Uploaded by Fatmah Alharazi

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1. The incidence of which disease has two 'peaks', one around 20-30 years and the other
>50 years
A . Acute Myeloid Leukaemia
B. Hodgkins Lymphoma
C. Multiple Myeloma
D. Non Hodgkins Lymphoma
2. Most common form of cancer in children
a.AML (Acute Myelogenous Leukemia)
b. ALL (Acute Lymphocytic Leukemia)
c. CLL (Chronic Lymphocytic Leukemia)
d. CML (Chronic Myelogenous Leukemia)
3. Uncertain etiology, but several proposed linkages such as: Genetic - Philadelphia
chromosome, Viral infection (EBV, HIV), Exposure to high energy radiation,Toxic
chemical exposure, Smoking
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
4. Seen in Men > Women, median age >60
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
5. Progressive accumulation of functionally incompetent lymphocytes.
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
6. Clinical presentation of painless, swelling of lymph nodes, lymphocytosis upon CBC,
Splenomegaly, Hepatomegaly, AI Thrombocytopenia, hemolytic anemia, and/or
Hypogammaglobulinemia
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CML (Chronic Myelogenous Leukemia)
D. CLL (Chronic Lymphocytic Leukemia)
7. Most cases > 60 years old. Most common leukemia in adults
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
8. Very poor prognosis. Fatal if untreated or if mismanaged in first few days
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
9. Characterized by: Pancytopenia, Hemmorhagic Findings, Easy Fatigue and weakness,
Gingival hyperplasia. Fever in the presence of infection only, and/or Luekemic cutis (skin
involvement)
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
10. Characterized by chromosomal aberrations such as: –Deletions –Polyploidy –
Translocations –Hyperploidy –Inversions
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
11. Median age is 50 years old with male predominance
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
c. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
12. Converts to acute leukemia (blast crisis) if treatment is not successful
A. AML (Acute Myelogenous Leukemia)
B. (Acute Lymphocytic Leukemia)
C. LL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
13. Characterized by easy fatigability, malaise, anorexia, early satiety, excessive sweating,
weight loss, and upon PE, splenomegaly, pallor, and sternal tenderness
A. AML (Acute Myelogenous Leukemia)
B. ALL (Acute Lymphocytic Leukemia)
C. CLL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
14. Lymphoma originates at extranodal sites and spreads to anatomically contiguous
nodes
A. Hodgkin's Lymphoma
B. Non-Hodgkin's Lymphoma
15. The main presenting symptom of lymphomas
A. Fever and night sweats
B Normocytic, normochromic anaemia
C Painful lymphadenopathy
D Painless lymphadenopathy
. Characterized by: Pancytopenia, Hemmorhagic Findings, Easy Fatigue and weakness,
Gingival hyperplasia. Fever in the presence of infection only, and/or Luekemic cutis
(skin involvement)
a. AML (Acute Myelogenous Leukemia)
b. ALL (Acute Lymphocytic Leukemia)
c. CLL (Chronic Lymphocytic Leukemia)
d. CML (Chronic Myelogenous Leukemia)
15 . Characterized by chromosomal aberrations such as: –Deletions –Polyploidy –
Translocations –Hyperploidy –Inversions
a.
b.
c.
d.
AML (Acute Myelogenous Leukemia)
ALL (Acute Lymphocytic Leukemia)
CLL (Chronic Lymphocytic Leukemia)
CML (Chronic Myelogenous Leukemia)
16. Hodgkin lymphoma is associated with
A . Bence Jones proteins in blood
B. Bence Jones proteins in urine
C. Reed-Stornberg cells in bone marrow
D. Reed-Stornberg cells in urine
17. While there are no current biomarkers to predict response to immunotherapy for
hematologic malignancies, polymorphisms in which of the following genes may predict
outcomes in B cell lymphoma?
a. CTLA-4
b. PD-1
c. PD-L1
18. Which of the following hematological malignancies has the most impressive rates of
response to immune checkpoint therapy?
a. T-cell lymphomas
b. B-cell lymphomas
c. Hodgkin lymphoma
19. Studies have demonstrated significantly increased expression of _______ on tumor
infiltrating lymphocytes (TILs) in low-grade B cell lymphomas and a significant
expression of ________ on the tumor cells.
a. PD-L1; PD-1
b. D-1; PD-L1
c. CD40; CTLA-4
20. A 12-year-old girl suffering from 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
c. Pulsing
b. Palliative therapy
d. Combined modality strategy
1) What is the first-line treatment of choice for a patient with Stage IIA Classical nonHodgkin lymphoma?
A. ABVD chemotherapy
B. Surgical resection
C. Involved field radiation
d. R-CHOP
39. What is the first-line treatment of choice for a patient with Hodgkin lymphoma?
a.
b.
c.
b.
ABVD chemotherapy
Surgical resection
Involved field radiation
R-CHOP
40. Which of the following is not a “B” (bulky) symptom?
A. Night sweats
B. Fever
C. Pruritus
D. Weight loss (>10%)
41. A 50-year-old white male presents with fatigue, weight loss, and fever and is later
diagnosed with Stage IV Hodgkin lymphoma. Additional labs include: Hgb 9.1 g/dL, WBC
23,000/µL, Plt 120,000/µL, albumin 3.2 g/dL, SCr 1.1 g/dL, and bili 1 g/dL.What would be
the most effective initial risk-adapted treatment for this patient?
A. COPP/ABVD
B. ABVD
C. MOPP
D. Escalated dose BEACOPP
42. A 22-year-old male with Stage IV Hodgkin lymphoma wants to retain fertility. What
chemotherapy regimen would you recommend for this patient?
A. ABVD
B. MOPP
C. ChlVPP
D. MOPP/ABV hybrid
43. A 25-year-old female is diagnosed early-stage Hodgkin lymphoma with favorable
prognosis. She is going to receive four cycles of ABVD. What is the overall survival rate
for this patient?
A. >10%
B. >30%
C. >60%
D. >90%
44. Which of the following long-term toxicities is a greater concern for escalated dose
BEACOPP as compared with ABVD?
A. Cardiac disease
B. Secondary leukemia
C. Interstitial pulmonary fibrosis
D. Renal insufficiency
45. Which of the following statements is true about a patient who relapses 4 months after
receiving MOPP chemotherapy for Stage IV Hodgkin lymphoma?
A. Autologous hematopoietic stem cell transplant offers a relatively high chance of
cure
B. The patient will likely be cured with ABVD or the Stanford V regimen
C. Salvage therapy should include radiation to optimize the cure rate
D. Patients who have an early relapse (<1 year) are not curable
46. Brentuximab is a monoclonal antibody targeted against lymphoma cells. What is the
molecular target of brentuximab?
A. CD20
B. CD30
C. CD52
D. LAP (lymphoma-associated protein)
47. Which of the following classification systems is currently used for non-Hodgkin
lymphoma?
A. REAL-WHO
B. Luke-Collins
C. Kiel
D. International Working Formulation
48. What is the clinical objective of the IPI and FLIPI score?
A. To classify the lymphoma as either indolent or aggressive
B. To predict likelihood for conversion to a more aggressive histology
C. To classify the lymphoma into molecular subtypes
D. To predict prognosis (i.e., survival)
49. What is the appropriate treatment for a newly diagnosed patient with advanced-stage
follicular lymphoma?
A. No initial treatment (“watch and wait”)
B. Rituximab alone
C. Rituximab and CHOP chemotherapy (R-CHOP)
D. All of the above are appropriate treatment options, depending on patient and
tumor characteristics and patient and physician preferences.
50. Which of the following terms best describe Bexxar and Zevalin?
A. Monoclonal antibodies
B. Radioimmunoconjugates
C. Immunotoxins
D. Recombinant proteins
51. What is the appropriate treatment for a newly diagnosed patient with advanced-stage
diffuse large B-cell lymphoma?
A. Rituximab and CHOP chemotherapy (R-CHOP)
B. Bendamustine
C. CHOP chemotherapy
D. Bexxar or Zevalin
52. Which of the following statements best describe the results of appropriate treatment in
patients with advanced-stage diffuse large B-cell lymphoma?
A. About 30% to 60% of patients can be cured of their cancer
B. About 60% to 90% of patients can be cured of their cancer
C. Patients are not cured of their disease, but they will probably live longer
D. Patients will probably not live longer, but they may have improved quality of life
53. Which of the following chemotherapy regimens warrant primary prophylaxis with
granulocyte colony-stimulating factor?
A. Dose-dense CHOP
B. Escalated-dose BEACOPP
C. BEACOPP-14
D. All of the above
54. A 50-year-old woman is in the clinic today to receive her third cycle of R-CHOP
(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for non-Hodgkin
lymphoma. He is very anxious, with nausea and vomiting lasting for about 12 hours after
his previous cycle of chemotherapy. The antiemetic regimen he received for his previous
cycle of chemotherapy was Granisetron × 1 dose plus dexamethasone × 1 dose
administered 30 minutes before chemotherapy.
Which regimen is most appropriate for the patient to receive on day 1 of the next cycle of
chemotherapy?
a. Granisetron × 1 dose plus dexamethasone × 1 dose administered 30 minutes before
chemotherapy.
b. Dolasetron × 1 dose plus dexamethasone × 1 dose administered 30 minutes before
chemotherapy.
c. Palonosetron × 1 dose plus dexamethasone × 1 dose plus lorazepam × 1 dose
administered 30 minutes before chemotherapy.
d. Metoclopramide × 1 dose plus dexamethasone × 1 dose plus aprepitant × 1 dose
administered 30 minutes before chemotherapy.
55. What is the first-line treatment of choice for a patient with Stage IIA Classical
Hodgkin lymphoma?
A. ABVD chemotherapy
B. Surgical resection
C. Involved field radiation
D. All of the above
56. Which of the following is not a “B” symptom?
A. Night sweats
B. Fever
C. Pruritus
D. Weight loss (>10%)
57. A 50-year-old white male presents with fatigue, weight loss, and fever and is later
diagnosed with Stage IV Hodgkin lymphoma. Additional labs include: Hgb 9.1 g/dL, WBC
23,000/µL, Plt 120,000/µL, albumin 3.2 g/dL, SCr 1.1 g/dL, and bili 1 g/dL.What would be
the most effective initial risk-adapted treatment for this patient?
A. COPP/ABVD
B. ABVD
C. MOPP
D. Escalated dose BEACOPP
58. A 22-year-old male with Stage IV Hodgkin lymphoma wants to retain fertility. What
chemotherapy regimen would you recommend for this patient?
A. ABVD
B. MOPP
C. ChlVPP
D. MOPP/ABV hybrid
59. A 25-year-old female is diagnosed early-stage Hodgkin lymphoma with favorable
prognosis. She is going to receive four cycles of ABVD. What is the overall survival rate
for this patient?
A. >10%
B. >30%
C. >60%
D. >90%
60. Which of the following long-term toxicities is a greater concern for escalated dose
BEACOPP as compared with ABVD?
A. Cardiac disease
B. Secondary leukemia
C. Interstitial pulmonary fibrosis
D. Renal insufficiency
61. Which of the following statements is true about a patient who relapses 4 months after
receiving MOPP chemotherapy for Stage IV Hodgkin lymphoma?
A. Autologous hematopoietic stem cell transplant offers a relatively high chance of
cure
B. The patient will likely be cured with ABVD or the Stanford V regimen
C. Salvage therapy should include radiation to optimize the cure rate
D. Patients who have an early relapse (<1 year) are not curable
62. Brentuximab is a monoclonal antibody targeted against lymphoma cells. What is the
molecular target of brentuximab?
A. CD20
B. CD30
C. CD52
D. LAP (lymphoma-associated protein)
63. Which of the following classification systems is currently used for non-Hodgkin
lymphoma?
A. REAL-WHO
B. Luke-Collins
C. Kiel
D. International Working Formulation
64. What is the clinical objective of the IPI and FLIPI score?
A. To classify the lymphoma as either indolent or aggressive
B. To predict likelihood for conversion to a more aggressive histology
C. To classify the lymphoma into molecular subtypes
D. To predict prognosis (i.e., survival)
65. What is the appropriate treatment for a newly diagnosed patient with advanced-stage
follicular lymphoma?
A. No initial treatment (“watch and wait”)
B. Rituximab alone
C. Rituximab and CHOP chemotherapy (R-CHOP)
D. All of the above are appropriate treatment options, depending on patient and
tumor characteristics and patient and physician preferences
66. Which of the following terms best describe Bexxar and Zevalin?
A. Monoclonal antibodies
B. Radioimmunoconjugates
C. Immunotoxins
D. Recombinant proteins
67. What is the appropriate treatment for a newly diagnosed patient with advanced-stage
diffuse large B-cell lymphoma?
A. Rituximab and CHOP chemotherapy (R-CHOP)
B. Bendamustine
C. CHOP chemotherapy
D. Bexxar or Zevalin
68. Which of the following statements best describe the results of appropriate treatment in
patients with advanced-stage diffuse large B-cell lymphoma?
A. About 30% to 60% of patients can be cured of their cancer
B. About 60% to 90% of patients can be cured of their cancer
C. Patients are not cured of their disease, but they will probably live longer
D. Patients will probably not live longer, but they may have improved quality of life
69. Which of the following chemotherapy regimens warrant primary prophylaxis with
granulocyte colony-stimulating factor?
A. Dose-dense CHOP
B. Escalated-dose BEACOPP
C. BEACOPP-14
D. All of the above
70. A 50-year-old woman is in the clinic today to receive her third cycle of R-CHOP
(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for non-Hodgkin
lymphoma. He is very anxious, with nausea and vomiting lasting for about 12 hours after
his previous cycle of chemotherapy. The antiemetic regimen he received for his previous
cycle of chemotherapy was Granisetron × 1 dose plus dexamethasone × 1 dose
administered 30 minutes before chemotherapy.
Which regimen is most appropriate for the patient to receive on day 1 of the next cycle of
chemotherapy?
a. Granisetron × 1 dose plus dexamethasone × 1 dose administered 30 minutes
before chemotherapy.
b. Dolasetron × 1 dose plus dexamethasone × 1 dose administered 30 minutes
before chemotherapy.
c. Palonosetron × 1 dose plus dexamethasone × 1 dose plus lorazepam × 1 dose
administered 30 minutes before chemotherapy.
d. Metoclopramide × 1 dose plus dexamethasone × 1 dose plus aprepitant × 1 dose
administered 30 minutes before chemotherapy.
71. Mr. T.Y., a 34-year-old male, is diagnosed with acute promyelocytic leukemia (APL).
Which of the following cytogenetic abnormalities is associated with APL?
A. t(9;22)
B. t(15;17)
C. t(8;14)
D. t(8;21)
72. Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent performance
status, an ejection fraction of 65%, and has no prior history of a myelodysplastic
syndrome. Based on the information listed above, what would be the most appropriate
treatment regimen?
A. Nilotinib 400 mg orally twice daily
B. Tretinoin 45 mg/m2/day divided into two doses orally plus an anthracycline for
four doses
C. Cytarabine 100 mg/m2 IV continuous infusion daily for 7 days plus an anthracycline for
3 days
D. Vincristine, prednisone, daunorubicin, and pegaspargase
73. Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent performance
status, an ejection fraction of 65%, and has no prior history of a myelodysplastic
syndrome. All of the following are side effects of the treatment chosen for APL except:
A. Prolonged QTc interval
B. Disseminated intravascular coagulation
C. Hyperleukocytosis
D. Differentiation syndrome
74. Poor prognostic factors in acute myeloid leukemia (AML) include:
A. Philadelphia chromosome-positive, high WBC at diagnosis, lack of CR after 4 to 5
weeks of induction chemotherapy
B. Older age, normal cytogenetics, low platelet count at diagnosis
C. t(15;17), preceding hematologic disorder, low platelet count at diagnosis
D. Older age, preceding hematologic disorder, del(5q)
75. Standard induction chemotherapy for pediatric acute lymphocytic leukemia (ALL)
includes:
A. High-dose cytarabine with or without anthracyclines
B. Vincristine, corticosteroid, and pegaspargase
C. Methotrexate, mercaptopurine, with or without prednisone
D. Daunorubicin, cytarabine, and etoposide
76. H.R. is a 73-year-old man, who presents with fever, increased fatigue, and bruising. A
complete blood count reveals a white cell (WBC) count of 900 cells/mm3, Hb of 7.8 g/dL,
and platelets of 44,000/mm3. After his workup, he is diagnosed with AML and also
develops disseminated intravascular coagulopathy. He has normal cytogenetics. The most
appropriate treatment regimen for H.R. is:
A. Cytarabine 2,000 mg/m2 IV every 12 hours on days 1, 3, and 5
B. All-trans retinoic acid orally 45 mg/m2/day divided into two doses
C. Daunorubicin 45 mg/m2/day on days 1 through 3 plus cytarabine 2,000 mg/m2/day IV
continuous infusion on days 1 through 7
D. Clofarabine 30 mg/m2/day IV on days 1 to 5
77. Which of the following are associated with a good prognosis in pediatric ALL?
A. Philadelphia chromosome
B. Trisomies of chromosome 4 and 10
C. T-cell immunophenotype
D. Mixed-lineage leukemia (MLL) gene rearrangement
78. When considering differentiation syndrome, which of the following is false?
A. Arsenic is not associated with differentiation syndrome
B. The syndrome may be predicted by the WBC at diagnosis
C. The syndrome is most commonly manifested as fever, weight gain, prolonged QTc
syndrome, and respiratory distress
D. The treatment of choice for differentiation syndrome is dexamethasone 10 mg IV twice
daily
79) To establish a diagnosis of adult AML, all of the following tests and procedures are
essential except:
A. Bone marrow aspirate and biopsy
B. Cytogenetic analysis
C. Lumbar puncture
D. Cytochemical staining
80) Therapy for pediatric ALL is divided into five phases. Which of the following
describes the correct sequence of treatment?
A. Remission induction, consolidation, delayed intensification, interim maintenance, and
maintenance
B. Interim maintenance, remission induction, delayed intensification, consolidation, and
maintenance
C. Remission induction, consolidation, interim maintenance, delayed intensification, and
maintenance
D. Interim maintenance, consolidation, delayed intensification, remission induction, and
maintenance
81) All of the following are poor prognostic risk factors for acute lymphoblastic leukemia,
except:
A. Age < 1 year
B. White blood cell count > 50,000 cells/mm3
C. t(4;11) or t (9;22)
D. TEL-AML
82) P.L. is a 14-year-old female who has started induction therapy for acute lymphoblastic
leukemia. Her monitoring plan should include the following:
A. Calcium, phosphorus, uric acid, glucose, CBC, and platelets
B. Calcium, phosphorus, uric acid, creatinine, glucose, CBC, and platelets
C. CBC and platelets
D. Calcium, phosphorus, and CBC
83) R.L. is a 49-year-old male with newly diagnosed acute lymphoblastic leukemia.
Cytogenetic analysis reveals t(9:22). His induction chemotherapy treatment regimen
should include which of the following agents?
A. Daunorubicin, vinblastine, prednisone, pegaspargase, and rituximab
B. Doxorubicin, methotrexate, dexamethasone, and trastuzumab
C. Daunorubicin, vincristine, prednisone, pegaspargase, and imatinib
D. Clofarabine, cytarabine, dexamethasone, and imatinib
84. For chronic myeloid leukemia (CML), a first-line treatment that is the best option for
keeping the disease in remission for the long-term with manageable toxicity is:
A. Interferon alfa
B. Allogeneic stem cell transplant
C. Imatinib
D. Cytarabine
E. Busulfan
85. The molecular marker in hematopoietic progenitor cells that defines CML is known as
which of the following?
A. Philadelphia chromosome (translocation of chromosome 9 and 22)
B. Deletion of chromosome 17
C. Deletion of chromosome 13
D. Inversion of chromosome 16
E. Translocation of chromosome 15 and 17
86. If a patient being treated for CML has the T315I mutation, which of the following is
the best option for inducing a clinical response?
A. Hydroxyurea
B. Imatinib
C. Ponatinib
D. Interferon alfa
E. Dasatinib
87. Which one of the following agents has clinical data that demonstrates the highest
degree of molecular response in first-line treatment of CML with at least 2 years of followup?
A. Ponatinib
B. Omacetaxine
C. Nilotinib
D. Imatinib
E. Lenalidomide
88. Which one of the following most accurately describes prominent toxicities to be
monitored for patients receiving dasatinib?
A. Myelosuppression, myalgias, pleural effusion
B. SIADH, alopecia, mucositis
C. Seizure, peripheral neuropathy, constipation
D. Thromboembolism, somnolence, neuropathy
E. Nausea/vomiting, neuropathy, hearing loss
89. Which one of the following patients with CML would be the best candidate for an
allogeneic stem cell transplant?
A. A 62-year-old patient with newly diagnosed disease, sibling-matched donor available
and no prior treatment for CML
B. A 45-year-old patient with a sibling match and CML harboring a T315I mutation
with disease that has progressed following salvage therapy with ponatinib
C. A 71-year-old patient with refractory CML to imatinib and a second-generation tyrosine
kinase inhibitor who has no suitable match for transplant
D. A 71-year-old patient with refractory CML to front-line nilotinib who has a sibling
match
E. A 31-year-old patient in chronic phase with molecular response achieved with imatinib
90. A newly diagnosed chronic phase CML patient is started on primary therapy with
imatinib 400 mg orally daily. At 3 months, the patient has not yet achieved a complete
hematologic remission, what is the most appropriate course of action?
A. Repeat the bone marrow biopsy for cytogenetic analysis
B. Continue imatinib 400 mg orally daily until 6 months then assess molecular response
C. Consider second-generation tyrosine kinase inhibitor, clinical trial, or
hematopoietic stem cell transplant if an appropriate candidate
D. Hold imatinib and monitor molecular response for the next 3 months
E. Discontinue imatinib and start interferon alfa plus cytarabine
91. A patient with CML progresses to myeloid blast crisis despite having received three
lines of tyrosine kinase inhibitor based therapy over the course of 22 months. What is the
best course of action for further therapy?
A. Re-treat with tyrosine kinase inhibitor therapy that was used first-line
B. There are no further treatment options
C. Induction/remission therapy with cytarabine and an anthracycline
D. Hydroxyurea
E. Refer for consideration of hospice
92. A standard first-line treatment for a patient with CLL with Stage III disease with
progressive symptoms such as thrombocytopenia, anemia, and lymphadenopathy would
be which of the following treatments?
A. No therapy
B. Autologous stem cell transplant
C. Bendamustine and rituximab
D. Imatinib
E. Bortezomib
93. Which of the following predicts a more aggressive disease course and shorter remission
with standard treatment options for CLL patients?
A. Age less than 70 years
B. Presence of the Philadelphia chromosome (translocation of chromosomes 9 and 22)
C. Presence of the cytogenetic abnormality involving deletion of chromosome 17
D. Having a confirmed sibling matched donor for allogeneic stem cell transplant
E. Presence of the cytogenetic abnormality involving deletion of chromosome 13
94. A 69-year-old patient with newly diagnosed stage III chronic lymphocytic leukemia
(CLL) is being considered for initial therapy. The patient has medical comorbidities
including diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease
(COPD), and diabetic neuropathy. The patient does not have the poor prognostic
cytogenetic abnormalities. Which one of the following treatment options would be best to
provide the patient with a chance for disease response while considering the patient’s frail
health?
A. Cytarabine and daunorubicin
B. Oxaliplatin, fludarabine, alemtuzumab, and rituximab
C. Bendamustine and rituximab
D. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
E. Carfilzomib
95. Which of the following regimens has demonstrated improvement in disease time to
progression for CLL treatment in both the front-line and second-line treatment settings?
A. Lenalidomide
B. Fludarabine, cyclophosphamide, and rituximab
C. Chlorambucil and prednisone
D. Ofatumumab
E. Nilotinib
96. Patients receiving active treatment for CLL may require which of the following
supportive care measures?
A. IV immune globulin for hypogammaglobinemia
B. Prophylactic cranial irradiation
C. Leucovorin rescue to prevent mucositis
D. Allopurinol for hyperuricemia
E. Zoledronic acid for treatment of bone lytic lesions
97. A 56-year-old female patient is receiving alemtuzumab as second-line therapy for
CLL. Which one of the following is the best choice as a supportive care measure for this
patient?
A. Revaccination with all live vaccines
B. Treatment with trimethoprim/sulfamethoxazole for Pneumocystis prophylaxis
C. White blood cell transfusions if the patient’s absolute neutrophil count falls below 500
mm3
D. Bi-weekly injections with pegfilgrastim
E. Hospitalization for 1 month during initiation of therapy
98. Which of the following treatment settings is most appropriate for the use of
ofatumumab in CLL?
A. First-line treatment as a single agent
B. As an substitute agent for rituximab in patients that experience infusion-related events
with rituximab
C. In combination with fludarabine and cyclophosphamide for front-line treatment
D. For refractory CLL in patients previously treated with a fludarabine-based
regimen and alemtuzumab
E. In combination with conditioning chemotherapy for allogeneic stem cell transplant
99. 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
100. Which one of the following most accurately describes prominent toxicities to be
monitored for patients receiving dasatinib?
A. Myelosuppression, myalgias, pleural effusion
B. SIADH, alopecia, mucositis
C. Seizure, peripheral neuropathy, constipation
D. Thromboembolism, somnolence, neuropathy
E. Nausea/vomiting, neuropathy, hearing loss
101. 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
102. A child is seen in the pediatrician’s office for complaints of bone and joint pain.
Which of the following other assessment findings may suggest acute myeloid leukemia
(AML)?
a.
b.
c.
d.
Abdominal pain
Increased activity level
Increased appetite
Petechiae
103. Mr. T.Y., a 34-year-old male, is diagnosed with acute promyelocytic leukemia (APL).
Which of the following cytogenetic abnormalities is associated with APL?
A. t(9;22)
B. t(15;17)
C. t(8;14)
D. t(8;21)
104. Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent
performance status, an ejection fraction of 65%, and has no prior history of a
myelodysplastic syndrome. Based on the information listed above, what would be the most
appropriate treatment regimen?
A. Nilotinib 400 mg orally twice daily
B. Tretinoin 45 mg/m2/day divided into two doses orally plus an anthracycline for
four doses
C. Cytarabine 100 mg/m2 IV continuous infusion daily for 7 days plus an anthracycline for
3 days
D. Vincristine, prednisone, daunorubicin, and pegaspargase
105. Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent
performance status, an ejection fraction of 65%, and has no prior history of a
myelodysplastic syndrome. All of the following are side effects of the treatment chosen for
APL except:
A. Prolonged QTc interval
B. Disseminated intravascular coagulation
C. Hyperleukocytosis
D. Differentiation syndrome
106. Poor prognostic factors in acute myeloid leukemia (AML) include:
A. Philadelphia chromosome-positive, high WBC at diagnosis, lack of CR after 4 to 5
weeks of induction chemotherapy
B. Older age, normal cytogenetics, low platelet count at diagnosis
C. t(15;17), preceding hematologic disorder, low platelet count at diagnosis
D. Older age, preceding hematologic disorder, del(5q)
107. Standard induction chemotherapy for pediatric acute lymphocytic leukemia (ALL)
includes:
A. High-dose cytarabine with or without anthracyclines
B. Vincristine, corticosteroid, and pegaspargase
C. Methotrexate, mercaptopurine, with or without prednisone
D. Daunorubicin, cytarabine, and etoposide
108. H.R. is a 73-year-old man, who presents with fever, increased fatigue, and bruising.
A complete blood count reveals a white cell (WBC) count of 900 cells/mm3, Hb of 7.8 g/dL,
and platelets of 44,000/mm3. After his workup, he is diagnosed with AML and also
develops disseminated intravascular coagulopathy. He has normal cytogenetics. The most
appropriate treatment regimen for H.R. is:
A. Cytarabine 2,000 mg/m2 IV every 12 hours on days 1, 3, and 5
B. All-trans retinoic acid orally 45 mg/m2/day divided into two doses
C. Daunorubicin 45 mg/m2/day on days 1 through 3 plus cytarabine 2,000 mg/m2/day IV
continuous infusion on days 1 through 7
D. Clofarabine 30 mg/m2/day IV on days 1 to 5
109. Which of the following are associated with a good prognosis in pediatric ALL?
A. Philadelphia chromosome
B. Trisomies of chromosome 4 and 10
C. T-cell immunophenotype
D. Mixed-lineage leukemia (MLL) gene rearrangement
110. When considering differentiation syndrome, which of the following is false?
A. Arsenic is not associated with differentiation syndrome
B. The syndrome may be predicted by the WBC at diagnosis
C. The syndrome is most commonly manifested as fever, weight gain, prolonged QTc
syndrome, and respiratory distress
D. The treatment of choice for differentiation syndrome is dexamethasone 10 mg IV twice
daily
111. To establish a diagnosis of adult AML, all of the following tests and procedures are
essential except:
A. Bone marrow aspirate and biopsy
B. Cytogenetic analysis
C. Lumbar puncture
D. Cytochemical staining
112. Therapy for pediatric ALL is divided into five phases. Which of the following
describes the correct sequence of treatment?
A. Remission induction, consolidation, delayed intensification, interim maintenance, and
maintenance
B. Interim maintenance, remission induction, delayed intensification, consolidation, and
maintenance
C. Remission induction, consolidation, interim maintenance, delayed intensification, and
maintenance
D. Interim maintenance, consolidation, delayed intensification, remission induction, and
maintenance
113. All of the following are poor prognostic risk factors for acute lymphoblastic leukemia,
except:
A. Age < 1 year
B. White blood cell count > 50,000 cells/mm3
C. t(4;11) or t (9;22)
D. TEL-AML
114. P.L. is a 14-year-old female who has started induction therapy for acute
lymphoblastic leukemia. Her monitoring plan should include the following:
A. Calcium, phosphorus, uric acid, glucose, CBC, and platelets
B. Calcium, phosphorus, uric acid, creatinine, glucose, CBC, and platelets
C. CBC and platelets
D. Calcium, phosphorus, and CBC
115. R.L. is a 49-year-old male with newly diagnosed acute lymphoblastic leukemia.
Cytogenetic analysis reveals t(9:22). His induction chemotherapy treatment regimen
should include which of the following agents?
A. Daunorubicin, vinblastine, prednisone, pegaspargase, and rituximab
B. Doxorubicin, methotrexate, dexamethasone, and trastuzumab
C. Daunorubicin, vincristine, prednisone, pegaspargase, and imatinib
D. Clofarabine, cytarabine, dexamethasone, and imatinib
116. For chronic myeloid leukemia (CML), a first-line treatment that is the best option for
keeping the disease in remission for the long-term with manageable toxicity is:
A. Interferon alfa
B. Allogeneic stem cell transplant
C. Imatinib
D. Cytarabine
E. Busulfan
117. Most cases > 60 years old. Most common leukemia in adults
A. AML (Acute Myelogenous Leukemia)
B. (Acute Lymphocytic Leukemia)
C. LL (Chronic Lymphocytic Leukemia)
D. CML (Chronic Myelogenous Leukemia)
3. R-CHOP stands for R = Rituximab. C = Cyclophosphamide. H = Doxorubicin
Hydrochloride (Hydroxydaunomycin) O = Vincristine Sulfate (Oncovin)
118. The molecular marker in hematopoietic progenitor cells that defines CML is known
as which of the following?
A. Philadelphia chromosome (translocation of chromosome 9 and 22)
B. Deletion of chromosome 17
C. Deletion of chromosome 13
D. Inversion of chromosome 16
E. Translocation of chromosome 15 and 17
119. If a patient being treated for CML has the T315I mutation, which of the following is
the best option for inducing a clinical response?
A. Hydroxyurea
B. Imatinib
C. Ponatinib
D. Interferon alfa
E. Dasatinib
120. Which one of the following agents has clinical data that demonstrates the highest
degree of molecular response in first-line treatment of CML with at least 2 years of followup?
A. Ponatinib
B. Omacetaxine
C. Nilotinib
D. Imatinib
E. Lenalidomide
121. Which one of the following most accurately describes prominent toxicities to be
monitored for patients receiving dasatinib?
A. Myelosuppression, myalgias, pleural effusion
B. SIADH, alopecia, mucositis
C. Seizure, peripheral neuropathy, constipation
D. Thromboembolism, somnolence, neuropathy
E. Nausea/vomiting, neuropathy, hearing loss
120. Which one of the following patients with CML would be the best candidate for an
allogeneic stem cell transplant?
A. A 62-year-old patient with newly diagnosed disease, sibling-matched donor available
and no prior treatment for CML
B. A 45-year-old patient with a sibling match and CML harboring a T315I mutation
with disease that has progressed following salvage therapy with ponatinib
C. A 71-year-old patient with refractory CML to imatinib and a second-generation tyrosine
kinase inhibitor who has no suitable match for transplant
D. A 71-year-old patient with refractory CML to front-line nilotinib who has a sibling
match
E. A 31-year-old patient in chronic phase with molecular response achieved with imatinib
122. A newly diagnosed chronic phase CML patient is started on primary therapy with
imatinib 400 mg orally daily. At 3 months, the patient has not yet achieved a complete
hematologic remission, what is the most appropriate course of action?
A. Repeat the bone marrow biopsy for cytogenetic analysis
B. Continue imatinib 400 mg orally daily until 6 months then assess molecular response
C. Consider second-generation tyrosine kinase inhibitor, clinical trial, or
hematopoietic stem cell transplant if an appropriate candidate
D. Hold imatinib and monitor molecular response for the next 3 months
E. Discontinue imatinib and start interferon alfa plus cytarabine
123. A patient with CML progresses to myeloid blast crisis despite having received three
lines of tyrosine kinase inhibitor based therapy over the course of 22 months. What is the
best course of action for further therapy?
A. Re-treat with tyrosine kinase inhibitor therapy that was used first-line
B. There are no further treatment options
C. Induction/remission therapy with cytarabine and an anthracycline
D. Hydroxyurea
E. Refer for consideration of hospice
124. A standard first-line treatment for a patient with CLL with Stage III disease with
progressive symptoms such as thrombocytopenia, anemia, and lymphadenopathy would
be which of the following treatments?
A. No therapy
B. Autologous stem cell transplant
C. Bendamustine and rituximab
D. Imatinib
E. Bortezomib
125. Which of the following predicts a more aggressive disease course and shorter
remission with standard treatment options for CLL patients?
A. Age less than 70 years
B. Presence of the Philadelphia chromosome (translocation of chromosomes 9 and 22)
C. Presence of the cytogenetic abnormality involving deletion of chromosome 17
D. Having a confirmed sibling matched donor for allogeneic stem cell transplant
E. Presence of the cytogenetic abnormality involving deletion of chromosome 13
126. A 69-year-old patient with newly diagnosed stage III chronic lymphocytic leukemia
(CLL) is being considered for initial therapy. The patient has medical comorbidities
including diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease
(COPD), and diabetic neuropathy. The patient does not have the poor prognostic
cytogenetic abnormalities. Which one of the following treatment options would be best to
provide the patient with a chance for disease response while considering the patient’s frail
health?
A. Cytarabine and daunorubicin
B. Oxaliplatin, fludarabine, alemtuzumab, and rituximab
C. Bendamustine and rituximab
D. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
E. Carfilzomib
127. Which of the following regimens has demonstrated improvement in disease time to
progression for CLL treatment in both the front-line and second-line treatment settings?
A. Lenalidomide
B. Fludarabine, cyclophosphamide, and rituximab
C. Chlorambucil and prednisone
D. Ofatumumab
E. Nilotinib
128. Patients receiving active treatment for CLL may require which of the following
supportive care measures?
A. IV immune globulin for hypogammaglobinemia
B. Prophylactic cranial irradiation
C. Leucovorin rescue to prevent mucositis
D. Allopurinol for hyperuricemia
E. Zoledronic acid for treatment of bone lytic lesions
129. A 56-year-old female patient is receiving alemtuzumab as second-line therapy for
CLL. Which one of the following is the best choice as a supportive care measure for this
patient?
A. Revaccination with all live vaccines
B. Treatment with trimethoprim/sulfamethoxazole for Pneumocystis prophylaxis
C. White blood cell transfusions if the patient’s absolute neutrophil count falls below 500
mm3
D. Bi-weekly injections with pegfilgrastim
E. Hospitalization for 1 month during initiation of therapy
130. Which of the following treatment settings is most appropriate for the use of
ofatumumab in CLL?
A. First-line treatment as a single agent
B. As an substitute agent for rituximab in patients that experience infusion-related events
with rituximab
C. In combination with fludarabine and cyclophosphamide for front-line treatment
D. For refractory CLL in patients previously treated with a fludarabine-based
regimen and alemtuzumab
E. In combination with conditioning chemotherapy for allogeneic stem cell transplant
131. 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
132) Mr. T.Y., a 34-year-old male, is diagnosed with acute promyelocytic leukemia (APL).
Which of the following cytogenetic abnormalities is associated with APL?
A. t(9;22)
B. t(15;17)
C. t(8;14)
D. t(8;21)
133) Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent
performance status, an ejection fraction of 65%, and has no prior history of a
myelodysplastic syndrome. Based on the information listed above, what would be the most
appropriate treatment regimen?
A. Nilotinib 400 mg orally twice daily
B. Tretinoin 45 mg/m2/day divided into two doses orally plus an anthracycline for four doses
C. Cytarabine 100 mg/m2 IV continuous infusion daily for 7 days plus an anthracycline for 3
days
D. Vincristine, prednisone, daunorubicin, and pegaspargase
134) Mr. T.Y., a 34-year-old male, is diagnosed with APL. He has an excellent
performance status, an ejection fraction of 65%, and has no prior history of a
myelodysplastic syndrome. All of the following are side effects of the treatment chosen for
APL except:
A. Prolonged QTc interval
B. Disseminated intravascular coagulation
C. Hyperleukocytosis
D. Differentiation syndrome
135) Poor prognostic factors in acute myeloid leukemia (AML) include:
A. Philadelphia chromosome-positive, high WBC at diagnosis, lack of CR after 4 to 5
weeks of induction chemotherapy
B. Older age, normal cytogenetics, low platelet count at diagnosis
C. t(15;17), preceding hematologic disorder, low platelet count at diagnosis
D. Older age, preceding hematologic disorder, del(5q)
136) Standard induction chemotherapy for pediatric acute lymphocytic leukemia (ALL)
includes:
A. High-dose cytarabine with or without anthracyclines
B. Vincristine, corticosteroid, and pegaspargase
C. Methotrexate, mercaptopurine, with or without prednisone
D. Daunorubicin, cytarabine, and etoposide
137) H.R. is a 73-year-old man, who presents with fever, increased fatigue, and bruising. A
complete blood count reveals a white cell (WBC) count of 900 cells/mm3, Hb of 7.8 g/dL,
and platelets of 44,000/mm3. After his workup, he is diagnosed with AML and also
develops disseminated intravascular coagulopathy. He has normal cytogenetics. The most
appropriate treatment regimen for H.R. is:
A. Cytarabine 2,000 mg/m2 IV every 12 hours on days 1, 3, and 5
B. All-trans retinoic acid orally 45 mg/m2/day divided into two doses
C. Daunorubicin 45 mg/m2/day on days 1 through 3 plus cytarabine 2,000 mg/m2/day IV
continuous infusion on days 1 through 7
D. Clofarabine 30 mg/m2/day IV on days 1 to 5
138) Which of the following are associated with a good prognosis in pediatric ALL?
A. Philadelphia chromosome
B. Trisomies of chromosome 4 and 10
C. T-cell immunophenotype
D. Mixed-lineage leukemia (MLL) gene rearrangement
139) When considering differentiation syndrome, which of the following is false?
A. Arsenic is not associated with differentiation syndrome
B. The syndrome may be predicted by the WBC at diagnosis
C. The syndrome is most commonly manifested as fever, weight gain, prolonged QTc
syndrome, and respiratory distress
D. The treatment of choice for differentiation syndrome is dexamethasone 10 mg IV twice
daily
140) To establish a diagnosis of adult AML, all of the following tests and procedures are
essential except:
A. Bone marrow aspirate and biopsy
B. Cytogenetic analysis
C. Lumbar puncture
D. Cytochemical staining
141) Therapy for pediatric ALL is divided into five phases. Which of the following
describes the correct sequence of treatment?
A. Remission induction, consolidation, delayed intensification, interim maintenance, and
maintenance
B. Interim maintenance, remission induction, delayed intensification, consolidation, and
maintenance
C. Remission induction, consolidation, interim maintenance, delayed intensification, and
maintenance
D. Interim maintenance, consolidation, delayed intensification, remission induction, and
maintenance
142) All of the following are poor prognostic risk factors for acute lymphoblastic
leukemia, except:
A. Age < 1 year
B. White blood cell count > 50,000 cells/mm3
C. t(4;11) or t (9;22)
D. TEL-AML
143) P.L. is a 14-year-old female who has started induction therapy for acute
lymphoblastic leukemia. Her monitoring plan should include the following:
A. Calcium, phosphorus, uric acid, glucose, CBC, and platelets
B. Calcium, phosphorus, uric acid, creatinine, glucose, CBC, and platelets
C. CBC and platelets
D. Calcium, phosphorus, and CBC
144) R.L. is a 49-year-old male with newly diagnosed acute lymphoblastic leukemia.
Cytogenetic analysis reveals t(9:22). His induction chemotherapy treatment regimen
should include which of the following agents?
A. Daunorubicin, vinblastine, prednisone, pegaspargase, and rituximab
B. Doxorubicin, methotrexate, dexamethasone, and trastuzumab
C. Daunorubicin, vincristine, prednisone, pegaspargase, and imatinib
D. Clofarabine, cytarabine, dexamethasone, and imatinib
145) For chronic myeloid leukemia (CML), a first-line treatment that is the best option for
keeping the disease in remission for the long-term with manageable toxicity is:
A. Interferon alfa
B. Allogeneic stem cell transplant
C. Imatinib
D. Cytarabine
E. Busulfan
146) The molecular marker in hematopoietic progenitor cells that defines CML is known
as which of the following?
A. Philadelphia chromosome (translocation of chromosome 9 and 22)
B. Deletion of chromosome 17
C. Deletion of chromosome 13
D. Inversion of chromosome 16
E. Translocation of chromosome 15 and 17
147) If a patient being treated for CML has the T315I mutation, which of the following is
the best option for inducing a clinical response?
A. Hydroxyurea
B. Imatinib
C. Ponatinib
D. Interferon alfa
E. Dasatinib
148) Which one of the following agents has clinical data that demonstrates the highest
degree of molecular response in first-line treatment of CML with at least 2 years of followup?
A. Ponatinib
B. Omacetaxine
C. Nilotinib
D. Imatinib
E. Lenalidomide
149) Which one of the following most accurately describes prominent toxicities to be
monitored for patients receiving dasatinib?
A. Myelosuppression, myalgias, pleural effusion
B. SIADH, alopecia, mucositis
C. Seizure, peripheral neuropathy, constipation
D. Thromboembolism, somnolence, neuropathy
E. Nausea/vomiting, neuropathy, hearing loss
150) Which one of the following patients with CML would be the best candidate for an
allogeneic stem cell transplant?
A. A 62-year-old patient with newly diagnosed disease, sibling-matched donor available and
no prior treatment for CML
B. A 45-year-old patient with a sibling match and CML harboring a T315I mutation with
disease that has progressed following salvage therapy with ponatinib
C. A 71-year-old patient with refractory CML to imatinib and a second-generation tyrosine
kinase inhibitor who has no suitable match for transplant
D. A 71-year-old patient with refractory CML to front-line nilotinib who has a sibling match
E. A 31-year-old patient in chronic phase with molecular response achieved with imatinib
151) A newly diagnosed chronic phase CML patient is started on primary therapy with
imatinib 400 mg orally daily. At 3 months, the patient has not yet achieved a complete
hematologic remission, what is the most appropriate course of action?
A. Repeat the bone marrow biopsy for cytogenetic analysis
B. Continue imatinib 400 mg orally daily until 6 months then assess molecular response
C. Consider second-generation tyrosine kinase inhibitor, clinical trial, or hematopoietic stem
cell transplant if an appropriate candidate
D. Hold imatinib and monitor molecular response for the next 3 months
E. Discontinue imatinib and start interferon alfa plus cytarabine
152) A patient with CML progresses to myeloid blast crisis despite having received three
lines of tyrosine kinase inhibitor based therapy over the course of 22 months. What is the
best course of action for further therapy?
A. Re-treat with tyrosine kinase inhibitor therapy that was used first-line
B. There are no further treatment options
C. Induction/remission therapy with cytarabine and an anthracycline
D. Hydroxyurea
E. Refer for consideration of hospice
153) A standard first-line treatment for a patient with CLL with Stage III disease with
progressive symptoms such as thrombocytopenia, anemia, and lymphadenopathy would
be which of the following treatments?
A. No therapy
B. Autologous stem cell transplant
C. Bendamustine and rituximab
D. Imatinib
E. Bortezomib
154. Which of the following predicts a more aggressive disease course and shorter
remission with standard treatment options for CLL patients?
A. Age less than 70 years
B. Presence of the Philadelphia chromosome (translocation of chromosomes 9 and 22)
C. Presence of the cytogenetic abnormality involving deletion of chromosome 17
D. Having a confirmed sibling matched donor for allogeneic stem cell transplant
E. Presence of the cytogenetic abnormality involving deletion of chromosome 13
155) A 69-year-old patient with newly diagnosed stage III chronic lymphocytic leukemia
(CLL) is being considered for initial therapy. The patient has medical comorbidities
including diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease
(COPD), and diabetic neuropathy. The patient does not have the poor prognostic
cytogenetic abnormalities. Which one of the following treatment options would be best to
provide the patient with a chance for disease response while considering the patient’s frail
health?
A. Cytarabine and daunorubicin
B. Oxaliplatin, fludarabine, alemtuzumab, and rituximab
C. Bendamustine and rituximab
D. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
E. Carfilzomib
156) Which of the following regimens has demonstrated improvement in disease time to
progression for CLL treatment in both the front-line and second-line treatment settings?
A. Lenalidomide
B. Fludarabine, cyclophosphamide, and rituximab
C. Chlorambucil and prednisone
D. Ofatumumab
E. Nilotinib
157) Patients receiving active treatment for CLL may require which of the following
supportive care measures?
A. IV immune globulin for hypogammaglobinemia
B. Prophylactic cranial irradiation
C. Leucovorin rescue to prevent mucositis
D. Allopurinol for hyperuricemia
E. Zoledronic acid for treatment of bone lytic lesions
158) A 56-year-old female patient is receiving alemtuzumab as second-line therapy for
CLL. Which one of the following is the best choice as a supportive care measure for this
patient?
A. Revaccination with all live vaccines
B. Treatment with trimethoprim/sulfamethoxazole for Pneumocystis prophylaxis
C. White blood cell transfusions if the patient’s absolute neutrophil count falls below 500 mm3
D. Bi-weekly injections with pegfilgrastim
E. Hospitalization for 1 month during initiation of therapy
159) Which of the following treatment settings is most appropriate for the use of
ofatumumab in CLL?
A. First-line treatment as a single agent
B. As an substitute agent for rituximab in patients that experience infusion-related events with
rituximab
C. In combination with fludarabine and cyclophosphamide for front-line treatment
D. For refractory CLL in patients previously treated with a fludarabine-based regimen and
alemtuzumab
E. In combination with conditioning chemotherapy for allogeneic stem cell transplant
160. A 12-year-old girl suffering from 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
161. 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
162. 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
163. 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. MESNA (2-mercaptoethane sulfonate)
D. Acetylcysteine
E. Vitamin K
F. Protamine sulfate
164. 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
165. 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
166. 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
167. 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
168. 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
169. 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
170. 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
171. 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
118. 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
172 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. MESNA (2-mercaptoethane sulfonate)
D. Acetylcysteine
E. Vitamin K
F. Protamine sulfate
E. Inhibition of microtubule assembly
173. 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
174. 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
175. 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
176. 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
177. 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
178. 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
179. 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 150,00400,000) 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
180. 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
181. 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
182. 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, 5Fluorouracil). 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
183. 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
184. The following diagram shows the intracellular signaling mechanisms involved in Tcell 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
A. What is substance Y?
B. MTOR
C. Immunophillin FKBP -12
D. Calcineurin phosphatase
185. 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. FU
E. Cytosine arabinoside
186. 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
187. 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
188. 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
189. Cells are usually capable of undergoing processes which allow them to adapt to a
given stress. However, sometimes there are irreversible changes. Which one of the
following is an irreversible cellular adaptation?
A Anaplasia
B Hyperplasia
C Metaplasia
D Dysplasia
E Atrophy
190. Cancer has several defining characteristics. Which one of the following would not be
a hallmark of cancer?
A Limited potential for replication
B Evasion of apoptosis
C Self-sufficiency in growth signals
D Immunity to anti-growth signals
E Sustained angiogenesis
191. cell-cycle specific (CCS) drugs include
a. Alkylating agents
b. hormones
c. Antitumor antibiotics
d. All of the above
192. Agents affecting synthesis of nucleic acids (antimetabolites) include
a. folic acid antagonist: MTX (methotrexate)
b. Purine antagonists: 6-MP (6-mercaptopurine),
6-TG (6-thioguanine)
c. Pyrimidine antagonists: 5-FU (5-fluorouracil), Ara-C (cytarabine), gemcitabine
d. All of the above
193. Mechanism of action of MTX is to :
a. inhibits dihydrofolate reductase activity, resulting in tetrahydrofolate (FH4) deficiency and
disorder in DNA synthesis in cancer cells
b. inhibits thymidylate synthase, inhibiting the formation of dTMP from dUMP and resulting in
disorder in DNA synthesis
c. inhibit DNA polymerase and exerting a cytotoxic effect.
d. All of the above
194. Mechanism of action of 5-FU is to:
a. inhibits dihydrofolate reductase activity, resulting in tetrahydrofolate (FH4) deficiency and
disorder in DNA synthesis in cancer cells
b. inhibits thymidylate synthase, inhibiting the formation of dTMP from dUMP and resulting in
disorder in DNA synthesis
c. inhibit DNA polymerase and exerting a cytotoxic effect.
d. All of the above
195. Adverse effects of MTX include:
a. myelosupression
b. alopecia
c. gastrointestinal reactions
d. All of the above
196. Clinical uses of Carmustine (BCNU) include
a. treatment of malignant astrocytomas and metastatic tumors of the brain
b. treatment of lymphomas.
c. treatment of multiple myeloma and chronic lymphocytic leukemia.
d. treatment of carcinomas of the lung, breast, cervix and ovary .
197. Adverse reactions of DDP( Cisplatins) include:
a. gastrointestinal distress
b. myelosupression,
c. ototoxicity and mild hepatotoxicity.
d. All of the above
198. Mechanism of Camptothecins is to:
a. target the nuclear enzyme topoisomerase I, causing damage of DNA structure and function
b. inhibits thymidylate synthase, inhibiting the formation of dTMP from dUMP and resulting in
disorder in DNA synthesis
c. inhibit DNA polymerase and exerting a cytotoxic effect.
d. All of the above
199. A target organ of doxorubicin-induced toxicity is
a. lung
b. heart
c. kidney
d. Brain
e. Stomach
200. Mechanism of action of MTX is to
a. inhibits dihydrofolate reductase activity, resulting in tetrahydrofolate (FH4) deficiency and
disorder in DNA synthesis in cancer cells
b. inhibits thymidylate synthase, inhibiting the formation of dTMP from dUMP and
resulting in disorder in DNA synthesis
c. inhibit DNA polymerase and exerting a cytotoxic effect.
d. Inhibit cell wall synthesis
e. Inhibit protein synthesis
201. Major acute side effect of cisplatin (Platinol)
a. bone marrow depression.and nephrotoxicity
b. renal dysfunction
c. Alopecia
d. acoustic nerve dysfunction
e. Neurotoxicity
202. Which of the following chemotherapeutic agents is specific for the M phase of the cell
cycle?
a. Cytarabine
b. Daunorubicin
c. Hydroxyurea
d. Mechlorethamine
e. Vincristine
203. 5. A 75-year-old man recently diagnosed with chronic lymphocytic leukemia started a
treatment with vinchristine. Which of the following statements best explains the mechanism
of action of this anticancer drug?
a. Inhibition of microtubule assembly
b. Formation of covalent bonds with nucleophile groups on DNA bases
c. Inhibition of DNA chain elongation
d. Inhibition of thymidylate synthetase
204. 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 prevents microtubule disassembly into tubulin monomers
b. It prevents assembly of tubulin dimers into microtubules
c. It alkylates nucleophilic groups on DNA bases
d. It intercalates between DNA strands and inhibit topoisomerase II
205. 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 M phase of the tumor cell cycle?
a. Vinblastine
c. Doxorubicin
b. Bleomycin
d. Dacarbazine
206. MDR(multi-drug resistance) to is a P-glycoprotein drug efflux pump used for
a. induction of resistance to chemotherapy.
b. targeting the cancer cells since it is expressed only in tumor cells.
c. stimulating the immune system
d. Identification of cancer cells
e. Monitoring the cancer prognosis.
207. Carmustine (BCNU) is
a. alkylating agent of DNA and RNA molecules. It is mainly used in the treatment of
malignant astrocytomas because of its ability to cross the blood-brain barrier.
b. The toxicities to bone marrow and gastrointestinal tract is very limited
c. It is anti-metabolite, used in treatment of Hepatic cancer.
d. Antibiotic and its mechanism of action depends on inhibition of tolemerase
e. Characterized by long half life, so, it can be used once.
208. In the development of cancer, there are two main types of genes; oncogenes, and
tumor suppressor genes, Which of the following genes is antiapoptotic gene that may
determine the diseases’ prognosis?
A bcl-2
B p53
C Rb
D BRCA1
E WT
209. Cisplatin can be used effectively in breast cancer patients if the tumor cells are expressing
a. High level of BCL-2
b. Low level of BRACA
c. High level of P53
d. Low level of P53
e. High level of BCL-2 and low level of P53
210. Mechanism of action of cyclosporine is
a. inhibits transcription of IL-2 gene plus other cytokine expression (IL-3, gamma
interferon)
b. Inhibit the production of Neutrophils
c. Decrease the production of prostaglandins and cytokines
d. Stimulate the release of tumor necrosis factors
e. It has nothing to do wiyh the immune system
211. Alemtuzumab (Campath) is all of the following except:
a. New Immunosuppressant
b. Recombinant DNA-derived humanized monoclonal antibody
c. Binds to CD52. a nonmodulating antigen present on surface of all T and B cells
d. Produces profound T cell depletion
e. Well known immunostimulant drug.
212. Glucocorticoid effects include all of the following except
a. Inhibition of IL-1 and TNF gene expression and synthesis
b. Decreased activation of T lymphocytes by decreasing IL-1 release
c. Decreased neutrophil functions esp chemotaxis
d. Decreased antibody production (high doses)
e. Stimulate bradykinin release
213. Side effects of Glucocortecoids include all of the following EXCEPT:
a.Growth retardation
b.Avascular Necrosis of Bone
c. Risk of Infection and Poor wound healing
d.Cataract, Hyperglycemia and Hypertension
e. Mental disorientation
214. Toxicity of Cyclophosfamide include all of the following EXCEPT
a. Gum hyperplasia and Hyperuricemia, worsens gout
b. Hypertension
c. Renal dysfunction
d. Tremor and hypertension
e. Alopecia
215. 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
216. A target organ of doxorubicin-induced toxicity is
a. lung
b. heart
c. kidney
d. Brain
217 . Classes of antineoplastic drugs include
a. Alkylating agents
b. Antimetabolites
c. Antitumor antibiotics
d. All of the above
218. 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
219. 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. MESNA (2-mercaptoethane sulfonate)
D. Acetylcysteine
E. Vitamin K
F. Protamine sulfate
220. The main clinical use of phosphamide is
a. Treatment of Lymphoma
b. Small cell lung Carcinoma treatment
c. Treatment of Prostate cancer
d. Head and neck resistant cancer treatment
e. Treatment of all solid tumors
221. A 55-year-old woman recently completed induction chemotherapy for acute myelogenous
leukemia (AML) with evidence of complete remission on bone marrow biopsy. She
subsequently was found to have a platelet count of 25,000/microliter with no clinical
evidence of bleeding.
222. According to a recent European study, expression of which of the following is associated
with poorer overall survival among patients with primary central nervous system diffuse
large B-cell lymphoma (PCNS-DLBCL), a rare and aggressive form of DLBCL?
a. Bcl-2
c. Myc
c. P53
d. PD1/PDL1
223. Rituximab might increase hepatic toxicity risk in patients who test positive for hepatitis
C virus.
A. True
B. False
224. Which of the following agents is associated with a dose-dependent increase in the risk
of secondary sarcomas in survivors of childhood leukemia?
A. Cyclophosphamide
B. Doxorubicin
C. Prednisone
D. Vincristine
225. The most common secondary cancers among survivors of childhood leukemia and
other childhood malignancies are which of the following?
A. Sarcomas and breast cancers
B. Thyroid cancers and lymphomas
C. Lymphomas and sarcomas
D. Breast and thyroid cancers
226. Flow cytometric analysis of bone marrow samples of children newly diagnosed with
chronic-phase chronic myeloid leukemia (CML) revealed that at 3 months poor outcomes
among imatinib-treated patients could be predicted by elevated expression of the _____
antibody.
A.
CD34
B.
CD38
C.
CD45Ra
D.
cMpl
227. Among pediatric ALL patients, what was the result of a recent study of vitamin D
and calcium supplementation on bone mineral density (BMD)?
A.
BMD scores decreased in the first 2 years, then increased
B.
BMD scores increased in the first 2 years
C.
No change was observed
D.
Results were similar to those who did not receive supplementation
228. A 62-year-old woman with PS 0 is found to have an elevated serum protein. She has a
IgG monoclonal protein (3 g/dL). Her Hgb is 11.6 g/dl. Calcium is normal. X-rays reveal
lytic lesions. Bone marrow revealed >50% plasma cells.
What is the treatment?
A
VAD (vincristine, Adriamycin, dexamethasone)
B
Melphalan + prednisone
C
Immediate stem cell transplantation
D
Lenalidomide + dexamethasone
E
Bisphosphonates alone
229. A 65-year-old woman goes in for a mammogram screening which shows an area of
abnormal calcifications in her right breast. Ultrasound is conducted and shows a mass
measuring 1.5 cm. A stereotactic biopsy is done which shows a low-grade, invasive ductal
carcinoma which is strongly ER+ and PR+, Her2 -. On exam, the mass is not palpable, and
there is no axillary lymphadenopathy.
Which one of the following procedures would be the most appropriate in treating her breast
cancer?
A
Lumpectomy and sentinel lymph node biopsy followed by 5 years of anastrozole
B
Mastectomy and axillary lymph node dissection followed by 5 years of anastrozole)
C
Radiation and 5 years of anastrozole
D
Lumpectomy and sentinel lymph node biopsy followed by radiation and 5 years of
anastrozole
E. Mastectomy and axillary lymph node dissection followed by radiation and 5 years of
anastrozole
230. Which one of the following blood malignancy is characterized by poorly
differentiated with many BLAST cells?
a. Non-Hodgkin's Lymphoma
b. ALL (Acute Lymphocytic Leukemia)
c. CLL (Chronic Lymphocytic Leukemia)
d. CML (Chronic Myelogenous Leukemia)
231. According to a standard staging classification of Hodgkin’s disease, which of the
following criteria reflects stage II?
A. Involvement of extralymphatic organs or tissues
B. Involvement of single lymph node region or structure
C. Involvement of two or more lymph node regions or structures.
D. Involvement of lymph node regions or structures on both sides of the diaphragm.
232. Which of the following complications are three main consequences of leukemia?
A. Bone deformities, spherocytosis, and infection.
B. Anemia, infection, and bleeding tendencies
C. Lymphocytopoiesis, growth delays, and hirsutism
D. Polycythemia, decreased clotting time, and infection.
233. You are teaching a 17-year old client and the client’s family about what to expect
with high-dose chemotherapy and the effects of neutropenia. What should the pharmacist
teach as the most reliable early indicator of infection in a neutropenic client?
A. Fever
B. Chills
C. Tachycardia
D. Dyspnea
234. hodgkin lymphoma is associated with
A . Bence Jones proteins in blood
B. Bence Jones proteins in urine
C. Reed-Stornberg cells in bone marrow
D. Reed-Stornberg cells in urine
235. While there are no current biomarkers to predict response to immunotherapy for
hematologic malignancies, polymorphisms in which of the following genes may predict
outcomes in B cell lymphoma?
a. CTLA-4
b. PD-1
c. PD-L1
236. Which of the following hematological malignancies has the most impressive rates of
response to immune checkpoint therapy?
a. T-cell lymphomas
b. B-cell lymphomas
c. Hodgkin lymphoma
237. Studies have demonstrated significantly increased expression of _______ on tumor
infiltrating lymphocytes (TILs) in low-grade B cell lymphomas and a significant
expression of ________ on the tumor cells.
a. PD-L1; PD-1
b. D-1; PD-L1
c. CD40; CTLA-4
238. In addition to having breast cancer with lymph-node negative tumors and no other
high-risk features, patients with tumors of what size may not benefit from adjuvant
chemotherapy?
a. Patients with T less than 1 mm
b. Patients with T less than 3 mm
c. Patients with T less than 5 mm
239. What is the appropriate treatment for a newly diagnosed patient with advanced-stage
diffuse large B-cell lymphoma?
A. Rituximab and CHOP chemotherapy (R-CHOP)
B. Bendamustine
C. CHOP chemotherapy
D. Bexxar or Zevalin
240. Which of the following statements best describe the results of appropriate treatment
in patients with advanced-stage diffuse large B-cell lymphoma?
A. About 30% to 60% of patients can be cured of their cancer
B. About 60% to 90% of patients can be cured of their cancer
C. Patients are not cured of their disease, but they will probably live longer
D. Patients will probably not live longer, but they may have improved quality of life
241. Which of the following chemotherapy regimens warrant primary prophylaxis with
granulocyte colony-stimulating factor?
A. Dose-dense CHOP
B. Escalated-dose BEACOPP
C. BEACOPP-14
D. All of the above
242. Regarding G-CSF - the best description of its mechanism of action and role in
chemotherapy is
a.
b.
c.
d.
e.
f.
reduced PMN nadir when used as prophylaxis
reduced duration of neutropenia when used as prophylaxis
not useful unless already neutropenic
reduce thrombocytopenia severity
reduces mortality
potentiates effects of chemotherapy
242. 180. 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
243. 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
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