Oncology Practice Questions

Q: A 55-year-old woman with a history of breast carcinoma presents with new-onset bone pain. What is the most appropriate diagnostic test?

Bone scan. A 55-year-old woman with a history of breast carcinoma presents with new-onset bone pain. What is the most appropriate diagnostic test? ***Bone scan*** - A **bone scan** is highly sensitive for detecting **metastatic bone disease**, especially in patients with a history of cancer and new-onset bone pain. - It identifies increased osteoblastic activity around bony metastases, even when other imaging might appear normal. *MRI of the spine* - While an **MRI of the spine** is excellent for visualizing **soft tissue involvement** and spinal cord compression from metastases, it is typically used for more localized pain or neurological deficits, not as an initial broad screening tool for diffuse bone pain. - It would be beneficial if the bone pain was localized to the spine, but it does not provide a comprehensive assessment of the entire skeletal system for metastases. *CT scan of the abdomen* - A **CT scan of the abdomen** is primarily used to evaluate **abdominal organs** and detect metastases within the abdomen. - It is not the most appropriate initial test for assessing **bone pain**, as it offers limited views of bone involvement beyond the abdominal region and less sensitivity for early bone lesions compared to a bone scan. *X-ray of the affected bone* - An **X-ray of the affected bone** can detect significant lytic or blastic lesions, but it often requires **30-50% bone demineralization** before a lesion becomes visible. - X-rays are less sensitive than bone scans for detecting early metastatic disease and may miss multifocal lesions.

Q: A 65-year-old man with a long history of smoking presents with a chronic cough, dyspnea, and clubbing of the fingers. Which of the following conditions is most likely associated with these findings?

Aortic stenosis. **Aortic stenosis** - While **aortic stenosis** can cause dyspnea and cough due to **heart failure** and **pulmonary congestion**, it is not typically associated with **clubbing of the fingers** [2] or a history of **heavy smoking** as a direct cause of these respiratory symptoms. - The link between aortic stenosis and clubbing is less common and usually indirect, through **severe heart failure** causing chronic hypoxia. *Periosteal inflammation* - **Periosteal inflammation** can cause bone pain and swelling, but it does not directly explain the triad of **chronic cough**, **dyspnea**, and **clubbing** in a smoker. [2] - It is a local rather than a systemic condition that would cause chronic respiratory symptoms. *Lung cancer* - **Lung cancer** is a strong consideration given the patient's **smoking history**, **chronic cough**, and **dyspnea**. [3] - However, the question asks for the *most likely associated condition* with clubbing, which can also be caused by various other conditions, and the options should be critically evaluated. [2] *Rheumatoid arthritis* - **Rheumatoid arthritis** primarily affects joints and can cause systemic symptoms, but it does not typically cause **chronic cough**, **dyspnea**, or **clubbing** directly. - Lung involvement in rheumatoid arthritis (e.g., **interstitial lung disease**) is possible but is a secondary manifestation and less directly linked to the initial presentation of cough, dyspnea, and clubbing in a smoker. [1]

Q: A young male with a testicular mass is found to have elevated beta-hCG levels. What is the most likely diagnosis?

Embryonal Carcinoma. ***Choriocarcinoma*** - Characterized by **elevated beta-hCG levels**, this indicates **germ cell tumors**, commonly associated with choriocarcinoma. - It often presents with a **testicular mass** and can metastasize to lungs and other organs. *Seminoma* - Typically presents with a **testicular mass** but usually has **normal beta-hCG levels** unless mixed with other germ cell tumors. - Most common germ cell tumor, but generally does not elevate **beta-hCG** significantly. *Embryonal Carcinoma* - Can produce beta-hCG but is usually seen in **mixed germ cell tumors** rather than isolated choriocarcinoma. - Typically presents with a **varied mass**, often painful, and may show **elevated AFP** levels if it's a mixed type. *Teratoma* - Often presents as a **benign mass** with **no elevation of beta-hCG**; typically does not produce hormones. - While teratomas can have malignant potential, they usually do not result in significant **beta-hCG elevation**.

Q: A 55-year-old woman with cirrhosis is found to have a liver lesion with elevated alpha-fetoprotein. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - **Elevated alpha-fetoprotein (AFP)** levels in a patient with cirrhosis are strongly indicative of hepatocellular carcinoma, which commonly arises in this context [1]. - Hepatocellular carcinoma typically presents as a **liver lesion** and is associated with chronic liver disease and cirrhosis [1]. *Hemangioma* - Generally, hemangiomas are **benign vascular tumors** and do not cause elevated levels of alpha-fetoprotein. - They are often asymptomatic and discovered incidentally on imaging, unlike hepatocellular carcinoma, which will present more aggressively in this setting. *Liver metastasis* - Liver metastases can occur in cirrhotic patients but are less likely to be associated with significant elevations of alpha-fetoprotein unless specific primary tumors are involved. - Primary tumors, such as colorectal cancer, usually produce **different markers**, and the presence of AFP suggests a primary liver cancer rather than metastatic disease. *Hepatic adenoma* - Hepatic adenomas are also benign tumors but are less common in patients with cirrhosis and typically do not cause elevated alpha-fetoprotein levels. - More frequently found in women taking **oral contraceptives**, they generally lack the aggressive features seen in hepatocellular carcinoma.

Q: A 65-year-old patient presents with hematuria, weight loss, and flank pain. CT shows a solid renal mass with calcifications and renal vein invasion. Laboratory results indicate hemoglobin of 10.8, ESR of 45, and creatinine of 1.6. What is the best diagnosis?

Renal cell carcinoma. ***Renal cell carcinoma*** - The classic triad of **hematuria, flank pain, and palpable mass** (though a palpable mass isn't explicitly stated, flank pain and hematuria are present) combined with **weight loss** and a **solid renal mass with calcifications and renal vein invasion** on CT are highly indicative of **renal cell carcinoma (RCC)** [1]. - The lab findings of **anemia (Hb 10.8)**, **elevated ESR (45)**, and mild renal dysfunction (creatinine 1.6) further support a diagnosis of RCC, especially with paraneoplastic syndromes. *Transitional cell carcinoma* - This typically arises in the **renal pelvis or ureter** and often presents with painless gross hematuria, but **solid mass with calcifications and renal vein invasion** is less characteristic of TCC. - While it can cause hematuria and flank pain, the imaging findings of a solid renal mass with calcifications and invasion are more typical of parenchymal tumors like RCC. *Angiomyolipoma* - This is a **benign tumor** composed of blood vessels, smooth muscle, and fat, making it appear hyperechoic or fat-containing on imaging, rather than a solid mass with calcifications. - It usually presents with symptoms only when large or hemorrhaging, and **weight loss and renal vein invasion** are not characteristic features. *Wilms' tumor* - Primarily affects **children**, typically presenting as an asymptomatic abdominal mass, hematuria, and hypertension. - This patient's age (65-year-old) makes Wilms' tumor an **extremely unlikely diagnosis** [1].

Q: A patient with non-small cell lung cancer (NSCLC) who is resistant to first-line chemotherapy should have which molecular marker evaluated to guide second-line targeted therapy?

EGFR mutation. ### EGFR mutation - **EGFR mutations** are common in NSCLC and can lead to resistance to first-line chemotherapy, specifically **tyrosine kinase inhibitors (TKIs)** [1]. - Identifying specific EGFR mutations, such as **T790M**, can guide the use of second-generation or third-generation EGFR TKIs like **osimertinib** as second-line therapy. *BRCA1 mutation* - **BRCA1 mutations** are primarily associated with an increased risk of **breast and ovarian cancers**, and occasionally prostate and pancreatic cancers. - They are not routinely evaluated or considered a primary target for guiding second-line therapy in NSCLC. *BCR-ABL fusion gene* - The **BCR-ABL fusion gene** is a hallmark of **chronic myeloid leukemia (CML)** and some cases of acute lymphoblastic leukemia (ALL) [1]. - This gene is a target for **tyrosine kinase inhibitors** like imatinib in these hematological malignancies but is not relevant for NSCLC [1]. *HER2 overexpression* - **HER2 overexpression** or amplification is a significant prognostic and predictive marker in **breast cancer** and some gastric cancers, guiding **trastuzumab** therapy [1]. - While HER2 alterations can occur in a small subset of NSCLC, they are less common and less established as a primary driver for second-line targeted therapy compared to EGFR mutations.

Q: A 40-year-old man presents with generalized lymphadenopathy and a mediastinal mass. Histology reveals Reed-Sternberg cells. Which combination of treatments offers the best chance of remission?

Chemotherapy and radiation therapy. The original explanation provided already accurately details that chemotherapy and radiation therapy are the standard treatment for Hodgkin's lymphoma [1], as the disease originates in lymphoid tissues and is identified by Reed-Sternberg cells [1]. Chemotherapy functions to reduce tumor burden, while radiation therapy is used to eliminate localized disease [1]. Historically, radiation alone was used for localized (stage IA/IIA) disease [1]. Immunotherapy and surgery are generally not first-line options. While stem cell transplant is used for relapsed or refractory cases, it is not the initial treatment strategy [1].

Q: A 25-year-old woman presents with painless hematuria and a history of recurrent urinary tract infections. Urine cytology reveals atypical cells, and cystoscopy shows a papillary lesion. What is the most likely diagnosis?

Transitional cell carcinoma. ***Transitional cell carcinoma*** - Characterized by **painless hematuria** [1] and often occurs in patients with a history of **urinary tract infections**. - The presence of **atypical cells in urine cytology** and a **papillary lesion** found via cystoscopy supports this diagnosis. *Renal cell carcinoma* - Typically presents with **flank pain**, **weight loss**, and **hematuria**, but is less common in young women compared to transitional cell carcinoma. - Uncommonly associated with cystoscopic findings of **papillary lesions**; it usually manifests as solid renal mass rather than urinary tract lesions. *Adenocarcinoma* - Generally arises in **glandular tissue** of the kidney and shows variable presentation, not typically linked to **hematuria** in the bladder. - Rare in the bladder environment and does not align well with **urinary tract infection** history or cystoscopy findings. *Squamous cell carcinoma* - More commonly associated with chronic irritation from **schistosomiasis** or prolonged bladder catheterization rather than recurrent UTIs. - Presents with **painful urination** or hematuria [1] and is not typically related to **papillary lesions** seen in this case.

Q: A 65-year-old man presents with fatigue, weight loss, and abdominal pain. A CT scan of the abdomen reveals a pancreatic mass. What is the most likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The combination of **fatigue, weight loss, and abdominal pain** in an elderly patient, alongside a **pancreatic mass** on CT, are classic signs of pancreatic adenocarcinoma [1]. - This cancer is often diagnosed at an advanced stage due to its subtle and nonspecific initial symptoms. *Chronic pancreatitis* - While chronic pancreatitis can cause abdominal pain and weight loss, it typically presents with a history of recurrent episodes of pancreatitis, often related to **alcohol abuse** [2] or **gallstones**. - A mass on CT in chronic pancreatitis is usually an **inflammatory pseudotumor** or **fibrotic change**, not a distinct solid mass with these systemic symptoms [2]. *Acute pancreatitis* - This condition presents with acute, severe upper abdominal pain, often radiating to the back, associated with elevated pancreatic enzymes (**amylase and lipase**). - It usually does not involve significant weight loss or prolonged fatigue unless it leads to severe complications. *Gastrointestinal stromal tumor* - GISTs are **mesenchymal tumors** that originate in the gastrointestinal tract, most commonly the stomach or small intestine, and rarely in the pancreas. - While they can cause abdominal pain and weight loss, a mass in the pancreas is less commonly a GIST compared to adenocarcinoma.

Question 1

A 55-year-old woman with a history of breast carcinoma presents with new-onset bone pain. What is the most appropriate diagnostic test?

Accepted Answer

Bone scan

Answer

MRI of the spine

Answer

CT scan of the abdomen

Answer

X-ray of the affected bone

Question 2

A 65-year-old man with a long history of smoking presents with a chronic cough, dyspnea, and clubbing of the fingers. Which of the following conditions is most likely associated with these findings?

Accepted Answer

Aortic stenosis

Answer

Periosteal inflammation

Answer

Rheumatoid arthritis

Answer

Lung cancer

Question 3

A 68-year-old male with a history of smoking presents with hemoptysis and weight loss. A chest X-ray shows a mass in the upper lobe, and laboratory results indicate hypercalcemia. Analyze and determine the diagnosis and initial treatment.

Accepted Answer

Squamous cell carcinoma; initial management includes bronchoscopy and biopsy

Answer

Tuberculosis; initial management includes sputum acid-fast bacilli test

Answer

COPD exacerbation; initial management includes bronchodilators and steroids

Answer

Pulmonary embolism; initial management includes CT angiography

Question 4

A young male with a testicular mass is found to have elevated beta-hCG levels. What is the most likely diagnosis?

Accepted Answer

Embryonal Carcinoma

Answer

Choriocarcinoma

Answer

Seminoma

Answer

Teratoma

Question 5

A 55-year-old woman with cirrhosis is found to have a liver lesion with elevated alpha-fetoprotein. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Hepatic adenoma

Answer

Liver metastasis

Answer

Hemangioma

Question 6

A 65-year-old patient presents with hematuria, weight loss, and flank pain. CT shows a solid renal mass with calcifications and renal vein invasion. Laboratory results indicate hemoglobin of 10.8, ESR of 45, and creatinine of 1.6. What is the best diagnosis?

Accepted Answer

Renal cell carcinoma

Answer

Transitional cell carcinoma

Answer

Angiomyolipoma

Answer

Wilms' tumor

Question 7

A patient with non-small cell lung cancer (NSCLC) who is resistant to first-line chemotherapy should have which molecular marker evaluated to guide second-line targeted therapy?

Accepted Answer

EGFR mutation

Answer

BRCA1 mutation

Answer

BCR-ABL fusion gene

Answer

HER2 overexpression

Question 8

A 40-year-old man presents with generalized lymphadenopathy and a mediastinal mass. Histology reveals Reed-Sternberg cells. Which combination of treatments offers the best chance of remission?

Accepted Answer

Chemotherapy and radiation therapy

Answer

Surgery and radiotherapy

Answer

Chemotherapy and stem cell transplant

Answer

Immunotherapy and radiation therapy

Question 9

A 25-year-old woman presents with painless hematuria and a history of recurrent urinary tract infections. Urine cytology reveals atypical cells, and cystoscopy shows a papillary lesion. What is the most likely diagnosis?

Accepted Answer

Transitional cell carcinoma

Answer

Renal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 10

A 65-year-old man presents with fatigue, weight loss, and abdominal pain. A CT scan of the abdomen reveals a pancreatic mass. What is the most likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Chronic pancreatitis

Answer

Acute pancreatitis

Answer

Gastrointestinal stromal tumor

Oncology — MCQs

Oncology — MCQs

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