Oncology Principles and Transplantation MCQs

Surgery · 77 free questions with answers & explanations.

1. A 45-year-old patient with end-stage renal failure undergoes a living-related renal transplant. Which immunosuppressive drug acts by inhibiting the calcineurin pathway to prevent T-cell activation?
2. In solid organ transplantation, calcineurin inhibitors (tacrolimus, cyclosporine) prevent acute rejection by which primary mechanism?
3. After kidney transplantation, a patient on triple immunosuppression (tacrolimus, mycophenolate mofetil, prednisolone) develops a cervical lymphadenopathy at 14 months. Biopsy shows an EBV-associated B-cell lymphoproliferative disorder. This condition is classified as:
4. A 35-year-old man with end-stage renal disease secondary to IgA nephropathy receives a living-related kidney transplant from his HLA-matched sibling. On postoperative day 5, he develops fever, oliguria, and graft tenderness. Renal biopsy shows diffuse interstitial lymphocytic infiltration with tubulitis (Banff Grade IA acute cellular rejection). The most appropriate first-line treatment is:
5. Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) specify which tumour parameters?
6. The R1 margin in surgical oncology is defined as microscopically involved margin. In pancreatic ductal adenocarcinoma after Whipple resection, the UK Royal College of Pathologists (RCPath) definition of R1 margin differs from the standard definition in which way?
7. In liver transplantation, what is the Calcineurin Inhibitor (CNI)-related nephrotoxicity mechanism, and which immunosuppressive agent is preferred to minimize renal damage in CNI-intolerant recipients?
8. In renal transplantation, the phenomenon of delayed graft function (DGF) requiring dialysis in the first week is primarily caused by which pathophysiological mechanism related to donor graft retrieval?
9. In the sentinel lymph node biopsy (SLNB) procedure for malignant melanoma, which combination of mapping agents provides the highest detection rate of the sentinel node?
10. In organ transplantation, hyperacute rejection occurs within minutes to hours of transplantation. The mechanism responsible is:
11. The Milan criteria are used to select hepatocellular carcinoma patients for liver transplantation. A patient meets Milan criteria if they have:
12. The Milan Criteria for liver transplantation in hepatocellular carcinoma (HCC) define the eligibility boundaries. Which of the following patients meets expanded University of California San Francisco (UCSF) criteria but NOT Milan criteria, and is thus an appropriate candidate for expansion protocols?
13. A patient with end-stage renal disease receives a deceased donor kidney transplant. On day 3, the transplanted kidney shows decreased urine output, rising creatinine, and on biopsy: tubulitis (> 10 T-lymphocytes/tubular cross-section) with intimal arteritis. C4d staining is negative. According to Banff 2019 classification, what is this rejection type and its treatment?
14. A 50-year-old patient with end-stage liver disease from NASH cirrhosis (MELD score 22) is being evaluated for liver transplantation. He is found to have 3 hepatocellular carcinoma (HCC) nodules: 2 cm, 2.5 cm, and 3.8 cm on CT. According to the Milan criteria for liver transplantation, he is:
15. A 35-year-old kidney transplant recipient on tacrolimus, mycophenolate, and prednisolone presents 5 months post-transplant with rising creatinine (180 to 310 μmol/L over 4 weeks). Kidney biopsy shows interstitial fibrosis and tubular atrophy with intimal arteritis. This is classified as:
16. A 55-year-old man with end-stage liver disease from hepatitis C cirrhosis (MELD score 18, Child-Pugh B) and a single 4.8 cm hepatocellular carcinoma on a background cirrhosis is being assessed for liver transplantation. According to the Milan criteria, this patient is:
17. A 40-year-old woman undergoes renal transplantation from a cadaveric donor. She develops acute cellular rejection on day 12 confirmed by Banff Grade IIA rejection on renal biopsy. The Banff classification 2022 Grade IIA indicates:
18. In the sentinel lymph node biopsy (SLNB) technique, which two tracers are injected to identify the sentinel node?
19. In solid organ transplantation, hyperacute rejection occurs within minutes to hours of reperfusion. The immunological mechanism is mediated by:
20. A 35-year-old recipient receives a deceased-donor renal transplant. Six months post-transplant, he develops a serum creatinine rise from 110 to 185 µmol/L over 2 weeks. Donor-specific antibodies (DSA) are detected and renal biopsy shows C4d-positive peritubular capillary staining with acute glomerulitis and peritubular capillaritis. What Banff classification category best describes this finding?
21. The Milan criteria for liver transplantation in hepatocellular carcinoma define acceptable tumor burden. Following the UCSF extension criteria, which patients with HCC are eligible for transplantation beyond Milan criteria?
22. A 50-year-old patient with end-stage liver disease (MELD score 28) secondary to hepatitis C cirrhosis is listed for liver transplantation. He has a 2 cm HCC on background cirrhosis. Regarding Milan criteria, which statement is correct?
23. A kidney transplant recipient on tacrolimus, mycophenolate mofetil, and prednisolone develops gradually rising creatinine 8 months post-transplant. Renal biopsy shows 'chronic allograft nephropathy' with interstitial fibrosis/tubular atrophy (IF/TA) and intimal fibrosis of vessels. What is the most likely immunological mechanism?
24. A 50-year-old patient on immunosuppression post-renal transplant is found to have a cutaneous squamous cell carcinoma (SCC). This is being attributed to post-transplant immunosuppression. Which immunosuppressant, when substituted for calcineurin inhibitors, has been shown to reduce de novo malignancy risk after organ transplantation?
25. The Milan criteria are used to select patients with hepatocellular carcinoma for liver transplantation. A patient has a single HCC nodule of 6.5 cm and no vascular invasion on imaging. He has liver cirrhosis (Child-Pugh B). Which statement is accurate regarding transplant eligibility and the UCSF criteria?
26. In solid organ transplantation, calcineurin inhibitors (tacrolimus, cyclosporine) act on which intracellular target to prevent T-cell activation?
27. Post-transplant lymphoproliferative disorder (PTLD) is most commonly associated with which viral infection and predominantly involves which cell type?
28. In liver transplantation for hepatocellular carcinoma, the Milan criteria define acceptable limits for transplant candidacy. Which correctly states the Milan criteria?
29. In solid organ transplantation, tacrolimus (FK506) exerts its immunosuppressive effect through which specific mechanism?
30. The Milan criteria define the selection of hepatocellular carcinoma (HCC) patients for liver transplantation. Which HCC burden exceeds the Milan criteria and therefore precludes standard transplant listing?
31. A renal transplant recipient on tacrolimus, mycophenolate mofetil, and prednisolone develops a rapidly enlarging cervical lymph node 18 months post-transplant. Biopsy confirms an EBV-associated post-transplant lymphoproliferative disorder (PTLD) — monomorphic B-cell type. First-line treatment is:
32. A patient with hepatocellular carcinoma (HCC) is evaluated for liver transplantation. He has two lesions: 4.5 cm and 2.8 cm, with AFP 450 ng/mL, no vascular invasion, and no extrahepatic disease. According to the Milan criteria, is he eligible for transplantation?
33. In solid organ transplantation, hyperacute rejection occurs within minutes to hours of reperfusion. What is the immunological mechanism?
34. Sentinel lymph node biopsy (SLNB) is now used in multiple cancers. For cutaneous melanoma, what is the Breslow thickness threshold above which SLNB is routinely recommended according to current guidelines?
35. The Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) define patients suitable for transplant as those with:
36. In renal transplantation, hyperacute rejection occurs within minutes to hours of reperfusion and is mediated by:
37. A patient with end-stage liver disease due to hepatocellular carcinoma (HCC) is evaluated for liver transplantation. His single HCC tumor measures 4.5 cm with no vascular invasion, no satellite nodules, and AFP is 200 ng/mL. Does he meet the Milan criteria for transplantation?
38. A renal transplant recipient on tacrolimus, mycophenolate, and prednisolone develops acute T-cell mediated rejection at 3 weeks post-transplant. What is the first-line treatment?
39. A patient receives a cadaveric kidney transplant. Six months later, he develops a renal mass in the native kidney. Which of the following immunosuppressants has evidence for ANTI-tumour properties and should be preferentially used in post-transplant malignancy settings?
40. A 45-year-old woman with colorectal cancer metastatic to the liver is evaluated for hepatic resection. Which of the following is the MOST important contraindication to resection?
41. In liver transplantation for hepatocellular carcinoma, the Milan criteria define candidates with acceptable post-transplant recurrence rates. Milan criteria include:
42. According to Clavien-Dindo classification, a postoperative complication requiring re-operation under general anaesthesia is classified as:
43. Calcineurin inhibitors (ciclosporin, tacrolimus) prevent transplant rejection primarily by inhibiting which pathway?
44. A 48-year-old man with end-stage liver disease due to hepatocellular carcinoma (HCC) is being evaluated for liver transplantation. His HCC has 2 lesions: one 3.5 cm and one 2 cm, with no macrovascular invasion or extrahepatic disease. What transplant criteria does he meet?
45. A renal transplant recipient develops de novo donor-specific antibodies (DSA) against HLA-DQ 3 months post-transplant with stable creatinine. Biopsy shows peritubular capillary C4d deposition and microvascular inflammation. This is classified as:
46. The R classification of surgical oncology resection margins is used to assess completeness of tumour excision. R1 resection denotes:
47. Calcineurin inhibitors (tacrolimus and cyclosporine) used in solid organ transplant immunosuppression inhibit which specific molecular pathway?
48. In solid organ transplantation, hyperacute rejection occurs within minutes to hours of reperfusion. The immunological mechanism responsible is:
49. The R classification of surgical resection margins in oncological surgery is critical for prognosis. An R1 resection is defined as:
50. The Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) define the boundaries for acceptable HCC burden. A patient with cirrhosis has a single HCC nodule of 4.8 cm with no vascular invasion and no extrahepatic disease. Does this patient meet the Milan criteria?
51. Sentinel lymph node biopsy (SLNB) uses blue dye and/or radioisotope (99mTc-sulfur colloid). The 'hot and blue' node concept identifies the sentinel node. What is the false-negative rate of SLNB in melanoma according to the MSLT-I trial?
52. Calcineurin inhibitors (cyclosporine and tacrolimus) are used for immunosuppression after solid organ transplantation. What is the mechanism of action of cyclosporine?
53. The Clavien-Dindo classification grades surgical complications. A patient develops a post-operative anastomotic leak requiring re-laparotomy under general anaesthesia. What Clavien-Dindo grade is this?
54. In liver transplantation, the Milan criteria are used to select patients with hepatocellular carcinoma (HCC). What are the Milan criteria?
55. Sentinel lymph node biopsy (SLNB) uses a dual technique in most centres. Which combination of agents provides the highest sentinel node identification rate?
56. A 48-year-old patient with hepatocellular carcinoma (HCC) is being assessed for liver transplantation. CT shows a single 5.5 cm HCC with no vascular invasion and no extrahepatic spread. Is this patient within Milan criteria for transplant?
57. A 35-year-old renal transplant recipient on tacrolimus + mycophenolate + prednisolone develops a squamous cell carcinoma of the lip 8 years post-transplant. The most appropriate immunosuppression modification is:
58. In renal transplantation, hyperacute rejection occurs within minutes to hours of graft reperfusion. The underlying mechanism is:
59. The R0, R1, and R2 classification of surgical resection margins is universally applied in oncological surgery. An R1 resection is defined as:
60. A 55-year-old man with Child-Pugh A cirrhosis and hepatocellular carcinoma is being assessed for liver transplantation. His imaging shows a single HCC nodule of 4.5 cm diameter with no vascular invasion and AFP 180 ng/mL. According to the Milan Criteria, is he eligible for liver transplantation?
61. The R classification of surgical resection margins is used in oncological surgery. A patient undergoes pancreatic cancer resection and the histopathology shows tumour cells within 1 mm of the posterior retroperitoneal margin (closest margin). What R-classification should be assigned according to the Leeds Pathology Protocol?
62. A 45-year-old renal transplant recipient on tacrolimus, mycophenolate mofetil, and prednisolone develops an enlarging perianal lesion. Biopsy shows squamous cell carcinoma. Which causative agent is most strongly associated with this complication of immunosuppression?
63. In renal transplantation, the Milan criteria govern listing for liver transplantation in hepatocellular carcinoma. A patient with 3 HCC nodules (1.5 cm, 2 cm, 2.5 cm) and no vascular invasion or extrahepatic spread falls within which category?
64. Hyperacute rejection in renal transplantation occurs within minutes to hours of reperfusion and is mediated by:
65. The R classification of surgical margins uses R0, R1, and R2. In the context of pancreatic cancer resection, the ISGPS (International Study Group of Pancreatic Surgery) definition of R1 margin is:
66. The Milan criteria define patient selection for liver transplantation in hepatocellular carcinoma. A patient with three HCC nodules measuring 2.5 cm, 2.0 cm, and 3.5 cm, with no vascular invasion, meets which criteria status?
67. In the WHO classification of tumor grade, low-grade gliomas (WHO Grade II) have which proliferative marker value on Ki-67 (MIB-1) immunostaining that distinguishes them from Grade III (anaplastic)?
68. In solid organ transplantation, the principal mechanism of hyperacute rejection occurring within minutes to hours of reperfusion is:
69. The Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) specify which tumour parameters as acceptable for listing?
70. In solid organ transplantation, antibody-mediated rejection (AMR) is mediated by donor-specific antibodies (DSA) targeting which antigens on the endothelium?
71. The R classification (residual tumour) after surgical resection has prognostic significance. Which of the following correctly defines R1 resection?
72. A patient undergoes deceased donor renal transplantation. Which of the following BEST describes the 'six-antigen match' in HLA compatibility testing?
73. A 48-year-old patient is on the kidney transplant waiting list. They are found to be highly sensitized with a Panel Reactive Antibody (PRA) of 95%. The most important cross-match test performed before transplantation is:
74. A 55-year-old woman undergoes prophylactic bilateral salpingo-oophorectomy after testing BRCA2 positive. The ovaries and tubes are sent for histopathological examination. The pathologist performs the SEE-FIM (Sectioning and Extensively Examining the Fimbria) protocol. This protocol targets which occult malignancy?
75. A 50-year-old patient undergoes curative resection of a colorectal carcinoma. The surgeon notes a resection margin of 0.5 mm from the tumour (positive CRM by the ≤1 mm definition). Histopathology confirms pT3 N2 M0, R1 resection. The implication and recommended management are:
76. A 55-year-old man undergoes laparoscopic Nissen fundoplication for GERD. Two years later, he presents with recurrence of heartburn and dysphagia. Endoscopy shows the wrap has herniated into the chest. This post-fundoplication complication is best described as:
77. A surgeon is performing a right-sided laparoscopic hemicolectomy and accidentally clips and divides a tubular structure thought to be the ureter. Intraoperatively, urine is seen. The correct immediate step and subsequent repair are: