Block 10 Antineoplastic MCQ's Prt2

16 Questions | By Chachelly | Last updated: Feb 19, 2013 | Total Attempts: 399

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1.

A 42-year-old man with stage III Hodgkin’s disease received six courses of chemotherapy with the ABVD regimen. Which of the following drugs of this regimen acts mainly in the G2 phase of the tumor cell cycle?
- A.
  
  Doxorubicin
- B.
  
  Bleomycin
- C.
  
  Vinblastine
- D.
  
  Dacarbazine
2.

A 4-year-old girl presented with increasing weakness and bleeding gums. Physical examination revealed hepatospenomelaly. A CBC with differential showed a WBC count of 65000 with 43% lymphoblasts and a bone marrow biopsy revealed 92% lymphoblasts. The girl received systemic remission chemotherapy and also intrathecal chemotherapy in order to prevent relapse within the CNS. Which of the following drugs was most likely injected intrathecally?
- A.
  
  Cisplatin
- B.
  
  Paclitaxel
- C.
  
  Etoposide
- D.
  
  Bleomycin
- E.
  
  Methotrexate
3.

A 45-year-old woman, who had undergone a radical mastectomy for infiltrating ductal carcinoma, started adjuvant combination therapy with CMF cyclophosphamide, methotrexate and fluorouracil). Which of the following statements best explains the mechanism of action of methotrexate?
- A.
  
  Inhibition of purine and pyrimidine biosynthesis
- B.
  
  Inhibition of DNA chain elongation
- C.
  
  Inhibition of ribonucleotide reductase
- D.
  
  Inhibition of topoisomerase II
- E.
  
  Inhibition of microtubule assembly
4.

A 32-year-old man presented to the hospital with increasing fatigue, anorexia, weight loss, and widespread ecchymoses. A blood examination revealed a white blood cell count of 70000/mm3 with 90% myeloblasts and a bone marrow biopsy showed blast cells that made up about 40% of the nucleated cells in the marrow normal < 5%). Which of the following drugs was most likely included in the initial chemotherapy of this patient?
- A.
  
  Cisplatin
- B.
  
  Paclitaxel
- C.
  
  Bleomycin
- D.
  
  Cytarabine
- E.
  
  Fluorouracil
5.

A 67-year-old man underwent surgery to remove an adenocarcinoma of the colon. Since the regional lymph nodes showed evidence of tumor involvement, adjuvant therapy was initiated after surgery. Which of the following drugs was most likely included in the therapeutic regimen of this patient?
- A.
  
  Cytarabine
- B.
  
  Fludarabine
- C.
  
  Asparaginase
- D.
  
  Hydroxyurea
- E.
  
  Fluorouracil
6.

A 6-year-old girl with acute lymphoblastic leukemia completed her induction therapy with a multidrug regimen. Now she is scheduled for maintenance therapy with a regimen that includes a CCS anticancer drug administered daily, for 7 days every 4 weeks. Which of the following is the drug she is about to receive?
- A.
  
  Cyclophosphamide
- B.
  
  Doxorubicin
- C.
  
  Mercaptopurine
- D.
  
  Cisplatin
- E.
  
  Carmustine
7.

A 39-year-old man with acute lymphoblastic leukemia was admitted to the hospital for remission chemotherapy. After three week of therapy the patient started complaining of numbness of his fingers and the soles of his feet. Physical examination showed loss of ankle jerk and depression of deep tendon reflexes. Which of the following drugs most likely caused these patient’s signs and symptoms?
- A.
  
  Vincristine
- B.
  
  Prednisone
- C.
  
  Methotrexate
- D.
  
  Mercaptopurine
- E.
  
  Doxorubicin
8.

A 66-year-old man came to his physician complaining of a persistent backache. He was found on rectal examination to have a single, hard, irregular nodule within his prostate. Subsequent exams found his prostatic specific antigen to be 100 ng/mL ( normal: < 3.0 ) and a CT scan showed several enlarged pelvic lymph nodes and multiple sclerotic lesions in his spine. Which of the following pairs of drugs would be most appropriate for that patient?
- A.
  
  Paclitaxel and cisplatin
- B.
  
  Vincristine and prednisone
- C.
  
  Leuprolide and flutamide
- D.
  
  Tamoxifen anastrozole
- E.
  
  Vincristine and dactinomycin
9.

A 42-year-old woman presented with fever, night sweats, cough and a 8 kg weight loss. Chest x-rays displayed a mediastinal mass and a CT scan of the abdomen showed multiple enlarged lymph nodes. A biopsy of an inguinal node revealed Reed-Sternberg cells. The patient was scheduled for a combination ABVD anticancer chemotherapy (doxorubicin, bleomycin vinblastine and dacarbazine). Which of the following malignancies was the patient most likely to suffer from?
- A.
  
  Bladder cancer
- B.
  
  Chronic myelogenous leukemia
- C.
  
  Hodgkin’s disease
- D.
  
  Acute lymphoblastic leukemia
- E.
  
  Lung cancer
10.

A 67-year-old man presents to his physician with a 10-day history of fatigue, bleeding gums, perirectal cellulitis and ringing in the ears. He has recently lost 9kg. He shows no evidence of hepatosplenomegaly or lymphadenopathy, but he is pale and weak. Results from blood tests: White blood cell count: 18, 300/mm³(normal 4000-11000/mm³⁾ (75%leukemic blastocytes(normal: none), 20% lymphocytes Hemoglobin: 9.1g/dL(normal 11-14g.dL) Hematocrit: 29%(normal 40-44%) Platelet count:98, 000/mm³(normal 150,00-400,000) He is diagnosed with Acute Myelogenous leukemia (sometimes called ANLL acute non lymphocytic leukemia). After induction therapy with daunorubicin and cytarabine, followed by etoposide 7 days later, further tests were performed: the patient’s K+ and creatinine levels significantly increased, together with seriously increased uric acid levels. Further test data indicate that the patient now has Tumor lysis Syndrome(TLS). Which of the following best explains his current condition?
- A.
  
  His first tests resulted in a diagnosis of AML which developed into TLS
- B.
  
  TLS is a side effect of daunorubicin and cytarabine therapy
- C.
  
  Daunorubicin and Cytarabine are toxic to the kidney and TLS is the result
- D.
  
  Cytotoxic drugs actions on a high growth fraction cancer, may result in TLS
- E.
  
  Etoposide uniquely acts on immature, nonfunctional, cells of the myeloid or lymphoid series, causing TLS
11.

A 15-year-old boy suffering from Acute Lymphoblastic Leukemia, had induction therapy with vincristine, prednisone, and asparaginase. To try to achieve complete remission, he was given a fourth drug IV, which was a cytotoxic antibiotic. To prevent CNS metastases, a chemotherapeutic agent was introduced intrathecally (IT). Identify the additional IV drug and the IT drug which were added to his regimen
- A.
  
  IV doxorubicin and IT cyclophosphamide
- B.
  
  IV daunorubicin and IT methotrexate
- C.
  
  IV bleomycin and IT vincristine
- D.
  
  IV doxorubicin and IT bleomycin
- E.
  
  IV methotrexate and IT cyclophosphamide
12.

Which of the following antimalignant drugs is correctly matched with the tissue to which it shows dose-limiting toxicity?
- A.
  
  Methotrexate-skeletal muscle
- B.
  
  Vincristine –nervous tissue
- C.
  
  Asparaginase-red blood cells
- D.
  
  Prednisolone-lung
- E.
  
  Cyclophosphamide-liver
13.

A 35-year-old woman was recently diagnosed with a breast cancer, identified as an invasive ductal carcinoma. After a lumpectomy followed by radiotherapy, a combination chemotherapy strategy was initiated using CMF (Cyclophosphamide, Methotrexate, 5-Fluorouracil). Why treat this patient with this combination of drugs rather than with a single drug?
- A.
  
  Only one IV infusion load , containing all of the drugs, would be required
- B.
  
  Single drug therapy is more toxic than combination chemotherapy
- C.
  
  CMF attacks cells in different phases of the cell cycle, thus maximizing kill
- D.
  
  Drug combinations ensure that if one drug fails, the others may work
- E.
  
  CMF is the only effective combination used to treat this type of cancer
14.

MW presents to his doctor with a painless swelling in his left testicle. Laboratory tests showed Alfa fetoprotein (AFP) 300ng/ml. After orchiectomy, persistent elevations of AFP were found. Abdominal CT revealed a 6x10cm mass. Further tests for pulmonary function, an audiogram, 24h creatinine clearance and CBC’s’s with differential and platelet counts were done to establish his current normal blood levels. Why were these further laboratory tests selected to be done?
- A.
  
  To detect whether the cancer had spread to the organs under test
- B.
  
  To establish base-line functioning of these organs prior to initiation of appropriate cytotoxic combination chemotherapy
- C.
  
  To exclude the use of certain antimalignant drugs known to be toxic to the organ under evaluation
- D.
  
  To facilitate selection of appropriate doses of antimalignant drugs to be used in combination chemotherapy
- E.
  
  As standard practice prior to initiation of all combination chemotherapy regimens
15.

The following diagram shows the intracellular signaling mechanisms involved in T-cell proliferation. Pharmacological agents affect T-cell proliferation by acting at different sites in this signaling pathway. The immunosuppressant drug sirolimus acts on substance Y in the diagram. What is substance Y?
- A.
  
  What is substance Y?
- B.
  
  MTOR
- C.
  
  Immunophillin FKBP -12
- D.
  
  Calcineurin phosphatase
16.

Your patient has been diagnosed and treated for bladder cancer with IV glucocorticoids and another chemotherapeutic agent, an antimetabolite. His wife brings him a week later to the ER, stating that he has been increasingly confused over the past several days. Normally a very active and athletic man, your 44-year-old male patient did not want to get out of bed this morning. Examination reveals a drowsy man with markedly decreased motor activity when asked to lift his arm or extend his leg. Temp is 37o C, BP 105/75. Laboratory evaluation of liver enzymes reveals hepatotoxicity. Your patient's symptoms could be associated with what chemotherapeutic agent?
- A.
  
  Cisplatin
- B.
  
  Methotrexate
- C.
  
  Vincristine
- D.
  
  5FU
- E.
  
  Cytosine arabinoside