MRI in a woman newly found to have multiple myeloma shows epidural plasmacytoma compressing the cord at T6 and T11. She can still walk with support and the spine is stable. Dexamethasone has been started. Which is the usual definitive local treatment?

Radiotherapy to the affected levels

Steroids alone until walking improves

Oncology and oncological emergencies

45 NEET-PG practice questions on Oncology and oncological emergencies, part of General Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Which region of the spine is most often involved in metastatic spinal cord compression?
1. ASacrococcygeal
2. BThoracic
3. CCervical
4. DLumbosacral
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Answer: B · Thoracic
About 60-70% of metastatic cord compression is thoracic, 20-30% lumbosacral and about 10% cervical, reflecting the number of vertebrae and blood flow through Batson's venous plexus. The thoracic canal is also narrow relative to the cord. Key point: Metastatic spinal cord compression is most often thoracic.
- A: The sacrococcygeal region carries no cord and rarely causes compression.
- C: Cervical involvement is least common, about a tenth.
- D: Lumbosacral disease is second, about a quarter of cases.
Question 2 · Medium
Blurred vision, nosebleeds and headache bring a man to casualty. Fundoscopy shows dilated, sausage-shaped retinal veins with haemorrhages. Serum IgM paraprotein is 6.2 g/dL and the marrow shows lymphoplasmacytic infiltration. What is the immediate treatment?
1. AHigh-dose dexamethasone alone
2. BAllopurinol and hydration
3. CPlasmapheresis
4. DRed cell transfusion
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Answer: C · Plasmapheresis
A high IgM paraprotein in Waldenström macroglobulinaemia raises serum viscosity because large pentameric IgM stays in the vessels; mucosal bleeding, visual change and neurological symptoms make up hyperviscosity syndrome. Plasmapheresis removes IgM quickly and relieves symptoms, while chemoimmunotherapy controls the disease. Transfusion before plasmapheresis worsens viscosity. Key point: Symptomatic hyperviscosity from an IgM paraprotein: urgent plasmapheresis.
- A: Steroids act too slowly for hyperviscosity.
- B: Allopurinol and hydration prevent tumour lysis, not hyperviscosity.
- D: Transfusion raises viscosity further and should wait until after plasmapheresis.
Question 3 · Medium
While an MRI is arranged tonight, a man with prostate cancer has thoracic back pain, new leg weakness (power 4/5) and brisk knee jerks. What should be given at once?
1. AIV mannitol infusion
2. BAnalgesia and bed rest only
3. CHigh-dose dexamethasone
4. DIV zoledronic acid
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Answer: C · High-dose dexamethasone
With suspected cord compression and neurological signs, high-dose dexamethasone (commonly 16 mg a day) is started at once to reduce vasogenic cord oedema and pain, with a proton pump inhibitor for gastric protection. It buys time while MRI and definitive radiotherapy or surgery are arranged, and glucose is monitored. Key point: Suspected cord compression with deficits: start dexamethasone immediately, without waiting for imaging.
- A: Mannitol is for raised intracranial pressure, not cord oedema.
- B: Analgesia alone delays the treatment that protects cord function.
- D: Bisphosphonates help bone pain and fractures but do not relieve cord compression.
Question 4 · Medium
A patient with a testicular germ cell tumour who received bleomycin is listed for retroperitoneal lymph node dissection. What should the anaesthetist avoid during surgery?
1. ANitrous oxide
2. BNeuromuscular blockers
3. CVolatile anaesthetic agents
4. DHigh inspired oxygen
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Answer: D · High inspired oxygen
Bleomycin generates oxygen free radicals and causes pulmonary toxicity, pneumonitis progressing to fibrosis, and later exposure to high inspired oxygen can trigger acute lung injury. The lowest FiO2 that keeps adequate saturation is used, with careful fluid balance. Lung function including DLCO is monitored during treatment. Key point: After bleomycin, avoid high FiO2 and fluid overload during anaesthesia because of lung toxicity.
- A: Nitrous oxide has no specific interaction with bleomycin lung injury.
- B: Muscle relaxants are not contraindicated after bleomycin.
- C: Volatile agents are not specifically harmful after bleomycin.
Question 5 · Medium
MRI in a woman newly found to have multiple myeloma shows epidural plasmacytoma compressing the cord at T6 and T11. She can still walk with support and the spine is stable. Dexamethasone has been started. Which is the usual definitive local treatment?
1. ASteroids alone until walking improves
2. BLaminectomy at both levels
3. CRadiotherapy to the affected levels
4. DVertebroplasty alone
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Answer: C · Radiotherapy to the affected levels
Myeloma and lymphoma are highly radiosensitive, so with a stable spine radiotherapy, together with dexamethasone and systemic therapy, is the usual definitive treatment even at more than one level. Surgery is reserved for instability, bony compression or progression during radiotherapy. Laminectomy alone can destabilise the spine and offers no advantage. Key point: Cord compression from radiosensitive tumours (myeloma, lymphoma) with a stable spine: radiotherapy.
- A: Steroids alone delay definitive treatment.
- B: Laminectomy alone does not help and can destabilise the spine.
- D: Vertebroplasty treats painful fractures but does not decompress the cord.
Question 6 · Medium
Weakness, oedema and hypertension have worsened rapidly over six weeks in a smoker: potassium 2.6 mmol/L (3.5-5.0), bicarbonate 34 mmol/L, glucose 260 mg/dL, very high ACTH, and cortisol not suppressed by high-dose dexamethasone. There are no striae. What is the most likely diagnosis?
1. APrimary hyperaldosteronism
2. BAdrenocortical carcinoma
3. CCushing disease from a pituitary adenoma
4. DEctopic ACTH from small cell lung cancer
Answer and explanation in LearnFree account
Question 7 · Medium
About immune-related adverse events of checkpoint inhibitors: 1. They can appear months after the last dose. 2. Hypothyroidism needs the drug to be stopped permanently. 3. Combined anti-CTLA-4 and anti-PD-1 therapy causes more severe events than either alone. 4. Most grade 1 events need only continued treatment with close monitoring. Which statements are correct?
1. A1, 2, 3 and 4
2. B2 and 3 only
3. C1, 3 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 8 · Medium
Proximal leg weakness that improves after a few seconds of sustained effort, a dry mouth, and absent knee jerks that return after exercise develop in a smoker who is losing weight. Antibodies against which target are expected?
1. ANeuronal Hu (ANNA-1) antigen
2. BPostsynaptic nicotinic acetylcholine receptors
3. CMuscle-specific kinase
4. DP/Q-type voltage-gated calcium channels
Answer and explanation in LearnFree account
Question 9 · Hard
In the twelfth week of ipilimumab for melanoma, a schoolteacher has severe frontal headache, fatigue, nausea and dizziness on standing; BP is 92/60 mmHg lying. Results: sodium 129 mmol/L (135-145), potassium 4.3 mmol/L, 8 a.m. cortisol 1.8 µg/dL (5-25) with a low ACTH, TSH 0.2 mIU/L (0.4-4.0) and free T4 0.6 ng/dL (0.8-1.8). MRI shows a mildly enlarged pituitary without chiasm compression. Both the adrenal and thyroid axes need treatment. What is the correct first step?
1. AHydrocortisone first, then levothyroxine
2. BLevothyroxine first, then hydrocortisone
3. CFludrocortisone alone
4. DLevothyroxine alone; cortisol will recover
Answer and explanation in LearnFree account
Question 10 · Easy
Which set of serum changes is typical of tumour lysis syndrome?
1. AHigh K, low phosphate, low urate, high Ca
2. BHigh K, high phosphate, high urate, low Ca
3. CLow K, low phosphate, high urate, high Ca
4. DLow K, high phosphate, low urate, low Ca
Answer and explanation in LearnFree account
Question 11 · Medium
New dry cough and breathlessness on climbing stairs develop in the second month of durvalumab after chemoradiation for stage III lung cancer. SpO2 is 95% on air. CT shows patchy ground-glass opacities in both lungs, outside the radiation field. Sputum and viral studies are negative. What is the best management?
1. AHold durvalumab; prednisolone 1-2 mg/kg/day
2. BContinue durvalumab and add inhaled budesonide
3. CBroad-spectrum antibiotics only
4. DStop durvalumab and begin infliximab
Answer and explanation in LearnFree account
Question 12 · Easy
Pembrolizumab, used in melanoma and lung cancer, is a monoclonal antibody against which target?
1. APD-1 on T cells
2. BVEGF-A in plasma
3. CPD-L1 on tumour cells
4. DCTLA-4 on T cells
Answer and explanation in LearnFree account
Question 13 · Medium
At the medical OPD, a chain smoker has had facial puffiness, a feeling of fullness in the head on bending and swelling of the right arm for three weeks. Dilated veins run over the upper chest, but he has no stridor, his voice is normal and he is not confused. He has lost 6 kg in two months and his SpO2 is 95% on air. CT shows a right upper mediastinal mass compressing the superior vena cava, with no tissue diagnosis yet. The resident proposes IV dexamethasone and urgent radiotherapy tonight. What is the best next step?
1. AEmergency radiotherapy tonight
2. BObtain a tissue diagnosis before treatment
3. CThrombolysis of the SVC
4. DIV dexamethasone at once
Answer and explanation in LearnFree account
Question 14 · Medium
Ketones 4.1 mmol/L, glucose 486 mg/dL, bicarbonate 11 mmol/L and an undetectable C-peptide are found in a previously non-diabetic man in his tenth week of nivolumab. HbA1c is 7.0%. Which statement about this condition is correct?
1. AIt needs insulin, usually for life
2. BNivolumab must be stopped for good
3. CMetformin is the first-line treatment
4. DHigh-dose steroids usually reverse it
Answer and explanation in LearnFree account
Question 15 · Medium
About metastatic spinal cord compression: 1. Lung, breast and prostate cancers are the commonest causes. 2. Sphincter disturbance is an early sign. 3. About a third of patients have disease at more than one level. 4. Radiotherapy is the treatment of choice for an unstable spine with bony compression. Which are correct?
1. A1 and 3 only
2. B1, 3 and 4 only
3. C1, 2 and 3 only
4. D2 and 4 only
Answer and explanation in LearnFree account
Question 16 · Hard
In a tertiary hospital in Kochi, a retired engineer with renal cell carcinoma, controlled on a targeted drug and expected to live well over a year, has had 18 hours of rapidly worsening leg weakness and now cannot walk. MRI shows a single-level metastasis at T9 with a pathological fracture, retropulsed bone and cord compression; the rest of the spine is clear. Dexamethasone has been given. He is fit for anaesthesia, his albumin is normal, and the family want every useful option. His haemoglobin and platelets are normal. Which is the best definitive management?
1. ARadiotherapy alone to T8-T10
2. BContinue steroids and review in a week
3. CHigh-dose systemic chemotherapy
4. DDecompressive surgery and fixation, then radiotherapy
Answer and explanation in LearnFree account
Question 17 · Hard
On the haematology ward at night, a man with multiple myeloma is confused. Serum calcium is 17.2 mg/dL (8.5-10.5), creatinine 6.8 mg/dL and potassium 5.9 mmol/L, and he has passed 80 mL of urine in 12 hours despite a litre of saline. He now has bibasal crackles, a raised JVP and SpO2 of 90% on air, though he is not hypotensive. Zoledronic acid has been withheld because of his renal function, and calcitonin has been started. The nephrologist is on call. Which treatment will lower his calcium most quickly and safely?
1. AIV furosemide 80 mg every 2 hours
2. BFurther rapid saline boluses
3. COral prednisolone 60 mg daily
4. DHaemodialysis with a low-calcium dialysate
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Question 18 · Easy
Immune-related adverse events of checkpoint inhibitors arise mainly because of:
1. ALoss of T-cell self-tolerance
2. BIgE-mediated hypersensitivity
3. CDirect damage to dividing cells
4. DOff-target kinase inhibition
Answer and explanation in LearnFree account
Question 19 · Hard
Troponin I is 18 times the upper limit in a woman admitted to the coronary care unit in the third week of ipilimumab plus nivolumab for renal cell carcinoma. She was well before treatment and now has fatigue, ptosis and proximal muscle weakness, with a CK of 2,400 U/L. ECG shows new complete heart block and echo an ejection fraction of 45%. Coronary angiography is normal and viral studies are negative. A temporary transvenous pacemaker has been placed by the cardiologist. Besides stopping immunotherapy permanently, which treatment should be started at once?
1. AIV methylprednisolone 1 g daily
2. BOral prednisolone 0.5 mg/kg/day
3. CIV immunoglobulin alone
4. DA beta-blocker and an ACE inhibitor
Answer and explanation in LearnFree account
Question 20 · Easy
Cisplatin is to be given to a man with head and neck cancer. Which measure best prevents its main dose-limiting toxicity?
1. AIV saline hydration
2. BLeucovorin rescue
3. CDexrazoxane before each dose
4. DMesna with each dose
Answer and explanation in LearnFree account
Question 21 · Easy
Euvolaemic hyponatraemia (sodium 121 mmol/L), with urine osmolality 520 mOsm/kg and urine sodium 46 mmol/L, is found in a smoker with a central lung mass. Which tumour type is most likely?
1. AAdenocarcinoma
2. BBronchial carcinoid
3. CSmall cell carcinoma
4. DSquamous cell carcinoma
Answer and explanation in LearnFree account
Question 22 · Medium
Hodgkin lymphoma with bulky mediastinal nodes has just been diagnosed in a college lecturer whose calcium is 12.8 mg/dL (8.5-10.5). PTH and PTHrP are suppressed and 1,25-dihydroxyvitamin D is raised. Besides fluids, which drug class acts on the cause of this hypercalcaemia?
1. AGlucocorticoids
2. BCalcimimetics
3. CBisphosphonates
4. DCalcitonin
Answer and explanation in LearnFree account
Question 23 · Medium
Which drug lowers serum calcium within hours but loses its effect in about 48 hours because of tachyphylaxis?
1. ACalcitonin
2. BDenosumab
3. CZoledronic acid
4. DPamidronate
Answer and explanation in LearnFree account
Question 24 · Medium
Recurrent fasting hypoglycaemia (glucose 38 mg/dL) with low insulin and low C-peptide is found in a man with a large solitary fibrous tumour of the pleura. Which tumour product causes it?
1. AGlucagon-like peptide-1
2. BEctopic insulin
3. CExcess IGF-1
4. DUnprocessed IGF-2
Answer and explanation in LearnFree account
Question 25 · Medium
Before monthly zoledronic acid is started for bone metastases from prostate cancer, the oncology team plans one step to cut the risk of the drug's most feared long-term complication. Which step is it?
1. ABaseline DEXA scan of the hip
2. BDental review and treatment
3. CEye review to exclude uveitis
4. DWeekly serum calcium for a month
Answer and explanation in LearnFree account

20 more Oncology and oncological emergencies questions

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Oncology and oncological emergencies

Which region of the spine is most often involved in metastatic spinal cord compression?

Blurred vision, nosebleeds and headache bring a man to casualty. Fundoscopy shows dilated, sausage-shaped retinal veins with haemorrhages. Serum IgM paraprotein is 6.2 g/dL and the marrow shows lymphoplasmacytic infiltration. What is the immediate treatment?

While an MRI is arranged tonight, a man with prostate cancer has thoracic back pain, new leg weakness (power 4/5) and brisk knee jerks. What should be given at once?

A patient with a testicular germ cell tumour who received bleomycin is listed for retroperitoneal lymph node dissection. What should the anaesthetist avoid during surgery?

MRI in a woman newly found to have multiple myeloma shows epidural plasmacytoma compressing the cord at T6 and T11. She can still walk with support and the spine is stable. Dexamethasone has been started. Which is the usual definitive local treatment?

Weakness, oedema and hypertension have worsened rapidly over six weeks in a smoker: potassium 2.6 mmol/L (3.5-5.0), bicarbonate 34 mmol/L, glucose 260 mg/dL, very high ACTH, and cortisol not suppressed by high-dose dexamethasone. There are no striae. What is the most likely diagnosis?

Proximal leg weakness that improves after a few seconds of sustained effort, a dry mouth, and absent knee jerks that return after exercise develop in a smoker who is losing weight. Antibodies against which target are expected?

Which set of serum changes is typical of tumour lysis syndrome?

Pembrolizumab, used in melanoma and lung cancer, is a monoclonal antibody against which target?

Ketones 4.1 mmol/L, glucose 486 mg/dL, bicarbonate 11 mmol/L and an undetectable C-peptide are found in a previously non-diabetic man in his tenth week of nivolumab. HbA1c is 7.0%. Which statement about this condition is correct?

Immune-related adverse events of checkpoint inhibitors arise mainly because of:

Cisplatin is to be given to a man with head and neck cancer. Which measure best prevents its main dose-limiting toxicity?

Euvolaemic hyponatraemia (sodium 121 mmol/L), with urine osmolality 520 mOsm/kg and urine sodium 46 mmol/L, is found in a smoker with a central lung mass. Which tumour type is most likely?

Hodgkin lymphoma with bulky mediastinal nodes has just been diagnosed in a college lecturer whose calcium is 12.8 mg/dL (8.5-10.5). PTH and PTHrP are suppressed and 1,25-dihydroxyvitamin D is raised. Besides fluids, which drug class acts on the cause of this hypercalcaemia?

Which drug lowers serum calcium within hours but loses its effect in about 48 hours because of tachyphylaxis?

Recurrent fasting hypoglycaemia (glucose 38 mg/dL) with low insulin and low C-peptide is found in a man with a large solitary fibrous tumour of the pleura. Which tumour product causes it?

Before monthly zoledronic acid is started for bone metastases from prostate cancer, the oncology team plans one step to cut the risk of the drug's most feared long-term complication. Which step is it?