Oncology Practice Questions

Q: Trousseau's sign is seen in all the following conditions except:

Liposarcoma. **Explanation:** **Trousseau’s sign of malignancy** (also known as Migratory Thrombophlebitis) refers to spontaneous, recurrent episodes of venous thrombosis at changing (migratory) sites. This phenomenon is a **paraneoplastic syndrome** caused by the release of procoagulants (like tissue factor and mucins) from tumor cells, which activate the coagulation cascade [1]. **Why Liposarcoma is the correct answer:** Trousseau’s sign is classically associated with **mucin-secreting adenocarcinomas**. Liposarcoma is a mesenchymal tumor (sarcoma) arising from fat cells and does not typically secrete the mucins or procoagulants required to trigger migratory thrombophlebitis. Therefore, it is the "except" in this list. **Analysis of other options:** * **Pancreatic Carcinoma:** This is the **most common** association [1]. Trousseau’s sign is frequently the presenting feature of occult pancreatic tail/body cancer. * **Gastric Carcinoma:** As a mucin-producing adenocarcinoma, it is a well-documented cause of hypercoagulability and Trousseau’s sign [1]. * **Lung Carcinoma:** Specifically, **Adenocarcinoma of the lung** is a known cause of paraneoplastic migratory thrombophlebitis. **NEET-PG Clinical Pearls:** 1. **Distinction:** Do not confuse this with *Trousseau’s sign of latent tetany* (carpal spasm induced by BP cuff inflation in hypocalcemia). 2. **Mechanism:** Tumor-derived **mucin** interacts with P-selectin and L-selectin, leading to the formation of platelet-rich microthrombi. 3. **High-Yield Association:** If a patient presents with migratory thrombophlebitis, the first investigation should often be an abdominal CT to rule out **Pancreatic Cancer**. 4. **Treatment:** Heparin is generally more effective than warfarin in managing cancer-associated thrombosis.

Q: Tumour lysis syndrome is associated with the treatment of which condition?

Burkitt's lymphoma. **Explanation:** **Tumor Lysis Syndrome (TLS)** is an oncologic emergency caused by the rapid destruction of a large number of tumor cells, leading to the release of intracellular contents into the bloodstream. **Why Burkitt’s Lymphoma is the Correct Answer:** TLS is most commonly associated with **high-grade hematologic malignancies** characterized by a high tumor burden, rapid cell turnover (high proliferation rate), and high sensitivity to chemotherapy [1]. **Burkitt’s lymphoma** is the classic prototype for this; it has a doubling time of approximately 24 hours [1]. When chemotherapy is initiated, the massive release of potassium, phosphate, and nucleic acids (which metabolize into uric acid) overwhelms the body's homeostatic mechanisms. **Why Other Options are Incorrect:** * **Hairy Cell Leukemia:** This is a chronic, indolent B-cell lymphoproliferative disorder. Because the cells divide slowly and the tumor burden is typically lower compared to high-grade lymphomas, the risk of TLS is minimal [1]. * **Plasmacytoma:** This is a localized collection of plasma cells [2]. While it is a plasma cell dyscrasia, it lacks the rapid proliferative kinetics required to trigger systemic TLS upon treatment. [2] **High-Yield Clinical Pearls for NEET-PG:** * **Metabolic Profile of TLS:** Hyperuricemia, Hyperkalemia, Hyperphosphatemia, and **Hypocalcemia** (due to calcium-phosphate precipitation). * **Renal Impact:** Acute Kidney Injury (AKI) occurs due to the precipitation of uric acid crystals or calcium phosphate in the renal tubules. * **Prophylaxis/Treatment:** Aggressive hydration is the mainstay. **Allopurinol** (prevents new uric acid formation) or **Rasburicase** (recombinant urate oxidase that breaks down existing uric acid) are used for management. * **Risk Factors:** High LDH levels and pre-existing renal insufficiency.

Q: Kaposi's sarcoma is associated with which of the following conditions?

HIV. **Explanation:** **Kaposi’s Sarcoma (KS)** is a vascular neoplasm caused by **Human Herpesvirus 8 (HHV-8)**, also known as Kaposi Sarcoma-associated Herpesvirus (KSHV). While HHV-8 is the primary oncogenic driver, the clinical manifestation of the disease is heavily dependent on the host's immune status. **Why HIV is the correct answer:** The most common and aggressive form of the disease is **AIDS-associated (Epidemic) Kaposi’s Sarcoma** [1]. In patients with HIV, the profound depletion of CD4+ T-cells and the presence of the HIV-Tat protein synergize with HHV-8 to promote spindle cell proliferation and angiogenesis. It is currently the most common neoplasm associated with HIV/AIDS and is considered an **AIDS-defining illness** [1]. **Analysis of Incorrect Options:** * **Bronchial Asthma:** This is a chronic inflammatory airway disease with no known association with HHV-8 or vascular malignancies. * **Hepatitis B:** While HBV is strongly associated with Hepatocellular Carcinoma (HCC), it does not play a role in the pathogenesis of Kaposi’s Sarcoma. * **Hairy Cell Leukaemia:** This is a rare B-cell lymphoproliferative disorder characterized by the BRAF V600E mutation; it is not linked to HHV-8. **Clinical Pearls for NEET-PG:** * **Morphology:** Presents as painless, non-blanching, violaceous (purple) macules, plaques, or nodules [1]. * **Histology:** Characterized by **spindle-shaped cells**, slit-like vascular spaces, and extravasated RBCs. * **Four Clinical Variants:** 1. Classic (Elderly Mediterranean men), 2. Endemic (African), 3. Iatrogenic (Transplant-related), 4. AIDS-associated [1]. * **Treatment:** Highly Active Antiretroviral Therapy (HAART) is the first-line management for AIDS-related KS. For localized lesions, intralesional vinblastine or cryotherapy is used; systemic chemotherapy (Liposomal Doxorubicin) is reserved for visceral involvement.

Q: Which type of lung carcinoma responds best to chemotherapy?

Oat cell type. **Explanation:** The correct answer is **Oat cell type**, also known as **Small Cell Lung Carcinoma (SCLC)**. **1. Why Oat cell type is correct:** Small cell lung carcinoma is characterized by a very high growth fraction and a rapid doubling time. In oncology, the "Law of Bergonie and Tribondeau" dictates that cells with high mitotic activity are more sensitive to cytotoxic agents. Because SCLC is highly aggressive and almost always disseminated at the time of diagnosis, it is treated primarily as a systemic disease [1]. It shows a dramatic initial response to chemotherapy (typically Etoposide + Cisplatin/Carboplatin), with objective response rates often exceeding 60-80%. **2. Why other options are incorrect:** * **Squamous cell type & Adenocarcinoma:** These are subtypes of Non-Small Cell Lung Carcinoma (NSCLC). Unlike SCLC, NSCLC is characterized by slower growth and is relatively chemoresistant. While chemotherapy is used in advanced stages, the response is much less dramatic than in SCLC. Surgery is the primary treatment for early-stage NSCLC. * **All respond equally:** This is incorrect because lung cancers are biologically heterogeneous. The distinction between SCLC (chemosensitive) and NSCLC (chemoresistant) is a fundamental principle in thoracic oncology. **Clinical Pearls for NEET-PG:** * **Strongest Association:** SCLC and Squamous cell carcinoma have the strongest association with **smoking** [1]. * **Location:** SCLC and Squamous cell carcinoma are typically **central/hilar**, while Adenocarcinoma is usually **peripheral** [1]. * **Paraneoplastic Syndromes:** SCLC is most commonly associated with **SIADH** and **ACTH production** (Cushing’s), as well as Lambert-Eaton Myasthenic Syndrome [1]. * **Prognosis:** Despite being the most chemo-responsive, SCLC has a poor long-term prognosis due to early metastasis and frequent recurrence.

Q: All of the following are carcinogenic except?

All the above. **Explanation:** The correct answer is **D (All the above)** because all three listed organisms are classified as **Group 1 Carcinogens** by the International Agency for Research on Cancer (IARC). These biological agents are known to induce oncogenesis through chronic inflammation, integration of viral DNA, or the expression of oncoproteins [1]. 1. **H. pylori (Option A):** This gram-negative bacterium is the most common cause of **Gastric Adenocarcinoma** and **MALT Lymphoma** [3]. It induces carcinogenesis through chronic mucosal inflammation and the action of virulence factors like **CagA** (Cytotoxin-associated gene A), which interferes with host cell signaling [2]. 2. **Hepatitis B Virus (Option B):** HBV is a DNA virus that integrates into the host genome. It causes **Hepatocellular Carcinoma (HCC)** via chronic necro-inflammation and the **HBx protein**, which inactivates the p53 tumor suppressor gene and promotes cell proliferation [1]. 3. **Epstein-Barr Virus (Option C):** EBV is associated with several malignancies, most notably **Burkitt Lymphoma** (starry-sky appearance), **Nasopharyngeal Carcinoma**, and Hodgkin Lymphoma. It transforms B-cells using proteins like **LMP-1** (Latent Membrane Protein 1), which mimics CD40 signaling [1]. **Clinical Pearls for NEET-PG:** * **H. pylori** is the only bacterium classified as a Type 1 carcinogen [3]. * **HBV vs. HCV:** While both cause HCC, HBV is a DNA virus that can cause cancer without preceding cirrhosis, whereas HCV (RNA virus) almost always requires cirrhosis to develop HCC. * **EBV Association:** Classically associated with the **t(8;14)** translocation in Burkitt Lymphoma involving the *c-myc* gene. * **Other high-yield carcinogens:** Human Papillomavirus (HPV 16, 18) for Cervical Cancer and *Schistosoma haematobium* for Squamous Cell Carcinoma of the bladder.

Q: A 57-year-old man presents with a serum sodium of 125 mEq/L. On examination, he has pitting edema and elevated neck veins. His urine sodium is 10 mEq/L and urine osmolality is 350 mOsm/kg. What is the most likely diagnosis for this patient's hyponatremia?

Congestive heart failure (CHF). ### Explanation The patient presents with **hypovolemic hyponatremia** (Sodium 125 mEq/L) and clinical signs of **volume overload** (pitting edema, elevated neck veins). This combination is the hallmark of hypervolemic hyponatremia [1]. **1. Why Congestive Heart Failure (CHF) is Correct:** In CHF, there is a decrease in "effective arterial blood volume" (EABV) despite an increase in total body water. This triggers the **Renin-Angiotensin-Aldosterone System (RAAS)** and the release of **Antidiuretic Hormone (ADH)** [2]. * **Low Urine Sodium ( 100 mOsm/kg):** ADH causes water reabsorption, concentrating the urine [2]. * **Edema/Elevated JVP:** Reflects the increased total body sodium and water [3]. **2. Why Incorrect Options are Wrong:** * **Extrarenal losses (e.g., vomiting/diarrhea):** These cause *hypovolemic* hyponatremia [1]. While urine sodium would be low ( 40 mEq/L)** because there is no stimulus for aldosterone-mediated sodium retention. * **Polydipsia:** This also causes euvolemic hyponatremia, but the urine would be **maximally dilute** (Urine Osmolality 20):** Think Acute or Chronic Renal Failure (kidneys cannot retain sodium) [1]. * **Key Differentiator:** The presence of edema/JVP separates hypervolemic causes from SIADH [3].

Question 1

Trousseau's sign is seen in all the following conditions except:

Accepted Answer

Liposarcoma

Answer

Lung carcinoma

Answer

Gastric carcinoma

Answer

Pancreatic carcinoma

Question 2

A 60-year-old patient presents with diarrhea and abdominal pain for 5 days. Ultrasound abdomen is normal, and CT abdomen shows a local mass in the jejunum. 24-hour urine test shows elevated 5-HIAA. What is the most common site for a primary tumor that causes these findings?

Accepted Answer

Bronchus

Answer

Gastrointestinal tract

Answer

Kidney

Answer

Adrenal gland

Question 3

Tumour lysis syndrome is associated with the treatment of which condition?

Accepted Answer

Burkitt's lymphoma

Answer

Hairy cell leukemia

Answer

Plasmacytoma

Answer

All of the above

Question 4

What is the initial treatment for tumor lysis syndrome?

Accepted Answer

Rasburicase, hydration, potassium binder, and urinary alkalization

Answer

Allopurinol, hydration, potassium binder, and alkalization

Answer

Both rasburicase and allopurinol, with hydration and a potassium binder

Answer

Hydration alone is sufficient

Question 5

Kaposi's sarcoma is associated with which of the following conditions?

Accepted Answer

HIV

Answer

Bronchial asthma

Answer

Hepatitis B

Answer

Hairy cell leukaemia

Question 6

Which type of lung carcinoma responds best to chemotherapy?

Accepted Answer

Oat cell type

Answer

Squamous cell type

Answer

Adenocarcinoma

Answer

All respond equally

Question 7

A 41-year-old man presented with a 9-month history of cough, exertional dyspnea, nocturnal diaphoresis, and weight loss of 10 kg. Physical examination revealed painless, massive, discrete, rubbery cervical, supraclavicular, and axillary lymphadenopathy. Chest radiography showed bilateral hilar lymphadenopathy. The serum calcium level was elevated at 16.2 mg/dL, with serum parathyroid hormone within the normal range. What is the urgent treatment to be instituted?

Accepted Answer

Intravenous administration of normal saline and a bisphosphonate

Answer

Oxygen 6 L/min by mask

Answer

Antibiotics and anti-inflammatory drugs

Answer

Antitussive and chest physiotherapy

Question 8

All of the following are carcinogenic except?

Accepted Answer

All the above

Answer

H. pylori

Answer

Hepatitis B virus

Answer

Epstein-Barr virus

Question 9

A 62-year-old man with a history of hypertension and gout, treated with metoprolol and allopurinol, presents with 4 weeks of drowsiness and generalized weakness. He experienced a tonic-clonic seizure. He is a long-term smoker (1 pack/day for 40 years) and has had unintentional weight loss of 20 lb over the past 2 months. His laboratory findings include hemoglobin 10.2 gm/dL, serum sodium 122 mEq/L, serum osmolality 258 mOsm/kg, urine osmolality 300 mOsm/kg, and urine sodium 48 mmol/L. TSH and cortisol levels are normal. What is the most likely diagnosis?

Accepted Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer

Trousseau syndrome

Answer

Sezary syndrome

Answer

Tumor lysis syndrome

Question 10

A 57-year-old man presents with a serum sodium of 125 mEq/L. On examination, he has pitting edema and elevated neck veins. His urine sodium is 10 mEq/L and urine osmolality is 350 mOsm/kg. What is the most likely diagnosis for this patient's hyponatremia?

Accepted Answer

Congestive heart failure (CHF)

Answer

Extrarenal sodium and fluid losses

Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer

Polydipsia

Oncology — MCQs

Oncology — MCQs

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