Oncology Practice Questions

Q: What is the standard treatment regimen for metastatic testicular carcinoma?

Bleomycin, Etoposide, Cisplatin. The standard of care for metastatic germ cell tumors (GCTs), including testicular carcinoma, is the **BEP regimen** (Bleomycin, Etoposide, and Cisplatin). This combination is highly effective, making testicular cancer one of the most curable solid malignancies. 1. **Why Option A is Correct:** * **Cisplatin:** The backbone of treatment; it causes DNA cross-linking. * **Etoposide:** A topoisomerase II inhibitor that prevents DNA replication. * **Bleomycin:** An antitumor antibiotic that induces DNA strand breaks. Depending on the risk stratification (IGCCCG criteria), patients receive either 3 or 4 cycles of BEP. 2. **Why Other Options are Incorrect:** * **Option B (VeIP):** Vinblastine, Ifosfamide, and Cisplatin is a second-line (salvage) regimen used if BEP fails. * **Option C & D:** These combinations (containing 5-FU, Doxorubicin, or Methotrexate) are used for gastrointestinal, breast, or hematological malignancies but have no role in the primary management of testicular GCTs. **High-Yield Clinical Pearls for NEET-PG:** * **Toxicity Profile:** * **Bleomycin:** Associated with **pulmonary fibrosis**. Avoid in patients over 40 or those with pre-existing lung disease. * **Cisplatin:** Highly emetogenic; causes **nephrotoxicity** (prevented by aggressive hydration) and **ototoxicity**. * **Etoposide:** Can lead to secondary leukemia (AML). * **Tumor Markers:** Always monitor **AFP, beta-hCG, and LDH** for diagnosis, staging, and response to treatment. (Note: AFP is never elevated in pure seminoma). * **Residual Mass:** If a mass >1 cm remains after chemotherapy in non-seminomatous GCTs, **Retroperitoneal Lymph Node Dissection (RPLND)** is indicated.

Q: What is the drug of choice for chronic myeloid leukemia?

Imatinib Mesylate. **Explanation:** **Correct Answer: A. Imatinib Mesylate** Chronic Myeloid Leukemia (CML) is characterized by the **Philadelphia chromosome [t(9;22)]**, which creates the **BCR-ABL1** fusion gene. This gene encodes a constitutively active tyrosine kinase protein that drives uncontrolled granulocyte proliferation. **Imatinib Mesylate** is a selective **Tyrosine Kinase Inhibitor (TKI)** that binds to the ATP-binding site of the BCR-ABL protein, inhibiting its activity [1], [2]. It is the first-line "Standard of Care" (Drug of Choice) for CML in the chronic phase, significantly improving 10-year survival rates [1]. **Why other options are incorrect:** * **B. Fludarabine:** A purine analog primarily used in the treatment of **Chronic Lymphocytic Leukemia (CLL)** and certain non-Hodgkin lymphomas. * **C. Cladribine (2-CdA):** The drug of choice for **Hairy Cell Leukemia**. It is a purine nucleoside analog that is resistant to degradation by adenosine deaminase. * **D. Pentostatin:** Another adenosine deaminase inhibitor used as an alternative treatment for Hairy Cell Leukemia, but not for CML. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** CML is associated with a decrease in **Leukocyte Alkaline Phosphatase (LAP) score**, which helps differentiate it from a leukemoid reaction (where LAP is high). * **Side Effects of Imatinib:** Most common side effects include **periorbital edema**, muscle cramps, and skin rashes. * **Resistance:** If resistance to Imatinib develops (often due to the T315I mutation), second-generation TKIs like **Dasatinib** or **Nilotinib** are used [1]. **Ponatinib** is specifically used for the T315I mutation. * **Monitoring:** Therapeutic response is monitored via quantitative PCR for BCR-ABL1 transcripts (Molecular Response) [1].

Q: A 64-year-old man is admitted to the hospital for the assessment of hematuria after being involved in a motor vehicle accident. His physical examination is normal. A CT scan of the abdomen is shown in Figure below. Which of the following is the most likely diagnosis?

renal cell carcinoma. ***Renal cell carcinoma*** - **Heterogeneous enhancing mass** on CT with areas of **necrosis** and **calcification** is classic for renal cell carcinoma in a 64-year-old male. - The **motor vehicle accident** led to incidental discovery of a pre-existing tumor, as **traumatic hematuria** would show different CT findings like fluid collections or lacerations. *Kidney contusion and laceration* - Would show **perinephric hematoma**, **fluid collections**, and **parenchymal disruption** on CT imaging following trauma. - **Acute traumatic injury** typically presents with obvious signs of tissue damage and bleeding around the kidney, not a solid enhancing mass. *Transitional cell carcinoma* - Arises from the **urothelium** lining the **renal pelvis** or **collecting system**, appearing as filling defects on imaging. - CT would show **hydronephrosis** and **ureteral obstruction** rather than a solid parenchymal mass with enhancement patterns. *Renal hamartoma* - Also known as **angiomyolipoma**, contains **fat**, **smooth muscle**, and **blood vessels** visible as low-density areas on CT. - Appears as a **well-circumscribed lesion** with **fat attenuation** (negative Hounsfield units), unlike the heterogeneous enhancement seen here.

Q: A patient presents with a seizure and serum electrolyte studies reveal a serum sodium of 128 mEq/L. The urine osmolarity is higher than the serum osmolarity. A chest x-ray shows a lung mass. Which type of lung cancer is most likely to cause this electrolyte imbalance?

Small cell carcinoma. ### Explanation **1. Why Small Cell Carcinoma (SCLC) is Correct:** The clinical presentation describes **SIADH (Syndrome of Inappropriate Antidiuretic Hormone)**. Key features include hyponatremia (128 mEq/L), neurological symptoms (seizures), and inappropriately concentrated urine (urine osmolarity > serum osmolarity) in a patient with a lung mass. [1] SCLC is a neuroendocrine tumor that frequently produces ectopic hormones. [2] It is the most common cause of **ectopic SIADH**, occurring in approximately 7–10% of patients. The tumor cells secrete ADH (vasopressin), which leads to water retention and dilutional hyponatremia. [1] **2. Why the Other Options are Incorrect:** * **Adenocarcinoma:** This is the most common type of lung cancer overall and is typically peripheral. While it can be associated with hypertrophic osteoarthropathy (clubbing), it is not classically associated with SIADH. * **Bronchioloalveolar Carcinoma (now Adenocarcinoma in situ):** This subtype typically presents as a

Q: A 60-year-old woman with heart failure and normal renal function is started on furosemide 80 mg/day. She experiences a good diuretic response with the medication. A few weeks later, she reports feeling unwell with fatigue and muscle weakness, although her heart failure symptoms have improved. What is the most likely explanation for her muscle weakness?

Hypokalemia. **Explanation:** The correct answer is **Hypokalemia (Option C)**. **Mechanism:** Furosemide is a potent **loop diuretic** that inhibits the Na+/K+/2Cl- symporter in the thick ascending limb of the Loop of Henle. By increasing the delivery of sodium and fluid to the distal nephron, it stimulates the renin-angiotensin-aldosterone system (RAAS). Aldosterone acts on the principal cells of the collecting duct to reabsorb sodium in exchange for secreting potassium and hydrogen ions into the urine. This "distal delivery" effect leads to significant urinary potassium wasting. Hypokalemia causes hyperpolarization of muscle cell membranes, leading to symptoms of **fatigue, muscle weakness, and cramps.** **Analysis of Incorrect Options:** * **Hyponatremia (A):** While loop diuretics can cause hyponatremia, it is much more common with Thiazides. In this clinical context, muscle weakness following diuretic use is a classic presentation of potassium depletion. * **Hypernatremia (B):** Diuretics typically cause loss of both water and solutes; they do not typically cause a rise in serum sodium unless there is profound dehydration with inadequate water intake. * **Hyperkalemia (D):** This is a side effect of potassium-sparing diuretics (e.g., Spironolactone) or ACE inhibitors, not loop diuretics. **High-Yield Clinical Pearls for NEET-PG:** * **Metabolic Profile of Loop Diuretics:** Hypokalemic, hypochloremic metabolic alkalosis (due to H+ loss) and hypocalcemia ("Loops lose calcium"). * **ECG Findings in Hypokalemia:** Flattened T-waves, prominent **U-waves**, and ST-segment depression. * **Drug Interaction:** Hypokalemia potentiates **Digoxin toxicity**, a critical consideration in heart failure patients. * **Ototoxicity:** Furosemide can cause dose-dependent hearing loss, especially when given intravenously or with other ototoxic drugs (e.g., Aminoglycosides).

Q: What is the standard treatment for Hodgkin lymphoma?

The ABVD regimen is commonly used.. **Explanation:** **1. Why Option A is Correct:** The **ABVD regimen** (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine) is the current gold standard for both early and advanced-stage Hodgkin Lymphoma (HL). It is preferred over older regimens like MOPP because it is highly effective, better tolerated, and associated with a significantly lower risk of secondary malignancies (like leukemia) and infertility. **2. Why Other Options are Incorrect:** * **Option B:** Unlike the older MOPP regimen (Mustine, Oncovin, Procarbazine, Prednisolone), **ABVD does not typically cause permanent sterility**. This is a major clinical advantage, as HL often affects young patients of reproductive age. * **Option C:** According to the **Hasenclever International Prognostic Index (IPI)** for advanced HL, a **WBC count ≥ 15 x 10⁹/L** is actually a **poor prognostic factor**, not a good one [1]. Other poor prognostic factors include age ≥ 45, male sex, Stage IV disease, Albumin < 4 g/dL, Hemoglobin < 10.5 g/dL, and Lymphopenia (< 0.6 x 10⁹/L). **3. High-Yield Clinical Pearls for NEET-PG:** * **Bleomycin Toxicity:** Monitor for **pulmonary fibrosis**; avoid high inspired oxygen concentrations during surgery. * **Adriamycin (Doxorubicin):** Associated with dose-dependent **cardiotoxicity** (dilated cardiomyopathy). * **Reed-Sternberg Cells:** The diagnostic hallmark of HL, typically expressing **CD15 and CD30** (except in the Nodular Lymphocyte Predominant subtype, which is CD20+) [1]. * **Staging:** The **Ann Arbor Staging System** (modified by Cotswolds) is used, with PET-CT being the preferred modality for initial staging and response assessment (Deauville Criteria) [1].

Q: Migratory thrombophlebitis is most commonly seen with which of the following malignancies?

Pancreatic cancer. **Explanation:** **Migratory thrombophlebitis**, also known as **Trousseau sign of malignancy**, is a paraneoplastic syndrome characterized by recurrent episodes of superficial venous thrombosis that appear at different sites (migrating) over time. **Why Pancreatic Cancer is correct:** The association is strongest with **adenocarcinomas**, particularly **pancreatic cancer** (most commonly involving the body and tail). The underlying pathophysiology involves the release of procoagulants, such as **mucin** and tissue factor-like substances, from the tumor cells. these substances activate the coagulation cascade (specifically Factor X), leading to a hypercoagulable state and spontaneous clot formation in superficial veins. **Why other options are incorrect:** * **Testicular cancer:** While it can increase the risk of deep vein thrombosis (DVT) due to bulky lymphadenopathy causing venous stasis, it is not classically associated with migratory thrombophlebitis. * **Breast cancer:** Although breast cancer is a common malignancy that increases general VTE risk, it does not typically present with the specific "migratory" pattern seen in Trousseau syndrome. * **Liver cancer:** Hepatocellular carcinoma is more frequently associated with portal vein thrombosis or Budd-Chiari syndrome rather than systemic migratory superficial phlebitis. **High-Yield Clinical Pearls for NEET-PG:** * **Trousseau Sign:** Do not confuse this with the Trousseau sign of latent tetany (carpopedal spasm induced by BP cuff inflation). * **Location:** Pancreatic **body and tail** tumors are more likely to present with Trousseau syndrome than head tumors, as head tumors present earlier with obstructive jaundice. * **Other associated cancers:** Lung, gastric, and colon adenocarcinomas. * **Management:** The treatment of choice for cancer-associated thrombosis is generally **Low Molecular Weight Heparin (LMWH)**, as these patients often show resistance to warfarin.

Q: What is the most common origin of cerebral metastases?

Lung. **Explanation:** Brain metastases are the most common intracranial tumors in adults, occurring much more frequently than primary brain malignancies. **1. Why Lung is Correct:** **Lung cancer** is the most common primary source of cerebral metastases, accounting for approximately **40–50%** of all cases. This is due to the high incidence of lung cancer and the direct access tumor cells have to the systemic arterial circulation via the pulmonary veins, bypassing the initial filtration of the lungs. Both Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC), particularly adenocarcinoma, have a high predilection for the brain. **2. Analysis of Incorrect Options:** * **Colon (A):** Colorectal cancer typically metastasizes to the liver first via the portal circulation. Brain involvement is rare (approx. 1–2%) and usually occurs in the setting of advanced, multi-organ systemic disease. * **Kidney (B):** Renal Cell Carcinoma (RCC) is a known cause of brain metastasis (approx. 7–10%), often presenting as a solitary, highly vascular lesion. However, it is significantly less common than lung or breast primaries. * **Melanoma (C):** While melanoma has the **highest propensity** (highest percentage of patients with the disease developing brain spread), it is not the most common overall because the general incidence of melanoma is lower than that of lung cancer. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common overall:** Lung > Breast > Melanoma > Renal > GI. * **Highest Propensity:** Melanoma (up to 50% of patients develop brain mets). * **Most common source in children:** Neuroblastoma. * **Location:** Most metastases (80%) occur at the **grey-white matter junction** due to the narrowing of blood vessels (embolic trapping). * **Imaging:** Contrast-enhanced MRI is the gold standard; lesions typically show "ring enhancement" with significant peritumoral edema.

Question 1

What is the standard treatment regimen for metastatic testicular carcinoma?

Accepted Answer

Bleomycin, Etoposide, Cisplatin

Answer

Vinblastine, Etoposide, Cisplatin

Answer

Doxorubicin, 5-Fluorouracil, Mercaptopurine

Answer

Methotrexate, 5-Fluorouracil, Vincristine

Question 2

A 74-year-old man presents with fatigue, shortness of breath on exertion, and back and rib pain worsened by movement. Investigations reveal anemia, elevated calcium, urea, and creatinine. X-rays show multiple lytic lesions in long bones and ribs, and protein electrophoresis is positive for an immunoglobulin G (IgG) paraprotein. What is the most likely mechanism for the renal injury?

Accepted Answer

Tubular damage by light chains

Answer

Plasma cell infiltrates

Answer

Glomerular injury

Answer

Vascular injury by light chains

Question 3

What is the drug of choice for chronic myeloid leukemia?

Accepted Answer

Imatinib Mesylate

Answer

Fludarabine

Answer

Cladribine

Answer

Pentostatin

Question 4

A 64-year-old man is admitted to the hospital for the assessment of hematuria after being involved in a motor vehicle accident. His physical examination is normal. A CT scan of the abdomen is shown in Figure below. Which of the following is the most likely diagnosis?

Accepted Answer

renal cell carcinoma

Answer

kidney contusion and laceration

Answer

transitional cell carcinoma

Answer

renal hamartoma

Question 5

A patient presents with a seizure and serum electrolyte studies reveal a serum sodium of 128 mEq/L. The urine osmolarity is higher than the serum osmolarity. A chest x-ray shows a lung mass. Which type of lung cancer is most likely to cause this electrolyte imbalance?

Accepted Answer

Small cell carcinoma

Answer

Adenocarcinoma

Answer

Bronchioloalveolar carcinoma

Answer

Large cell carcinoma

Question 6

Which group of lymph nodes is classically involved in tuberculosis of the larynx?

Accepted Answer

Posterior cervical lymph nodes

Answer

Anterior cervical lymph nodes

Answer

Pretracheal lymph nodes

Answer

Submandibular lymph nodes

Question 7

A 60-year-old woman with heart failure and normal renal function is started on furosemide 80 mg/day. She experiences a good diuretic response with the medication. A few weeks later, she reports feeling unwell with fatigue and muscle weakness, although her heart failure symptoms have improved. What is the most likely explanation for her muscle weakness?

Accepted Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypernatremia

Answer

Hyperkalemia

Question 8

What is the standard treatment for Hodgkin lymphoma?

Accepted Answer

The ABVD regimen is commonly used.

Answer

Sterility is a common side effect of the ABVD regimen.

Answer

A WBC count greater than 16 x 10^9/L is considered a good prognostic factor.

Answer

None of the above.

Question 9

Migratory thrombophlebitis is most commonly seen with which of the following malignancies?

Accepted Answer

Pancreatic cancer

Answer

Testicular cancer

Answer

Breast cancer

Answer

Liver cancer

Question 10

What is the most common origin of cerebral metastases?

Accepted Answer

Lung

Answer

Colon

Answer

Kidney

Answer

Melanoma

Oncology — MCQs

Oncology — MCQs

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