Anti-neoplastic drugs Practice Questions

Question 1

A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?

Accepted Answer

Level 3

Answer

Level 1

Answer

Level 5

Answer

Level 4

Answer

Level 2

Question 2

A 55-year-old Caucasian male presents for a routine colonoscopy. A polyp is found in the patient's transverse colon and is found to be cancerous on histological evaluation. Upon examination, it is found that these cancerous cells have decreased MHC class I expression on their surface. Which immune system cell is most capable of killing these tumor cells?

Accepted Answer

Natural killer cells

Answer

Cytotoxic T-cells

Answer

B-cells

Answer

Macrophages

Answer

Eosinophils

Question 3

A 60-year-old female presents to her gynecologist with bloating, abdominal discomfort, and fatigue. She has a history of hypertension and takes hydrochlorothiazide. Physical exam reveals ascites and right adnexal tenderness. Initial imaging reveals a mass in the right ovary and eventual biopsy of the mass reveals ovarian serous cystadenocarcinoma. She is started on a chemotherapeutic agent with plans for surgical resection. Soon after starting the medication, she develops dysuria and hematuria. Laboratory analysis of her urine is notable for the presence of a cytotoxic metabolite. Which of the following mechanisms of action is consistent with the medication in question?

Accepted Answer

DNA alkylating agent

Answer

Folate analog

Answer

Microtubule inhibitor

Answer

Platinum-based DNA cross-linking agent

Answer

BRAF inhibitor

Question 4

A 62-year-old woman presents to her oncologist to discuss the chemotherapy options for her newly diagnosed breast cancer. During the meeting, they discuss a drug that inhibits the breakdown of mitotic spindles in cells. Her oncologist explains that this will be more toxic to cancer cells because those cells are dividing more rapidly. Which of the following side effects is closely associated with the use of this chemotherapeutic agent?

Accepted Answer

Peripheral neuropathy

Answer

Photosensitivity

Answer

Paralytic ileus

Answer

Hemorrhagic cystitis

Answer

Pulmonary fibrosis

Question 5

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?

Accepted Answer

"It must be very challenging having received this diagnosis. I want to work with you to create a plan."

Answer

"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."

Answer

"It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."

Answer

"We are going to need to treat your lung cancer. I am here to help you throughout the process."

Answer

"I respect your decision and we will not administer any treatment. Let me know if I can help in any way."

Question 6

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?

Accepted Answer

Tyrosine kinase inhibitor

Answer

Ribonucleotide reductase inhibitor

Answer

Monoclonal anti-HER-2 antibody

Answer

Topoisomerase II inhibitor

Answer

Monoclonal anti-CD20 antibody

Question 7

A 55-year-old man comes to the physician because of a 4-month history of fatigue, increased sweating, and a 5.4-kg (12-lb) weight loss. Over the past 3 weeks, he has had gingival bleeding when brushing his teeth. Twenty years ago, he was diagnosed with a testicular tumor and treated with radiation therapy. His temperature is 37.8°C (100°F), pulse is 70/min, respirations are 12/min, and blood pressure is 130/80 mm Hg. He takes no medications. Cardiopulmonary examination shows no abnormalities. The spleen is palpated 4 cm below the left costal margin. Laboratory studies show:
Hemoglobin 9 g/dL
Mean corpuscular volume 86 μm3
Leukocyte count 110,000/mm3
Segmented neutrophils 24%
Metamyelocytes 6%
Myelocytes 34%
Promyelocytes 14%
Blasts 1%
Lymphocytes 11%
Monocytes 4%
Eosinophils 4%
Basophils 2%
Platelet count 650,000/mm3
Molecular testing confirms the diagnosis. Which of the following is the most appropriate next step in treatment?

Accepted Answer

Imatinib therapy

Answer

Phlebotomy

Answer

Cytarabine and daunorubicin therapy

Answer

Rituximab therapy

Answer

Low-dose aspirin therapy

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?

Accepted Answer

Doxorubicin has a maximum lifetime dose, due to the risk of cardiac toxicity

Answer

Doxorubicin has a maximum lifetime dose, due to the risk of pulmonary toxicity

Answer

Doxorubicin will increase her risk for deep vein thrombosis (DVT) and pulmonary embolism (PE)

Answer

Doxorubicin frequently causes an acneiform rash

Answer

Doxorubicin frequently causes cystitis

Question 9

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?

Accepted Answer

Echocardiography

Answer

No regular monitoring indicated

Answer

Chest radiograph

Answer

Cardiac MRI

Answer

ECG

Question 10

A 25-year-old college student is diagnosed with acute myelogenous leukemia after presenting with a 3-week history of fever, malaise, and fatigue. He has a history of type 1 diabetes mellitus, multiple middle ear infections as a child, and infectious mononucleosis in high school. He 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 87/min, and respiratory rate 17/min. On physical examination, his pulses are bounding; his complexion is pale, but breath sounds remain clear. A rapidly progressive form of leukemia is identified, and the patient is scheduled to start intravenous chemotherapy. Which of the following treatments should be given to this patient to prevent or decrease the likelihood of developing acute renal failure during treatment?

Accepted Answer

Allopurinol

Answer

Sulfinpyrazone

Answer

Indomethacin

Answer

Probenecid

Answer

Colchicine

Anti-neoplastic drugs

Study Resources

Lessons

Questions

Flashcards

Lessons

Alkylating agents

Antimetabolites

Antitumor antibiotics

Topoisomerase inhibitors

Vinca alkaloids and taxanes

Platinum compounds

Targeted therapies (kinase inhibitors)

Monoclonal antibodies in cancer

Hormonal therapies

Immunotherapies and checkpoint inhibitors

Proteasome inhibitors

Antineoplastic combination regimens

Management of chemotherapy toxicities

Practice Questions

Flashcards

About Anti-neoplastic drugs for USMLE

Lessons in Anti-neoplastic drugs

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