Antineoplastic combination regimens US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Antineoplastic combination regimens. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Antineoplastic combination regimens US Medical PG Question 1: A 65-year-old male with diffuse large B cell lymphoma is treated with a chemotherapy regimen including 6-mercaptopurine. Administration of which of the following agents would increase this patient’s risk for mercaptopurine toxicity?
- A. Allopurinol (Correct Answer)
- B. Mesna
- C. Leucovorin
- D. Dexrazoxane
- E. Amifostine
Antineoplastic combination regimens Explanation: ***Allopurinol***
- **Allopurinol** inhibits **xanthine oxidase**, an enzyme responsible for metabolizing **6-mercaptopurine (6-MP)** into inactive metabolites.
- Concurrent administration significantly increases **6-MP levels**, leading to enhanced myelotoxicity and other severe adverse effects.
*Mesna*
- **Mesna** (2-mercaptoethane sulfonate) is a uroprotectant used to prevent **hemorrhagic cystitis** caused by oxazaphosphorine chemotherapy agents like **ifosfamide** and **cyclophosphamide**.
- It does not interact with the metabolism of **6-mercaptopurine**.
*Leucovorin*
- **Leucovorin** (folinic acid) is a rescue agent for **methotrexate toxicity** and enhances the efficacy of **5-fluorouracil**.
- It does not have a direct interaction with the metabolism or toxicity of **6-mercaptopurine**.
*Dexrazoxane*
- **Dexrazoxane** is a cardioprotective agent used to prevent **doxorubicin-induced cardiotoxicity**.
- It does not interact with the metabolic pathways of **6-mercaptopurine**.
*Amifostine*
- **Amifostine** is a cytoprotective agent that reduces the toxicity of **cisplatin** and **radiation therapy** to normal tissues, particularly the kidneys and salivary glands.
- It is not involved in the metabolism or potentiation of **6-mercaptopurine toxicity**.
Antineoplastic combination regimens US Medical PG Question 2: A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Blood investigations are shown:
Aspartate aminotransferase (AST) 90 U/L
Alanine aminotransferase (ALT) 50 U/L
Total bilirubin 2 mg/dL
Albumin 3 g/dL
Alkaline phosphatase 100 U/L
Alpha fetoprotein 600 micrograms/L
Which of the following targeted agents is approved for advanced-stage hepatoma?
- A. Ustekinumab
- B. Daclizumab
- C. Sorafenib (Correct Answer)
- D. Abciximab
- E. Palivizumab
Antineoplastic combination regimens Explanation: ***Sorafenib***
- This patient's presentation with chronic hepatitis B, cirrhosis, a liver mass, and an **elevated alpha-fetoprotein** is highly suggestive of **hepatocellular carcinoma (HCC)**, also known as hepatoma.
- **Sorafenib** is a **multi-targeted tyrosine kinase inhibitor** that inhibits tumor cell proliferation and angiogenesis by targeting VEGFR, PDGFR, Raf kinases, and other kinases involved in tumor progression.
- It was the **first systemic therapy approved for advanced-stage HCC** and remains an important first-line treatment option for patients with advanced disease who are not candidates for surgical or locoregional therapies.
*Ustekinumab*
- **Ustekinumab** is a monoclonal antibody that targets the **p40 subunit of IL-12 and IL-23**, primarily used in the treatment of **psoriasis** and psoriatic arthritis, not HCC.
- It works by blocking inflammatory pathways involved in autoimmune conditions.
*Daclizumab*
- **Daclizumab** is a humanized monoclonal antibody that targets the **CD25 subunit of the IL-2 receptor**; it was previously used for treating **multiple sclerosis** but has been largely discontinued due to safety concerns.
- It is not indicated for the treatment of any form of cancer.
*Abciximab*
- **Abciximab** is a monoclonal antibody that targets the **glycoprotein IIb/IIIa receptor** on platelets, used as an **antiplatelet agent** in patients undergoing percutaneous coronary intervention.
- Its mechanism of action is related to inhibition of platelet aggregation and thrombosis, not cancer therapy.
*Palivizumab*
- **Palivizumab** is a monoclonal antibody used for the **prevention of serious lower respiratory tract disease** caused by **respiratory syncytial virus (RSV)** in high-risk infants.
- It provides passive immunity against RSV and has no role in cancer treatment.
Antineoplastic combination regimens US Medical PG Question 3: A 54-year-old woman is diagnosed with locally-advanced invasive ductal carcinoma of the breast. She undergoes surgical resection, radiation therapy, and is now being started on adjunctive chemotherapy with cyclophosphamide and doxorubicin. The patient is scheduled for follow up by her primary care provider. Which of the following tests should be performed regularly to monitor her current treatment regimen?
- A. No regular monitoring indicated
- B. Chest radiograph
- C. Cardiac MRI
- D. ECG
- E. Echocardiography (Correct Answer)
Antineoplastic combination regimens Explanation: ***Echocardiography***
- **Doxorubicin** is an anthracycline chemotherapy agent known for its dose-dependent **cardiotoxicity**, which can lead to **dilated cardiomyopathy** and heart failure.
- Regular echocardiography is crucial to monitor **left ventricular ejection fraction (LVEF)** and detect early signs of cardiac dysfunction, allowing for timely intervention or adjustment of treatment.
*No regular monitoring indicated*
- This is incorrect as **doxorubicin**, a component of the chemotherapy regimen, has significant cardiotoxic effects that require close monitoring to prevent severe cardiac complications.
- Neglecting monitoring could lead to irreversible cardiac damage.
*Chest radiograph*
- A chest radiograph primarily assesses lung fields and cardiac silhouette, but it is not sensitive enough to detect early-stage **doxorubicin-induced myocardial damage** or changes in **LVEF**.
- While useful for detecting pulmonary complications or metastases, it is not the primary tool for monitoring cardiotoxicity.
*Cardiac MRI*
- Cardiac MRI is a highly sensitive and specific imaging modality for assessing cardiac function and structure, but it is typically reserved for cases where echocardiography findings are equivocal or more detailed assessment is needed.
- It is not the routine or initial test for monitoring cardiotoxicity due to its higher cost and complexity.
*ECG*
- An ECG assesses the electrical activity of the heart and can detect arrhythmias or signs of ischemia, but it is generally not sufficient for monitoring **doxorubicin-induced cardiotoxicity**.
- While it can show nonspecific changes, it does not directly measure changes in **LVEF** or structural heart damage, which are key indicators of cardiotoxicity.
Antineoplastic combination regimens US Medical PG Question 4: A 57-year-old man presents to his oncologist to discuss management of small cell lung cancer. The patient is a lifelong smoker and was diagnosed with cancer 1 week ago. The patient states that the cancer was his fault for smoking and that there is "no hope now." He seems disinterested in discussing the treatment options and making a plan for treatment and followup. The patient says "he does not want any treatment" for his condition. Which of the following is the most appropriate response from the physician?
- A. "You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."
- B. "It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."
- C. "It must be very challenging having received this diagnosis. I want to work with you to create a plan." (Correct Answer)
- D. "We are going to need to treat your lung cancer. I am here to help you throughout the process."
- E. "I respect your decision and we will not administer any treatment. Let me know if I can help in any way."
Antineoplastic combination regimens Explanation: ***"It must be very challenging having received this diagnosis. I want to work with you to create a plan."***
- This response **acknowledges the patient's emotional distress** and feelings of guilt and hopelessness, which is crucial for building rapport and trust.
- It also gently **re-engages the patient** by offering a collaborative approach to treatment, demonstrating the physician's commitment to supporting him through the process.
*"You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."*
- While acknowledging distress, sending the patient home without further engagement **delays urgent care** for small cell lung cancer, which is aggressive.
- This response might be perceived as dismissive of his immediate feelings and can **exacerbate his sense of hopelessness** and isolation.
*"It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."*
- This statement moves too quickly to treatment efficacy without adequately addressing the patient's current **emotional state and fatalism**.
- While factual, it **lacks empathy** for his personal feelings of blame and hopelessness, potentially making him feel unheard.
*"We are going to need to treat your lung cancer. I am here to help you throughout the process."*
- This response is **too directive and authoritarian**, which can alienate a patient who is already feeling guilty and resistant to treatment.
- It fails to acknowledge his stated feelings of "no hope now" or his disinterest in treatment, which are critical to address before discussing the necessity of treatment.
*"I respect your decision and we will not administer any treatment. Let me know if I can help in any way."*
- While respecting patient autonomy is vital, immediately accepting a patient's decision to refuse treatment without exploring the underlying reasons (e.g., guilt, hopelessness, lack of information) is **premature and potentially harmful**.
- The physician has a responsibility to ensure the patient is making an informed decision, especially for a rapidly progressing condition like small cell lung cancer.
Antineoplastic combination regimens US Medical PG Question 5: A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL fusion gene. A drug with which of the following mechanisms of action is most appropriate for this patient?
- A. Ribonucleotide reductase inhibitor
- B. Monoclonal anti-HER-2 antibody
- C. Topoisomerase II inhibitor
- D. Monoclonal anti-CD20 antibody
- E. Tyrosine kinase inhibitor (Correct Answer)
Antineoplastic combination regimens Explanation: ***Tyrosine kinase inhibitor***
- The patient's symptoms (abdominal discomfort, fatigue, weight loss, pallor, splenomegaly), laboratory findings (**anemia with pronounced leukocytosis and thrombocytosis**), and the presence of a **BCR-ABL fusion gene** are highly characteristic of **Chronic Myeloid Leukemia (CML)**.
- The **BCR-ABL fusion gene** encodes a constitutively active **tyrosine kinase**, which is the hallmark of CML and the primary therapeutic target for **tyrosine kinase inhibitors (TKIs)** like imatinib.
*Ribonucleotide reductase inhibitor*
- **Ribonucleotide reductase inhibitors** (e.g., hydroxyurea) block DNA synthesis and are used in myeloproliferative disorders to reduce cell counts, but they are not specific to the **BCR-ABL fusion gene** and are not the most appropriate first-line targeted therapy for CML.
- While they can control symptoms, they do not target the underlying molecular defect in CML as effectively as TKIs.
*Monoclonal anti-HER-2 antibody*
- **Monoclonal anti-HER-2 antibodies** (e.g., trastuzumab) are used to treat **HER-2 positive breast cancer** and some gastric cancers.
- They are not relevant to the treatment of CML, which is characterized by the **BCR-ABL fusion gene**.
*Topoisomerase II inhibitor*
- **Topoisomerase II inhibitors** (e.g., etoposide, doxorubicin) prevent DNA unwinding and replication, leading to cell death, and are used in various hematologic malignancies and solid tumors.
- These drugs are broad-spectrum chemotherapeutic agents not specifically targeted to the **BCR-ABL fusion protein** in CML and are not first-line therapy for this condition.
*Monoclonal anti-CD20 antibody*
- **Monoclonal anti-CD20 antibodies** (e.g., rituximab) target the CD20 protein on B lymphocytes and are primarily used to treat **B-cell non-Hodgkin lymphoma** and some autoimmune diseases.
- They have no role in the direct treatment of CML, which is a myeloid malignancy.
Antineoplastic combination regimens US Medical PG Question 6: A 72-year-old man has been recently diagnosed with stage 3 squamous cell carcinoma of the oral cavity. After the necessary laboratory workup, concurrent chemoradiation therapy has been planned. Radiation therapy is planned to take place over 7 weeks and he will receive radiation doses daily, Monday–Friday, in 2.0 Gy fractions. For concurrent chemotherapy, he will receive intravenous cisplatin at a dosage of 50 mg/m2 weekly for 7 weeks. Which of the following best explains the mechanism of action of the antineoplastic drug that the patient will receive?
- A. Free radical-mediated lipid peroxidation
- B. Inhibition of polymerization of tubulin
- C. Inhibition of topoisomerase 1
- D. Inhibition of topoisomerase 2
- E. Formation of interstrand DNA cross-links (Correct Answer)
Antineoplastic combination regimens Explanation: ***Formation of interstrand DNA cross-links***
- **Cisplatin** is a **platinum-based chemotherapeutic agent** that acts by forming **interstrand and intrastrand DNA cross-links**.
- These cross-links interfere with **DNA replication and transcription**, leading to **DNA damage** and ultimately **apoptosis** in cancer cells.
*Free radical-mediated lipid peroxidation*
- While some chemotherapeutic agents, like **anthracyclines**, can induce **free radical formation** and subsequent damage, this is not the primary mechanism of action for cisplatin.
- **Lipid peroxidation** primarily affects cell membranes, whereas cisplatin's main target is DNA.
*Inhibition of polymerization of tubulin*
- This mechanism of action is characteristic of **vinca alkaloids** (e.g., vincristine, vinblastine) and **taxanes** (e.g., paclitaxel, docetaxel), which disrupt microtubule formation and function.
- Cisplatin does not target **tubulin polymerization**.
*Inhibition of topoisomerase 1*
- **Topoisomerase 1 inhibitors** such as **irinotecan** and **topotecan** prevent DNA unwinding by stabilizing the cleavable complex, leading to DNA breaks.
- This is not how cisplatin exerts its therapeutic effects.
*Inhibition of topoisomerase 2*
- **Topoisomerase 2 inhibitors** like **etoposide** and **doxorubicin** interfere with DNA replication and repair by preventing the religation of DNA strands.
- Cisplatin's mechanism is distinct from topoisomerase inhibition.
Antineoplastic combination regimens US Medical PG Question 7: A 13-year-old Caucasian male presents with his father to the pediatrician’s office complaining of left lower thigh pain. He reports slowly progressive pain over the distal aspect of his left thigh over the past three months. He denies any recent trauma to the area. His temperature is 100.9°F (38.3°C). On exam, there is swelling and tenderness overlying the inferior aspect of the left femoral diaphysis. Laboratory evaluation is notable for an elevated white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). Biopsy of the lesion demonstrates sheets of monotonous small round blue cells with minimal cytoplasm. He is diagnosed and started on a medication that inhibits transcription by intercalating into DNA at the transcription initiation complex. Which of the following adverse events will this patient be at highest risk for following initiation of this medication?
- A. Peripheral neuropathy
- B. Bone marrow suppression (Correct Answer)
- C. Gingival hyperplasia
- D. Pulmonary fibrosis
- E. Hemorrhagic cystitis
Antineoplastic combination regimens Explanation: ***Bone marrow suppression***
- The medication described, which inhibits transcription by intercalating into DNA at the transcription initiation complex, is likely **dactinomycin (actinomycin D)**.
- **Bone marrow suppression** is a common and severe adverse effect of dactinomycin, leading to issues like **neutropenia** and **thrombocytopenia**.
*Peripheral neuropathy*
- This is a common side effect of **vinca alkaloids** (e.g., vincristine, vinblastine) and **taxanes**, which are not described by the mechanism of action given.
- Dactinomycin does not typically cause significant peripheral neuropathy.
*Gingival hyperplasia*
- **Gingival hyperplasia** is a known side effect of medications such as **cyclosporine**, **phenytoin**, and **calcium channel blockers** like nifedipine.
- It is not associated with dactinomycin.
*Pulmonary fibrosis*
- This is a serious adverse effect of certain chemotherapeutic agents like **bleomycin** and **busulfan**, and other drugs like **amiodarone** and **methotrexate**.
- Dactinomycin is not primarily associated with pulmonary fibrosis.
*Hemorrhagic cystitis*
- **Hemorrhagic cystitis** is a classic adverse effect of **cyclophosphamide** and **ifosfamide**, caused by the metabolite **acrolein**.
- This adverse event is prevented by co-administration of **MESNA**, and is not a common side effect of dactinomycin.
Antineoplastic combination regimens US Medical PG Question 8: A 71-year-old woman presents to her hematologist-oncologist for follow up after having begun doxorubicin and cyclophosphamide in addition to radiation therapy for the treatment of her stage 3 breast cancer. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, the pulses are strong and irregular, she has a grade 3/6 holosystolic murmur heard best at the left upper sternal border, clear bilateral breath sounds, and erythema over her site of radiation. Which of the following statements regarding doxorubicin is true?
- A. Doxorubicin has a maximum lifetime dose, due to the risk of cardiac toxicity (Correct Answer)
- B. Doxorubicin has a maximum lifetime dose, due to the risk of pulmonary toxicity
- C. Doxorubicin will increase her risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)
- D. Doxorubicin frequently causes an acneiform rash
- E. Doxorubicin frequently causes cystitis
Antineoplastic combination regimens Explanation: ***Doxorubicin has a maximum lifetime dose, due to the risk of cardiac toxicity***
- **Doxorubicin** is a potent chemotherapy agent (anthracycline) with a well-known risk of **cardiotoxicity**, which can lead to **dilated cardiomyopathy** and heart failure.
- To mitigate this severe side effect, a **cumulative lifetime dose limit** (usually 450-550 mg/m²) is established for doxorubicin.
*Doxorubicin has a maximum lifetime dose, due to the risk of pulmonary toxicity*
- While some chemotherapy agents can cause pulmonary toxicity, **doxorubicin** is not primarily associated with this as its main dose-limiting toxicity.
- The most significant and common dose-limiting toxicity of doxorubicin is **cardiotoxicity**, not pulmonary.
*Doxorubicin will increase her risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)*
- Chemotherapy in general can increase the risk of **thromboembolic events**, but this is not a specific dose-limiting toxicity of **doxorubicin** that dictates a lifetime maximum dose.
- The concern for DVT/PE is a broader complication of cancer and its treatment, distinct from doxorubicin's specific cardiac risk.
*Doxorubicin frequently causes an acneiform rash*
- **Acneiform rash** is a common side effect of epidermal growth factor receptor (EGFR) inhibitors (e.g., cetuximab, erlotinib), not typically associated with **doxorubicin**.
- Doxorubicin's dermatologic side effects usually involve **alopecia**, hand-foot syndrome, and radiation recall, but not a predominant acneiform rash.
*Doxorubicin frequently causes cystitis*
- **Cystitis**, particularly hemorrhagic cystitis, is a well-known side effect of **cyclophosphamide** (another drug the patient is receiving), not **doxorubicin**.
- **Mesna** is often administered with cyclophosphamide to prevent this urological toxicity.
Antineoplastic combination regimens US Medical PG Question 9: A 67-year-old man presents to his primary care physician for a decline in his hearing that he noticed over the past week. The patient has a past medical history of hypertension and diabetes mellitus and was recently diagnosed with bladder cancer which is currently appropriately being treated. The patient is a hunter and often goes shooting in his spare time. His recent sick contacts include his grandson who is being treated with amoxicillin for ear pain. Physical exam is notable for decreased hearing bilaterally. The Weber test does not localize to either ear, and the Rinne test demonstrates air conduction is louder than bone conduction. Which of the following is the most likely etiology for this patient's hearing loss?
- A. Otitis externa
- B. Presbycusis
- C. Otosclerosis
- D. Medication regimen (Correct Answer)
- E. Otitis media
Antineoplastic combination regimens Explanation: ***Medication regimen***
- The patient's history of bladder cancer treatment suggests recent exposure to **chemotherapeutic agents**, such as **cisplatin**, which are known to be **ototoxic**.
- A **sudden decline in hearing** over the past week points to an acute cause, such as drug-induced hearing loss.
*Otitis externa*
- This condition typically presents with **ear pain**, **pruritus**, and **discharge**, none of which are mentioned in the patient's presentation.
- The **Weber and Rinne test results** (normal AC > BC, no lateralization) are inconsistent with a conductive hearing loss typically associated with otitis externa.
*Presbycusis*
- **Presbycusis** is an age-related **sensorineural hearing loss** that typically develops **gradually over years**, not suddenly over a week.
- While the patient's age (67) is a risk factor, the acute onset makes this diagnosis less likely.
*Otosclerosis*
- **Otosclerosis** usually causes a **progressive conductive hearing loss**, often starting in young adulthood.
- The **Weber and Rinne test results** (normal AC > BC, no lateralization) are inconsistent with a conductive hearing loss.
*Otitis media*
- **Otitis media** typically presents with **ear pain**, **fullness**, and often **fever** or **discharge**, which are absent in this patient.
- The **Weber and Rinne test results** (normal AC > BC, no lateralization) are inconsistent with the conductive hearing loss that would be expected with otitis media.
Antineoplastic combination regimens US Medical PG Question 10: A 69-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 16/min, and blood pressure 155/90 mm Hg. The neurologic examination shows paraparesis. The 8th thoracic vertebra is tender to palpation. An X-ray of the thoracic vertebrae confirms a compression fracture at the same level. The laboratory studies show the following:
Laboratory test
Hemoglobin 9 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 5,000/mm3
Platelet count 240,000/mm3
ESR 85 mm/hour
Serum
Na+ 135 mEq/L
K+ 4.2 mEq/L
Cl− 113 mEq/L
HCO3− 20 mEq/L
Ca+ 11.5 mg/dL
Albumin 4 g/dL
Urea nitrogen 18 mg/dL
Creatinine 1.2 mg/dL
Serum electrophoresis shows a monoclonal protein level of 38 g/L. To reduce the likelihood of fracture recurrence, it is most appropriate to administer which of the following?
- A. Calcitonin
- B. Calcitriol
- C. Pamidronate (Correct Answer)
- D. Fluoride
- E. Testosterone
Antineoplastic combination regimens Explanation: ***Pamidronate***
- The patient's presentation with **bone pain**, **hypercalcemia**, **anemia**, **elevated ESR**, **renal insufficiency**, and a **monoclonal protein** in serum electrophoresis is highly suggestive of **multiple myeloma**.
- **Bisphosphonates** like pamidronate are crucial in managing multiple myeloma by inhibiting osteoclast activity, reducing bone resorption, and thereby decreasing the risk of **pathological fractures** and managing **hypercalcemia**.
*Calcitonin*
- **Calcitonin** primarily works to lower serum calcium levels quickly but has a less sustained effect on bone remodeling compared to bisphosphonates.
- While it can be used for acute hypercalcemia, its role in preventing long-term fracture recurrence in multiple myeloma is limited.
*Calcitriol*
- **Calcitriol**, the active form of **vitamin D**, promotes calcium absorption from the gut and bone mineralization.
- Administering calcitriol in a patient with pre-existing hypercalcemia due to multiple myeloma would worsen the condition.
*Fluoride*
- **Fluoride** can increase bone density by affecting hydroxyapatite crystal formation.
- However, high doses of fluoride can lead to **fluorosis** and paradoxically increase bone fragility, making it unsuitable for preventing fractures in multiple myeloma.
*Testosterone*
- **Testosterone** is an anabolic steroid that can improve bone density in individuals with **hypogonadism**.
- It is not indicated for preventing fractures in the context of multiple myeloma, where bone destruction is driven by osteoclast activation due to plasma cell proliferation.
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