Oncology — MCQs
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Which of the following statements is true about small cell lung cancer?
A 65-year-old male diagnosed by biopsy as having lung carcinoma presents with a paraneoplastic syndrome and increased PTH. What is the probable cause?
A 25-year-old woman presents with nausea and vomiting for 2 days. Her physical examination is normal except for a postural drop in blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
Eaton Lambert syndrome is associated with which of the following?
A 19-year-old man and one of his two brothers have had polyuria and polydipsia since birth. His sisters and parents are unaffected. What is the most likely diagnosis for this patient presenting with polyuria and polydipsia?
A 72-year-old man with a significant smoking history presents with dyspnea and one week of truncal, arm, and facial swelling. Physical examination reveals facial erythema, facial, truncal, and arm edema, with prominence of thoracic and neck veins. Chest x-ray shows a right mediastinal mass with adenopathy. What is the most likely diagnosis?
What is the most common cause of Superior Vena Cava (SVC) syndrome?
A 71-year-old man presents for evaluation of a recently discovered elevated erythrocyte sedimentation rate (ESR) from a routine blood test. His medical history includes well-controlled hypertension, managed with metoprolol. A physical examination reveals no abnormalities. Laboratory findings include hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, platelet count 265,000/mL, total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis shows a sharp, narrow spike, and serum immunofixation identifies M-protein at 1.2 gm/dL. Bone marrow examination reveals fewer than 10% monoclonal plasma cells, and a skeletal survey is negative for lytic lesions. What is the most likely diagnosis?
According to the Ann Arbor staging of Hodgkin's lymphoma, which of the following defines Stage III?
Which of the following tumors is most likely associated with either hyponatremia or diffuse pigmentation of the skin?
Oncology Indian Medical PG Practice Questions and MCQs
Question 11: Which of the following statements is true about small cell lung cancer?
- A. Bone marrow is uncommonly involved.
- B. It is typically located in the periphery.
- C. Destruction of alveolar cells occurs. (Correct Answer)
- D. Treatment primarily involves chemotherapy.
Explanation: **Explanation:** Small Cell Lung Cancer (SCLC) is a highly aggressive neuroendocrine tumor strongly associated with cigarette smoking [1]. **Why Option C is Correct:** SCLC is characterized by a high nuclear-to-cytoplasmic ratio and a lack of prominent nucleoli. A hallmark pathological feature is the **Azzopardi effect**, where DNA from necrotic tumor cells encrusts the walls of small blood vessels. As the tumor grows rapidly and infiltrates the lung parenchyma, it leads to the **destruction of alveolar cells** and the surrounding architecture. Unlike some other tumors that may grow along alveolar walls (lepidic growth), SCLC is invasive and destructive. **Analysis of Incorrect Options:** * **Option A:** Bone marrow involvement is actually **common** in SCLC (occurring in up to 20-30% of cases at diagnosis) [1]. It is considered a systemic disease from the outset. * **Option B:** SCLC is typically **centrally located**, arising from the major bronchi, often presenting with hilar or mediastinal lymphadenopathy [1]. Peripheral presentation is rare. * **Option D:** While chemotherapy is a cornerstone of treatment, SCLC is uniquely sensitive to **both chemotherapy and radiotherapy**. For limited-stage disease, concurrent chemoradiotherapy is the standard of care. (Note: In many exam contexts, "primarily chemotherapy" is considered "mostly true," but "destruction of alveolar cells" is a more definitive pathological characteristic). **High-Yield Clinical Pearls for NEET-PG:** * **Markers:** Positive for Chromogranin A, Synaptophysin, and CD56. * **Paraneoplastic Syndromes:** Most commonly associated with **SIADH** and **Ectopic ACTH** (Cushing syndrome) [1]. Also associated with **Lambert-Eaton Myasthenic Syndrome**. * **Genetics:** Nearly 100% have mutations in **TP53** and **RB1**. * **Staging:** Often staged as "Limited" vs. "Extensive" rather than TNM [1].
Question 12: A 65-year-old male diagnosed by biopsy as having lung carcinoma presents with a paraneoplastic syndrome and increased PTH. What is the probable cause?
- A. Parathyroid
- B. Parathyroid hormone-related peptide (Correct Answer)
- C. Calcitonin
- D. Calcitonin-related peptide
Explanation: ### Explanation **Concept:** The patient is presenting with **Humoral Hypercalcemia of Malignancy (HHM)**, a classic paraneoplastic syndrome [1]. In lung cancer—specifically **Squamous Cell Carcinoma (SCC)**—tumor cells secrete a substance that mimics the action of parathyroid hormone (PTH) [1]. This substance is **Parathyroid hormone-related peptide (PTHrP)** [1]. **Why Option B is Correct:** PTHrP shares a high degree of homology with the N-terminal end of native PTH. It binds to the same **PTH-1 receptor** in the bone and kidneys, leading to increased bone resorption and decreased renal calcium excretion [2]. This results in hypercalcemia. Crucially, because PTHrP mimics PTH, the body’s negative feedback loop suppresses the actual production of native PTH by the parathyroid glands [2]. Therefore, in these patients, **PTHrP is high, but serum PTH is low [3].** **Why Other Options are Incorrect:** * **Option A (Parathyroid):** Ectopic production of true native PTH by a tumor is extremely rare. In malignancy-associated hypercalcemia, the parathyroid glands are typically suppressed [3]. * **Option C & D (Calcitonin/CGRP):** Calcitonin is a hormone that *lowers* serum calcium levels. It is a marker for Medullary Thyroid Carcinoma, not a cause of hypercalcemia in lung carcinoma. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic:** **S**quamous cell carcinoma is associated with **S**-p-p-p-ellable (PTHrP) and **S**-tones (Hypercalcemia) [1]. * **Small Cell Lung Cancer (SCLC)** is more commonly associated with **ACTH** (Cushing syndrome) and **ADH** (SIADH) [1]. * **Lab Findings in HHM:** ↑ Calcium, ↓ Phosphate, **↓ PTH**, ↑ PTHrP [3]. * **Treatment of Choice:** Aggressive IV hydration (Normal Saline) followed by Bisphosphonates (e.g., Zoledronic acid).
Question 13: A 25-year-old woman presents with nausea and vomiting for 2 days. Her physical examination is normal except for a postural drop in blood pressure from 110/80 mm Hg supine to 90/80 mm Hg standing. Her serum electrolytes are sodium 130 mEq/L, potassium 3 mEq/L, chloride 90 mEq/L, bicarbonate 30 mEq/L, urea 50 mg/dL, and creatinine 0.8 mg/dL. Which of the following electrolytes is most likely to be filtered through the glomerulus but unaffected by tubular secretion?
- A. Potassium
- B. Sodium
- C. Bicarbonate
- D. Urea (Correct Answer)
Explanation: ### Explanation The correct answer is **Urea (Option D)**. **1. Why Urea is correct:** The question asks for a substance that is filtered at the glomerulus but is **unaffected by tubular secretion**. Urea is freely filtered at the glomerulus [1]. Its handling in the renal tubules involves significant **reabsorption** (approximately 50% in the proximal tubule and further regulated reabsorption in the medullary collecting ducts via urea transporters), but it does **not undergo active tubular secretion** [1]. In this clinical scenario (nausea, vomiting, postural hypotension, and a high Urea-to-Creatinine ratio), the patient is in a **pre-renal state** due to volume depletion. In such states, the kidney increases the reabsorption of water and sodium, which passively drags more urea back into the blood, leading to "Pre-renal Azotemia." **2. Why the other options are incorrect:** * **Potassium (A):** Potassium is filtered, reabsorbed, and significantly **secreted** in the distal convoluted tubule and collecting duct (mediated by aldosterone) [1]. * **Sodium (B):** Sodium is filtered and extensively reabsorbed throughout the nephron [1]. While it is not secreted, the question specifically targets the unique handling of urea in the context of renal clearance and the absence of a secretory pathway. * **Bicarbonate (C):** Bicarbonate is filtered and reabsorbed (primarily in the proximal tubule) [1]. It is not secreted; however, in states of alkalosis, the kidney simply reduces reabsorption rather than utilizing a sensory mechanism. **3. NEET-PG High-Yield Pearls:** * **BUN/Creatinine Ratio:** A ratio **>20:1** is a classic indicator of pre-renal azotemia. Urea reabsorption increases with increased proximal sodium/water reabsorption, whereas creatinine is not reabsorbed. * **Creatinine Handling:** Unlike urea, a small amount of creatinine (approx. 10-20%) is **secreted** by the proximal tubule [1]. This is why Creatinine Clearance slightly overestimates the true GFR. * **Vomiting Electrolytes:** Classic pattern is **Hypokalemic, Hypochloremic, Metabolic Alkalosis** (as seen in this patient: K+ 3, Cl- 90, HCO3- 30).
Question 14: Eaton Lambert syndrome is associated with which of the following?
- A. Anti P/Q antibody (Correct Answer)
- B. Anti HU antibody
- C. Anti Jo 1 antibody
- D. Large cell carcinoma
Explanation: **Lambert-Eaton Myasthenic Syndrome (LEMS)** is a paraneoplastic autoimmune disorder of the neuromuscular junction, most commonly associated with **Small Cell Lung Cancer (SCLC)** [1]. ### Explanation of Options: * **A. Anti P/Q antibody (Correct):** LEMS is caused by autoantibodies directed against **presynaptic P/Q-type voltage-gated calcium channels (VGCC)** [1]. These antibodies block the influx of calcium into the nerve terminal, preventing the release of acetylcholine into the synaptic cleft, which leads to muscle weakness [1]. * **B. Anti-Hu antibody:** These are typically associated with **Paraneoplastic Encephalomyelitis** or sensory neuronopathy, also seen in Small Cell Lung Cancer, but not LEMS [2]. * **C. Anti-Jo-1 antibody:** This is a classic marker for **Dermatomyositis/Polymyositis**, specifically associated with "Antisynthetase Syndrome" (interstitial lung disease, Raynaud's, and mechanic's hands). * **D. Large cell carcinoma:** LEMS is strongly associated with **Small Cell Lung Cancer (SCLC)** (approx. 50-60% of cases), not large cell carcinoma [1]. ### High-Yield Clinical Pearls for NEET-PG: * **Clinical Triad:** Proximal muscle weakness (starts in lower limbs), autonomic dysfunction (dry mouth, erectile dysfunction), and depressed deep tendon reflexes. * **The "Lambert Sign":** Unlike Myasthenia Gravis, strength and reflexes in LEMS **improve with repeated muscle contraction** (post-exercise facilitation). * **Electrophysiology (NCS/EMG):** Shows a **"Decrement-Increment"** pattern. There is a low baseline compound muscle action potential (CMAP) that shows a **significant increment (>100%)** following high-frequency repetitive nerve stimulation or brief exercise. * **Treatment:** The first-line symptomatic treatment is **Amifampridine (3,4-diaminopyridine)**, which prolongs the depolarization of the presynaptic membrane [1].
Question 15: A 19-year-old man and one of his two brothers have had polyuria and polydipsia since birth. His sisters and parents are unaffected. What is the most likely diagnosis for this patient presenting with polyuria and polydipsia?
- A. Central diabetes insipidus (DI)
- B. Nephrogenic DI (Correct Answer)
- C. Primary polydipsia
- D. Osmotic diuresis
Explanation: **Explanation:** The clinical presentation of polyuria and polydipsia since birth in a male patient, with a similarly affected brother and unaffected parents/sisters, strongly suggests an **X-linked recessive inheritance pattern**. **1. Why Nephrogenic Diabetes Insipidus (NDI) is correct:** The most common cause of congenital NDI is a mutation in the **AVPR2 gene** (encoding the V2 receptor), which is inherited in an **X-linked recessive** manner [2]. This explains why only the males in the family are affected. In NDI, the kidneys are insensitive to Antidiuretic Hormone (ADH), leading to an inability to concentrate urine from birth. **2. Why the other options are incorrect:** * **Central DI:** While it causes similar symptoms, the most common hereditary form (mutations in the AVP-neurophysin II gene) is usually **Autosomal Dominant**. It typically presents later in childhood rather than at birth. * **Primary Polydipsia:** This is characterized by excessive water intake leading to polyuria. It is usually acquired (psychogenic) and does not follow a clear X-linked inheritance pattern starting from birth. In primary polydipsia, the plasma osmolality is low, unlike in diabetes insipidus [1]. * **Osmotic Diuresis:** This occurs due to the presence of non-reabsorbable solutes in the renal tubules (e.g., glucose in Diabetes Mellitus). It is not a congenital hereditary condition presenting in this specific familial pattern. **Clinical Pearls for NEET-PG:** * **Inheritance:** 90% of congenital NDI cases are X-linked recessive (V2 receptor mutation); 10% are Autosomal Recessive/Dominant (Aquaporin-2 channel mutation) [2]. * **Diagnosis:** NDI is characterized by high serum osmolality, low urine osmolality, and **no increase in urine osmolality** after the administration of exogenous ADH (Desmopressin) [1]. * **Management:** Treatment includes low-salt/low-protein diet, thiazide diuretics, and NSAIDs (like Indomethacin) to reduce glomerular filtration and increase proximal water reabsorption.
Question 16: A 72-year-old man with a significant smoking history presents with dyspnea and one week of truncal, arm, and facial swelling. Physical examination reveals facial erythema, facial, truncal, and arm edema, with prominence of thoracic and neck veins. Chest x-ray shows a right mediastinal mass with adenopathy. What is the most likely diagnosis?
- A. Adenocarcinoma
- B. Hodgkin's lymphoma
- C. Large cell carcinoma
- D. Small cell carcinoma (Correct Answer)
Explanation: **Explanation:** The clinical presentation of facial, truncal, and arm edema, coupled with venous prominence and a mediastinal mass, is classic for **Superior Vena Cava (SVC) Syndrome**. This occurs due to extrinsic compression or invasion of the SVC, most commonly by malignant tumors. **Why Small Cell Carcinoma (SCLC) is correct:** While non-small cell lung cancer (NSCLC) is numerically the most common cause of SVC syndrome due to its higher overall incidence, **Small Cell Carcinoma** has the strongest association with this condition. SCLC is typically **centrally located** and grows rapidly, leading to early compression of mediastinal structures [2]. In a 72-year-old smoker with a right-sided mediastinal mass, SCLC is the most likely histological diagnosis causing SVC obstruction [1]. **Why other options are incorrect:** * **Adenocarcinoma:** This is the most common type of lung cancer overall, but it is typically **peripherally located**, making it a less frequent cause of SVC syndrome compared to central tumors [2]. * **Hodgkin’s Lymphoma:** While it can cause SVC syndrome (especially in younger patients), the patient’s age (72) and significant smoking history point strongly toward primary lung malignancy [2]. * **Large Cell Carcinoma:** This is a less common subtype of NSCLC and, while it can cause SVC syndrome, it is statistically less likely than SCLC in the context of a central mediastinal mass. **Clinical Pearls for NEET-PG:** * **Most common cause of SVC Syndrome:** Malignancy (Lung cancer > Lymphoma). * **Pemberton’s Sign:** Facial flushing and respiratory distress upon elevating both arms (indicates thoracic outlet obstruction). * **Management:** Immediate management includes head elevation and oxygen. Definitive treatment for SCLC-induced SVC syndrome is **Chemotherapy**, as SCLC is highly chemo-sensitive [3]. Radiation is used for NSCLC.
Question 17: What is the most common cause of Superior Vena Cava (SVC) syndrome?
- A. Thrombosis
- B. Extrinsic compression (Correct Answer)
- C. Mediastinal lymphoma
- D. Teratoma
Explanation: **Explanation:** **1. Why Extrinsic Compression is Correct:** Superior Vena Cava (SVC) syndrome occurs due to the obstruction of blood flow through the SVC. The most common underlying mechanism is **extrinsic compression** of the vessel wall by an adjacent mass. Because the SVC is a thin-walled, low-pressure vessel located in the tight confines of the middle mediastinum, it is highly susceptible to compression by surrounding structures. Malignancy is responsible for approximately 60–90% of cases, with **Bronchogenic Carcinoma** (specifically Small Cell Lung Cancer) being the single most common cause. **2. Analysis of Incorrect Options:** * **A. Thrombosis:** While intraluminal thrombosis is an increasing cause due to the rising use of indwelling central venous catheters and pacemakers (iatrogenic causes), it remains less frequent than extrinsic compression by tumors. * **C. Mediastinal Lymphoma:** This is a common *type* of malignancy causing SVC syndrome (especially in younger patients), but it is statistically less common than bronchogenic carcinoma. * **D. Teratoma:** This is a rare cause of a mediastinal mass and only infrequently leads to SVC syndrome compared to lung cancer or lymphoma. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common cause overall:** Bronchogenic Carcinoma (Small cell > Squamous cell) [1]. * **Most common benign cause:** Historically Syphilitic aneurysm; currently **Iatrogenic thrombosis** (catheters/leads) or Fibrosing Mediastinitis (often due to Histoplasmosis). * **Clinical Presentation:** Facial puffiness (worse in the morning), "plethora," neck vein distention, and the **Pemberton sign** (facial flushing when arms are raised). * **Management:** The priority is airway assessment. Definitive treatment depends on the histology (Radiation for NSCLC; Chemotherapy for SCLC/Lymphoma) [1]. Stenting is the gold standard for rapid symptomatic relief.
Question 18: A 71-year-old man presents for evaluation of a recently discovered elevated erythrocyte sedimentation rate (ESR) from a routine blood test. His medical history includes well-controlled hypertension, managed with metoprolol. A physical examination reveals no abnormalities. Laboratory findings include hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, platelet count 265,000/mL, total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis shows a sharp, narrow spike, and serum immunofixation identifies M-protein at 1.2 gm/dL. Bone marrow examination reveals fewer than 10% monoclonal plasma cells, and a skeletal survey is negative for lytic lesions. What is the most likely diagnosis?
- A. Multiple myeloma
- B. Smoldering multiple myeloma
- C. Monoclonal gammopathy of undetermined significance (Correct Answer)
- D. Waldenstrom macroglobulinemia
Explanation: This case describes a classic presentation of **Monoclonal Gammopathy of Undetermined Significance (MGUS)**, a common premalignant condition in the elderly. ### 1. Why MGUS is the Correct Diagnosis The diagnosis of MGUS is based on three specific criteria, all of which are met by this patient: * **M-protein level:** < 3 g/dL (Patient has 1.2 g/dL). * **Bone marrow plasma cells:** < 10% (Patient has < 10%). * **Absence of end-organ damage (CRAB features):** No **C**alcium elevation, **R**enal insufficiency, **A**nemia (significant), or **B**one lesions. The patient’s ESR is elevated due to the presence of the M-protein (paraproteinemia), which causes "rouleaux formation" of RBCs [1]. [1] ### 2. Why Other Options are Incorrect * **Multiple Myeloma (MM):** Requires M-protein ≥ 3 g/dL OR marrow plasma cells ≥ 10%, **PLUS** evidence of CRAB features [1]. This patient lacks end-organ damage. * **Smoldering Multiple Myeloma (SMM):** Requires M-protein ≥ 3 g/dL OR marrow plasma cells 10–60%, but **without** CRAB features. This patient’s M-protein and plasma cell counts are below these thresholds. * **Waldenstrom Macroglobulinemia:** This is a B-cell lymphoma characterized by **IgM** monoclonal protein [1] and lymphoplasmacytic infiltration of the bone marrow, typically presenting with hyperviscosity and hepatosplenomegaly, which are absent here. ### 3. NEET-PG High-Yield Pearls * **Risk of Progression:** MGUS progresses to Multiple Myeloma at a rate of approximately **1% per year**. * **Management:** MGUS requires "watchful waiting" (observation) rather than chemotherapy. * **Most common M-protein in MGUS:** IgG (followed by IgA). * **Skeletal Survey:** Always use plain X-rays or low-dose CT; **Technetium-99m bone scans are often negative** in myeloma because they detect osteoblastic activity, whereas myeloma is purely osteolytic.
Question 19: According to the Ann Arbor staging of Hodgkin's lymphoma, which of the following defines Stage III?
- A. Involvement of lymph nodes on the same side of the diaphragm
- B. Liver infiltration
- C. Involvement of lymph node regions or lymphoid structures on both sides of the diaphragm (Correct Answer)
- D. Disseminated involvement of extralymphatic sites, including bone marrow and bronchial infiltration
Explanation: ### Explanation The **Ann Arbor Staging System** is the standard classification used to determine the anatomical extent of Hodgkin’s Lymphoma (HL). Staging is critical as it dictates the choice between localized radiotherapy and systemic chemotherapy. **1. Why Option C is Correct:** **Stage III** is defined by the involvement of lymph node regions or lymphoid structures (such as the spleen, thymus, or Waldeyer’s ring) on **both sides of the diaphragm** [2]. This indicates a transition from localized disease to systemic lymphatic spread [1]. It is further subclassified into III₁ (upper abdomen, e.g., splenic/celiac nodes) and III₂ (lower abdomen, e.g., para-aortic/iliac nodes). **2. Why Other Options are Incorrect:** * **Option A (Stage I & II):** Involvement of a single node region is Stage I. Involvement of two or more regions on the **same side** of the diaphragm is Stage II [2]. * **Option B & D (Stage IV):** Stage IV represents **disseminated (multifocal) involvement** of one or more extralymphatic organs (e.g., liver, bone marrow, lungs, or pleura) [2] with or without associated lymph node involvement. Liver infiltration specifically signifies Stage IV disease. **3. High-Yield Clinical Pearls for NEET-PG:** * **"B" Symptoms:** Fever (>38°C), drenching night sweats, and weight loss (>10% in 6 months). Their presence is denoted by the suffix 'B' (e.g., Stage IIIB), while their absence is 'A' [2]. * **Bulky Disease:** Defined as a mediastinal mass >1/3rd of the transthoracic diameter or any node >10 cm [2]. * **Cotswolds Modification:** A modern update to Ann Arbor that includes the 'X' designation for bulky disease and 'E' for limited extranodal extension from an adjacent node. * **Most Common Subtype:** Nodular Sclerosis is the most common subtype of HL, often presenting as a mediastinal mass in young females.
Question 20: Which of the following tumors is most likely associated with either hyponatremia or diffuse pigmentation of the skin?
- A. Renal adenocarcinoma
- B. Small cell carcinoma of the lung (Correct Answer)
- C. Hepatocellular carcinoma
- D. Primary squamous cell carcinoma of the lung
Explanation: The correct answer is **Small cell carcinoma of the lung (SCLC)**. This tumor is a neuroendocrine malignancy derived from Kulchitsky cells, which possess the metabolic machinery to produce various ectopic hormones, leading to **Paraneoplastic Syndromes (PNS)**. [1] 1. **Hyponatremia:** SCLC is the most common cause of the **Syndrome of Inappropriate Antidiuretic Hormone (SIADH)** [1]. The tumor secretes ectopic ADH (Arginine Vasopressin), leading to water retention and dilutional hyponatremia [2]. 2. **Diffuse Pigmentation:** SCLC can secrete ectopic **ACTH (Adrenocorticotropic Hormone)** [2]. High levels of ACTH (or its precursor POMC) stimulate melanocytes directly or via MSH-like activity, resulting in generalized hyperpigmentation. This is often seen in "Ectopic ACTH Syndrome" rather than Cushing’s Disease [1]. **Analysis of Incorrect Options:** * **Renal Adenocarcinoma (RCC):** Classically associated with polycythemia (Erythropoietin) [1], hypercalcemia (PTHrP), and Stauffer’s syndrome, but not typically SIADH or ACTH secretion. * **Hepatocellular Carcinoma:** Associated with hypoglycemia (IGF-II) and erythrocytosis [1], but rarely causes these specific electrolyte or pigmentary changes. * **Squamous Cell Carcinoma (SCC) of the Lung:** This is the classic lung cancer associated with **Hypercalcemia** due to the secretion of Parathyroid Hormone-related Protein (PTHrP) [1]. It does not typically cause SIADH or ectopic ACTH. **High-Yield Clinical Pearls for NEET-PG:** * **SCLC (Small Cell):** Think "S" for **S**IADH, **S**eizures (due to hyponatremia), and **S**ubacute cerebellar degeneration [3]. It is also associated with Lambert-Eaton Myasthenic Syndrome [3]. * **SCC (Squamous Cell):** Think "C" for **C**alcium (Hypercalcemia) and **C**entral location. * **Adenocarcinoma:** Most common lung cancer in non-smokers; associated with hypertrophic osteoarthropathy (clubbing) [2].
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