Oncology

Front 1

Which type of lymphoma is characterized by a localized, single group of nodes?

Back 1

Hodgkin; non-Hodgkin involves multiple, peripheral nodes

Front 2

Which type of lymphoma has a better prognosis?

Back 2

Hodgkin

Front 3

What age group is typically affected by Hodgkin lymphoma?

Back 3

Bimodal distribution-young adulthood and >55 years; more common in men except for nodular sclerosing type

Front 4

What age group is typically affected by non- Hodgkin lymphoma?

Back 4

Peak incidence for certain subtypes at 20-40 years

Front 5

What infection(s)/disease(s) is associated with Hodgkin lymphoma?

Back 5

Strongly associated with EBV

Front 6

What infection/disease is associated with non-Hodgkin lymphoma?

Back 6

May be associated with HIV and autoimmune diseases

Front 7

Most common type of non-Hodgkin lymphoma in adults

Back 7

diffuse large B-cell lymphoma (note also that 20% of cases occur in children)

Front 8

Which lymphoma presents as "waxing and waning" LAD?

Back 8

Follicular lymphoma

Front 9

Which lymphoma is CD5+?

Back 9

Mantle cell lymphoma

Front 10

Which neoplasia shows numerous plasma cells with "clock-face" chromatin and intracytoplasmic inclusions containing Ig on histology?

Back 10

Multiple myeloma

Front 11

Pseudo-Pelger-Huet anomaly

Back 11

Neutrophils with bilobed nuclei; typically seen after chemotherapy

Front 12

Which drug in addition to cladribine is used to treat Hairy Cell leukemia?

Back 12

pentostatin

Front 13

M3 AML

Back 13

acute promyelocytic leukemia; t(15;17)

Front 14

Median age of onset for AML

Back 14

65

Front 15

erythromelalgia

Back 15

sever, burning pain and red-blue coloration due to episodic blood clots in vessels of extremities; rare but classic symptoms of polycythemia vera

Front 16

Azathioprine, 6-mercaptopurine, 6-thioguanine

Back 16

• Purine analog
• Preventing organ rejection, rheumatoid arthritis, IBD, SLE; used to wean patients off steroids in chronic disease and to treat steroid-refractory chronic disease
• Toxicity with allopurinol or rebuxostat because azathioprine & 6-MP are metabolized by xanthine oxidase
• Myelosuppression (6-MP)

Front 17

Cytarabine (arabinofuranosyl cytidine)

Back 17

• Pyrimidine analog
• AML, lymphomas
• causes pancytopenias

Front 18

5-FU

Back 18

• Pyrimidine analog
• Colon cancer, pancreatic cancer, basal cell carcinoma (topical)
• causes irreversible myelosuppresion

Front 19

MTX

Back 19

• folic acid analog
• cancers: ALL, lymphomas, choriocarcinoma, sarcomas
• non-neoplastic: ectopic pregnancy, medical abortion (w/misoprostol), RA, psoriasis, IBD, vasculitis
• causes myelosuppresion that is reversible with leucovorin, hepatotoxicity, mucositis, pulmonary fibrosis

Front 20

Bleomycin

Back 20

• induces free radical formation
• testicular cancer, Hodgkin lymphoma
• pulmonary fibrosis, skin hyperpigmentation, mucositis; minimal myelosuppresion

Front 21

Dactinomycin

Back 21

• intercalates in DNA
• used for childhood tumors: Wilms tumor, Ewing sarcoma, rhabdomyosarcoma
• causes myelosuppresion

Front 22

Doxorubicin, daunorubicin

Back 22

• generates free radicals
• solid tumors, leukemias, lymphomas
• cardiotoxicity (prevented with dexrazoxane), myelosuppression, alopecia

Front 23

Busulfan

Back 23

• Cross-links DNA
• CML, bone marrow ablation before transplant
• causes severe myelosuppression, pulmonary fibrosis, hyperpigmentation

Front 24

Cyclophosphamide, ifosfamide

Back 24

• Cross-link DNA at guanine N-7

• Solid tumors, leukemia, lymphomas

• Myelosuppression; hemorrhagic cystitis, partially prevented with mesna (thiol group of mesna binds toxic metabolites)

Front 25

Nitrosoureas (carmustine, lomustine, semustine, streptozocin)

Back 25

• Cross blood-brain barrier > CNS. Cross-link DNA

• Brain tumors (including glioblastoma multiforme)

• CNS toxicity (convulsions, dizziness, ataxia).

Front 26

Paclitaxel, other taxols

Back 26

• Microtubule inhibitor

• Ovarian and breast carcinomas.

• Myelosuppression, alopecia, hypersensitivity

Front 27

Vincristine, vinblastine

Back 27

• Vinca alkaloids that bind β-tubulin and inhibit its polymerization into microtubules prevent mitotic spindle formation (M-phase arrest).

• Solid tumors, leukemias, Hodgkin (vinblastine) and non-Hodgkin (vincristine) lymphomas.

• Vincristine: neurotoxicity (areflexia, peripheral neuritis), paralytic ileus.

• Vinblastine blasts bone marrow (suppression).

Front 28

Cisplatin, carboplatin

Back 28

• Cross-link DNA.

• Testicular, bladder, ovary, and lung carcinomas.

• Nephrotoxicity, ototoxicity. Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis.

Front 29

Etoposide, teniposide

Back 29

• Etoposide inhibits topoisomerase II - increase DNA degradation.

• Solid tumors (particularly testicular and small cell lung cancer), leukemias, lymphomas

• Myelosuppression, GI upset, alopecia

Front 30

Irinotecan, topotecan

Back 30

• Inhibit topoisomerase I and prevent DNA unwinding and replication.

• Colon cancer (irinotecan); ovarian and small cell lung cancers (topotecan).

• Severe myelosuppression, diarrhea

Front 31

Hydroxyurea

Back 31

• Inhibits ribonucleotide reductase- decrease DNA Synthesis (S-phase specific)

• Melanoma, CML, sickle cell disease (increase HbF)

• Severe myelosuppression, GI upset

Front 32

Prednisone, prednisolone

Back 32

• Various; bind intracytoplasmic receptor; alter gene transcription

• Most commonly used glucocorticoids in cancer chemotherapy. Used in CLL, non-Hodgkin lymphoma (part of combination chemotherapy regimen). Also used as immunosuppressants (e.g., in autoimmune diseases)

• Cushing-like symptoms; weight gain, central obesity, muscle breakdown, cataracts, acne, osteoporosis, hypertension, peptic ulcers, hyperglycemia, psychosis

Front 33

Bevacizumab

Back 33

• Monoclonal antibody against VEGF. Inhibits angiogenesis.

• Solid tumors (colorectal cancer, renal cell carcinoma).

• Hemorrhage, blood clots, and impaired wound healing.

Front 34

Erlotinib

Back 34

• EGFR tyrosine kinase inhibitor

• Non-small cell lung carcinoma

• Rash

Front 35

Imatinib

Back 35

• Tyrosine kinase inhibitor of BCR-ABL (Philadelphia chromosome fusion gene in CML) and c-kit (common in GI stromal tumors).

• CML, GI stromal tumors.

• Fluid rentention

Front 36

Rituximab

Back 36

• Monoclonal antibody against CD20, which is found on most B-cell neoplasms

• Non-Hodgkin lymphoma, CLL, IBD, rheumatoid arthritis.

• Increased risk of progressive multifocal leukoencephalopathy

Front 37

Tamoxifen, raloxifene

Back 37

• Selective estrogen receptor modulators (SERMs)—receptor antagonists in breast and agonists in bone. Block the binding of estrogen to ER ⊕ cells.

• Breast cancer treatment (tamoxifen only) and prevention. Raloxifene also useful to prevent osteoporosis.

• Tamoxifen—partial agonist in endometrium, which increases the risk of endometrial cancer; “hot flashes.”

• Raloxifene—no increase in endometrial carcinoma because it is an estrogen receptor antagonist in endometrial tissue

Front 38

Trastuzumab (Herceptin)

Back 38

• Monoclonal antibody against HER-2 (c-erbB2), a tyrosine kinase receptor. Helps kill cancer cells that overexpress HER-2, through inhibition of HER2-initiated cellular signaling and antibody- dependent cytotoxicity.

• HER-2 ⊕ breast cancer and gastric cancer (tras2zumab).

• Cardiotoxicity. “Heartceptin” damages the heart

Front 39

Vemurafenib

Back 39

• Small molecule inhibitor of BRAF oncogene ⊕ melanoma
• Metastatic melanoma