PHRM 868 (Therapeutics IV) Exam 1 Sample Questions

Question 1

A 6 month-old boy is determined to have a systemic malignancy originating from precursor cells of the nervous system. The pathology report would state?

A. Adenocarcinoma
B. Neuroblastoma
C. Leukemia
D. Metastatic sarcoma

Answer 1

B. Neuroblastoma

Question 2

What would the TNM staging be for: A breast cancer is found to be a large tumor that has spread outside the breast to nearby lymph nodes but not to other parts of the body

Answer 2

T3 N2 M0

Question 3

What would the TNM staging be for: A prostate cancer is located only in the prostate and has not spread to the lymph nodes or any other part of the body

Answer 3

T2 N0 M0

Question 4

A 48-year-old woman has a routine physical examination. A 4 cm diameter non-tender mass is palpated in her right breast. The mass appears fixed to the chest wall. Another 2 cm non-tender mass is palpable in the left axillary node. A chest radiograph reveals multiple 0.5 to 2 cm nodules in both lungs. Which of the following TNM classifications best indicates the stage of her disease?

A. T1 N1 M0
B. T1 N0 M1
C. T2 N1 M0
D. T3 N0 M0
E. T4 N1 M1

Answer 4

E. T4 N1 M1

Question 5

Which of the following is potentially 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. Is often overexpressed in cancer

Answer 5

C. Produces proteins that block the activity of cyclins

*note: cyclins promote the cell cycle

Question 6

A chemotherapy that interferes with DNA synthesis is:

A. S-phase specific
B. G1-phase specific
C. Cell cycle non-specific
D. M-phase specific

Answer 6

A. S-phase specific

Question 7

Which phase of the cell cycle do you think is targeted by Palbociclib (the CDK 4/6 inhibitor)?
A. G1
B. S
C. G2
D. M

Answer 7

A. G1

Question 8

*What is the most common reason for resistance to MULTIPLE chemotherapies at once?
A. Decreased activation of prodrugs
B. Transport out of cells
C. Cell cycle changes
D. Mutations in drug targets

Answer 8

B. Drug transport out of cells

Question 9

Which hormone is produced in the pituitary gland?
A. GnRH
B. LH
C. Estrogen
D. Progesterone

Answer 9

B. LH

Question 10

Estrogen receptor primarily binds estrogen where in the cell?
A. On the plasma membrane
B. In the mitochondria
C. In the cytoplasm
D. In the nucleus

Answer 10

C. In the cytoplasm

(then moves to the nucleus once it is bound)

Question 11

What enzyme converts androstenedione to estrone?
A. CYP19
B. 5 alpha-reductase
C. 17, 20 lyase
D. P450scc

Answer 11

A. CYP19

Question 12

Which compound directly inhibits the activity of the estrogen receptor throughout the body?
A. Letrozole
B. Exemestane
C. Tamoxifen
D. Fulvestrant

Answer 12

D. Fulvestrant

Question 13

Which compound is referred to as a SERM?
A. Letrozole
B. Exemestane
C. Tamoxifen
D. Fulvestrant

Answer 13

C. Tamoxifen

Question 14

What are the Androgen Receptor Antagonists?

Answer 14

Enzalutamide
Apalutamide
Darolutamide

Question 15

What is the MOA of the Androgen Receptor Antagonists?

Answer 15

Prevent the translocation of the androgen receptor (AR) to the nucleus

Inhibit AR binding to DNA

Question 16

What do the Androgen Receptor Antagonists treat?

Answer 16

BOTH metastatic and non-metastatic prostate cancer

Question 17

What is unique about the action of Tamoxifen compared to Fluvestrant?
A. It leads to ER degradation
B. It holds ER out of the nucleus
C. It ejects ER from the cell
D. It activates ER in bone

Answer 17

D. It activated ER in bone

Question 18

Which of the following is not a hormone responsive cancer type?
A. Breast cancer
B. Ovarian cancer
C. Prostate cancer
D. Endometrial cancer

Answer 18

B. Ovarian cancer

Question 19

Which of the following is only used in the postmenopausal setting?
A. Letrozole
B. Tamoxifen
C. Leuprolide
D. Raloxifene

Answer 19

A. Letrozole

Question 20

Which compound acts directly on AR?
A. Leuprolide
B. Abiraterone
C. Degarelix
D. Enzalutamide

Answer 20

D. Enzalutamide

Question 21

Which amino acid is not a target of phosphorylation?
A. Tyrosine
B. Serine
C. Threonine
D. Alanine

Answer 21

D. Alanine

Question 22

What is the source of the phosphate that gets transferred onto a substrate by a kinase?
A. SAM
B. DNA
C. RNA
D. ATP

Answer 22

D. ATP

Question 23

Which compound inhibits EGFR?
A. Gefitinib
B. Osmertinib
C. Afatinib
D. Lapatinib
E. All of the above

Answer 23

E. All of the above

Question 24

What mutation in EGFR confers resistance to 1st and 2nd generation EGFR inhibitors?
A. L858R
B. Exon 19 deletion
C. Exon 14 deletion
D. T790M

Answer 24

D. T790M

Question 25

Which of the following drugs targets HER2?
A. Sirolimus
B. Alectinib
C. Vemurafinib
D. Tucatinib

Answer 25

D. Tucatinib

Question 26

Which of the following drugs targets a kinase that is produced by formation of the Philadelphia chromosome?
A. Alectinib
B. Gefitinib
C. Imatinib
D. Binimetinib

Answer 26

C. Imatinib

Question 27

Which compound below is not a covalent kinase inhibitor?
A. Gefitinib
B. Osimertinib
C. Afatinib
D. Acalabrutinib

Answer 27

A. Gefitinib

Question 28

Which type of kinase inhibitor can bind in the ATP binding site and stabilize the inactive conformation of a kinase?
A. Type I
B. Type II
C. Type III
D. Type IV

Answer 28

B. Type II

Question 29

A CML patient initially tested positive for the Philadelphia chromosome and has enjoyed a 5-year response to imatinib. Unfortunately, the disease has recurred and now tests positive for the T315I mutation.
Describe how T315I prevents the efficacy of imatinib?

What is the next course of BCR-Abl-targeted therapy to include?

Answer 29

This mutation prevents compounds from binding in their binding pocket (why it is a very specific mutation and not a random mutation)

Ponatinib is indicated

Question 30

Which drug is a NUCLEOSIDE analog?
A. 5-FU
B. Cytarabine

Answer 30

B. Cytarabine

(5-FU is a nucleobase that must undergo two conversions to reach an active nucleotide)

Question 31

Which drug primarily interferes with purine biosynthesis?

A. 5-Fluorouracil
B. Capecitabine
C. 6-Mercaptopurine
D. Cytosine arabinoside

Answer 31

C. 6-Mercaptopurine

Question 32

Anti-folates all share the following characteristics except:
A. They inhibit DHFR
B. They cause myelosuppression
C. They induce a G2/M cell cycle block
D. The toxic effects are “rescued” by Leucovorin

Answer 32

C. They induce a G2/M cell cycle block

(these drugs cause an S phase block)

Question 33

What rescues a 5-FU overdose?
A. Leucovorin
B. Cytosine arabinose
C. Thymidine
D. Methotrexate

Answer 33

C. Thymidine

Question 34

What increases the efficacy of 5-FU?
A. Leucovorin
B. Cytosine arabinoside
C. Thymidine
D. Methotrexate

Answer 34

A. Leucovorin

Question 35

Which antimetabolite should not be given to patients being treated for gout?
A. Cytosine arabinoside
B. 6-mercaptopurine
C. Cladribine
D. 5-FU

Answer 35

B. 6-mercaptopurine

Question 36

Which anti-metabolite does not directly inhibit DNA/RNA synthesis?
A. 5-fluorouracil
B. Cytosine Arabinoside
C. Nelarabine
D. Methotrexate

Answer 36

D. Methotrexate

Question 37

Alkylating agents are potent…
A. Reducing agents
B. Electrophiles
C. Nucleophiles
D. Oxidizing agents

Answer 37

B. Electrophiles

Question 38

Which of the following is a prodrug?
A. Mechlorethamine
B. Cyclophosphamide
C. Mitomycin C
D. Chlorambucil

Answer 38

B. Cyclophosphamide

Question 39

To block hemorrhagic cystitis, Mesna is coadministered with which drug?
A. Methotrexate
B. Cyclophosphamide
C. Cisplatin
D. Mitomycin C

Answer 39

B. Cyclophosphamide

Question 40

Which of the following is not a cross-linker?
A. Cytarabine
B. Cyclophosphamide
C. Carboplatin
D. Chlorambucil

Answer 40

A. Cytarabine (anti-metabolite)

Question 41

Topoisomerase I inhibitors primarily halt cells in which phase of the cell cycle?
A. G0/G1
B. S
C. G2
D. M

Answer 41

B. S

Question 42

A patient has a history of heart disease and poor cardiac function. Which topoisomerase inhibitor should not be prescribed?
A. Doxorubicin
B. Etoposide
C. Irinotecan

Answer 42

A. Doxorubicin

Question 43

Which of the following microtubule inhibitors block the polymerization of tubulin?
A. Paclitaxel
B. Vincristine
C. Ixabepilone

Answer 43

B. Vincristine

Question 44

Which of the following is used to describe a cancer derived from pigment producing cells of the eye?
A. Teratoma
B. Papilloma
C. Sarcoma
D. Melanoma
E. All of the above

Answer 44

D. Melanoma

Question 45

Which of the following is not a hallmark of cancer?
A. Resisting cell death
B. Evading growth suppressors
C. Enabling replicative immortality
D. Activating invasion and metastasis
E. Increasing in cell size

Answer 45

E. Increasing in cell size

Question 45

Molecular pathology is different from traditional pathology because?
A. It uses a numerical system to categorize tumor progression
B. It uses some kind of genetic testing to indicate therapy or predict for tumor recurrence
C. It uses stains that allow pathologists to visualize nuclear and cytoplasmic size and shape
D. It is not useful when determining a patient’s course of treatment

Answer 45

B. It uses some kind of genetic testing to indicate therapy or predict for tumor recurrence

Question 46

Which of the following terms is associated with substitution of one tissue type for another?
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Desmoplasia

Answer 46

C. Metaplasia

Question 47

Which of the following antibodies targets HER2?
A. Neratinib
B. Cetuximab
C. Lapatinib
D. Pertuzumab

Answer 47

D. Pertuzumab

Question 48

What was the first immunotherapy?
A. Pertuzumab
B. Keytruda
C. Coley’s Toxin
D. Trastuzumab

Answer 48

C. Coley’s Toxin

Question 49

The antibody Fakeumab has just entered the market. What type of antibody is it?
A. Fully human
B. Humanized
C. Fully mouse
D. Chimeric

Answer 49

A. Fully Human

Question 50

Which antibody is effective against metastatic melanoma and targets CTLA-4?
A. Ipilimumab
B. Trastuzumab
C. Daratumumab
D. Blinatumomab

Answer 50

A. Ipilimumab

Question 51

Which of the following proteins is used as a cancer biomarker test to determine eligibility for treatment of NSCLC with pemrolizumab?
A. CD19
B. CTLA4
C. PDL1
D. PD1

Answer 51

C. PDL1

*note: PD1 is on the T-cell

Question 52

Which of the following antigens is a common target for CAR-T therapy in B cell malignancy?
A. CD4
B. CD19
C. CD28
D. CTLA4

Answer 52

A. CD19

Question 53

What is the primary mechanism of action of bispecific T cell engagers in cancer immunotherapy?
A. They inhibit the PD1/PDL1 interaction
B. They bring T cells and cancer cells in close proximity to facilitate T cell mediated cytotoxicity
C. They stimulate the innate immune system to recognize tumor cells
D. They increase neoantigens

Answer 53

B. they bring T cells and cancer cells in close proximity to facilitate T cell mediated cytotoxicity

Question 54

Which of the following drugs acts by binding to HER2?
A. Trastuzumab
B. Pertuzumab
C. All of the above

Answer 54

C. All of the above

Question 55

Which of the following drugs exerts antitumor effects by inhibiting the interaction between PD1 and PDL1?
A. Cetuximab
B. Ipilimumab
C. Atezolizumab
D. All of the above

Answer 55

C. Atezolizumab

Question 56

What concept of immunity must be overcome for the immune system to successfully eliminate cancer cells?
A. Antibody-dependent cellular cytotoxicity
B. Central tolerance
C. T-cell activity
D. B-cell activity

Answer 56

B. Cental tolerance

Question 57

What is the function of the cetuximab?
A. To block EGFR ligand binding
B. The same as panitumumab
C. To bind VEGF
D. The same as Pertuzumab
E. A and B

Answer 57

E. A and B