Oncology Practice Questions

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: Hypercalcemia in the setting of squamous cell carcinoma of the esophagus is mainly due to which of the following?

Parathormone-related peptide secretion. Explanation: Hypercalcemia of malignancy is a common paraneoplastic syndrome, and in the context of **Squamous Cell Carcinoma (SCC)**—whether of the esophagus, lung, or head and neck—the most common mechanism is **Humoral Hypercalcemia of Malignancy (HHM)**. **1. Why Option D is Correct:** The tumor cells secrete **Parathyroid Hormone-related Protein (PTHrP)**. PTHrP mimics the action of PTH by binding to the same PTH-1 receptors in the bone and kidneys [1]. This leads to increased osteoclastic bone resorption and increased renal calcium reabsorption, resulting in systemic hypercalcemia [1]. Unlike true hyperparathyroidism, the endogenous PTH levels in these patients are typically suppressed [1]. **2. Why Other Options are Incorrect:** * **Option A (Bone metastasis):** While local osteolytic hypercalcemia occurs in cancers like breast cancer or multiple myeloma, it is less common than PTHrP secretion in esophageal SCC. * **Option B (Calcitonin excess):** Calcitonin actually *lowers* serum calcium levels. It is a marker for Medullary Thyroid Carcinoma, not SCC. * **Option C (Parathormone excess):** Ectopic production of true PTH by non-endocrine tumors is extremely rare. Hypercalcemia in malignancy is almost always due to the "related peptide" (PTHrP), not the hormone itself. **Clinical Pearls for NEET-PG:** * **Most common cause of HHM:** PTHrP secretion (associated with SCC of lung, esophagus, and cervix). * **1,25-dihydroxyvitamin D (Calcitriol) excess:** This is the mechanism for hypercalcemia in **Lymphomas** and granulomatous diseases (Sarcoidosis). * **Laboratory Findings in HHM:** High Calcium, Low PTH, High PTHrP, and Low/Normal Vitamin D levels. * **Treatment of Choice:** Aggressive IV hydration with Normal Saline, followed by IV Bisphosphonates (e.g., Zoledronic acid).

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].

Q: Which of the following is NOT a feature of superior vena cava syndrome?

Aggravation of symptoms in the supine position. ### Explanation Superior Vena Cava (SVC) syndrome results from the obstruction of blood flow through the SVC, most commonly due to malignancy (e.g., Small Cell Lung Cancer, Non-Hodgkin Lymphoma). **Why Option C is the Correct Answer:** The statement "Aggravation of symptoms in the supine position" is **incorrect** regarding SVC syndrome. In fact, symptoms typically **improve** or remain unchanged in the supine position compared to leaning forward. The classic clinical sign is the **Pemberton maneuver**, where elevation of the arms above the head (which mimics a "crowding" effect at the thoracic inlet) leads to facial flushing, cyanosis, and respiratory distress. While lying flat increases venous return, the most dramatic clinical aggravation occurs with maneuvers that further compress the thoracic inlet. **Analysis of Other Options:** * **A. Facial swelling:** This is the most common presenting feature. Obstruction leads to venous congestion in the head, neck, and upper extremities. * **B. Hoarseness:** This occurs due to laryngeal edema or compression of the recurrent laryngeal nerve by the primary tumor causing the SVC obstruction. * **D. Syncope:** Cerebral venous hypertension and decreased cardiac output (due to reduced preload) can lead to neurological symptoms, including dizziness and syncope. **NEET-PG High-Yield Pearls:** * **Most common cause:** Lung cancer (specifically Small Cell CA). * **Most common benign cause:** Iatrogenic (indwelling catheters/pacemaker wires) or Fibrosing Mediastinitis (Histoplasmosis). * **Clinical Hallmark:** "Puffiness" of the face, conjunctival suffusion, and dilated collateral veins on the upper chest wall. * **Management:** Emergency radiation is indicated for airway obstruction or cerebral edema; otherwise, stenting is the preferred palliative treatment.

Q: What is the standard treatment regimen for Hodgkin's lymphoma?

ABVD. **Explanation:** **Correct Option: C (ABVD)** The standard first-line chemotherapy for Hodgkin’s Lymphoma (HL) is the **ABVD regimen**. It consists of: * **A:** Adriamycin (Doxorubicin) – Antitumor antibiotic * **B:** Bleomycin – Glycopeptide antibiotic * **V:** Vinblastine – Vinca alkaloid * **D:** Dacarbazine – Alkylating agent This regimen is preferred over the older MOPP regimen because it is associated with a lower risk of secondary leukemia and permanent infertility. **Incorrect Options:** * **A (VAD):** (Vincristine, Adriamycin, Dexamethasone) was historically used for **Multiple Myeloma**, though it has largely been replaced by proteasome inhibitors like Bortezomib. * **B (CMF):** (Cyclophosphamide, Methotrexate, 5-Fluorouracil) is a classic adjuvant chemotherapy regimen for **Breast Cancer**. * **D (CHOP):** (Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) is the gold-standard treatment for **Non-Hodgkin Lymphoma (NHL)**, specifically Diffuse Large B-Cell Lymphoma (DLBCL) [1]. **High-Yield Clinical Pearls for NEET-PG:** 1. **Staging:** The **Ann Arbor Staging** system is used for HL [2]. 2. **Pathognomonic Cell:** Presence of **Reed-Sternberg (RS) cells** (Owl’s eye appearance) which are CD15+ and CD30+ [2]. 3. **Specific Side Effects:** * **Bleomycin:** Pulmonary fibrosis (monitor with DLCO). * **Doxorubicin:** Cardiotoxicity (Dilated cardiomyopathy). * **Vinblastine:** Bone marrow suppression (unlike Vincristine, which is more neurotoxic). 4. **Relapsed HL:** Brentuximab Vedotin (anti-CD30 antibody-drug conjugate) is a high-yield salvage therapy option.

Q: What is the most common malignancy observed in individuals undergoing immunosuppressive therapy?

Skin. The correct answer is **Skin (Option B)**. Immunosuppression, whether due to organ transplantation (post-transplant lymphoproliferative disorders) or chronic therapy for autoimmune diseases, significantly impairs the body's immune surveillance. This leads to a markedly increased risk of malignancies, particularly those with viral etiologies or those exacerbated by UV radiation [1]. **Why Skin is Correct:** Skin cancers are the most common malignancies in immunosuppressed patients [1]. Specifically, **Squamous Cell Carcinoma (SCC)** is the most frequent, occurring at a rate 65–250 times higher than in the general population [2]. Unlike the general population where Basal Cell Carcinoma (BCC) is more common, the **SCC:BCC ratio is reversed** in immunosuppressed individuals. The primary drivers are the loss of T-cell mediated surveillance of UV-damaged cells and the oncogenic effects of Human Papillomavirus (HPV) [1][2]. **Why other options are incorrect:** * **Lung (Option A):** While lung cancer risk is slightly elevated in transplant recipients (especially smokers), it is not the most common. * **Hodgkin Lymphoma (Option C):** Immunosuppressed patients are at a high risk for **Non-Hodgkin Lymphoma (NHL)**, particularly those associated with Epstein-Barr Virus (EBV) [1]. Hodgkin lymphoma is much less common in this demographic. * **Kidney (Option D):** Renal cell carcinoma risk is increased (especially in renal transplant recipients due to acquired cystic kidney disease), but its incidence remains lower than that of skin cancers. **NEET-PG High-Yield Pearls:** 1. **Most common malignancy overall:** Skin Cancer (SCC > BCC) [2]. 2. **Most common non-cutaneous malignancy:** Non-Hodgkin Lymphoma (NHL) [1]. 3. **Kaposi Sarcoma:** Highly associated with HHV-8 in immunosuppressed patients; it can regress if immunosuppression is reduced [1]. 4. **Cervical/Anogenital Cancers:** Increased risk due to persistent HPV infection under immunosuppression.

Question 1

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 2

Hypercalcemia in the setting of squamous cell carcinoma of the esophagus is mainly due to which of the following?

Accepted Answer

Parathormone-related peptide secretion

Answer

Bone metastasis

Answer

Calcitonin excess

Answer

Parathormone excess

Question 3

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.

Question 4

Which of the following is NOT a feature of superior vena cava syndrome?

Accepted Answer

Aggravation of symptoms in the supine position

Answer

Facial swelling

Answer

Hoarseness

Answer

Syncope

Question 5

What is the standard treatment regimen for Hodgkin's lymphoma?

Accepted Answer

ABVD

Answer

VAD

Answer

CMF

Answer

CHOP

Question 6

A 68-year-old woman presents with new symptoms of burning when voiding. She has no fever, chills, or back discomfort. Her urinalysis reveals numerous white cells and bacteria. Which of the following medical comorbidities is most likely to coexist in this patient?

Accepted Answer

diabetes mellitus

Answer

anemia

Answer

exercise

Answer

influenza

Question 7

Ten days after a kidney transplant, a 32-year-old man returns to the hospital with symptoms of fever and decreased urine output. He reports no cough, sputum, or dysuria. An ultrasound of the transplant kidney shows allograft enlargement. Which of the following is the most likely diagnosis?

Accepted Answer

Acute rejection

Answer

Steroid-induced hyperglycemia

Answer

Erythrocytosis

Answer

Hyperacute rejection

Question 8

A 63-year-old woman with well-controlled Type 2 diabetes mellitus presents with peripheral neuropathy in the feet and non-proliferative retinopathy. Urinalysis is positive for proteinuria. Which of the following treatments is most likely to attenuate the course of renal disease?

Accepted Answer

ACE inhibitors

Answer

Calcium channel blockers

Answer

Hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) inhibitors

Answer

Dietary carbohydrate restriction

Question 9

A 62-year-old man with a history of hypertension and stage-III squamous cell carcinoma of the lung who recently completed chemotherapy presents with sudden onset of right calf swelling and pain for 2 days. He denies trauma or recent travel and has no prior history of blood clots. Physical examination reveals a tender swelling of the right calf without erythema. His D-dimer is elevated at 640 ng/mL, and venous Doppler confirms occlusive thrombi in the deep veins of the right leg. A plan is made to initiate anticoagulation for 6 months. What is the drug of choice for anticoagulation in this patient?

Accepted Answer

Low-molecular-weight heparin

Answer

Rivaroxaban

Answer

Warfarin

Answer

Low dose aspirin (81 mg/d)

Question 10

What is the most common malignancy observed in individuals undergoing immunosuppressive therapy?

Accepted Answer

Skin

Answer

Lung

Answer

Hodgkin lymphoma

Answer

Kidney

Oncology — MCQs

Oncology — MCQs

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