Tumor Immunology — MCQs
Which among the following drugs is the new FDA approved immune checkpoint inhibitor for endometrial carcinoma?
Which of the following is not a component of innate immunity?
An example of an IMiD (immunomodulatory derivative of thalidomide) is:
What is the best marker to assess prognosis after surgery for colon carcinoma?
Which of the following is the most potent stimulator of Naive T-cells?
A patient with gastric cancer shows positive CEA. What is its significance?
What is the Rose Waaler test used for?
Which of the following breast cancers is most often bilateral ?
All are true about autoimmune disease except:
All are true about the condition shown in the image except:
Tumor Immunology Indian Medical PG Practice Questions and MCQs
Question 1: Which among the following drugs is the new FDA approved immune checkpoint inhibitor for endometrial carcinoma?
- A. Ipilimumab
- B. Pembrolizumab (Correct Answer)
- C. Trastuzumab
- D. Nivolumab
Explanation: **Pembrolizumab** * **Pembrolizumab** (Keytruda), a **PD-1 inhibitor**, received accelerated FDA approval for patients with **advanced endometrial carcinoma** that is mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H), and has progressed following prior systemic therapy or is not a candidate for curative surgery or radiation. * This approval was based on data from the KEYNOTE-158 study, demonstrating **durable responses** in these specific subsets of endometrial cancer, highlighting its role in precision oncology. *Ipilimumab* * **Ipilimumab** (Yervoy) is a **CTLA-4 inhibitor** primarily approved for the treatment of **melanoma** and renal cell carcinoma, often in combination with nivolumab. * While it is an immune checkpoint inhibitor, its primary indications and specific FDA approvals do not include **endometrial carcinoma**. *Trastuzumab* * **Trastuzumab** (Herceptin) is a **monoclonal antibody** that targets the **HER2 protein**, commonly used in the treatment of **HER2-positive breast cancer** and certain types of gastric cancer. * It is not an immune checkpoint inhibitor and its mechanism of action is distinct from blocking immune checkpoints like PD-1 or CTLA-4. *Nivolumab* * **Nivolumab** (Opdivo) is a **PD-1 inhibitor** with broad FDA approvals for various cancers, including melanoma, non-small cell lung cancer, renal cell carcinoma, classical Hodgkin lymphoma, and others. * While a potent immune checkpoint inhibitor, **pembrolizumab** received the specific accelerated approval for advanced endometrial carcinoma in the context described, making it the most direct answer for the "new FDA approved" status in this specific indication.
Question 2: Which of the following is not a component of innate immunity?
- A. Epithelial barriers
- B. NK cells
- C. Dendritic cells
- D. Helper T lymphocytes (Correct Answer)
Explanation: ***Helper T lymphocyte*** - Helper T lymphocytes are a crucial part of **adaptive immunity** [4], facilitating responses against pathogens. - They specifically activate B cells and cytotoxic T cells [2], unlike components of innate immunity, which respond nonspecifically. *NK cells* - Natural Killer (NK) cells are integral to **innate immunity** [1], targeting infected or tumor cells without prior sensitization. - They play a role in the initial response to viral infections and can produce **cytokines** [2]. *Epithelial barriers* - Epithelial barriers act as the first line of defense in **innate immunity** [1], preventing pathogen entry. - They include physical and chemical barriers like skin and mucous membranes [3]. *Dendritic cells* - Dendritic cells are key antigen-presenting cells involved in **innate immunity** [1] and link to adaptive immunity. - They capture and present antigens [2], activating T cells to mount an immune response. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 194-196. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 207-208. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 152-153. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 196-198.
Question 3: An example of an IMiD (immunomodulatory derivative of thalidomide) is:
- A. Palivizumab
- B. Lenalidomide (Correct Answer)
- C. Ribavirin
- D. None of the options
Explanation: ***Lenalidomide*** - **Lenalidomide** is a well-known **immunomodulatory imide drug (IMiD)** derived from thalidomide, commonly used in the treatment of multiple myeloma and myelodysplastic syndromes. - IMiDs are characterized by their ability to modulate immune responses, enhance T-cell and NK-cell activity, and have direct anti-cancer effects through inhibition of angiogenesis and tumor cell proliferation. *Palivizumab* - **Palivizumab** is a **monoclonal antibody** that targets the fusion protein of respiratory syncytial virus (RSV), used for prophylaxis in high-risk infants. - It is not classified as an immunomodulatory imide drug and has a completely different structure and mechanism of action. *Ribavirin* - **Ribavirin** is an **antiviral agent** primarily used to treat chronic hepatitis C virus infection and respiratory syncytial virus. - Its mechanism of action is antiviral, not immunomodulatory in the same way as IMiDs. *None of the options* - This option is incorrect because **Lenalidomide** is indeed an example of an IMiD, making the statement false. - At least one correct answer exists among the given choices.
Question 4: What is the best marker to assess prognosis after surgery for colon carcinoma?
- A. CA 19-9
- B. CA-125
- C. Alpha fetoprotein
- D. CEA (Correct Answer)
Explanation: ***CEA*** - Carcinoembryonic antigen (**CEA**) is a well-established tumor marker for monitoring colorectal cancer post-surgery and assessing prognosis [1]. - Elevated **CEA levels** after surgery may indicate recurrence or residual disease, making it valuable in follow-up care [1]. *CA 19-9* - Primarily associated with **pancreatic** and **biliary tract cancers**, and not specific for colon carcinoma. - While it may elevate in some gastrointestinal malignancies, it is not the best indicator for prognosis after colon cancer surgery. *Alpha fetoprotein* - Mostly used for monitoring **hepatocellular carcinoma** and germ cell tumors, not colorectal malignancies. - Elevated levels are not typically correlated with prognosis in colon cancer patients. *CA-125* - Mainly utilized as a tumor marker for **ovarian cancer** and some other malignancies, not specifically for colon carcinoma. - Its use in colorectal cancer prognosis is limited and lacks relevance in this context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 253-254.
Question 5: Which of the following is the most potent stimulator of Naive T-cells?
- A. Macrophages
- B. B-cell
- C. Mature dendritic cells (Correct Answer)
- D. Follicular dendritic cells
Explanation: ***Mature dendritic cells*** - **Mature dendritic cells** are the most potent professional antigen-presenting cells (APCs) for activating **naive T cells** due to their efficient antigen processing, presentation abilities, and high expression of costimulatory molecules (e.g., CD80, CD86) and MHC-peptide complexes. - Activated by pathogens or inflammatory signals, they migrate to secondary lymphoid organs where they initiate primary immune responses by presenting antigens to and activating naive T cells. *Follicular dendritic cells* - **Follicular dendritic cells** primarily present intact antigens to **B cells** in germinal centers of secondary lymphoid organs, playing a crucial role in B cell maturation, selection, and antibody production. - They lack MHC class II molecules and thus cannot directly present antigens to naive T cells. *Macrophages* - While **macrophages** are professional APCs, they are generally less efficient than mature dendritic cells at activating **naive T cells**, especially in the initiation of primary immune responses. - They are more involved in presenting antigens to already activated T cells and clearing pathogens, often acting as secondary APCs. *B-cell* - **B cells** can act as APCs, but they are generally less efficient than **dendritic cells** in activating **naive T cells**, especially for the primary immune response. - Their primary role in antigen presentation is to present processed antigens to **helper T cells** to receive costimulation for their own activation and differentiation into plasma cells, often after being activated themselves.
Question 6: A patient with gastric cancer shows positive CEA. What is its significance?
- A. Prognostic (Correct Answer)
- B. Diagnostic
- C. Therapeutic
- D. Screening
Explanation: ***Prognostic*** - A positive **carcinoembryonic antigen (CEA)** in gastric cancer indicates **larger tumor burden** and more advanced disease [1] - Elevated preoperative CEA levels are associated with **poorer prognosis**, higher risk of recurrence, and decreased survival [1] - CEA levels can be used to **monitor treatment response** and detect early recurrence after curative resection [1] - Higher CEA values correlate with advanced stage, lymph node involvement, and distant metastases *Diagnostic* - CEA is **not specific enough** for diagnosing gastric cancer as it can be elevated in other malignancies (colorectal, pancreatic, lung) and benign conditions (smoking, cirrhosis, inflammatory bowel disease) [2] - Diagnosis of gastric cancer requires **endoscopic biopsy** with histopathological examination - CEA may be normal even in confirmed gastric cancer cases (limited sensitivity) [2] *Therapeutic* - CEA is a **tumor marker**, not a therapeutic agent or treatment modality - While CEA levels help guide treatment decisions and monitor response, the marker itself has no therapeutic role - Treatment decisions are based on staging, histology, and patient factors, not solely on CEA values *Screening* - CEA lacks sufficient **sensitivity and specificity** for population-based screening of gastric cancer [2] - Screening for gastric cancer uses **endoscopy** in high-risk populations, not serum tumor markers - CEA is primarily used for post-treatment surveillance in patients with known cancer, not for detecting occult disease in asymptomatic individuals **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 254-255. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 346.
Question 7: What is the Rose Waaler test used for?
- A. Ring precipitation
- B. Precipitation in gel
- C. Complement fixation test
- D. Passive hemagglutination test (Correct Answer)
Explanation: ***Passive hemagglutination test*** - The **Rose Waaler test** is a historical **rheumatoid factor (RF)** detection method based on **passive hemagglutination**. - It uses sheep red blood cells coated with a subagglutinating dose of rabbit anti-sheep red blood cell antibody to detect RF in patient serum. *Complement fixation test* - This assay detects the presence of **antibody** or **antigen** by observing whether **complement** is consumed in an antigen-antibody reaction. - The Rose Waaler test does not involve the measurement of complement consumption. *Precipitation in gel* - This technique, such as **immunodiffusion**, involves the formation of a visible **precipitate** when soluble antigens and antibodies diffuse through a gel matrix and meet at optimal concentrations. - The Rose Waaler test relies on agglutination of red blood cells, not precipitation in gel. *Ring precipitation* - A **ring precipitation test** involves layering an antigen solution over an antibody solution, creating an antigen-antibody complex visible as a **precipitate ring** at the interface of the two solutions. - This method is distinct from the Rose Waaler test which uses red blood cell agglutination.
Question 8: Which of the following breast cancers is most often bilateral ?
- A. Lobular carcinoma of the breast (Correct Answer)
- B. Medullary carcinoma of the breast
- C. Ductal carcinoma of the breast
- D. Colloid carcinoma of the breast
Explanation: ***Lobular carcinoma of the breast*** - **Invasive lobular carcinoma (ILC)** is the breast cancer subtype most frequently associated with **bilateral disease**, occurring in 5% to 28% of cases. [1] - This higher rate of bilaterality is partly due to the diffuse growth pattern of lobular carcinoma, which can make it more challenging to detect and may lead to synchronous or metachronous involvement of both breasts. [1] *Medullary carcinoma of the breast* - **Medullary carcinoma** is a rare and often well-circumscribed type of breast cancer that typically presents as a solitary mass and is not characteristically bilateral. [1] - It has a generally better prognosis than other invasive ductal carcinomas and is often associated with a BRCA1 mutation. [1] *Ductal carcinoma of the breast* - **Invasive ductal carcinoma (IDC)**, also known as no special type (NST), is the most common form of breast cancer, but it is less frequently bilateral than lobular carcinoma. [1] - While bilateral IDC can occur, it is a less defining characteristic compared to ILC. *Colloid carcinoma of the breast* - **Colloid (mucinous) carcinoma** is a distinct and relatively rare subtype of invasive ductal carcinoma, characterized by tumor cells floating in pools of mucin. - It usually presents as a solitary mass and is not known for a higher incidence of bilaterality. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 454-456.
Question 9: All are true about autoimmune disease except:
- A. Higher incidence among males (Correct Answer)
- B. T cells recognize self-antigen
- C. Polyclonal B cell activation
- D. Hashimoto's thyroiditis is an example
Explanation: ***Higher incidence among males*** - Autoimmune diseases (Ads) generally have a **higher incidence among females** than males, challenging the statement that they are more common in males [1]. - For example, conditions like **Systemic Lupus Erythematosus (SLE)** and **Rheumatoid Arthritis (RA)** show a pronounced female predominance [1]. *T cells recognize self-antigen* - This statement is true; in autoimmune diseases, **autoreactive T cells** fail to undergo proper selection and differentiation, leading them to recognize and attack **self-antigens** [2]. - This recognition often mediates tissue damage, as seen in **Type 1 Diabetes** where T cells target pancreatic beta cells [2]. *Polyclonal B cell activation* - This is also true; autoimmune diseases often involve **polyclonal B cell activation**, leading to the production of various **autoantibodies** that target self-components. - This broad activation contributes to the diverse clinical manifestations and systemic nature of many autoimmune conditions like **Systemic Lupus Erythematosus**. *Hashimoto's thyroiditis is an example* - This statement is true; **Hashimoto's thyroiditis** is a classic example of an **organ-specific autoimmune disease** where autoantibodies and autoreactive T-cells attack thyroid gland components [3]. - It results in **hypothyroidism** due to chronic inflammation and gradual destruction of thyroid follicles [3]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 175-178. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 176-177. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1089-1090.
Question 10: All are true about the condition shown in the image except:
- A. Occurs due to lymphatics destruction
- B. Overexpression of HER 2/neu shows poor response to adriamycin (Correct Answer)
- C. Peau d'orange
- D. Van Nuys prognostic index
Explanation: ***Overexpression of HER 2/neu shows poor response to adriamycin*** - This statement is **FALSE** and represents the correct answer. **HER2-positive breast cancers** actually show **GOOD response** to anthracycline-based chemotherapy including adriamycin (doxorubicin) [1]. - Multiple clinical trials have demonstrated that **HER2-overexpressing tumors are chemosensitive** to anthracyclines, with improved response rates compared to HER2-negative tumors [1]. - Modern treatment combines adriamycin with **HER2-targeted therapy** (trastuzumab) for optimal outcomes in HER2+ inflammatory breast cancer [1]. *Occurs due to lymphatics destruction* - This is **TRUE** for inflammatory breast cancer. The pathognomonic feature involves **dermal lymphatic invasion** by malignant cells causing obstruction. - This lymphatic blockage leads to the characteristic clinical presentation including **peau d'orange appearance** and rapid onset of breast erythema and edema. *Peau d'orange* - This is **TRUE** and represents a classic sign of inflammatory breast cancer. The **"orange peel" appearance** results from skin edema with tethering at hair follicles. - Caused by **dermal lymphatic obstruction** by tumor emboli, leading to lymphedema that accentuates the skin pores. *Van Nuys prognostic index* - This statement is **TRUE** as written. The **Van Nuys Prognostic Index (VNPI)** is a scoring system specifically developed for **ductal carcinoma in situ (DCIS)**, not for inflammatory breast cancer. - Inflammatory breast cancer is an **aggressive invasive carcinoma** (stage IIIB minimum) and uses different prognostic systems including TNM staging and molecular markers, making VNPI inappropriate for this condition. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1066.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free