Medicine
Oncology
A patient with metastatic cancer has severe persistent pain despite regular non-opioid therapy. What principle is appropriate?
A. Escalate analgesia according to pain severity, including opioids when indicated
B. Avoid opioids categorically
C. Use antibiotics for pain
D. Stop all palliative treatment
Correct Answer: A
Cancer pain should be treated proportionately using multimodal analgesia, including opioids when clinically indicated.
Medicine
Oncology
A patient receiving cisplatin requires monitoring for which major toxicity?
A. Nephrotoxicity and ototoxicity
B. Severe hypoglycemia only
C. Hyperthyroidism only
D. Aplastic crisis in every patient
Correct Answer: A
Cisplatin can cause dose-limiting kidney injury and ototoxicity, among other adverse effects.
Medicine
Oncology
Which symptom in a cancer patient most strongly suggests superior vena cava syndrome?
A. Facial swelling with distended neck veins and dyspnea
B. Isolated ankle sprain
C. Watery diarrhea only
D. Unilateral calf pain without chest symptoms
Correct Answer: A
Obstruction of the SVC causes venous congestion of the head, neck and upper limbs with dyspnea and visible collateral veins.
Medicine
Oncology
A patient with colorectal cancer has a KRAS mutation. Why is this clinically relevant?
A. It can predict lack of benefit from anti-EGFR therapy in metastatic disease
B. It confirms small-cell lung cancer
C. It proves hereditary breast cancer
D. It indicates sensitivity to trastuzumab
Correct Answer: A
Activating RAS mutations predict resistance to anti-EGFR monoclonal antibodies in metastatic colorectal cancer.
Medicine
Oncology
A patient with prostate cancer develops new severe back pain. Which metastatic pattern is classically associated with prostate cancer?
A. Osteoblastic bone metastases
B. Purely lytic lesions only
C. No bone metastases
D. Brain metastases only
Correct Answer: A
Prostate cancer commonly spreads to bone and often produces osteoblastic/sclerotic lesions.
Medicine
Oncology
A smoker presents with hematuria and a renal mass. Which paraneoplastic finding can renal cell carcinoma produce?
A. Polycythemia from ectopic erythropoietin
B. Severe neutropenia from EPO
C. Hypocalcemia from calcitonin
D. Central diabetes insipidus
Correct Answer: A
Renal cell carcinoma can produce erythropoietin and cause secondary erythrocytosis, among several paraneoplastic syndromes.
Medicine
Oncology
A patient with HER2-positive breast cancer may benefit from which targeted monoclonal antibody?
A. Trastuzumab
B. Bevacizumab for every case
C. Rituximab
D. Cetuximab only
Correct Answer: A
Trastuzumab targets HER2 and is a key component of therapy for appropriate HER2-positive breast cancers.
Medicine
Oncology
A woman with estrogen receptor-positive breast cancer receives adjuvant endocrine therapy. Which drug is a selective estrogen receptor modulator?
A. Tamoxifen
B. Trastuzumab
C. Imatinib
D. Rituximab
Correct Answer: A
Tamoxifen is a selective estrogen receptor modulator used in hormone receptor-positive breast cancer.
Medicine
Oncology
A patient receiving immune checkpoint inhibitor therapy develops severe diarrhea and colitis. What is the likely mechanism?
A. Immune-related adverse event
B. Bacterial food poisoning is certain
C. Lactose intolerance only
D. Tumor lysis syndrome
Correct Answer: A
Checkpoint inhibitors can trigger autoimmune-like inflammatory toxicities, including colitis, hepatitis, pneumonitis and endocrinopathies.
Medicine
Oncology
Which medication is used to rapidly lower uric acid in high-risk tumor lysis syndrome?
A. Rasburicase
B. Warfarin
C. Tamoxifen
D. Mesna
Correct Answer: A
Rasburicase converts uric acid to a more soluble metabolite and is used for rapid uric acid reduction in high-risk TLS.
Medicine
Oncology
A patient with bulky high-grade lymphoma develops hyperkalemia, hyperphosphatemia, hypocalcemia and uric acid elevation after chemotherapy. What is the diagnosis?
A. Tumor lysis syndrome
B. SIADH
C. DIC only
D. Nephrotic syndrome
Correct Answer: A
Rapid tumor-cell breakdown releases potassium, phosphate and nucleic acids, producing tumor lysis syndrome and acute kidney injury.
Medicine
Oncology
A patient with squamous cell lung carcinoma has severe hypercalcemia and low PTH. Which mediator is often responsible?
A. PTH-related peptide
B. ACTH only
C. Calcitonin excess
D. ADH deficiency
Correct Answer: A
Squamous cancers can produce PTHrP, causing humoral hypercalcemia of malignancy.
Medicine
Oncology
A patient with small-cell lung cancer develops confusion, sodium 118 mmol/L and concentrated urine. What paraneoplastic syndrome is most likely?
A. SIADH
B. Hyperparathyroidism
C. Diabetes insipidus
D. Addison disease
Correct Answer: A
Small-cell lung carcinoma commonly causes ectopic ADH secretion and SIADH.
Medicine
Oncology
A patient with metastatic cancer develops back pain, leg weakness and urinary retention. What is the immediate concern?
A. Malignant spinal cord compression
B. Simple muscular strain
C. Peripheral neuropathy only
D. Osteoarthritis
Correct Answer: A
Back pain with neurologic deficits and bladder dysfunction in cancer suggests spinal cord compression requiring urgent imaging and treatment.
Medicine
Oncology
A cancer patient on chemotherapy presents with fever and an absolute neutrophil count of 300/µL. What is the immediate management priority?
A. Prompt empiric broad-spectrum antipseudomonal antibiotics
B. Wait for culture results before treatment
C. Give oral iron
D. Start chemotherapy again
Correct Answer: A
Febrile neutropenia is an oncologic emergency; empiric antipseudomonal antibiotics should be started promptly after cultures when feasible.
Medicine
Oncology
Which electrolyte abnormality is typical of tumor lysis syndrome?
A. Persistent hypophosphatemia as the rule
B. Isolated hypernatremia only
C. Severe hypouricemia
D. Hyperkalemia
Correct Answer: D
Tumor lysis classically causes hyperkalemia, hyperphosphatemia, hyperuricemia and secondary hypocalcemia.
Medicine
Oncology
Which complication or major adverse outcome is particularly associated with Tumor lysis syndrome?
A. Acute kidney injury and arrhythmia
B. Metastatic bone disease
C. Acute kidney injury with life-threatening hyperkalemia
D. Superior vena cava syndrome
Correct Answer: C
Uric acid and phosphate nephropathy plus electrolyte release can cause renal failure and fatal arrhythmias.
Medicine
Oncology
A patient is diagnosed with Tumor lysis syndrome. Which is the most appropriate management principle?
A. Give urgent corticosteroid therapy when appropriate and arrange immediate oncology or neurosurgical management
B. Use aggressive risk-based prophylaxis or treatment with hydration and uric-acid-lowering therapy
C. Start intravenous isotonic fluid resuscitation and use calcium-lowering therapy according to severity and cause
D. Refer to a multidisciplinary breast team for stage- and receptor-directed local and systemic therapy
Correct Answer: B
Prevention is crucial in high-risk patients; established tumor lysis may require intensive electrolyte management and dialysis.
Medicine
Oncology
In a patient with suspected Tumor lysis syndrome, which investigation or diagnostic approach is most appropriate at this stage?
A. Serial potassium, phosphate, calcium, uric acid and kidney-function monitoring
B. Prompt cultures and focused infection evaluation while treatment is initiated
C. Urgent MRI of the spine
D. Repeat or confirm calcium with renal function and targeted evaluation of the mechanism
Correct Answer: A
Frequent biochemical monitoring detects evolving tumor lysis before life-threatening arrhythmia or renal failure occurs.
Medicine
Oncology
A patient develops acute kidney injury and electrolyte abnormalities soon after treatment of a high-burden, treatment-sensitive malignancy. What is the most likely diagnosis?
A. Prostate cancer
B. Febrile neutropenia
C. Malignant spinal cord compression
D. Tumor lysis syndrome
Correct Answer: D
Rapid malignant-cell breakdown releases potassium, phosphate and nucleic-acid metabolites, producing tumor lysis syndrome.