NBME 21 Bleomycin (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 3/Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin 🔍 / 📺 / 🌳 / 📖
tags:

+5 upvote downvote
submitted by ∗lilmonkey(63)

get full access to all content ⋅ pick a username

Chemo-tox man picture from the FA (last page of the hem and onco section) works well for me in these types of questions.

get full access to all content ⋅ pick a username

lovebug Bleomycin Induces free radical formation -> breaks in DNA strands.(Anti-tumor effect) FA19, pg431. and other tissues have Bleomycin Hydrolase. but Lung doesn't. So lead to Pulmonary fibrosis. +2

+0 upvote downvote
submitted by infundibidum6(0)

get full access to all content ⋅ pick a username

I got it down to bleomycin & chlorambucil and went with chlorambucil (sounded like “bu”sulfan ... lol) because I thought bleomycin was for testicular cancer/Hodgkins lymphoma. I later found out that chlorambucil is actually a preferred treatment for CLL! Is it because chlorambucil causes severe immunosuppression? So you wouldn’t be giving it to a 72 yo man in the first place?

get full access to all content ⋅ pick a username

yotsubato Bleomycin is the big boy of cancer treatment. I've never heard of chlorambucil and its not in FA. +1

vulcania I had never heard of chlorambucil either and after researching it found out that it's also an alkylating agent, specifically a nitrogen mustard - same as busulfan, so you weren't wrong! Based on what FA says re: bleomycin & busulfan (extrapolating this to chlorambucil), they both cause pulmonary fibrosis & skin hyperpigmentation, however, in the Lange Pharmacology flashcards it says that the hyperpigmentation with busulfan is from adrenal insufficiency so I guess you would expect to see symptoms of that as well if the same applies to chlorambucil? +1

vulcania jk ignore my previous comment. just checked uptodate and it doesn't list hyperpigmentation as a side effect of chlorambucil. +

+0 upvote downvote
submitted by ∗dr.xx(176)

get full access to all content ⋅ pick a username

Bleomycin is known to cause lung and skin toxicity due to relative absence of hydrolase in skin tissue resulting in decreased metabolism and delayed clearance. Pulmonary complications are common but skin changes are rare and include hyper-pigmentation, plaques, hyperkeratotic lesions, erythema multiforme, alopecia, stomatitis and nail changes. The exact mechanism of skin changes caused by bleomycin is not known. The treatment involves management of underlying disorders or withdrawal of the offending drug.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003049/

get full access to all content ⋅ pick a username

Must-See Comments from nbme21

nosancuck on Absorption atelectasis
assoplasty on Free T4
seagull on GM2
lnsetick on Apocrine
niboonsh on NMDA receptors are blocked by Mg2+ at the ...
drdoom on Deletion of a hydrophobic amino acid ...
hayayah on HCO3− transported in the plasma
mcl on Aortic
notadoctor on Usual interstitial pneumonitis
madojo on Genital herpes
hungrybox on Obstruction of the bile duct
jambo2222 on Lung
hungrybox on Mismatch repair
hungrybox on Hydrochlorothiazide