Oncology Practice Questions

Q: Hormonal treatment is given for which of the following malignancies?

Carcinoma of the prostate. **Explanation:** **1. Why Carcinoma of the Prostate is Correct:** Prostate cancer is a classic example of a **hormone-dependent malignancy**. The growth and survival of prostatic adenocarcinoma cells are largely driven by androgens (testosterone and dihydrotestosterone) [1]. Therefore, **Androgen Deprivation Therapy (ADT)** is a cornerstone of management, especially in metastatic or advanced stages [2]. This is achieved through surgical castration (orchiectomy) or medical castration using GnRH agonists (e.g., Leuprolide), GnRH antagonists (e.g., Degarelix), or androgen receptor blockers (e.g., Enzalutamide). **2. Analysis of Incorrect Options:** * **Choriocarcinoma (A):** This is a highly malignant germ cell tumor that is exquisitely sensitive to **chemotherapy** (specifically Methotrexate or the EMA-CO regimen). While it produces hormones (hCG), it is not treated with hormonal therapy [1]. * **Hepatoma (C):** Hepatocellular carcinoma (HCC) is primarily treated with surgical resection, liver transplantation, or targeted systemic therapies like Multikinase inhibitors (e.g., **Sorafenib**, Lenvatinib) and immunotherapy. It does not respond to hormonal manipulation. * **Teratoma (D):** Teratomas are germ cell tumors composed of multiple germ layers. Mature teratomas are treated with **surgical excision**, while malignant components (immature teratoma) require chemotherapy [1]. They are not hormone-sensitive. **Clinical Pearls for NEET-PG:** * **Other Hormone-Dependent Tumors:** Breast cancer (ER/PR positive), Endometrial cancer, and some Thyroid cancers (TSH suppression). * **First-line for Metastatic Prostate CA:** ADT is the standard of care. * **Tumor Flare:** GnRH agonists can cause a transient surge in testosterone; this is prevented by co-administering Flutamide (anti-androgen) for the first 2 weeks.

Q: Which of the following is NOT a risk factor for developing cholangiocarcinoma?

Working in the rubber industry. **Explanation:** Cholangiocarcinoma (CCA) is a malignancy arising from the biliary epithelium [1]. The primary pathophysiology involves **chronic inflammation** and cholestasis, which lead to DNA damage and malignant transformation of cholangiocytes. **Why Option D is the Correct Answer:** Working in the **rubber industry** is a well-established risk factor for **Bladder Cancer** (due to exposure to aromatic amines like benzidine) and certain leukemias, but it is **not** associated with cholangiocarcinoma. In contrast, the chemical industry exposure specifically linked to cholangiocarcinoma is the **aircraft and PVC industry** (exposure to 1,2-dichloropropane and dichloromethane). **Analysis of Incorrect Options:** * **Choledochal Cyst (Option A):** These congenital cystic dilatations of the bile duct cause bile stasis and chronic inflammation. The risk of malignancy is as high as 10-15%, necessitating surgical excision. * **Cholelithiasis (Option B):** While gallstones are primarily a risk factor for **Gallbladder Cancer**, large or long-standing stones in the biliary tree (especially hepatolithiasis/intrahepatic stones) cause chronic mucosal irritation, significantly increasing the risk of cholangiocarcinoma [1]. * **Liver Flukes (Option C):** Infection with *Opisthorchis viverrini* and *Clonorchis sinensis* (common in SE Asia) is a classic, high-yield risk factor. These parasites reside in the bile ducts, causing chronic mechanical injury and inflammation [1]. **NEET-PG High-Yield Pearls:** * **Most common risk factor (Worldwide):** Primary Sclerosing Cholangitis (PSC). * **Tumor Marker:** CA 19-9 is commonly elevated (also seen in pancreatic cancer). * **Klatskin Tumor:** A hilar cholangiocarcinoma occurring at the confluence of the right and left hepatic ducts [1]. * **Thorotrast:** A historical radiocontrast agent strongly linked to both cholangiocarcinoma and hepatic angiosarcoma.

Q: Which of the following is not an oncological emergency?

Carcinoma cervix stage- III B with Pyometra. An **oncological emergency** is defined as an acute condition caused by cancer or its treatment that requires immediate intervention to prevent death or severe permanent disability. **Why Option D is the correct answer:** **Carcinoma cervix stage-III B with Pyometra** is a chronic complication or a local progression of the disease. While pyometra (accumulation of pus in the uterine cavity) requires drainage and antibiotics, it is generally a localized infection and does not pose an immediate threat to life or vital organ function in the same way systemic or compressive oncological emergencies do. It is considered a clinical complication rather than an acute oncological emergency. **Why the other options are incorrect:** * **A. Spinal Cord Compression:** A structural emergency [1]. Delay in treatment (steroids/radiation/surgery) leads to irreversible paralysis. * **B. Superior Vena Cava (SVC) Syndrome:** A vascular emergency caused by obstruction of blood flow through the SVC [1]. It can lead to cerebral edema and airway compromise. * **C. Tumor Lysis Syndrome (TLS):** A metabolic emergency. Rapid breakdown of tumor cells leads to hyperkalemia, hyperuricemia, and hyperphosphatemia, causing acute renal failure and fatal arrhythmias. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of SVC Syndrome:** Bronchogenic carcinoma (Small cell lung cancer) [2]. * **Earliest sign of Spinal Cord Compression:** Localized back pain (precedes neurological deficits). * **TLS Prophylaxis:** Aggressive hydration and Allopurinol (Rasburicase for high-risk cases). * **Hypercalcemia of Malignancy:** The most common metabolic oncological emergency overall [1].

Question 1

A 43-year-old woman complains of fatigue and night sweats associated with itching for 2 months. On physical examination, there is diffuse nontender lymphadenopathy, including small supraclavicular, epitrochlear, and scalene nodes. CBC and chemistry studies (including liver enzymes) are normal. Chest x-ray shows hilar lymphadenopathy. Which of the following is the best next step in evaluation?

Accepted Answer

Excisional lymph node biopsy

Answer

Monospot test

Answer

Toxoplasmosis IgG serology

Answer

Serum angiotensin-converting enzyme level

Question 2

A 69-year-old man, whose friend died of prostate cancer, wishes to be evaluated for the disease. He has no urinary symptoms. Which of the following tests is most likely indicated to screen him for prostate cancer?

Accepted Answer

DRE and prostate specific antigen (PSA)

Answer

prostate ultrasound

Answer

digital rectal examination (DRE)

Answer

PSA

Question 3

A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies show: Hct: 38%, WBC: 15,000/mL, Platelet count: 40,000/mL, fragmented RBCs on peripheral blood smear, elevated PT, elevated PTT, plasma fibrinogen: 70 mg/dL. Which of the following is the best course of therapy in this patient?

Accepted Answer

Treat underlying disease

Answer

Begin heparin

Answer

Begin plasmapheresis

Answer

Give vitamin K

Question 4

Hormonal treatment is given for which of the following malignancies?

Accepted Answer

Carcinoma of the prostate

Answer

Choriocarcinoma

Answer

Hepatoma

Answer

Teratoma

Question 5

Which of the following is NOT a risk factor for developing cholangiocarcinoma?

Accepted Answer

Working in the rubber industry

Answer

Choledochal cyst

Answer

Cholelithiasis

Answer

Liver flukes

Question 6

Which of the following is not an oncological emergency?

Accepted Answer

Carcinoma cervix stage- III B with Pyometra

Answer

Spinal cord compression

Answer

Superior venacaval syndrome

Answer

Tumor lysis syndrome

Question 7

A 42-year-old man is on amitriptyline for depression. Recently he has been feeling more lethargic and unwell. His clinical examination is normal. Serum sodium is 125 mEq/L and osmolality is 260 mOsm/kg, and urine sodium is 40 mEq/L and osmolality is 450 mOsm/kg. For the above patient with hyponatremia, select the most likely diagnosis.

Accepted Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer

Congestive heart failure (CHF)

Answer

Extrarenal sodium and fluid losses

Answer

Polydipsia

Question 8

A 28-year-old woman presents with a recent episode of coughing up blood, frequent nosebleeds, and decreased urine output. Physical examination reveals an ulcerated nasal mucosa. Urinalysis is positive for protein and red blood cells, consistent with acute glomerulonephritis. Chest X-ray shows two cavitary lesions, and serology is positive for antineutrophil cytoplasmic antibodies (ANCA). Which of the following is the most likely diagnosis?

Accepted Answer

Wegener granulomatosis

Answer

Bacterial endocarditis

Answer

Goodpasture syndrome

Answer

Lupus erythematosus

Question 9

What is the commonest site of extramedullary relapse?

Accepted Answer

Central Nervous System (CNS)

Answer

Lung

Answer

Liver

Answer

Testis

Question 10

Which of the following statements regarding cancer therapy with interleukin 2 (IL-2) is true?

Accepted Answer

It induces a major response in patients with metastatic melanoma

Answer

It is a B-cell growth factor

Answer

It induces a major response in patients with metastatic breast cancer

Answer

It induces a major response in patients with metastatic colon cancer

Oncology — MCQs

Oncology — MCQs

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