Hematological malignancies: pharmacologic management MCQs With Answer

Hematological malignancies: pharmacologic management MCQs With Answer

This question set is designed for M.Pharm students studying Pharmacotherapeutics II (MPP 202T). It focuses on pharmacologic principles, mechanisms of action, therapeutic indications, adverse effects, monitoring and supportive care strategies relevant to leukemia, lymphoma, myeloma and related disorders. Questions emphasize drug classes used in modern hematologic oncology—cytotoxics, targeted small molecules, monoclonal antibodies, immunomodulators, proteasome inhibitors, hypomethylating agents and cell therapies—and common clinical problems such as tumor lysis, infection prophylaxis and drug interactions. Answers include concise key-point recall to aid exam preparation and deepen understanding of rational pharmacotherapy in hematologic malignancies.

Q1. Which description best characterizes the mechanism of action of imatinib in chronic myeloid leukemia?

• Inhibits BCR-ABL tyrosine kinase by binding the ATP-binding site
• Proteasome inhibitor leading to accumulation of pro-apoptotic proteins
• Anti-CD20 monoclonal antibody causing complement-mediated cytolysis
• Folate antagonist that inhibits dihydrofolate reductase

Correct Answer: Inhibits BCR-ABL tyrosine kinase by binding the ATP-binding site

Q2. What is the principal pharmacologic action of all-trans retinoic acid (ATRA) in acute promyelocytic leukemia (APL)?

• Induces differentiation of promyelocytes by targeting the PML-RARα fusion protein
• Intercalates DNA and inhibits topoisomerase II
• Alkylates DNA causing cross-links and strand breaks
• Inhibits proteasome activity to induce apoptosis

Correct Answer: Induces differentiation of promyelocytes by targeting the PML-RARα fusion protein

Q3. Arsenic trioxide is used in APL. Its main anti-leukemic mechanism is:

• Induces degradation of PML-RARα and triggers apoptosis
• Blocks dihydrofolate reductase activity
• Inhibits microtubule polymerization
• Neutralizes circulating cytokines to reduce inflammation

Correct Answer: Induces degradation of PML-RARα and triggers apoptosis

Q4. Rituximab targets which antigen and mediates tumor cell killing primarily through ADCC and complement activation?

• CD20 on B lymphocytes
• CD33 on myeloid blasts
• CD52 on mature lymphocytes
• PD-1 on T cells

Correct Answer: CD20 on B lymphocytes

Q5. A common dose-limiting toxicity of bortezomib therapy in multiple myeloma is:

• Peripheral neuropathy
• Cardiomyopathy
• Hemorrhagic cystitis
• Interstitial pneumonitis

Correct Answer: Peripheral neuropathy

Q6. Lenalidomide exerts its anti-myeloma effects mainly by which pharmacologic actions?

• Immunomodulation (enhances T and NK cell activity) and anti-angiogenesis
• Direct DNA alkylation and cross-linking
• Inhibition of topoisomerase I resulting in DNA breaks
• Inhibition of dihydrofolate reductase causing folate depletion

Correct Answer: Immunomodulation (enhances T and NK cell activity) and anti-angiogenesis

Q7. Azacitidine and decitabine are classified as which type of epigenetic agents?

• DNA hypomethylating agents that inhibit DNA methyltransferase
• Histone deacetylase inhibitors that increase acetylation
• Proteasome inhibitors that prevent protein degradation
• Telomerase inhibitors that shorten telomeres

Correct Answer: DNA hypomethylating agents that inhibit DNA methyltransferase

Q8. For a patient at high risk of tumor lysis syndrome before induction chemotherapy, the most rapid agent to lower uric acid is:

• Rasburicase (urate oxidase) that converts uric acid to allantoin
• Allopurinol that inhibits xanthine oxidase
• Febuxostat as a weak uricosuric agent
• Probenecid to increase renal uric acid excretion

Correct Answer: Rasburicase (urate oxidase) that converts uric acid to allantoin

Q9. A frequent molecular mechanism underlying acquired resistance to imatinib in CML is:

• Point mutations in the BCR-ABL kinase domain (e.g., T315I)
• Increased efflux due to P-glycoprotein overexpression only
• Loss of the BCR-ABL fusion gene by deletion
• Enhanced DNA repair mechanisms similar to solid tumors

Correct Answer: Point mutations in the BCR-ABL kinase domain (e.g., T315I)

Q10. Which agent is considered the prototypical first-generation BCR-ABL tyrosine kinase inhibitor?

• Imatinib
• Dasatinib
• Nilotinib
• Ponatinib

Correct Answer: Imatinib

Q11. Use of rituximab can lead to reactivation of which latent viral infection, necessitating screening before therapy?

• Hepatitis B virus (HBV)
• Human papillomavirus (HPV)
• West Nile virus
• Norovirus

Correct Answer: Hepatitis B virus (HBV)

Q12. Chimeric antigen receptor T-cell (CAR-T) therapy for B-cell malignancies most commonly targets which antigen?

• CD19
• CD30
• CD33
• BCMA

Correct Answer: CD19

Q13. Filgrastim (G-CSF) is used in myelosuppressive chemotherapy primarily to:

• Stimulate neutrophil production and shorten duration of neutropenia
• Increase platelet production to prevent thrombocytopenia
• Enhance erythropoiesis to reduce transfusion needs
• Act as an antiemetic to prevent chemotherapy-induced nausea

Correct Answer: Stimulate neutrophil production and shorten duration of neutropenia

Q14. Venetoclax is an oral targeted agent that selectively inhibits which anti-apoptotic protein?

• BCL-2
• BRCA1
• FLT3
• PD-L1

Correct Answer: BCL-2

Q15. Co-administration of allopurinol requires dose adjustment of which antimetabolite to avoid increased toxicity?

• 6-mercaptopurine (6-MP)
• 5-fluorouracil (5-FU)
• Cytarabine
• Vincristine

Correct Answer: 6-mercaptopurine (6-MP)

Q16. Which agent is indicated as a cardioprotective chelator to reduce anthracycline-induced cardiotoxicity?

• Dexrazoxane
• Mesna
• Amifostine
• N-acetylcysteine

Correct Answer: Dexrazoxane

Q17. Leucovorin rescue after high-dose methotrexate is given to:

• Replenish reduced folate and rescue normal cells from toxicity
• Inhibit methotrexate uptake into tumor cells
• Enhance methotrexate cytotoxicity by blocking clearance
• Bind free methotrexate in plasma to increase excretion

Correct Answer: Replenish reduced folate and rescue normal cells from toxicity

Q18. Asparaginase used in acute lymphoblastic leukemia exerts its anti-leukemic effect by:

• Depleting circulating asparagine necessary for leukemic lymphoblast survival
• Intercalating DNA and blocking replication
• Inhibiting microtubule dynamics during mitosis
• Blocking nucleotide synthesis via thymidylate synthase inhibition

Correct Answer: Depleting circulating asparagine necessary for leukemic lymphoblast survival

Q19. Cyclophosphamide can cause hemorrhagic cystitis; which agent is used prophylactically to prevent this complication?

• Mesna (sodium 2-mercaptoethanesulfonate)
• Allopurinol
• Leucovorin
• Amifostine

Correct Answer: Mesna (sodium 2-mercaptoethanesulfonate)

Q20. Differentiation syndrome, a potentially life-threatening complication of ATRA or arsenic therapy in APL, is best managed initially with:

• High-dose corticosteroids (e.g., dexamethasone)
• Immediate cytarabine infusion
• Broad-spectrum antibiotics and antifungals
• Plasmapheresis to remove circulating toxins

Correct Answer: High-dose corticosteroids (e.g., dexamethasone)

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