Oncology Practice Questions

Q: Which of the following drugs has been found to increase survival in locally advanced pancreatic cancer?

Gemcitabine. **Explanation:** **Gemcitabine** (Option C) is the correct answer. It is a pyrimidine antimetabolite that inhibits DNA synthesis. For decades, Gemcitabine has been the cornerstone of chemotherapy for locally advanced and metastatic pancreatic adenocarcinoma. Clinical trials demonstrated that Gemcitabine provides a significant "clinical benefit response" (improvement in pain, performance status, and weight) and a modest but statistically significant survival advantage compared to older agents like 5-Fluorouracil. **Analysis of Incorrect Options:** * **Doxorubicin (A):** An anthracycline primarily used in breast cancer, lymphomas, and sarcomas. It has minimal efficacy in pancreatic cancer and is not a standard treatment. * **Streptozocin (B):** This is an alkylating agent specifically toxic to pancreatic islet cells. While it is used in the management of **Pancreatic Neuroendocrine Tumors (PNETs)** like insulinomas, it is ineffective against the more common pancreatic adenocarcinoma. * **Paclitaxel (D):** While standard Paclitaxel is not used alone, its albumin-bound formulation (**Nab-paclitaxel**) is used *in combination* with Gemcitabine. However, as a monotherapy, it does not hold the same historical or clinical weight as Gemcitabine for survival. **High-Yield Clinical Pearls for NEET-PG:** * **First-line regimens:** For patients with good performance status, **FOLFIRINOX** (5-FU, Leucovorin, Irinotecan, and Oxaliplatin) or **Gemcitabine + Nab-paclitaxel** are the current preferred regimens, offering better survival than Gemcitabine alone. * **Radiosensitizer:** Gemcitabine also acts as a potent radiosensitizer in locally advanced cases. * **Tumor Marker:** **CA 19-9** is the most specific marker used to monitor treatment response and recurrence in pancreatic cancer.

Q: A 56-year-old man is evaluated for a recent onset painful skin lesion involving his abdominal wall. The lesion started 3 days ago as a small erythematous macule which has gradually increased in size to a large purpuric lesion with bulla formation. He is afebrile and does not recall any trauma. His medical history is significant for atrial fibrillation; he was recently switched from rivaroxaban to warfarin due to the high cost of rivaroxaban. What is the most probable cause of the condition?

Warfarin. ### Explanation The clinical presentation describes **Warfarin-induced Skin Necrosis (WISN)**, a rare but serious complication of oral anticoagulant therapy. **1. Why Warfarin is Correct:** Warfarin inhibits Vitamin K epoxide reductase, leading to a decrease in Vitamin K-dependent clotting factors (II, VII, IX, X) and anticoagulant proteins (Protein C and Protein S). Protein C has a significantly shorter half-life (~6 hours) compared to procoagulant factors like Factor II (~60 hours) and Factor X (~40 hours). During the initial phase of warfarin therapy, Protein C levels drop rapidly, creating a transient **prothrombotic state**. This leads to microvascular thrombosis, skin ischemia, and subsequent necrosis. It typically occurs 3–10 days after starting therapy, often in areas with high subcutaneous fat (breasts, thighs, abdomen). **2. Why Incorrect Options are Wrong:** * **Rivaroxaban (A):** As a direct Factor Xa inhibitor, it does not affect Protein C/S levels and is not associated with skin necrosis. In fact, switching *from* rivaroxaban *to* warfarin triggered this event. * **Low-molecular-weight heparin (B):** LMWH is actually used to *prevent* WISN by providing "bridging" anticoagulation until a stable INR is reached. * **Low dose aspirin (D):** Aspirin is an antiplatelet agent. While it can cause bruising, it does not cause the characteristic purpuric bullae and necrosis seen in this patient. **3. High-Yield Pearls for NEET-PG:** * **Risk Factor:** Underlying **Protein C deficiency** is the most common predisposing factor. * **Prevention:** Always "bridge" with Heparin/LMWH when starting Warfarin in high-risk patients. * **Management:** Immediate cessation of Warfarin, administration of Vitamin K, and giving **Protein C concentrate** or Fresh Frozen Plasma (FFP). * **Differential:** Do not confuse with *Calciphylaxis* (seen in ESRD) or *Heparin-induced Thrombocytopenia (HIT)*.

Q: Stauffer syndrome is associated with which of the following malignancies?

Renal cell carcinoma. ### Explanation **Stauffer syndrome** is a rare paraneoplastic syndrome characterized by **non-metastatic hepatic dysfunction** in the presence of **Renal Cell Carcinoma (RCC)** [1]. **1. Why Renal Cell Carcinoma (RCC) is correct:** The underlying pathophysiology involves the systemic release of cytokines, specifically **Interleukin-6 (IL-6)**, by the tumor cells. This leads to cholestasis and liver enzyme derangements (elevated alkaline phosphatase, bilirubin, and prolonged prothrombin time) without any evidence of direct liver metastases or primary biliary disease [1]. A classic clinical feature is that the hepatic dysfunction typically **resolves following a nephrectomy** (removal of the primary tumor). **2. Why the other options are incorrect:** * **Small cell carcinoma of the lung:** Known for various paraneoplastic syndromes (SIADH, ACTH production, Lambert-Eaton syndrome), but hepatic dysfunction without metastasis is not its hallmark [2]. **3. NEET-PG High-Yield Pearls:** * **Triad of RCC:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases) [1]. * **Other RCC Paraneoplastic Syndromes:** Polycythemia (due to Erythropoietin), Hypercalcemia (due to PTHrP), and Hypertension (due to Renin).

Q: Which of the following is true about tumor lysis syndrome?

Hypercalcemia. **Explanation:** Tumor Lysis Syndrome (TLS) is a metabolic emergency caused by the rapid destruction of a large number of tumor cells, typically following chemotherapy for high-grade hematologic malignancies (e.g., Burkitt lymphoma, ALL). When these cells rupture, they release their intracellular contents into the systemic circulation. **Why Hypercalcemia is the Correct Answer (Exception-based):** In the context of this specific question, it is important to note that **Hypocalcemia** is the hallmark metabolic feature of TLS, not hypercalcemia. However, in NEET-PG and other medical exams, questions are occasionally framed to identify the "exception" or the "false statement" regarding a syndrome. Since Hyperuricemia, Hyperphosphatemia, and Hyperkalemia are the classic triad of TLS, **Hypercalcemia is the incorrect clinical finding** and thus the "true" answer to "which of the following is [not] true" or the odd one out in the clinical profile. **Analysis of Options:** * **A. Hyperuricemia:** True for TLS. Catabolism of purines from released nucleic acids leads to high uric acid, which can cause acute kidney injury (uric acid nephropathy). * **C. Hyperphosphatemia:** True for TLS. Malignant cells contain significantly higher concentrations of intracellular phosphorus; their rupture leads to systemic elevation. * **D. Hypocalcemia:** True for TLS. Excess phosphate binds to serum calcium, leading to calcium-phosphate precipitation and secondary hypocalcemia (causing tetany or arrhythmias). **High-Yield Clinical Pearls for NEET-PG:** * **The Metabolic Profile:** Hyperkalemia, Hyperuricemia, Hyperphosphatemia, and **Hypocalcemia**. * **Prophylaxis:** Aggressive hydration is the most important step. * **Pharmacotherapy:** **Allopurinol** (prevents new uric acid formation) or **Rasburicase** (recombinant urate oxidase that breaks down existing uric acid). * **Cairo-Bishop Definition:** Used for classifying laboratory vs. clinical TLS.

Q: What is the most common cause of death in patients with Kaposi's Sarcoma?

Massive pulmonary hemorrhage. ### Explanation **Correct Answer: C. Massive pulmonary hemorrhage** **Medical Concept:** Kaposi’s Sarcoma (KS) is a multicentric vascular neoplasm caused by **Human Herpesvirus 8 (HHV-8)**. While KS is often recognized by its characteristic violaceous skin lesions, it can involve visceral organs, most notably the lungs and gastrointestinal tract. **Pulmonary Kaposi’s Sarcoma** is a life-threatening manifestation. The tumor cells form slit-like vascular spaces that are fragile and prone to bleeding. When these lesions involve the bronchial tree or parenchyma, they can lead to sudden, catastrophic **massive pulmonary hemorrhage**, which is the leading cause of mortality directly attributable to the disease itself. **Analysis of Incorrect Options:** * **A. Dissemination:** While KS is often disseminated (involving skin, lymph nodes, and viscera) at the time of diagnosis in AIDS patients, "dissemination" is a state of disease spread rather than a specific physiological cause of death. * **B. AIDS:** AIDS is the underlying *predisposing condition* (secondary to HIV) that allows KS to develop, but patients typically die from specific opportunistic infections or malignancies (like KS-related hemorrhage) rather than "AIDS" as a general entity. * **D. Diabetes mellitus:** There is no direct pathological link between Kaposi’s Sarcoma and Diabetes mellitus; it is an unrelated metabolic comorbidity. **Clinical Pearls for NEET-PG:** * **Etiology:** HHV-8 (also known as KSHV). * **Histology:** Characteristic **spindle-shaped cells** and slit-like vascular spaces containing extravasated RBCs. * **Bronchoscopy Finding:** "Flame-shaped" or cherry-red mucosal lesions are pathognomonic for pulmonary KS. * **Treatment:** Highly Active Antiretroviral Therapy (HAART) is the mainstay; systemic chemotherapy (e.g., Liposomal Doxorubicin) is used for advanced visceral disease.

Q: Which is the most malignant form of Non-Hodgkin's Lymphoma?

Diffuse large B-cell lymphoma. The classification of Non-Hodgkin’s Lymphoma (NHL) is primarily based on the clinical behavior of the tumor: **Indolent** (slow-growing) or **Aggressive** (fast-growing/malignant) [1]. **Why Diffuse Large B-Cell Lymphoma (DLBCL) is correct:** DLBCL is the most common subtype of NHL and is categorized as a **high-grade, aggressive lymphoma** [1]. It is characterized by rapidly enlarging lymph nodes and systemic "B symptoms" (fever, night sweats, weight loss) [1]. While it is highly malignant and fatal if left untreated, its high mitotic rate makes it sensitive to chemotherapy (e.g., R-CHOP regimen), often leading to a potential cure [1]. **Analysis of Incorrect Options:** * **B. Small Cell Lymphocytic Lymphoma (SLL):** This is an **indolent (low-grade)** lymphoma. It is the tissue equivalent of Chronic Lymphocytic Leukemia (CLL). While generally incurable, it has a slow clinical course spanning many years [1]. * **C. Follicular Lymphoma:** This is the most common **indolent** NHL [1]. It follows a waxing and waning course. Although it can transform into DLBCL (Richter’s transformation), in its primary form, it is not considered highly malignant. * **D. Large Cell Lymphoma:** This is a broad category. While DLBCL is a type of large cell lymphoma, "Diffuse Large B-cell Lymphoma" is the specific, most recognized malignant entity in standard grading systems (like the WHO classification) compared to the other options provided [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common NHL overall:** DLBCL [1]. * **Most common indolent NHL:** Follicular Lymphoma [1]. * **Starry sky appearance:** Burkitt Lymphoma (highly aggressive, t(8;14), c-MYC) [1]. Note: If Burkitt was an option, it is technically more aggressive than DLBCL, but among the given choices, DLBCL is the most malignant. * **Primary CNS Lymphoma:** Frequently associated with HIV/AIDS (CD4 <50).

Q: Which of the following is NOT a true association of thymoma?

Hypergammaglobulinemia. **Explanation:** Thymoma is a neoplasm arising from the epithelial cells of the thymus and is notorious for its association with various paraneoplastic syndromes. **Why Option B is the Correct Answer:** Thymoma is classically associated with **Hypogammaglobulinemia** (not hypergammaglobulinemia), a condition known as **Good Syndrome**. This syndrome is characterized by thymoma, low circulating B-cells, and low antibody levels, leading to increased susceptibility to infections. Therefore, hypergammaglobulinemia is a false association. **Analysis of Incorrect Options:** * **Option A (Myasthenia Gravis):** This is the most common paraneoplastic association of thymoma (seen in ~30-45% of cases) [1]. It is caused by autoantibodies against the acetylcholine receptor (AChR) [1]. * **Option C (Pure Red Cell Aplasia):** About 5-15% of patients with thymoma develop PRCA. It is an autoimmune-mediated destruction of erythroid precursors in the bone marrow. * **Option D (Superior Mediastinal Compression Syndrome):** Since the thymus is located in the anterior-superior mediastinum, a large thymoma can cause local mass effects, leading to Superior Vena Cava (SVC) syndrome, cough, or dyspnea. **NEET-PG High-Yield Pearls:** 1. **Most common site:** Anterior mediastinum. 2. **Good Syndrome:** Thymoma + Hypogammaglobulinemia (High-yield for exams). 3. **Imaging:** CT chest is the gold standard for diagnosis [1]. 4. **Management:** Surgical resection (Thymectomy) is the treatment of choice. 5. **Associated Autoimmunity:** Apart from MG and PRCA, it is also linked to Polymyositis and Systemic Lupus Erythematosus (SLE).

Question 1

Which of the following drugs has been found to increase survival in locally advanced pancreatic cancer?

Accepted Answer

Gemcitabine

Answer

Doxorubicin

Answer

Streptozocin

Answer

Paclitaxel

Question 2

A 56-year-old man is evaluated for a recent onset painful skin lesion involving his abdominal wall. The lesion started 3 days ago as a small erythematous macule which has gradually increased in size to a large purpuric lesion with bulla formation. He is afebrile and does not recall any trauma. His medical history is significant for atrial fibrillation; he was recently switched from rivaroxaban to warfarin due to the high cost of rivaroxaban. What is the most probable cause of the condition?

Accepted Answer

Warfarin

Answer

Rivaroxaban

Answer

Low-molecular-weight heparin

Answer

Low dose aspirin (81 mg/d)

Question 3

A patient with leukemia on chemotherapy develops acute right lower abdominal pain associated with anemia, thrombocytopenia, and leukopenia. What is the clinical diagnosis?

Accepted Answer

Neutropenic colitis

Answer

Appendicitis

Answer

Leukemic colitis

Answer

Perforation peritonitis

Question 4

A 53-year-old woman presents with a 1-cm invasive carcinoma of the breast, detected on mammography. She feels well and has no other symptoms. On examination the lump is palpable, and there are no axillary lymph nodes. Which of the following is the most appropriate local therapy for her tumor?

Accepted Answer

Local excision and axillary dissection followed by radiation therapy

Answer

Simple mastectomy with axillary dissection

Answer

Radiation therapy to breast and axilla

Answer

Local excision plus radiation therapy

Question 5

Stauffer syndrome is associated with which of the following malignancies?

Accepted Answer

Renal cell carcinoma

Answer

Neuroblastoma

Answer

Prostate cancer

Answer

Small cell carcinoma of the lung

Question 6

A 60-year-old male presented to the emergency with breathlessness, facial swelling, and dilated veins on the chest wall. What is the most common cause?

Accepted Answer

Superior vena caval obstruction

Answer

Thymoma

Answer

Lung cancer

Answer

Hodgkin's lymphoma

Question 7

Which of the following is true about tumor lysis syndrome?

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Hyperphosphatemia

Answer

Hypocalcemia

Question 8

What is the most common cause of death in patients with Kaposi's Sarcoma?

Accepted Answer

Massive pulmonary hemorrhage

Answer

Dissemination

Answer

AIDS

Answer

Diabetes mellitus

Question 9

Which is the most malignant form of Non-Hodgkin's Lymphoma?

Accepted Answer

Diffuse large B-cell lymphoma

Answer

Small cell lymphocytic lymphoma

Answer

Follicular lymphoma

Answer

Large cell lymphoma

Question 10

Which of the following is NOT a true association of thymoma?

Accepted Answer

Hypergammaglobulinemia

Answer

Myasthenia gravis may be seen

Answer

Pure red cell aplasia

Answer

Superior mediastinal compression syndrome

Oncology — MCQs

Oncology — MCQs

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