Oncology Practice Questions

Q: In humoral hypercalcemia of malignancy, what serum calcium level indicates severe hypercalcemia, which may present with symptoms such as fatigue, mental status changes, dehydration, or nephrolithiasis?

14 mg/dl. ### Explanation **Core Concept:** Hypercalcemia of malignancy is primarily driven by the secretion of **Parathyroid Hormone-related Protein (PTHrP)**, which mimics PTH action on bones and kidneys. In clinical practice, hypercalcemia is categorized by total serum calcium levels: * **Mild:** 10.5 – 11.9 mg/dL * **Moderate:** 12.0 – 13.9 mg/dL * **Severe (Hypercalcemic Crisis):** **≥ 14.0 mg/dL** [1] **Why Option A is Correct:** A serum calcium level of **14 mg/dL** is the threshold for **severe hypercalcemia**. At this level, patients are frequently symptomatic and require urgent inpatient management. Symptoms include profound dehydration (due to nephrogenic diabetes insipidus), altered mental status (lethargy/coma), and cardiac arrhythmias (shortened QT interval) [1]. **Analysis of Incorrect Options:** * **Option B (12 mg/dl):** This falls into the **moderate** range. While patients may be symptomatic, it does not represent the threshold for "severe" hypercalcemia or a medical emergency unless the rise is very acute. * **Option C (11 mg/dl):** This represents **mild** hypercalcemia. Most patients at this level are asymptomatic or have vague symptoms like mild fatigue. * **Option D (10 mg/dl):** This is within the **normal range** (typically 8.5–10.5 mg/dL). **NEET-PG High-Yield Pearls:** 1. **Most Common Cause:** In hospitalized patients, malignancy is the #1 cause of hypercalcemia; in outpatients, it is Primary Hyperparathyroidism [2]. 2. **Mechanism:** PTHrP is most commonly associated with **Squamous Cell Carcinomas** (Lung, Head/Neck) [2]. 3. **Treatment Priority:** The immediate first step in managing severe hypercalcemia (≥14 mg/dL) is **aggressive IV hydration with Normal Saline**, followed by Bisphosphonates (Zoledronic acid) or Denosumab [1]. 4. **ECG Finding:** Look for a **shortened QT interval**; this is a classic board-style question.

Q: What is the primary treatment for Superior Vena Cava (SVC) syndrome caused by Small Cell Lung Carcinoma?

Chemotherapy. **Explanation:** Superior Vena Cava (SVC) syndrome is a clinical emergency characterized by the obstruction of blood flow through the SVC. The choice of treatment depends primarily on the **histological type** of the underlying malignancy [1]. **1. Why Chemotherapy is Correct:** Small Cell Lung Carcinoma (SCLC) is a highly **chemosensitive** tumor. In cases of SVC syndrome caused by SCLC (or Lymphomas), chemotherapy is the treatment of choice because it induces a rapid systemic response, leading to tumor shrinkage and decompression of the vena cava. Relief of symptoms typically occurs within 7 to 10 days of starting treatment. **2. Why Other Options are Incorrect:** * **Radiotherapy:** While radiotherapy is the treatment of choice for **Non-Small Cell Lung Carcinoma (NSCLC)** causing SVC syndrome [1] (as NSCLC is less sensitive to chemotherapy), it is reserved as a second-line or palliative option for SCLC if chemotherapy fails. * **Surgery:** Surgical bypass or resection is rarely indicated in malignant SVC syndrome due to the high morbidity and the effectiveness of medical management [2]. It is generally reserved for benign causes (e.g., retrosternal goiter). * **No treatment:** SVC syndrome is a medical emergency that can lead to cerebral edema or airway compromise; leaving it untreated is life-threatening. **Clinical Pearls for NEET-PG:** * **Most common cause overall:** Lung Cancer (NSCLC > SCLC). * **Most common benign cause:** Iatrogenic (Indwelling catheters/pacemaker wires). * **Pemberton’s Sign:** Facial flushing and inspiratory stridor upon raising both arms (indicates SVC obstruction). * **Immediate Management:** Elevate the head of the bed, oxygen, and loop diuretics to reduce hydrostatic pressure while awaiting definitive diagnosis.

Q: What is the standard treatment regimen for metastatic testicular carcinoma?

Bleomycin, Etoposide, Cisplatin. The standard of care for metastatic germ cell tumors (GCTs), including testicular carcinoma, is the **BEP regimen** (Bleomycin, Etoposide, and Cisplatin). This combination is highly effective, making testicular cancer one of the most curable solid malignancies. 1. **Why Option A is Correct:** * **Cisplatin:** The backbone of treatment; it causes DNA cross-linking. * **Etoposide:** A topoisomerase II inhibitor that prevents DNA replication. * **Bleomycin:** An antitumor antibiotic that induces DNA strand breaks. Depending on the risk stratification (IGCCCG criteria), patients receive either 3 or 4 cycles of BEP. 2. **Why Other Options are Incorrect:** * **Option B (VeIP):** Vinblastine, Ifosfamide, and Cisplatin is a second-line (salvage) regimen used if BEP fails. * **Option C & D:** These combinations (containing 5-FU, Doxorubicin, or Methotrexate) are used for gastrointestinal, breast, or hematological malignancies but have no role in the primary management of testicular GCTs. **High-Yield Clinical Pearls for NEET-PG:** * **Toxicity Profile:** * **Bleomycin:** Associated with **pulmonary fibrosis**. Avoid in patients over 40 or those with pre-existing lung disease. * **Cisplatin:** Highly emetogenic; causes **nephrotoxicity** (prevented by aggressive hydration) and **ototoxicity**. * **Etoposide:** Can lead to secondary leukemia (AML). * **Tumor Markers:** Always monitor **AFP, beta-hCG, and LDH** for diagnosis, staging, and response to treatment. (Note: AFP is never elevated in pure seminoma). * **Residual Mass:** If a mass >1 cm remains after chemotherapy in non-seminomatous GCTs, **Retroperitoneal Lymph Node Dissection (RPLND)** is indicated.

Q: What is the drug of choice for chronic myeloid leukemia?

Imatinib Mesylate. **Explanation:** **Correct Answer: A. Imatinib Mesylate** Chronic Myeloid Leukemia (CML) is characterized by the **Philadelphia chromosome [t(9;22)]**, which creates the **BCR-ABL1** fusion gene. This gene encodes a constitutively active tyrosine kinase protein that drives uncontrolled granulocyte proliferation. **Imatinib Mesylate** is a selective **Tyrosine Kinase Inhibitor (TKI)** that binds to the ATP-binding site of the BCR-ABL protein, inhibiting its activity [1], [2]. It is the first-line "Standard of Care" (Drug of Choice) for CML in the chronic phase, significantly improving 10-year survival rates [1]. **Why other options are incorrect:** * **B. Fludarabine:** A purine analog primarily used in the treatment of **Chronic Lymphocytic Leukemia (CLL)** and certain non-Hodgkin lymphomas. * **C. Cladribine (2-CdA):** The drug of choice for **Hairy Cell Leukemia**. It is a purine nucleoside analog that is resistant to degradation by adenosine deaminase. * **D. Pentostatin:** Another adenosine deaminase inhibitor used as an alternative treatment for Hairy Cell Leukemia, but not for CML. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** CML is associated with a decrease in **Leukocyte Alkaline Phosphatase (LAP) score**, which helps differentiate it from a leukemoid reaction (where LAP is high). * **Side Effects of Imatinib:** Most common side effects include **periorbital edema**, muscle cramps, and skin rashes. * **Resistance:** If resistance to Imatinib develops (often due to the T315I mutation), second-generation TKIs like **Dasatinib** or **Nilotinib** are used [1]. **Ponatinib** is specifically used for the T315I mutation. * **Monitoring:** Therapeutic response is monitored via quantitative PCR for BCR-ABL1 transcripts (Molecular Response) [1].

Q: A 64-year-old man is admitted to the hospital for the assessment of hematuria after being involved in a motor vehicle accident. His physical examination is normal. A CT scan of the abdomen is shown in Figure below. Which of the following is the most likely diagnosis?

renal cell carcinoma. ***Renal cell carcinoma*** - **Heterogeneous enhancing mass** on CT with areas of **necrosis** and **calcification** is classic for renal cell carcinoma in a 64-year-old male. - The **motor vehicle accident** led to incidental discovery of a pre-existing tumor, as **traumatic hematuria** would show different CT findings like fluid collections or lacerations. *Kidney contusion and laceration* - Would show **perinephric hematoma**, **fluid collections**, and **parenchymal disruption** on CT imaging following trauma. - **Acute traumatic injury** typically presents with obvious signs of tissue damage and bleeding around the kidney, not a solid enhancing mass. *Transitional cell carcinoma* - Arises from the **urothelium** lining the **renal pelvis** or **collecting system**, appearing as filling defects on imaging. - CT would show **hydronephrosis** and **ureteral obstruction** rather than a solid parenchymal mass with enhancement patterns. *Renal hamartoma* - Also known as **angiomyolipoma**, contains **fat**, **smooth muscle**, and **blood vessels** visible as low-density areas on CT. - Appears as a **well-circumscribed lesion** with **fat attenuation** (negative Hounsfield units), unlike the heterogeneous enhancement seen here.

Q: A patient presents with a seizure and serum electrolyte studies reveal a serum sodium of 128 mEq/L. The urine osmolarity is higher than the serum osmolarity. A chest x-ray shows a lung mass. Which type of lung cancer is most likely to cause this electrolyte imbalance?

Small cell carcinoma. ### Explanation **1. Why Small Cell Carcinoma (SCLC) is Correct:** The clinical presentation describes **SIADH (Syndrome of Inappropriate Antidiuretic Hormone)**. Key features include hyponatremia (128 mEq/L), neurological symptoms (seizures), and inappropriately concentrated urine (urine osmolarity > serum osmolarity) in a patient with a lung mass. [1] SCLC is a neuroendocrine tumor that frequently produces ectopic hormones. [2] It is the most common cause of **ectopic SIADH**, occurring in approximately 7–10% of patients. The tumor cells secrete ADH (vasopressin), which leads to water retention and dilutional hyponatremia. [1] **2. Why the Other Options are Incorrect:** * **Adenocarcinoma:** This is the most common type of lung cancer overall and is typically peripheral. While it can be associated with hypertrophic osteoarthropathy (clubbing), it is not classically associated with SIADH. * **Bronchioloalveolar Carcinoma (now Adenocarcinoma in situ):** This subtype typically presents as a

Q: A 60-year-old woman with heart failure and normal renal function is started on furosemide 80 mg/day. She experiences a good diuretic response with the medication. A few weeks later, she reports feeling unwell with fatigue and muscle weakness, although her heart failure symptoms have improved. What is the most likely explanation for her muscle weakness?

Hypokalemia. **Explanation:** The correct answer is **Hypokalemia (Option C)**. **Mechanism:** Furosemide is a potent **loop diuretic** that inhibits the Na+/K+/2Cl- symporter in the thick ascending limb of the Loop of Henle. By increasing the delivery of sodium and fluid to the distal nephron, it stimulates the renin-angiotensin-aldosterone system (RAAS). Aldosterone acts on the principal cells of the collecting duct to reabsorb sodium in exchange for secreting potassium and hydrogen ions into the urine. This "distal delivery" effect leads to significant urinary potassium wasting. Hypokalemia causes hyperpolarization of muscle cell membranes, leading to symptoms of **fatigue, muscle weakness, and cramps.** **Analysis of Incorrect Options:** * **Hyponatremia (A):** While loop diuretics can cause hyponatremia, it is much more common with Thiazides. In this clinical context, muscle weakness following diuretic use is a classic presentation of potassium depletion. * **Hypernatremia (B):** Diuretics typically cause loss of both water and solutes; they do not typically cause a rise in serum sodium unless there is profound dehydration with inadequate water intake. * **Hyperkalemia (D):** This is a side effect of potassium-sparing diuretics (e.g., Spironolactone) or ACE inhibitors, not loop diuretics. **High-Yield Clinical Pearls for NEET-PG:** * **Metabolic Profile of Loop Diuretics:** Hypokalemic, hypochloremic metabolic alkalosis (due to H+ loss) and hypocalcemia ("Loops lose calcium"). * **ECG Findings in Hypokalemia:** Flattened T-waves, prominent **U-waves**, and ST-segment depression. * **Drug Interaction:** Hypokalemia potentiates **Digoxin toxicity**, a critical consideration in heart failure patients. * **Ototoxicity:** Furosemide can cause dose-dependent hearing loss, especially when given intravenously or with other ototoxic drugs (e.g., Aminoglycosides).

Q: What is the standard treatment for Hodgkin lymphoma?

The ABVD regimen is commonly used.. **Explanation:** **1. Why Option A is Correct:** The **ABVD regimen** (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine) is the current gold standard for both early and advanced-stage Hodgkin Lymphoma (HL). It is preferred over older regimens like MOPP because it is highly effective, better tolerated, and associated with a significantly lower risk of secondary malignancies (like leukemia) and infertility. **2. Why Other Options are Incorrect:** * **Option B:** Unlike the older MOPP regimen (Mustine, Oncovin, Procarbazine, Prednisolone), **ABVD does not typically cause permanent sterility**. This is a major clinical advantage, as HL often affects young patients of reproductive age. * **Option C:** According to the **Hasenclever International Prognostic Index (IPI)** for advanced HL, a **WBC count ≥ 15 x 10⁹/L** is actually a **poor prognostic factor**, not a good one [1]. Other poor prognostic factors include age ≥ 45, male sex, Stage IV disease, Albumin < 4 g/dL, Hemoglobin < 10.5 g/dL, and Lymphopenia (< 0.6 x 10⁹/L). **3. High-Yield Clinical Pearls for NEET-PG:** * **Bleomycin Toxicity:** Monitor for **pulmonary fibrosis**; avoid high inspired oxygen concentrations during surgery. * **Adriamycin (Doxorubicin):** Associated with dose-dependent **cardiotoxicity** (dilated cardiomyopathy). * **Reed-Sternberg Cells:** The diagnostic hallmark of HL, typically expressing **CD15 and CD30** (except in the Nodular Lymphocyte Predominant subtype, which is CD20+) [1]. * **Staging:** The **Ann Arbor Staging System** (modified by Cotswolds) is used, with PET-CT being the preferred modality for initial staging and response assessment (Deauville Criteria) [1].

Question 1

In humoral hypercalcemia of malignancy, what serum calcium level indicates severe hypercalcemia, which may present with symptoms such as fatigue, mental status changes, dehydration, or nephrolithiasis?

Accepted Answer

14 mg/dl

Answer

12 mg/dl

Answer

11 mg/dl

Answer

10 mg/dl

Question 2

What is the primary treatment for Superior Vena Cava (SVC) syndrome caused by Small Cell Lung Carcinoma?

Accepted Answer

Chemotherapy

Answer

Radiotherapy

Answer

Surgery

Answer

No treatment

Question 3

What is the standard treatment regimen for metastatic testicular carcinoma?

Accepted Answer

Bleomycin, Etoposide, Cisplatin

Answer

Vinblastine, Etoposide, Cisplatin

Answer

Doxorubicin, 5-Fluorouracil, Mercaptopurine

Answer

Methotrexate, 5-Fluorouracil, Vincristine

Question 4

A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain worsened by movement. Investigations reveal anemia, elevated calcium, urea, and creatinine. X-rays show multiple lytic lesions in long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein. What is the most likely mechanism for the renal injury?

Accepted Answer

Tubular damage by light chains

Answer

Plasma cell infiltrates

Answer

Glomerular injury

Answer

Vascular injury by light chains

Question 5

What is the drug of choice for chronic myeloid leukemia?

Accepted Answer

Imatinib Mesylate

Answer

Fludarabine

Answer

Cladribine

Answer

Pentostatin

Question 6

A 64-year-old man is admitted to the hospital for the assessment of hematuria after being involved in a motor vehicle accident. His physical examination is normal. A CT scan of the abdomen is shown in Figure below. Which of the following is the most likely diagnosis?

Accepted Answer

renal cell carcinoma

Answer

kidney contusion and laceration

Answer

transitional cell carcinoma

Answer

renal hamartoma

Question 7

A patient presents with a seizure and serum electrolyte studies reveal a serum sodium of 128 mEq/L. The urine osmolarity is higher than the serum osmolarity. A chest x-ray shows a lung mass. Which type of lung cancer is most likely to cause this electrolyte imbalance?

Accepted Answer

Small cell carcinoma

Answer

Adenocarcinoma

Answer

Bronchioloalveolar carcinoma

Answer

Large cell carcinoma

Question 8

Which group of lymph nodes is classically involved in tuberculosis of the larynx?

Accepted Answer

Posterior cervical lymph nodes

Answer

Anterior cervical lymph nodes

Answer

Pretracheal lymph nodes

Answer

Submandibular lymph nodes

Question 9

A 60-year-old woman with heart failure and normal renal function is started on furosemide 80 mg/day. She experiences a good diuretic response with the medication. A few weeks later, she reports feeling unwell with fatigue and muscle weakness, although her heart failure symptoms have improved. What is the most likely explanation for her muscle weakness?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypernatremia

Answer

Hyperkalemia

Question 10

What is the standard treatment for Hodgkin lymphoma?

Accepted Answer

The ABVD regimen is commonly used.

Answer

Sterility is a common side effect of the ABVD regimen.

Answer

A WBC count greater than 16 x 10^9/L is considered a good prognostic factor.

Answer

None of the above.

Oncology — MCQs

Oncology — MCQs

On this page

Practice by Chapter

Want unlimited practice?