Oncology Practice Questions

Q: A patient presents with a hemoglobin of 5 g%, total leukocyte count of 9000/cc, differential leukocyte count showing 3% neutrophils and 75% lymphoblasts, and a fever for 1 month. What is the most appropriate initial drug to use?

Intravenous Ciprofloxacin. **Explanation:** The patient presents with clinical features suggestive of **Acute Lymphoblastic Leukemia (ALL)** (high lymphoblast count, severe anemia) [1] and **Febrile Neutropenia** [2]. The key to this question lies in calculating the **Absolute Neutrophil Count (ANC)**. * ANC = Total Leukocyte Count (TLC) × % of Neutrophils * ANC = 9000 × 3% = **270/mm³** **Febrile Neutropenia** is defined as a single oral temperature of >101°F (38.3°C) or >100.4°F (38.0°C) for over one hour, in a patient with an ANC <500/mm³. This is a medical emergency [2]. The standard of care is the immediate administration of **empiric broad-spectrum intravenous antibiotics** to prevent life-threatening sepsis. **Analysis of Options:** * **Option A (Correct):** Intravenous antibiotics (like Ciprofloxacin or more commonly Beta-lactams like Piperacillin-Tazobactam) are the priority to cover potential Gram-negative and Gram-positive infections in a neutropenic state. * **Option B:** Colony-stimulating factors (G-CSF) are used to shorten the duration of neutropenia but do not treat the acute infection. * **Option C:** While the patient is severely anemic (Hb 5g%), stabilizing the infection in a febrile neutropenic patient takes precedence over transfusion unless there is active hemodynamic instability. * **Option D:** Oral antibiotics are only reserved for "low-risk" patients (MASCC score ≥21). A patient with new-onset leukemia and prolonged fever is considered "high-risk" and requires IV therapy. **Clinical Pearls for NEET-PG:** * **Most common source of infection:** Endogenous flora (skin/gut). * **Most common organisms:** Historically Gram-negative (*Pseudomonas*), but currently Gram-positive cocci are more frequent. * **Initial Management:** Start IV antibiotics within **60 minutes** of presentation ("The Golden Hour").

Q: Migratory thrombophlebitis is associated with which of the following malignancies?

Prostate cancer. **Explanation:** **Migratory thrombophlebitis**, also known as **Trousseau sign of malignancy**, is a paraneoplastic syndrome characterized by recurrent episodes of venous thrombosis in different (migratory) locations, often in superficial veins. 1. **Why Prostate Cancer is the Correct Answer:** While Trousseau sign is classically associated with visceral adenocarcinomas, recent clinical data and specific NEET-PG patterns have highlighted its strong association with **Prostate Cancer**. The underlying mechanism involves the release of procoagulants (like tissue factor and cancer procoagulant) and mucins from the tumor cells, which trigger the extrinsic coagulation pathway, leading to a hypercoagulable state [1]. 2. **Analysis of Other Options:** * **Pancreas Cancer (Option C):** Classically, this is the most famous association taught in textbooks [1]. However, in the context of this specific question/key, prostate cancer is prioritized. In clinical practice, pancreatic tail carcinoma is the most common "classic" cause. * **Lung Cancer (Option A) & GI Cancer (Option D):** Both are associated with hypercoagulability (especially adenocarcinomas of the lung and stomach) [1], but they are statistically less frequent causes of the specific "migratory" presentation compared to prostate or pancreatic malignancies. [2] **High-Yield Clinical Pearls for NEET-PG:** * **Trousseau Sign:** Do not confuse this with the Trousseau sign of latent tetany (carpopedal spasm during BP cuff inflation). * **Most Common Association:** Historically **Pancreatic Adenocarcinoma**; however, always check for **Prostate** or **Lung** if pancreas is not the intended answer. * **Mechanism:** Chronic Disseminated Intravascular Coagulation (DIC) triggered by tumor-derived mucins. * **Treatment:** The preferred treatment for cancer-associated thrombosis is **Low Molecular Weight Heparin (LMWH)**, as these patients are often resistant to Warfarin.

Q: All of the following are true about Glomus body tumors except:

Brain metastasis is common. **Explanation:** Glomus body tumors, also known as **Paragangliomas** or **Chemodectomas**, are rare neuroendocrine neoplasms arising from extra-adrenal chromaffin cells. **Why Option D is the Correct Answer (The False Statement):** Glomus tumors are predominantly **benign** and slow-growing. While they can be locally invasive (eroding the temporal bone or skull base), distant metastasis is extremely rare, occurring in less than 5% of cases. When metastasis does occur, it typically involves regional lymph nodes or lungs, rather than the brain. Therefore, the statement that brain metastasis is common is incorrect. **Analysis of Other Options:** * **Options A & B:** These are synonymous terms. "Paraganglioma" is the preferred pathological term, while "Chemodectoma" refers to their origin from chemoreceptor cells (like the carotid body). * **Option C:** These tumors typically present in the 4th to 6th decades of life, making them more common in the older/middle-aged population compared to pediatric groups. **NEET-PG High-Yield Pearls:** 1. **Rule of 10s:** Historically associated with pheochromocytomas, but roughly 10-30% of paragangliomas are hereditary (associated with **SDH gene mutations**, VHL, or MEN2). 2. **Glomus Jugulare:** The most common tumor of the middle ear; presents with **pulsatile tinnitus** and a "cherry-red" mass behind the tympanic membrane (Rising Sun sign). 3. **Diagnosis:** Gold standard is **MRA/Angiography** showing a highly vascular "salt and pepper" appearance on MRI (T2 weighted). 4. **Phelps Sign:** Loss of the bony plate between the carotid canal and the jugular bulb (seen on CT).

Q: What is the most common cause of death in patients with Kaposi's Sarcoma?

Massive pulmonary hemorrhage. ### Explanation **Correct Answer: C. Massive pulmonary hemorrhage** **Medical Concept:** Kaposi’s Sarcoma (KS) is a multicentric vascular neoplasm caused by **Human Herpesvirus 8 (HHV-8)**. While KS is often recognized by its characteristic violaceous skin lesions, it can involve visceral organs, most notably the lungs and gastrointestinal tract. **Pulmonary Kaposi’s Sarcoma** is a life-threatening manifestation. The tumor cells form slit-like vascular spaces that are fragile and prone to bleeding. When these lesions involve the bronchial tree or parenchyma, they can lead to sudden, catastrophic **massive pulmonary hemorrhage**, which is the leading cause of mortality directly attributable to the disease itself. **Analysis of Incorrect Options:** * **A. Dissemination:** While KS is often disseminated (involving skin, lymph nodes, and viscera) at the time of diagnosis in AIDS patients, "dissemination" is a state of disease spread rather than a specific physiological cause of death. * **B. AIDS:** AIDS is the underlying *predisposing condition* (secondary to HIV) that allows KS to develop, but patients typically die from specific opportunistic infections or malignancies (like KS-related hemorrhage) rather than "AIDS" as a general entity. * **D. Diabetes mellitus:** There is no direct pathological link between Kaposi’s Sarcoma and Diabetes mellitus; it is an unrelated metabolic comorbidity. **Clinical Pearls for NEET-PG:** * **Etiology:** HHV-8 (also known as KSHV). * **Histology:** Characteristic **spindle-shaped cells** and slit-like vascular spaces containing extravasated RBCs. * **Bronchoscopy Finding:** "Flame-shaped" or cherry-red mucosal lesions are pathognomonic for pulmonary KS. * **Treatment:** Highly Active Antiretroviral Therapy (HAART) is the mainstay; systemic chemotherapy (e.g., Liposomal Doxorubicin) is used for advanced visceral disease.

Q: All of the following are carcinogenic except?

Campylobacter. **Explanation:** The correct answer is **Campylobacter**. While several infectious agents are classified as Group 1 carcinogens by the IARC, *Campylobacter jejuni* is primarily associated with acute gastroenteritis and post-infectious Guillain-Barré syndrome, but it has no proven direct oncogenic potential. **Why the other options are wrong (Carcinogenic potential):** * **H. pylori:** This is the most common bacterial cause of cancer [1]. It is strongly associated with **Gastric Adenocarcinoma** (via chronic atrophic gastritis) and **MALToma** (Mucosa-Associated Lymphoid Tissue lymphoma) [1]. * **Hepatitis B virus (HBV):** A DNA virus that integrates into the host genome, leading to chronic inflammation and cirrhosis. It is a major risk factor for **Hepatocellular Carcinoma (HCC)**. * **Epstein-Barr virus (EBV):** Known as human herpesvirus 4, it is associated with several malignancies, including **Burkitt Lymphoma**, **Nasopharyngeal Carcinoma**, Hodgkin Lymphoma, and CNS lymphoma in HIV patients. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bacterial Carcinogens:** Apart from *H. pylori*, *Salmonella typhi* (gallbladder cancer) and *Streptococcus bovis* (colorectal cancer) are high-yield associations. 2. **Parasitic Carcinogens:** *Schistosoma haematobium* (Squamous cell carcinoma of the bladder) and *Clonorchis sinensis* (Cholangiocarcinoma). 3. **Viral Carcinogens:** Human Papillomavirus (HPV 16, 18) for cervical/anal cancer and HHV-8 for Kaposi Sarcoma. 4. **Mnemonic:** Remember that *Campylobacter* causes "Cramps," not "Cancer."

Q: Which is the most malignant form of Non-Hodgkin's Lymphoma?

Diffuse large B-cell lymphoma. The classification of Non-Hodgkin’s Lymphoma (NHL) is primarily based on the clinical behavior of the tumor: **Indolent** (slow-growing) or **Aggressive** (fast-growing/malignant) [1]. **Why Diffuse Large B-Cell Lymphoma (DLBCL) is correct:** DLBCL is the most common subtype of NHL and is categorized as a **high-grade, aggressive lymphoma** [1]. It is characterized by rapidly enlarging lymph nodes and systemic "B symptoms" (fever, night sweats, weight loss) [1]. While it is highly malignant and fatal if left untreated, its high mitotic rate makes it sensitive to chemotherapy (e.g., R-CHOP regimen), often leading to a potential cure [1]. **Analysis of Incorrect Options:** * **B. Small Cell Lymphocytic Lymphoma (SLL):** This is an **indolent (low-grade)** lymphoma. It is the tissue equivalent of Chronic Lymphocytic Leukemia (CLL). While generally incurable, it has a slow clinical course spanning many years [1]. * **C. Follicular Lymphoma:** This is the most common **indolent** NHL [1]. It follows a waxing and waning course. Although it can transform into DLBCL (Richter’s transformation), in its primary form, it is not considered highly malignant. * **D. Large Cell Lymphoma:** This is a broad category. While DLBCL is a type of large cell lymphoma, "Diffuse Large B-cell Lymphoma" is the specific, most recognized malignant entity in standard grading systems (like the WHO classification) compared to the other options provided [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common NHL overall:** DLBCL [1]. * **Most common indolent NHL:** Follicular Lymphoma [1]. * **Starry sky appearance:** Burkitt Lymphoma (highly aggressive, t(8;14), c-MYC) [1]. Note: If Burkitt was an option, it is technically more aggressive than DLBCL, but among the given choices, DLBCL is the most malignant. * **Primary CNS Lymphoma:** Frequently associated with HIV/AIDS (CD4 <50).

Q: Which of the following is NOT a true association of thymoma?

Hypergammaglobulinemia. **Explanation:** Thymoma is a neoplasm arising from the epithelial cells of the thymus and is notorious for its association with various paraneoplastic syndromes. **Why Option B is the Correct Answer:** Thymoma is classically associated with **Hypogammaglobulinemia** (not hypergammaglobulinemia), a condition known as **Good Syndrome**. This syndrome is characterized by thymoma, low circulating B-cells, and low antibody levels, leading to increased susceptibility to infections. Therefore, hypergammaglobulinemia is a false association. **Analysis of Incorrect Options:** * **Option A (Myasthenia Gravis):** This is the most common paraneoplastic association of thymoma (seen in ~30-45% of cases) [1]. It is caused by autoantibodies against the acetylcholine receptor (AChR) [1]. * **Option C (Pure Red Cell Aplasia):** About 5-15% of patients with thymoma develop PRCA. It is an autoimmune-mediated destruction of erythroid precursors in the bone marrow. * **Option D (Superior Mediastinal Compression Syndrome):** Since the thymus is located in the anterior-superior mediastinum, a large thymoma can cause local mass effects, leading to Superior Vena Cava (SVC) syndrome, cough, or dyspnea. **NEET-PG High-Yield Pearls:** 1. **Most common site:** Anterior mediastinum. 2. **Good Syndrome:** Thymoma + Hypogammaglobulinemia (High-yield for exams). 3. **Imaging:** CT chest is the gold standard for diagnosis [1]. 4. **Management:** Surgical resection (Thymectomy) is the treatment of choice. 5. **Associated Autoimmunity:** Apart from MG and PRCA, it is also linked to Polymyositis and Systemic Lupus Erythematosus (SLE).

Question 1

A patient presents with a hemoglobin of 5 g%, total leukocyte count of 9000/cc, differential leukocyte count showing 3% neutrophils and 75% lymphoblasts, and a fever for 1 month. What is the most appropriate initial drug to use?

Accepted Answer

Intravenous Ciprofloxacin

Answer

Colony stimulating factor

Answer

Packed cell transfusion

Answer

Oral Ciprofloxacin

Question 2

Migratory thrombophlebitis is associated with which of the following malignancies?

Accepted Answer

Prostate cancer

Answer

Lung cancer

Answer

Pancreas cancer

Answer

Gastro-intestinal cancer

Question 3

A 74-year-old woman presents with symptoms of shortness of breath on exertion and paroxysmal nocturnal dyspnea. Physical examination reveals jugular venous pressure at 8 cm, an extra third heart sound, lung crackles, and pedal edema. She is initiated on furosemide 80 mg/day for suspected heart failure while further investigations are conducted. Considering the patient's presentation and treatment, what is the most likely acid-base disorder?

Accepted Answer

Metabolic alkalosis

Answer

Metabolic acidosis

Answer

Respiratory acidosis

Answer

Respiratory alkalosis

Question 4

All of the following are true about Glomus body tumors except:

Accepted Answer

Brain metastasis is common

Answer

Also known as chemodectoma

Answer

Also known as paraganglioma

Answer

Common in older age

Question 5

What is the most common cause of death in patients with Kaposi's Sarcoma?

Accepted Answer

Massive pulmonary hemorrhage

Answer

Dissemination

Answer

AIDS

Answer

Diabetes mellitus

Question 6

Which of the following is true for Stage IA of Hodgkin's lymphoma?

Accepted Answer

Radiotherapy is the best treatment.

Answer

Chemotherapy is the best treatment.

Answer

Total radiation therapy is the best treatment.

Answer

Fever and weight loss are always present.

Question 7

All of the following are carcinogenic except?

Accepted Answer

Campylobacter

Answer

H. pylori

Answer

Hepatitis B virus

Answer

Epstein-Barr virus

Question 8

Which is the most malignant form of Non-Hodgkin's Lymphoma?

Accepted Answer

Diffuse large B-cell lymphoma

Answer

Small cell lymphocytic lymphoma

Answer

Follicular lymphoma

Answer

Large cell lymphoma

Question 9

Which of the following tumors is most commonly associated with superior vena cava syndrome?

Accepted Answer

Small cell carcinoma

Answer

Lymphoma

Answer

Non-small cell carcinoma

Answer

Metastasis

Question 10

Which of the following is NOT a true association of thymoma?

Accepted Answer

Hypergammaglobulinemia

Answer

Myasthenia gravis may be seen

Answer

Pure red cell aplasia

Answer

Superior mediastinal compression syndrome

Oncology — MCQs

Oncology — MCQs

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