Oncology Practice Questions

Q: A 69-year-old woman presents with left flank pain and hematuria. Physical examination reveals a blood pressure of 165/96 mmHg, heart rate of 104/min, and left costovertebral angle tenderness. An abdominal CT scan shows a 5-cm left kidney mass. Which of the following laboratory abnormalities might also be present?

polycythemia. The clinical presentation of a flank mass, hematuria, and hypertension in an elderly patient is highly suggestive of **Renal Cell Carcinoma (RCC)** [1]. ### **Explanation of the Correct Answer** **Polycythemia (Option A)** is a classic paraneoplastic syndrome associated with RCC. It occurs due to the ectopic production of **Erythropoietin (EPO)** by the tumor cells, which stimulates the bone marrow to increase red blood cell production. While anemia is actually more common in RCC (due to chronic disease), polycythemia is a high-yield diagnostic clue. ### **Analysis of Incorrect Options** * **Thrombocytopenia (B):** RCC is more likely to cause thrombocytosis (as an acute phase reactant) rather than a low platelet count. * **Hypocalcemia (C):** RCC is famously associated with **Hypercalcemia**, not hypocalcemia. This occurs either due to bone metastasis or the secretion of **Parathyroid Hormone-related Protein (PTHrP)**. * **Leukocytosis (D):** While non-specific inflammation can occur, it is not a classic paraneoplastic hallmark of RCC compared to erythrocytosis. ### **NEET-PG High-Yield Pearls: RCC Paraneoplastic Syndromes** * **The "Internist's Tumor":** RCC is known by this name because it presents with diverse systemic symptoms. * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs, alkaline phosphatase) in the absence of liver metastases. * **Hypertension:** Caused by increased **Renin** production or direct compression of the renal artery by the tumor. * **Classic Triad:** Flank pain, hematuria, and palpable abdominal mass (seen in only 10% of cases, usually indicating advanced disease) [1]. * **Most Common Histology:** Clear cell carcinoma (originates from the proximal convoluted tubule) [1].

Q: Paraneoplastic syndromes associated with renal cell carcinoma include all of the following except?

Acromegaly. Renal Cell Carcinoma (RCC) is often referred to as the **"Internist’s Tumor"** because it frequently presents with a wide array of paraneoplastic syndromes (PNS) due to the ectopic secretion of hormones or cytokines. **Why Acromegaly is the Correct Answer:** Acromegaly is caused by the excessive secretion of Growth Hormone (GH), typically from a pituitary adenoma. While RCC can secrete various hormones, it is **not** associated with the production of GH or Growth Hormone-Releasing Hormone (GHRH). Therefore, acromegaly is not a recognized paraneoplastic manifestation of RCC. **Analysis of Incorrect Options:** * **Polycythemia (Option A):** This occurs in 1–5% of patients due to the ectopic production of **Erythropoietin (EPO)** by the tumor cells [1]. * **Hypercalcemia (Option B):** This is the most common paraneoplastic syndrome in RCC. It is primarily caused by the secretion of **Parathyroid Hormone-related Protein (PTHrP)**, which mimics PTH action, or less commonly via osteolytic bone metastases [1]. * **Hypertension (Option C):** This can result from the ectopic production of **Renin** by the tumor, or via compression of the renal artery/parenchyma leading to activation of the RAAS pathway. **High-Yield Clinical Pearls for NEET-PG:** * **Stauffer’s Syndrome:** A unique PNS of RCC characterized by reversible hepatic dysfunction (elevated ALP, bilirubin) in the absence of liver metastases. * **Classic Triad:** Hematuria, flank pain, and a palpable mass (seen in only ~10% of cases; usually indicates advanced disease). * **Other PNS in RCC:** Cushing’s syndrome (ectopic ACTH), Galactorrhea (Prolactin), and AA Amyloidosis [1]. * **Most common histological subtype:** Clear cell carcinoma (associated with VHL gene mutations on Chromosome 3p).

Q: Which of the following conditions is associated with hypercalcemia?

Hepatocellular carcinoma. **Explanation:** Hypercalcemia in malignancy is primarily driven by three mechanisms: secretion of **Parathyroid Hormone-related Protein (PTHrP)**, local osteolytic bone metastases, or excessive production of 1,25-dihydroxyvitamin D [1]. **Hepatocellular Carcinoma (HCC)** is a well-recognized cause of **Paraneoplastic Syndrome**, specifically through the secretion of PTHrP [1]. This protein mimics the action of PTH by binding to the same receptors in the bone and kidneys, leading to increased bone resorption and calcium reabsorption [3]. While not the most common malignancy associated with hypercalcemia (squamous cell carcinomas of the lung and head/neck are more frequent), HCC is the correct choice among the provided gastrointestinal/hepatobiliary options [1]. **Analysis of Incorrect Options:** * **Pancreatic, Gastric, and Gallbladder cancers:** While any advanced malignancy with extensive bone metastasis can theoretically cause hypercalcemia, these cancers are rarely associated with humoral hypercalcemia of malignancy (PTHrP secretion) [2]. They are much more likely to present with other paraneoplastic features (e.g., Trousseau sign in pancreatic cancer) or obstructive symptoms rather than metabolic hypercalcemia. **High-Yield NEET-PG Pearls:** * **Most common cause of hypercalcemia in hospitalized patients:** Malignancy. * **Most common mechanism:** Humoral hypercalcemia of malignancy (PTHrP) – accounts for ~80% of cases. * **Common PTHrP-secreting tumors:** Squamous cell carcinoma (Lung, Head/Neck), Renal Cell Carcinoma (RCC), Breast cancer, and HCC [1]. * **Treatment of choice:** Aggressive IV hydration with normal saline is the first step; Bisphosphonates (Zoledronic acid) are the mainstay for long-term management.

Q: Which paraneoplastic syndrome is NOT seen in renal cell carcinoma?

Polycythemia. Renal Cell Carcinoma (RCC) is famously known as the **"Internist’s Tumor"** because it presents with a wide array of paraneoplastic syndromes (PNS) due to the ectopic secretion of hormones and cytokines [1]. **Explanation of the Correct Answer:** The question asks which syndrome is **NOT** seen in RCC. However, there appears to be a discrepancy in the provided key: **Polycythemia is actually a classic paraneoplastic manifestation of RCC**, occurring in 1-5% of patients due to the ectopic production of **Erythropoietin (EPO)** [1]. In the context of standard medical examinations, **Systemic Lupus Erythematosus (SLE)** (Option D) is the correct answer for "NOT seen." While RCC can cause various autoimmune-like phenomena, it does not typically cause SLE. If the provided key insists on Polycythemia, it contradicts standard medical literature (Harrison’s Principles of Internal Medicine). **Analysis of Options:** * **Polycythemia:** A classic PNS of RCC caused by inappropriate EPO production [1]. * **Amyloidosis:** Secondary (AA) amyloidosis occurs in ~3-5% of RCC cases due to chronic inflammation and elevated Serum Amyloid A. * **Acanthosis Nigricans:** While more common in gastric cancer, it is a recognized (though rare) cutaneous paraneoplastic manifestation of various visceral malignancies, including RCC. * **SLE:** This is a primary autoimmune disease and is not recognized as a paraneoplastic syndrome of RCC. **High-Yield Clinical Pearls for NEET-PG:** * **Most common PNS in RCC:** Hypercalcemia (due to PTHrP) [1]. * **Stauffer’s Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Other common PNS:** Hypertension (Renin), Cushing’s syndrome (ACTH), and Galactorrhea (Prolactin). * **Classic Triad (only in 10%):** Hematuria, Flank pain, and Palpable mass [2].

Q: A 58-year-old man with a 700-pack-year smoking history presents with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass centrally located within the left lung field. The serum calcium is 13.0 mg/dL (normal 8.5 to 10.2). The metabolic abnormality described here is likely due to elaboration of which substance?

Parathyroid-related hormone. The patient presents with a central lung mass, a heavy smoking history, and significant hypercalcemia (13.0 mg/dL). This clinical triad is classic for **Squamous Cell Carcinoma (SCC)** of the lung. [1] **1. Why Option D is Correct:** Hypercalcemia in lung cancer is most commonly a **paraneoplastic syndrome** caused by the secretion of **Parathyroid Hormone-related Protein (PTHrP)** [2]. PTHrP mimics the action of PTH by binding to the same receptors in the bone and kidney, leading to increased bone resorption and decreased renal calcium excretion. This is specifically associated with Squamous Cell Carcinoma (mnemonic: **S**quamous = **S**ecretion of PTHrP = **S**tones/Hypercalcemia) [2]. **2. Why the Other Options are Incorrect:** * **Option A (ACTH):** Ectopic ACTH production leads to Cushing Syndrome (hypokalemia, hypertension). This is a paraneoplastic syndrome associated with **Small Cell Lung Cancer (SCLC)**, not SCC [2]. * **Option B (ADH):** Ectopic ADH secretion causes SIADH (hyponatremia). This is also a classic feature of **Small Cell Lung Cancer** [2]. * **Option C (CEA):** Carcinoembryonic antigen is a tumor marker used for monitoring colorectal and some lung adenocarcinomas, but it does not cause metabolic abnormalities like hypercalcemia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Central Lung Tumors:** Squamous Cell Carcinoma and Small Cell Carcinoma (The "S" tumors are **S**moking-related and **S**entral) [1]. * **Peripheral Lung Tumors:** Adenocarcinoma (most common in non-smokers and females). * **Hypercalcemia of Malignancy:** PTHrP is the most common cause (80%); the second most common is local osteolytic hypercalcemia (bone metastases). * **Small Cell Lung Cancer (SCLC):** Associated with Lambert-Eaton Syndrome, SIADH, and ACTH [2]. * **Squamous Cell Carcinoma (SCC):** Associated with PTHrP (Hypercalcemia) and Pancoast tumors [2].

Q: Which of the following is a risk factor for colorectal cancer?

Red meat consumption. ### Explanation **Correct Answer: B. Red meat consumption** The association between diet and colorectal cancer (CRC) is a high-yield topic for NEET-PG. **Red meat** (beef, lamb, pork) and **processed meats** (ham, bacon, salami) are classified by the IARC as Group 1 carcinogens. The underlying medical mechanism involves the formation of **N-nitroso compounds (NOCs)**, polycyclic aromatic hydrocarbons, and heterocyclic amines during cooking. These compounds cause DNA damage and promote colonic carcinogenesis. **Analysis of Options:** * **A. Male sex:** While the incidence of CRC is slightly higher in males, **age** is a much more significant non-modifiable risk factor than sex. Most cases occur after age 50. * **C. High intake of animal fat:** Historically, high fat was linked to CRC; however, recent large-scale prospective studies (like the Nurses' Health Study) have shown that the **type of food** (red/processed meat) is a more definitive risk factor than total animal fat intake alone. * **D. Use of NSAIDs:** This is a **protective factor**, not a risk factor. Regular use of Aspirin or other NSAIDs inhibits the COX-2 enzyme, which is overexpressed in 80-90% of colorectal adenocarcinomas. NSAIDs are known to reduce the size and number of polyps, especially in FAP patients. **High-Yield Clinical Pearls for NEET-PG:** 1. **Protective Factors:** High-fiber diet, Calcium, Vitamin D, Physical activity, and NSAIDs/Aspirin. 2. **Most Common Site:** Historically the rectum/sigmoid, but there is a rising trend of **right-sided (proximal) colon cancers** [1]. Over 65% occur in the rectosigmoid and a further 15% recur in the caecum or ascending colon [1]. 3. **Screening Gold Standard:** Colonoscopy every 10 years, starting at age 45 (updated guideline) for average-risk individuals. 4. **Streptococcus bovis (S. gallolyticus):** If found in blood culture (endocarditis), always perform a colonoscopy to rule out occult CRC.

Q: Which of the following is the most effective treatment for ER-positive breast cancer?

Tamoxifen. Explanation: In ER-positive (Estrogen Receptor-positive) breast cancer, the tumor cells depend on estrogen for growth. **Tamoxifen** is a Selective Estrogen Receptor Modulator (SERM) that acts as a competitive antagonist at the estrogen receptors in breast tissue, effectively blocking the proliferative signals. It is considered the gold standard and most widely used hormonal therapy for both pre-menopausal and post-menopausal women with ER-positive breast cancer. Analysis of Options: * **Tamoxifen (A):** The drug of choice for ER+ breast cancer across all age groups. It reduces the risk of recurrence and contralateral breast cancer. * **Exemestane (B):** This is an Aromatase Inhibitor (AI). While AIs are highly effective (and often preferred) in **post-menopausal** women, they are ineffective in pre-menopausal women unless combined with ovarian suppression, making Tamoxifen the more "universal" correct answer for general ER+ treatment. * **Leuprolide (C):** A GnRH agonist used for ovarian suppression. While used in breast cancer management to induce medical menopause, it is rarely used as a monotherapy and is usually an adjunct to Tamoxifen or AIs. * **Bicalutamide (D):** An anti-androgen used primarily in the treatment of **Prostate Cancer**, not breast cancer. High-Yield Clinical Pearls for NEET-PG: * **Tamoxifen Side Effects:** It acts as an agonist in the uterus and bone. This leads to an increased risk of **Endometrial Carcinoma** and thromboembolism (DVT/PE), but it helps prevent osteoporosis. * **Aromatase Inhibitors (Letrozole, Anastrozole):** These are the first-line choice specifically for **post-menopausal** ER+ patients but carry a risk of osteoporosis and joint pain. * **HER2/neu positive:** For these patients, **Trastuzumab** (a monoclonal antibody against ErbB2) is the treatment of choice.

Question 1

A 69-year-old woman presents with left flank pain and hematuria. Physical examination reveals a blood pressure of 165/96 mmHg, heart rate of 104/min, and left costovertebral angle tenderness. An abdominal CT scan shows a 5-cm left kidney mass. Which of the following laboratory abnormalities might also be present?

Accepted Answer

polycythemia

Answer

thrombocytopenia

Answer

hypocalcemia

Answer

leukocytosis

Question 2

Paraneoplastic syndromes associated with renal cell carcinoma include all of the following except?

Accepted Answer

Acromegaly

Answer

Polycythemia

Answer

Hypercalcemia

Answer

Hypertension

Question 3

A 60-year-old man with a 20-year smoking history presents with altered behavior over the past week, personality changes, and a productive cough for the past month. He is not a known drug addict, diabetic, or hypertensive. Physical examination reveals multiple bruises, hyper-pigmented spots on the buccal mucosa and the back of his neck. His blood pressure is 160/90 mmHg, and pulse is 70/mm. Laboratory studies show random blood sugar of 224 mg/dL, serum sodium of 140 mEq/L, serum potassium of 2.0 mEq/L, and serum bicarbonate of 27 mEq/L. Which of the following tests is most likely to be abnormal in this patient?

Accepted Answer

CT chest

Answer

MRI brain

Answer

Plasma metanephrine levels

Answer

Renal Doppler

Question 4

A 68-year-old male presented with low back pain that is worse at night and interferes with sleep. Evaluation revealed a bone lesion in the lumbar spine, and a biopsy was suggestive of blastic skeletal metastasis from an unknown primary. What is the next best blood test to order for this patient?

Accepted Answer

Serum prostatic specific antigen (PSA)

Answer

Serum alkaline phosphatase

Answer

Serum alpha fetoprotein

Answer

Serum calcium

Question 5

Lutetium dotatate was approved by FDA in 2018 for which of the following conditions?

Accepted Answer

Neuroendocrine tumours

Answer

Tuberculosis

Answer

Crohn's disease

Answer

Peptic ulcer

Question 6

Which of the following conditions is associated with hypercalcemia?

Accepted Answer

Hepatocellular carcinoma

Answer

Pancreatic cancer

Answer

Gastric cancer

Answer

Gallbladder cancer

Question 7

Which paraneoplastic syndrome is NOT seen in renal cell carcinoma?

Accepted Answer

Polycythemia

Answer

Acanthosis nigricans

Answer

Amyloidosis

Answer

Systemic Lupus Erythematosus (SLE)

Question 8

A 58-year-old man with a 700-pack-year smoking history presents with shortness of breath and hemoptysis. Portable chest radiography demonstrates a large mass centrally located within the left lung field. The serum calcium is 13.0 mg/dL (normal 8.5 to 10.2). The metabolic abnormality described here is likely due to elaboration of which substance?

Accepted Answer

Parathyroid-related hormone

Answer

Adrenocorticotropic hormone-like substance

Answer

Antidiuretic hormone

Answer

Carcinoembryonic antigen

Question 9

Which of the following is a risk factor for colorectal cancer?

Accepted Answer

Red meat consumption

Answer

Male sex

Answer

High intake of animal fat

Answer

Use of NSAIDS

Question 10

Which of the following is the most effective treatment for ER-positive breast cancer?

Accepted Answer

Tamoxifen

Answer

Exemestane

Answer

Leuprolide

Answer

Bicalutamide

Oncology — MCQs

Oncology — MCQs

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