Oncology Practice Questions

Q: What is the most common cause of a single vertebral collapse?

Metastasis. Metastasis - Metastatic disease is the leading cause of a single vertebral collapse, especially in older adults, due to the preferential vascularity of the spine [1]. - The vertebral body is a common site for secondary spread of cancers, such as those originating from the breast, prostate, lung, and kidney [3]. Trauma - While trauma can cause vertebral collapse, it typically results from significant force and may involve multiple contiguous vertebrae or present with other signs of injury [1]. - Traumatic vertebral fractures are more common in younger individuals or in severe accidents, whereas metastasis is more prevalent in a single vertebral collapse in the absence of significant trauma. Tuberculosis - Pott's disease (tuberculous spondylitis) can cause vertebral collapse, but it often involves multiple adjacent vertebrae and disc spaces [2]. - It usually presents with constitutional symptoms like fever, night sweats, and weight loss, which are not implied by "single vertebral collapse" alone. All of the options - While all listed conditions can cause vertebral collapse, metastasis is statistically the most frequent cause for a single vertebral collapse, making this option incorrect. - This choice fails to identify the most common primary etiology and is thus not the best answer.

Q: International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:

Hemoglobin and albumin. ***Hemoglobin and albumin*** - While hemoglobin and albumin can be indicators of overall health and nutritional status, they are **not part of the standard International Prognostic Index (IPI)** for lymphomas. - The IPI specifically focuses on factors directly related to tumor burden and patient vitality, not general systemic markers like these. *LDH* - **Lactate dehydrogenase (LDH)** is a crucial component of the IPI, reflecting tumor burden and aggressiveness [1]. - Elevated LDH levels indicate a higher risk and are associated with a poorer prognosis [1]. *Number of extralymphatic sites involved* - The **number of extralymphatic sites involved** is a key prognostic factor in the IPI. - Involvement of more than one extralymphatic site indicates more widespread disease and a worse prognosis. *Stage of disease* - The **stage of disease**, as defined by the Ann Arbor staging system, is an essential element of the IPI [1]. - Advanced stages (III or IV) are associated with a poorer prognosis compared to early stages [1].

Q: Most common cancer worldwide among the following -

Lung. ***Lung*** - **Lung cancer** is the most common cancer worldwide, based on incidence and mortality rates [1]. - It is strongly associated with **smoking** and environmental factors [1], [2]. *Liver* - **Liver cancer** is a significant global health problem, but it ranks below lung cancer in overall incidence [1]. - Risk factors include **hepatitis B and C infections** and **alcohol abuse** [1]. *Kidney* - **Kidney cancer**, while relatively common, has a lower incidence rate compared to lung cancer [1]. - Its incidence is often higher in developed countries and is linked to **obesity and smoking** [1]. *Prostate* - **Prostate cancer** is the most common cancer among men in many Western countries, but its worldwide incidence is lower than that of lung cancer. - It is primarily seen in **older men** and is influenced by genetic and hormonal factors.

Q: Mucositis heals after ___ months of radiotherapy:

2 Months. ***2 Months*** - **Oral mucositis** typically resolves within **2-4 weeks** after the cessation of radiotherapy. The question asks about healing *after* radiotherapy, implying a timeframe of recovery following the treatment completion. Therefore, 2 months is a reasonable timeframe for complete resolution, especially for severe cases. - While acute mucositis can appear during treatment, the healing phase usually begins post-treatment, with most symptoms subsiding completely within a couple of months. *6 Months* - This is an excessively long duration for the healing of typical mucositis. Most cases resolve much sooner unless there are severe complications or chronic issues such as fibrosis. - Persistent symptoms beyond 2-3 months would suggest a chronic problem or a different underlying cause rather than typical mucositis healing. *5 Months* - Similar to 6 months, 5 months is a prolonged period. While some very severe cases might have residual effects, complete healing of mucositis usually occurs much earlier. - This timeframe might be associated with long-term complications or secondary infections, not the standard healing process of mucositis itself. *3 Months* - While closer to the typical resolution time than 5 or 6 months, 3 months is still longer than the average for complete healing of mucositis. - Most patients experience significant improvement and resolution of acute symptoms well before the 3-month mark after radiotherapy completion.

Q: A 88 year-old woman from Mexico is admitted to the hospital following a bout of severe vomiting and generalized weakness. Initial laboratory values reveal elevated Ca2+ levels. The referring physician tells you that she has breast cancer and her bone scan indicates metastasis to bone. The most likely cause of hypercalcemia is:

Increased PTHrP production. ***Increased PTHrP production*** - **Breast cancer** with bone metastases commonly leads to **humoral hypercalcemia of malignancy (HHM)**, which is typically mediated by the production of **parathyroid hormone-related protein (PTHrP)** by tumor cells. - This PTHrP mimics the action of PTH on bone and kidney, causing **increased bone resorption** and **renal calcium reabsorption**, leading to elevated serum calcium [2]. *Decreased responsiveness to calcitonin* - While calcitonin normally lowers calcium levels, a decreased responsiveness to it is not the primary mechanism behind cancer-associated hypercalcemia. - Tumors primarily cause hypercalcemia through increased bone resorption, not by directly inhibiting calcitonin's effects to a clinically significant degree. *Increased responsiveness of the PTH receptor 1* - Although PTHrP acts on the **PTH receptor 1**, the issue is not an increased responsiveness of the receptor itself, but rather the **overproduction of its ligand (PTHrP)** by the tumor. - The receptor's intrinsic responsiveness is typically normal; it's the external stimulus from PTHrP that drives the hypercalcemia. *Increased PTH production* - This scenario describes **primary hyperparathyroidism**, which is typically caused by a parathyroid adenoma or hyperplasia [1]. - While PTH causes hypercalcemia, in the context of advanced breast cancer with bone metastasis, the hypercalcemia is almost always due to malignancy itself, not primary parathyroid dysfunction [3]. *Increased PTHrP secretion* - This option is essentially a rephrasing of the correct answer but in a less precise format. - The term "production" is more appropriate when referring to the synthesis of a protein by tumor cells.

Q: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

ECHO. ***ECHO*** - **Echocardiography (ECHO)** is the primary and most widely used non-invasive method for detecting cardiotoxicity due to its ability to assess **left ventricular ejection fraction (LVEF)**, a key indicator of cardiac function, and structural changes. - It is crucial for **baseline assessment**, monitoring during treatment, and follow-up, identifying both systolic and diastolic dysfunction effectively. *Endomyocardial Biopsy* - While **endomyocardial biopsy** is considered the gold standard for definitive diagnosis of some cardiomyopathies (e.g., myocarditis), it is **invasive** and carries risks such as perforation, tamponade, and arrhythmias. - It is usually reserved for cases where other non-invasive tests are inconclusive and there's a strong clinical suspicion of severe cardiac disease, or for research, not routine monitoring of cardiotoxicity. *ECG* - An **ECG** can detect arrhythmias and ischemic changes but is **not sensitive or specific** enough to reliably detect early or subtle changes in cardiac function characteristic of cardiotoxicity. - It may show changes secondary to heart failure, but it does not directly measure ejection fraction or assess overall cardiac mechanical function. *Radionuclide Scan* - **Radionuclide scans**, specifically **MUGA (Multigated Acquisition)** scans, can accurately measure **LVEF** and are an alternative to ECHO, particularly when ECHO images are suboptimal [1]. - However, they involve **radiation exposure**, making them less ideal for frequent monitoring compared to echocardiography, especially in cancer patients who are already exposed to radiation.

Q: Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:

Carcinoma small bowel. Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT: ***Carcinoma small bowel*** - **Radiation therapy** is rarely used as a primary treatment for **small bowel carcinoma**, as surgical resection is the main modality. - Therefore, the small bowel is typically not exposed to direct radiation in a manner that would cause proctitis. *Carcinoma cervix* - **Pelvic radiation** is a common treatment for **cervical carcinoma**, which often involves the rectum within the radiation field. - This proximity makes chronic radiation proctitis a known and relatively frequent complication. *Carcinoma prostate* - **External beam radiation therapy** is a standard treatment option for **prostate cancer**, directly targeting the prostate gland which is anatomically close to the rectum. - This close proximity frequently leads to chronic radiation-induced damage to the rectal tissue, resulting in proctitis. *Carcinoma testes* - While **testicular cancer** itself is not directly adjacent to the rectum, certain stages of testicular cancer are treated with **retroperitoneal lymph node irradiation** or whole-pelvis radiation. - This can expose portions of the rectum to radiation, leading to chronic radiation proctitis as a potential side effect.

Q: Which of the following conditions can produce hemothorax?

malignancy. ***Malignancy*** - **Malignant pleural effusions** can be hemorrhagic due to tumor invasion of blood vessels and increased vascular fragility [1]. - Tumors frequently metastasize to the pleura, often leading to **hemothorax** due to friable microvasculature [1]. *Congestive heart failure* - Typically causes a **transudative pleural effusion** due to increased hydrostatic pressure, which is usually serous, not bloody [1]. - While fluid overload occurs, it does not directly lead to **blood accumulation** in the pleural space. *Myxoma* - A **benign cardiac tumor** that can embolize or cause constitutional symptoms, but it does not directly cause hemothorax. - Pleural effusions associated with myxomas are generally serous and related to **cardiac dysfunction**, not hemorrhage. *Rheumatoid arthritis* - Can cause **pleural effusions** (rheumatoid pleurisy), which are typically exudative and lymphocytosis-predominant [1]. - These effusions are rarely hemorrhagic and generally do not lead to **gross blood** in the pleural space.

Q: The most chemoresistant tumor amongst the following:

Undifferentiated pleomorphic sarcoma. ***Undifferentiated pleomorphic sarcoma*** - **Undifferentiated pleomorphic sarcoma (UPS)** is known for its aggressive nature and inherent resistance to conventional chemotherapy. - Its **heterogeneous genetic profile** and lack of specific therapeutic targets contribute to its poor response to systemic treatments. *Osteosarcoma* - While osteosarcoma is a highly aggressive bone tumor, it is generally considered **chemosensitive**, particularly to agents like **methotrexate, doxorubicin, and cisplatin**. - **Neoadjuvant chemotherapy** is a standard part of treatment, often leading to significant tumor necrosis and improved outcomes. *Clear cell sarcoma* - **Clear cell sarcoma** is a rare soft tissue sarcoma with a distinct genetic translocation, t(12;22), involving the **EWSR1 gene**. - Although it can be challenging to treat, it is not consistently ranked as the most chemoresistant among sarcomas; specific targeted therapies are being investigated. *Synovial sarcoma* - **Synovial sarcoma** is often sensitive to chemotherapy, particularly regimens containing **ifosfamide and doxorubicin**. - Its response to chemotherapy can be variable, but it is generally *more chemosensitive* than undifferentiated pleomorphic sarcoma.

Q: Which of the following tumors is cured by radiation?

Seminoma. ***Seminoma*** - **Seminoma** is a highly radiosensitive tumor, making radiation therapy a primary curative modality, especially for localized disease [1]. - Due to its exquisite sensitivity, even relatively low doses of radiation can achieve **high cure rates** [1]. *Rhabdomyosarcoma* - While radiation therapy is often part of the treatment for **rhabdomyosarcoma**, it is typically used in conjunction with **chemotherapy and surgery** and is not curative on its own. - Its cure usually requires a **multimodal approach** due to its aggressive nature and potential for metastasis. *Renal cell cancer* - **Renal cell carcinoma** is generally considered **radioresistant**, meaning radiation therapy is not effective as a primary curative treatment. - Surgery (nephrectomy) is the **primary curative modality** for localized renal cell cancer. *Chloroma* - A **chloroma**, also known as granulocytic sarcoma, is a solid tumor of myeloid cells that often occurs in patients with acute myeloid leukemia. - Treatment focuses on systemic chemotherapy for the underlying leukemia, and while radiation can be used for local control, it is **not curative** for the underlying disease.

Question 1

What is the most common cause of a single vertebral collapse?

Accepted Answer

Metastasis

Answer

Trauma

Answer

Tuberculosis

Answer

All of the options

Question 2

International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:

Accepted Answer

Hemoglobin and albumin

Answer

LDH

Answer

Number of extralymphatic sites involved

Answer

Stage of disease

Question 3

Most common cancer worldwide among the following -

Accepted Answer

Lung

Answer

Liver

Answer

Kidney

Answer

Prostate

Question 4

Mucositis heals after ___ months of radiotherapy:

Accepted Answer

2 Months

Answer

6 Months

Answer

5 Months

Answer

3 Months

Question 5

A 88 year-old woman from Mexico is admitted to the hospital following a bout of severe vomiting and generalized weakness. Initial laboratory values reveal elevated Ca2+ levels. The referring physician tells you that she has breast cancer and her bone scan indicates metastasis to bone. The most likely cause of hypercalcemia is:

Accepted Answer

Increased PTHrP production

Answer

Decreased responsiveness to calcitonin

Answer

Increased responsiveness of the PTH receptor 1

Answer

Increased PTH production

Answer

Increased PTHrP secretion

Question 6

Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by

Accepted Answer

ECHO

Answer

Endomyocardial Biopsy

Answer

ECG

Answer

Radionuclide Scan

Question 7

Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:

Accepted Answer

Carcinoma small bowel

Answer

Carcinoma cervix

Answer

Carcinoma prostate

Answer

Carcinoma testes

Question 8

Which of the following conditions can produce hemothorax?

Accepted Answer

malignancy

Answer

Congestive heart failure

Answer

Myxoma

Answer

Rheumatoid arthritis

Question 9

The most chemoresistant tumor amongst the following:

Accepted Answer

Undifferentiated pleomorphic sarcoma

Answer

Osteosarcoma

Answer

Clear cell sarcoma

Answer

Synovial sarcoma

Question 10

Which of the following tumors is cured by radiation?

Accepted Answer

Seminoma

Answer

Rhabdomyosarcoma

Answer

Renal cell cancer

Answer

Chloroma

Oncology — MCQs

Oncology — MCQs

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