Block 10 Antineoplastic MCQ's Prt1

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Questions and Answers
  • 1. 

    A 12-year-old girl suffering fro acute lymphoblastic leukemia received an anticancer therapy, which included high dose methotrexate. Leucovorin was also given along with methotrexate. Which of the following concepts specifically underlies this therapeutic strategy?

    • A.

      Log kill

    • B.

      Recruitment

    • C.

      Pulsing

    • D.

      Combined modality strategy

    • E.

      Rescue therapy

    Correct Answer
    E. Rescue therapy
    Explanation
    Rescue therapy is the concept that underlies the therapeutic strategy of giving leucovorin along with high dose methotrexate in the treatment of acute lymphoblastic leukemia. Methotrexate is a chemotherapy drug that works by inhibiting the growth of cancer cells, but it can also affect normal cells. Leucovorin is given to "rescue" the normal cells from the toxic effects of methotrexate by providing a source of folic acid, which is necessary for normal cell function. This allows for the selective targeting of cancer cells while minimizing damage to normal cells.

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  • 2. 

    A 10-year-old girl, recently diagnosed with a lymphoblastic T-cell lymphoma, received her first combination chemotherapeutic regimen which included cyclophosphamide, vincristine, doxorubicin and prednisone. Which of the following adverse effects was the patient most likely to suffer from, during the first day of treatment?

    • A.

      Neuropathy

    • B.

      Hemorrhagic cystitis

    • C.

      Pulmonary fibrosis

    • D.

      Congestive heart failure

    • E.

      Nausea and vomiting

    Correct Answer
    E. Nausea and vomiting
    Explanation
    The patient is most likely to suffer from nausea and vomiting during the first day of treatment with the given combination chemotherapeutic regimen. Chemotherapy drugs such as cyclophosphamide, vincristine, doxorubicin, and prednisone are known to cause gastrointestinal side effects, including nausea and vomiting, in many patients. These side effects are commonly experienced shortly after starting chemotherapy and can be managed with antiemetic medications.

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  • 3. 

    A 47-year-old man with a non-Hodgkin’s lymphoma is being treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) and rituximab. He is in the clinic to receive his four cycle of CHOP. Physical examination reveals tachycardia, shortness of breath, neck vein distension, pulmonary rales and ankle edema. Which of the following drugs has most likely caused this findings?

    • A.

      Cyclophosphamide

    • B.

      Doxorubicin

    • C.

      Prednisone

    • D.

      Vincristine

    • E.

      Rituximab

    Correct Answer
    B. Doxorubicin
    Explanation
    Doxorubicin is the most likely drug that has caused the findings described. Doxorubicin is known to have cardiotoxic effects, which can lead to tachycardia, shortness of breath, neck vein distension, pulmonary rales, and ankle edema. These symptoms are consistent with congestive heart failure, which can be a side effect of doxorubicin treatment. The other drugs listed do not typically cause these specific symptoms.

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  • 4. 

    A 12-year-old boy presents with fatigue, malaise and nosebleed. He has a one week history of an upper respiratory tract infection and otitis media. A blood examination reveals a normochromic, normocytic anemia and a differential white blood cell count shows 11% lymphoblasts. A bone marrow biopsy is performed which reveals 95% lymphoblasts. Which of the following pairs of drugs are most likely included in the therapeutic management of this boy?

    • A.

      Cisplatin and etoposide

    • B.

      Flutamide and goserelin

    • C.

      Vincristine and prednisone

    • D.

      Tamoxifen and anastrozole

    • E.

      Fluorouracil and cisplatin

    Correct Answer
    C. Vincristine and prednisone
    Explanation
    The patient's presentation, including fatigue, malaise, and nosebleeds, along with the findings of normochromic, normocytic anemia and lymphoblasts in the blood and bone marrow, are consistent with acute lymphoblastic leukemia (ALL). Vincristine and prednisone are commonly used in the induction phase of treatment for ALL. Vincristine is a vinca alkaloid that disrupts cell division, while prednisone is a corticosteroid that helps to kill lymphoblasts. Therefore, Vincristine and prednisone are the most likely drugs included in the therapeutic management of this boy.

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  • 5. 

    A 66-year-old woman with inoperable lung cancer is being treated with a combination chemotherapy regimen. Laboratory exams reveal the following plasma levels: creatinine 7.5 mg/dL (normal: 0.6-1.5), BUN 45 mg/dL (normal 7-30), Mg++ 0.2 mmol/L (normal 0.6-1.0). Which of the following drugs most likely caused these laboratory abnormalities?

    • A.

      Fluorouracil

    • B.

      Doxorubicin

    • C.

      Vincristine

    • D.

      Cisplatin

    • E.

      Paclitaxel

    Correct Answer
    D. Cisplatin
    Explanation
    Cisplatin is a platinum-based chemotherapy drug that is known to cause kidney damage. The elevated levels of creatinine and BUN suggest impaired kidney function, which is a common side effect of cisplatin. Additionally, the low level of magnesium in the plasma is also consistent with cisplatin-induced kidney damage, as the kidneys play a role in maintaining magnesium levels in the body. Therefore, cisplatin is the most likely drug to have caused these laboratory abnormalities.

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  • 6. 

    A 69-year-old man with a large-cell lymphoreticular lymphoma was started on a chemotherapeutic regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and bleomycin 1 year ago. Three weeks after his sixth course he developed dyspnea, a nonproductive cough and fever. Chest x-ray showed diffuse bilateral infiltrates and a lung biopsy revealed inflammation and fibrosis with no evidence of lymphoma. Bacterial, fungal and viral cultures were negative. Which of the drugs administered to the patient could have caused this pulmonary disorder?

    • A.

      Cyclophosphamide

    • B.

      Doxorubicin

    • C.

      Vincristine

    • D.

      Prednisone

    • E.

      Bleomycin

    Correct Answer
    E. Bleomycin
    Explanation
    Bleomycin could have caused the pulmonary disorder in this patient. Bleomycin is known to cause pulmonary toxicity, which can present as dyspnea, cough, and infiltrates on chest x-ray. The lung biopsy findings of inflammation and fibrosis are consistent with bleomycin-induced lung injury. This adverse effect is dose-dependent and can occur at any time during treatment, but is more common with prolonged use. Other drugs in the regimen, such as cyclophosphamide, doxorubicin, vincristine, and prednisone, are not typically associated with this type of pulmonary toxicity.

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  • 7. 

    A 6-year-old child presented with hematuria and complained of pain when urinating. The child, recently diagnosed with neuroblastoma, had begun a chemotherapy program five days previously. Which of the following drugs most likely caused the patient’s symptoms?

    • A.

      Prednisone

    • B.

      Vincristine

    • C.

      Cisplatin

    • D.

      Cyclophosphamide

    • E.

      Doxorubicin

    Correct Answer
    D. Cyclophosphamide
    Explanation
    Cyclophosphamide is a chemotherapy drug that can cause bladder irritation and inflammation, leading to symptoms such as hematuria (blood in the urine) and pain during urination. These symptoms are consistent with the child's presentation. Prednisone is a corticosteroid and does not typically cause these urinary symptoms. Vincristine, cisplatin, and doxorubicin are other chemotherapy drugs that can have various side effects, but they are not typically associated with hematuria and pain during urination.

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  • 8. 

    A 45-year-old man recently diagnosed with small cell lung cancer starts his first course of combination chemotherapy with cisplatin, topotecan and etoposide. Which of the following peripheral blood cells will decrease first in this patient?

    • A.

      Lymphocytes

    • B.

      Platelets

    • C.

      Monocytes

    • D.

      Granulocytes

    • E.

      Erythrocytes

    Correct Answer
    D. Granulocytes
    Explanation
    Granulocytes are a type of white blood cell that includes neutrophils, eosinophils, and basophils. They are responsible for fighting infections and are highly sensitive to chemotherapy drugs. Therefore, it is expected that the granulocytes will decrease first in this patient as a result of the chemotherapy treatment. Lymphocytes, monocytes, platelets, and erythrocytes may also be affected by chemotherapy, but the granulocytes are typically the most sensitive and will decrease first.

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  • 9. 

    A 50-year-old woman, recently diagnosed with ovarian cancer, started her first cycle of combination chemotherapy with paclitaxel, cisplatin and cyclophosphamide. Which of the following drugs should also be administered in order to counteract a specific adverse effect of cyclophosphamide?

    • A.

      Erythropoietin

    • B.

      Leucovorin

    • C.

      MESNA (2-mercaptoethane sulfonate)

    • D.

      Acetylcysteine

    • E.

      Vitamin K

    • F.

      Protamine sulfate

    Correct Answer
    C. MESNA (2-mercaptoethane sulfonate)
    Explanation
    Cyclophosphamide is known to cause hemorrhagic cystitis, which is characterized by bleeding and inflammation in the bladder. MESNA (2-mercaptoethane sulfonate) is a drug that is commonly used to counteract this specific adverse effect. It works by binding to and inactivating the toxic metabolites of cyclophosphamide that are responsible for causing bladder damage. By administering MESNA along with cyclophosphamide, the risk of developing hemorrhagic cystitis is reduced.

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  • 10. 

    ) A 75-year-old man recently diagnosed with chronic lymphocytic leukemia started a treatment with chlorambucil. Which of the following statements best explains the mechanism of action of this anticancer drug?

    • A.

      Formation of covalent bonds with nucleophile groups on DNA bases

    • B.

      Inhibition of DNA chain elongation

    • C.

      Inhibition of thymidylate synthetase

    • D.

      Prevention of resealing of nicked strands of DNA

    • E.

      Inhibition of microtubule assembly

    Correct Answer
    A. Formation of covalent bonds with nucleophile groups on DNA bases
    Explanation
    Chlorambucil is an alkylating agent, which means it forms covalent bonds with nucleophile groups on DNA bases. This leads to the cross-linking of DNA strands and prevents their separation and replication. By interfering with DNA structure and function, chlorambucil inhibits the growth and division of cancer cells, ultimately leading to their death.

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  • 11. 

    A 52-year-old woman recently diagnosed with malignant glioblastoma received radiation therapy followed by a cycle of combination therapy which included carmustine. Which of the following statements best explains why this anticancer drug is most often used to treat CNS neoplasms?

    • A.

      It inhibits only tumor cells which originate from neurons

    • B.

      It is highly lipid soluble and therefore can easily enter the brain

    • C.

      It has negligible neurological adverse effects

    • D.

      It is uptaken into the nerve terminals by the amine pump

    • E.

      It is biotransformed into active metabolites in the brain only

    Correct Answer
    B. It is highly lipid soluble and therefore can easily enter the brain
    Explanation
    The correct answer is "It is highly lipid soluble and therefore can easily enter the brain." Carmustine is a chemotherapy drug that is commonly used to treat CNS neoplasms because it is highly lipid soluble. This means that it can easily cross the blood-brain barrier and enter the brain, where it can target and kill cancer cells. Its ability to penetrate the brain makes it an effective treatment option for tumors in the central nervous system.

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  • 12. 

    A 10-year-old boy recently diagnosed with neuroblastoma, received his first course of combination chemotherapy. Now he complains of tinnitus and earing loss. Which of the following drugs most likely caused these symptoms?

    • A.

      Cisplatin

    • B.

      Vincristine

    • C.

      Doxorubicin

    • D.

      Dactinomycin

    • E.

      Cyclophosphamide

    Correct Answer
    A. Cisplatin
    Explanation
    Cisplatin is a chemotherapy drug known to cause ototoxicity, which can manifest as tinnitus and hearing loss. The symptoms of tinnitus and hearing loss in the 10-year-old boy are likely caused by cisplatin, as it is a known side effect of this specific drug.

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  • 13. 

    50-year-old woman underwent surgical operation to resect an ovarian carcinoma. Following surgery she started her first course of combination chemotherapy in order to eradicate the remaining tumor cells. Which of the following pairs of drugs were most likely included in her combination regimen?

    • A.

      Mercaptopurine and asparaginase

    • B.

      Methotrexate and hydroxyurea

    • C.

      Cytarabine and prednisone

    • D.

      Cisplatin and paclitaxel

    • E.

      Methotrexate and tamoxifen

    Correct Answer
    D. Cisplatin and paclitaxel
    Explanation
    The most likely drugs included in the woman's combination chemotherapy regimen are cisplatin and paclitaxel. These drugs are commonly used in the treatment of ovarian carcinoma. Cisplatin is a platinum-based chemotherapy drug that works by damaging the DNA of cancer cells, preventing their replication and growth. Paclitaxel is a taxane chemotherapy drug that works by disrupting the microtubules in cancer cells, inhibiting their division and growth. The combination of these drugs is often used to target different aspects of cancer cell growth and increase the effectiveness of treatment.

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  • 14. 

    A 62-year-old woman with advanced Hodgkin’s disease is to begin chemotherapy with the ABVD regimen (doxorubicin, bleomycin vinblastine and dacarbazine). Which of the following statements best explains the mechanism of anticancer action of doxorubicin?

    • A.

      It intercalates between DNA strands and inhibit topoisomerase II

    • B.

      It prevent microtubule disassembly into tubulin monomers

    • C.

      It prevents assembly of tubulin dimers into microtubules

    • D.

      It alkylates nucleophilic groups on DNA bases

    • E.

      It blocks the synthesis of both ribonucleotides and deoxynucleotides

    Correct Answer
    A. It intercalates between DNA strands and inhibit topoisomerase II
    Explanation
    Doxorubicin is a chemotherapy drug that works by intercalating between DNA strands and inhibiting topoisomerase II. Topoisomerase II is an enzyme that helps to unwind and separate DNA strands during replication and transcription. By inhibiting this enzyme, doxorubicin prevents DNA from being properly replicated and transcribed, leading to cell death. This mechanism of action is particularly effective against rapidly dividing cancer cells, as they rely heavily on DNA replication and transcription for their growth and survival.

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  • 15. 

    A 3 year-old boy diagnosed with a favorable histology Wilms’ tumor underwent surgery followed by 18 week of vincristine and dactinomycin therapy. Which of the following statement best explains the mechanism of action of dactinomycin?

    • A.

      It alkylates nucleophilic groups on RNA bases

    • B.

      It inhibit dihydrofolate reductase

    • C.

      It inhibits pyrimidine biosynthesis

    • D.

      It binds to double-stranded DNA so inhibiting DNA transcription

    • E.

      It inhibits free radical formation

    Correct Answer
    D. It binds to double-stranded DNA so inhibiting DNA transcription
    Explanation
    Dactinomycin binds to double-stranded DNA, which inhibits the process of DNA transcription. This means that it prevents the DNA from being used as a template to produce RNA, which is an essential step in protein synthesis. By inhibiting DNA transcription, dactinomycin interferes with the ability of cancer cells to replicate and divide, ultimately leading to cell death. This mechanism of action is particularly effective against rapidly dividing cells, such as those found in Wilms' tumor.

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