Correct Answers

Correct Answers

Acute Lymphoblastic Leukemia (ALL)

  1. HyperCVAD + TKI (Ponatinib or dasatinib) is the standard treatment for ALL with the Philadelphia chromosome
  2.  Blinatumomab is an ALL treatment that should be reserved for relapsed disease or +MRD at ~3 months
  3.  Clofarabine single-agent therapy should be reserved for patients with co-morbidities
  4. Inotuzumab ozogamicin would only be appropriate in fulminant relapsed or refractory disease.
  5. Nelarabine would not be appropriate because DH has B-cell ALL (not T-cell ALL)
  6. High-dose Cytarabine can cause cerebellar toxicity
  7. HyperCVAD + dasatinib
  8. Continue current therapy
  9. C. Continue C10403
  10. C. Continue hyperCVAD + ponatinib
  11. D. Cytokine release syndrome
  12. D. Dexamethasone (ICANS)
  13. A. Supportive care
  14. A. Supportive care (grade 1 cytokine release syndrome)
  15. C. Levetiracetam (CAR-T)
  16. The initial WBCs
  17. A. Aggressive hydration (normal saline)   (TLS)
  18. D. ECOG1910
  19. D. HyperCVAD + ponatinib
  20. d. Asparaginase
  21. An Induction therapy - CNS prophylaxis - Consolidation therapy - Maintenance therapy (88%)

Acute Myeloid Leukemia (AML)

  1. b. Greek word for ‘white blood’
  2. C. del 7
  3. C. AML with mutations in FLT3
  4. d. Patients with RUNX1-RUNX1T1 detected by RT-PCR in remission have a poor prognosis
  5. c. Maintenance therapy is not effective
  6. c. 109
  7. d. Zero
  8. e. None of the above
  9. a. First complete remission
  10. d. Detection of clonal rearrangement of the immunoglobulin heavy chain gene
  11. c. CLL (Chronic Lymphocytic Leukemia)
  12. a. AML with t(8;21)
  13. a. Cytarabine 100–200 mg/m² for 7 days
  14. d. Addition of etoposide increases remission rates.
  15. C. More than 20% blast cells in the bone marrow are required for all cases of AML
  16. C. Allogeneic stem cell transplantation is needed in all patients less than 50 years old with an HLA-matched donor (Wrong)
  17. C. Cytarabine continuous infusion for 7 days and daunorubicin IV push for 3 days.
  18. C. Poor Risk. (FLT3-ITD mutation)
  19. Cytarabine continuous infusion for 7 days and daunorubicin IV push for 3 days.
  20. B. 7+3, with daunorubicin 90 mg/m2/day
  21. A. Cytarabine 3,000 mg/m2/dose IV Q12 hours on days 1,3,5
  22. C: Cytarabine 200 mg/m² × 7 days + daunorubicin 90 mg/m² × 3 days.
  23. B Cytarabine 100mg/m² x 7 days plus daunorubicin 90mg/m² x 3 days.
  24. C. AML-M3 Acute promyelocytic leukemia (87%)
  25. . 7+3 plus gemtuzumab
  26. B. Intermediate dose cytarabine, daunorubicin, and gemtuzumab
  27. D. Liposomal cytarabine and daunorubicin
  28. C. Liposomal daunorubicin 29 mg/m2 and cytarabine 65 mg/m2 on days 1 and 3
  29. C. Azacitidine + venetoclax
  30. C. Azacitidine + ivosidenib
  31. C. MEC
  32. a. More than 50 percent of cells
  33. d. 3+7 induction
  34. d. All of the above (Correct answer).

Acute Promyelocytic Leukemia (APL)

  1. B. t(15;17)(q24;q21)
  2. C. Acute promyelocytic leukemia (APL)
  3. C. Tretinoin, idarubicin and arsenic trioxide
  4. D. Differentiation syndrome
  5. C. Sinusoidal obstruction syndrome
  6. 3- Fresh-frozen plasma.
  7. 3- Methylprednisolone.
  8. 2- The initial WBCs.
  9.  Arsenic trioxide followed by transplantation.
  10. c. Total leukocyte count
  11. d. Induction failure is defined as PML-RARA positive after induction therapy
  12. d. All of the above
  13. b. WBC and platelet count
  14. d. Starting dexamethasone 10 mg twice daily
  15. c. Both are equally effective
  16. Answer: e. None of the above
  17. e. All of the above
  18. d. With-hold ATRA and give acetazolamide
  19. d. All of the above
  20. c. Daunorubicin
  21. All-trans retinoic acid (ATRA) + Idarubicin
  22. A. All-trans retinoic acid (ATRA) + idarubicin + arsenic trioxide
  23. D. Hydroxyurea (42%)
  24. Tretinoin (Vesanoid) (31%)

Adult Sarcomas

  1. B. Post-operative chemotherapy decreases risk for relapse.
  2. C. Ifosfamide and doxorubicin (Synovial)
  3. C. Ifosfamide and doxorubicin
  4. A. Imatinib for 1 year
  5. B. Imatinib for 3 years
  6. A. Imatinib 400 mg twice daily
  7. A. Samples of your urine will be tested for the presence of red blood cells prior to each dose of ifosfamide.
  8. Mesna and hydration with normal saline
  9. C. Mesna 500 mg/m2 IV in 3 divided doses, one 15 minutes prior to ifosfamide infusion, the second 4 hours after ifosfamide and third 8 hours after ifosfamide and hydration with normal saline
  10. A. Cisplatin and doxorubicin
  11. A. High dose methotrexate, cisplatin and doxorubicin
  12. A. Increase leucovorin
  13. B. Start glucarpidase
  14. B. Hold the patient’s thiazide diuretic for at least 2 days prior to methotrexate and until after clearance
  15. A. Increase leucovorin
  16. B. Take the pexidartinib with a low-fat meal
  17. D. Neuropathy
  18. D. Pazopanib
  19. C. MRI of the left lower extremity and CT chest
  20. A. Methotrexate, doxorubicin, and cisplatin followed by surgery
  21. B. Mitotic index <5/50 high-powered fields

 

Bladder, Renal Cell And Testicular Cancers

  1. A. Intravesical Bacillus Calmette-Guerin (BCG)
  2. B) Gemcitabine/carboplatin followed by avelumab maintenance
  3. D) Dose-dense MVAC
  4. C. Nitrosoureas like carmustine may cause disease
  5. A. Repeat staging with transurethral resection of bladder tumor (TURBT)
  6. C. Cisplatin
  7. B) Gemcitabine/carboplatin followed by avelumab maintenance
  8. B. Carboplatin + gemcitabine
  9. C. Avelumab maintenance
  10. B. Vision disorders is a major concern, C. FGFR2/3 alterations should be tested before treatment (Erdafitinib)
  11. C. Chemoradiation with cisplatin and 5-fluorouracil (5-FU)
  12. pembrolizumab (D)
  13. D) LL is unlikely to derive any overall survival benefit from adjuvant sunitinib.
  14. C) Lenvatinib + pembrolizumab
  15.  Axitinib + pembrolizumab
  16. D) Pazopanib
  17. B) Thyroid function
  18. B) Hypertension
  19. D) Electrolyte abnormalities should be replaced, then repeat his ECG
  20. A) Cabozantinib
  21. C. RB
  22. D. FLCN
  23. D. Ipilimumab/nivolumab
  24. A) Good risk
  25. D) G-CSF may increase one’s risk of bleomycin induced pulmonary toxicity, but this risk is not proven and G-CSF may still be used when necessary in patients receiving BEP.
  26. A) Secondary malignancies and cardiovascular disease
  27. A. Good risk
  28. B. Four cycles of BEP (bleomycin/etoposide/cisplatin) chemotherapy
  29. C) Partial nephrectomy then observation
  30. D) Pazopanib
  31. A) Cardiac arrhythmias

Breast Cancer

  1. D. Docetaxel and cyclophosphamide (TC) followed by tamoxifen (for RS = 26)
  2. A. Anastrozole x 5 years
  3. A. Anastrozole (RS = 11)
  4. C. Tamoxifen x 10 years
  5. B. Anastrozole + abemaciclib
  6. D. Olaparib
  7. D. Capecitabine
  8. C. TCH + pertuzumab x 6 cycles
  9. A. Every 12 weeks
  10. B. Ado-trastuzumab emtansine (with residual disease)
  11. C. Trastuzumab + pertuzumab (without risdual disease)
  12. Hold trastuzumab and pertuzumab
  13. B. Pembrolizumab + carboplatin + paclitaxel → pembrolizumab + doxorubicin + cyclophosphamide (AC)
  14. C. Dose dense doxorubicin + cyclophosphamide (AC) → paclitaxel
  15. B. Fam-trastuzumab deruxtecan
  16. D. Trastuzumab + pertuzumab + docetaxel
  17. B. Ado-trastuzumab emtansine
  18. A. Ribociclib + letrozole
  19. D. Elacestrant
  20. B. Talazoparib
  21. A. Initiate denosumab every 6 months
  22. B. Embryo cryopreservation
  23. C. Zoledronic acid 4 mg IV every 12 weeks
  24. D. Discontinue tamoxifen; start goserelin and anastrozole
  25. D. Abemaciclib + letrozole + goserelin
  26. A. Palbociclib + letrozole
  27. C. Alpelisib + fulvestrant + goserelin
  28. B. Everolimus + exemestane
  29. D. Abemaciclib + anastrozole
  30. B. Everolimus + exemestane
  31. A. Alpelisib and fulvestrant
  32. Correct Answer: C – “You should start CBE, mammogram when you are 39 years old then yearly”
  33. A. Ixabepilone

Cancer Related Infectious Diseases

  1. D. Meropenem + vancomycin
  2. D. De-escalate to oral step-down therapy since BL has not received an adequate course for pneumonia
  3. B. Cefdinir, fluconazole, dapsone, valacyclovir, entecavir
  4. A. Initiate entecavir and proceed with rituximab
  5. E. Vancomycin 500 mg PO and rectally Q6H + metronidazole 500 mg IV Q8H (Ileus)
  6. D. Fidaxomicin 200 mg PO BID (Without Ileus)
  7. D. Switch fluconazole to voriconazole
  8. D. Switch fluconazole to liposomal amphotericin B (Vincristine)
  9. D. Patients receiving R-ICE should receive live vaccines ≥ 6 months after chemotherapy.
  10. C. Cefepime + vancomycin
  11. D. De-escalate to oral step-down therapy since BL has not received an adequate course for pneumonia
  12. D. Immunoglobulins will be suppressed for ~ 1 year following blinatumomab; consider monitoring antibody level if inactivated viruses administered.
  13. C. TS may receive any of the mRNA COVID-19 vaccines ≥ 3 months after CAR-T.
  14. C. Levofloxacin ± clindamycin
  15. D. De-escalate to oral step-down therapy since LB has not received an adequate course for pneumonia
  16. B. Switch posaconazole to liposomal amphotericin B

Chronic Lymphocytic Leukemia (CLL)

  1. D. Venetoclax + obinutuzumab (Short term)
  2. A. Acalabrutinib +/- obinutuzumab (long term)
  3. C. Zanubrutinib
  4. C. Venetoclax + rituximab
  5. C. Venetoclax + rituximab
  6. B. Diarrhea may be severe. (Idelalisib)
  7. A. Sulfamethoxazole-trimethoprim
  8. A. Acyclovir
  9. C. Headache (Acalabrutinib)
  10. A. Zoster vaccine recombinant, adjuvanted
  11. A. Ibrutinib
  12. A. Richter’s transformation
  13. D. Observation only - no therapy (93%)
  14. Alemtuzumab + Rituximab (45%)
  15. D Fludarabine/Cyclophosphamide/Rituximab (92%)
  16. C. Unlike ibrutinib, idelalisib does not lead to a treatment-induced lymphocytosis. (57%)
  17. A. Sulfamethoxazole/trimethoprim (88%)
  18. D. Since KT is young and does not have comorbidities, she should be started on chemoimmunotherapy (52%)
  19.   d. del 13q14
  20.   f. All of the above
  21. B. ZAP70 ≥ 10%
  22. D. No treatment, only surveillance
  23. C. Inpatient: Pre-dose, 4, 8, 12, and 24 hours at first dose of 20 mg and 50 mg, then Outpatient: Pre-dose before subsequent doses  
  24. A. Corticosteroids  (Immune Thrombocytopenic Purpura)

Chronic Myeloid Leukemia (CML)

  1. B. Bosutinib
  2. C. Order BCR::ABL mutational analysis
  3. C. Change to dasatinib
  4. D. TKIs may be discontinued if MMR is sustained for 2 years.
  5. B. Omacetaxine
  6. B. Bosutinib
  7. Adherence with TKI therapy is directly associated with outcome
  8. Imatinib 400 mg daily (43%) (No drug interaction with PPIs)
  9. translocation 9:22 (75%)
  10. Ponatinib is also indicated in T315I-positive Ph+ ALL.
  11. Dasatinib (60%)
  12. CML (44%)
  13. Imatinib, nilotinib, dasatinib (83%)
  14. Imatinib
  15. Chronic myelogenous leukemia (71%)
  16. 100 mg once daily (66%)
  17. The presence of t(9;22) is diagnostic for CML (67%)
  18. Allogeneic stem cell transplantation
  19. Allogenic stem cell transplantation
  20. c. Fusion protein p190 is most common though p210 is also seen in some cases
  21. c. Basophil percent
  22. d. All of the above
  23.  d. Interferon 
  24. c. CML (Hasford system)
  25. d. Renal dysfunction
  26. c. p210
  27. d. All of the above
  28. b. Dephosphorylation
  29. b. Hair loss
  30. E. CCyR should be achieved at 12 months maximum: Correct – ELN recommends CCyR (i.e., 0% Ph+ metaphases) to be achieved by 12 months.

Gynecologic Malignancies

  1. . Carboplatin/paclitaxel for 6 cycles (not 3 cycles,  IB, high-grade serous ovarian cancer)
  2. b. Observation:  IA grade 1 ovarian cancer
  3. c. Dose-dense paclitaxel IV + carboplatin IV followed by interval debulking surgery
  4. c. Carboplatin + paclitaxel followed by interval debulking surgery
  5. b. Niraparib 300 mg once daily
  6. a. Niraparib 300 mg once daily
  7. d. Olaparib 300 mg oral twice daily plus bevacizumab 15 mg/kg every 3 weeks (if bevacizumab is used neoadjuvant and HRD positive)
  8. b. Pegylated liposomal doxorubicin
  9. a. IV carboplatin + gemcitabine
  10. a. Carboplatin + pegylated liposomal doxorubicin
  11. B. Pembrolizumab is only appropriate if MSI-H or dMMR when there is no satisfactory alternative
  12. D. Stop infusion, start oxygen, administer H1 and H2 blocker and corticosteroid
  13. C. Chemoradiation
  14. A. Cisplatin 50 mg/m2 + paclitaxel 175 mg/m2 + bevacizumab 15 mg/kg
  15. b. Observation or vaginal brachytherapy
  16. c. Pelvic EBRT and brachytherapy
  17. a. Chemotherapy
  18. D. Males 9 to 21 years old and females 9 to 26 years old
  19. A. Chemotherapy with cisplatin, paclitaxel, and bevacizumab
  20. B. HPV 16 and 18
  21. D. Intravenous paclitaxel on day 1, intraperitoneal cisplatin on day 2,and intraperitoneal paclitaxel on day 8 of a 21-day cycle for six cycles
  22. Observation (low malignant potential)
  23. B. National Comprehensive Cancer Network (NCCN) guidelines recommend genetic testing given her personal history of ovarian cancer
  24. B. Adjuvant radiation therapy
  25. C. Recommend age-appropriate colon cancer screening and immunohistochemical staining of tumor tissue for MLH1, MSH2, MSH6, and PMS2. Refer for genetic counseling if protein stains are absent
  26. A. Hormonal therapy with an aromatase inhibitor
  27. A. Observation
  28. b. Olaparib 300 mg twice daily (somatic deleterious mutation in BRCA1)
  29. a. IV carboplatin + liposomal doxorubicin
  30. d. Olaparib 300 mg twice daily plus bevacizumab 15 mg/kg every 3 weeks

Head & Neck Carcinomas

  1. B) Concurrent radiation and every 3 week cisplatin
  2. B) Pembrolizumab/Fluorouracil/ Cisplatin
  3. He will need to swish and spit with a salt and soda solution
  4. B) Add morphine swishes for pain
  5. A) Dexamethasone mouthwash (Everolimus)
  6. C. Radioactive iodine
  7. C. Selpercatinib
  8. B. Hypersensitivity
  9. B. Prolonged QTc
  10. B. Radiation followed by procarbazine, lomustine (CCNU), and vincristine
  11. C) Concurrent radiation and every-3-week cisplatin
  12. B) Pembrolizumab/Fluorouracil/Carboplatin
  13. B. Radioactive iodine
  14. B. Temozolomide with concurrent radiation followed by temozolomide maintenance
  15. C. HPV testing is part of oropharyngeal cancer diagnosis
  16. D. Resection
  17. B. Pembrolizumab
  18. A. nutrition supplements plus prednisolone 10 mg BID
  19.  C. NRT + behavior therapy is correct.
  20. A. External beam radiation therapy to the mass with radiosensitizing doxorubicin
  21. D. Cabozantinib
  22. B. Is associated with hypermethylation of DNA & prevention of differentiation is correct. (IDH mutation)
  23. Concurrent radiation and weekly cisplatin
  24. C) Euphoria is correct.
  25. : D. Temozolomide with concurrent radiation followed by temozolomide is correct.

Hematopoietic Stem Cell Transplantation (HSCT)

  1. A. Carmustine, etoposide, cytarabine, melphalan + rituximab (BEAM -R) myeloablative conditioning followed by autologous HSCT.
  2. C. Ice chips
  3. . Bone mineral density testing
  4. C. Ursodiol
  5. D. Tacrolimus + mycophenolate + post-transplant cyclophosphamide.
  6. C. Methylprednisolone 2 mg/kg/day. (Lower GVHD)
  7. D. Acyclovir, sulfamethoxazole/trimethoprim, posaconazole, and penicillin
  8. D. Myeloablative haploidentical allogeneic HCT
  9. Answer: C. Ursodiol (Fludarabine)
  10. D. Tacrolimus + mycophenolate + post-transplant cyclophosphamide
  11. B. Methylprednisolone 2 mg/kg/day + therapeutic tacrolimus
  12.  C. Prednisone 0.5 mg/kg/day and beclomethasone 8 mg daily (Upper GVHD)
  13. A. Sulfamethoxazole/trimethoprim, acyclovir, posaconazole
  14. B. Sorafenib (Sorafenib is the preferred post-transplant maintenance agent for FLT3-ITD AML)
  15.  C. Hepatitis B
  16. C. Mesna (Cyclophosphamide)
  17. A. Decrease due to posaconazole
  18. B. Levofloxacin, acyclovir, letermovir, posaconazole

Hodgkin Lymphoma (HL)

  1. B. ABVD
  2. Proceed with chemotherapy at full doses
  3. A. Treat the anthracycline extravasation
  4. ABVD x 2 cycles followed by AVD x 4 cycles
  5.  Ice packs and dexrazoxane
  6. Nodular lymphocyte-predominant Hodgkin lymphoma (Popcorn)
  7. d. All of the above
  8. d. After 3 weeks
  9. Relapsed/refractory HL (Brentuximab Vedotin )
  10. Visual interpretation of PET-CT
  11. d. 85–90
  12. c. It represents the majority of cells in a lymph node of Hodgkin’s lymphoma (False)
  13. Dexrazoxane

Lower GIT

  1. B.Capecitabine
  2. . FOLFIRI + bevacizumab
  3. B. Acute diarrhea may be accompanied by sweating which is treated with atropine
  4. A. Give atropine, and consider pre-medication with atropine for future cycles (Irinotecan)
  5. B. Continue panitumumab at same dose and initiate topical hydrocortisone ( grade 2 papulopustular rash)
  6. mFOLFIRINOX
  7. mFOLFIRINOX
  8. Gemcitabine + capecitabine (if the patient has neuropathy)
  9. mFOLFIRINOX
  10. C. Gemcitabine + cisplatin
  11. C. Gemcitabine + nab-paclitaxel
  12. C. Pembrolizumab
  13. C. Chemoradiation with 5-FU and mitomycin (localized anal cancer)
  14. A. CAPEOX x3 months (high-risk stage III colon cancer)
  15. B. Instruct him to have his next colonoscopy in 5 years
  16. B.do 50 % dose reduction(1200 mg/m2)
  17. A. Celecoxib proved to decrease risk but not used due to CVS toxicity
  18. D. He should start colonoscopy at 35 years old then every 5-10 years
  19. B. FOLFOX
  20. A. Capecitabine chemoradiation, followed by FOLFOX followed by surgery
  21. B. FOLFOX + cetuximab
  22. C. Continue Bevacizumab and start FOLFIRI
  23. A. Synchronous resection of primary colon tumor and en bloc resection of regional lymph nodes, along with metastasectomy of liver lesion followed by 6 months of adjuvant FOLFOX
  24. A. History and physical along with a CEA, and CT chest, abdomen, and pelvis every 3 to 6 months for 2 years then every 6 months every 5 years & Colonoscopy in 1 year then after 3 & 5 years
  25. Answer: C. Hold till recovery to GO or G1, Use Urea 20% cream BID plus clobetasol 0.05% cream daily plus pain control with NSAIDs or GABA agonists or opioids
  26. A. Avoid cold drinks and ice for 3-5 days after infusion to prevent laryngospasm and dysphagia
  27. B. Obtain a PET/CT scan
  28. A. Instruct her to take loperamide 4 mg now, then 2 mg after every loose stool, up to 16 mg/day
  29. A. Ogilvie syndrome (acute colonic pseudo-obstruction)

Lung Cancer

  1. B. Yes, she is a candidate for an annual chest CT
  2. d. Carboplatin AUC 5 IV Day 1 and etoposide 100 mg/m2 IV Days 1-3 and atezolizumab 1200 mg IV Day 1 Q 21 days x 4 cycles followed by atezolizumab 1200 mg IV Day 1 Q 21 days
  3. a. Carboplatin AUC 5 IV Day 1 and etoposide 100 mg/m2 IV days 1-3 every 21 days
  4. A. Lurbinectedin 3.2 mg/m2 IV Day 1 Q 21 days (for relapsed/refractory SCLC)
  5. B. Refer to Radiation Oncology for possible stereotactic brain radiation
  6. c. Cisplatin and pemetrexed
  7. a. Pembrolizumab
  8. a. Drain the fluid
  9. C. Cisplatin and pemetrexed for 4 cycles, followed by atezolizumab for 1 year
  10. d. EGFR:Osimertinib
  11. C. Ondansetron 8 mg IV plus dexamethasone 12 mg PO plus olanzapine 5 mg PO (Acute)
  12. B. Dexamethasone 8 mg PO daily on days 2 to 4 plus olanzapine 5 mg PO daily on days 2 to 4 (Prevention)
  13. A. Metoclopramide 10 mg PO every 6 hours
  14. B. Dexamethasone 8 mg PO daily days 5 and 6 (Delayed)
  15. C. Poor nausea control with prior chemotherapy
  16. A. Palonosetron 0.25 mg IV plus dexamethasone 12 mg PO plus olanzapine 5 mg PO (Acute)
  17. B. Dexamethasone 8 mg PO daily on days 2 to 4 plus olanzapine 5 mg PO daily on days 2 to 4 (Prevention)
  18. A. Lorazepam 0.5 mg PO every 6 hours
  19. C. Alectinib: Myalgias
  20. A. Cemiplimab
  21. D. Concomitant use of proton pump inhibitors with sotorasib should be avoided.
  22. C. Docetaxel and ramucirumab
  23. C. Dexamethasone, diphenhydramine, and acetaminophen
  24. A) B.carotene & selenium has a no rule in lung cancer prevention
  25. B. Carboplatin + pemetrexed + pembrolizumab × 4 cycles followed by maintenance pemetrexed + pembrolizumab
  26. A. Tobacco use
  27. D.Nivolumab plus ipilimumab
  28. B. patient should receive vit B12 IV/IM every 9 weeks plus folic acid 350 mcg PO daily 3 weeks before treatment and continue these medications for 3 weeks after treatment
  29. D. Do not give cisplatin until CrCl ≥60 ml/min
  30. C. stop drug if baseline SBP is 135 and it decreased to 100 after 5 mins of infusion (Amifostine)
  31. A Hold pembrolizumab until AD’s symptoms return to baseline. Start levothyroxine and recheck TSH/T4 in 6 weeks (55%)
  32. B Lorlatinib (35%)
  33. A Carboplatin/paclitaxel (76%)
  34. C Ceritinib (62%)
  35.  D (All of the above)
  36. B Lung cancer (94%)
  37. A Pembrolizumab, Carboplatin, Pemetrexed (48%)
  38. C Cisplatin/etoposide (62%)
  39.  Carboplatin/paclitaxel/bevacizumab (66%)
  40. D Chemotherapy and radiation (61%)
  41. B Surgery and adjuvant cisplatin/ vinorelbine (68%)
  42. A Crizotinib (91%)
  43. B 10–15% (34%)

Multiple Myloma

  1. D. BMPC=70%
  2. A. stage I
  3. D. Observation (Smoldering myeloma )
  4. d. Zoledronic acid 4 mg IV + calcitonin 4 IU/kg SubQ
  5. B. Enoxaparin 40 mg SubQ q12h (Prophylaxis: 0.5 mg/kg)
  6. C. Daratumumab, bortezomib, thalidomide, dexamethasone
  7. C. Daratumumab, bortezomib, lenalidomide, dexamethasone
  8. C. 1.3 mg/m2 SubQ D 1, 4, 8 and 11
  9. C. Carfilzomib, lenalidomide, dexamethasone (KRd) (relapsed)
  10. C. Daratumumab, carfilzomib, dexamethasone (Relapsed)
  11. A. Acyclovir
  12. A. Aspirin, acyclovir
  13. B. Pamidronate 90 mg IV over 4 hours
  14. B. Zoledronic acid 4 mg IV over 30 min
  15. D. Zoledronic acid 3 mg IV over 15 min every 4 weeks (CrCl of 35 mL/min)
  16. A. Zoledronic acid 4 mg IV once + calcitonin 4 IU/kg SubQ every 12 hours
  17. C. Denosumab 120 mg SubQ every 4 weeks
  18. A. Apixaban 2.5 mg twice daily
  19. A. Therapy with lenalidomide and dexamethasone (risk factors for DVT)
  20. D. Bortezomib, lenalidomide, dexamethasone
  21. C. Isatuximab, carfilzomib, dexamethasone
  22. D. Teclistamab
  23. B. Dexamethasone, acetaminophen, diphenhydramine
  24. B. Lenalidomide
  25. A. Aspirin 81 mg once daily (SAVED score <2)
  26. D. Enoxaparin 60 mg SubQ q12h Treatment: 1mg/kg)
  27. d. Clinical trials (relapsed 6 months after Auto SCT)
  28. c. Safe in renal failure (wrong)
  29. Thrombosis (Wrong)
  30. C Bone marrow biopsy. skeletal survey, B2 microglobulin (83%).
  31. A plasma cells (63% 7)
  32. B Hypercalcemia, renal failure, anemia, bone metastasis (69%)

Myelodysplastic Syndromes (MDS)

  1. A. Erythropoietin
  2. B. Luspatercept (low risk MDS with ringed sideroblasts in patients who have failed or are unlikely to respond to ESAs)
  3. C. Epoetin
  4. B. Del(5q)
  5. A. Untreated iron overload
  6. e. All of the above
  7. a. 4–8 months
  8. d. Reduced intensity allo-SCT (Wrong)
  9. D. Allogeneic HSCT (71%)
  10. D. A 61-year-old female with newly diagnosed higher risk MDS undergoing an allogeneic cell transplantation

Non-Hodgkin Lymphoma (NHL)

  1. B. BR x 6 cycles
  2. A. Yes, he should receive rituximab every 2 months x 2 years.
  3. D. Rituximab every 2 months x 2 years
  4. A. Disease cure
  5. . Pola-R-CHP x 6 cycles
  6. C. R-CHOP x 6 cycles
  7.  C (R-CHOP x 6 cycles +/- RT)
  8. R-GDP followed by autologous stem cell transplant
  9. D. R-ESHAP followed by autologous stem cell transplant
  10. A. Initiate rituximab as scheduled
  11. D. Zanubrutinib
  12. C. Pruritus
  13.  CHOP
  14.  Sex
  15. e. All except b and d
  16. R-CHOP x 3 cycles followed by PET-CT and RT in PET negative
  17. a. R-CVP regimen
  18. d. All of the above
  19. a. Radiotherapy
  20. a. Wait and watch
  21. d. Clinical trials
  22. B. Hepatitis B surface antigen
  23. B. High β2-microglobulin
  24. C. Cyclin D1 overexpression & t(11;14)(q13;q32)
  25. C. Observation
  26.  A. Acalabrutinib
  27. D. Entecavir during rituximab + 12 months post-therapy
  28. B. ABVD + R

 

Pediatric Malignancies

  1. A. Acute lymphoblastic leukemia (ALL)
  2. C. Wilms tumor
  3. D. Neuroblastoma
  4. A. Brain/CNS tumors
  5. B. High-dose methotrexate, doxorubicin, cisplatin (Osteosarcoma)
  6. B. Pneumocystis jirovecii prophylaxis
  7. C. Asparaginase
  8. B. Intrathecal methotrexate ± cytarabine and hydrocortisone are required
  9. B. Rasburicase
  10. B. Surgery + chemotherapy (vincristine + actinomycin D ± doxorubicin) (Willms)
  11. B. High-dose methotrexate + doxorubicin + cisplatin
  12. B. Echocardiogram (LVEF)
  13. B. Hemorrhagic cystitis
  14. C. Homovanillic acid (HVA) and vanillylmandelic acid (VMA) in urine
  15. B. RB1 mutation increases risk for secondary malignancies such as osteosarcoma
  16. D. Dexamethasone, vincristine, pegaspargase, and daunorubicin
  17. A. Dexamethasone, vincristine, and pegaspargase
  18. D. 6MP decreased to 10% dosing three days per week
  19. B. Hold both mercaptopurine and methotrexate
  20. D. The risk of long-term neurocognitive toxicity
  21. C. Cyclophosphamide, doxorubicin, vincristine (CAV) alternating with cisplatin/etoposide (P-VP) plus local control with surgical resection and radiation therapy
  22. B. Potentiate antibody-dependent cell mediated cytotoxicity
  23. B. Corticosteroids
  24. C. A single reduction course followed by four cycles of multi-agent chemotherapy and maintenance therapy
  25. C. Loss of heterozygosity at chromosomes 1p and 16q
  26. B. Vincristine, doxorubicin, cyclophosphamide (VDC) alternating with ifosfamide/etoposide (IE) every 2 weeks
  27. D. Focal therapy and vincristine, etoposide, and carboplatin x 6 cycles
  28. B. Yes, KM should receive levofloxacin prophylaxis until his ANC recovers to greater than 500 cells/mm3.
  29. C. Aprepitant and 5-HT3 antagonist
  30. D. Permission from one parent
  31. B. Every 2 years
  32. A. Decrease risk of complications from tumor lysis syndrome
  33. D. Nelarabine
  34. B. Cefepime
  35. D. Not required by federal law, but check state laws for specific details
  36. A. Beneficence and respect for autonomy
  37. B. 2-year-old receiving cisplatin-based therapy for neuroblastoma

Prostate Cancer

  1. C) Leuprolide + Docetaxel
  2. B) Add abiraterone + prednisone
  3. B) Hypokalemia
  4. C) Neutropenia
  5. C. Radiation therapy + short term androgen deprivation therapy
  6. A. Active surveillance
  7. D. Enzalutamide
  8. C. Darolutamide
  9. Continue leuprolide, add darolutamide
  10. C. Stop enzalutamide, add Docetaxel + prednisone
  11. Radium-223
  12. D. Denosumab 120 mg every 4 weeks and calcium plus vitamin D 500mg-400 IU twice daily
  13. Intermittent ADT with leuprolide
  14. Docetaxel + darolutamide
  15. Cabazitaxel + prednisone
  16.  Lutetium-177 PSMA
  17. A. Olaparib
  18. Docetaxel + darolutamide
  19.  Talazoparib + enzalutamide
  20. A, D, E, G (BRCA 1, MYC, FOXA1, SRD5A1)
  21. C. 42 years old man whose father diagnosed with prostate cancer at 57 years old
  22. C. Normal PSA </= 4 ng/dl but prostate cancer may occur at PSA 2.5-4ng/dl
  23. C. In men who are taking finasteride for BPH, the potential benefits and risks should be discussed
  24. C. 4
  25. B. Insulin resistance
  26. E.Degarelix
  27. A. Abirateron+prednisolone
  28. C. Patient should do cardiovascular work up and tests prior to therapy

Skin Cancers

  1. C. Dabrafenib and trametinib
  2. A. Skin rash (Pembrolizumab)
  3. C. Methylprednisolone (Grade 3 diarrhea)
  4. D. Dabrafenib and trametinib
  5. B. Hold dabrafenib and trametinib until fever has resolved, then restart at full dose
  6. D. Vismodegib
  7. A. Changes in taste
  8. D: Pembrolizumab
  9. D. pembrolizumab
  10. C: Ipilimumab and nivolumab
  11. C. Continue nivolumab and start levothyroxine
  12. Encorafenib and binimetinib
  13. CBC, CMP, CK, EKG, echocardiogram, routine eye exams
  14. Talimogene laherparepvec
  15. C. Hold therapy, monitor electrolytes, start prednisone 1 mg/kg/day
  16. A. Continue nivolumab
  17. B. Adjuvant use of either interferon or ipilimumab has shown improvement in RFS but not OS in stage III melanoma
  18. C. Perform adrenocorticotropic hormone (ACTH) stimulation test
  19. D. Purified protein derivative (PPD) testing for tuberculosis (TB)
  20. A. Dabrafenib/trametinib
  21. E. A, B & D
  22. B. Intermittent exposure during childhood and youth more than prolonged exposure
  23. D. One of the screening criteria: lesion larger than ¼ inch is suspected to be melanoma
  24.  D. Pembrolizumab
  25. A. Nivolumab
  26. A. Continue therapy with nivolumab and monitor TSH and T4
  27. C: Start levothyroxine

Upper GIT

  1. C. FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)
  2. C. HER2 expression
  3. B. FOLFOX + trastuzumab + pembrolizumab
  4. B. Fam-trastuzumab deruxtecan
  5. D. Nivolumab
  6. D. Paclitaxel
  7. Atezolizumab + bevacizumab
  8. A. Observation and continue therapy with no modifications
  9. D. Prophylactic gastrectomy
  10. A. Neoadjuvant chemoradiation with carboplatin and paclitaxel
  11. A. Nivolumab
  12.  E. All of the above
  13. B. History of chronic hepatitis C with Child–Pugh class A cirrhosis
  14. B. Local-regional therapy (transarterial chemoembolization [TACE] or transarterial radioembolization [TARE])