Oncology — MCQs

Oncology Indian Medical PG Practice Questions and MCQs

Question 291: A 55-year-old man with a history of smoking presents with chronic cough and dyspnea. His chest X-ray reveals a mass. Which imaging study is the most appropriate next step for further evaluation?

A. Low-dose CT scan (Correct Answer)
B. Chest X-ray
C. Sputum cytology
D. MRI

Explanation: ***Low-dose CT scan*** - A **CT scan** provides much greater detail and **cross-sectional imaging** compared to a chest X-ray, allowing for better characterization of the mass, including its size, location, and potential involvement of surrounding structures [1]. - This detailed information is crucial for determining the next steps in diagnosis and staging, such as guiding biopsies or surgical planning for suspected lung cancer [1]. *Chest X-ray* - A chest X-ray has already been performed and revealed the mass, but it offers **limited resolution** and **three-dimensional information**, making it insufficient for detailed characterization or staging of a suspicious lesion [1]. - Further evaluation requires a more advanced imaging modality to better define the mass and assess for potential malignancy. *Sputum cytology* - **Sputum cytology** is a non-invasive test that can identify **malignant cells** in respiratory secretions, but its sensitivity is generally low, especially for peripheral lesions. - While it can be part of a diagnostic workup, it is not the most appropriate immediate next step for further evaluating a mass seen on imaging, which requires better anatomical definition. *MRI* - **MRI** is excellent for soft tissue contrast and can be used in some cases of lung cancer for **staging**, particularly for assessing **chest wall invasion** or **brain metastases**. - However, for initial evaluation of a pulmonary mass, its role is typically secondary to CT, as CT offers superior resolution for lung parenchyma and is faster and more cost-effective for primary characterization.

Question 292: Which marker is most commonly elevated in hepatocellular carcinoma?

A. CEA
B. CA 19-9
C. Alpha-fetoprotein (Correct Answer)
D. PSA

Explanation: ***Alpha-fetoprotein*** - ***Alpha-fetoprotein (AFP)*** is the most common tumor marker elevated in **hepatocellular carcinoma (HCC)**, with levels often significantly higher in affected individuals [1]. - Its elevation is associated with **liver disease**, making it a crucial marker in the diagnosis and monitoring of HCC [1]. *PSA* - **Prostate-specific antigen (PSA)** is primarily elevated in **prostate cancer** and does not correlate with hepatocellular carcinoma [2]. - It is a marker for **prostate disease**, not liver pathology, distinguishing it from AFP [2]. *CEA* - **Carcinoembryonic antigen (CEA)** is more commonly associated with **colorectal** and other cancers but is not specific to hepatocellular carcinoma [2]. - Levels may be elevated in various malignancies, making it less reliable as a specific marker for HCC. *CA 19-9* - **CA 19-9** is mainly associated with **pancreatic** and **biliary tract cancers**, not hepatocellular carcinoma. - Elevated levels usually indicate gastrointestinal malignancies rather than liver issues.

Question 293: A patient with known breast cancer presents with shortness of breath. A chest CT reveals multiple nodules throughout both lungs. What is the most likely diagnosis?

A. Primary lung cancer
B. Pneumonia
C. Metastatic disease (Correct Answer)
D. Pulmonary embolism

Explanation: Metastatic disease - The presence of **multiple lung nodules** in a patient with a known history of **breast cancer** strongly suggests hematogenous spread to the lungs [1]. - Breast cancer frequently metastasizes to the lungs, and these **multiple, widespread nodules** are a classic presentation of such progression [1]. Patients with two or more pulmonary nodules can often be assumed to have metastases [2]. *Primary lung cancer* - While lung cancer can manifest as nodules, the presence of **multiple, scattered nodules in both lungs** in a patient with an existing primary cancer makes this less likely to be a *de novo* primary lung cancer. - Primary lung cancer typically presents as a **single mass** or a more localized process, although multifocal primary lung cancers can occur, they are less common than metastatic disease in this context [2]. *Pneumonia* - Pneumonia would typically present with **infiltrates or consolidation**, often associated with fever, cough with sputum, and elevated inflammatory markers. - **Multiple, discrete lung nodules** are not a typical presentation of pneumonia. *Pulmonary embolism* - Pulmonary embolism causes **filling defects** in the pulmonary arteries and can lead to infarcts, which might appear as wedge-shaped opacities, but usually not as **multiple, diffuse nodules** throughout both lungs. - Symptoms would typically include sudden onset of **pleuritic chest pain** and hypoxemia, which may or may not be present with shortness of breath.

Question 294: A patient presents with chest pain and a pericardial effusion. Histology reveals malignant mesothelial cells. Which risk factor is most strongly associated with malignant mesothelioma?

A. Asbestos exposure (Correct Answer)
B. Consumption of alcohol
C. Exposure to silica dust
D. Exposure to tobacco smoke

Explanation: ***Asbestos exposure*** - Asbestos exposure is the most significant risk factor associated with **malignant mesothelioma**, particularly affecting the pleura and pericardium [1]. - This malignancy often presents with **pericardial effusion** and pleuritic chest pain, aligning with the patient's symptoms. - Mesothelioma is exceptionally rare in the absence of asbestos exposure [1]. *Silica dust exposure* - While silica exposure is a risk factor for lung diseases, particularly **silicosis** and **lung cancer**, it is not strongly linked to mesothelioma. - Mesothelioma is predominantly associated with **asbestos**, not silica [1]. *Tobacco smoke* - Tobacco smoke is primarily linked to **lung cancer** and respiratory diseases, but does not have a significant correlation with **mesothelioma**. - Mesothelioma can occur in non-smokers, indicating a separation from tobacco exposure. *Alcohol consumption* - Alcohol consumption is linked to various health conditions but is not recognized as a risk factor for **mesothelioma**. - The disease's association is predominantly with **asbestos exposure**, not lifestyle factors like alcohol use [1].

Question 295: A 55-year-old female presents with a gradually enlarging, painless mass in her left breast. She also reports recent nipple retraction and peau d'orange skin changes. What is the most likely diagnosis?

A. Fibroadenoma
B. Breast cyst
C. Ductal carcinoma in situ
D. Invasive ductal carcinoma (Correct Answer)

Explanation: ***Invasive ductal carcinoma*** - The combination of a **gradually enlarging, painless mass**, **nipple retraction**, and **peau d'orange skin changes** are classic signs of advanced **invasive ductal carcinoma** [1]. - **Peau d'orange** occurs due to **lymphatic obstruction** by tumor cells, leading to edema and thickening of the skin, mimicking an orange peel. *Fibroadenoma* - This is a **benign tumor** typically found in younger women, presenting as a **mobile, rubbery, well-defined mass**. - It does not usually cause **nipple retraction** or **peau d'orange** changes. *Breast cyst* - **Breast cysts** are fluid-filled sacs that are often **tender** or **painful** and can fluctuate in size with the menstrual cycle. - They typically present as **smooth, mobile masses** and do not cause the advanced signs like **nipple retraction** or **peau d'orange**. *Ductal carcinoma in situ* - **Ductal carcinoma in situ (DCIS)** is a **non-invasive cancer** confined to the milk ducts [1]. - It often presents as **microcalcifications on mammography** and typically does not manifest with palpable masses, nipple retraction, or peau d'orange unless associated with an invasive component [1].

Question 296: A 50-year-old woman with metastatic melanoma has started a new immunotherapy drug. Which of the following is a common side effect of immune checkpoint inhibitors?

A. Nephrotoxicity
B. Hepatotoxicity
C. Cardiotoxicity
D. Pneumonitis (Correct Answer)

Explanation: ***Pneumonitis*** - **Pneumonitis** is a common and potentially severe immune-related adverse event (irAE) associated with immune checkpoint inhibitors, occurring when the activated immune system targets lung tissue. - Patients may present with cough, dyspnea, and hypoxia, and imaging often shows ground-glass opacities or interstitial infiltrates. *Nephrotoxicity* - While **renal irAEs** can occur, leading to **acute kidney injury** or interstitial nephritis, they are less common than pneumonitis or colitis. - The incidence of severe **nephrotoxicity** is relatively low compared to other organ toxicities. *Hepatotoxicity* - **Hepatotoxicity** in the form of **immune-mediated hepatitis** is a recognized irAE that can range from asymptomatic transaminitis to acute liver failure. - However, it occurs with a lower frequency than pneumonitis in many studies of immune checkpoint inhibitors. *Cardiotoxicity* - **Immune-mediated myocarditis** is a rare but life-threatening irAE, often presenting with non-specific symptoms like fatigue or dyspnea, or more severely as **heart failure** or arrhythmias. - Though highly morbid, its overall incidence is much lower than that of pneumonitis.

Question 297: A 70-year-old man presents with fatigue, weight loss, and jaundice. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. Imaging reveals bile duct dilation and a mass at the pancreatic head. A biopsy confirms adenocarcinoma. What is the likely diagnosis?

A. Cholangiocarcinoma
B. Hepatocellular carcinoma
C. Pancreatic adenocarcinoma (Correct Answer)
D. Gallbladder carcinoma

Explanation: ***Pancreatic adenocarcinoma*** - The presence of a **mass at the pancreatic head**, alongside elevated alkaline phosphatase and bilirubin levels, is indicative of pancreatic adenocarcinoma, often causing obstructive jaundice [1]. - **Fatigue** and **weight loss** are common systemic symptoms due to malignancy and are consistent with this diagnosis [2]. *Gallbladder carcinoma* - While it can present with jaundice, it more commonly involves **gallbladder-related symptoms** and typically does not manifest as a mass at the **pancreatic head**. - Imaging findings would show issues focused on the **gallbladder** or nearby structures rather than the **pancreatic duct**. *Hepatocellular carcinoma* - This type of cancer usually arises in the presence of **chronic liver disease** and may show liver lesions rather than a mass in the **pancreas**. - The imaging would likely demonstrate **focal liver lesions** rather than bile duct dilation associated with obstruction. *Cholangiocarcinoma* - Although it involves the bile ducts and can cause jaundice, it would typically present with a mass specifically in the **bile duct** rather than the **pancreatic head**. - Patients often showcase different imaging characteristics and potential intrahepatic lesions compared to the described findings [3].

Question 298: Which of the following is the most appropriate screening test for colorectal cancer in average-risk individuals?

A. Stool-based test for hidden blood (FOBT)
B. Imaging-based colon examination (CT colonography)
C. Endoscopic examination of the lower colon (Flexible sigmoidoscopy)
D. Comprehensive endoscopic examination of the colon (Colonoscopy) (Correct Answer)

Explanation: ***Comprehensive endoscopic examination of the colon (Colonoscopy)*** - **Colonoscopy** is considered the **gold standard** for colorectal cancer screening in average-risk individuals due to its ability to visualize the entire colon [1]. - It allows for the **detection and removal of polyps** (which can be precancerous) during the same procedure, significantly reducing cancer risk [1], [3]. *Stool-based test for hidden blood (FOBT)* - **FOBT** (fecal occult blood test) can detect blood in the stool, which might indicate polyps or cancer, but it has a **high false-positive rate** and does not directly visualize the colon [2]. - It has **lower sensitivity** for detecting advanced adenomas and early-stage cancers compared to colonoscopy [1]. *Imaging-based colon examination (CT colonography)* - While less invasive than colonoscopy, **CT colonography** (virtual colonoscopy) requires a bowel preparation similar to colonoscopy and does not allow for **biopsy or polyp removal** during the procedure [1]. - It uses radiation and may miss small or flat lesions, often requiring a follow-up colonoscopy if abnormalities are found. *Endoscopic examination of the lower colon (Flexible sigmoidoscopy)* - **Flexible sigmoidoscopy** only evaluates the **distal colon** and rectum, missing any polyps or cancers located in the proximal colon [1]. - It is less effective as a standalone screening tool for complete colorectal cancer prevention compared to full colonoscopy [1].

Question 299: A 60-year-old female with chronic kidney disease presents with generalized weakness and hyperreflexia. Her serum calcium level is 14 mg/dL. What is the most likely cause?

A. Primary hyperparathyroidism (Correct Answer)
B. Sarcoidosis
C. Thiazide diuretics
D. Malignancy-associated hypercalcemia

Explanation: ***Primary hyperparathyroidism*** - In patients with **chronic kidney disease (CKD)**, the kidneys may struggle to activate Vitamin D, which can lead to **secondary hyperparathyroidism**. However, if hypercalcemia is present alongside hyperreflexia, this points to **primary disease**, where one or more parathyroid glands are overactive independently of serum calcium levels. - While CKD typically involves complications like **renal osteodystrophy** and **low calcium/high phosphate**, persistent hypercalcemia with hyperreflexia, especially at this critical level, despite CKD, strongly suggests autonomous **parathyroid gland dysfunction**. *Sarcoidosis* - Sarcoidosis causes **hypercalcemia** due to extrarenal production of **1,25-dihydroxyvitamin D** by activated macrophages. - While it can cause generalized weakness, hyperreflexia is not a typical neurological manifestation of sarcoidosis. *Thiazide diuretics* - Thiazide diuretics can cause mild **hypercalcemia** by increasing **renal calcium reabsorption**. - However, the serum calcium level of 14 mg/dL is usually more severe than what is typically caused by thiazide diuretics alone, and chronic kidney disease typically makes this less likely given impaired calcium and phosphate handling. *Malignancy-associated hypercalcemia* - **Malignancy-associated hypercalcemia** can present with severe hypercalcemia and generalized weakness, due to the release of **PTHrP** or bone destruction. - While possible, the combination of **chronic kidney disease** and hyperreflexia makes primary hyperparathyroidism a more specific and likely underlying cause in this scenario.

Question 300: A 65-year-old man with a long history of smoking presents with a chronic cough, dyspnea, and clubbing of the fingers. Which of the following conditions is most likely associated with these findings?

A. Aortic stenosis (Correct Answer)
B. Periosteal inflammation
C. Rheumatoid arthritis
D. Lung cancer

Explanation: **Aortic stenosis** - While **aortic stenosis** can cause dyspnea and cough due to **heart failure** and **pulmonary congestion**, it is not typically associated with **clubbing of the fingers** [2] or a history of **heavy smoking** as a direct cause of these respiratory symptoms. - The link between aortic stenosis and clubbing is less common and usually indirect, through **severe heart failure** causing chronic hypoxia. *Periosteal inflammation* - **Periosteal inflammation** can cause bone pain and swelling, but it does not directly explain the triad of **chronic cough**, **dyspnea**, and **clubbing** in a smoker. [2] - It is a local rather than a systemic condition that would cause chronic respiratory symptoms. *Lung cancer* - **Lung cancer** is a strong consideration given the patient's **smoking history**, **chronic cough**, and **dyspnea**. [3] - However, the question asks for the *most likely associated condition* with clubbing, which can also be caused by various other conditions, and the options should be critically evaluated. [2] *Rheumatoid arthritis* - **Rheumatoid arthritis** primarily affects joints and can cause systemic symptoms, but it does not typically cause **chronic cough**, **dyspnea**, or **clubbing** directly. - Lung involvement in rheumatoid arthritis (e.g., **interstitial lung disease**) is possible but is a secondary manifestation and less directly linked to the initial presentation of cough, dyspnea, and clubbing in a smoker. [1]

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Oncology — MCQs

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