Palliative Care in Oncology — MCQs
In immediate disaster response management (first 24-48 hours), which of the following is not typically practiced?
For medical termination of pregnancy, consent is given by-
Many drugs are used as rescue therapy for preventing the adverse effects of anticancer drugs. Folinic acid is used in:-
Which of the following is an inappropriate indication for concomitant chemotherapy in cases of head and neck cancer?
An elderly housewife lost her husband who died suddenly of Myocardial infarction. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. Over the past couple of years since his death, this has continued and provokes anxiety and sadness of mood when she is preoccupied with his thought. She should be treated with:
Death of a patient due to an unintentional act by a doctor, staff or hospital is
Late effects of radiation therapy include:
A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?
Match List-I with List-II and select the correct answer using the code given below the Lists:
Hypercalcemia related to malignancy is seen in which of the following cancers?
Palliative Care in Oncology Indian Medical PG Practice Questions and MCQs
Question 1: In immediate disaster response management (first 24-48 hours), which of the following is not typically practiced?
- A. Rehabilitation
- B. Triage
- C. Mass vaccination (Correct Answer)
- D. Search and rescue
Explanation: ***Mass vaccination*** - **Mass vaccination** is typically a strategy for **preparedness/prevention phase** or **post-disaster disease prevention**, not an immediate disaster response activity. - Immediate disaster response focuses on **saving lives, providing emergency medical care, establishing shelter, and restoring critical infrastructure**, rather than large-scale preventative health campaigns. - Mass vaccination requires **planning, logistics, cold chain management**, which are incompatible with chaotic immediate response scenarios. *Triage* - **Triage** is a **critical and immediate** component of disaster response, involving the **prioritization of injured patients** for treatment based on severity and survival likelihood. - It ensures limited resources are allocated effectively to **maximize lives saved** during the acute phase. - Typically uses **color-coded tags** (red-immediate, yellow-delayed, green-minor, black-deceased). *Rehabilitation* - While **rehabilitation** is part of the **recovery phase** (weeks to months post-disaster), **early rehabilitation activities** may begin during the immediate response period. - Basic rehabilitation services like **mobility aids, psychological first aid**, can be initiated alongside acute care. - This makes it partially practiced even in immediate response, unlike mass vaccination which is never immediate. *Search and rescue* - **Search and rescue** is the **primary immediate response activity**, focusing on locating and extracting survivors from disaster-affected areas. - Time-critical operation following the **"golden period"** principle where survival rates decrease rapidly after 72 hours. - Involves specialized teams with equipment for **debris removal, victim location, and emergency extraction**.
Question 2: For medical termination of pregnancy, consent is given by-
- A. Guardian
- B. Husband of the lady
- C. Concerned lady (Correct Answer)
- D. Both husband and wife
Explanation: ***Concerned lady*** - For a medical termination of pregnancy, **informed consent** must be given directly by the woman seeking the procedure. - This upholds her **autonomy** and right to make decisions regarding her own body and healthcare. *Guardian* - A guardian's consent is typically required only if the woman is a **minor** or is otherwise **legally incapacitated** and unable to provide consent herself. - In most cases, an adult woman is presumed to be competent to consent for her own medical procedures. *Husband of the lady* - The husband's consent is **not legally required** for a medical termination of pregnancy, as it is the woman's fundamental right to decide. - Requiring a husband's consent would infringe upon the woman's **bodily autonomy** and reproductive rights. *Both husband and wife* - While open communication with a spouse is often encouraged, **joint consent** from both the husband and wife is not a legal prerequisite for a medical termination of pregnancy. - The ultimate decision-making authority rests solely with the **pregnant woman**.
Question 3: Many drugs are used as rescue therapy for preventing the adverse effects of anticancer drugs. Folinic acid is used in:-
- A. Cyclophosphamide toxicity
- B. Doxorubicin toxicity
- C. Methotrexate toxicity (Correct Answer)
- D. Cisplatin toxicity
Explanation: ***Methotrexate toxicity*** - **Folinic acid (leucovorin)** is a reduced folate that bypasses the metabolic block caused by **methotrexate** on dihydrofolate reductase. - It replenishes the body's **folate stores** and protects healthy cells from methotrexate's cytotoxic effects, particularly in the bone marrow and gastrointestinal tract. *Cyclophosphamide toxicity* - **Cyclophosphamide** toxicity, primarily hemorrhagic cystitis, is prevented by **mesna** (2-mercaptoethane sulfonate). - Mesna inactivates the urotoxic metabolite **acrolein** in the urine, preventing bladder damage. *Doxorubicin toxicity* - **Doxorubicin** causes cardiotoxicity, which can be mitigated by the iron-chelating agent **dexrazoxane**. - Dexrazoxane reduces the formation of **free radicals** that contribute to doxorubicin-induced myocardial damage. *Cisplatin toxicity* - **Cisplatin** toxicity, especially nephrotoxicity, is largely prevented by **aggressive hydration** and administration of **diuretics**. - **Amifostine** is another agent that can reduce cisplatin-induced nephrotoxicity, neurotoxicity, and ototoxicity by acting as a cytoprotectant.
Question 4: Which of the following is an inappropriate indication for concomitant chemotherapy in cases of head and neck cancer?
- A. Metastatic advanced head and neck cancer (Correct Answer)
- B. As an organ-preserving method of treatment
- C. Primary treatment for patients with unresectable disease
- D. Postoperative case of intermediate stage resectable tumor
Explanation: ***Metastatic advanced head and neck cancer*** - While chemotherapy is used in metastatic head and neck cancer, the term "concomitant chemotherapy" implies simultaneous administration with radiation therapy. For **metastatic disease**, the primary treatment strategy is usually **systemic chemotherapy** or targeted therapy, not necessarily concomitant with radiation to a local site with curative intent. - Concomitant chemoradiation is primarily used for **locally advanced, non-metastatic disease** to improve local control and survival, not typically for systemic metastatic disease where the goal is palliation or systemic control. *As an organ-preserving method of treatment* - Concomitant chemoradiation is a well-established strategy for organ preservation, particularly in advanced laryngeal and pharyngeal cancers, allowing patients to avoid **laryngectomy** or extensive surgical resections while achieving similar oncologic outcomes. - This approach aims to maintain **swallowing and speech function** by reducing tumor burden and eradicating microscopic disease. *Primary treatment for patients with unresectable disease* - For **unresectable locally advanced head and neck cancers**, concomitant chemoradiation is often considered the **definitive primary treatment** to achieve local control and improve survival outcomes. - Surgery is not feasible in these cases due to tumor extent or involvement of critical structures, making chemoradiation the best curative option. *Postoperative case of intermediate stage resectable tumor* - **Adjuvant concomitant chemoradiation** is indicated postoperatively for resected tumors with high-risk features such as **extracapsular extension (ECE)** or positive surgical margins, even in intermediate stages. - This is done to eradicate microscopic residual disease and reduce the risk of **local-regional recurrence**.
Question 5: An elderly housewife lost her husband who died suddenly of Myocardial infarction. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. Over the past couple of years since his death, this has continued and provokes anxiety and sadness of mood when she is preoccupied with his thought. She should be treated with:
- A. Benztropine
- B. Risperidone
- C. Sertraline (Correct Answer)
- D. Lorazepam
Explanation: ***Sertraline*** - The patient exhibits symptoms consistent with **prolonged grief disorder**, characterized by persistent longing for the deceased, intense emotional pain, and clinically significant distress or functional impairment following bereavement. Sertraline, an **SSRI antidepressant**, is effective in treating symptoms of grief, anxiety, and depression. - The auditory hallucinations of her deceased husband's voice, while concerning, are described as routine and conversational, suggesting a **psychotic feature secondary to severe depression or complicated grief**, rather than a primary psychotic disorder. Treating the underlying mood and anxiety component with an antidepressant is the priority. *Benztropine* - **Benztropine is an anticholinergic medication** primarily used to treat **extrapyramidal symptoms** (EPS) associated with antipsychotic use or Parkinson's disease. - There is no indication of EPS or Parkinson's disease in this patient, making benztropine an inappropriate choice for her symptoms of grief, anxiety, and auditory phenomena. *Risperidone* - **Risperidone is an atypical antipsychotic** primarily used to treat schizophrenia, bipolar disorder, and agitation. While it can address psychotic symptoms, the auditory hallucinations described here ("heard his voice clearly talking to her as he would in a routine manner") are likely **grief-related pseudohallucinations** or a reflection of the intense emotional bond, rather than frank psychosis requiring antipsychotic medication. - Administering an antipsychotic without first addressing the underlying grief and mood disorder could result in unnecessary side effects and may not effectively resolve her primary distress. The anxiety and sadness following preoccupation with his thought suggest a **depressive component** rather than a primary thought disorder. *Lorazepam* - **Lorazepam is a benzodiazepine** used for short-term management of anxiety, insomnia, and seizures. - While the patient experiences anxiety, lorazepam would only provide **symptomatic relief** for acute anxiety and does not address the underlying prolonged grief, sadness, or the grief-related auditory experiences. Long-term use of benzodiazepines can lead to dependence and withdrawal issues.
Question 6: Death of a patient due to an unintentional act by a doctor, staff or hospital is
- A. Diminished liability
- B. Therapeutic privilege
- C. Vicarious liability
- D. Therapeutic misadventure (Correct Answer)
Explanation: ***Therapeutic misadventure*** - This term refers to an **unintentional or unexpected complication or death** that occurs during appropriate medical treatment, despite the absence of negligence. - It acknowledges that medical interventions carry inherent risks and that adverse outcomes can occur even when healthcare providers act reasonably and skillfully. *Diminished liability* - This concept typically arises in **criminal law**, referring to a partial defense that may reduce the degree of criminal responsibility due to mental impairment. - It does not apply to situations involving unintentional harm or death during medical treatment in the absence of negligence. *Therapeutic privilege* - This is a legal doctrine allowing a physician to **withhold information** from a patient if disclosure would likely cause significant harm to the patient. - It is unrelated to unintentional adverse outcomes or death in the context of medical treatment. *Vicarious liability* - This legal doctrine holds one party (e.g., a hospital or employer) responsible for the actions of another (e.g., a doctor or employee), especially when the latter is acting within the scope of their employment. - While a hospital might be vicariously liable for a doctor's negligence, the term itself describes the *type* of liability, not the unintentional adverse event itself.
Question 7: Late effects of radiation therapy include:
- A. Mucositis, Enteritis, Nausea and vomiting, Pneumonitis
- B. Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations
- C. Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations
- D. Mucositis, Enteritis, Pneumonitis, Somatic mutations (Correct Answer)
Explanation: ***Mucositis, Enteritis, Pneumonitis, Somatic mutations*** - **Somatic mutations** leading to **secondary malignancies** are a classic late effect of radiation (occurs years after exposure due to DNA damage) [1] - **Radiation pneumonitis** progressing to **pulmonary fibrosis** is a well-recognized late complication (typically 1-3 months to years post-treatment) [1] - **Chronic radiation enteritis** with fibrosis and vascular damage can occur months to years after abdominal/pelvic radiation [1] - **Chronic mucositis** with fibrosis can persist as a late effect, though mucositis is more commonly acute - This option represents the **most comprehensive list of late effects** among the choices *Mucositis, Enteritis, Nausea and vomiting, Pneumonitis* - **Nausea and vomiting** are predominantly **acute side effects** occurring during or immediately after radiation therapy, not late effects - While mucositis and enteritis can have chronic forms, including nausea/vomiting makes this option incorrect *Enteritis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Though it includes somatic mutations (correct late effect), the presence of an acute symptom invalidates this choice *Mucositis, Nausea and vomiting, Pneumonitis, Somatic mutations* - Incorrectly includes **nausea and vomiting** as a late effect - Omits enteritis, which can manifest as chronic radiation enteritis with fibrosis and strictures **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Central Nervous System Synapse, pp. 437-439.
Question 8: A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?
- A. Surgical resection with adjuvant chemotherapy
- B. Radiation therapy alone
- C. Palliative chemotherapy (Correct Answer)
- D. Supportive care only
Explanation: Palliative chemotherapy - The presence of **multiple small metastases** in the liver indicates **metastatic disease**, which is generally considered incurable with surgery [2]. - **Palliative chemotherapy** aims to control disease progression, alleviate symptoms, and improve quality of life in patients with advanced metastatic cancer. Surgical resection with adjuvant chemotherapy - **Surgical resection** is not indicated due to the presence of **distant metastases** (to the liver), classifying the disease as Stage IV [1]. - **Adjuvant chemotherapy** is given after curative surgery to reduce recurrence risk, which is not the goal here as the disease is already metastatic. Radiation therapy alone - **Radiation therapy alone** is typically reserved for localized disease or for palliative symptom management (e.g., pain from bone metastases), not for widespread metastatic disease. - It would not adequately address the systemic nature of **multiple liver metastases** from a pancreatic primary. Supportive care only - While supportive care is crucial, **palliative chemotherapy** offers a chance to prolong survival and manage symptoms more effectively than supportive care alone in suitable patients with advanced pancreatic cancer. - Skipping chemotherapy entirely would mean foregoing potential benefits in terms of disease control and quality of life, especially for patients with a good performance status.
Question 9: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→4 B→3 C→1 D→2
- B. A→4 B→2 C→3 D→1
- C. A→3 B→4 C→1 D→2
- D. A→4 B→1 C→3 D→2 (Correct Answer)
Explanation: **A→4 B→1 C→3 D→2** - This option correctly matches each endocrine gland with its primary hormone: the **pineal gland** produces **melatonin**, the **testis** produces **testosterone**, the **adrenal gland** produces **cortisol**, and the **ovary** produces **estrogen**. - These pairings are fundamental to understanding the basic functions of the endocrine system. *A→4 B→3 C→1 D→2* - This option incorrectly matches the **testis** with **cortisol** (should be testosterone) and the **adrenal gland** with **melatonin** (should be cortisol). - Cortisol is a steroid hormone produced by the adrenal cortex, while melatonin from the pineal gland regulates sleep-wake cycles. *A→4 B→2 C→3 D→1* - This option incorrectly matches the **testis** with **estrogen** (should be testosterone) and the **ovary** with **melatonin** (should be estrogen). - Estrogen is the primary female sex hormone, while testosterone is the primary male sex hormone. *A→3 B→4 C→1 D→2* - This option incorrectly matches the **pineal gland** with **cortisol** (should be melatonin) and the **testis** with **estrogen** (should be testosterone). - The pineal gland is known for its role in circadian rhythms through melatonin production, not stress response hormones like cortisol.
Question 10: Hypercalcemia related to malignancy is seen in which of the following cancers?
- A. Multiple myeloma
- B. Lung carcinoma
- C. Carcinoma breast
- D. All the above (Correct Answer)
Explanation: Hypercalcemia of Malignancy (HCM) is the most common life-threatening metabolic complication of cancer, occurring in approximately 20-30% of patients. It occurs via four primary mechanisms: 1. **Humoral Hypercalcemia of Malignancy (HHM):** Mediated by the secretion of **Parathyroid Hormone-related Protein (PTHrP)** [1]. This is most commonly associated with **Squamous Cell Carcinoma of the Lung**, head and neck, and esophagus [1]. 2. **Local Osteolytic Hypercalcemia:** Direct bone destruction by tumor cells and activation of osteoclasts via cytokines (RANKL). This is the hallmark of **Multiple Myeloma** and **Breast Carcinoma** (which frequently metastasizes to bone) [3]. 3. **1,25-dihydroxyvitamin D (Calcitriol) Production:** Seen primarily in Lymphomas [2]. 4. **Ectopic PTH secretion:** Extremely rare. **Analysis of Options:** * **Multiple Myeloma:** Causes extensive "punched-out" lytic lesions due to osteoclast-activating factors (OAFs), making hypercalcemia a classic feature (part of the CRAB criteria) [2], [3]. * **Lung Carcinoma:** Specifically the Squamous Cell variant is the most frequent cause of PTHrP-mediated hypercalcemia [1]. * **Carcinoma Breast:** Frequently causes hypercalcemia through both direct bone metastasis (osteolysis) and PTHrP secretion [1], [3]. Since all three conditions are well-known causes of malignancy-associated hypercalcemia, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of HCM overall:** PTHrP secretion (Humoral). * **Most common cancer associated with HCM:** Breast cancer (due to high prevalence), but **Squamous Cell Lung Cancer** has the highest *incidence* per case. * **Laboratory Findings:** High Calcium, **Low PTH** (suppressed), and Low/Normal Phosphate [2]. * **Treatment of Choice:** Aggressive IV hydration with Normal Saline is the first step; **IV Bisphosphonates** (e.g., Zoledronic acid) are the gold standard for long-term management. Denosumab is used in refractory cases.
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