Respiratory: lung adenocarcinoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Respiratory: lung adenocarcinoma

Sample item

A 58-year-old Indian woman who has never smoked has metastatic peripheral lung adenocarcinoma on biopsy. Which molecular test should be requested on the tissue before choosing systemic therapy, and what would a positive result allow?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. EGFR mutation testing, allowing treatment with an EGFR tyrosine kinase inhibitor such as gefitinib

Lung adenocarcinoma in never-smokers, women and people of East and South Asian ancestry often carries activating EGFR mutations, usually exon 19 deletions or the L858R substitution. Such tumours respond better to EGFR tyrosine kinase inhibitors than to chemotherapy. ALK, ROS1 and other drivers are also tested on advanced disease.

Option by option

  • A. BRCA testing, allowing PARP inhibitor therapy as standard first-line care

    BRCA status guides PARP inhibitors in ovarian, breast, prostate and pancreatic cancers, not lung adenocarcinoma.

  • B. BCR-ABL testing, allowing imatinib therapy

    BCR-ABL is the fusion of chronic myeloid leukaemia, not lung adenocarcinoma.

  • C. EGFR mutation testing, allowing treatment with an EGFR tyrosine kinase inhibitor such as gefitinib (correct)

    Correct. EGFR mutation positivity is common in this setting and predicts response to EGFR inhibitors.

  • D. HER2 amplification testing, allowing trastuzumab therapy

    HER2 amplification guides trastuzumab in breast and gastric cancers, not standard care in lung adenocarcinoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, EGFR mutation testing, allowing treatment with an EGFR tyrosine kinase inhibitor such as gefitinib. Lung adenocarcinoma in never-smokers, women and people of East and South Asian ancestry often carries activating EGFR mutations, usually exon 19 deletions or the L858R substitution.

Why is "BRCA testing, allowing PARP inhibitor therapy as standard first-line…" not the answer?

BRCA status guides PARP inhibitors in ovarian, breast, prostate and pancreatic cancers, not lung adenocarcinoma.

Why is "BCR-ABL testing, allowing imatinib therapy" not the answer?

BCR-ABL is the fusion of chronic myeloid leukaemia, not lung adenocarcinoma.

Why is "HER2 amplification testing, allowing trastuzumab therapy" not the answer?

HER2 amplification guides trastuzumab in breast and gastric cancers, not standard care in lung adenocarcinoma.

What concept does this question test?

It tests Respiratory: lung adenocarcinoma in Pathology. Such tumours respond better to EGFR tyrosine kinase inhibitors than to chemotherapy. ALK, ROS1 and other drivers are also tested on advanced disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory: lung adenocarcinoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.