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As published by the Kerala Public Service Commission.

All 100 questions with answers

Tap an option to check yourself, or open the answer. Answers follow the official Kerala PSC answer key.

  1. 1.
    All the following are risk reduction strategies in BRCA mutated individuals except
    Show answer and explanation
    Answer: C —
    Prophylactic B/L Oophorectomy
    Prophylactic B/L oophorectomy alone is not recommended over salpingo-oophorectomy as both fallopian tubes and ovaries should be removed.
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  2. 2.
    Which of the following will have very low/no risk of prolonged Azoospermia?
    Show answer and explanation
    Answer: B —
    ABVD chemotherapy
    ABVD chemotherapy has a very low risk of causing permanent or prolonged azoospermia compared to alkylating agents or multi-agent regimens like BEP or CHOP.
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  3. 3.
    Which of the following is the preferred method to establish tissue diagnosis of cutaneous melanoma?
    Show answer and explanation
    Answer: D —
    Excision biopsy
    Excision biopsy with a narrow clinical margin is the preferred method to diagnose cutaneous melanoma to preserve prognostic information like Breslow thickness.
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  4. 4.
    Cancer immune editing includes all except
    Show answer and explanation
    Answer: C —
    Evolution
    The three phases of cancer immunoediting are Elimination, Equilibrium, and Escape.
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  5. 5.
    Which of the following is not a factor used in the prognostication of advanced stage Hodgkin lymphoma by the International Prognostic Score (IPS)?
    Show answer and explanation
    Answer: D —
    Age 40 years and more
    The IPS for advanced Hodgkin lymphoma considers age ≥45\geq 45 years, not 40 years.
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  6. 6.
    What is the treatment of choice for solitary plasmacytoma?
    Show answer and explanation
    Answer: B —
    40 to 50 Gy of radiation
    Solitary plasmacytoma is highly radiosensitive, and definitive radiation therapy (40 to 50 Gy) is the treatment of choice.
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  7. 7.
    MRD negativity in ALL and MMR in CML:
    Show answer and explanation
    Answer: B —
    < 0.01% and < 0.1% respectively
    Minimal residual disease (MRD) negativity in ALL is generally defined as <0.01%< 0.01\%, and major molecular response (MMR) in CML is BCR-ABL1 ≤0.1%\leq 0.1\%.
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  8. 8.
    A 45 year old gentleman underwent endoscopic removal of a colonic polyp. Which of the following is NOT an indication for colon resection surgery?
    Show answer and explanation
    Answer: C —
    Lesion in upper 1/3rd of submucosa
    High-risk features for endoscopic polypectomy requiring resection include lymphovascular invasion, poorly differentiated histology, positive margins, and deep submucosal invasion (lower 1/3rd, not upper 1/3rd).
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  9. 9.
    A 50 year-old patient presents with breast cancer involving axillary and infraclavicular lymph nodes and exhibits a pCR at mastectomy and sentinel node biopsy following neo adjuvant chemotherapy. What is the current standard of care for adjuvant RT?
    Show answer and explanation
    Answer: B —
    Adjuvant RT to the chest wall and regional nodes
    Despite pathologic complete response (pCR) following neoadjuvant chemotherapy, regional nodal irradiation including chest wall and regional nodes is indicated due to high initial burden.
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  10. 10.
    What is the most common type of small bowel malignancy?
    Show answer and explanation
    Answer: C —
    Carcinoid
    Carcinoid (neuroendocrine) tumors are the most common malignant tumors of the small bowel, followed closely by adenocarcinomas.
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  11. 11.
    Which is the most common tumour suppressor gene mutation in pancreatic cancer?
    Show answer and explanation
    Answer: B —
    CDKN2A/p16
    While KRAS is the most common oncogene mutation, CDKN2A/p16 is a major tumor suppressor gene frequently mutated/inactivated in pancreatic cancer.
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  12. 12.
    Platelet dysfunction is seen with
    Show answer and explanation
    Answer: B —
    Dasatinib
    Dasatinib is well known for causing platelet dysfunction and bleeding complications, partly related to its inhibition of Lyn and Src kinases.
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  13. 13.
    Which of the following is not included in 5 A's model of smoking Cessation?
    Show answer and explanation
    Answer: C —
    Analyze
    The 5 A's model consists of Ask, Advise, Assess, Assist, and Arrange.
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  14. 14.
    Among the following, routine antiemetic prophylaxis can be avoided in all except:
    Show answer and explanation
    Answer: D —
    Eribulin
    Eribulin has moderate emetogenic potential requiring routine antiemetic prophylaxis, whereas Bevacizumab, Fludarabine, and Vinblastine are classified as minimal/low emetogenic risk.
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  15. 15.
    Which drug-adverse event is wrongly matched?
    Show answer and explanation
    Answer: B —
    Bosutinib - Constipation/Ileus
    Bosutinib typically causes diarrhea rather than constipation or ileus.
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  16. 16.
    All of the following are indication for annual screening MRI of breast except
    Show answer and explanation
    Answer: B —
    Atypical hyperplasia
    Atypical hyperplasia is an indication for annual mammographic screening, but high-risk MRI screening is typically reserved for those with lifetime risk ≥20−25%\ge 20-25\%, BRCA mutation, or strong family history.
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  17. 17.
    All of the following are indication for surgical biopsy after core needle biopsy except
    Show answer and explanation
    Answer: A —
    LCIS
    Lobular carcinoma in situ (LCIS) diagnosed on core needle biopsy generally does not mandate surgical excision if radiologic-pathologic concordance exists, unlike atypical ductal hyperplasia and radial scars.
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  18. 18.
    Anthracyclines inhibit:
    Show answer and explanation
    Answer: B —
    Trop 2A
    Anthracyclines inhibit Topoisomerase II (specifically Topoisomerase II alpha / Trop 2A).
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  19. 19.
    All of the following tumours are positive for CD 30 except:
    Show answer and explanation
    Answer: D —
    Follicular Lymphoma
    Follicular lymphoma is typically CD30 negative, whereas Hodgkin lymphoma, ALCL, and embryonal carcinoma are CD30 positive.
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  20. 20.
    ENDURANCE trial studied newly disgnosed patients with Multiple Myeloma. All are true except
    Show answer and explanation
    Answer: B —
    Improvement was seen in PFS (Progression free survival) but not in OS (Overall survival)
    The ENDURANCE trial did not show a PFS benefit for KRd over VRd in the standard-risk population.
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  21. 21.
    B/I prophylactic mastectomy - decreases the breast cancer risk by
    Show answer and explanation
    Answer: A —
    90-95%
    Bilateral prophylactic mastectomy reduces the risk of breast cancer by approximately 90-95%.
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  22. 22.
    Which of the following is not a component of Gail model for breast cancer risk estimation?
    Show answer and explanation
    Answer: D —
    No of 1st and 2nd degree relatives with breast cancer
    The Gail model specifically considers first-degree relatives; second-degree relatives are not a standard component of the calculation.
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  23. 23.
    The statement regarding dermatofibrosarcoma protuberans is true except:
    Show answer and explanation
    Answer: C —
    The hallmark of dermatofibrosarcoma protuberans is t(15;22) (q22;q13)
    The hallmark translocation for dermatofibrosarcoma protuberans is t(17;22)(q22;q13), not t(15;22).
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  24. 24.
    Which feature is NOT a criterion for MGUS?
    Show answer and explanation
    Answer: D —
    Normal free light chain ratio
    MGUS is defined by the presence of an M-protein, but an abnormal free light chain ratio is often present; a normal ratio is not a defining criterion.
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  25. 25.
    In CML, presence of which of the following points towards poor prognosis?
    Show answer and explanation
    Answer: C —
    Lymphadenopathy
    Lymphadenopathy in CML is often a sign of progression to accelerated phase or blast crisis, indicating a poor prognosis.
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  26. 26.
    Oberlin criteria is used in which malignancy?
    Show answer and explanation
    Answer: B —
    Rhabdomyosarcoma
    The Oberlin criteria are used for risk stratification in rhabdomyosarcoma.
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  27. 27.
    All are acquired resistance genes in NSCLC except
    Show answer and explanation
    Answer: C —
    BRAF class 2 and class 3 alterations in non V600E mutant lung cancer
    BRAF class 2 and 3 alterations are generally not classified as standard acquired resistance mechanisms in the same way as T790M or MET amplification.
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  28. 28.
    For which of the following cancers is alcohol consumption not a risk factor?
    Show answer and explanation
    Answer: D —
    Pharyngeal cancer
    Alcohol is a well-established risk factor for breast, esophageal, and pharyngeal cancers, but its link to pancreatic cancer is not as strongly established.
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  29. 29.
    Which is most accurate regarding risk factors for breast cancer?
    Show answer and explanation
    Answer: B —
    A prior diagnosis of breast cancer is a well-established risk factor for developing a new breast cancer
    A personal history of breast cancer is a significant risk factor for the development of a second primary breast cancer.
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  30. 30.
    According to the Society of Surgical Oncology, American Society for Radiation Oncology and American Society of Clinical Oncology Consensus Guidelines, which statement regarding Breast-Conserving Surgery (BCS) in ductal carcinoma in situ is most accurate?
    Show answer and explanation
    Answer: A —
    Positive margins are associated with at least a twofold increase in Ipsilateral Breast Tumor Recurrence (IBTR)
    Consensus guidelines emphasize that positive margins significantly increase the risk of recurrence in DCIS.
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  31. 31.
    Regarding the use of High dose methotrexate, choose the CORRECT statement.
    Show answer and explanation
    Answer: C —
    The drug is not dialysable during conventional hemodialysis
    High-dose methotrexate is not effectively removed by conventional hemodialysis, requiring glucarpidase in cases of severe toxicity.
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  32. 32.
    Regarding induction therapy of Acute myeloid leukemia in older adults, which is TRUE?
    Show answer and explanation
    Answer: A —
    Venetoclax and azacytidine can produce CR in around 60% of patients
    The combination of Venetoclax and Azacytidine has shown high complete remission (CR) rates in older AML patients.
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  33. 33.
    Which of the following is a suitable agent for tackling positive MRD status in acute lymphoblastic leukemia?
    Show answer and explanation
    Answer: B —
    Blinatumumab
    Blinatumumab is an FDA-approved bispecific T-cell engager for the treatment of MRD-positive B-cell precursor ALL.
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  34. 34.
    Which of the following is NOT an inhibitor of VEGF?
    Show answer and explanation
    Answer: D —
    Alpelisib
    Alpelisib is a PI3K-alpha inhibitor, whereas the others are multi-kinase inhibitors with anti-VEGF activity.
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  35. 35.
    Regarding CDK4/6 inhibitors in hormone-positive breast cancer, choose the CORRECT statement.
    Show answer and explanation
    Answer: C —
    Abemaciclib has the highest inhibitory effect on CDK6
    Abemaciclib is known for its distinct potency and selectivity profile compared to other CDK4/6 inhibitors.
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  36. 36.
    Which of the following is NOT TRUE regarding DNA repair and use of PARP inhibitors?
    Show answer and explanation
    Answer: C —
    PARP-1 inhibition affects both single-stranded as well as double-stranded break repairs
    PARP inhibitors primarily target single-strand break repair, leading to double-strand breaks during replication, which are then lethal in BRCA-deficient cells.
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  37. 37.
    Which of the following is the target of lenalidomide?
    Show answer and explanation
    Answer: B —
    Cereblon
    Lenalidomide acts as a molecular glue that binds to Cereblon (CRBN), an E3 ubiquitin ligase component.
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  38. 38.
    Regarding the mechanism of action of anti-emetic agents, choose the CORRECT statement.
    Show answer and explanation
    Answer: D —
    5HT3 antagonists act by blocking the effect of serotonin from GI mucosa afferent transmission to CNS
    5HT3 receptor antagonists block serotonin receptors on vagal afferents in the GI tract, preventing the signal from reaching the vomiting center.
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  39. 39.
    Regarding the management of toxicities of BTK inhibitors, choose the CORRECT statement.
    Show answer and explanation
    Answer: D —
    Bruising in a patient on ibrutinib can be managed conservatively and need not trigger stop of the agent
    Minor bruising and petechiae are common side effects of ibrutinib and generally do not require discontinuation unless severe bleeding occurs.
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  40. 40.
    Regarding immune therapy (Check point inhibitors) related AE (irAE), which is the TRUE statement?
    Show answer and explanation
    Answer: A —
    Most irAEs happen in the first 8-12 weeks of starting treatment
    Immune-related adverse events (irAEs) typically manifest within the first few months of initiating checkpoint inhibitor therapy.
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  41. 41.
    A 46-year-old male with NSCLC, Adenocarcinoma, PDL1 60%, is started on Pembrolizumab. After 6 weeks, when he presents for his 3rd dose, he complains of abdominal pain and increased stool frequency upto 5 times a day, with occasional streaks of blood. His CBC, RFT, LFT, TSH and Cortisol levels are normal. Which of the following is a TRUE statement regarding further management of the current problem?
    Show answer and explanation
    Answer: B —
    Stool culture and C diff evaluation should be done as the first step and then a colonoscopy may be considered
    In patients presenting with diarrhea on immunotherapy, it is essential to rule out infectious causes like C. difficile before attributing it to immune-mediated colitis.
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  42. 42.
    Regarding cytokine release syndrome associated with immune therapies, choose the CORRECT statement.
    Show answer and explanation
    Answer: C —
    Cardic dysfunction associated with CRS is usually reversible
    Cardiac dysfunction in CRS is often transient and reversible with appropriate management of the underlying cytokine storm.
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  43. 43.
    Regarding ALK mutated lung cancer and ALK inhibitors in lung cancer, choose the INCORRECT statement.
    Show answer and explanation
    Answer: C —
    Alectinib is more efficacious in terms of PFS than crizotinib and also causes lesser anemia
    While Alectinib is more efficacious than Crizotinib, the statement regarding anemia is not the primary differentiator; the clinical trial data shows superior CNS penetration and PFS.
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  44. 44.
    A 50-year female with ER+ve, PR-ve, Her-2 2+ (FISH negative) breast cancer with metastatic disease is treated with first-line paclitaxel and has progressive disease while on letrozole and palbociclib. Which of the following would NOT be a reasonable choice of treatment for her?
    Show answer and explanation
    Answer: D —
    Trastuzumab with abemaciclib
    Since the patient is FISH negative (HER2 non-amplified), Trastuzumab is not indicated.
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  45. 45.
    Regarding de-escalation of therapy in ER-positive, early breast cancer using gene profiling (Oncotype Dx), choose the TRUE statement.
    Show answer and explanation
    Answer: C —
    A menopausal woman with a score <10 does not need chemotherapy
    The TAILORx trial demonstrated that postmenopausal women with low recurrence scores (0-25) do not derive significant benefit from chemotherapy.
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  46. 46.
    A 45-year-old male presents with 3 week history of cough and hemoptysis. He has a large lung lesion and multiple liver metastases. Bilirubin is 2.5 mg/dL. He has dyspnea. He has several bone lesions with pain. Biopsy is adenocarcinoma. The NGS panel is negative. PDL 1 is 50%. Which of the following is the most appropriate therapy?
    Show answer and explanation
    Answer: A —
    Pembrolizumab with pemetrexed carboplatin
    For metastatic non-squamous NSCLC with high PD-L1 expression, the combination of immunotherapy and platinum-doublet chemotherapy is a standard first-line treatment.
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  47. 47.
    Regarding the infusion of paclitaxel, choose the CORRECT statement.
    Show answer and explanation
    Answer: C —
    Premedication with steroids will reduce infusion reactions
    Premedication with corticosteroids and H1/H2 antagonists is standard practice to prevent hypersensitivity reactions associated with paclitaxel.
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  48. 48.
    Which of the following is an absolute contraindication for rechallenge with any form of L-asparaginase in a patient with Acute lymphoblastic leukemia?
    Show answer and explanation
    Answer: C —
    Symptomatic pancreatitis
    Symptomatic pancreatitis is a severe toxicity that mandates permanent discontinuation of L-asparaginase.
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  49. 49.
    Regarding Daratumumab used in myeloma, please choose the CORRECT statement.
    Show answer and explanation
    Answer: D —
    For patients with myeloma kidney, it is recommended to use 50% doses
    Daratumumab dosing adjustments or specific considerations are often applied in the context of renal impairment in myeloma patients.
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  50. 50.
    A 54-year-old male presents with hematuria. The evaluation shows a bladder tumor (biopsy : urothelial carcinoma) and PET CT shows bilateral lung metastasis and retroperitoneal and pelvic lymphadenopathy. He is ECOG PS 1 and has normal renal and liver functions. The first line treatment of choice for him would be :
    Show answer and explanation
    Answer: B —
    Pembrolizumab + Enfortumab vedotin
    The EV-302 trial established Pembrolizumab plus Enfortumab vedotin as the new standard of care for first-line treatment of locally advanced or metastatic urothelial carcinoma.
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  51. 51.
    Which of the following is not correct about Superior Venacava Syndrome (SVCS)?
    Show answer and explanation
    Answer: B —
    Adenocarcinoma Lung is the most common malignant cause of SVCS
    Small cell lung cancer (SCLC) is more commonly associated with SVCS than adenocarcinoma of the lung.
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  52. 52.
    Which of the following statement(s) is/are correct? I. CAR T-cell therapy - diffuse cerebral edema II. L-asparaginase - dural venous sinus thrombosis III. ATRA - idiopathic intracranial hypertension
    Show answer and explanation
    Answer: D —
    All of the above (I, II and III)
    All listed associations are recognized neurological side effects of the respective oncologic therapies.
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  53. 53.
    MNOP algorithm is used for the management of the following oncologic emergency
    Show answer and explanation
    Answer: A —
    Malignant spinal cord compression
    The MNOP algorithm (Methylprednisolone, Neurosurgery, Oncology, Physical therapy/Radiation) is a framework for managing malignant spinal cord compression.
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  54. 54.
    Which of the following Laboratory abnormality is not seen in tumor Lysis syndrome?
    Show answer and explanation
    Answer: D —
    Hypercalcemia
    Tumor Lysis Syndrome is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia (not hypercalcemia).
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  55. 55.
    Which among the following is the most common etiology of hypercalcemia seen in cancer patients?
    Show answer and explanation
    Answer: B —
    Humoral hypercalcemia of malignancy
    Humoral hypercalcemia of malignancy, mediated by PTHrP, is the most frequent cause of hypercalcemia in cancer patients.
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  56. 56.
    The most common type of classical Hodgkin Lymphoma is
    Show answer and explanation
    Answer: B —
    Nodular sclerosis CHL
    Nodular sclerosis is the most common histological subtype of classical Hodgkin lymphoma.
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  57. 57.
    According to EORTC criteria to stratify early stage Hodgkin Lymphoma, which among the following is not a risk factor?
    Show answer and explanation
    Answer: D —
    ≥ 3 nodal areas
    The EORTC criteria for early-stage Hodgkin lymphoma risk stratification include mediastinal mass, age, and ESR, but not specifically ≥ 3 nodal areas as a primary risk factor.
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  58. 58.
    Which among the following statement(s) is/are correct? I. t(11;14) is a characteristic chromosomal translocation found in Burkitt's lymphoma II. Plasma cell neoplasms usually express CD 138 III. Phenytoin use is associated with increased risk of developing NHL
    Show answer and explanation
    Answer: B —
    Only II and III are correct
    t(11;14) is characteristic of Mantle Cell Lymphoma, not Burkitt's. Plasma cells express CD138, and phenytoin is linked to lymphoproliferative disorders.
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  59. 59.
    Which among the following is not a FDA approved PIK-3 inhibitor for patients with relapsed and refractory follicular lymphoma?
    Show answer and explanation
    Answer: C —
    Alpelisib
    Alpelisib is approved for PIK3CA-mutated breast cancer, not for follicular lymphoma.
    Report a mistake
  60. 60.
    Which among the following statement is not true about HIV associated NHL?
    Show answer and explanation
    Answer: D —
    Plasmablastic Lymphoma is associated with HHV-8 infection
    Plasmablastic lymphoma is typically associated with EBV, whereas Primary Effusion Lymphoma is associated with HHV-8.
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  61. 61.
    According to revised European Leukemia/Net classification system of AML, which among the following is an adverse risk category?
    Show answer and explanation
    Answer: B —
    t(9;22) : BCR ABL-1
    The t(9;22)(q34;q11.2) BCR-ABL1 translocation is classified in the adverse risk category in AML.
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  62. 62.
    Which among the following are FDA approved treatment options for primary refractory/relapsed adult ALL?\nI. Blinatumomab\nII. Inotuzumab ozogomycin\nIII. Tisagenlecleucal
    Show answer and explanation
    Answer: D —
    All Three (I, II and III)
    Blinatumomab, inotuzumab ozogomycin, and tisagenlecleucel are all FDA-approved therapies for relapsed/refractory B-cell ALL.
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  63. 63.
    Which among the following is not a Myeloma Defining Event (MDE) according to international myeloma working group revised diagnostic criteria?
    Show answer and explanation
    Answer: B —
    40% or more clonal plasma cells in the marrow
    The bone marrow plasma cell percentage defining MDE is ≥60%\ge 60\%, not 40%.
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  64. 64.
    Which among the following TKI is/are active in CML patients with T315I mutation?\nI. Ponatinib\nII. Bosutinib\nIII. Nilotinib\nIV. Asciminib
    Show answer and explanation
    Answer: A —
    Only I and IV
    Ponatinib and asciminib (specifically targeting the myristoyl pocket) have activity against the T315I gatekeeper mutation.
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  65. 65.
    SEQUOIA trial is associated with which of the following agent?
    Show answer and explanation
    Answer: B —
    Zanubrutinib
    The SEQUOIA clinical trial evaluated zanubrutinib in patients with chronic lymphocytic leukemia / small lymphocytic lymphoma.
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  66. 66.
    _______________ is defined as having smoked fever than 100 cigarettes in a person's lifetime and no current cigarette use.
    Show answer and explanation
    Answer: A —
    Never smoking
    A never smoker is defined as someone who has smoked fewer than 100 cigarettes in their lifetime.
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  67. 67.
    The increased risk of malignancy associated with obesity is strongest in
    Show answer and explanation
    Answer: C —
    Endometrial cancer
    Endometrial cancer shows one of the strongest relative risk increases associated with obesity.
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  68. 68.
    Which among the following statements about nutrition and cancer risk are true?\nI. Diet rich in calcium decreases colon cancer.\nII. Diet high in glycemic load increases risk of endometrial cancer.\nIII. Coffee consumption associated with decreased risk of liver cancer.
    Show answer and explanation
    Answer: D —
    All are true
    All stated nutritional associations with respective cancer risks are supported by epidemiological evidence.
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  69. 69.
    According to 2017 AJCC staging of regional node involvement (non HPV associated oropharyngeal cancer) metastasis to a single ipsilateral node with extranodal extension is
    Show answer and explanation
    Answer: D —
    N3b
    Any single or multiple lymph node with clinical extranodal extension (ENE+) is designated as N3b in non-HPV oropharyngeal/head and neck cancers under AJCC 8th edition.
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  70. 70.
    Among the following, the most common mutation observed in adenocarcinoma lung is
    Show answer and explanation
    Answer: B —
    KRAS
    KRAS is the most frequently mutated oncogene in lung adenocarcinoma overall (especially in western populations).
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  71. 71.
    Deficiency of the following micro nutrient in diet is associated with increased risk of esophageal squamous cell carcinoma
    Show answer and explanation
    Answer: C —
    Selenium
    Selenium deficiency (along with zinc and vitamin deficiencies) has been linked to an increased risk of esophageal squamous cell carcinoma.
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  72. 72.
    Aflatoxin is associated with increased risk of
    Show answer and explanation
    Answer: A —
    Hepato cellular carcinoma
    Aflatoxin exposure (produced by Aspergillus species) is a major risk factor for hepatocellular carcinoma, especially synergistically with Hepatitis B.
    Report a mistake
  73. 73.
    Which among the following is not a preferred agent for breast cancer risk reduction in high risk post menopausal women?
    Show answer and explanation
    Answer: B —
    T oremifine
    Toremifene is not a standard preferred/FDA-approved agent for chemoprevention of breast cancer compared to tamoxifen, raloxifene, and aromatase inhibitors.
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  74. 74.
    Which of the following is not a side effect of T amoxifen?
    Show answer and explanation
    Answer: D —
    Increase in blood cholesterol levels
    Tamoxifen actually has an estrogenic lipid-lowering effect that decreases serum cholesterol levels, rather than increasing them.
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  75. 75.
    Which of the following is not associated with Small Cell Lung Carcinoma (SCLC)?
    Show answer and explanation
    Answer: C —
    Screening CT scans can decrease cancer specific mortality in SCLC
    Low-dose CT screening decreases mortality in general lung cancer (predominantly NSCLC), but screening specifically for SCLC has not been shown to decrease disease-specific mortality due to its rapid doubling time.
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  76. 76.
    A 52 year old male, is diagnosed as a case of nasopharyngeal squamous cell carcinoma, moderately differentiated, with bilateral cervical lymph nodes and multiple lung metastasis. Which agent along with chemotherapy in the first line has shown progression free survival and overall survival benefit in this setting as per the JUPITER 02 trial?
    Show answer and explanation
    Answer: B —
    T oripalimab
    The JUPITER-02 trial evaluated toripalimab combined with gemcitabine and cisplatin in recurrent or metastatic nasopharyngeal carcinoma.
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  77. 77.
    As per the TNM Staging System for Cervical Lymph Nodes and Unknown Primary T umors of the Head and Neck (8th edition AJCC), a 48 year old lady is designated N2 U status. What does U stand for?
    Show answer and explanation
    Answer: A —
    metastasis above the lower border of the cricoid
    In head and neck staging, 'U' and 'L' denote upper (above the lower border of the cricoid) and lower neck lymph node levels.
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  78. 78.
    What is the first line recommended systemic treatment for metastatic triple negative breast cancer with PDL1 CPS<10 and no germline BRCA1/2 mutation?
    Show answer and explanation
    Answer: B —
    Systemic chemotherapy
    Without PD-L1 expression (CPS < 10) and without germline BRCA mutations, standard single-agent chemotherapy is the recommended first-line systemic treatment.
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  79. 79.
    Name the genomic prognostic tool that was explored in the APT trial update.
    Show answer and explanation
    Answer: A —
    HER2DX
    HER2DX is the genomic test evaluated in updates related to the APT (Adjuvant Paclitaxel and Trastuzumab) trial cohort for HER2-positive breast cancer.
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  80. 80.
    Which is the bispecific T-cell engager (BiTE) agent which has demonstrated promising survival outcomes in advanced small cell lung cancer?
    Show answer and explanation
    Answer: C —
    T arlatamab
    Tarlatamab is a DLL3-targeting bispecific T-cell engager showing efficacy in small cell lung cancer.
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  81. 81.
    56 Year old with metastatic adenocarcinoma of lung is on Trametinib. For which side effect, would you permanently discontinue the drug?
    Show answer and explanation
    Answer: D —
    Retinal vein occlusion
    Retinal vein occlusion (RVO) is a severe ocular toxicity requiring permanent discontinuation of MEK inhibitors like trametinib.
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  82. 82.
    Which is the first oral selective ER degrader which is approved for ER positive, HER2 negative advanced breast cancer patients with ESR1 mutations following at least one prior line of endocrine therapy?
    Show answer and explanation
    Answer: B —
    Elacestrant
    Elacestrant is the first oral selective estrogen receptor degrader (SERD) approved for ESR1-mutated ER+/HER2- advanced breast cancer.
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  83. 83.
    Most common subtype of basal cell carcinoma is:
    Show answer and explanation
    Answer: A —
    Nodular basal cell carcinoma
    Nodular basal cell carcinoma is the most frequent clinical and histological subtype of basal cell carcinoma.
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  84. 84.
    T ebentufusp-tebn is approved for the treatment of
    Show answer and explanation
    Answer: D —
    Metastatic uveal melanoma
    Tebentafusp is a gp100/CD3 bispecific protein approved for unresectable or metastatic uveal melanoma.
    Report a mistake
  85. 85.
    Adagrasib is approved for the systemic treatment of
    Show answer and explanation
    Answer: C —
    Non small cell lung cancer
    Adagrasib is a KRAS G12C inhibitor approved for KRAS G12C-mutated non-small cell lung cancer.
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  86. 86.
    Along with chemotherapy, which of these agents are approved for the primary treatment of endometrial cancer?
    Show answer and explanation
    Answer: D —
    All of the above
    Depending on specific molecular subgroups (dMMR/MSI-H for dostarlimab/pembrolizumab, HER2-positive for trastuzumab), these agents are used in primary treatment regimens for endometrial cancer.
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  87. 87.
    What is the dose of IV Methotrexate in standard EMACO regimen?
    Show answer and explanation
    Answer: A —
    300 mg/m2
    The EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, Vincristine) regimen uses methotrexate at 300 mg/m2300\text{ mg/m}^2 (infusion over 12 hours) on days 1 and 8.
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  88. 88.
    What is the gold standard for identifying POLE mutation?
    Show answer and explanation
    Answer: A —
    Sequencing
    DNA sequencing (such as next-generation sequencing) is required to accurately detect pathogenic exonuclease domain mutations in the POLE gene.
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  89. 89.
    What are the treatment groups compared in TIGER trial for relapsed testicular germ cell tumors?
    Show answer and explanation
    Answer: C —
    TIP vs TI-CE
    The TIGER trial compares conventional-dose paclitaxel plus ifosfamide and cisplatin (TIP) with high-dose chemotherapy (TI-CE: paclitaxel, ifosfamide, carboplatin, etoposide) in relapsed germ cell tumors.
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  90. 90.
    Pemigatinib, a selective fibroblast growth factor receptor inhibitor is approved for the treatment of which of these malignancies?
    Show answer and explanation
    Answer: D —
    Cholangiocarcinoma
    Pemigatinib is a selective FGFR1/2/3 inhibitor approved for previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with FGFR2 fusions or rearrangements.
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  91. 91.
    A 60 year old male is diagnosed with metastatic gastrointestinal stromal tumor with a platelet-derived growth factors receptor alpha (PDGFRA) exon 18 mutation - PDGFRA D842V. Which is your preferred systemic agent?
    Show answer and explanation
    Answer: B —
    Avapritinib
    Avapritinib is specifically indicated for GIST harboring the PDGFRA D842V mutation, which is resistant to standard TKI therapies like imatinib.
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  92. 92.
    Which among the following is a high risk factor when adjuvant treatment for stage II carcinoma colon is considered?
    Show answer and explanation
    Answer: D —
    All of the above
    High-risk clinicopathological features for stage II colon cancer include lymphovascular/perineural invasion, T4 stage, bowel obstruction, perforation, and high tumor budding.
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  93. 93.
    What is N2b in the TNM staging for rectal cancer as per AJCC 8th edition?
    Show answer and explanation
    Answer: C —
    Seven or more regional lymph nodes are positive
    In AJCC 8th edition for colorectal cancer, N2b is defined as 7 or more regional lymph nodes involved.
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  94. 94.
    Compadri regimen is used in the treatment of
    Show answer and explanation
    Answer: A —
    Osteosarcoma
    COMPADRI (cyclophosphamide, vincristine, melphalan, doxorubicin, etc.) is a historical combination chemotherapy regimen used in osteosarcoma.
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  95. 95.
    PAX3-FOXO1 molecular abnormality is mostly associated with
    Show answer and explanation
    Answer: B —
    Alveolar rhabdomyosarcoma
    Alveolar rhabdomyosarcoma is classically characterized by chromosomal translocations involving PAX3-FOXO1 or PAX7-FOXO1.
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  96. 96.
    Steinherz/Blayer algorithm is related to:
    Show answer and explanation
    Answer: A —
    Central Nervous System leukemic status in acute lymphoblastic leukemia
    The Steinherz-Blayer algorithm addresses risk stratification and management of CNS leukemia or traumatic lumbar punctures in ALL.
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  97. 97.
    'High risk sites' in Langerhans cell histiocytosis is all, except:
    Show answer and explanation
    Answer: B —
    Pituitary gland
    Risk organs (high-risk sites) in LCH include the hematopoietic system (bone marrow), liver, and spleen. The pituitary gland (causing diabetes insipidus) is a risk site for CNS/endocrine dysfunction but not a traditional multi-system risk organ defining mortality risk.
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  98. 98.
    As per Modified Change staging system for posterior fossa medulloblastoma metastasis, what is the notation for gross nodular seeding in spinal subarachnoid space?
    Show answer and explanation
    Answer: C —
    M3
    Chang staging M3 denotes gross nodular seeding in the spinal subarachnoid space.
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  99. 99.
    MaGIC risk stratification is related to :
    Show answer and explanation
    Answer: A —
    Pediatric germ cell tumors
    The Malignant Germ Cell International Consortium (MaGIC) risk stratification is used for pediatric extracranial germ cell tumors.
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  100. 100.
    What is the treatment of stage I Wilms' tumor, with focal anaplasia and no loss of heterozygosity 1p and 16q?
    Show answer and explanation
    Answer: D —
    AVD×25 weeks, 10.8 Gy RT to flank
    Stage I Wilms tumor with focal anaplasia is treated with three-drug chemotherapy (Vincristine, Dactinomycin, Doxorubicin - AVD) for 25 weeks and flank radiation therapy.
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