Bleomycin MCQs With Answer
Bleomycin is an important antineoplastic glycopeptide used in oncology and studied in B.Pharm curricula for its unique pharmacology, mechanisms, and toxicities. This concise introduction covers bleomycin’s source, mechanism of DNA strand scission via free radical formation, clinical indications (e.g., Hodgkin lymphoma, testicular cancer, squamous cell carcinomas), pharmacokinetics (renal excretion), dose-limiting pulmonary fibrosis, cutaneous reactions, and monitoring strategies such as DLCO and chest imaging. Emphasis is given to cumulative dose limits, risk factors, and management of adverse effects to prepare pharmacy students for clinical decision-making. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which organism is the primary natural source of bleomycin?
- Streptomyces verticillus
- Staphylococcus aureus
- Pseudomonas aeruginosa
- Bacillus subtilis
Correct Answer: Streptomyces verticillus
Q2. What is the principal mechanism of action of bleomycin?
- Topoisomerase I inhibition
- DNA cross-linking via alkylation
- Generation of free radicals causing DNA strand breaks
- Microtubule stabilization
Correct Answer: Generation of free radicals causing DNA strand breaks
Q3. Bleomycin is most active in which phase of the cell cycle?
- G1 phase
- S phase
- G2 phase
- M phase
Correct Answer: G2 phase
Q4. Which of the following is a major dose-limiting toxicity of bleomycin?
- Severe neutropenia
- Pulmonary fibrosis
- Renal tubular necrosis
Correct Answer: Pulmonary fibrosis
Q5. Which clinical regimen commonly includes bleomycin for Hodgkin lymphoma?
- CHOP
- ABVD
- Cis/Vin
- MOPP
Correct Answer: ABVD
Q6. Which organ mainly clears bleomycin from the body?
- Liver via biliary excretion
- Renal excretion
- Pulmonary metabolism
- Intestinal metabolism
Correct Answer: Renal excretion
Q7. Which patient factor increases the risk of bleomycin-induced pulmonary toxicity?
- Young age under 20 years
- Poor renal function
- Hyperthyroidism
- Low body mass index only
Correct Answer: Poor renal function
Q8. What cumulative dose threshold is commonly associated with increased pulmonary toxicity risk?
- 50 units
- 200 units
- 400 units
- 1000 units
Correct Answer: 400 units
Q9. Which pulmonary function parameter is most useful for monitoring bleomycin toxicity?
- Forced vital capacity (FVC) only
- Diffusing capacity for carbon monoxide (DLCO)
- Peak expiratory flow rate (PEFR)
- Arterial oxygen tension at rest only
Correct Answer: Diffusing capacity for carbon monoxide (DLCO)
Q10. Which skin reaction is characteristically associated with bleomycin?
- Psoriasis-like plaques only
- Flagellate erythema with linear hyperpigmentation
- Vesicular dermatitis similar to herpes zoster
- Urticaria without pigmentation changes
Correct Answer: Flagellate erythema with linear hyperpigmentation
Q11. Why does bleomycin cause relatively limited myelosuppression compared to many cytotoxics?
- It is rapidly inactivated by hepatic enzymes
- Bone marrow has high bleomycin hydrolase activity
- It does not enter systemic circulation
- It selectively binds only tumoral DNA
Correct Answer: Bone marrow has high bleomycin hydrolase activity
Q12. Which monitoring is recommended before and during bleomycin therapy?
- Baseline echocardiography monthly
- Baseline and periodic pulmonary function tests and chest imaging
- Daily liver function tests
- Continuous blood glucose monitoring
Correct Answer: Baseline and periodic pulmonary function tests and chest imaging
Q13. What is the recommended management for suspected bleomycin-induced pulmonary fibrosis?
- Continue therapy and add bronchodilators
- Immediate discontinuation of bleomycin and start corticosteroids
- Switch to higher oxygen concentrations
- Administer amphotericin B
Correct Answer: Immediate discontinuation of bleomycin and start corticosteroids
Q14. Bleomycin’s DNA damage involves which metal ion in its catalytic cycle?
- Copper (Cu2+)
- Magnesium (Mg2+)
- Iron (Fe2+)
- Calcium (Ca2+)
Correct Answer: Iron (Fe2+)
Q15. Which formulation name is commonly used for bleomycin in clinical practice?
- Bleomycin sulfate
- Bleomycin nitrate
- Bleomycin chloride
- Bleomycin acetate
Correct Answer: Bleomycin sulfate
Q16. Which cancer type is bleomycin NOT typically indicated for?
- Testicular cancer
- Hodgkin lymphoma
- Squamous cell carcinoma of head and neck
- Chronic myeloid leukemia (CML)
Correct Answer: Chronic myeloid leukemia (CML)
Q17. Which route(s) of administration are used for bleomycin?
- Oral only
- Intravenous, intramuscular, and intrapleural routes
- Topical only
- Inhalational aerosol only
Correct Answer: Intravenous, intramuscular, and intrapleural routes
Q18. Which laboratory abnormality is most characteristic during bleomycin therapy?
- Marked thrombocytopenia
- Severe hyperbilirubinemia
- Usually minimal myelosuppression
- Profound hypokalemia
Correct Answer: Usually minimal myelosuppression
Q19. Why are high inspired oxygen concentrations a concern in patients who received bleomycin?
- They reduce bleomycin renal clearance
- They can precipitate or worsen bleomycin-induced lung injury
- They increase bleeding risk
- They cause immediate hypersensitivity to bleomycin
Correct Answer: They can precipitate or worsen bleomycin-induced lung injury
Q20. What histologic finding is typical in bleomycin-induced lung injury?
- Astrocytoma-like proliferation
- Interstitial pneumonitis and progressive pulmonary fibrosis
- Granulomatous inflammation with caseation
- Emphysematous bullae only
Correct Answer: Interstitial pneumonitis and progressive pulmonary fibrosis
Q21. Which enzyme deficiency in tissues contributes to bleomycin toxicity in lung and skin?
- CYP3A4 deficiency
- Bleomycin hydrolase deficiency
- Glucose-6-phosphate dehydrogenase deficiency
- Acetylcholinesterase deficiency
Correct Answer: Bleomycin hydrolase deficiency
Q22. Which symptom often precedes clinically evident bleomycin pulmonary toxicity?
- Persistent dry cough and dyspnea on exertion
- Severe chest pain radiating to the arm
- Hematuria
- Profuse watery diarrhea
Correct Answer: Persistent dry cough and dyspnea on exertion
Q23. Which statement about bleomycin dosing in renal impairment is correct?
- No dose adjustment is necessary regardless of renal function
- Dose reduction or avoidance is recommended if renal clearance is significantly reduced
- Dosing should be increased to overcome decreased renal clearance
- Biliary dosing adjustment is required
Correct Answer: Dose reduction or avoidance is recommended if renal clearance is significantly reduced
Q24. Which of the following is NOT an adverse effect associated with bleomycin?
- Fever and mucositis
- Skin hyperpigmentation and ulceration
- Severe cardiomyopathy as the primary toxicity
- Alopecia in some patients
Correct Answer: Severe cardiomyopathy as the primary toxicity
Q25. In the molecular action of bleomycin, which nucleic acid component does it preferentially bind?
- Tubulin proteins
- DNA bases causing strand breaks
- Ribosomal RNA only
- Membrane phospholipids selectively
Correct Answer: DNA bases causing strand breaks
Q26. Which clinical test is most sensitive for early detection of bleomycin pulmonary toxicity?
- Routine chest radiograph only
- DLCO measurement
- Electrocardiogram (ECG)
- Serum troponin level
Correct Answer: DLCO measurement
Q27. Which patient population requires extra caution when prescribing bleomycin?
- Patients with pre-existing pulmonary disease
- Patients with mild acne
- Children under routine vaccination
- Young adults with no comorbidities
Correct Answer: Patients with pre-existing pulmonary disease
Q28. Which intervention has the most evidence for treating bleomycin pulmonary toxicity?
- High-dose intravenous antibiotics
- Systemic corticosteroids and discontinuation of bleomycin
- Immediate hemofiltration
- Administration of activated charcoal
Correct Answer: Systemic corticosteroids and discontinuation of bleomycin
Q29. Which pharmacokinetic property of bleomycin is clinically important?
- Extensive hepatic metabolism by CYP450
- Rapid renal clearance with significant dependence on kidney function
- Complete oral bioavailability
- Long-term accumulation in adipose tissue only
Correct Answer: Rapid renal clearance with significant dependence on kidney function
Q30. Which preventive measure is recommended perioperatively for patients with prior bleomycin exposure?
- Use high FiO2 intraoperatively as routine
- Avoid high inspired oxygen concentrations if possible and monitor pulmonary status closely
- Stop all antibiotics to prevent interactions
- Increase fluid intake to enhance clearance
Correct Answer: Avoid high inspired oxygen concentrations if possible and monitor pulmonary status closely
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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