Sample question paper for neet pg, usmle, plab and fmge (mci screeing exam) on thymoma

Q:1 Which of the following condition is associated with thymoma?
A: Myasthenia gravis
B: Rheumatoid arthritis
C: Scleroderma
D: Renal failure
Correct Ans:A
Explanation
In patients with myasthenia gravis, thymus is abnormal in 75% cases, it is hyperplastic in 65%
and thymoma is present in 10% of cases.
Reference:
Harrison's Principles Of Internal Medicine 18th edition chapter
386.
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Q:2 Which is the most common cause of SVC syndrome?
A: Lung cancer
B: Trauma
C: Thymoma
D: Fibrosis of SVC
Correct Ans:A
Explanation
Lung cancer is the most common cause of SVC syndrome. Non
Hodgkins lymphoma is the second most common cause. Primary
mediastinal malignancies such as thymoma and germ cell tumors
account for less than 2% cases. Breast cancer is the most
common metastatic disease causing SVC syndrome.
Q:3 Which of the following is not associated with thymoma:
A: Red cell aplasia

B: Myasthenia gravis
C: Hypergammaglobulinemia
D: Compression of the superior mediastinum
Correct Ans:C
Explanation
Thymoma associated autoimmune diseases are:

?    Myasthenia gravis
?    Phemphigus
?    Systemic lupus erythematosus
?    Pure red cell aplasia
?    Hypogammaglobulinemia

Ref: Illustrated Dictionary of Immunology By M.P. Arora, Pages 257258 ; Cancer and
Autoimmunity By Yehuda Shoenfeld, M. Eric Gershwin, Page 249 ; Harrison’s Principle
of Internal Medicine, 16th Edition, Page 1946
Q:4
A 60 year old male presented to the emergency with breathlessness, facial
swelling and dilated veins on the chest wall. Which of the following is the most
common cause?
A: Thymoma
B: Lung cancer
C: Hodgkin's lymphoma
D: Superior vena caval obstruction
Correct Ans:D
Explanation

Patient in the question is showing signs and symptoms typical of superior vena caval
obstruction which result in severe reduction in venous return from the head, neck, and
upper extremities.
Most common causes includes lung cancer, lymphoma, and metastatic tumors. 85% of
cases occur due to small and squamous cell carcinoma of the lung. In young adults,
malignant lymphoma is a leading cause. Other causes include benign tumors, aortic
aneurysm, thyromegaly, thrombosis, and fibrosing mediastinitis from prior irradiation,
histoplasmosis, or Behçet's syndrome.
Ref: Harrsions Internal Medicine, 18th Edition, Chapter 276
Q:5 All of the following may be associated with Thymoma, except:
A: SIADH

B: Cushing's syndrome
C: Hypogammaglobulinemia
D: None of the above
Correct Ans:D
Explanation
Thymoma is rare tumor in children and account for less than 1% of all the anterior
mediastinal tumors. Thymomas are associated with a variety of paraneoplastic
conditions.
Ref: Harrison’s Principles of internal medicine 18th edition/chapter 340, table 340
2; Pediatric Thoracic SurgeryBy Dakshesh Parikh, page 581; Manual of Clinical
Oncology By Dennis Albert Casciato, page 409.
Q:6 To diagnose thymoma in a case of mediastinal mass is:
A: Thoracotomy and biopsy
B: FNAC
C: Chest CT scan
D: Somatostatin receptor imaging
Correct Ans:A
Explanation
Once a mediastinal mass is detected,
Next step:
1. Initial mediastinoscopy or limited thoracotomy to get sufficient tissue to make an
accurate diagnosis.
2. Fineneedle aspiration is poor at distinguishing between lymphomas and thymomas
3. Subsequent staging of thymoma can be done with chest CT scans
4. MRI has a defined role in the staging of posterior mediastinal tumors
5. Somatostatin receptor imaging with indiumlabeled somatostatin analogues also
used for staging

Ref: Harrison, E18, chapter e20.
Q:7 The staging system for thymoma was developed by:
A: Masaoka
B: Yokohama
C: Todani
D: Kluivert

Correct Ans:A
Explanation
The staging system for thymoma was developed by Masaoka
The stage is increased on the basis of the degree of invasiveness.

The 5year survival in stage I, 96%; stage II, 86%; stage III, 69%; stage IV, 50%.

The French Study Group on Thymic Tumors (GETT) has modified the Masaoka scheme
based on the degree of surgical removal.
Q:8 Important chemotherapy agent used for the thymoma treatment is:
A: Cisplatin
B: 5FU
C: Doxorubicin
D: Methotrexate
Correct Ans:A
Explanation
Treatment of thymoma
Encapsulated tumors and stage I disease, complete resection is curative.

Stage II disease, complete resection may be followed by 30–60 Gy of postoperative
radiation therapy Stage III and IV disease, the use of neoadjuvant chemotherapy
followed by radical surgery, with or without additional radiation therapy + additional
consolidation chemotherapy

Most effective chemotherapy regimens includes a platinum compound (either cisplatin
or carboplatin) and an anthracycline. Addition of cyclophosphamide, vincristine, and
prednisone improves response rates.
Ref: Harrison, E18, chapter e20
Q:9 All are true about the effect of thymectomy, EXCEPT:
A:
Thymectomy results in the resolution of pure red cell aplasia in ~30% of
patients
B: Hypogammaglobulinemia usually responds to thymectomy
C:
Patients with myasthenia gravis have a overt thymoma is present in 10–15%
of patients

D: The course of myasthenia gravis is not significantly different in patients with
or without thymoma
Correct Ans:B
Explanation
FACTS about thymectomy:
Patients with myasthenia gravis have a overt thymoma is present in 10–15% of
patients
The course of myasthenia gravis is not significantly different in patients with or
without thymoma.
Thymectomy produces at least some symptomatic improvement in 65% of
patients with myasthenia gravis.
Thymoma patients with myasthenia gravis had a better longterm survival from
thymoma resection
Thymectomy results in the resolution of pure red cell aplasia in 30% of patients.
Hypogammaglobulinemia rarely responds to thymectomy.
Q:10 Thymoma with hypogammaglobulinemia is also known as:
A: Goods syndrome
B: Capgras syndrome
C: Fregoli syndrome
D: Todd syndrome
Correct Ans:A
Explanation
Thymoma with hypogammaglobulinemia : Good's syndrome.
The Capgras syndrome is a disorder in which a person thinks that a friend, spouse,
parent, or other close family member has been replaced by an identical impostor.
Fregoli syndrome is the delusional belief that one or more familiar persons, usually
persecutors following the patient, repeatedly change their appearance.

AliceinWonderland syndrome also known as Todd's syndrome[1] or lilliputian
hallucinations, is a disorienting neurological condition that affects human perception.
Sufferers may experience micropsia, macropsia, or size distortion of other sensory
modalities.
Ref: Harrison, E18, Chapter e20.
Q:11 Thymoma may be associated with all the conditions, EXCEPT:

A: Polymyositis
B: Sjogrens syndrome
C: Ulcerative colitis
D: Crohns disease
Correct Ans:D
Explanation
Patients with myasthenia gravis10–15% have thymoma.
Thymoma may be associated with polymyositis, systemic lupus erythematosus,
thyroiditis, Sjögren's syndrome, ulcerative colitis, pernicious anemia, Addison's disease,
scleroderma, and panhypopituitarism.
Ref: Harrison, E18, Chapter e20
Q:12 The correct statement regarding thymectomy in myasthenia gravis patients is:
A: Should be done in all cases
B: Should be done in cases with ocular involvement only
C: Not required if controlled by medical management
D: Should be done only in cases that are associated with thymoma
Correct Ans:A
Explanation
Thymectomy should be carried out in every patient associated with generalized
myasthenia gravis between the age groups from puberty to ~55 yrs of age and should
be considered in every patient <60 yrs of age. Done even in those cases, controlled by
medical treatment.

Ref: Harrison’s Principle of Internal Medicine, 16th Edition, Page 2522

Q:13
During exploration, a patient is found to have a tumor in the thymus that is
invading the pericardium and surrounding the left and right phrenic nerves.
The pathologist says that appears on frozen section to be a benign thymoma.
The surgeon now should
A: Repeat frozen section
B: Attempt as complete a resection as possible
C: Close the chest and plan irradiation therapy

D: Close the chest and await permanent sections
Correct Ans:B
Explanation
Thymomas usually appear histologically benign even though they may be grossly
invasive, and operative decisions must be based upon this fact. The presence of a
thymoma is sufficient indication for exploration regardless of whether or not an
affected patient has an associated syndrome, and a median sternotomy is the
preferred approach because the extent of resection needed can be determined only
intraoperatively. The treatment of choice for the patient presented in the question is as
complete a resection as possible while at least one phrenic nerve is preserved.
Postoperatively, the patient should receive xray therapy, and the combination of
surgery plus irradiation offers a good chance of satisfactorily controlling the
neoplasm.
Q:14
A patient presents with mediastinal mass with sheets of epithelial cells giving
arborizing pattern in Asia of reactivity on keratin, alongwith interspersed lympoid
cells. The apt diagnosis would be:
A: Thymoma
B: Thymic carcinoid
C: Primary mediastinal lymphoma
D: NonHodgkin lymphoma
Correct Ans:A
Explanation
Thymoma [Ref Internet reference]
Tumours made up of to two different lineage of cells i.e. lymphocytes and
epithelial cells suggests the diagnosis of thymoma (Keratin positively indicates the
presence of epithelial cells)
Thymomas are benign tumours of mediastirum.
They are composed of two types of cells i.e. epithelial cells and variable infiltrate
of lymphocytes. The thymomas
Type A
Thymoma composed of bland spindle to oval cells with few to no lymphocyte
Type AB
Thymoma with a mixture of lymphocyte poor and lymphocyte rich areas Type
B1
Thymoma exihibiting areas of both normal thymic cortex and medulla. Type B2
Thymoma with prominent large epithelial cells within admixture of numerous

lymphocytes. Type B3
Thymoma composed of sheets of epithelial cells with little atypia and scant
lymphocytes. Thymic carcinoid
In these cases the tumour is composed of neuroendocrine cells.
On histochemistry neuroendocrine cells will be positive for chromogranin,
synaptophysin.
Q:15 Amyloidosis is found in the following except ?
A: Multiple myeloma
B: Hypernephroma
C: Thymoma
D: Lymphoma
Correct Ans:C
Explanation
Ans. is 'c' i.e., Thymoma
Primary amyloid (AL) may occur in multiple myeloma (see above explanation).
Secondory amyloidosis
o It occurs secondary to an associated inflammatory conditions like
1. Rheumatoid arthritis (most common)
2. Ankylosing spondylitis
3. IBD (crohn disease, ulcerative colitis) o It may also occur in some tumors ?
4. TB & Leprosy
5. Chronic osteomyelitis
6. Bronchiectasis
1. Renal cell carcinoma (Hypernephroma)
2. Hodgkin lymphoma
Q:16 All of the following malignancies are seen in anterior mediastinum except
A: Teratoma
B: Thymoma
C: Lymphoma
D: Neuroenteric cyst

Correct Ans:D
Explanation
Ans. is 'd' i.e., Neuroenteric cyst

Sample question paper for neet pg, usmle, plab and fmge (mci screeing exam) on thymoma

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Sample question paper for neet pg, usmle, plab and fmge (mci screeing exam) on thymoma