MCQ Quiz- Lymphomas

Lymphomas are a diverse group of cancers originating from lymphocytes within the lymphatic system. Understanding their classification into Hodgkin and Non-Hodgkin types, distinct pathological features, clinical presentation, staging, and the principles of various treatment modalities—including chemotherapy, radiation, targeted therapies, and immunotherapy—is crucial for pharmacists involved in oncology care. This quiz will test your knowledge on these key aspects of lymphoma diagnosis and management. Let’s begin!

1. Lymphomas are cancers that originate from which type of cells?

• a) Epithelial cells
• b) Myeloid stem cells
• c) Lymphocytes (B-cells or T-cells/NK cells)
• d) Red blood cells

Answer: c) Lymphocytes (B-cells or T-cells/NK cells)

2. The two main categories of lymphoma are Hodgkin Lymphoma (HL) and:

• a) Myeloma
• b) Leukemia
• c) Non-Hodgkin Lymphoma (NHL)
• d) Sarcoma

Answer: c) Non-Hodgkin Lymphoma (NHL)

3. The characteristic diagnostic cell found in classical Hodgkin Lymphoma is the:

• a) Plasma cell
• b) Myeloblast
• c) Reed-Sternberg cell
• d) Burkitt cell

Answer: c) Reed-Sternberg cell

4. Which of the following is the most common subtype of Hodgkin Lymphoma in Western countries?

• a) Nodular lymphocyte-predominant Hodgkin lymphoma
• b) Lymphocyte-depleted classical Hodgkin lymphoma
• c) Nodular sclerosis classical Hodgkin lymphoma
• d) Mixed cellularity classical Hodgkin lymphoma

Answer: c) Nodular sclerosis classical Hodgkin lymphoma

5. Non-Hodgkin Lymphomas (NHL) are a diverse group of malignancies. The majority of NHLs arise from:

• a) T-lymphocytes
• b) B-lymphocytes
• c) Natural Killer (NK) cells
• d) Myeloid cells

Answer: b) B-lymphocytes

6. Diffuse Large B-cell Lymphoma (DLBCL) is classified as what type of Non-Hodgkin Lymphoma in terms of its clinical behavior?

• a) Indolent (low-grade)
• b) Aggressive (high-grade)
• c) Always curable with observation alone
• d) Primarily a pediatric cancer

Answer: b) Aggressive (high-grade)

7. Follicular Lymphoma, another common type of NHL, typically has which clinical behavior?

• a) Very aggressive, requiring immediate intensive chemotherapy.
• b) Indolent (slow-growing), often with a relapsing and remitting course.
• c) Always transforms into Hodgkin Lymphoma.
• d) Primarily affects T-cells.

Answer: b) Indolent (slow-growing), often with a relapsing and remitting course.

8. The Ann Arbor staging system for lymphomas is primarily based on:

• a) The aggressiveness of the lymphoma cells under the microscope.
• b) The number and location of affected lymph node regions, and the involvement of extranodal sites.
• c) The patient’s age and performance status.
• d) The presence of specific genetic mutations.

Answer: b) The number and location of affected lymph node regions, and the involvement of extranodal sites.

9. “B symptoms” in lymphoma refer to a specific triad of systemic symptoms, which are:

• a) Painless lymphadenopathy, fatigue, and itching.
• b) Unexplained fever, drenching night sweats, and significant unexplained weight loss (>10% in 6 months).
• c) Rash, joint pain, and headache.
• d) Nausea, vomiting, and diarrhea.

Answer: b) Unexplained fever, drenching night sweats, and significant unexplained weight loss (>10% in 6 months).

10. The definitive diagnosis of lymphoma requires:

• a) A blood test showing elevated white blood cells.
• b) A CT scan showing enlarged lymph nodes.
• c) A lymph node biopsy for histopathological examination and immunophenotyping.
• d) The presence of B symptoms alone.

Answer: c) A lymph node biopsy for histopathological examination and immunophenotyping.

11. Rituximab is a monoclonal antibody widely used in the treatment of many B-cell Non-Hodgkin Lymphomas. It targets which antigen on B-cells?

• a) CD30
• b) CD20
• c) PD-1
• d) HER2

Answer: b) CD20

12. The R-CHOP chemotherapy regimen, commonly used for Diffuse Large B-cell Lymphoma (DLBCL), includes Rituximab, Cyclophosphamide, Doxorubicin (Hydroxydaunorubicin), Vincristine (Oncovin), and:

• a) Bleomycin
• b) Prednisone (a corticosteroid)
• c) Methotrexate
• d) Etoposide

Answer: b) Prednisone (a corticosteroid)

13. The ABVD chemotherapy regimen is a standard first-line treatment for most patients with:

• a) Follicular Lymphoma
• b) Diffuse Large B-cell Lymphoma
• c) Hodgkin Lymphoma
• d) Mantle Cell Lymphoma

Answer: c) Hodgkin Lymphoma

14. Which of the following viruses is strongly associated with an increased risk of developing certain types of lymphoma, such as Burkitt lymphoma and some Hodgkin lymphomas?

• a) Influenza virus
• b) Epstein-Barr Virus (EBV)
• c) Hepatitis C Virus (HCV) (associated with some NHLs, but EBV is more classic for Burkitt/HL links)
• d) Human Papillomavirus (HPV)

Answer: b) Epstein-Barr Virus (EBV)

15. A “watch and wait” or observation approach may be appropriate for some patients with which type of lymphoma, if they are asymptomatic and have low tumor burden?

• a) Burkitt Lymphoma
• b) Diffuse Large B-cell Lymphoma (DLBCL)
• c) Indolent Non-Hodgkin Lymphomas (e.g., some cases of Follicular Lymphoma)
• d) Advanced-stage Hodgkin Lymphoma

Answer: c) Indolent Non-Hodgkin Lymphomas (e.g., some cases of Follicular Lymphoma)

16. Brentuximab vedotin is an antibody-drug conjugate (ADC) used in some types of Hodgkin Lymphoma and T-cell lymphomas. It targets which antigen?

• a) CD20
• b) CD19
• c) CD30
• d) PD-L1

Answer: c) CD30

17. One of the major acute toxicities associated with the doxorubicin component of CHOP or ABVD regimens is:

• a) Severe peripheral neuropathy.
• b) Cardiotoxicity (risk of cardiomyopathy).
• c) Pulmonary fibrosis.
• d) Hemorrhagic cystitis.

Answer: b) Cardiotoxicity (risk of cardiomyopathy).

18. The “A” in the ABVD regimen for Hodgkin Lymphoma stands for:

• a) Asparaginase
• b) Anastrozole
• c) Adriamycin (Doxorubicin)
• d) Alemtuzumab

Answer: c) Adriamycin (Doxorubicin)

19. Which of the following is a characteristic of Burkitt Lymphoma?

• a) It is an indolent, slow-growing lymphoma.
• b) It is a very aggressive B-cell NHL with a high proliferation rate, often associated with translocations involving the MYC gene.
• c) It primarily affects elderly individuals.
• d) It is always cured with single-agent chemotherapy.

Answer: b) It is a very aggressive B-cell NHL with a high proliferation rate, often associated with translocations involving the MYC gene.

20. Involved-field radiation therapy (IFRT) or involved-site radiation therapy (ISRT) in lymphoma treatment refers to delivering radiation:

• a) To the entire body.
• b) Only to the originally involved lymph node regions or sites of disease.
• c) Prophylactically to the brain.
• d) To the bone marrow before stem cell transplant.

Answer: b) Only to the originally involved lymph node regions or sites of disease.

21. Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are generally considered different manifestations of the same B-cell malignancy. The distinction is primarily based on:

• a) The cell of origin (T-cell vs B-cell).
• b) The primary site of involvement (CLL: predominantly blood and bone marrow; SLL: predominantly lymph nodes).
• c) The presence of Reed-Sternberg cells.
• d) The patient’s age.

Answer: b) The primary site of involvement (CLL: predominantly blood and bone marrow; SLL: predominantly lymph nodes).

22. The Philadelphia chromosome, resulting from a t(9;22) translocation leading to the BCR-ABL fusion gene, is characteristic of Chronic Myeloid Leukemia (CML) but can rarely be found in some types of:

• a) Hodgkin Lymphoma
• b) Acute Lymphoblastic Leukemia (ALL), and not typically in lymphomas discussed in this context.
• c) Follicular Lymphoma
• d) Diffuse Large B-cell Lymphoma

Answer: b) Acute Lymphoblastic Leukemia (ALL), and not typically in lymphomas discussed in this context. (While the question asks about lymphomas, it is a distractor. The primary association is CML, then ALL). *(Self-correction: Re-reading the PHA5782 syllabus, Module 6.7 specifies “Non-Hodgkin Lymphoma”. The Philadelphia chromosome is not a primary topic for NHL or HL general principles typically taught to PharmD students in an intro module. I should replace this question with something more central to lymphoma).

Revised Question 22: 22. The t(14;18) translocation, leading to overexpression of the BCL-2 protein (an anti-apoptotic protein), is a characteristic genetic abnormality found in many cases of:

• a) Hodgkin Lymphoma
• b) Diffuse Large B-cell Lymphoma
• c) Follicular Lymphoma
• d) Burkitt Lymphoma

Answer: c) Follicular Lymphoma

23. What is a common long-term complication of treatment for Hodgkin Lymphoma, particularly with older radiation techniques or certain chemotherapy agents?

• a) Chronic kidney disease
• b) Development of secondary malignancies and cardiovascular disease.
• c) Persistent B symptoms.
• d) Recurrent viral infections only.

Answer: b) Development of secondary malignancies and cardiovascular disease.

24. BTK (Bruton’s tyrosine kinase) inhibitors like ibrutinib and acalabrutinib are targeted therapies primarily used in certain B-cell malignancies, including:

• a) Classical Hodgkin Lymphoma.
• b) Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma.
• c) T-cell lymphomas.
• d) Diffuse Large B-cell Lymphoma (as first-line).

Answer: b) Chronic Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma.

25. The term “indolent” lymphoma implies that the disease:

• a) Is always rapidly fatal if not treated.
• b) Has a slow growth rate and natural history, and may not require immediate treatment if asymptomatic.
• c) Is highly resistant to all forms of therapy.
• d) Only occurs in children.

Answer: b) Has a slow growth rate and natural history, and may not require immediate treatment if asymptomatic.

26. Which component of the ABVD regimen for Hodgkin Lymphoma is known for causing significant pulmonary toxicity, particularly at higher cumulative doses?

• a) Adriamycin (Doxorubicin)
• b) Bleomycin
• c) Vinblastine
• d) Dacarbazine

Answer: b) Bleomycin

27. Immunophenotyping by flow cytometry or immunohistochemistry is crucial in lymphoma diagnosis to:

• a) Determine the stage of the disease.
• b) Identify the specific lineage (B-cell, T-cell) and maturation stage of the lymphoma cells by detecting cell surface markers (e.g., CD antigens).
• c) Measure the patient’s overall immune function.
• d) Count the number of red blood cells.

Answer: b) Identify the specific lineage (B-cell, T-cell) and maturation stage of the lymphoma cells by detecting cell surface markers (e.g., CD antigens).

28. Mantle Cell Lymphoma is a type of B-cell NHL often characterized by the t(11;14) translocation, leading to overexpression of:

• a) BCL-2
• b) MYC
• c) Cyclin D1
• d) CD30

Answer: c) Cyclin D1

29. The role of PET-CT scans in lymphoma management includes:

• a) Only initial diagnosis.
• b) Initial staging, assessing response to therapy (interim PET), and detecting relapse.
• c) Only guiding radiation therapy planning.
• d) Only monitoring for B symptoms.

Answer: b) Initial staging, assessing response to therapy (interim PET), and detecting relapse.

30. Vincristine, a component of CHOP and other regimens, frequently causes which dose-limiting toxicity?

• a) Myelosuppression
• b) Peripheral neuropathy (sensory and motor)
• c) Cardiotoxicity
• d) Nephrotoxicity

Answer: b) Peripheral neuropathy (sensory and motor)

31. Which of the following is a common principle when treating aggressive Non-Hodgkin Lymphomas like DLBCL?

• a) Initial observation is always preferred.
• b) The goal is generally curative with prompt initiation of combination chemoimmunotherapy.
• c) Single-agent therapy is usually sufficient.
• d) Radiation therapy is the primary modality for all stages.

Answer: b) The goal is generally curative with prompt initiation of combination chemoimmunotherapy.

32. Tumor Lysis Syndrome (TLS) is an oncologic emergency that can occur in rapidly proliferating cancers like Burkitt lymphoma, especially after initiation of chemotherapy. It is characterized by:

• a) Hypercalcemia, hypophosphatemia, hypokalemia.
• b) Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
• c) Severe anemia and thrombocytopenia.
• d) Uncontrolled tumor growth.

Answer: b) Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.

33. The “B” in the ABVD regimen stands for:

• a) Bortezomib
• b) Bendamustine
• c) Bleomycin
• d) Bevacizumab

Answer: c) Bleomycin

34. Which of the following lymphomas is NOT primarily a B-cell lymphoma?

• a) Follicular Lymphoma
• b) Diffuse Large B-cell Lymphoma
• c) Peripheral T-cell Lymphoma, Not Otherwise Specified (PTCL-NOS)
• d) Mantle Cell Lymphoma

Answer: c) Peripheral T-cell Lymphoma, Not Otherwise Specified (PTCL-NOS)

35. A key difference between Hodgkin Lymphoma and most Non-Hodgkin Lymphomas in terms of disease spread is that Hodgkin Lymphoma often:

• a) Spreads randomly and unpredictably.
• b) Arises in extranodal sites primarily.
• c) Spreads in an orderly, contiguous fashion from one lymph node group to the next.
• d) Rarely involves lymph nodes.

Answer: c) Spreads in an orderly, contiguous fashion from one lymph node group to the next.

36. Autologous stem cell transplantation in lymphoma is a procedure where:

• a) Stem cells are donated by a matched sibling or unrelated donor.
• b) The patient’s own stem cells are collected, stored, and then reinfused after high-dose chemotherapy.
• c) Only red blood cells are transplanted.
• d) It is used as a first-line therapy for all lymphoma types.

Answer: b) The patient’s own stem cells are collected, stored, and then reinfused after high-dose chemotherapy.

37. The International Prognostic Index (IPI) is used for risk stratification in which type of lymphoma?

• a) Classical Hodgkin Lymphoma
• b) Aggressive Non-Hodgkin Lymphomas, particularly Diffuse Large B-cell Lymphoma
• c) Indolent Follicular Lymphoma
• d) T-cell lymphoblastic lymphoma

Answer: b) Aggressive Non-Hodgkin Lymphomas, particularly Diffuse Large B-cell Lymphoma

38. Common side effects of rituximab infusion can include:

• a) Severe cardiotoxicity.
• b) Infusion-related reactions (fever, chills, rigors, hypotension), especially with the first dose.
• c) Delayed pulmonary fibrosis.
• d) Hemorrhagic cystitis.

Answer: b) Infusion-related reactions (fever, chills, rigors, hypotension), especially with the first dose.

39. The “V” in the ABVD regimen stands for:

• a) Vancomycin
• b) Vincristine
• c) Vinblastine
• d) Vemurafenib

Answer: c) Vinblastine (Vincristine is “O” for Oncovin in CHOP)

40. Which of the following is a principle of supportive care for patients receiving chemotherapy for lymphoma?

• a) Prophylaxis against tumor lysis syndrome in high-risk cases.
• b) Management of chemotherapy-induced nausea and vomiting.
• c) Use of growth factors (e.g., G-CSF) for neutropenia if indicated.
• d) All of the above.

Answer: d) All of the above.

41. The presence of the t(8;14) translocation, involving the MYC gene and immunoglobulin heavy chain gene, is a hallmark of:

• a) Follicular Lymphoma
• b) Hodgkin Lymphoma
• c) Burkitt Lymphoma
• d) Mantle Cell Lymphoma

Answer: c) Burkitt Lymphoma

42. Peripheral neuropathy is a well-known side effect of which components of common lymphoma regimens?

• a) Doxorubicin and Bleomycin
• b) Vinca alkaloids (vincristine, vinblastine) and potentially some taxanes or platinum agents if used.
• c) Prednisone
• d) Cyclophosphamide

Answer: b) Vinca alkaloids (vincristine, vinblastine) and potentially some taxanes or platinum agents if used.

43. For patients with Hodgkin Lymphoma, cure rates are generally:

• a) Very low, even in early stages.
• b) High, especially for early-stage disease, with appropriate therapy.
• c) Similar to those for metastatic pancreatic cancer.
• d) Dependent solely on the patient’s age.

Answer: b) High, especially for early-stage disease, with appropriate therapy.

44. Extranodal involvement in lymphoma means the cancer is found in:

• a) Only lymph nodes.
• b) Sites outside of the lymph nodes, such as the GI tract, bone, brain, or skin.
• c) Only the spleen.
• d) Only the bone marrow.

Answer: b) Sites outside of the lymph nodes, such as the GI tract, bone, brain, or skin.

45. The “D” in the ABVD regimen stands for:

• a) Doxorubicin
• b) Docetaxel
• c) Dexamethasone
• d) Dacarbazine

Answer: d) Dacarbazine

46. Which of the following is a principle of personalized medicine as applied to lymphoma treatment?

• a) Using a standard chemotherapy regimen for all lymphoma patients.
• b) Identifying specific molecular markers or genetic alterations in the lymphoma cells to guide the selection of targeted therapies or predict prognosis.
• c) Only considering the patient’s preference for IV versus oral medications.
• d) Focusing solely on the Ann Arbor stage.

Answer: b) Identifying specific molecular markers or genetic alterations in the lymphoma cells to guide the selection of targeted therapies or predict prognosis.

47. The most common symptom that leads to a diagnosis of lymphoma is often:

• a) Severe pain.
• b) Persistent, unexplained fever.
• c) Painless enlargement of lymph nodes.
• d) A characteristic skin rash.

Answer: c) Painless enlargement of lymph nodes.

48. One of the roles of the pharmacist in managing lymphoma patients on complex chemoimmunotherapy regimens is to:

• a) Administer radiation therapy.
• b) Perform lymph node biopsies.
• c) Educate patients on their medications, manage and counsel on side effects, verify doses, and monitor for drug interactions.
• d) Make the definitive diagnosis of lymphoma type.

Answer: c) Educate patients on their medications, manage and counsel on side effects, verify doses, and monitor for drug interactions.

49. For classical Hodgkin Lymphoma, Reed-Sternberg cells are often positive for which CD markers?

• a) CD20 and CD5
• b) CD15 and CD30
• c) CD3 and CD4
• d) CD10 and BCL6

Answer: b) CD15 and CD30 (CD20 is typically negative or weakly expressed in classical HL).

50. Treatment decisions in lymphoma are highly individualized and depend on:

• a) Only the patient’s age.
• b) The specific type and subtype of lymphoma, stage of disease, patient’s age and performance status, comorbidities, and increasingly, molecular features of the tumor.
• c) Only the results of the most recent CT scan.
• d) The availability of the newest drug only.

Answer: b) The specific type and subtype of lymphoma, stage of disease, patient’s age and performance status, comorbidities, and increasingly, molecular features of the tumor.