Anticancer drugs: bleomycin and oxygen: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Anticancer drugs: bleomycin and oxygen

Sample item

A 28-year-old man treated for Hodgkin lymphoma with a regimen containing bleomycin needs an abdominal operation under general anaesthesia. Which precaution is most important?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Use the lowest inspired oxygen concentration that maintains adequate saturation

Bleomycin is inactivated by bleomycin hydrolase, which is low in lung and skin, so pulmonary fibrosis is its dose-limiting toxicity. High inspired oxygen concentrations can potentiate bleomycin lung injury, even years after exposure, so anaesthetists keep the inspired fraction as low as safely possible and avoid fluid overload. Pulmonary function is monitored during therapy.

Option by option

  • A. Give mesna cover during the operation

    Mesna prevents haemorrhagic cystitis from cyclophosphamide and ifosfamide.

  • B. Use the lowest inspired oxygen concentration that maintains adequate saturation (correct)

    Correct. Oxygen-derived free radicals worsen bleomycin-induced lung injury.

  • C. Give folinic acid rescue before surgery

    Folinic acid rescue is used after methotrexate.

  • D. Give prophylactic dexrazoxane infusion

    Dexrazoxane protects against anthracycline cardiotoxicity.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Use the lowest inspired oxygen concentration that maintains adequate saturation. Bleomycin is inactivated by bleomycin hydrolase, which is low in lung and skin, so pulmonary fibrosis is its dose-limiting toxicity.

Why is "Give mesna cover during the operation" not the answer?

Mesna prevents haemorrhagic cystitis from cyclophosphamide and ifosfamide.

Why is "Give folinic acid rescue before surgery" not the answer?

Folinic acid rescue is used after methotrexate.

Why is "Give prophylactic dexrazoxane infusion" not the answer?

Dexrazoxane protects against anthracycline cardiotoxicity.

What concept does this question test?

It tests Anticancer drugs: bleomycin and oxygen in Pharmacology. High inspired oxygen concentrations can potentiate bleomycin lung injury, even years after exposure, so anaesthetists keep the inspired fraction as low as safely possible and avoid fluid overload. Pulmonary function is monitored during therapy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anticancer drugs: bleomycin and oxygen?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.