **Supportive care** is crucial for managing complications and side effects but is insufficient as a standalone treatment for ALL, which is a rapidly progressive and life-threatening cancer. [1] - Delaying definitive treatment with chemotherapy would lead to **rapid disease progression** and poor outcomes. *Low-dose oral chemotherapy* - **Low-dose oral chemotherapy** is typically used for less aggressive malignancies or as maintenance therapy in certain contexts but is inadequate for the initial treatment of **acute lymphoblastic leukemia (ALL)** in adults. [1] - ALL requires an **intensive regimen** to achieve and maintain remission due to the rapid proliferation of leukemic cells. *Surgical removal of the lymph nodes* - **Surgical removal of lymph nodes** is not a primary treatment for **leukemia**, which is a cancer of the blood and bone marrow, not a localized solid tumor. - While ALL can involve lymph nodes, the disease is **systemic** and requires systemic therapy, such as chemotherapy, to target malignant cells throughout the body.

Q: A 50-year-old woman with chronic hepatitis B presents with an abdominal mass, and serum alpha-fetoprotein is elevated. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - The **elevated alpha-fetoprotein (AFP)** level [1] and history of **chronic hepatitis B** strongly indicate hepatocellular carcinoma, as these factors are closely associated with this type of liver cancer [1]. - It commonly presents as an **abdominal mass** [1] in patients with underlying liver disease, particularly in those with chronic hepatitis or cirrhosis. *Metastatic colon cancer* - Typically presents with **elevated tumor markers** like CEA, not AFP, making it less likely in this case. - It often involves multiple liver lesions rather than a singular **abdominal mass** [1] due to liver metastases. *Cholangiocarcinoma* - While associated with liver lesions, it usually leads to **elevated CA 19-9 levels** rather than AFP. - Patients often present with **jaundice and bile duct obstruction**, which are not noted in this scenario. *Hepatic adenoma* - Generally seen in younger individuals, often associated with **oral contraceptive use**, and tends not to elevate AFP significantly. - Usually asymptomatic or may present with abdominal pain, unlike the strong association with chronic liver disease seen in this case.

Q: A 55-year-old man presents with fatigue and splenomegaly. His complete blood count reveals a marked increase in mature lymphocytes. What condition is consistent with these findings?

Chronic lymphocytic leukemia. ***Chronic lymphocytic leukemia*** - Characterized by a marked increase in **mature lymphocytes** and often presents with **fatigue and splenomegaly** [1][2]. - Typically seen in older adults, with a **slow progression** and lymphocytic predominance in the blood and bone marrow [2]. *Acute myeloid leukemia* - Presents with **immature myeloid cells** and often involves severe **anemia**, thrombocytopenia, and neutropenia. - Symptoms frequently include **rapid onset of fatigue** and bleeding, not typically splenomegaly as a primary feature. *Acute lymphoblastic leukemia* - Characterized by **immature lymphoblasts** rather than mature lymphocytes, leading to more aggressive symptoms. - Often presents with **bone pain**, lymphadenopathy, and more severe cytopenias, different from the chronic features noted here. *Chronic myeloid leukemia* - Features an increase in **myeloid cells**, particularly **granulocytes**, and is commonly associated with the **Philadelphia chromosome**. - Splenomegaly is common [3][4], but it primarily involves a **myeloid lineage**, not mature lymphocytes as seen in this case. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 611-612. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 625-626.

Q: A patient with known breast cancer presents with shortness of breath. A chest CT reveals multiple nodules throughout both lungs. What is the most likely diagnosis?

Metastatic disease. Metastatic disease - The presence of **multiple lung nodules** in a patient with a known history of **breast cancer** strongly suggests hematogenous spread to the lungs [1]. - Breast cancer frequently metastasizes to the lungs, and these **multiple, widespread nodules** are a classic presentation of such progression [1]. Patients with two or more pulmonary nodules can often be assumed to have metastases [2]. *Primary lung cancer* - While lung cancer can manifest as nodules, the presence of **multiple, scattered nodules in both lungs** in a patient with an existing primary cancer makes this less likely to be a *de novo* primary lung cancer. - Primary lung cancer typically presents as a **single mass** or a more localized process, although multifocal primary lung cancers can occur, they are less common than metastatic disease in this context [2]. *Pneumonia* - Pneumonia would typically present with **infiltrates or consolidation**, often associated with fever, cough with sputum, and elevated inflammatory markers. - **Multiple, discrete lung nodules** are not a typical presentation of pneumonia. *Pulmonary embolism* - Pulmonary embolism causes **filling defects** in the pulmonary arteries and can lead to infarcts, which might appear as wedge-shaped opacities, but usually not as **multiple, diffuse nodules** throughout both lungs. - Symptoms would typically include sudden onset of **pleuritic chest pain** and hypoxemia, which may or may not be present with shortness of breath.

Q: A 70-year-old man presents with fatigue, weight loss, and jaundice. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. Imaging reveals bile duct dilation and a mass at the pancreatic head. A biopsy confirms adenocarcinoma. What is the likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The presence of a **mass at the pancreatic head**, alongside elevated alkaline phosphatase and bilirubin levels, is indicative of pancreatic adenocarcinoma, often causing obstructive jaundice [1]. - **Fatigue** and **weight loss** are common systemic symptoms due to malignancy and are consistent with this diagnosis [2]. *Gallbladder carcinoma* - While it can present with jaundice, it more commonly involves **gallbladder-related symptoms** and typically does not manifest as a mass at the **pancreatic head**. - Imaging findings would show issues focused on the **gallbladder** or nearby structures rather than the **pancreatic duct**. *Hepatocellular carcinoma* - This type of cancer usually arises in the presence of **chronic liver disease** and may show liver lesions rather than a mass in the **pancreas**. - The imaging would likely demonstrate **focal liver lesions** rather than bile duct dilation associated with obstruction. *Cholangiocarcinoma* - Although it involves the bile ducts and can cause jaundice, it would typically present with a mass specifically in the **bile duct** rather than the **pancreatic head**. - Patients often showcase different imaging characteristics and potential intrahepatic lesions compared to the described findings [3].

Q: A 50-year-old woman with metastatic melanoma has started a new immunotherapy drug. Which of the following is a common side effect of immune checkpoint inhibitors?

Pneumonitis. ***Pneumonitis*** - **Pneumonitis** is a common and potentially severe immune-related adverse event (irAE) associated with immune checkpoint inhibitors, occurring when the activated immune system targets lung tissue. - Patients may present with cough, dyspnea, and hypoxia, and imaging often shows ground-glass opacities or interstitial infiltrates. *Nephrotoxicity* - While **renal irAEs** can occur, leading to **acute kidney injury** or interstitial nephritis, they are less common than pneumonitis or colitis. - The incidence of severe **nephrotoxicity** is relatively low compared to other organ toxicities. *Hepatotoxicity* - **Hepatotoxicity** in the form of **immune-mediated hepatitis** is a recognized irAE that can range from asymptomatic transaminitis to acute liver failure. - However, it occurs with a lower frequency than pneumonitis in many studies of immune checkpoint inhibitors. *Cardiotoxicity* - **Immune-mediated myocarditis** is a rare but life-threatening irAE, often presenting with non-specific symptoms like fatigue or dyspnea, or more severely as **heart failure** or arrhythmias. - Though highly morbid, its overall incidence is much lower than that of pneumonitis.

Q: A 60-year-old female with chronic kidney disease presents with generalized weakness and hyperreflexia. Her serum calcium level is 14 mg/dL. What is the most likely cause?

Primary hyperparathyroidism. ***Primary hyperparathyroidism*** - In patients with **chronic kidney disease (CKD)**, the kidneys may struggle to activate Vitamin D, which can lead to **secondary hyperparathyroidism**. However, if hypercalcemia is present alongside hyperreflexia, this points to **primary disease**, where one or more parathyroid glands are overactive independently of serum calcium levels. - While CKD typically involves complications like **renal osteodystrophy** and **low calcium/high phosphate**, persistent hypercalcemia with hyperreflexia, especially at this critical level, despite CKD, strongly suggests autonomous **parathyroid gland dysfunction**. *Sarcoidosis* - Sarcoidosis causes **hypercalcemia** due to extrarenal production of **1,25-dihydroxyvitamin D** by activated macrophages. - While it can cause generalized weakness, hyperreflexia is not a typical neurological manifestation of sarcoidosis. *Thiazide diuretics* - Thiazide diuretics can cause mild **hypercalcemia** by increasing **renal calcium reabsorption**. - However, the serum calcium level of 14 mg/dL is usually more severe than what is typically caused by thiazide diuretics alone, and chronic kidney disease typically makes this less likely given impaired calcium and phosphate handling. *Malignancy-associated hypercalcemia* - **Malignancy-associated hypercalcemia** can present with severe hypercalcemia and generalized weakness, due to the release of **PTHrP** or bone destruction. - While possible, the combination of **chronic kidney disease** and hyperreflexia makes primary hyperparathyroidism a more specific and likely underlying cause in this scenario.

Q: What is the best tumor marker for pancreatic cancer?

CA 19-9. **CA 19-9** - **CA 19-9** is the most widely accepted and commonly used tumor marker for **pancreatic adenocarcinoma**, particularly for monitoring response to treatment and recurrence. - Elevated levels are often seen in patients with pancreatic cancer and can correlate with **tumor burden** and prognosis. *CA 15-3* - **CA 15-3** is primarily used as a tumor marker for **breast cancer**, not pancreatic cancer. - It is utilized for monitoring treatment response and detecting recurrence in patients with breast cancer, especially **metastatic disease**. *CEA* - **CEA (Carcinoembryonic Antigen)** is a general tumor marker elevated in various cancers, including **colorectal**, **lung**, and **gastric cancer**. - While it can be elevated in some pancreatic cancer cases, it is less specific and sensitive for pancreatic cancer than CA 19-9. *AFP* - **AFP (Alpha-fetoprotein)** is the primary tumor marker for **hepatocellular carcinoma (HCC)** and **germ cell tumors**. - It is not routinely used for the diagnosis or monitoring of pancreatic cancer.

Q: A 55-year-old woman with cirrhosis is found to have a liver lesion with elevated alpha-fetoprotein. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - **Elevated alpha-fetoprotein (AFP)** levels in a patient with cirrhosis are strongly indicative of hepatocellular carcinoma, which commonly arises in this context [1]. - Hepatocellular carcinoma typically presents as a **liver lesion** and is associated with chronic liver disease and cirrhosis [1]. *Hemangioma* - Generally, hemangiomas are **benign vascular tumors** and do not cause elevated levels of alpha-fetoprotein. - They are often asymptomatic and discovered incidentally on imaging, unlike hepatocellular carcinoma, which will present more aggressively in this setting. *Liver metastasis* - Liver metastases can occur in cirrhotic patients but are less likely to be associated with significant elevations of alpha-fetoprotein unless specific primary tumors are involved. - Primary tumors, such as colorectal cancer, usually produce **different markers**, and the presence of AFP suggests a primary liver cancer rather than metastatic disease. *Hepatic adenoma* - Hepatic adenomas are also benign tumors but are less common in patients with cirrhosis and typically do not cause elevated alpha-fetoprotein levels. - More frequently found in women taking **oral contraceptives**, they generally lack the aggressive features seen in hepatocellular carcinoma.

Question 1

Management of acute lymphoblastic leukemia (ALL) in adults includes which of the following treatments?

Accepted Answer

High-dose chemotherapy

Answer

Supportive care only

Answer

Low-dose oral chemotherapy

Answer

Surgical removal of the lymph nodes

Question 2

A 50-year-old woman with chronic hepatitis B presents with an abdominal mass, and serum alpha-fetoprotein is elevated. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Cholangiocarcinoma

Answer

Hepatic adenoma

Answer

Metastatic colon cancer

Question 3

A 55-year-old man presents with fatigue and splenomegaly. His complete blood count reveals a marked increase in mature lymphocytes. What condition is consistent with these findings?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Acute myeloid leukemia

Answer

Chronic myeloid leukemia

Answer

Acute lymphoblastic leukemia

Question 4

A patient with known breast cancer presents with shortness of breath. A chest CT reveals multiple nodules throughout both lungs. What is the most likely diagnosis?

Accepted Answer

Metastatic disease

Answer

Primary lung cancer

Answer

Pneumonia

Answer

Pulmonary embolism

Question 5

A 70-year-old man presents with fatigue, weight loss, and jaundice. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. Imaging reveals bile duct dilation and a mass at the pancreatic head. A biopsy confirms adenocarcinoma. What is the likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Cholangiocarcinoma

Answer

Hepatocellular carcinoma

Answer

Gallbladder carcinoma

Question 6

A 50-year-old woman with metastatic melanoma has started a new immunotherapy drug. Which of the following is a common side effect of immune checkpoint inhibitors?

Accepted Answer

Pneumonitis

Answer

Nephrotoxicity

Answer

Hepatotoxicity

Answer

Cardiotoxicity

Question 7

Which of the following is the most appropriate screening test for colorectal cancer in average-risk individuals?

Accepted Answer

Comprehensive endoscopic examination of the colon (Colonoscopy)

Answer

Stool-based test for hidden blood (FOBT)

Answer

Imaging-based colon examination (CT colonography)

Answer

Endoscopic examination of the lower colon (Flexible sigmoidoscopy)

Question 8

A 60-year-old female with chronic kidney disease presents with generalized weakness and hyperreflexia. Her serum calcium level is 14 mg/dL. What is the most likely cause?

Accepted Answer

Primary hyperparathyroidism

Answer

Sarcoidosis

Answer

Thiazide diuretics

Answer

Malignancy-associated hypercalcemia

Question 9

What is the best tumor marker for pancreatic cancer?

Accepted Answer

CA 19-9

Answer

CA 15-3

Answer

CEA

Answer

AFP

Question 10

A 55-year-old woman with cirrhosis is found to have a liver lesion with elevated alpha-fetoprotein. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Hepatic adenoma

Answer

Liver metastasis

Answer

Hemangioma

Oncology — MCQs

Oncology — MCQs

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