FINAL EXAM NATIONAL BOARD OF EXAMINATIONS
JUNE 2018

POSSESSION/USE OF CELL PHONES OR ANY SUCH ELECTRONIC GADGETS IS NOT PERMITTED INSIDE THE EXAMINATION HALL.
MEDICAL ONCOLOGY
PAPER-III
MEDONCO/J/18/17/III
Time: 3 hours
Max. Marks:100
IMPORTANT INSTRUCTIONS
Attempt all questions in order.
Each question carries 10 marks.
Read the question carefully and answer to the point neatly and legibly.
Do not leave any blank pages between two answers.
Indicate the question number correctly for the answer in the margin space
Answer all the parts of a single question together.
Start the answer to a question on a fresh page or leave adequate space between two answers.
Draw table/diagrams/flowcharts wherever appropriate.
Write short notes on:
1. Epidemiology of gastric cancer in India.
Risk factors for gastric cancer.
Impact of molecular biology in the treatment of gastric
cancer.

2. Define concept of metronomic therapy.
List various agents with dose/schedule which could be used
for this approach.
Plan metronomic therapy for a 50-year-old lady with epithelial
ovarian cancer stage IIIC who has received 4 lines of therapy
and now having progressive disease.

3. Enumerate the incidence risk factors for breast cancer
associated lymphedema.
Management of breast cancer associated lymphedema.
How will you palliate backache in a lady with breast cancer
having multiple vertebral metastases?

4. Enumerate the steps of drug development process.
What are the objectives of phase-1 Clinical trial?
Briefly give plan with essential components of a clinical trial
for study of palliative chemotherapy for advanced gall
bladder cancer with jaundice.

5. List the changes in the staging of head neck cancer in the
recent AJCC 8th edition.
What are the distinct clinical features of HPV associated
oropharyngeal cancers?
Role of immunotherapy in head neck cancer.

6. Plan investigations in a newly diagnosed case of smoldering
multiple myeloma in a 60-year-old male.
How do you stage myeloma?
Discuss choice of induction therapy in a newly diagnosed
transplant eligible multiple myeloma.


7. Critically discuss any two chemoprevention trials in breast
cancer.
List various paraneoplastic syndromes associated with breast
cancer.
Indications and side effects of PARP (Polyadenosine
diphosphate ribose polymerase) inhibitors.

8. Briefly mention the risk assessment of a patient with febrile
neutropenia. What are the indications of gram positive
antibiotics in the treatment of febrile neutropenia? Enumerate
the indications of primary secondary GCSF prophylaxis.

9. A 50-year-old lady with disseminated intra-abdominal
malignancy has cachexia and is in ECOG performance status 4.
What could be the etio-pathogenesis of cachexia in this
case?
Outline supportive care for this case.
Give indications, components complications of total
parenteral nutrition in this patient.

10. List investigations for a 50-year-old male suspected to have
chronic myeloproliferative disorder (CMPD).
What is the basis of various molecular tests done for these
disorders?
Outline management for primary myelofibrosis.