Oncology, Hematology, and Immunologic Therapies
What the exam tests
Oncology and hematology questions emphasize safe administration, supportive care and recognizing emergencies. Immunology adds immunosuppressants, biologics and vaccine timing.
Core rules
- Chemotherapy prescribing is a closed-loop process: verify regimen, dose per body surface area or AUC, renal and hepatic function, cumulative anthracycline dose and antiemetic prophylaxis.
- Emetogenic risk guides antiemetics: 5-HT3 antagonist, dexamethasone and NK1 antagonist for highly emetogenic regimens; give before chemotherapy.
- Febrile neutropenia: start empiric broad-spectrum antibiotics within 60 minutes, usually piperacillin–tazobactam or a carbapenem, after cultures.
- Tumor lysis syndrome: hydration, allopurinol or rasburicase, and frequent electrolytes.
- Methotrexate toxicity is increased by NSAIDs, trimethoprim–sulfamethoxazole and renal impairment; leucovorin rescues.
- Live vaccines are avoided during immunosuppression; inactivated vaccines are preferred.
Worked example
A 60-year-old receiving cyclophosphamide and doxorubicin develops a temperature of 38.5°C and an absolute neutrophil count of 0.4 × 10⁹/L. Obtain blood cultures, then give piperacillin–tazobactam within one hour. Add vancomycin only for suspected line infection, MRSA colonization or hemodynamic instability. Reassess after 48–72 hours.
Traps
Delaying antibiotics until cultures return; giving live vaccines to immunosuppressed patients; ignoring methotrexate interactions; using rasburicase in G6PD deficiency; missing cardiotoxicity risk with cumulative doxorubicin.