Question 1 : What percentage of lung cancers occur in lifetime of never smokers :
a) 10
b) 20
c) 30
d) 40
Answer : 20%
Question 2 : What percentage of adenocarcinoma of lung patients have a driver gene mutation :
a) 76 – 85
b) 100
c) 40 – 55
d) < 25
Answer : 76 – 85%
Question 3 : What is the lifetime risk of development of lung cancer in lifelong smokers in their eighth decade of life :
a) 36%
b) 16%
c) 26%
d) 6%
Answer : 16%
Question 4 : Which of the following is not true about lung cancer :
a) N-nitrosamines and polycyclic aromatic hydrocarbons (PAHs) are primarily responsible for lung cancer development
b) Lung cancer have some familial preponderance studies showing odds ration ranging from 1.63 to 3.6
c) 25% of worldwide lung cancer cases are least in part related to occupational exposures
d) COPD and pulmonary fibrosis are risk factors for lung cancer, independent of smoking
Answer : 25% of worldwide lung cancer cases are at least in part related to occupational exposures.
Question 5 : Which of the following is the most common cause of occupational lung cancer :
a) Asbestosis
b) Silicosis
c) Radon gas
d) Beryllium exposure
Answer : asbestosis
Question 6 : Which of the following is not true regarding smoking cessation interventions :
a) NRT coupled with pharmacotherapy increases the chances of abstinence two – to threefold
b) Currently approved smoking cessation interventions result in abstinence rates of approximately 25%
c) Varenicline has the black box warning regarding the increased risk of moderate to severe risk of psychiatric disorders
d) There are seven forms of nicotine replacement therapies approved as of 2019
Answer : Varenicline has the black box warning regarding the increased risk of moderate to severe risk of psychiatric disorders
Question 7 : Which of the following are more commonly seen with smell cell lung cancer :
a) LEMS
b) SIADH
c) Cushing syndrome
d) All of the above
Answer : all of the above
Question 8 : What is the cutoff dimension for a solitary pulmonary nodule (SPN) :
a) < 3 mm
b) < 3 cm
c) < 5 mm
d) < 5 cm
Answer : < 3 cm
Question 9 : PET scanning has a high false negative rate with :
a) Ground glass opacities
b) Carcinoid tumors
c) Small lesions
d) All of the above
Answer : all of the above
Question 10 : When is PET scanning most helpful in the diagnosis algorithm of lung cancer :
a) when the probability of cancer is intermediate (i.e., about 5% to 65%)
b) when the probability of cancer is intermediate (i.e., about 25% to 65%)
c) when the probability of cancer is intermediate (i.e., about 25% to 35%)
d) when the probability of cancer is intermediate (i.e., about 5% to 25%)
Answer : when the probability of cancer is intermediate (i.e., about 5% to 65%)
Question 11 : Which of the following is true regarding various stages of lung cancer and the possibility of having distant metastases and occult disease :
a) For clinical stage I by CT the incidence of distant meta is 5%
b) For clinical stage II the incidence of distant mets is 15-20%
c) For clinical stage III the incidence of occult disease is 25-30%
d) all of the above
Answer : all of the above
Question 12 : Radiation pneumonitis a dose limiting toxicity of radiation therapy while treating lung cancer. Although it can present even while the treatment is completed, what is the time of peak incidence of radiation pneumonitis :
a) 2 weeks
b) 2 months
c) 4 weeks
d) 4 months
Answer : 2 months
Question 13 : Which is the drug choice for radiation pneumonitis :
a) Glucocorticoids
b) Amifostine
c) Pentoxifylline
d) Captopril
Answer : glucocorticoids
Question 14 : Which of the following is the standard of care for healthy patients with a clinical stage I NSCLC :
a) Surgical resection
b) SBRT
c) Chemoradiation
d) Immunotherapy
Answer : surgical resection
Question 15 : Lobar resections are the treatment of choice for stage I NSCLC, but in some instances a resection less than lobar is undertaken. Which of the following is not an indication for doing a sublobar resection :
a) Elderly patients
b) Tumors < 2 cm
c) Pure GGO lesions
d) Solitary pulmonary nodule
Answer : Solitary pulmonary nodule
Question 16 : Following complete resection of stage I NSCLC, which of the following adjuvant treatment is indicated :
a) Chemotherapy
b) Radiotherapy
c) Chemoradiation
d) None of the above
Answer : none of the above
Question 17 : Surgery is the treatment of choice for stage II NSCLC. As an adjuvant therapy which of the following is recommended in a completely resected stage II NSCLC :
a) Chemotherapy
b) Radiotherapy
c) Chemoradiation
d) None of the above
Answer : chemotherapy
Question 18 : For patients of T3 N0, 1 M0 NSCLC involving the chest wall, which of the following is the preferred primary therapeutic modality :
a) Surgery
b) Radiation alone
c) Chemoradiation
d) None of the above
Answer : surgery
Question 19 : What is the treatment of choice for Pancoast tumors :
a) Induction chemotherapy followed by surgery
b) Surgery followed by adjuvant chemoradiation
c) Chemoradiation followed by surgery
d) Radiation followed by sequential chemotherapy
Answer : Chemoradiation followed by surgery
Question 20 : If a patient is suspected of having N0/N1 disease but intraoperatively is found to be having N2 disease, the so called incidental N2 disease; then which of the following will be the best course of treatment :
a) Abandon the procedure and threat with chemoradiation
b) Complete the procedure and treat with adjuvant chemotherapy
c) Using interoperative radiotherapy (IORT) and completing the resection
d) Doing a thorough mediastinal node clearance and treating with adjuvant chemoradiation
Answer : Abandon the procedure and threat with chemoradiation
Question 21 : For a patient of NSCLC having N2 (stage III) disease, which of the following is an accepted management option :
a) Concurrent chemoradiation followed by adjuvant chemotherapy
b) Concurrent chemoradiation followed by immune checkpoint inhibitor therapy
c) Both of the above
d) Neither I nor 2
Answer : Both of the above
Question 22 : Which of the following is not true regarding the immune checkpoint inhibitor durvalumab :
a) It leads to improvement in PFS when used in adjuvant setting after concurrent chemoradiation in stage III NSCLC patients.
b) It leads to significant increase in toxicity as compared with placebo
c) The improvement in survival endpoints is seen regardless of PD-L 1 status
d) In patients with EGFR mutation is likely to be ineffective
Answer : It leads to significant increase in toxicity as compared with placebo
Question 23 : Cytotoxic chemotherapy will not be recommended in which of the following performance status of a patient with NSCLC :
a) PS1
b) PS2
c) PS3
d) It is recommended in all of the above
Answer : PS3
Question 24 : If a patient of advanced NSCLC, no targetable driver mutation is found and PD-L1 expression is ≥ 50%, which of the following will be the best treatment approach :
a) Pembrolizumab
b) Pembrolizumab plus single agent platinum
c) Pembrolizumab plus platinum based doublet chemotherapy
d) Platinum based doublet chemotherapy
Answer : Pembrolizumab
Question 25 : Molecular testing on tumor specimens should be performed on which of the following advanced squamous lung cancer subsets :
a) Never-smokers
b) Small biopsies
c) Mixed histology
d) All of the above
Answer : all of the above
Question 26 : Which of the following mutation is not routinely tested in lung cancer patients :
a) EGFR
b) BRAF
c) MET
d) ROS 1
Answer : note that all of the above are to be tested
Question 27 : Based on the results of IMPRESS trail in NSCLC, which of the following is true :
a) NSCLC with EGFR MUTATION were studied and after progression on gefitinib the trail arm that used gefitinib and chemotherapy combination showed similar PFS as the arm that used chemotherapy alone
b) NSCLC with EGFR MUTATION were studied and after progression on gefitinib the trail arm that used gefitinib and chemotherapy combination showed similar OS as the arm that used chemotherapy alone
c) NSCLC with EGFR MUTATION were studied and after progression on gefitinib the trail arm that used gefitinib and chemotherapy combination showed lesser PFS as the arm that used chemotherapy alone
d) NSCLC with EGFR MUTATION were studied and after progression on gefitinib the trail arm that used gefitinib and chemotherapy combination showed superior PFS but same OS as the arm that used chemotherapy alone
Answer : NSCLC with EGFR MUTATION were studied and after progression on gefitinib the trail arm that used gefitinib and chemotherapy combination showed similar PFS as the arm that used chemotherapy alone
Question 28 : Which of the following is true regarding EGFR mutations :
a) found in 20% of NSCLC patients in the western world
b) found in 50% of patients of NSCLC in East Asia
c) Anti-PD-1 / PD-L1 therapies are not used in these patients
d) all of the above
Answer : all of the above
Question 29 : Which of the following is not a second generation EGFR TKI used in NSCLC
a) Afatinib
b) Erlotinib
c) Dacomintinib
d) All are second generation
Answer : erlotinib
Question 30 : Which of the following is the most common cause of acquired resistance to EGFR TKI therapy :
a) Mutation is exon 20 (T790M)
b) Mutation is exon 21 (T790M)
c) MET exon 14 skipping mutation
d) Gain of function mutation in TP533
Answer : Mutation is exon 20 (T790M)
Question 31 : The FLAURA study compared first-line osimertinib versus geftitinib or erlotinib and demonstrated :
a) Improved response rates with osimertinib
b) Statistically nonsignificant improvement in PFS with osimertinib
c) Overall survival was the same
d) Osimertinib was associated with lower risk of adverse events
Answer : Osimertinib was associated with lower risk of adverse events
Question 32 : Crizotinib has activity against which of the following mutations :
a) ALK
b) ROS1
c) MET
d) all of the above
Answer : all of the above
Question 33 : Which of the following is the treatment of choice in V 600E BRAF-mutant NSCLC :
a) Dabrafenib
b) Dabrafenib plus vemurafenib
c) Dabrafenib plus trametinib
d) Dabrafenib plus ipilimumab
Answer : Dabrafenib plus trametinib
Question 34 : Larotrectinib is a :
a) NTRK inhibitor
b) RET inhibitor
c) cMYC inhibitor
d) Bcl-2 inhibitor
Answer : NTRK inhibitor
Question 35 : In squamous cell lung cancer, which of the following drug is not effective :
a) Irinotecan
b) Pemetrexed
c) Carboplatin
d) Etoposide
Answer : Pemetrexed
Question 36 : Bevacizumab should not be used in which of the following patients of lung cancer :
a) In patients having hemoptysis
b) Untreated brain metastasis
c) Squamous cell histology
d) All of the above
Answer : all of the above
Question 37 : Ramucirumab is approved by the FDA in combination with docetaxel in patients with progression after platinum-based chemotherapy in NSCLC. Which of the following is not true regarding ramucirumab in NSCLC :
a) Its a murine IgG1 monoclonal antibody, specific to the VEGFR2
b) In the trial leading to its approval, ramucirumab in combination with docetaxel demonstrated superior ORR, PFS, and OS versus docetaxel monotherapy
c) Both of the above
Answer : Its a murine IgG1 monoclonal antibody, specific to the VEGFR2
Question 38 : Which of the following statements about isolated brain metastasis in NSCLC is not true :
a) Stereotactic radiosurgery (SRS) or surgical resection both are equally effective
b) Surgery is usually reserved for smaller isolated brain mets which don’t have much perilesional edema
c) Curative resection or definitive tradition of primary lung cancer in patients who have isolated brain metastasis is to be undertaken as in patients who don’t have brain metastasis
d) In case of surgery of primary lung lesion is done by VATS then SRS / surgery of brain lesion is done and then adjuvant chemotherapy is started
Answer : Surgery is usually reserved for smaller isolated brain mets which don’t have much perilesional edema
Question 39 : What is the incidence of second primary lung cancers after the primary tumor has been successfully cured :
a) 1%
b) 2%
c) 5%
d) 10%
Answer : 5%
Question 40 : Which of the following is not true about the rare types of NSCLC :
a) In multifocal Ground Glass/ Lepidic Adenocarcinoma nodal involvement or distant metastases are very rare
b) In multifocal Ground Glass/ Lepidic Adenocarcinoma patients have an excellent overall survival
c) In Pneumonic Type of Adenocarcinoma nodal or distant metastasis are common
d) In Pneumonic Type of Adenocarcinoma 5-year survival rates are 30%
Answer : In Pneumonic Type of Adenocarcinoma nodal or distant metastasis are common
Question 41 : Which of the following is true about bone metastasis in lung cancer :
a) In bony mets not causing structural weakness or pathologic fractures radiation therapy and bisphosphonates are preferred
b) Surgical stabilization is a must in the management of bony mets causing pathologic fractures or destruction of more than half of the cortex of weight bearing bones
c) Surgery is preferred modality for treatment of spinal cord compression
d) All of the above
Answer : all of the above
Question 42 : Lung cancer is the cause of half of all brain metastasis. Which of the following is true :
a) For patients with a single brain metastasis, surgery or radiosurgery , either with or without WBRT
b) Patients with one to three brain metastases may be treated with radio surgery alone, WBRT, or both
c) Patients with more than five brain metastases, good PS, and limited extracranial disease, the role of WBRT versus SRS is ill-defined
d) All of the above
Answer : all of the above
Question 43 : Neuroendocrine tumors (NETs) constitute what percentage of lung cancers :
a) 10
b) 20
c) 30
d) 40
Answer : 20%
Question 44 : Tobacco is responsible for what percentage of small cell lung cancers :
a) 77
b) 87
c) 97
d) 57
Answer : 97%
Question 45 : In what percentage of resected lung cancer specimens “combined” SCLC may be found :
a) 28
b) 5
c) 18
d) < 2
Answer : 28%
Question 46 : Chromogranin, synaptophysin, and CD56 are IHC markers of small cell lung cancer. What percentage of SCLC are negative for these markers :
a) 10
b) 20
c) 15
d) < 5
Answer : 10%
Question 47 : What is the recommended time interval for screening of small cell ca lung by low dose CT scan (LDCT) :
a) Every yearly
b) Every 6 months
c) Every 3 months
d) None of the above
Answer : none of the above
Question 48 : Which of the following paraneoplastic syndromes are found in small cell carcinoma lung :
a) SIADH
b) Hypercalcemia
c) Lambert-Eaton syndrome
d) Encephalomyelitis
Answer : all of the above
Question 49 : According to the Veterans Administration Lung Study Group (VALSG), limited stage (LS) small cell lung cancer is defined as :
a) Disease confined to one hemithorax that can be encompassed in a tolerable radiation field
b) Disease that can be treated with four cycles of radiation concurrent with chemo and not involving opposite side mediastinal nodes
c) Disease involving less than 90% of one lung and at most contralateral scalene nymph nodes
d) none of the above
Answer : Disease confined to one hemithorax that can be encompassed in a tolerable radiation field
Question 50 : Which of the following radiologic studies are essential for small cell lung cancer workup :
a) Contrast-enhanced CT scan of the chest and abdomen
b) Brain MRI or contrast-enhanced head CT
c) PET scan
d) all of the above
Answer : All of the above