A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?
Q202
Which of the following is the diagnostic test for carcinoid tumors?
Q203
A 50-year-old smoker presents to the hospital with a painless oral lesion and white patch that develops in the oral cavity, as shown in the image. What is the diagnosis?
Q204
A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?
Q205
Which of the following malignancies is unrelated to obesity?
Q206
A 40-year-old patient presents with complains of low back pain and development of pallor. During workup very high levels of urinary beta2 microglobulin was noted. X-ray skull was performed. Bone marrow aspiration shows >10% plasma cells and serum electrophoresis shows M protein >30 g/L. All are useful for management of this patient except?
Q207
A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?
Q208
Which of the following statements with regard to Colorectal Carcinoma are correct ?
1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.
2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.
3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.
4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.
Select the correct answer using the code given below :
Q209
A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :
Q210
Which of the following statements are correct regarding renal cell carcinoma?
1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.
Oncology Indian Medical PG Practice Questions and MCQs
Question 201: A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?
A. Ptosis
B. Miosis
C. Exophthalmos (Correct Answer)
D. Anhidrosis
Explanation: ***Exophthalmos***- This finding, characterized by the **protrusion of the eyeball**, is typically associated with conditions like **Graves' disease** (hyperthyroidism) or orbital tumors.- It is *not* a component of **Horner's syndrome**, which is the classic neurological manifestation of a Pancoast tumor due to damage to the sympathetic chain.*Anhidrosis*- Pancoast tumors (superior sulcus tumors) often invade the **stellate ganglion** or other parts of the sympathetic chain.- Damage to sympathetic fibers causes reduced or absent sweating on the ipsilateral face and neck, manifesting as **anhidrosis**.*Miosis*- This refers to the **constriction of the pupil** and is a classic sign resulting from the loss of sympathetic input, which normally causes pupillary dilation.- The resulting unopposed action of the parasympathetic system leads to **miosis**.*Ptosis*- Ptosis, or the **drooping of the upper eyelid**, occurs due to paralysis of the **superior tarsal muscle** (Müller's muscle).- This small muscle is innervated by the sympathetic pathway, and its dysfunction results in mild **ptosis**, a core component of Horner's syndrome.
Question 202: Which of the following is the diagnostic test for carcinoid tumors?
A. Serum chromogranin A
B. Serum calcitonin levels
C. Urinary 5-hydroxyindoleacetic acid (Correct Answer)
D. 24-hour urinary catecholamines
Explanation: ***Urinary 5-hydroxyindoleacetic acid***- Carcinoid tumors actively produce **serotonin**, which is rapidly metabolized by **monoamine oxidase** into the inactive metabolite **5-hydroxyindoleacetic acid (5-HIAA)**.- A **24-hour urinary collection** for 5-HIAA is the most specific and confirms the functional diagnosis of **carcinoid syndrome** [1].*24-hour urinary catecholamines*- This test is primarily used for the diagnosis of **pheochromocytoma**, which secretes excess **norepinephrine** and **epinephrine**.- High levels of catecholamine metabolites, such as **metanephrines** and **vanillylmandelic acid (VMA)**, are diagnostic for pheochromocytoma, not carcinoid tumors, which primarily produce serotonin.*Serum calcitonin levels*- **Calcitonin** secretion is the key diagnostic and monitoring marker for **medullary thyroid carcinoma (MTC)**, a non-related neuroendocrine tumor originating from C-cells.- This marker is not specific or elevated in typical **carcinoid tumors** originating from the small bowel or lungs.*Serum chromogranin A*- **Chromogranin A (CgA)** is a general biomarker for **neuroendocrine tumors (NETs)** and is useful for screening and monitoring disease burden [2].- While sensitive for carcinoid tumors, it lacks the specificity of **5-HIAA** for diagnosing **carcinoid syndrome** and can be falsely elevated in conditions like PPI use or renal failure.
Question 203: A 50-year-old smoker presents to the hospital with a painless oral lesion and white patch that develops in the oral cavity, as shown in the image. What is the diagnosis?
A. Leukoplakia (Correct Answer)
B. Candidiasis
C. Lichen planus
D. Oral cancer
Explanation: ***Leukoplakia***
- Leukoplakia is a clinical diagnosis for a white patch or plaque on the oral mucosa that **cannot be scraped off**, distinguishing it from other lesions like candidiasis.
- It is strongly associated with chronic irritation, particularly **tobacco use** (as in this smoker), and is considered a **premalignant condition** with a risk of transforming into squamous cell carcinoma.
*Candidiasis*
- Oral candidiasis (thrush) presents as creamy white, curd-like plaques that **can typically be scraped off**, revealing an underlying erythematous and sometimes bleeding base.
- It is an opportunistic fungal infection more common in **immunocompromised** patients, infants, or those using steroids or broad-spectrum antibiotics.
*Lichen planus*
- Oral lichen planus is a chronic inflammatory autoimmune disease that classically appears as a fine, lace-like network of white lines known as **Wickham's striae**.
- While it can present as plaques, the typical reticular pattern is a key differentiating feature, and it is not primarily caused by smoking.
*Oral cancer*
- While this lesion could be oral cancer (squamous cell carcinoma), **leukoplakia** is the correct clinical descriptive term for the white patch itself. A definitive diagnosis of cancer requires a **biopsy**.
- Oral cancers often present as **indurated ulcers**, red patches (erythroplakia), or fungating masses, which may or may not be painful, in addition to white patches.
Question 204: A 45-year-old patient with a history of smoking a pack of cigarettes for the past 15 years presents with hemoptysis. Chest X-ray shows a 3cm upper lobe mass near the apex of the lung. What is the next best step for managing this patient?
A. Bronchoscopy
B. Sputum cytology
C. Sputum for AFB
D. CT-guided biopsy (Correct Answer)
Explanation: ***CT-guided biopsy***- This procedure is the preferred method for obtaining a definitive **tissue diagnosis** for a solitary **peripheral lung mass**, especially one highly suspicious of malignancy due to the patient's smoking history and hemoptysis [1].- Since the mass is **3cm** and located peripherally near the **apex**, a percutaneous **CT-guided transthoracic needle aspiration (TTNA)** provides the highest diagnostic yield compared to other non-invasive alternatives [2].*Bronchoscopy*- Bronchoscopy is primarily used to evaluate **central lesions** (proximal to segmental bronchi) or suspicious findings directly within the airway lumen.- It has a low diagnostic yield for discrete, small, or **peripheral masses** like this 3cm apical lesion, as the scope or biopsy instruments cannot reliably reach the target.*Sputum cytology*- Sputum cytology has low overall sensitivity, particularly for **peripheral lung masses** which are unlikely to shed sufficient malignant cells into the central airways.- While non-invasive, it often results in a non-diagnostic result and is therefore not the **next best step** for confirming the diagnosis of a discrete, radiographically apparent mass.*Sputum for AFB*- While an infectious process like tuberculosis (TB) can present as a mass, the patient's robust history of **heavy smoking** and the mass morphology strongly prioritize ruling out **lung carcinoma**.- Obtaining a tissue sample (biopsy) is mandatory due to the high suspicion of malignancy (indicated by hemoptysis and smoking) and takes precedence over attempting an infectious diagnosis first [3].
Question 205: Which of the following malignancies is unrelated to obesity?
A. Pancreas
B. Stomach
C. Meningioma
D. Multiple myeloma (Correct Answer)
Explanation: ***Multiple myeloma***
- While obesity is a risk factor for several cancers, there is limited or conflicting evidence directly linking **multiple myeloma** to high BMI, making it the most unrelated option among the choices provided.
- The primary established risk factors for multiple myeloma include age (over 65), African descent, male sex, and a history of monoclonal gammopathy of undetermined significance (**MGUS**). [1]
***Stomach***
- Obesity, particularly abdominal obesity, increases the risk of developing **gastric cardia adenocarcinoma** due to increased prevalence of **gastroesophageal reflux disease (GERD)** and subsequent Barrett's esophagus.
- Chronic inflammation and hormonal changes associated with high body fat contribute to the oncogenesis of stomach cancer.
***Pancreas***
- Obesity is a well-established risk factor for **pancreatic cancer**, increasing the risk by approximately 20-50% compared to healthy-weight individuals. [2]
- The mechanism involves chronic low-grade inflammation, **insulin resistance**, and altered levels of adipokines (like leptin) and insulin-like growth factors.
***Meningioma***
- **Meningioma**, the most common primary central nervous system tumor, has a clear association with obesity.
- High BMI contributes to increased risk, possibly mediated by elevated levels of **leptin** and **estrogen** (especially in postmenopausal women) which can act as growth factors.
Question 206: A 40-year-old patient presents with complains of low back pain and development of pallor. During workup very high levels of urinary beta2 microglobulin was noted. X-ray skull was performed. Bone marrow aspiration shows >10% plasma cells and serum electrophoresis shows M protein >30 g/L. All are useful for management of this patient except?
A. Lenalidomide
B. Bortezomib
C. Melphalan (Correct Answer)
D. Autologous transplantation
Explanation: ***Melphalan***
- While melphalan is used in **multiple myeloma**, its high-dose application is primarily a conditioning regimen for **autologous stem cell transplantation**, rather than a standalone maintenance or initial therapy, especially in younger patients who are transplant-eligible.
- Furthermore, alkylating agents like melphalan are associated with an increased risk of **secondary malignancies**, making their long-term use less favorable in transplant-eligible patients when newer, less toxic agents are available.
*Lenalidomide*
- **Lenalidomide** is an immunomodulatory drug (IMiD) that is highly effective in the treatment of multiple myeloma, often used in maintenance therapy post-transplant or as part of initial induction regimens.
- It works by modulating the immune system and has direct anti-myeloma activity, making it a valuable tool in the management of this patient [1].
*Bortezomib*
- **Bortezomib** is a proteasome inhibitor that is a cornerstone of initial induction therapy for transplant-eligible and transplant-ineligible multiple myeloma patients [1].
- It effectively inhibits the break down of cellular proteins, leading to apoptosis of myeloma cells, and is crucial for achieving deep responses.
*Autologous transplantation*
- Given the patient's age (40 years old) and likely fitness, **autologous stem cell transplantation** is a standard and highly effective treatment option for multiple myeloma, aimed at achieving deep and durable remissions [1].
- It involves harvesting the patient's own stem cells, then administering high-dose chemotherapy (often melphalan) to eradicate myeloma cells, followed by reinfusion of the stored stem cells to rescue hematopoiesis [1].
Question 207: A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?
A. Large intestine
B. Breast (Correct Answer)
C. Adrenal
D. Small intestine
Explanation: **Breast**
- **Breast cancer** is a common primary malignancy in women that frequently metastasizes to bone, causing **lytic lesions** in the vertebrae and ribs [4].
- The patient's age (60-year-old female) and the presence of severe, recent-onset back pain with multiple lytic lesions strongly suggest metastatic disease [2], with **breast cancer** being a top differential [4].
*Large intestine*
- While **colorectal cancer** can metastasize to bone, it typically causes mixed lytic and blastic lesions or predominantly blastic lesions, rather than purely lytic lesions.
- Furthermore, the frequency of bone metastases from colorectal cancer is generally lower compared to breast or lung primary tumors [1].
*Adrenal*
- Primary **adrenal tumors** (e.g., adrenal cortical carcinoma, pheochromocytoma) rarely metastasize to bone and are not a common cause of diffuse lytic bone lesions.
- Bone metastases from adrenal cancers are much less frequent and typically associated with advanced, aggressive disease [3].
*Small intestine*
- **Small bowel malignancies** (e.g., adenocarcinomas, neuroendocrine tumors) rarely metastasize to bone.
- When they do, the pattern of bone involvement is variable but less commonly presents as widespread lytic lesions in the spine and ribs without other systemic symptoms.
Question 208: Which of the following statements with regard to Colorectal Carcinoma are correct ?
1. Left-sided Colorectal Carcinoma presents with bleeding per rectum.
2. Right-sided Colorectal Carcinoma presents with iron deficiency anaemia.
3. Right-sided Colorectal Carcinoma is more common as compared to the left-sided Colorectal Carcinoma.
4. Colonoscopy is the investigation of choice for suspected Colorectal Carcinoma.
Select the correct answer using the code given below :
A. 1, 2 and 3 (Correct Answer)
B. 2, 3 and 4
C. 1, 2 and 4
D. 1, 3 and 4
Explanation: ***1, 2 and 4***
- **Left-sided colorectal carcinoma** often presents with **bleeding per rectum** due to its proximity to the anus [1].
- **Right-sided colorectal carcinoma** is more likely to cause insidious blood loss, leading to **iron deficiency anemia** [1].
- **Colonoscopy** is considered the **gold standard** for diagnosing colorectal carcinoma due to its ability to visualize the entire colon and allow for biopsy [1].
*2, 3 and 4*
- While statements 2 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more common** than right-sided colorectal carcinoma [1].
- Right-sided lesions more generally cause anemia, and colonoscopy is the appropriate investigation of choice [1].
*1, 2 and 3*
- Statements 1 and 2 are correct. However, statement 3 is incorrect; **left-sided colorectal carcinoma has a higher incidence** compared to right-sided colorectal carcinoma [1].
- Bleeding per rectum is characteristic of left-sided lesions while iron deficiency anemia for right-sided lesions [1].
*1, 3 and 4*
- While statements 1 and 4 are correct, statement 3 is incorrect. **Left-sided colorectal carcinoma is more prevalent** than right-sided colorectal carcinoma [1].
- Clinical presentation with bleeding per rectum is typical for left-sided cancers, and colonoscopy is the definitive diagnostic tool [1].
Question 209: A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :
A. Erythroplakia
B. Oral candidiasis
C. Leukoplakia
D. Speckled leucoplakia (Correct Answer)
Explanation: ***Speckled leucoplakia***
- This patient, a **tobacco chewer** and **bidi smoker**, has risk factors and presents with a "white buccal mucosa with a bright red velvety plaque" (known as **speckled leukoplakia**), which is a highly suspicious lesion for **oral squamous cell carcinoma (OSCC)**, especially with symptoms like diminished mouth opening and occasional spitting of blood.
- **Speckled leukoplakia** combines features of both leukoplakia (white areas) and erythroplakia (red velvety areas), and is considered the **highest risk precancerous lesion** for malignant transformation.
*Erythroplakia*
- Characterized by a **bright red velvety patch** that is flat or slightly depressed.
- While highly suspicious for malignancy (with a 90% chance of being dysplastic or malignant), the description also includes a "white buccal mucosa," indicating a mixed white and red lesion.
*Oral candidiasis*
- Presents as **white, curdy patches** that can be scraped off, often revealing an erythematous base, and is typically associated with immunosuppression or antibiotic use.
- It does not usually present with a persistent **red velvety component** or symptoms of diminished mouth opening indicative of malignancy.
*Leukoplakia*
- Defined as a **white plaque** that cannot be rubbed off and cannot be characterized as any other diagnosable disease.
- Only describes the white component, while the patient's lesion also has a significant **red, velvety component**, classifying it more accurately as speckled leukoplakia.
Question 210: Which of the following statements are correct regarding renal cell carcinoma?
1. It arises from the epithelium of the proximal convoluted tubule.
2. It has a female preponderance.
3. Major subtypes are clear cell, papillary and chromophobe.
4. Surgery is the mainstay of treatment for organ-confined disease. Select the answer using the code given below.
A. 1, 2 and 3
B. 1, 3 and 4 (Correct Answer)
C. 1, 2 and 4
D. 2, 3 and 4
Explanation: ***1, 3 and 4***
- **Renal cell carcinoma (RCC)** most commonly arises from the **epithelium of the proximal convoluted tubule**, particularly the clear cell subtype [1]. This makes statement 1 correct.
- The major subtypes of RCC are indeed **clear cell, papillary, and chromophobe carcinomas**, accounting for the vast majority of cases [1]. This validates statement 3.
- For **organ-confined renal cell carcinoma**, **surgical resection (nephrectomy)** remains the primary and most effective treatment modality, making statement 4 correct. [1]
*1, 2 and 3*
- This option incorrectly includes statement 2, which claims a female preponderance for RCC. **Renal cell carcinoma is more common in males** than females, not the reverse [1].
- While statements 1 and 3 are correct regarding the origin and major subtypes of RCC, the inclusion of an incorrect epidemiological fact makes this option wrong.
*1, 2 and 4*
- This option falls short by incorrectly including statement 2, which asserts a female predominance for RCC. **RCC has a male predominance**, with a male-to-female ratio of about 2:1 [1].
- This option also omits statement 3, which correctly identifies the major subtypes (clear cell, papillary, and chromophobe), even though statements 1 and 4 are correct.
*2, 3 and 4*
- This option incorrectly includes statement 2, which states a female preponderance for RCC; **renal cell carcinoma is actually more prevalent in males** [1].
- While statements 3 and 4 are correct regarding the major subtypes and the role of surgery in organ-confined disease, the factual error in statement 2 invalidates this option.
