Oncology Practice Questions

Q: The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Hickman catheter. ***Hickman catheter*** - The image clearly displays a **tunneled central venous catheter** with an external segment, consistent with a Hickman catheter. These catheters are used for long-term venous access, crucial for patients undergoing chemotherapy for conditions like acute lymphoblastic leukemia. - Hickman catheters are characterized by a **cuff** that promotes tissue ingrowth, anchoring the catheter and reducing infection risk, and having one or more lumens for infusions, blood draws, and medication administration. *Malecot catheter* - A Malecot catheter is a **self-retaining suprapubic catheter** typically used for bladder drainage, not for long-term venous access and multiple infusions. - Its design features winged tips that expand to hold it in place within an organ, which is distinct from the central venous access device shown. *Cimino-Brescia catheter* - A Cimino-Brescia fistula is an **arteriovenous fistula** created surgically for hemodialysis access, involving the direct connection of an artery and a vein. It is not an external catheter like the one pictured. - This option refers to a vascular access point rather than a catheter, and it's used for **dialysis**, not primarily for chemotherapy administration in the manner shown. *Peripherally inserted centrally catheter* - A peripherally inserted central catheter (PICC) is inserted into a peripheral vein (usually in the arm) and threaded into a central vein. While also a central venous catheter, it does not typically exit the chest wall as depicted. - Although it provides central venous access, the visual representation of the catheter exiting the chest through a subcutaneous tunnel indicates a **tunneled catheter**, not a PICC line typically inserted in the arm.

Q: A 3-year-old girl brought with swelling in left eye which had shown rapid growth in last 4 weeks. On examination it is a bulbous fleshy mass about 5 x 4 cm arising from lower eyelid. No organomegaly or was noted and lymph node examination was unremarkable. The Complete blood counts are normal. Probable diagnosis is?

Rhabdomyosarcoma. ***Rhabdomyosarcoma*** - This is the most common **primary orbital malignancy in children**, often presenting as a rapidly growing, fleshy periorbital mass, consistent with the 3-year-old girl's symptoms. - The rapid growth (4 weeks) and the description of a **bulbous, fleshy mass** arising from the eyelid are classic presentations of rhabdomyosarcoma. *Retinoblastoma* - This is a malignancy of the retina and typically presents with **leukocoria (white pupillary reflex)**, strabismus, or vision impairment, not usually as an external fleshy mass arising from the eyelid. - While it is a common pediatric eye tumor, its clinical presentation differs significantly from the described external swelling. *Chloroma* - Also known as granulocytic sarcoma, chloroma is an extramedullary manifestation of **acute myeloid leukemia** and would typically be associated with systemic symptoms of leukemia (e.g., anemia, thrombocytopenia, leukocytosis/leukopenia) and abnormal blood counts. - The patient's normal CBC and lack of organomegaly/lymphadenopathy make chloroma less likely. *Orbital metastasis* - While possible, orbital metastases in children are rare and typically arise from **neuroblastoma** or occasionally other primary tumors. - Such metastases usually present with features suggestive of the primary tumor, which are not mentioned here.

Q: One-year-old child presents with abdominal lump. All are true about the condition shown below except:

Gain of distal short arm of chromosome 1. ***Gain of distal short arm of chromosome 1*** - **Gain of distal short arm of chromosome 1 (1p duplication)** is not a characteristic genetic abnormality associated with neuroblastoma. - Instead, **deletion of the short arm of chromosome 1 (1p deletion)** is a common genetic alteration seen in neuroblastoma, indicating a poorer prognosis. *Dancing eyes and dancing feet* - This refers to **opsoclonus-myoclonus syndrome (OMS)**, a paraneoplastic syndrome associated with neuroblastoma, characterized by rapid, irregular eye movements (opsoclonus) and involuntary muscle jerks (myoclonus). - OMS is one of the classic paraneoplastic manifestations of neuroblastoma, seen in a small percentage of cases, especially those with tumors that spontaneously regress. *Homer Wright pseudo-Rosettes* - **Homer Wright pseudo-rosettes** are a characteristic histological feature of neuroblastoma, consisting of tumor cells arranged concentrically around a central area of neuropil. - This finding on histopathology is highly suggestive of neuroblastoma, a tumor of neural crest origin. *Horner syndrome* - **Horner syndrome** (ptosis, miosis, anhidrosis) can be caused by neuroblastoma arising in the neck or superior mediastinum, which infiltrates or compresses the **sympathetic chain**. - The image shows a child with proptosis and exophthalmos from likely orbital metastases, and another common site for neuroblastoma is the adrenal gland, but also sympathetic ganglia throughout the body.

Q: A 6-month-old infant with a progressively increasing abdominal lump. Investigations revealed a stage IVs neuroblastoma. All are correct about the condition except:

Most common stage of neuroblastoma. ***Most common stage of neuroblastoma*** - Stage IVs neuroblastoma is typically seen in infants under 1 year of age, but it is **not the most common stage** overall. - While it has distinct features, stage IV (disseminated disease with distant metastases) is generally considered the most common presentation of neuroblastoma at diagnosis across all age groups. *Favorable prognosis* - Stage IVs neuroblastoma generally has a **favorable prognosis** due to its unique biological behavior compared to other advanced stages. - This stage is characterized by **spontaneous regression** in many cases, contributing to better outcomes despite widespread disease. *Can regress spontaneously* - A hallmark of Stage IVs neuroblastoma is the potential for **spontaneous regression**, often without intensive therapy. - This characteristic is attributed to specific biological features of the tumor cells in this subset of patients. *Low dose cyclophosphamide* - For stage IVs neuroblastoma, particularly in symptomatic cases, **low-dose chemotherapy**, such as cyclophosphamide, is often used. - The goal is to manage symptoms and encourage regression rather than aggressive eradication, given the tumor's favorable biology.

Q: The following appearance of a child can occur in which of the following situations:

Meconium aspiration syndrome. ***Meconium aspiration syndrome*** - The image shows a **post-term infant** with **peeling skin** and a **greenish-yellow discoloration** of the skin, umbilical cord, and nails, which is characteristic of meconium staining. - This staining is a key indicator of **fetal distress** and meconium passage in utero, often leading to meconium aspiration syndrome. *Infant of diabetic mother* - Infants of diabetic mothers typically present with **macrosomia** (large for gestational age), **ruddy complexion**, and conditions like **hypoglycemia** or **respiratory distress syndrome**, but not meconium staining as seen here. - They also often have **increased fat deposition**, giving them a plump appearance. *Cold stress* - An infant experiencing **cold stress** would typically present with symptoms like **tachypnea**, **hypoglycemia**, **lethargy**, and a **mottled appearance**, but not the characteristic meconium staining or peeling skin shown. - The primary concern in cold stress is heat loss, leading to metabolic derangements. *Hyaline membrane disease* - Hyaline membrane disease, or **respiratory distress syndrome**, primarily affects **premature infants** due to **surfactant deficiency**, leading to severe respiratory difficulty. - While it causes respiratory distress, it does not typically present with the extensive **skin peeling** and **meconium staining** seen in the image.

Q: Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Neuroblastoma. ***Neuroblastoma*** - The image shows **periorbital ecchymosis** and **proptosis** in a child, which are classic signs of orbital metastatic neuroblastoma, often referred to as "raccoon eyes." - The abdominal scar suggests a prior surgery, possibly for removal of the primary tumor, which is typically found in the **adrenal gland** or **sympathetic ganglia**. *Chloroma* - **Chloromas** (also known as granulocytic sarcomas) are extramedullary manifestations of myeloid leukemia, presenting as solid tumors composed of myeloid blast cells. - While they can appear in the orbit and mimic proptosis, the presence of bilateral periorbital ecchymosis ("raccoon eyes") is more characteristic of neuroblastoma metastasis. *Wilms tumor* - **Wilms tumor** is a kidney cancer, typically presenting as an **abdominal mass** and occasionally with hypertension or hematuria. - Ocular manifestations, such as proptosis, are extremely **rare** and do not typically involve periorbital ecchymosis. *Ameloblastoma* - An **ameloblastoma** is a benign but locally aggressive tumor of odontogenic (tooth-forming) origin, primarily affecting the **jawbones**. - It does not metastasize to the orbit and would not present with periorbital swelling or ecchymosis.

Q: A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Ultrasound, CT scan with contrast, and CBC. ***Ultrasound, CT scan with contrast, and CBC*** - This combination allows for comprehensive **assessment of the kidney mass**, its extent, and helps differentiate it from other abdominal masses, while a CBC checks for paraneoplastic anemia or polycythemia. - **Ultrasound** is typically the initial imaging modality due to its non-invasiveness and ability to characterize the mass as solid or cystic, followed by a **CT scan with contrast** for detailed anatomical information and staging. *Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy* - While ultrasound, CT scan with contrast, and CBC are appropriate, a **bone marrow biopsy** is usually reserved for suspected metastasis or specific types of tumors like neuroblastoma, not as an initial step for a primary renal mass presentation in a 3-year-old child. - The initial focus is on characterizing the renal mass and systemic workup, and bone marrow biopsy would be considered later if there's evidence or high suspicion of metastatic disease to the bone marrow. *Ultrasound and CT scan with contrast* - While these imaging studies are crucial for diagnosing and staging the renal mass, neglecting a **complete blood count (CBC)** would be an oversight. - A CBC can reveal important information such as anemia (common with renal tumors), thrombocytosis, or other hematological abnormalities that might influence treatment decisions or indicate prognosis. *CT scan with contrast and Bone marrow biopsy* - Relying solely on a **CT scan with contrast** as the initial imaging can be less efficient than starting with ultrasound, especially in children, and lacks the preliminary information provided by a CBC. - A **bone marrow biopsy** is not typically part of the initial workup for a suspected Wilms' tumor unless there is specific concern for bone marrow involvement or to rule out a neuroblastoma.

Q: Which of the following malignant diseases of children has the best prognosis -

Wilms tumor. ***Wilms tumor*** - **Wilms tumor**, also known as **nephroblastoma**, has one of the best prognoses among childhood malignancies, with a **survival rate exceeding 90%** for localized disease. - Its high curability is attributed to its **chemosensitivity**, surgical resectability, and advancements in multimodal therapy. *Primitive neuroectodermal tumor* - **Primitive neuroectodermal tumors (PNETs)** are highly aggressive and often associated with a **poor prognosis**, particularly when they are large or metastatic. - These tumors arise from neuroectoderm and can occur in the central nervous system (e.g., medulloblastoma) or peripherally, making treatment challenging due to their infiltrative nature. *Neuroblastoma* - **Neuroblastoma** is a common extracranial solid tumor in children, originating from neural crest cells, and its prognosis varies widely based on age, stage, and biological features, but it often has a **guarded prognosis**, especially in older children or with unfavorable genetic markers. - High-risk neuroblastomas frequently exhibit **amplification of the MYCN oncogene** and often require intensive, multi-modal treatment, still leading to significant mortality. *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is a malignant tumor of mesenchymal origin with skeletal muscle differentiation, and its prognosis depends heavily on site, histology (e.g., alveolar vs. embryonal), and resectability, with **overall survival rates lower than Wilms tumor**, especially for unfavorable subtypes or metastatic disease. - Aggressive treatment including chemotherapy, radiation, and surgery is often necessary, but recurrence rates can be high.

Q: Most common cause of suprasellar enlargement with calcification in children is –

Craniopharyngioma. ***Craniopharyngioma*** - This is the **most common suprasellar tumor in children** and is well-known for its characteristic **calcifications** and cystic components. - It arises from remnants of Rathke's pouch and can cause **endocrine dysfunction** and **visual field defects** due to compression of surrounding structures. *Meningioma* - While meningiomas can occur in the suprasellar region and may calcify, they are **much more common in adults** and are rare in children. - They typically arise from the **meninges** and are often dural-based, which is less consistent with the primary presentation in this context. *Astrocytoma* - Astrocytomas are common brain tumors in children, but they are **less likely to be suprasellar** in origin and **calcifications are not a prominent feature** compared to craniopharyngiomas. - Optic pathway gliomas (a type of astrocytoma) can occur in this region but usually present as solid masses with less overt calcification. *Suprasellar tuberculoma* - Tuberculomas are granulomatous lesions that can occur in the brain, including the suprasellar region, especially in areas with a **high prevalence of tuberculosis**. - While they can calcify, they are **not the most common cause** of suprasellar enlargement with calcification in children globally, and craniopharyngiomas are more prevalent in this context.

Q: Most common tumor in the part of the brain shown (arrow) among children is

Astrocytoma. ***Astrocytoma*** - The image shows a **brainstem lesion**, which is a common location for astrocytomas in children. - **Pilocytic astrocytoma** is the most common brain tumor in children, often presenting in the cerebellum, brainstem, or optic pathways. *DNET (Dysembryoplastic Neuroepithelial Tumor)* - DNETs are typically found in the **temporal lobe** and are associated with a history of seizures. - While benign, their characteristic location and symptoms do not align with a brainstem mass as the primary finding. *Ependymoma* - Ependymomas frequently arise in the **fourth ventricle** in children, often causing hydrocephalus. - Although they can occur in the brainstem, astrocytomas are generally more common in this specific region in pediatric cases. *Medulloblastoma* - Medulloblastomas are nearly always located in the **cerebellum** (infratentorial region) and are known for their aggressive nature and propensity for CSF dissemination. - The lesion shown appears to be within the brainstem, making medulloblastoma less likely given its typical cerebellar location.

Question 1

The image shows a child with acute lymphoblastic leukemia. Identify the type of catheter shown:

Accepted Answer

Hickman catheter

Answer

Malecot catheter

Answer

Cimino-Brescia catheter

Answer

Peripherally inserted centrally catheter

Question 2

A 3-year-old girl brought with swelling in left eye which had shown rapid growth in last 4 weeks. On examination it is a bulbous fleshy mass about 5 x 4 cm arising from lower eyelid. No organomegaly or was noted and lymph node examination was unremarkable. The Complete blood counts are normal. Probable diagnosis is?

Accepted Answer

Rhabdomyosarcoma

Answer

Retinoblastoma

Answer

Chloroma

Answer

Orbital metastasis

Question 3

One-year-old child presents with abdominal lump. All are true about the condition shown below except:

Accepted Answer

Gain of distal short arm of chromosome 1

Answer

Dancing eyes and dancing feet

Answer

Homer Wright pseudo-Rosettes

Answer

Horner syndrome

Question 4

A 6-month-old infant with a progressively increasing abdominal lump. Investigations revealed a stage IVs neuroblastoma. All are correct about the condition except:

Accepted Answer

Most common stage of neuroblastoma

Answer

Favorable prognosis

Answer

Can regress spontaneously

Answer

Low dose cyclophosphamide

Question 5

The following appearance of a child can occur in which of the following situations:

Accepted Answer

Meconium aspiration syndrome

Answer

Infant of diabetic mother

Answer

Cold stress

Answer

Hyaline membrane disease

Question 6

Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Accepted Answer

Neuroblastoma

Answer

Chloroma

Answer

Wilms tumor

Answer

Ameloblastoma

Question 7

A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?

Accepted Answer

Ultrasound, CT scan with contrast, and CBC

Answer

Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy

Answer

Ultrasound and CT scan with contrast

Answer

CT scan with contrast and Bone marrow biopsy

Question 8

Which of the following malignant diseases of children has the best prognosis -

Accepted Answer

Wilms tumor

Answer

Primitive neuroectodermal tumor

Answer

Neuroblastoma

Answer

Rhabdomyosarcoma

Question 9

Most common cause of suprasellar enlargement with calcification in children is –

Accepted Answer

Craniopharyngioma

Answer

Meningioma

Answer

Astrocytoma

Answer

Suprasellar tuberculoma

Question 10

Most common tumor in the part of the brain shown (arrow) among children is

Accepted Answer

Astrocytoma

Answer

DNET

Answer

Ependymoma

Answer

Medulloblastoma

Oncology — MCQs

Oncology — MCQs

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