Neoplasia: initiation and promotion: 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 · Neoplasia: initiation and promotion

Sample item

In a skin carcinogenesis experiment, a single low dose of a mutagen is applied, followed by repeated application of a phorbol ester that is not itself mutagenic. Tumours appear only when both are given in that order. What is the role of the phorbol ester?

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

The answer and the reasoning

C. Promoter that drives proliferation of initiated cells

Initiation produces a permanent DNA change; promotion is non-mutagenic, reversible early, and works by stimulating proliferation of initiated cells (for example through protein kinase C), allowing further mutations. Promoters alone, or given before the initiator, do not cause tumours.

Option by option

  • A. Inhibitor of DNA repair enzymes

    Phorbol esters act on growth signalling and not on DNA repair.

  • B. Procarcinogen that needs liver activation

    Procarcinogens are metabolised to ultimate carcinogens, which is unrelated to this ester's action.

  • C. Promoter that drives proliferation of initiated cells (correct)

    Correct. A promoter expands the initiated clone without causing the first mutation.

  • D. Initiator that causes the first mutation

    The initiator is the mutagen given first, not the phorbol ester.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Promoter that drives proliferation of initiated cells. Initiation produces a permanent DNA change; promotion is non-mutagenic, reversible early, and works by stimulating proliferation of initiated cells (for example through protein kinase C), allowing further mutations.

Why is "Inhibitor of DNA repair enzymes" not the answer?

Phorbol esters act on growth signalling and not on DNA repair.

Why is "Procarcinogen that needs liver activation" not the answer?

Procarcinogens are metabolised to ultimate carcinogens, which is unrelated to this ester's action.

Why is "Initiator that causes the first mutation" not the answer?

The initiator is the mutagen given first, not the phorbol ester.

What concept does this question test?

It tests Neoplasia: initiation and promotion in Pathology. Promoters alone, or given before the initiator, do not cause tumours.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Neoplasia: initiation and promotion?

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.