BCPS Oncology & Hematology Pharmacotherapy

Question 1

Methotrexate exerts its cytotoxic effect primarily by inhibiting which enzyme?

Accepted Answer

Dihydrofolate reductase (DHFR)

Answer

Thymidylate synthase

Answer

Ribonucleotide reductase

Answer

Topoisomerase II

Question 2

A patient is diagnosed with Philadelphia chromosome-positive CML in chronic phase. Which of the following represents the most appropriate initial therapy?

Accepted Answer

A BCR-ABL tyrosine kinase inhibitor (TKI)

Answer

Hydroxyurea monotherapy

Answer

Allogeneic hematopoietic stem cell transplant

Answer

Interferon-alpha

Question 3

Which combination of laboratory abnormalities is characteristic of tumor lysis syndrome (TLS)?

Accepted Answer

Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

Answer

Hypokalemia, hypophosphatemia, hypercalcemia, hypouricemia

Answer

Hypernatremia, hyperchloremia, metabolic alkalosis

Answer

Hyperkalemia, hypomagnesemia, hyperglycemia

Question 4

For a patient receiving highly emetogenic chemotherapy (HEC) such as cisplatin, which antiemetic regimen is recommended for acute emesis prevention?

Accepted Answer

A 5-HT3 antagonist + NK1 receptor antagonist + dexamethasone

Answer

Metoclopramide alone

Answer

A 5-HT3 antagonist as monotherapy

Answer

Lorazepam + prochlorperazine

Question 5

A patient receiving chemotherapy develops a fever of 38.5°C with an absolute neutrophil count (ANC) of 400 cells/mm³. Which initial antibiotic regimen is most appropriate?

Accepted Answer

IV antipseudomonal beta-lactam monotherapy (e.g., piperacillin-tazobactam)

Answer

Oral ciprofloxacin + amoxicillin-clavulanate

Answer

IV vancomycin alone

Answer

IV cefazolin

Question 6

R-CHOP is a standard regimen for diffuse large B-cell lymphoma (DLBCL). Which of the following correctly identifies all five components?

Accepted Answer

Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone

Answer

Rituximab, carboplatin, hydroxydaunorubicin, oxaliplatin, prednisone

Answer

Rituximab, cyclophosphamide, hydroxyurea, omeprazole, prednisolone

Answer

Rituximab, cetuximab, hydroxychloroquine, oxaliplatin, paclitaxel

Question 7

Leucovorin (folinic acid) is administered after high-dose methotrexate to rescue normal cells. Its mechanism is to:

Accepted Answer

Bypass DHFR inhibition by providing reduced folate directly

Answer

Directly inhibit methotrexate uptake into cells via folate transporters

Answer

Enhance renal methotrexate elimination via alkalinization

Answer

Chelate methotrexate and inactivate it in plasma