Pharm Cancer Fungal Anesthetics

17 Questions | By Chachelly | Updated: Mar 21, 2022 | Attempts: 143

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Cancer, & anesthetics & antifungals

Questions and Answers

1.

A 48-year-old woman presented to her physician complaining of pain, abdominal distension, and changes in her bowel habits. Abdominal and pelvic ultrasound revealed a 10-15cm pelvic mass and her serum CA125 antigen level was significantly elevated. She was diagnosed with epithelial ovarian cancer, advanced stageIII. Her tumor was considered too large for initial surgery; systemic rather than intraperitoneal neoadjuvant chemotherapy was instituted to shrink her tumor prior to debulking surgery. She received 6 cycles of combination chemotherapy with paclitaxel and carboplatin. Which of the following statements correctly describes the mechanisms by which the drug combination sends a higher proportion of neoplastic cells into apoptotic mode?
- A.
  
  Paclitaxel inhibits purine synthesis; carboplatin inhibits microtubular protein polymerization
- B.
  
  Paclitaxel blocks thymidylate synthase: carboplatin blocks dihydrofolate reductase
- C.
  
  Paclitaxel inhibits telomerases; carboplatin is toxic to topoisomerases
- D.
  
  Paclitaxel inhibits microtubule disassembly; carboplatin disrupts DNA
- E.
  
  Paclitaxel is toxic to cells in Go phase; carboplatin is specifically toxic to cell in S phase.
2.

A 68-year-old woman with a history of breast cancer came to her physician complaining of back pain. 7 years previously she had a lumpectomy in her left breast followed by localized radiotherapy. At that time her tumor was documented as positive for both estrogen and progesterone receptors; she received 5 years of daily oral tamoxifen, which finished 2 years ago. As there is now radiographic evidence of bony metastases, it was decided to initiate combination of endocrine therapy, together with a bisphosphonate. Which of the following paired drugs may be identified as representatives of these two classes of therapeutic agents?
- A.
  
  Tamoxifen and zoledronic acid
- B.
  
  Fulvestrant and pamidronate
- C.
  
  Anastrozole and finasteride
- D.
  
  Finasteride and trastuzumab
3.

In 1957 Ethel Longoria was admitted into intensive care bleeding rapidly into the lining of her lungs. Three years previously she had an ectopic pregnancy. Now a tumor had grown out of the placental tissue surrounding the abnormal pregnancy; it had metastasized into her lungs, where the tumor hung in grapelike clusters bleeding profusely. Her oncologist, Min Chiu Li, stabilized her, measured her plasma levels of human chorionic gonadotropin, (hCG) and started treatment with an antifolate drug. After four cycles of chemotherapy, the lung tumors disappeared, the chest X-ray improved, and the hCG levels diminished but were still measurable. What is the most likely outcome if antifolate treatment is continued?
- A.
  
  Lung toxicity
- B.
  
  Proliferation of micrometastases
- C.
  
  Severe anemia
- D.
  
  CNS meningeal metastases
4.

A 26-year-old man, presents with a painless swelling in his left testicle. On examination an indurated mass was located in the lower pole of the left testicle. Blood tests show: alfa fetoprotein (AFP) 300ng/ml (normal<40); beta human chorionic gonadotrophin (beta-hCG) <5 IU/L. He is referred to an urologist who performs an orchiectomy followed by a retroperitoneal lymph node dissection. The pathologist’s report reveals embryonal carcinoma, and four positive nodes. A combination chemotherapy regimen was designed. In preparation for this regimen, appropriate baseline tests were done: pulmonary function tests; an audiogram; and a 24h creatinine clearance; and plasma electrolytes, CBC and differential platelet counts. The patient was hydrated with IV sodium chloride, prior to receiving combination chemotherapy. A 21day cycle of treatment was implemented (x4.) In the light of the tests ordered to establish baseline functioning of specific organs, what is the most likely combination of drugs used to treat this cancer?
- A.
  
  Leuprolide and finasteride
- B.
  
  Bleomycin, vinblastine and cisplatin
- C.
  
  Paclitaxel and cyclophosphamide
- D.
  
  Cyclophosphamide, methotrexate and 5-fluorouracil
5.

The now 30-year-old male from the previous question came to his doctor complaining of fatigue, easy bruising, bleeding, fever and infection. The results from blood smears and a marrow biopsy confirm a diagnosis of Acute Myelogenous Leukemia. His doctor notes that four years previously the patient was successfully treated for testicular cancer using bleomycin, etoposide and cisplatin. A mixture including vinblastine was also employed as a variant regime. Which of the agents used to treat his testicular cancer most likely caused the development of AML in this patient?
- A.
  
  Cisplatin
- B.
  
  Vinblastine
- C.
  
  Etoposide
- D.
  
  Bleomycin
6.

A 73-year-old man presents to his doctor with blood in his urine and complains that his shoulder is hurting. He had been taking finasteride to treat benign prostatic hypertrophy and his PSA levels had been < 4.5. His PSA now is 35.7ng/L. After various tests and evaluations, he is diagnosed with prostatic carcinoma, Gleeson score 9 with positive perineural invasion. He has metastatic, androgen-dependent, hormone-sensitive disease, with skeletal metastases involving skull and right shoulder. Which one of the following drugs would be part of a neoadjuvant androgen –deprivation therapy?
- A.
  
  Anastrozole
- B.
  
  Mifepristone
- C.
  
  Flutamide
- D.
  
  Oxandrolone
- E.
  
  Spironolactone
7.

A 56-year-old obese woman went to her doctor with complaints of episodes of long, heavy ,vaginal bleeding and lower abdominal pain. On questioning , it was established that she was post menopausal and she had vaginal bleeding for over 6 months. After further tests, she was diagnosed with endometrial carcinoma for which she had an abdominal hysterectomy. Adjuvant chemotherapy was instituted with doxorubicin and paclitaxel. Unfortunately, within eight months there was recurrent disease. Which is the most likely explanation for drug therapy failure?
- A.
  
  Mutations in beta tubulin isoforms
- B.
  
  Overexpression of multidrug resistance gene(MDR1)
- C.
  
  Enhanced activity of enzymes which reseal DNA breaks
- D.
  
  Changes in receptor affinity characteristics
- E.
  
  Increase in the production of drug-inactivating enzymes
8.

A 37-year-old man complained of anorexia, nausea, enlargement of his breast and impotence. The man, recently diagnosed with pulmonary coccidioidomycosis, has been receiving an antifungal treatment for two weeks. Which of the following drugs most likely caused these adverse effects?
- A.
  
  Amphotericin B
- B.
  
  Nystatin
- C.
  
  Ketoconazole
- D.
  
  Flucytosine
- E.
  
  Griseofulvin
- F.
  
  Terbinafine
9.

A 32-year-old woman presents to her gynecologist with a 4 days history of perineal pruritus and a non-malodorous, thick, cheesy vaginal discharge. The only medication the woman is taking is an oral contraceptive. A wet preparation of vaginal secretion shows budding yeast cells and pseudohyphae. Which of the following drugs, given locally, would be appropriate for this patient?
- A.
  
  Miconazole
- B.
  
  Amphotericin B
- C.
  
  Fluconazole
- D.
  
  Anidulafungin
- E.
  
  Griseofulvin
10.

A 31-year-old homosexual male with AIDS presents to the emergency room with fever (102.3 °F), headache, confusion, muddled thinking and vomiting. Physical examination reveals nuchal rigidity, diplopia, and loss of vision. An agglutination test of the spinal fluid for capsular polysaccharide antigen is positive suggesting infection with the organism Cryptococcus neoformans. The patient is started on IV amphotericin B in combination with another drug which functions by disrupting fungal nucleic acid synthesis. Which of the following drugs is being used in conjunction with amphotericin B?
- A.
  
  Caspofungin
- B.
  
  Ciclopirox
- C.
  
  Nystatin
- D.
  
  Flucytosine
- E.
  
  Tolnaftate
- F.
  
  Terbinafine
11.

A 37-year-old woman with AIDS has been recently diagnosed with systemic candidiasis due to Candida cruzii, and an IV antifungal treatment has been prescribed. Four days later the following lab results were obtained: serum creatinine 5.9 mg/dL (normal: 0.6-1.5), BUN 53 mg/dL (normal 7-30), plasma potassium 2.3 mmol/L (normal 3.5-5.3). Which of the following drugs was most likely prescribed?
- A.
  
  Fluconazole
- B.
  
  Amphotericin B
- C.
  
  Griseofulvin
- D.
  
  Flucytosine
- E.
  
  Micafungin
12.

A 7-year-old girl is brought to the physician by her mother because she has several small hairless patches in her scalp. Upon close physical examination, the patches look like black dots in the skin surface. Microscopic examination reveals a dense sheath of spores around the hair. Which of the following drugs, given orally, would be an appropriate treatment for this patient?
- A.
  
  Miconazole
- B.
  
  Tolnaftate
- C.
  
  Amphotericin B
- D.
  
  Flucytosine
- E.
  
  Griseofulvin
13.

A 32-year-old woman undergoing a minor gynecological surgical procedure undergoes spinal anesthesia by administration of bupivacaine. If the final level of motor anesthesia achieved by bupivacaine in this patient is at the T10 dermatome, what would most likely be the final level of sensory and sympathetic anesthesia achieved in this patient by this drug?
- A.
  
  U
- B.
  
  V
- C.
  
  W
- D.
  
  X
- E.
  
  Y
- F.
  
  Z
14.

A 26-year-old man undergoes local anesthesia with lidocaine for a minimally invasive medical procedure. Which of the following bio-macromolecules that is the primary drug receptor for lidocaine has the lowest affinity for this drug?
- A.
  
  Resting Na+ channels
- B.
  
  Inactivated Na+ channels
- C.
  
  Activated K+ channels
- D.
  
  Activated Na+ channels
- E.
  
  Inactivated K+ channels
- F.
  
  Na+/K+ ATPase
15.

Which of the following types of nerve fibers would most likely be the least sensitive to administration of a local anesthetic such as lidocaine?
- A.
  
  Type A delta fibers
- B.
  
  Type C sympathetic fibers
- C.
  
  Type B fibers
- D.
  
  Type C dorsal root fibers
- E.
  
  Type A alpha fibers
16.

A 34-year-old woman presents to the emergency department with a 3-inch laceration on her left forearm caused by an accident while cleaning her yard. The physician injects lidocaine in several places within the lacerated tissue before proceeding to stitch up the wound. Which of the following terms most correctly identifies this specific clinical utilization of lidocaine?
- A.
  
  Surface anesthesia
- B.
  
  Epidural anesthesia
- C.
  
  Local infiltration
- D.
  
  Peripheral nerve block
- E.
  
  Topical anesthesia
- F.
  
  Central neuraxial block
17.

A 46-year-old man complains of dizziness, blurred vision, a pounding headache, perioral tingling, and a metallic taste. The patient is currently undergoing a surgical procedure on his shoulder that required administration lidocaine to induce a brachial plexus block. Which of the following is the most likely reason why lidocaine is inducing these adverse effects in this patient?
- A.
  
  Lidocaine was injected directly into a nerve
- B.
  
  Lidocaine was rapidly broken down
- C.
  
  Lidocaine was injected intravascularly
- D.
  
  Lidocaine was administered together with epinephrine
- E.
  
  Lidocaine was inappropriately used as a regional anesthetic