pediatric oncology mcq

Mustafa Mohamed Selim, NCI

1

By Dr: Mustafa Selim

National Cancer Institute

MCQ


2

How to succeed in the exam?

Be confident and proud of yourself

Now let’s begin


3

1. Which of the following agents is most effective when administered in divided

doses or by continuous infusion?

A. Asparaginase

B. Cyclophosphamide

C. Cytarabine

D. Doxorubicin

Answer C: Cell-cycle specific drugs include plant alkaloids and antimetabolites.

These agents have their most cytotoxic effects during the active S and M phases of the

cell cycle. Cytatabine is an antimetabolite.

2. Which of the following is true of a tumor suppressor gene?

A. Allows unrestricted cell growth and proliferation.

B. Promotes different phases of the cell cycle.

C. Produces proteins that block the activity of cyclins.

D. Regulates cell growth and repair.

Answer C: Progress through each phase of the cell cycle is controlled tightly by a

group of proteins called cyclins. Tumor suppressor genes produce proteins that block

the activity of cyclins, thereby inhibiting cell growth and division.

3. When reviewing the chemistry panel of a newly diagnosed patient with AML

who is lethargic, complaining of flank pain, and experiencing nausea and

vomiting, the nurse would expect to see which of the following:

A. Potassium 4.5, Phosphorus 8, Uric Acid 7, Calcium 9.0, BUN 12

B. Potassium 6.5, Phosphorus 8, Uric Acid 9, Calcium 10, BUN 14

C. Potassium 4, Phosphorus 9, Uric Acid 10, Calcium 10, BUN 10

D. Potassium 7, Phosphorus 12, Uric Acid 10, Calcium 7, BUN 25

Answer D: Lethargy, flank pain, and nausea and/or vomiting are symptoms of tumor

lysis syndrome. Patients with ALL, AML, and NHL are at risk for TLS. In TLS,

abnormal lab findings include elevated WBC, phosphorus, uric acid, potassium, BUN,

creatinine, and LDH and decreased calcium.

4. A patient with pulmonary fibrosis, seen as a late effect of chemotherapy

received as a child, would most likely have received which of the following

chemotherapeutic agents?

A. Carmustine

B. Doxorubicin

C. Etoposide

D. Gemcitabine


4

Answer A: Carmustine: A common side effect of Carmustine is late pulmonary

dysfunction.

5. The single-best predictor of favorable outcome in AML is the presence of

which of the following?

A. Ataxia Telangiectasia

B. Fanconi anemia

C. Myelodyplastic syndrome

D. Trisomy 21

Answer D: The presence of Trisomy 21 (Down Syndrome) is the single-best predictor

of favorable outcome in AML.

6. You are taking care of a 15 year old patient with Medulloblastoma who is

being admitted for his second round of chemotherapy. The patient states that he

became nauseated as he walked into the hospital lobby. Given this information,

the nurse should:

A. Administer the ordered Ondansetron immediately. B. Advise the parents to give Ondansetron prior to coming to the hospital before the next course of chemotherapy. C. Check the orders for Lorazepam and if not ordered, obtain an order for it. D. Encourage the patient to drink a carbonated beverage and eat some crackers.

Answer C: Lorazepam is indicated for the prevention of anticipatory nausea and vomiting.

7. Which of the following is a non-profit organization that provides information

about the legal rights of cancer survivors?

A. American Cancer Survivors Foundation

B. Candlelighters Childhood Cancer Foundation

C. Light the Lamp Foundation

D. Young Adult Cancer Survivors of America

Answer B: Candlelighter’s Childhood Cancer Foundation is a non-profit organization

that provides information about the legal rights of cancer survivors.

8. Your patient’s hemoglobin is 7.5. He has a history of severe transfusion

reactions. The blood bank calls to tell you that his packed red blood cells are

ready and that they are in a syringe. When you call to inform his mother she

asks if they can return later that evening. What is the best response?

A. “No, the packed red blood cells must be given now because they are irradiated.”

B. “No, the packed red blood cells had to be washed and will expire in four hours.”

C. “Yes, the packed red blood cells will not expire for 24 hours.”

D. “Yes, because his hemoglobin is higher than 7 it will be okay to wait.”

Answer B: Patients who have had severe transfusion reactions to PRBC’s receive

PRBC’s that have to be washed. This process reduces the amount of WBC’s, protein,

and cellular waste in the unit. PRBC’s expire 4 hours after they have been washed and

placed in a syringe.


5

If u want more→

move to the next

slide


6

41. A 2-year old boy presents to the emergency room with temperature of 38.5C,

hepatosplenomegaly and petechiae. His complete blood count revealed white blood

cell of 27,000/mm3 with 20% blasts, hemoglobin of 9g/dl and platelets of 60 x 106/L.

His bone marrow aspirate showed 35% of myeloid blast, 50% of monoblasts and

abnormal eosinophilic precursors. A diagnosis of AML M4eo was made. 1) When

looking at the result of this child’s cytogenetic study, the pediatric

hematologist-oncologist recognizes that the most common cytogenetic abnormality

associated with AML M4eo is:

A. t (9;11)

B. PML-RARA

C. inv(16)(p13;q22)

D. t(8;21)

Answer C

42. Agents used to treat AML M4eo include:

A. Prednisone, L-asparaginase and vincristine

B. All trans retinoic acid (ATRA) and cytarabine

C. Arsenic trioxide and dexamethasone

D. Cytarabine and daunomycin

Answer D

43. During induction therapy, the patient developed temperature of 39.4C, heart rate

of 147 bpm and respiratory rate of 52/ min. The patient fulfills the criteria for:

A. Sepsis

B. Tumor lysis syndrome

C. ATRA syndrome

D. Systemic inflammatory response syndrome

Answer D

44. In addition to the above vital signs, the patient’s blood pressure was noted to be

74/35. Appropriate interventions at this point are:

A. Administer fluid bolus and oxygen

B. Withhold ATRA and start dexamethasone

C. Hyperhydration and alkalinization

D. Start antifungal therapy and reverse isolation

Answer A

CASE


7

45. This patient’s prognosis can be severely affected if the patient develops:

A. Hypotension refractory to fluids and requiring inotropic support

B. Line infection requiring central line removal

C. Oliguria requing diuretics

D. Respiratory failure requiring mechanical ventilation

Answer D


8

CHEMOTHERAPY QUIZ

Warning: More than one answer may be correct!

209. You are a new intern on Ellison 18 and have

been assigned a patient with newly diagnosed ALL

who is receiving induction chemotherapy with:

PREDNISONE,VINCRISTINE,

L-ASPARAGINASE, DAUNOMYCIN. This

morning she has 4+glucose in her urine, and her

serum glucose is 360. This is likely due to:

a) leukemic infiltration of the pancreas

b) prednisone

c) vincristine

d) L-asparaginase

e) Daunomycin

Answer A+D

210. Today, she received all 4 drugs and it's your

first night on call. The nurse calls you at 2 a.m. and

tells you that her urine is now red. You suspect…

a) a UTI because of her underlying neutropenia

b) hemorrhagic cystitis due to chemo

c) excretion of one of the chemo agents in the urine

d) hematuria due to underlying thrombocytopenia

Answer C

211. You order:

a) stat platelet transfusion

b) stat urinalysis and culture

c) stat increase in IVF

d) the nurse to dip the urine

e) a stat phone call to the heme/onc attending on call

Answer D


9

212. Just as you fall back to sleep, your pager goes

off and you are called STAT to the bedside. There

you find your patient dyspneic, hypotensive, and

complaining of numbness around the lips and a

feeling like her "tongue is swollen". The most

likely etiology of these symptoms is:

a) allergic reaction to one of the chemo agents

b) PCP pneumonia

c) Sepsis due to underlying neutropenia

d) Acute cardiotoxicity from daunomycin

Answer A

213. You prescribe:

a) high dose bactrim

b) timentin & gent

c) digoxin

d) benadryl

e) hydrocortisone

f) epinephrine

g) a fluid bolus

Answer D,E,F,G

Match your patient's side effects with the offending

chemotherapy agent:

SIDE EFFECT AGENT

*Use only one agent per side effect

214. Vincristine

A. Weight gain

B. Nausea/vomiting

C. Jaw pain

D. Constipation

Answer C +D

215. Prednisone

A. Gastritis

B. Hyperactivity

C. Pancreatitis

D. Weight gain

E.Insomnia

Answer A+D+E


10

216. L-asparaginase

A.Low blood counts

B. Anaphylaxis

C. Insomnia

217.

245. An otherwise healthy child has on his 1-year-old routine CBC the

polymorphonuclear neutrophil shown in the following illustration

(hypersegmented neutrophils). This child likely has

A. Malignancy

B. Iron deficiency

C. Folic acid deficiency

D. Döhle inclusion bodies

E. The Pelger-Huët nuclear anomaly

Answer C The finding of hypersegmented neutrophils in the peripheral blood is one of the

most useful laboratory aids in making an early diagnosis of folate deficiency. Serum folate levels

become low in weeks with an inadequate dietary source. The Pelger-Huët anomaly is an inherited

disorder in which neutrophils have no more than two lobes. Neutrophils in severe bacterial

infections have toxic granulation, Döhle inclusion bodies, and cytoplasmic vacuoles.

246. The previous malformations are characteristics of ???

Answer→Wilms tumour

247. Patient of ALL on maintaince

chemotherapy identify the skin lesion?

Answer→herps zoster


11

295. When reviewing the chemistry panel of a newly diagnosed patient with

AML who is lethargic, complaining of flank pain, and experiencing nausea and

vomiting, the nurse would expect to see which of the following:

A. Potassium 4.5, Phosphorus 8, Uric Acid 7, Calcium 9.0, BUN 12

B. Potassium 6.5, Phosphorus 8, Uric Acid 9, Calcium 10, BUN 14

C. Potassium 4, Phosphorus 9, Uric Acid 10, Calcium 10, BUN 10

D. Potassium 7, Phosphorus 12, Uric Acid 10, Calcium 7, BUN 25

Answer D: Lethargy, flank pain, and nausea and/or vomiting are symptoms of

tumor lysis syndrome. Patients with ALL, AML, and NHL are at risk for TLS.

In TLS, abnormal lab findings include elevated WBC, phosphorus, uric acid,

potassium, BUN, creatinine, and LDH and decreased calcium.

296. A patient with pulmonary fibrosis, seen as a late effect of chemotherapy

received as a child, would most likely have received which of the following

chemotherapeutic agents?

A. Carmustine

B. Doxorubicin

C. Etoposide

D. Gemcitabine

Answer A: Carmustine: A common side effect of Carmustine is late pulmonary

dysfunction.

297. The single-best predictor of favorable outcome in AML is the presence of

which of the following?

A. Ataxia Telangiectasia

B. Fanconi anemia

C. Myelodyplastic syndrome

D. Trisomy 21

Answer D: The presence of Trisomy 21 (Down Syndrome) is the single-best

predictor of favorable outcome in AML.


12

If u want

more→ please

contact me on

[email protected]

LinkedIn: Mostafa Selim

phone:00201067332790

mailto:[email protected]


13

pediatric oncology mcq

Health & Medicine