Oncology Practice Questions

Q: Which of the following statements regarding the Philadelphia chromosome is NOT true?

Specific for CML.. The Philadelphia (Ph) chromosome is the hallmark of Chronic Myeloid Leukemia (CML), but it is not exclusive to it. **Explanation of the Correct Answer (C):** The statement "Specific for CML" is **incorrect** because the Philadelphia chromosome is also found in other hematological malignancies. It is present in approximately **25-30% of adults with Acute Lymphoblastic Leukemia (ALL)**, 2-5% of pediatric ALL, and occasionally in Acute Myeloid Leukemia (AML). In ALL, its presence signifies a poor prognosis [1]. **Analysis of Other Options:** * **Option A:** It is present in **>95% of CML patients**. The remaining 5% are "Ph-negative" but usually harbor the cryptic *BCR-ABL1* fusion gene detectable by FISH or PCR. * **Option B & D:** The Ph chromosome is a **reciprocal translocation** between chromosomes 9 and 22, designated as **t(9;22)(q34;q11)** [2]. This results in the fusion of the *ABL1* proto-oncogene (Ch 9) with the *BCR* gene (Ch 22), creating a chimeric protein with constitutive tyrosine kinase activity [2]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Molecular Weight:** The fusion protein in CML is typically **p210**, whereas in Ph+ ALL, it is often **p190**. 2. **Diagnosis:** While karyotyping identifies the Ph chromosome, **FISH** is more sensitive, and **RT-PCR** is the gold standard for monitoring Minimal Residual Disease (MRD) [3]. 3. **Treatment:** The first-line treatment for Ph+ CML is **Imatinib** (a Tyrosine Kinase Inhibitor) [2], [3]. 4. **Blast Crisis:** CML can transform into either AML (70%) or ALL (30%) during a blast crisis.

Q: A 50-year-old woman presents with pain and swelling in her proximal interphalangeal joints, wrists, and knees, accompanied by morning stiffness. She has a history of hysterectomy 10 years ago. Physical examination reveals swelling and synovial thickening of the proximal interphalangeal (PIP) joints. Her laboratory findings include: Hemoglobin 10.3 g/dL, MCV 80 fL, serum iron 28 mg/dL, iron-binding capacity 200 mg/dL, and saturation 14%. What is the most likely explanation for this woman's anemia?

Anemia of chronic disease. The patient presents with clinical features classic for **Rheumatoid Arthritis (RA)**: symmetrical inflammatory polyarthritis involving the PIP joints and wrists with significant morning stiffness [1]. In the context of a chronic inflammatory state like RA, the most common cause of anemia is **Anemia of Chronic Disease (ACD)**. [2] **1. Why Anemia of Chronic Disease is correct:** In chronic inflammation, cytokines (especially IL-6) trigger the liver to produce **Hepcidin** [1]. Hepcidin inhibits **ferroportin**, preventing iron release from macrophages and decreasing intestinal iron absorption. This leads to "iron sequestration" [3]. * **Lab Profile in ACD:** Low serum iron, **low Total Iron Binding Capacity (TIBC)**, and normal-to-high ferritin. * In this case, the TIBC is low (200 mg/dL; normal 250–450), which is the hallmark that distinguishes ACD from Iron Deficiency Anemia (IDA). **2. Why the other options are incorrect:** * **A. Occult blood loss:** This leads to Iron Deficiency Anemia. While IDA also has low serum iron, it is characterized by a **high TIBC** (compensatory increase in transferrin), which is not present here. [3] * **B. Vitamin deficiency:** B12 or Folate deficiency causes megaloblastic anemia with a **high MCV** (>100 fL). This patient has a low-normal MCV (80 fL). * **C. Sideroblastic anemia:** This typically presents with **increased** serum iron and saturation due to the inability to incorporate iron into hemoglobin, often showing "ringed sideroblasts" in the bone marrow. **High-Yield Clinical Pearls for NEET-PG:** * **ACD vs. IDA:** The most reliable differentiator is **Ferritin** (Low in IDA, Normal/High in ACD) and **TIBC** (High in IDA, Low in ACD). * **Hepcidin** is the "master regulator" of iron metabolism and an acute-phase reactant [3]. * In RA, the severity of anemia usually correlates with the degree of joint inflammation and ESR/CRP levels.

Q: A 19-year-old man presents to the emergency department with symptoms of malaise, nausea, and decreased urine output. He was previously well, and his physical examination is normal except for an elevated jugular venous pressure (JVP) and a pericardial rub. His electrolytes reveal acute kidney injury (AKI). Which of the following findings on the urinalysis is most likely in keeping with acute glomerulonephritis (GN)?

Erythrocyte casts. ### Explanation **Correct Answer: D. Erythrocyte casts** The presence of **erythrocyte (red blood cell) casts** is the pathognomonic hallmark of **acute glomerulonephritis (GN)** [1]. In GN, the glomerular filtration barrier is damaged, allowing RBCs to leak into the nephron [2]. As these cells pass through the distal convoluted tubule and collecting duct, they are trapped within a matrix of Tamm-Horsfall mucoprotein, forming a cylindrical cast. Finding RBC casts definitively localizes the source of hematuria to the renal parenchyma (glomerulus) rather than the lower urinary tract [1]. **Analysis of Incorrect Options:** * **A. Proteinuria:** While common in GN, proteinuria is non-specific [2]. It can occur in nephrotic syndrome, tubular diseases, or even functional states like heavy exercise or fever. * **B. White blood cell (WBC) casts:** These are characteristic of **acute pyelonephritis** or **acute tubulointerstitial nephritis (AIN)** [3]. They indicate inflammation or infection within the kidney interstitium. * **C. Granular casts:** Often described as "muddy brown" casts, these are the hallmark of **Acute Tubular Necrosis (ATN)**. They represent degenerated tubular epithelial cells. **Clinical Pearls for NEET-PG:** * **Dysmorphic RBCs (Acanthocytes):** Along with RBC casts, these are highly suggestive of glomerular bleeding. * **Clinical Context:** In this 19-year-old patient, the combination of AKI, elevated JVP, and a pericardial rub suggests **uremic pericarditis**—a medical emergency requiring urgent dialysis [4]. * **Nephritic Syndrome Triad:** Hematuria (RBC casts), Hypertension, and Azotemia (AKI) [5]. * **High-Yield Association:** If a young male presents with hemoptysis and RBC casts, consider **Goodpasture Syndrome** (Anti-GBM disease) [3].

Q: Which of the following statements regarding oat cell carcinoma of the lung is FALSE?

It is a variant of large cell anaplastic carcinoma.. **Explanation:** **Oat cell carcinoma** is a historical synonym for **Small Cell Lung Cancer (SCLC)**. It is characterized by small, round-to-oval cells with scanty cytoplasm, hyperchromatic nuclei, and "salt-and-pepper" chromatin. 1. **Why Option A is the Correct Answer (The False Statement):** Oat cell carcinoma is a distinct neuroendocrine tumor and is **not** a variant of large cell anaplastic carcinoma. Large cell carcinoma is a subtype of Non-Small Cell Lung Cancer (NSCLC) characterized by large nuclei and prominent nucleoli. SCLC and Large Cell Carcinoma are histologically and clinically separate entities. 2. **Analysis of Other Options:** * **Option B:** SCLC is highly sensitive to chemotherapy and radiotherapy (though it has a high recurrence rate). It is considered a "systemic disease" at presentation, making chemotherapy the mainstay of treatment. * **Option C & D:** SCLC is the most common lung cancer associated with **paraneoplastic syndromes** due to its neuroendocrine origin [1]. It frequently secretes ectopic hormones, most notably **ADH (causing SIADH)** and **ACTH (causing Cushing Syndrome)** [1], [2]. It is also associated with Lambert-Eaton Myasthenic Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Typically **central/hilar** (arises from neuroendocrine Kulchitsky cells). * **Strongest Association:** Almost exclusively seen in **smokers** [3]. * **Genetics:** Nearly 100% show mutations in **TP53 and RB1** genes. * **Azzopardi Effect:** A characteristic histological finding where DNA from necrotic tumor cells encrusts venule walls. * **Staging:** Uses "Limited" vs. "Extensive" stage rather than traditional TNM for treatment decisions [4].

Q: Which of the following is the most common functioning pancreatic islet cell tumor?

Insulinoma. **Explanation:** **Insulinoma** is the most common functioning pancreatic neuroendocrine tumor (pNET). These tumors arise from the beta cells of the pancreatic islets and are characterized by the autonomous secretion of insulin, leading to fasting hypoglycemia [1]. **Why Insulinoma is correct:** Statistically, insulinomas represent the most frequent functioning pNET [2]. Clinically, they present with the **Whipple Triad**: symptoms of hypoglycemia, low blood glucose levels (<50 mg/dL), and immediate relief of symptoms upon glucose administration [1]. Unlike many other pNETs, approximately 90% of insulinomas are benign, solitary, and small (<2 cm). **Why other options are incorrect:** * **Gastrinoma:** This is the second most common functioning pNET. It causes **Zollinger-Ellison Syndrome**, characterized by refractory peptic ulcers and diarrhea. While common, its incidence is lower than that of insulinoma. * **Glucagonoma:** A rare tumor of alpha cells [3]. It presents with the "4 Ds": Diabetes, Dermatitis (**Necrolytic Migratory Erythema**), Deep vein thrombosis, and Depression. * **Vipoma:** Also known as Verner-Morrison syndrome or **WDHA syndrome** (Watery Diarrhea, Hypokalemia, Achlorhydria). It is significantly rarer than insulinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 90s for Insulinoma:** 90% are benign, 90% are solitary, 90% are intrapancreatic, and 90% are <2 cm. * **Localization:** Most insulinomas are distributed equally across the head, body, and tail of the pancreas. * **MEN1 Association:** While most insulinomas are sporadic, they can be associated with Multiple Endocrine Neoplasia Type 1 (3Ps: Parathyroid, Pancreas, Pituitary). * **Diagnosis:** The gold standard is the **72-hour supervised fast** showing elevated insulin and C-peptide levels during hypoglycemia [1].

Q: The mutation of the Wilms' tumor gene is located on which chromosome band?

11p13. ### Explanation **Correct Answer: C. 11p13** **1. Why 11p13 is Correct:** Wilms' tumor (Nephroblastoma) is the most common primary renal tumor of childhood. The **WT1 gene**, a tumor suppressor gene essential for normal kidney and gonadal development, is located on **chromosome 11p13**. Mutations or deletions in this specific band lead to the development of Wilms' tumor, often as part of the **WAGR syndrome** (Wilms' tumor, Aniridia, Genitourinary anomalies, and intellectual disability/Range of developmental delays). **2. Analysis of Incorrect Options:** * **13p:** Chromosome 13p consists mostly of repetitive DNA sequences and ribosomal RNA genes; it is not associated with major tumor suppressor genes. * **13q14:** This is the locus for the **RB1 (Retinoblastoma) gene** [1]. Mutations here are associated with Retinoblastoma and Osteosarcoma, not Wilms' tumor. * **11q13:** This locus is associated with the **MEN1 gene** (Multiple Endocrine Neoplasia Type 1) and the *CCND1* (Cyclin D1) gene, often implicated in Mantle Cell Lymphoma and Breast Cancer. **3. Clinical Pearls for NEET-PG:** * **WT1 vs. WT2:** While WT1 is at **11p13**, the **WT2 gene** (associated with Beckwith-Wiedemann Syndrome) is located at **11p15.5**. * **Histology:** Look for the "Triphasic pattern" on microscopy—blastemal, stromal, and epithelial cells. * **Clinical Presentation:** Usually presents as a large, smooth, firm abdominal mass that **does not cross the midline** (unlike Neuroblastoma). * **Denys-Drash Syndrome:** Characterized by the triad of Wilms' tumor, early-onset nephrotic syndrome (diffuse mesangial sclerosis), and male pseudohermaphroditism; also linked to WT1 mutations.

Question 1

Which parameter best predicts the return of renal function in a patient with tumor lysis syndrome?

Accepted Answer

Serum uric acid

Answer

Serum creatinine

Answer

Serum phosphate

Answer

Serum potassium

Question 2

Which of the following statements regarding the Philadelphia chromosome is NOT true?

Accepted Answer

Specific for CML.

Answer

Present in 95% of chronic myeloid leukemia (CML) patients.

Answer

It is the result of a reciprocal translocation.

Answer

Designated as t(9;22)(q34;q11).

Question 3

A 32-year-old man presents with a serum sodium of 125 mEq/L. On examination, his blood pressure is 110/70 mmHg and pulse is 110/min. When sitting up, he feels lightheaded with a drop in blood pressure. His urine sodium is 5 mEq/L and urine osmolality is 800 mOsm/kg. What is the most likely diagnosis for this patient's hyponatremia?

Accepted Answer

Extrarenal sodium and fluid losses

Answer

Congestive heart failure (CHF)

Answer

Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH)

Answer

Polydipsia

Question 4

What is the treatment of choice for anti-CD120 antibody?

Accepted Answer

All low-grade non-Hodgkin's lymphomas

Answer

Relapsed B cell follicular lymphomas

Answer

Relapsed Hodgkin's disease

Answer

Chronic lymphatic leukemia

Question 5

A 50-year-old woman presents with pain and swelling in her proximal interphalangeal joints, wrists, and knees, accompanied by morning stiffness. She has a history of hysterectomy 10 years ago. Physical examination reveals swelling and synovial thickening of the proximal interphalangeal (PIP) joints. Her laboratory findings include: Hemoglobin 10.3 g/dL, MCV 80 fL, serum iron 28 mg/dL, iron-binding capacity 200 mg/dL, and saturation 14%. What is the most likely explanation for this woman's anemia?

Accepted Answer

Anemia of chronic disease

Answer

Occult blood loss

Answer

Vitamin deficiency

Answer

Sideroblastic anemia

Question 6

A 19-year-old man presents to the emergency department with symptoms of malaise, nausea, and decreased urine output. He was previously well, and his physical examination is normal except for an elevated jugular venous pressure (JVP) and a pericardial rub. His electrolytes reveal acute kidney injury (AKI). Which of the following findings on the urinalysis is most likely in keeping with acute glomerulonephritis (GN)?

Accepted Answer

Erythrocyte casts

Answer

Proteinuria

Answer

White blood cell casts

Answer

Granular casts

Question 7

Which of the following statements regarding oat cell carcinoma of the lung is FALSE?

Accepted Answer

It is a variant of large cell anaplastic carcinoma.

Answer

Chemotherapy is generally effective.

Answer

Paraneoplastic syndromes may be present.

Answer

It can cause the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH).

Question 8

A 69-year-old man with a 60 pack-year smoking history presents with dizziness and visual disturbances. Physical examination reveals a purplish discoloration of his face, arms, and neck; retinal vein engorgement; and visible distention of his neck veins. His complete blood count reveals a normocytic anemia. The pathophysiology of this patient’s clinical presentation most likely involves which of the following?

Accepted Answer

Obstruction of the superior vena cava by a primary tumor arising in the lungs

Answer

Right heart failure secondary to left heart failure

Answer

Metastatic disease to the cervical lymph nodes with compression of the jugular veins

Answer

Polycythemia rubra vera

Question 9

Which of the following is the most common functioning pancreatic islet cell tumor?

Accepted Answer

Insulinoma

Answer

Gastrinoma

Answer

Glucagonoma

Answer

Vipoma

Question 10

The mutation of the Wilms' tumor gene is located on which chromosome band?

Accepted Answer

11p13

Answer

13p

Answer

13q14

Answer

11q13

Oncology — MCQs

Oncology — MCQs

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