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2014 Step 1 Review Oncology

2014 Step 1 Review Oncology. Wednesday, February 15th Seth Wander sawander@med.miami.edu. Oncology. General comments Lymphomas Leukemias Chemotherapeutics Sample questions. Hodgkin’s Lymphoma. Low-grade fever, night sweats, weight loss Constitutional “B” symptoms

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2014 Step 1 Review Oncology

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  1. 2014 Step 1 ReviewOncology Wednesday, February 15th Seth Wander sawander@med.miami.edu

  2. Oncology • General comments • Lymphomas • Leukemias • Chemotherapeutics • Sample questions

  3. Hodgkin’s Lymphoma • Low-grade fever, night sweats, weight loss • Constitutional “B” symptoms • Localized group of nodes, contiguous spread • Mediastinal lymphadenopathy • 50% associated with EBV • Reed-Sternberg cells • Good prognosis = ↑lymphocytes ↓RS CD30+, CD15+ B cell origin

  4. Non-Hodgkin’s Lymphoma • Neoplasms of mature B cells: • Burkitt’s lymphoma: • t(8;14) = c-myc:Ig • Children • “starry-sky” histology • Associated with EBV • Jaw lesion in Africa • Diffuse large B-cell lymphoma: • Most common adult NHL • Most B cell (20% T cell) • Mantle cell lymphoma: • t(11;14)cyclin D1 overexpression • Adults • CD5+ B cells • Peyer’s patches@ terminal ileum • Follicular lymphoma: • t(14;18) bcl2 overexpression • Indolent, waxing + waning lymphadenopathy

  5. Leukemias Abnormal stem cells @ bone marrow • Acute • Blasts • Children • Short course • Chronic • Mature cells • Midlife • Longer course • Acute Lymphoblastic • Lymphoblasts @ bone marrow • Responsive to therapy • May spread to CNS/testes • Acute Myelogenous • M3 t(15;17) = PML-RAR, all-trans retinoic acid • Auer rods • Myeloblasts • Chronic Lymphocytic • Asymptomatic, indolent • Autoimmune hemolytic anemia • Smudge cells • Chronic Myelogenous • t(9;22) = bcr-abl • Neutrophils, basophils • Blast crisis (AML) • Low leukocyte alkaline phosphatase

  6. Leukemias • CML: • t(9;22) Philadelphia chromosome • bcr-abl fusion • Abl = tyrosine kinase • Imatinib (gleevac) = anti-bcr-abl antibody • ** Oncogene addiction + Rational drug design

  7. Chemotherapeutics Nucleotide synthesis DNA RNA Protein Cellular division Methotrexate, 5-FU: (↓ thymidine synthesis) 6-MP: (↓ purine synthesis) Cytarabine (ara-C) (inhibits DNA Pol) Alkylating agents, cisplatin: (cross-link DNA) Doxorubicin, dactinomycin: (intercalate DNA) Bleomycin: (free radical formation) Etoposide: (inhibits Topoisomerase II) Vinca alkaloids: (inhibits microtubule assembly) Paclitaxel: (inhibits microtubule disassembly)

  8. 1) Which of the following features represents a typical presentation for Non-Hodgkin’s lymphoma? A) Low-grade fever and night sweats B) Contiguous spread C) Extranodal involvement D) Reed-Sternberg cells

  9. 2) A young child in Africa presents to the clinic with the following lesion in his jaw. You suspect a certain type of lymphoma with which of the following characteristic translocations? A) t(14;18) B) t(9;22) C) t(11;22) D) t(8;14)

  10. 3) A patient with a history of testicular cancer returns to the clinic for a regular follow up. He reports increasing shortness of breath. Pulmonary function tests reveal a restrictive pattern. Which of the following drugs was likely included in his treatment protocol? A) Doxorubicin B) Bleomycin C) Etoposide D) Paclitaxel

  11. 4) An adult patient presents with a rapidly progressive history of infections and excessive bleeding. The peripheral blood smear demonstrates increased circulating myeloblasts. A representative image is shown below. This patient might benefit from which of the following treatments? A) All-trans retinoic acid B) Imatinib C) Vincristine D) Doxorubicin

  12. 5) An elderly patient presents with pancytopenia and splenomegaly but does not demonstrate lymphadenopathy. The peripheral blood smear is shown below. What is the likely diagnosis? A) CLL B) Hodgkin’s lymphoma C) CML D) Hairy cell leukemia

  13. 6) Which of the following best describes the molecular function of Imatinib/Gleevac, used to treat CML? A) Inhibitor of Topoisomerase II B) Tyrosine kinase inhibitor C) Alkylating agent D) Microtubule assembly inhibitor

  14. 7) Both vincristine and paclitaxel act at which stage of the cell cycle? A) G1 B) S C) G2 D) M

  15. 8) An elderly patient presents following a wrist fracture. X-rays demonstrate several “punched-out” lytic lesions. Urinalysis reveals elevated Ig light chains. What is the diagnosis? A) Metastatic breast cancer B) Osteosarcoma C) Multiple Myeloma D) CLL

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