Oncology Practice Questions

Q: Which is the most common metastatic disease causing Superior Vena Cava (SVC) syndrome?

Metastatic breast carcinoma. **Explanation:** Superior Vena Cava (SVC) syndrome results from the external compression or internal thrombosis of the SVC, leading to venous congestion in the head, neck, and upper extremities. **1. Why Metastatic Breast Carcinoma is correct:** While **Bronchogenic carcinoma** is the most common *overall* cause of SVC syndrome (accounting for ~75% of cases), the question specifically asks for the most common **metastatic** disease. In the context of secondary spread from a distant primary site (excluding direct extension from the lung), **Breast carcinoma** is the most frequent metastatic malignancy to cause SVC syndrome [1]. This typically occurs via mediastinal lymph node metastasis or direct compression from metastatic masses. **2. Analysis of Incorrect Options:** * **A. Bronchogenic carcinoma:** This is the most common **primary** malignancy causing SVC syndrome. It is categorized as a primary intrathoracic tumor rather than a "metastatic disease" in this context [2]. * **C. Metastatic vertebral carcinoma:** While vertebral metastases are common in many cancers, they rarely involve the anterior mediastinal space or the SVC directly [3]. * **D. Gastric carcinoma:** Though it can metastasize to Virchow’s node (supraclavicular), it rarely involves the mediastinal nodes to a degree that causes SVC obstruction. **3. NEET-PG High-Yield Pearls:** * **Most common cause overall:** Bronchogenic carcinoma (Small Cell Lung Cancer > Non-Small Cell). * **Second most common cause:** Lymphoma (especially Non-Hodgkin Lymphoma). * **Most common benign cause:** Iatrogenic (indwelling central venous catheters or pacemakers). * **Clinical Sign:** Pemberton’s sign (facial flushing/cyanosis when arms are raised). * **Management:** Emergency radiotherapy is indicated if there is airway compromise or cerebral edema; otherwise, stenting and treating the underlying malignancy is the mainstay.

Q: A 14-year-old girl presents with a rash, abdominal pain, arthralgias, nausea, vomiting, and bloody stools. Physical examination reveals a palpable purpuric rash on her buttocks and lower legs, a tender abdomen, and no active joint inflammation. Urinalysis shows RBCs and RBC casts, and her renal function deteriorates rapidly. A renal biopsy is performed. Considering the clinical presentation and biopsy, what is the most likely diagnosis on renal biopsy for this patient with glomerulonephritis (GN)?

Diffuse proliferative GN. **Explanation:** The clinical presentation of a palpable purpuric rash (buttocks/legs), abdominal pain, arthralgia, and hematuria in a young patient is classic for **Henoch-Schönlein Purpura (HSP)**, also known as IgA Vasculitis. When HSP involves the kidneys, it is termed HSP nephritis. **Why Option A is Correct:** The renal manifestations of HSP are histologically identical to IgA Nephropathy [1]. The severity of the biopsy findings correlates with the clinical presentation. While HSP can show a spectrum of changes, in cases where there is **rapidly deteriorating renal function** and significant hematuria (RBC casts), the most common underlying histological pattern is **Diffuse Proliferative Glomerulonephritis (DPGN)**. This involves global involvement of more than 50% of glomeruli with significant mesangial and endocapillary proliferation. **Why other options are incorrect:** * **B. Crescentic GN:** While this represents the most severe form (Type VI) and can cause rapid deterioration [2], DPGN is the broader pathological category often associated with the initial aggressive proliferative phase in systemic vasculitis. * **C. Focal Proliferative GN:** This is seen in milder clinical cases of HSP where renal function is usually preserved. * **D. Membranoproliferative GN (MPGN):** This is characterized by "tram-track" basement membrane splitting and is typically associated with Hepatitis C or complement dysregulation, not classic HSP. **High-Yield Clinical Pearls for NEET-PG:** * **HSP Tetrad:** Purpura (non-thrombocytopenic), Arthralgia, Abdominal pain, and Renal disease. * **Pathogenesis:** Systemic deposition of **IgA1-containing immune complexes**. * **Biopsy Gold Standard:** Immunofluorescence showing **mesangial IgA deposits** [1]. * **Prognosis:** Generally excellent in children, but the presence of RBC casts and nephritic/nephrotic range proteinuria indicates a higher risk of chronic kidney disease.

Q: Which of the following statements regarding the Philadelphia chromosome is NOT true?

Specific for CML.. The Philadelphia (Ph) chromosome is the hallmark of Chronic Myeloid Leukemia (CML), but it is not exclusive to it. **Explanation of the Correct Answer (C):** The statement "Specific for CML" is **incorrect** because the Philadelphia chromosome is also found in other hematological malignancies. It is present in approximately **25-30% of adults with Acute Lymphoblastic Leukemia (ALL)**, 2-5% of pediatric ALL, and occasionally in Acute Myeloid Leukemia (AML). In ALL, its presence signifies a poor prognosis [1]. **Analysis of Other Options:** * **Option A:** It is present in **>95% of CML patients**. The remaining 5% are "Ph-negative" but usually harbor the cryptic *BCR-ABL1* fusion gene detectable by FISH or PCR. * **Option B & D:** The Ph chromosome is a **reciprocal translocation** between chromosomes 9 and 22, designated as **t(9;22)(q34;q11)** [2]. This results in the fusion of the *ABL1* proto-oncogene (Ch 9) with the *BCR* gene (Ch 22), creating a chimeric protein with constitutive tyrosine kinase activity [2]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Molecular Weight:** The fusion protein in CML is typically **p210**, whereas in Ph+ ALL, it is often **p190**. 2. **Diagnosis:** While karyotyping identifies the Ph chromosome, **FISH** is more sensitive, and **RT-PCR** is the gold standard for monitoring Minimal Residual Disease (MRD) [3]. 3. **Treatment:** The first-line treatment for Ph+ CML is **Imatinib** (a Tyrosine Kinase Inhibitor) [2], [3]. 4. **Blast Crisis:** CML can transform into either AML (70%) or ALL (30%) during a blast crisis.

Q: A 50-year-old woman presents with pain and swelling in her proximal interphalangeal joints, wrists, and knees, accompanied by morning stiffness. She has a history of hysterectomy 10 years ago. Physical examination reveals swelling and synovial thickening of the proximal interphalangeal (PIP) joints. Her laboratory findings include: Hemoglobin 10.3 g/dL, MCV 80 fL, serum iron 28 mg/dL, iron-binding capacity 200 mg/dL, and saturation 14%. What is the most likely explanation for this woman's anemia?

Anemia of chronic disease. The patient presents with clinical features classic for **Rheumatoid Arthritis (RA)**: symmetrical inflammatory polyarthritis involving the PIP joints and wrists with significant morning stiffness [1]. In the context of a chronic inflammatory state like RA, the most common cause of anemia is **Anemia of Chronic Disease (ACD)**. [2] **1. Why Anemia of Chronic Disease is correct:** In chronic inflammation, cytokines (especially IL-6) trigger the liver to produce **Hepcidin** [1]. Hepcidin inhibits **ferroportin**, preventing iron release from macrophages and decreasing intestinal iron absorption. This leads to "iron sequestration" [3]. * **Lab Profile in ACD:** Low serum iron, **low Total Iron Binding Capacity (TIBC)**, and normal-to-high ferritin. * In this case, the TIBC is low (200 mg/dL; normal 250–450), which is the hallmark that distinguishes ACD from Iron Deficiency Anemia (IDA). **2. Why the other options are incorrect:** * **A. Occult blood loss:** This leads to Iron Deficiency Anemia. While IDA also has low serum iron, it is characterized by a **high TIBC** (compensatory increase in transferrin), which is not present here. [3] * **B. Vitamin deficiency:** B12 or Folate deficiency causes megaloblastic anemia with a **high MCV** (>100 fL). This patient has a low-normal MCV (80 fL). * **C. Sideroblastic anemia:** This typically presents with **increased** serum iron and saturation due to the inability to incorporate iron into hemoglobin, often showing "ringed sideroblasts" in the bone marrow. **High-Yield Clinical Pearls for NEET-PG:** * **ACD vs. IDA:** The most reliable differentiator is **Ferritin** (Low in IDA, Normal/High in ACD) and **TIBC** (High in IDA, Low in ACD). * **Hepcidin** is the "master regulator" of iron metabolism and an acute-phase reactant [3]. * In RA, the severity of anemia usually correlates with the degree of joint inflammation and ESR/CRP levels.

Q: What is the most common cause of carcinomatous meningitis?

Carcinoma of the breast. **Explanation:** **Carcinomatous meningitis** (also known as Leptomeningeal Carcinomatosis) occurs when cancer cells infiltrate the subarachnoid space and spread via the cerebrospinal fluid (CSF). **1. Why Breast Carcinoma is the Correct Answer:** Statistically, **Breast Carcinoma** is the most common solid tumor to cause leptomeningeal metastasis, accounting for approximately 30–40% of cases. [1] This is followed closely by lung cancer. The high prevalence is attributed to the biological tendency of breast cancer cells to seed the CNS and the prolonged survival of these patients due to improved systemic therapies, allowing time for late-stage meningeal seeding to manifest. **2. Analysis of Incorrect Options:** * **Carcinoma of the Lung (Option B):** This is the second most common cause. While lung cancer is the most common cause of *parenchymal* brain metastases, it ranks just behind breast cancer for purely leptomeningeal involvement. * **Malignant Melanoma (Option D):** Melanoma has the highest *relative risk* or "propensity" per case to spread to the meninges; however, because melanoma is less common than breast or lung cancer in the general population, it is not the most common cause overall. * **Gastrointestinal Tract (Option C):** GI malignancies (like gastric or colorectal cancer) can cause carcinomatous meningitis, but this is significantly rarer compared to breast, lung, and melanoma. **3. NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Characterized by "multifocal" neurological deficits (e.g., cranial nerve palsies + radiculopathy + headache). * **Gold Standard Diagnosis:** CSF Cytology (shows malignant cells). Note: The first tap may be negative; sensitivity increases with repeated taps (up to 3 taps). [2] * **MRI Finding:** "Sugar coating" or linear enhancement of the leptomeninges and cranial nerves (Zuckerguss appearance). * **Most common primary in children:** Medulloblastoma and Ependymoma.

Q: Which of the following is NOT a paraneoplastic manifestation of bronchogenic carcinoma?

Acanthosis nigricans. **Explanation:** Paraneoplastic syndromes are clinical syndromes involving non-metastatic systemic effects that accompany malignant disease [3]. While many cancers share similar paraneoplastic manifestations, certain signs are classically associated with specific primary tumors. **Why Acanthosis Nigricans is the correct answer:** Acanthosis nigricans (specifically the malignant type) is most strongly associated with **intra-abdominal adenocarcinomas**, with **gastric carcinoma** being the most common (approx. 55-60% of cases). While it can rarely occur with other cancers, it is not a classic paraneoplastic manifestation of bronchogenic carcinoma. **Analysis of other options:** * **Dermatomyositis (A):** This inflammatory myopathy has a strong association with several malignancies, particularly **Small Cell Lung Cancer (SCLC)** and non-small cell lung cancer, as well as ovarian and breast cancers [1]. * **Cerebellar degeneration (C):** Paraneoplastic cerebellar degeneration is a well-documented neurological manifestation of **Small Cell Lung Cancer**, often mediated by anti-Hu or anti-VGCC antibodies [3]. * **Hyperkeratosis of palms and soles (D):** Also known as **Tylosis**, this is a recognized paraneoplastic feature of **Squamous Cell Carcinoma of the Lung** (and esophagus). **NEET-PG High-Yield Pearls:** * **Small Cell Lung Cancer (SCLC):** Most common cause of SIADH, Ectopic ACTH (Cushing’s), and Lambert-Eaton Myasthenic Syndrome [1], [3]. * **Squamous Cell Carcinoma:** Most common cause of Hypercalcemia (due to PTHrP) [1]. * **Hypertrophic Osteoarthropathy (HOA):** Classically associated with Adenocarcinoma of the lung [2]. * **Leser-Trélat sign:** Sudden onset of multiple seborrheic keratoses; like malignant acanthosis nigricans, it points toward **Gastric Adenocarcinoma**.

Question 1

Which of the following is NOT included in the management of febrile neutropenic patients receiving anti-cancer therapy?

Accepted Answer

Transfusion of granulocytes

Answer

Colony stimulating factors

Answer

Antibiotic prophylaxis

Answer

Repeated hand washing

Question 2

Which is the most common metastatic disease causing Superior Vena Cava (SVC) syndrome?

Accepted Answer

Metastatic breast carcinoma

Answer

Bronchogenic carcinoma

Answer

Metastatic vertebral carcinoma

Answer

Gastric carcinoma

Question 3

A 14-year-old girl presents with a rash, abdominal pain, arthralgias, nausea, vomiting, and bloody stools. Physical examination reveals a palpable purpuric rash on her buttocks and lower legs, a tender abdomen, and no active joint inflammation. Urinalysis shows RBCs and RBC casts, and her renal function deteriorates rapidly. A renal biopsy is performed. Considering the clinical presentation and biopsy, what is the most likely diagnosis on renal biopsy for this patient with glomerulonephritis (GN)?

Accepted Answer

Diffuse proliferative GN

Answer

Crescentic GN

Answer

Focal proliferative GN

Answer

Membranoproliferative GN

Question 4

Which parameter best predicts the return of renal function in a patient with tumor lysis syndrome?

Accepted Answer

Serum uric acid

Answer

Serum creatinine

Answer

Serum phosphate

Answer

Serum potassium

Question 5

Which of the following statements regarding the Philadelphia chromosome is NOT true?

Accepted Answer

Specific for CML.

Answer

Present in 95% of chronic myeloid leukemia (CML) patients.

Answer

It is the result of a reciprocal translocation.

Answer

Designated as t(9;22)(q34;q11).

Question 6

A 50-year-old woman presents with pain and swelling in her proximal interphalangeal joints, wrists, and knees, accompanied by morning stiffness. She has a history of hysterectomy 10 years ago. Physical examination reveals swelling and synovial thickening of the proximal interphalangeal (PIP) joints. Her laboratory findings include: Hemoglobin 10.3 g/dL, MCV 80 fL, serum iron 28 mg/dL, iron-binding capacity 200 mg/dL, and saturation 14%. What is the most likely explanation for this woman's anemia?

Accepted Answer

Anemia of chronic disease

Answer

Occult blood loss

Answer

Vitamin deficiency

Answer

Sideroblastic anemia

Question 7

A 69-year-old man with a 60 pack-year smoking history presents with dizziness and visual disturbances. Physical examination reveals a purplish discoloration of his face, arms, and neck; retinal vein engorgement; and visible distention of his neck veins. His complete blood count reveals a normocytic anemia. The pathophysiology of this patient’s clinical presentation most likely involves which of the following?

Accepted Answer

Obstruction of the superior vena cava by a primary tumor arising in the lungs

Answer

Right heart failure secondary to left heart failure

Answer

Metastatic disease to the cervical lymph nodes with compression of the jugular veins

Answer

Polycythemia rubra vera

Question 8

Which of the following is NOT recommended for the management of Tumour lysis syndrome?

Accepted Answer

Urinary alkalinisation using soda bicarbonate

Answer

Allopurinol

Answer

Febuxostat

Answer

Rasburicase

Question 9

What is the most common cause of carcinomatous meningitis?

Accepted Answer

Carcinoma of the breast

Answer

Carcinoma of the lung

Answer

Carcinoma of the gastrointestinal tract

Answer

Malignant melanoma

Question 10

Which of the following is NOT a paraneoplastic manifestation of bronchogenic carcinoma?

Accepted Answer

Acanthosis nigricans

Answer

Dermatomyositis

Answer

Cerebellar degeneration

Answer

Hyperkeratosis of palm and soles

Oncology — MCQs

Oncology — MCQs

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