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

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 terminal ileum
Follicular lymphoma:
t(14;18) bcl2 overexpression
Indolent, waxing + waning lymphadenopathy

5. Abnormal stem cells @ bone marrow
Leukemias
Abnormal stem bone marrow
Acute
Blasts
Children
Short course
Chronic
Mature cells
Midlife
Longer course
Acute Lymphoblastic
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?
B) S
C) G2
D) M

15. 8) An elderly patient presents following a wrist fracture
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