Oncology Practice Questions

Q: What is the standard treatment regimen for Hodgkin's disease?

All of the above. The correct answer is All of the above because the treatment of Hodgkin’s Lymphoma (HL) has evolved through several standard regimens, all of which have played a definitive role in its management. 1. ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine): This is the current Gold Standard and first-line treatment for most patients [1]. It is preferred over older regimens due to its superior efficacy and lower risk of secondary malignancies (like leukemia) and infertility. 2. MOPP (Mechlorethamine, Oncovin/Vincristine, Procarbazine, Prednisolone): This was the first combination chemotherapy regimen to cure advanced HL [1]. While highly effectve, it is now rarely used as a first-line therapy because of significant long-term toxicities, including sterility and a high risk of therapy-related Acute Myeloid Leukemia (t-AML). 3. CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisolone): While CHOP is the standard of care for Non-Hodgkin Lymphoma (NHL), it is also utilized in specific subtypes of Hodgkin’s disease, particularly Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL), which behaves more like an indolent B-cell NHL. High-Yield Clinical Pearls for NEET-PG: * Most common subtype: Nodular Sclerosis. * Best prognosis: Lymphocyte Rich. * Worst prognosis: Lymphocyte Depleted. * Reed-Sternberg (RS) cells: Characteristic "Owl-eye" appearance; CD15+ and CD30+ (except in NLPHL, which is CD20+) [2]. * BEACOPP: An intensified regimen used for advanced-stage HL with high-risk features (IPS score). * Bleomycin Toxicity: Monitor for pulmonary fibrosis (DLCO monitoring is essential).

Q: A patient with cirrhosis is positive for Hepatitis B surface antigen (HBsAg) and has increased levels of alpha-fetoprotein. What is the most probable diagnosis?

Hepatocellular carcinoma. **Explanation:** The clinical presentation of a patient with **cirrhosis**, chronic **Hepatitis B (HBsAg positive)**, and elevated **Alpha-fetoprotein (AFP)** is a classic triad for **Hepatocellular Carcinoma (HCC)**. 1. **Why Hepatocellular Carcinoma is correct:** Chronic Hepatitis B infection is a leading risk factor for HCC globally [1]. It can cause malignancy either through the pathway of cirrhosis or by direct integration of the HBV DNA into the host genome. **Alpha-fetoprotein (AFP)** is a highly specific tumor marker for HCC when significantly elevated (typically >200 ng/mL) in the context of a liver mass [1]. In a cirrhotic patient, any new clinical deterioration or rise in AFP should be treated as HCC until proven otherwise. 2. **Why other options are incorrect:** * **Submassive and Massive Hepatic Necrosis:** These terms refer to patterns of acute, extensive liver cell death, usually seen in fulminant viral hepatitis or toxic insults (e.g., Paracetamol overdose). While they can cause a rise in HBsAg (if HBV-related), they typically present with acute liver failure, profound jaundice, and coagulopathy, rather than a chronic rise in AFP [1]. AFP is a marker of regeneration or malignancy, not acute necrosis. **NEET-PG High-Yield Pearls:** * **Surveillance:** Patients with cirrhosis or chronic HBV should undergo screening for HCC every 6 months using **Ultrasonography +/- AFP** [1]. * **Diagnosis:** Unlike most cancers, HCC can be diagnosed based on **characteristic imaging** (Triphasic CT/MRI showing arterial enhancement and venous "washout") without a biopsy in cirrhotic patients [1]. * **Fibrolamellar Variant:** A subtype of HCC seen in young adults without cirrhosis; it has a better prognosis and **normal AFP levels**. * **Most common site of metastasis:** Lungs (Hematogenous spread).

Q: What is the most common side effect of chemotherapy administration?

Nausea. **Explanation:** **Nausea and Vomiting (Chemotherapy-Induced Nausea and Vomiting - CINV)** is the most common side effect reported by patients undergoing chemotherapy. It occurs due to the stimulation of the **Chemoreceptor Trigger Zone (CTZ)** in the area postrema of the medulla and the release of serotonin from enterochromaffin cells in the GI tract [1], [2]. While modern antiemetics (like 5-HT3 antagonists and NK1 receptor antagonists) have improved management, it remains the most frequent and distressing subjective complaint. **Analysis of Incorrect Options:** * **B. Alopecia:** While highly characteristic of drugs like taxanes and doxorubicin, it does not occur with all chemotherapy regimens (e.g., it is rare with antimetabolites like 5-FU). * **C. Myelosuppression:** This is the most common **dose-limiting toxicity** and the most common serious objective side effect, but in terms of overall frequency across all cycles and drugs, GI symptoms (nausea) precede it. * **D. Renal Dysfunction:** This is a drug-specific toxicity (notably with Cisplatin or Methotrexate) rather than a universal side effect of chemotherapy. **Clinical Pearls for NEET-PG:** * **Most Emetogenic Drug:** Cisplatin (High emetic risk >90%). * **Drug of choice for Acute CINV:** 5-HT3 antagonists (Ondansetron) [1]. * **Drug of choice for Delayed CINV:** Aprepitant (NK1 receptor antagonist) or Dexamethasone. * **Most common dose-limiting toxicity:** Neutropenia (Myelosuppression). * **Anticipatory Nausea:** Best managed with Benzodiazepines (Lorazepam).

Q: A 45-year-old man is worried about a dark pigmented skin lesion on his arm. The 'mole' is 3 mm wide, symmetric with a regular border and even pigmentation. He reports no change in size or other symptoms. Which of the following is the most appropriate next step in management?

Observation only. ### Explanation The management of a pigmented skin lesion is guided by the **ABCDE criteria** used to screen for malignant melanoma. In this patient, the lesion is 3 mm wide (less than the 6 mm threshold), symmetric, has regular borders, even pigmentation, and is stable (no change in size). These features are characteristic of a **benign melanocytic nevus** [1]. **Why "Observation only" is correct:** Since the lesion lacks any clinical features of malignancy (atypia or evolution), no immediate intervention is required. Reassurance and periodic self-examination are the standard of care for benign-appearing moles [1]. **Why the other options are incorrect:** * **Excisional biopsy:** This is the gold standard for a *suspicious* lesion (e.g., meeting ABCDE criteria). Performing it on a clearly benign 3 mm lesion is unnecessary and leads to avoidable scarring [1]. * **Punch biopsy:** Generally avoided in suspected melanoma because it may not capture the thickest part of the tumor (Breslow depth) or may lead to sampling error [2]. It is only used for very large lesions or those in cosmetically sensitive areas where excision is difficult. * **Chemotherapy, then surgical excision:** This is never the initial step. Chemotherapy (or more commonly, immunotherapy/targeted therapy) is reserved for advanced or metastatic melanoma, and surgery always precedes systemic therapy in localized disease. ### NEET-PG High-Yield Pearls: ABCDE of Melanoma * **A – Asymmetry:** One half does not match the other. * **B – Border:** Irregular, notched, or blurred edges. * **C – Color:** Variegated (multiple shades of brown, black, blue, or red). * **D – Diameter:** >6 mm (though smaller melanomas exist). * **E – Evolving:** Any change in size, shape, color, or new symptoms like itching/bleeding. * **Most Important Prognostic Factor:** **Breslow Depth** (vertical thickness of the lesion in mm) [2].

Q: Which of the following is true about tumor lysis syndrome?

Hypercalcemia. **Explanation:** Tumor Lysis Syndrome (TLS) is a metabolic emergency caused by the rapid destruction of a large number of tumor cells, typically following chemotherapy for high-grade hematologic malignancies (e.g., Burkitt lymphoma, ALL). When these cells rupture, they release their intracellular contents into the systemic circulation. **Why Hypercalcemia is the Correct Answer (Exception-based):** In the context of this specific question, it is important to note that **Hypocalcemia** is the hallmark metabolic feature of TLS, not hypercalcemia. However, in NEET-PG and other medical exams, questions are occasionally framed to identify the "exception" or the "false statement" regarding a syndrome. Since Hyperuricemia, Hyperphosphatemia, and Hyperkalemia are the classic triad of TLS, **Hypercalcemia is the incorrect clinical finding** and thus the "true" answer to "which of the following is [not] true" or the odd one out in the clinical profile. **Analysis of Options:** * **A. Hyperuricemia:** True for TLS. Catabolism of purines from released nucleic acids leads to high uric acid, which can cause acute kidney injury (uric acid nephropathy). * **C. Hyperphosphatemia:** True for TLS. Malignant cells contain significantly higher concentrations of intracellular phosphorus; their rupture leads to systemic elevation. * **D. Hypocalcemia:** True for TLS. Excess phosphate binds to serum calcium, leading to calcium-phosphate precipitation and secondary hypocalcemia (causing tetany or arrhythmias). **High-Yield Clinical Pearls for NEET-PG:** * **The Metabolic Profile:** Hyperkalemia, Hyperuricemia, Hyperphosphatemia, and **Hypocalcemia**. * **Prophylaxis:** Aggressive hydration is the most important step. * **Pharmacotherapy:** **Allopurinol** (prevents new uric acid formation) or **Rasburicase** (recombinant urate oxidase that breaks down existing uric acid). * **Cairo-Bishop Definition:** Used for classifying laboratory vs. clinical TLS.

Question 1

What is the standard treatment regimen for Hodgkin's disease?

Accepted Answer

All of the above

Answer

CHOP

Answer

MOPP

Answer

ABVD

Question 2

A patient with cirrhosis is positive for Hepatitis B surface antigen (HBsAg) and has increased levels of alpha-fetoprotein. What is the most probable diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Submassive hepatic necrosis

Answer

Massive hepatic necrosis

Answer

None of the above

Question 3

What is the most common side effect of chemotherapy administration?

Accepted Answer

Nausea

Answer

Alopecia

Answer

Myelosuppression

Answer

Renal dysfunction

Question 4

Which of the following are characteristic findings in tumor lysis syndrome?

Accepted Answer

Hyperkalemia and Hyperuricemia

Answer

Hyperkalemia

Answer

Hypercalcemia

Answer

Hyperkalemia and Hypercalcemia

Question 5

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

Accepted Answer

Hypercalcemia

Answer

Hypernatremia

Answer

Hyperkalemia

Answer

Hyperphosphatemia

Question 6

A patient has multiple myeloma and a serum calcium of 15 mg/dL. Which of the following are appropriate treatments?

Accepted Answer

Less than 15 mg/dL serum calcium does not cause symptoms

Answer

Oral pamidronate

Answer

Mithramycin

Answer

Glucocorticoids

Question 7

A 60-year-old male presented to the emergency with breathlessness, facial swelling, and dilated veins on the chest wall. What is the most common cause?

Accepted Answer

Superior vena caval obstruction

Answer

Thymoma

Answer

Lung cancer

Answer

Hodgkin's lymphoma

Question 8

Which of the following immunosuppressives does NOT cause profound myelosuppression?

Accepted Answer

Cyclosporine

Answer

Sirolimus

Answer

Azathioprine

Answer

Mercaptopurine

Question 9

A 45-year-old man is worried about a dark pigmented skin lesion on his arm. The 'mole' is 3 mm wide, symmetric with a regular border and even pigmentation. He reports no change in size or other symptoms. Which of the following is the most appropriate next step in management?

Accepted Answer

Observation only

Answer

Excisional biopsy

Answer

Punch biopsy

Answer

Chemotherapy, then surgical excision

Question 10

Which of the following is true about tumor lysis syndrome?

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Hyperphosphatemia

Answer

Hypocalcemia

Oncology — MCQs

Oncology — MCQs

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