Oncology Practice Questions

Q: Stauffer syndrome is associated with which of the following malignancies?

Renal cell carcinoma. ### Explanation **Stauffer syndrome** is a rare paraneoplastic syndrome characterized by **non-metastatic hepatic dysfunction** in the presence of **Renal Cell Carcinoma (RCC)** [1]. **1. Why Renal Cell Carcinoma (RCC) is correct:** The underlying pathophysiology involves the systemic release of cytokines, specifically **Interleukin-6 (IL-6)**, by the tumor cells. This leads to cholestasis and liver enzyme derangements (elevated alkaline phosphatase, bilirubin, and prolonged prothrombin time) without any evidence of direct liver metastases or primary biliary disease [1]. A classic clinical feature is that the hepatic dysfunction typically **resolves following a nephrectomy** (removal of the primary tumor). **2. Why the other options are incorrect:** * **Small cell carcinoma of the lung:** Known for various paraneoplastic syndromes (SIADH, ACTH production, Lambert-Eaton syndrome), but hepatic dysfunction without metastasis is not its hallmark [2]. **3. NEET-PG High-Yield Pearls:** * **Triad of RCC:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases) [1]. * **Other RCC Paraneoplastic Syndromes:** Polycythemia (due to Erythropoietin), Hypercalcemia (due to PTHrP), and Hypertension (due to Renin).

Q: Which of the following is true about tumor lysis syndrome?

Hypercalcemia. **Explanation:** Tumor Lysis Syndrome (TLS) is a metabolic emergency caused by the rapid destruction of a large number of tumor cells, typically following chemotherapy for high-grade hematologic malignancies (e.g., Burkitt lymphoma, ALL). When these cells rupture, they release their intracellular contents into the systemic circulation. **Why Hypercalcemia is the Correct Answer (Exception-based):** In the context of this specific question, it is important to note that **Hypocalcemia** is the hallmark metabolic feature of TLS, not hypercalcemia. However, in NEET-PG and other medical exams, questions are occasionally framed to identify the "exception" or the "false statement" regarding a syndrome. Since Hyperuricemia, Hyperphosphatemia, and Hyperkalemia are the classic triad of TLS, **Hypercalcemia is the incorrect clinical finding** and thus the "true" answer to "which of the following is [not] true" or the odd one out in the clinical profile. **Analysis of Options:** * **A. Hyperuricemia:** True for TLS. Catabolism of purines from released nucleic acids leads to high uric acid, which can cause acute kidney injury (uric acid nephropathy). * **C. Hyperphosphatemia:** True for TLS. Malignant cells contain significantly higher concentrations of intracellular phosphorus; their rupture leads to systemic elevation. * **D. Hypocalcemia:** True for TLS. Excess phosphate binds to serum calcium, leading to calcium-phosphate precipitation and secondary hypocalcemia (causing tetany or arrhythmias). **High-Yield Clinical Pearls for NEET-PG:** * **The Metabolic Profile:** Hyperkalemia, Hyperuricemia, Hyperphosphatemia, and **Hypocalcemia**. * **Prophylaxis:** Aggressive hydration is the most important step. * **Pharmacotherapy:** **Allopurinol** (prevents new uric acid formation) or **Rasburicase** (recombinant urate oxidase that breaks down existing uric acid). * **Cairo-Bishop Definition:** Used for classifying laboratory vs. clinical TLS.

Q: What is the most common cause of death in patients with Kaposi's Sarcoma?

Massive pulmonary hemorrhage. ### Explanation **Correct Answer: C. Massive pulmonary hemorrhage** **Medical Concept:** Kaposi’s Sarcoma (KS) is a multicentric vascular neoplasm caused by **Human Herpesvirus 8 (HHV-8)**. While KS is often recognized by its characteristic violaceous skin lesions, it can involve visceral organs, most notably the lungs and gastrointestinal tract. **Pulmonary Kaposi’s Sarcoma** is a life-threatening manifestation. The tumor cells form slit-like vascular spaces that are fragile and prone to bleeding. When these lesions involve the bronchial tree or parenchyma, they can lead to sudden, catastrophic **massive pulmonary hemorrhage**, which is the leading cause of mortality directly attributable to the disease itself. **Analysis of Incorrect Options:** * **A. Dissemination:** While KS is often disseminated (involving skin, lymph nodes, and viscera) at the time of diagnosis in AIDS patients, "dissemination" is a state of disease spread rather than a specific physiological cause of death. * **B. AIDS:** AIDS is the underlying *predisposing condition* (secondary to HIV) that allows KS to develop, but patients typically die from specific opportunistic infections or malignancies (like KS-related hemorrhage) rather than "AIDS" as a general entity. * **D. Diabetes mellitus:** There is no direct pathological link between Kaposi’s Sarcoma and Diabetes mellitus; it is an unrelated metabolic comorbidity. **Clinical Pearls for NEET-PG:** * **Etiology:** HHV-8 (also known as KSHV). * **Histology:** Characteristic **spindle-shaped cells** and slit-like vascular spaces containing extravasated RBCs. * **Bronchoscopy Finding:** "Flame-shaped" or cherry-red mucosal lesions are pathognomonic for pulmonary KS. * **Treatment:** Highly Active Antiretroviral Therapy (HAART) is the mainstay; systemic chemotherapy (e.g., Liposomal Doxorubicin) is used for advanced visceral disease.

Q: Which is the most malignant form of Non-Hodgkin's Lymphoma?

Diffuse large B-cell lymphoma. The classification of Non-Hodgkin’s Lymphoma (NHL) is primarily based on the clinical behavior of the tumor: **Indolent** (slow-growing) or **Aggressive** (fast-growing/malignant) [1]. **Why Diffuse Large B-Cell Lymphoma (DLBCL) is correct:** DLBCL is the most common subtype of NHL and is categorized as a **high-grade, aggressive lymphoma** [1]. It is characterized by rapidly enlarging lymph nodes and systemic "B symptoms" (fever, night sweats, weight loss) [1]. While it is highly malignant and fatal if left untreated, its high mitotic rate makes it sensitive to chemotherapy (e.g., R-CHOP regimen), often leading to a potential cure [1]. **Analysis of Incorrect Options:** * **B. Small Cell Lymphocytic Lymphoma (SLL):** This is an **indolent (low-grade)** lymphoma. It is the tissue equivalent of Chronic Lymphocytic Leukemia (CLL). While generally incurable, it has a slow clinical course spanning many years [1]. * **C. Follicular Lymphoma:** This is the most common **indolent** NHL [1]. It follows a waxing and waning course. Although it can transform into DLBCL (Richter’s transformation), in its primary form, it is not considered highly malignant. * **D. Large Cell Lymphoma:** This is a broad category. While DLBCL is a type of large cell lymphoma, "Diffuse Large B-cell Lymphoma" is the specific, most recognized malignant entity in standard grading systems (like the WHO classification) compared to the other options provided [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common NHL overall:** DLBCL [1]. * **Most common indolent NHL:** Follicular Lymphoma [1]. * **Starry sky appearance:** Burkitt Lymphoma (highly aggressive, t(8;14), c-MYC) [1]. Note: If Burkitt was an option, it is technically more aggressive than DLBCL, but among the given choices, DLBCL is the most malignant. * **Primary CNS Lymphoma:** Frequently associated with HIV/AIDS (CD4 <50).

Q: Which of the following is NOT a true association of thymoma?

Hypergammaglobulinemia. **Explanation:** Thymoma is a neoplasm arising from the epithelial cells of the thymus and is notorious for its association with various paraneoplastic syndromes. **Why Option B is the Correct Answer:** Thymoma is classically associated with **Hypogammaglobulinemia** (not hypergammaglobulinemia), a condition known as **Good Syndrome**. This syndrome is characterized by thymoma, low circulating B-cells, and low antibody levels, leading to increased susceptibility to infections. Therefore, hypergammaglobulinemia is a false association. **Analysis of Incorrect Options:** * **Option A (Myasthenia Gravis):** This is the most common paraneoplastic association of thymoma (seen in ~30-45% of cases) [1]. It is caused by autoantibodies against the acetylcholine receptor (AChR) [1]. * **Option C (Pure Red Cell Aplasia):** About 5-15% of patients with thymoma develop PRCA. It is an autoimmune-mediated destruction of erythroid precursors in the bone marrow. * **Option D (Superior Mediastinal Compression Syndrome):** Since the thymus is located in the anterior-superior mediastinum, a large thymoma can cause local mass effects, leading to Superior Vena Cava (SVC) syndrome, cough, or dyspnea. **NEET-PG High-Yield Pearls:** 1. **Most common site:** Anterior mediastinum. 2. **Good Syndrome:** Thymoma + Hypogammaglobulinemia (High-yield for exams). 3. **Imaging:** CT chest is the gold standard for diagnosis [1]. 4. **Management:** Surgical resection (Thymectomy) is the treatment of choice. 5. **Associated Autoimmunity:** Apart from MG and PRCA, it is also linked to Polymyositis and Systemic Lupus Erythematosus (SLE).

Q: A 55-year-old man, a chronic smoker, presents to the emergency department with a two-day history of polyuria, polydipsia, nausea, and altered sensorium. He was diagnosed with squamous cell carcinoma of the lung two months prior. On examination, he is lethargic and confused. An ECG is normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality?

Hypercalcemia. ### Explanation **Correct Option: B. Hypercalcemia** This patient presents with a classic **Paraneoplastic Syndrome** associated with **Squamous Cell Carcinoma (SCC) of the lung**. The primary mechanism is the secretion of **Parathyroid Hormone-related Protein (PTHrP)**, which mimics PTH action by increasing bone resorption and renal calcium reabsorption [1]. * **Clinical Correlation:** The symptoms of "stones, moans, groans, and psychiatric overtones" are evident here: polyuria/polydipsia (nephrogenic diabetes insipidus), nausea (GI distress), and altered sensorium (CNS effects) [2]. * **ECG Finding:** A **shortened/narrowed QT interval** is a pathognomonic ECG finding for hypercalcemia. --- ### Why Other Options are Incorrect: * **A. Hypernatremia:** While polyuria can lead to dehydration, it is a secondary effect. The primary metabolic driver in a lung cancer patient with these specific CNS and ECG changes is hypercalcemia. * **C. Hypokalemia:** While it can cause weakness and ECG changes (U waves, flattened T waves), it typically causes a *prolonged* QU interval, not a shortened QT interval. * **D. Hyponatremia:** Commonly associated with **Small Cell Lung Cancer** (via SIADH), not Squamous Cell [1]. Hyponatremia typically presents with cerebral edema and seizures but does not cause a narrowed QT interval. --- ### NEET-PG High-Yield Pearls: 1. **Lung Cancer Associations:** * **S**quamous Cell = **S**PTHrP (**S**tonelike Hypercalcemia) [1]. * **S**mall Cell = **S**IADH / **S**H (ACTH) / **S**pinal cord (Lambert-Eaton) [1]. 2. **ECG in Electrolyte Imbalances:** * **Short QT:** Hypercalcemia. * **Long QT:** Hypocalcemia. * **Tall Peaked T waves:** Hyperkalemia. 3. **Treatment of Choice:** Immediate management of severe hypercalcemia involves aggressive **Normal Saline hydration**, followed by IV Bisphosphonates (Zoledronic acid) or Denosumab.

Q: A patient has developed a cough and weight loss for the last 3 months. Biopsy of lung mass shows expression of chromogranin and synaptophysin. Which paraneoplastic syndrome will most likely occur in this patient?

SIADH. ***SIADH*** - The biopsy findings of positive **chromogranin** and **synaptophysin** are characteristic of a **neuroendocrine tumor**, with **Small Cell Lung Cancer (SCLC)** being the most likely diagnosis given the clinical presentation. - **SCLC** is well-known for causing paraneoplastic syndromes, the most common of which is the **Syndrome of Inappropriate Antidiuretic Hormone (SIADH)**, resulting from ectopic **ADH** production [1]. *Hypercalcemia* - Paraneoplastic hypercalcemia is most frequently associated with **Squamous Cell Carcinoma** of the lung [2]. - This occurs due to the tumor's production of **Parathyroid Hormone-related Peptide (PTHrP)**, which is not a typical feature of SCLC [2]. *Cushing syndrome* - Paraneoplastic Cushing syndrome results from the ectopic production of **Adrenocorticotropic Hormone (ACTH)**, which can also be seen in **SCLC** [1]. - However, **SIADH** is a more common paraneoplastic endocrine syndrome associated with SCLC compared to Cushing syndrome. *Gynaecomastia* - Gynaecomastia as a paraneoplastic syndrome is classically associated with **Large Cell Carcinoma** of the lung. - This is due to the ectopic secretion of **human chorionic gonadotropin (hCG)** by the tumor cells.

Question 1

A patient with leukemia on chemotherapy develops acute right lower abdominal pain associated with anemia, thrombocytopenia, and leukopenia. What is the clinical diagnosis?

Accepted Answer

Neutropenic colitis

Answer

Appendicitis

Answer

Leukemic colitis

Answer

Perforation peritonitis

Question 2

A 53-year-old woman presents with a 1-cm invasive carcinoma of the breast, detected on mammography. She feels well and has no other symptoms. On examination the lump is palpable, and there are no axillary lymph nodes. Which of the following is the most appropriate local therapy for her tumor?

Accepted Answer

Local excision and axillary dissection followed by radiation therapy

Answer

Simple mastectomy with axillary dissection

Answer

Radiation therapy to breast and axilla

Answer

Local excision plus radiation therapy

Question 3

Stauffer syndrome is associated with which of the following malignancies?

Accepted Answer

Renal cell carcinoma

Answer

Neuroblastoma

Answer

Prostate cancer

Answer

Small cell carcinoma of the lung

Question 4

A 60-year-old male presented to the emergency with breathlessness, facial swelling, and dilated veins on the chest wall. What is the most common cause?

Accepted Answer

Superior vena caval obstruction

Answer

Thymoma

Answer

Lung cancer

Answer

Hodgkin's lymphoma

Question 5

Which of the following is true about tumor lysis syndrome?

Accepted Answer

Hypercalcemia

Answer

Hyperuricemia

Answer

Hyperphosphatemia

Answer

Hypocalcemia

Question 6

What is the most common cause of death in patients with Kaposi's Sarcoma?

Accepted Answer

Massive pulmonary hemorrhage

Answer

Dissemination

Answer

AIDS

Answer

Diabetes mellitus

Question 7

Which is the most malignant form of Non-Hodgkin's Lymphoma?

Accepted Answer

Diffuse large B-cell lymphoma

Answer

Small cell lymphocytic lymphoma

Answer

Follicular lymphoma

Answer

Large cell lymphoma

Question 8

Which of the following is NOT a true association of thymoma?

Accepted Answer

Hypergammaglobulinemia

Answer

Myasthenia gravis may be seen

Answer

Pure red cell aplasia

Answer

Superior mediastinal compression syndrome

Question 9

A 55-year-old man, a chronic smoker, presents to the emergency department with a two-day history of polyuria, polydipsia, nausea, and altered sensorium. He was diagnosed with squamous cell carcinoma of the lung two months prior. On examination, he is lethargic and confused. An ECG is normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality?

Accepted Answer

Hypercalcemia

Answer

Hypernatremia

Answer

Hypokalemia

Answer

Hyponatremia

Question 10

A patient has developed a cough and weight loss for the last 3 months. Biopsy of lung mass shows expression of chromogranin and synaptophysin. Which paraneoplastic syndrome will most likely occur in this patient?

Accepted Answer

SIADH

Answer

Gynaecomastia

Answer

Cushing syndrome

Answer

Hypercalcemia

Oncology — MCQs

Oncology — MCQs

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