Oncology — MCQs
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All of the following cancers are linked with HIV except?
A 54-year-old construction worker has smoked two packs of cigarettes daily for the past 25 years. He notes swelling in his upper extremity and face, along with dilated veins in this region. A computerized tomography (CT) scan and venogram of the neck are performed. What is the most likely cause of the obstruction?
Due to advances in cancer treatment, the prognosis of which of the following malignancies has become significantly better?
Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?
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?
A 19-year-old girl develops sudden-onset non-bloody diarrhea. She was previously well and is not taking any medications or traveled anywhere recently. Her abdomen is soft and nontender on examination, and the anion gap is normal. For the above patient with new symptoms, select the most likely acid-base disorder.
Hypoglycemia is associated with all of the following conditions, except?
Which group of lymph nodes is classically involved in tuberculosis of the larynx?
Measurement of urine vanillyl mandelic acid can help in the diagnosis of which condition?
Which of the following types of multiple myeloma is most commonly associated with an increased risk of hyperviscosity syndrome?
Oncology Indian Medical PG Practice Questions and MCQs
Question 61: All of the following cancers are linked with HIV except?
- A. Kaposi sarcoma
- B. Urogenital cancer
- C. Non-Hodgkin lymphoma
- D. Adult T-cell leukemia (Correct Answer)
Explanation: ### Explanation The correct answer is **Adult T-cell leukemia (ATL)**. **1. Why Adult T-cell leukemia is the correct answer:** While HIV is associated with several malignancies due to profound immunosuppression, **Adult T-cell leukemia/lymphoma (ATLL)** is specifically caused by the **Human T-lymphotropic virus type 1 (HTLV-1)**. Although both HIV and HTLV-1 are retroviruses and can be co-transmitted via similar routes (blood, sexual contact), HTLV-1 is the direct oncogenic driver of ATLL, not HIV-induced immunosuppression. **2. Analysis of incorrect options:** * **Kaposi Sarcoma (KS):** This is the most common HIV-associated malignancy [1]. It is caused by **HHV-8** (KSHV). It is considered an AIDS-defining illness [2]. * **Non-Hodgkin Lymphoma (NHL):** HIV patients have a significantly higher risk of aggressive B-cell lymphomas (e.g., Diffuse Large B-cell Lymphoma, Burkitt Lymphoma) [1]. Many are associated with **Epstein-Barr Virus (EBV)** [2]. * **Urogenital Cancer:** HIV-infected individuals have a high prevalence of persistent **Human Papillomavirus (HPV)** infection [2]. This leads to increased rates of **Cervical cancer** (AIDS-defining) and **Anal cancer** (highly prevalent in MSM with HIV). **3. NEET-PG High-Yield Pearls:** * **AIDS-Defining Malignancies:** 1. Kaposi Sarcoma, 2. Non-Hodgkin Lymphoma (specifically Burkitt, Immunoblastic, or Primary CNS lymphoma), 3. Invasive Cervical Cancer. * **Non-AIDS Defining Cancers (NADC):** These are increasing as patients live longer on ART. Common examples include Anal cancer, Hodgkin lymphoma, and Hepatocellular carcinoma (due to HBV/HCV co-infection). * **Primary CNS Lymphoma:** Strongly associated with **EBV** in HIV patients [2]; it is a critical differential for ring-enhancing lesions on MRI. * **Most common cause of death in HIV:** Currently, non-AIDS defining conditions (including NADCs and cardiovascular disease) are rising, but infections remain a leading cause globally.
Question 62: A 54-year-old construction worker has smoked two packs of cigarettes daily for the past 25 years. He notes swelling in his upper extremity and face, along with dilated veins in this region. A computerized tomography (CT) scan and venogram of the neck are performed. What is the most likely cause of the obstruction?
- A. Aortic aneurysm
- B. Metastasis
- C. Bronchogenic carcinoma (Correct Answer)
- D. Chronic fibrosing mediastinitis
Explanation: The clinical presentation of facial and upper extremity swelling, coupled with dilated neck veins, is classic for **Superior Vena Cava (SVC) Syndrome**. This occurs due to the extrinsic compression or intrinsic obstruction of the SVC, leading to venous congestion in the head, neck, and arms [1]. **1. Why Bronchogenic Carcinoma is Correct:** In the modern era, **malignancy** is the cause of approximately 70–90% of SVC syndrome cases. Among these, **Bronchogenic Carcinoma** (specifically Small Cell Lung Cancer and Squamous Cell Carcinoma) is the most common etiology [1]. The patient’s significant smoking history (50 pack-years) and occupational exposure strongly point toward a primary lung malignancy as the cause of the mediastinal mass obstructing the SVC [1]. **2. Why Other Options are Incorrect:** * **Aortic Aneurysm:** While a large ascending aortic aneurysm can compress the SVC, it is a much rarer cause compared to malignancy. * **Metastasis:** While mediastinal lymph node metastasis (e.g., from breast or testicular cancer) can cause SVC syndrome, primary bronchogenic carcinoma is statistically more frequent in a heavy smoker. * **Chronic Fibrosing Mediastinitis:** This is a rare non-malignant cause, often associated with *Histoplasma capsulatum* infection or sarcoidosis. It was more common historically but is now rare compared to cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Bronchogenic Carcinoma (Small cell > Squamous cell). * **Most common non-malignant cause:** Iatrogenic (indwelling catheters/pacemaker wires) followed by Fibrosing Mediastinitis. * **Pemberton’s Sign:** Facial flushing and inspiratory stridor upon elevating both arms (indicates thoracic outlet obstruction/SVC syndrome). * **Management:** The priority is airway assessment. Treatment involves radiation therapy (for NSCLC) or chemotherapy (for SCLC/Lymphoma) and stenting for immediate relief [1].
Question 63: Due to advances in cancer treatment, the prognosis of which of the following malignancies has become significantly better?
- A. Glioblastoma Multiforme
- B. Esophageal Carcinoma
- C. Acute Lymphoblastic Leukemia in children (Correct Answer)
- D. Cholangiocarcinoma
Explanation: **Explanation:** The correct answer is **Acute Lymphoblastic Leukemia (ALL) in children**. This represents one of the greatest success stories in modern oncology. **1. Why the correct answer is right:** In the 1960s, pediatric ALL was virtually a terminal diagnosis with a 5-year survival rate of less than 10%. Due to the development of risk-stratified multi-agent chemotherapy protocols (including induction, consolidation, and long-term maintenance therapy) and CNS prophylaxis, the cure rate now exceeds **90%**. The medical concept behind this success is the high sensitivity of lymphoid blast cells to combination chemotherapy and the implementation of standardized international treatment protocols. **2. Why the incorrect options are wrong:** * **Glioblastoma Multiforme (GBM):** Remains one of the most lethal malignancies with a median survival of only 12–15 months despite surgery, radiation, and Temozolomide. * **Esophageal Carcinoma:** Often diagnosed at an advanced stage; even with neoadjuvant chemoradiotherapy and surgery, the 5-year survival remains relatively low (approx. 20%). * **Cholangiocarcinoma:** This "silent killer" is typically resistant to chemotherapy and radiation. Unless it is resectable at an early stage, the prognosis remains very poor. **3. NEET-PG High-Yield Pearls:** * **Most common malignancy in children:** ALL. * **Best prognostic factor in ALL:** Age between 1–10 years and a low initial WBC count (<50,000/µL). * **Cytogenetic "Good Prognosis":** t(12;21) [ETV6-RUNX1]. * **Cytogenetic "Poor Prognosis":** t(9;22) [Philadelphia chromosome] and t(4;11). * **L-Asparaginase:** A key drug in ALL protocols; watch for side effects like pancreatitis and thrombosis.
Question 64: Paraneoplastic cerebellar ataxia with anti-Yo antibody positivity is seen in which of the following malignancies?
- A. Breast and ovarian malignancy (Correct Answer)
- B. Breast and lung malignancy
- C. Ovarian and small cell carcinoma lung
- D. Small cell carcinoma lung and Hodgkin's disease
Explanation: **Explanation:** **Paraneoplastic Cerebellar Degeneration (PCD)** is an immune-mediated syndrome where the body produces antibodies against tumor antigens that cross-react with Purkinje cells in the cerebellum [1]. **1. Why Option A is Correct:** The **anti-Yo antibody** (also known as Purkinje cell cytoplasmic antibody type 1 or PCA-1) is the most common antibody associated with PCD in women. It specifically targets the **cdr2** protein. This antibody is highly specific for **gynecological malignancies (ovarian, fallopian tube, or uterine)** and **breast cancer** [2]. Patients typically present with rapidly progressive pancerebellar dysfunction (ataxia, dysarthria, nystagmus) often before the primary tumor is diagnosed. **2. Why Other Options are Incorrect:** * **Small Cell Carcinoma Lung (SCLC):** While SCLC is the most common cause of paraneoplastic syndromes overall, it is typically associated with **anti-Hu** (ANNA-1) or **anti-CV2** antibodies, not anti-Yo. * **Hodgkin’s Lymphoma:** This is classically associated with **anti-Tr** (DNER) antibodies, leading to "Ophelia syndrome" or cerebellar ataxia. * **Lung Malignancy (Non-SCLC):** Generally associated with anti-Ri (ANNA-2) antibodies, which often present with opsoclonus-myoclonus rather than pure cerebellar ataxia. **High-Yield Clinical Pearls for NEET-PG:** * **Anti-Yo:** Breast and Ovary (The "Female" antibody). * **Anti-Hu:** Small Cell Lung Cancer (associated with encephalomyelitis and sensory neuronopathy) [1]. * **Anti-Ri:** Breast and Lung (associated with Opsoclonus-Myoclonus). * **Anti-Tr:** Hodgkin’s Lymphoma. * **Lambert-Eaton Myasthenic Syndrome (LEMS):** Associated with SCLC and **Voltage-Gated Calcium Channel (VGCC)** antibodies [3]. * **NMDA Receptor Encephalitis:** Classically associated with **Ovarian Teratoma**.
Question 65: 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?
- A. Adenocarcinoma
- B. Bronchioloalveolar carcinoma
- C. Large cell carcinoma
- D. Small cell carcinoma (Correct Answer)
Explanation: ### 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
Question 66: A 19-year-old girl develops sudden-onset non-bloody diarrhea. She was previously well and is not taking any medications or traveled anywhere recently. Her abdomen is soft and nontender on examination, and the anion gap is normal. For the above patient with new symptoms, select the most likely acid-base disorder.
- A. Metabolic acidosis (Correct Answer)
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Explanation: **Explanation:** The patient presents with sudden-onset diarrhea and a normal anion gap. The correct answer is **Metabolic Acidosis** (specifically, Normal Anion Gap Metabolic Acidosis or NAGMA) [1]. **1. Why Metabolic Acidosis is Correct:** Diarrhea is a classic cause of NAGMA [2]. Intestinal secretions (below the stomach) are rich in bicarbonate ($HCO_3^-$). In profuse diarrhea, the body loses large amounts of bicarbonate. According to the principle of electroneutrality, as bicarbonate is lost, the kidneys retain chloride ($Cl^-$) to maintain electrical balance, leading to **hyperchloremic metabolic acidosis** [3]. Because the decrease in $HCO_3^-$ is offset by an increase in $Cl^-$, the Anion Gap ($Na^+ - [Cl^- + HCO_3^-]$) remains within the normal range (8–12 mEq/L) [3]. **2. Why Incorrect Options are Wrong:** * **Metabolic Alkalosis:** This occurs with the loss of acid (e.g., persistent vomiting or nasogastric suction) or the use of diuretics [4]. Diarrhea causes base loss, not acid loss. * **Respiratory Acidosis:** This is caused by alveolar hypoventilation (e.g., COPD, opioid overdose), leading to $CO_2$ retention [5]. It is not a primary result of GI losses. * **Respiratory Alkalosis:** This results from hyperventilation (e.g., anxiety, high altitude, pulmonary embolism), leading to excessive $CO_2$ washout [5]. **Clinical Pearls for NEET-PG:** * **NAGMA Mnemonic (USED CARP):** **U**reterosigmoidostomy, **S**aline infusion, **E**ndocrine (Addison’s), **D**iarrhea, **C**arbonic anhydrase inhibitors (Acetazolamide), **A**mmonium chloride, **R**enal tubular acidosis (RTA), **P**ancreatic fistula. * **Urine Anion Gap (UAG):** In NAGMA, UAG helps differentiate GI loss (negative UAG) from RTA (positive UAG) [3]. * **High Anion Gap Metabolic Acidosis (HAGMA):** Remember the mnemonic **MUDPILES** (Methanol, Uremia, DKA, Propylene glycol, Iron/INH, Lactate, Ethylene glycol, Salicylates).
Question 67: Hypoglycemia is associated with all of the following conditions, except?
- A. Fibroma
- B. Soft tissue sarcoma
- C. Small cell carcinoma of the lung (Correct Answer)
- D. Hepatocellular carcinoma
Explanation: **Explanation:** The correct answer is **Small cell carcinoma (SCLC) of the lung**. While SCLC is notorious for causing various paraneoplastic syndromes, it is typically associated with **SIADH** (hyponatremia) and **Ectopic ACTH production** (Cushing syndrome) [1], [2], but **not hypoglycemia**. **Underlying Medical Concept:** Hypoglycemia in non-islet cell tumors (NICTH) is primarily caused by the production of **"Big" IGF-II** (Insulin-like Growth Factor II). This precursor molecule binds to insulin receptors and increases glucose utilization while inhibiting hepatic glucose output. **Analysis of Options:** * **Fibroma & Soft Tissue Sarcoma (Options A & B):** These are classic examples of mesenchymal tumors that cause **Doege-Potter Syndrome**. They produce large amounts of IGF-II, leading to profound fasting hypoglycemia. * **Hepatocellular Carcinoma (Option D):** HCC is a well-known cause of paraneoplastic hypoglycemia [1]. It occurs via two mechanisms: Type A (rapidly growing tumor outstripping glucose supply) or Type B (production of IGF-II). * **Small Cell Carcinoma (Option C):** As mentioned, SCLC is associated with ectopic hormone production (ACTH, ADH) and Lambert-Eaton syndrome, but it does not typically secrete IGF-II or insulin-like substances [1], [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Doege-Potter Syndrome:** Hypoglycemia associated specifically with solitary fibrous tumors (pleural or mesenchymal). * **Most common cause of paraneoplastic hypoglycemia:** Non-islet cell tumors secreting IGF-II. * **SCLC Mnemonic:** Remember the **3 S's**: **S**IADH, **S**ubacute cerebellar degeneration, and **S**mall cell (ACTH/Cushing) [2]. * **Squamous Cell Carcinoma of Lung:** Associated with **PTHrP** (Hypercalcemia), not hypoglycemia [1].
Question 68: Which group of lymph nodes is classically involved in tuberculosis of the larynx?
- A. Posterior cervical lymph nodes (Correct Answer)
- B. Anterior cervical lymph nodes
- C. Pretracheal lymph nodes
- D. Submandibular lymph nodes
Explanation: **Explanation:** Laryngeal tuberculosis is almost always secondary to pulmonary tuberculosis, occurring via the bronchogenic route where infected sputum constantly bathes the laryngeal mucosa. **Why Posterior Cervical Lymph Nodes are correct:** In laryngeal tuberculosis, the lymphatic drainage typically involves the **posterior cervical (Level V)** and the **upper deep cervical** chain. This is a classic clinical association often tested in postgraduate exams. The involvement of these nodes is frequently bilateral and may present as "cold abscesses." [1] The posterior triangle involvement is a distinguishing feature of tubercular lymphadenitis in the neck compared to pyogenic infections. **Analysis of Incorrect Options:** * **Anterior cervical lymph nodes:** These primarily drain the internal structures of the neck, including the thyroid and anterior larynx, but are not the "classic" site specifically associated with the systemic/lymphatic spread seen in laryngeal TB. * **Pretracheal lymph nodes:** These nodes drain the subglottic larynx and trachea. While they can be involved in laryngeal pathologies, they are not the primary or classical group associated with the clinical presentation of laryngeal TB. * **Submandibular lymph nodes:** These nodes primarily drain the oral cavity, submandibular salivary glands, and lips. They are rarely involved in laryngeal tuberculosis unless there is extensive oral cavity involvement. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** The **posterior commissure** (interarytenoid fold) is the most common site involved in laryngeal TB. * **Appearance:** Classically described as "mammillated" or having a "mouse-nibbled" appearance of the vocal cords. * **Symptom:** Hoarseness of voice is the most common presenting symptom, followed by odynophagia (painful swallowing). [1] * **Diagnosis:** Chest X-ray is mandatory as most cases have active pulmonary TB. Sputum for AFB and laryngeal biopsy confirm the diagnosis.
Question 69: Measurement of urine vanillyl mandelic acid can help in the diagnosis of which condition?
- A. Carcinoid syndrome
- B. Acute pancreatitis
- C. Zollinger-Ellison syndrome
- D. Pheochromocytoma (Correct Answer)
Explanation: Explanation: Pheochromocytoma is a catecholamine-secreting tumor arising from the chromaffin cells of the adrenal medulla [1]. The underlying medical concept involves the metabolic pathway of catecholamines (epinephrine and norepinephrine). These hormones are metabolized by the enzymes COMT (Catechol-O-methyltransferase) and MAO (Monoamine oxidase) into end-products: * Norepinephrine → Normetanephrine → Vanillylmandelic Acid (VMA) * Epinephrine → Metanephrine → Vanillylmandelic Acid (VMA) VMA is the final stable urinary metabolite. While 24-hour urinary VMA is a classic diagnostic test, it has lower sensitivity compared to plasma or urinary metanephrines, which are now the preferred screening tests [1]. Why other options are incorrect: * Carcinoid Syndrome: Diagnosed by measuring 5-HIAA (5-Hydroxyindoleacetic acid) in a 24-hour urine sample, which is a metabolite of serotonin. * Acute Pancreatitis: Diagnosed via clinical presentation and elevated serum amylase and lipase levels. * Zollinger-Ellison Syndrome: Characterized by gastrin-secreting tumors; diagnosis involves measuring fasting serum gastrin levels and the secretin stimulation test. High-Yield Clinical Pearls for NEET-PG: * Rule of 10s: 10% are bilateral, 10% are malignant, 10% are extra-adrenal (Paragangliomas), and 10% are familial [1]. * Classic Triad: Episodic headache, sweating (diaphoresis), and tachycardia. * Pre-op Management: Always give Alpha-blockers first (e.g., Phenoxybenzamine) followed by Beta-blockers to avoid a hypertensive crisis [1]. * Most Sensitive Test: Plasma free metanephrines. * Most Specific Test: 24-hour urinary metanephrines.
Question 70: Which of the following types of multiple myeloma is most commonly associated with an increased risk of hyperviscosity syndrome?
- A. IgM (Correct Answer)
- B. IgG
- C. IgD
- D. IgA
Explanation: ### Explanation **Correct Option: A (IgM)** Hyperviscosity syndrome (HVS) is most frequently associated with **IgM paraproteinemia** [1]. This is due to the unique structural properties of IgM: it is a large **pentameric** molecule with a high molecular weight (approx. 900,000 Daltons). Because of its size and high intrinsic viscosity, it significantly increases blood resistance to flow even at relatively low concentrations. While IgM is the hallmark of Waldenström Macroglobulinemia, "IgM Myeloma" is a rare but distinct subtype of Multiple Myeloma that carries the highest risk of HVS among all myeloma types. **Incorrect Options:** * **B (IgG):** This is the most common subtype of Multiple Myeloma [2]. However, IgG is a small monomer; HVS usually only occurs if IgG levels exceed 10 g/dL, making it much less common than with IgM. * **C (IgD):** This is a rare subtype often associated with light chain excretion (Bence-Jones proteinuria) and renal failure, but not typically with hyperviscosity. * **D (IgA):** IgA is the second most common subtype. It can form polymers (dimers or trimers), which increases the risk of HVS more than IgG, but it still lacks the massive pentameric structure and viscosity potential of IgM. **NEET-PG High-Yield Pearls:** 1. **Clinical Triad of HVS:** Mucosal bleeding (epistaxis), visual disturbances ("sausage-link" or "box-car" appearance of retinal veins), and neurological symptoms (headache, vertigo, coma) [1]. 2. **Sia Water Test:** A bedside test where a drop of patient serum added to distilled water forms a precipitate (positive in Waldenström/IgM Myeloma). 3. **Treatment:** The immediate management of symptomatic hyperviscosity is **Plasmapheresis** to rapidly reduce the protein load [1]. 4. **Most Common Myeloma:** IgG > IgA > Light Chain > IgD.
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