Oncology — MCQs
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What is the most common cause of a single vertebral collapse?
International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:
Most common cancer worldwide among the following -
Mucositis heals after ___ months of radiotherapy:
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:
Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by
Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:
Which of the following conditions can produce hemothorax?
The most chemoresistant tumor amongst the following:
Which of the following tumors is cured by radiation?
Oncology Indian Medical PG Practice Questions and MCQs
Question 261: What is the most common cause of a single vertebral collapse?
- A. Metastasis (Correct Answer)
- B. Trauma
- C. Tuberculosis
- D. All of the options
Explanation: 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.
Question 262: International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:
- A. LDH
- B. Number of extralymphatic sites involved
- C. Hemoglobin and albumin (Correct Answer)
- D. Stage of disease
Explanation: ***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].
Question 263: Most common cancer worldwide among the following -
- A. Lung (Correct Answer)
- B. Liver
- C. Kidney
- D. Prostate
Explanation: ***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.
Question 264: Mucositis heals after ___ months of radiotherapy:
- A. 6 Months
- B. 5 Months
- C. 3 Months
- D. 2 Months (Correct Answer)
Explanation: ***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.
Question 265: 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:
- A. Increased PTHrP production (Correct Answer)
- B. Decreased responsiveness to calcitonin
- C. Increased responsiveness of the PTH receptor 1
- D. Increased PTH production
- E. Increased PTHrP secretion
Explanation: ***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.
Question 266: Cardiotoxicity caused by radiotherapy & chemotherapy is best detected by
- A. ECHO (Correct Answer)
- B. Endomyocardial Biopsy
- C. ECG
- D. Radionuclide Scan
Explanation: ***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.
Question 267: Chronic radiation proctitis is associated with the treatment of all malignancies, EXCEPT:
- A. Carcinoma cervix
- B. Carcinoma small bowel (Correct Answer)
- C. Carcinoma prostate
- D. Carcinoma testes
Explanation: 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.
Question 268: Which of the following conditions can produce hemothorax?
- A. Congestive heart failure
- B. malignancy (Correct Answer)
- C. Myxoma
- D. Rheumatoid arthritis
Explanation: ***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.
Question 269: The most chemoresistant tumor amongst the following:
- A. Osteosarcoma
- B. Clear cell sarcoma
- C. Undifferentiated pleomorphic sarcoma (Correct Answer)
- D. Synovial sarcoma
Explanation: ***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.
Question 270: Which of the following tumors is cured by radiation?
- A. Rhabdomyosarcoma
- B. Renal cell cancer
- C. Chloroma
- D. Seminoma (Correct Answer)
Explanation: ***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.
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