MCQ Quiz: Oncology

Oncology pharmacy is a rapidly evolving and highly specialized field that demands a deep understanding of complex pharmacotherapy, from traditional cytotoxic chemotherapy to cutting-edge targeted agents and immunotherapies. Pharmacists are integral members of the cancer care team, responsible for ensuring the safe and effective use of these high-risk medications, managing treatment-related toxicities, and providing crucial supportive care. This quiz is designed for PharmD students to test their knowledge on the principles of oncology, the management of specific malignancies like breast, lung, and prostate cancer, and critical supportive care topics such as chemotherapy-induced nausea and vomiting (CINV) and oncologic emergencies.

1. A chemotherapy agent that exerts its effect regardless of the cell cycle phase is known as:

• a) Cell cycle-specific
• b) Cell cycle non-specific
• c) Phase-specific
• d) Mitosis-specific

Answer: b) Cell cycle non-specific

2. A patient is scheduled to receive a highly emetogenic chemotherapy (HEC) regimen. According to ASCO/NCCN guidelines, which combination of antiemetics is recommended for preventing acute CINV?

• a) A 5-HT3 receptor antagonist alone.
• b) Dexamethasone alone.
• c) A 5-HT3 antagonist + Dexamethasone + an NK-1 receptor antagonist.
• d) Metoclopramide + Lorazepam.

Answer: c) A 5-HT3 antagonist + Dexamethasone + an NK-1 receptor antagonist.

3. What is the primary mechanism of action of tamoxifen in the treatment of ER-positive breast cancer?

• a) It inhibits the aromatase enzyme, preventing estrogen synthesis.
• b) It is a selective estrogen receptor modulator (SERM) that blocks estrogen receptors in breast tissue.
• c) It is a monoclonal antibody that targets the HER2 receptor.
• d) It causes apoptosis of all rapidly dividing cells.

Answer: b) It is a selective estrogen receptor modulator (SERM) that blocks estrogen receptors in breast tissue.

4. A patient receiving chemotherapy has an absolute neutrophil count (ANC) of 400 cells/mm³ and a single oral temperature of 38.5°C. This condition is defined as:

• a) Tumor lysis syndrome
• b) Chemotherapy-induced nausea and vomiting
• c) Febrile neutropenia
• d) Hypercalcemia of malignancy

Answer: c) Febrile neutropenia

5. Which of the following is a cornerstone of initial empiric antibiotic therapy for a high-risk patient with febrile neutropenia?

• a) Oral amoxicillin
• b) Intravenous vancomycin alone.
• c) An intravenous anti-pseudomonal beta-lactam (e.g., cefepime, piperacillin-tazobactam).
• d) Oral doxycycline.

Answer: c) An intravenous anti-pseudomonal beta-lactam (e.g., cefepime, piperacillin-tazobactam).

6. Trastuzumab (Herceptin®) is a targeted therapy used for breast cancers that overexpress which receptor?

• a) Estrogen Receptor (ER)
• b) Progesterone Receptor (PR)
• c) Human Epidermal Growth Factor Receptor 2 (HER2)
• d) Vascular Endothelial Growth Factor (VEGF)

Answer: c) Human Epidermal Growth Factor Receptor 2 (HER2)

7. A significant, potentially life-threatening toxicity that requires monitoring with an echocardiogram before and during therapy with trastuzumab is:

• a) Nephrotoxicity
• b) Hepatotoxicity
• c) Cardiotoxicity (e.g., decreased left ventricular ejection fraction)
• d) Peripheral neuropathy

Answer: c) Cardiotoxicity (e.g., decreased left ventricular ejection fraction)

8. Leuprolide is used to treat prostate cancer. What is its mechanism of action?

• a) It is an antiandrogen that blocks the androgen receptor.
• b) It is a Luteinizing Hormone-Releasing Hormone (LHRH) agonist that initially causes a surge, then downregulation of testosterone production.
• c) It is a form of cytotoxic chemotherapy.
• d) It inhibits the 5-alpha reductase enzyme.

Answer: b) It is a Luteinizing Hormone-Releasing Hormone (LHRH) agonist that initially causes a surge, then downregulation of testosterone production.

9. A patient with non-small cell lung cancer (NSCLC) is found to have an EGFR exon 19 deletion. Which targeted therapy would be most appropriate?

• a) Crizotinib
• b) Pembrolizumab
• c) Osimertinib
• d) Bevacizumab

Answer: c) Osimertinib

10. What is the mechanism of action of immune checkpoint inhibitors like pembrolizumab and nivolumab?

• a) They directly kill cancer cells by damaging their DNA.
• b) They block the PD-1/PD-L1 pathway, restoring the ability of T-cells to recognize and attack cancer cells.
• c) They inhibit angiogenesis.
• d) They block hormone receptors on cancer cells.

Answer: b) They block the PD-1/PD-L1 pathway, restoring the ability of T-cells to recognize and attack cancer cells.

11. A patient receiving immunotherapy with ipilimumab develops severe, bloody diarrhea. The pharmacist recognizes this as a potential immune-related adverse event (irAE) and anticipates treatment with:

• a) Loperamide and increased fluids.
• b) High-dose corticosteroids.
• c) An oral antibiotic.
• d) An antiviral agent.

Answer: b) High-dose corticosteroids.

12. Tumor Lysis Syndrome (TLS) is an oncologic emergency characterized by a constellation of metabolic abnormalities. Which of the following is NOT a typical finding in TLS?

• a) Hyperuricemia
• b) Hyperkalemia
• c) Hypocalcemia
• d) Hypophosphatemia

Answer: d) Hypophosphatemia

13. Allopurinol or rasburicase can be used as prophylaxis for TLS to prevent the accumulation of which substance?

• a) Potassium
• b) Phosphate
• c) Calcium
• d) Uric acid

Answer: d) Uric acid

14. Anastrozole and letrozole are used in postmenopausal women with ER-positive breast cancer. What is their mechanism of action?

• a) They are selective estrogen receptor modulators (SERMs).
• b) They are aromatase inhibitors, blocking the peripheral conversion of androgens to estrogen.
• c) They are LHRH agonists.
• d) They degrade the estrogen receptor.

Answer: b) They are aromatase inhibitors, blocking the peripheral conversion of androgens to estrogen.

15. A patient receiving cisplatin is at high risk for which toxicities?

• a) Cardiotoxicity and alopecia.
• b) Highly emetogenic CINV, nephrotoxicity, and ototoxicity.
• c) Pulmonary fibrosis and mucositis.
• d) Hand-foot syndrome and diarrhea.

Answer: b) Highly emetogenic CINV, nephrotoxicity, and ototoxicity.

16. What is the primary purpose of leucovorin rescue when given with high-dose methotrexate?

• a) To enhance the efficacy of methotrexate.
• b) To prevent methotrexate-induced nephrotoxicity.
• c) To replenish the folate pool in healthy cells, thereby reducing methotrexate toxicity.
• d) To treat methotrexate-induced nausea.

Answer: c) To replenish the folate pool in healthy cells, thereby reducing methotrexate toxicity.

17. The FOLFOX regimen, used for colorectal cancer, consists of Folinic acid (leucovorin), Fluorouracil, and which other agent?

• a) Oxaliplatin
• b) Irinotecan
• c) Cisplatin
• d) Paclitaxel

Answer: a) Oxaliplatin

18. A patient on oxaliplatin complains of cold-induced numbness and tingling in their hands and throat. This is a characteristic sign of:

• a) An allergic reaction.
• b) Acute neurotoxicity.
• c) Tumor lysis syndrome.
• d) Myelosuppression.

Answer: b) Acute neurotoxicity.

19. Bevacizumab (Avastin®) is a monoclonal antibody that works by inhibiting:

• a) The HER2 receptor.
• b) The epidermal growth factor receptor (EGFR).
• c) The vascular endothelial growth factor (VEGF).
• d) The PD-1 immune checkpoint.

Answer: c) The vascular endothelial growth factor (VEGF).

20. A patient being treated for metastatic colorectal cancer must have a “wild-type” status for which gene in order to be a candidate for therapy with cetuximab or panitumumab?

• a) ALK
• b) BRCA
• c) KRAS
• d) HER2

Answer: c) KRAS

21. Vinca alkaloids like vincristine exert their cytotoxic effect by targeting which phase of the cell cycle?

• a) G1 phase
• b) S phase
• c) G2 phase
• d) M phase (mitosis)

Answer: d) M phase (mitosis)

22. A dose-limiting toxicity of vincristine is:

• a) Myelosuppression
• b) Peripheral neuropathy
• c) Nephrotoxicity
• d) Cardiotoxicity

Answer: b) Peripheral neuropathy

23. Chemotherapy given before a primary treatment like surgery to shrink a tumor is known as:

• a) Adjuvant therapy
• b) Neoadjuvant therapy
• c) Palliative therapy
• d) Maintenance therapy

Answer: b) Neoadjuvant therapy

24. The R-CHOP regimen is a standard treatment for Diffuse Large B-Cell Lymphoma. The “R” stands for:

• a) Radiation
• b) Rasburicase
• c) Rituximab
• d) Raloxifene

Answer: c) Rituximab

25. A patient receiving doxorubicin, an anthracycline, must be monitored for a cumulative dose-related toxicity affecting which organ?

• a) The brain
• b) The lungs
• c) The heart
• d) The kidneys

Answer: c) The heart

26. Mesna is a uroprotective agent given with high doses of ifosfamide or cyclophosphamide to prevent:

• a) Myelosuppression
• b) Nausea and vomiting
• c) Hemorrhagic cystitis
• d) Alopecia

Answer: c) Hemorrhagic cystitis

29. Filgrastim (G-CSF) is used in oncology supportive care to:

• a) Treat anemia.
• b) Prevent or reduce the duration of severe neutropenia.
• c) Treat chemotherapy-induced diarrhea.
• d) Prevent tumor lysis syndrome.

Answer: b) Prevent or reduce the duration of severe neutropenia.

30. Palonosetron is a 5-HT3 receptor antagonist with a longer half-life, making it particularly effective for preventing which type of CINV?

• a) Anticipatory CINV
• b) Acute CINV
• c) Delayed CINV
• d) Refractory CINV

Answer: c) Delayed CINV

31. The standard induction therapy for a younger, fit patient with Acute Myeloid Leukemia (AML) is known as the “7 + 3” regimen, which consists of:

• a) 7 days of vincristine and 3 days of prednisone.
• b) 7 days of cytarabine and 3 days of an anthracycline (e.g., idarubicin).
• c) 7 days of methotrexate and 3 days of leucovorin.
• d) 7 days of mercaptopurine and 3 days of allopurinol.

Answer: b) 7 days of cytarabine and 3 days of an anthracycline (e.g., idarubicin).

32. A patient on an aromatase inhibitor like anastrozole should be counseled about an increased risk for:

• a) Blood clots.
• b) Uterine cancer.
• c) Osteoporosis and bone fractures.
• d) Hot flashes.

Answer: c) Osteoporosis and bone fractures.

33. What is the mechanism of action of irinotecan?

• a) It is an alkylating agent.
• b) It inhibits topoisomerase I.
• c) It is an antimetabolite.
• d) It inhibits microtubule formation.

Answer: b) It inhibits topoisomerase I.

34. A severe, dose-limiting toxicity of irinotecan is:

• a) Nephrotoxicity
• b) Cardiotoxicity
• c) Diarrhea (both acute and delayed)
• d) Neurotoxicity

Answer: c) Diarrhea (both acute and delayed)

35. A patient taking the oral targeted therapy imatinib for chronic myeloid leukemia (CML) should be counseled to:

• a) Take the medication on an empty stomach.
• b) Take the medication with food and a large glass of water to minimize GI irritation.
• c) Avoid all dairy products.
• d) Take it with grapefruit juice to increase absorption.

Answer: b) Take the medication with food and a large glass of water to minimize GI irritation.

36. A patient receiving a high dose of the alkylating agent cyclophosphamide is at risk for:

• a) Hemorrhagic cystitis.
• b) Severe myelosuppression.
• c) Infertility.
• d) All of the above.

Answer: d) All of the above.

37. Which of the following is an example of palliative chemotherapy?

• a) Chemotherapy given after surgery to eliminate any remaining cancer cells.
• b) Chemotherapy given to shrink a tumor before surgery.
• c) Chemotherapy given to relieve symptoms and improve quality of life in a patient with incurable, advanced cancer.
• d) A one-time dose of chemotherapy to prevent cancer.

Answer: c) Chemotherapy given to relieve symptoms and improve quality of life in a patient with incurable, advanced cancer.

38. The “nadir” in the context of chemotherapy refers to:

• a) The highest point of nausea and vomiting.
• b) The point at which blood cell counts are at their lowest after a chemotherapy cycle.
• c) The peak concentration of the chemotherapy drug in the blood.
• d) The end of the chemotherapy infusion.

Answer: b) The point at which blood cell counts are at their lowest after a chemotherapy cycle.

39. A patient on androgen deprivation therapy for prostate cancer should be counseled on the risk of:

• a) Hot flashes, decreased libido, and osteoporosis.
• b) Hypertension and hyperlipidemia.
• c) Hair growth and increased muscle mass.
• d) Diarrhea and nausea.

Answer: a) Hot flashes, decreased libido, and osteoporosis.

40. The main advantage of pegfilgrastim over filgrastim is:

• a) It is more effective at stimulating neutrophil production.
• b) It is less expensive.
• c) It has a longer half-life, allowing for a single dose per chemotherapy cycle.
• d) It has no side effects.

Answer: c) It has a longer half-life, allowing for a single dose per chemotherapy cycle.

41. A patient on bleomycin should be monitored for which potentially fatal toxicity?

• a) Liver failure
• b) Kidney failure
• c) Pulmonary fibrosis
• d) Heart failure

Answer: c) Pulmonary fibrosis

42. The most common adverse effect of checkpoint inhibitors like nivolumab and pembrolizumab is:

• a) Severe nausea and vomiting.
• b) Fatigue, rash, and pruritus.
• c) Complete alopecia.
• d) Severe myelosuppression.

Answer: b) Fatigue, rash, and pruritus.

43. A pharmacist’s role in oral chemotherapy adherence is critical because:

• a) These medications are less toxic than IV chemotherapy.
• b) These medications are often self-administered at home, and non-adherence can lead to treatment failure.
• c) Oral chemotherapy is not effective.
• d) Insurance companies do not cover oral chemotherapy.

Answer: b) These medications are often self-administered at home, and non-adherence can lead to treatment failure.

44. A patient with metastatic breast cancer is being treated with a CDK4/6 inhibitor like palbociclib. This drug is typically combined with:

• a) IV chemotherapy.
• b) Endocrine therapy (e.g., letrozole or fulvestrant).
• c) Radiation therapy.
• d) An immune checkpoint inhibitor.

Answer: b) Endocrine therapy (e.g., letrozole or fulvestrant).

45. A major side effect of CDK4/6 inhibitors that requires monitoring of the CBC is:

• a) Neutropenia
• b) Anemia
• c) Thrombocytopenia
• d) All of the above

Answer: d) All of the above

46. Which of the following is an example of an oncologic emergency?

• a) Mild nausea
• b) Fatigue
• c) Spinal cord compression from a tumor
• d) A common cold

Answer: c) Spinal cord compression from a tumor

47. A patient on tamoxifen has an increased risk of which of the following?

• a) Osteoporosis
• b) Venous thromboembolism (VTE) and endometrial cancer
• c) Heart failure
• d) Breast cancer recurrence in all patients

Answer: b) Venous thromboembolism (VTE) and endometrial cancer

48. The “A” in the CINV risk assessment for a chemotherapy regimen often refers to which drug class?

• a) Alkylating agents
• b) Anthracyclines (e.g., doxorubicin)
• c) Antimetabolites
• d) Aromatase inhibitors

Answer: b) Anthracyclines (e.g., doxorubicin)

49. An appropriate counseling point for a patient receiving their first cycle of chemotherapy is:

• a) “You will not experience any side effects.”
• b) “It’s important to report any new or worsening side effects, like fever, to your care team immediately.”
• c) “You should stop taking all your other home medications.”
• d) “There is no need to use the anti-nausea medications unless you are actively vomiting.”

Answer: b) “It’s important to report any new or worsening side effects, like fever, to your care team immediately.”

50. What is a key principle of combination chemotherapy?

• a) To use drugs with overlapping mechanisms and toxicities.
• b) To use drugs that are all cell cycle-specific.
• c) To use drugs with different mechanisms of action and non-overlapping toxicities to maximize efficacy and minimize side effects.
• d) To use the lowest possible dose of each drug.

Answer: c) To use drugs with different mechanisms of action and non-overlapping toxicities to maximize efficacy and minimize side effects.