Vinca alkaloids and taxanes — MCQs

A 32-year-old man presents with a 1-week history of progressive diplopia followed by numbness and tingling in his hands and feet, some weakness in his extremities, and occasional difficulty swallowing. He was recently diagnosed with Hodgkin's lymphoma and started on a chemotherapeutic regimen that included bleomycin, doxorubicin, cyclophosphamide, vincristine, and prednisone. He denies fever, recent viral illness, or vaccination. On neurological examination, he has bilateral ptosis. His bilateral pupils are 5 mm in diameter and poorly responsive to light and accommodation. He has a bilateral facial weakness and his gag reflex is reduced. Motor examination using the Medical Research Council scale reveals a muscle strength of 4/5 in the proximal muscles of upper extremities bilaterally and 2/5 in distal muscles. In his lower extremities, hip muscles are mildly weak bilaterally, and he has bilateral foot drop. Deep tendon reflexes are absent. Sensory examination reveals a stocking-pattern loss to all sensory modalities in the lower extremities up to the middle of his shins. A brain MRI is normal. Lumbar puncture is unremarkable. His condition can be explained by a common adverse effect of which of the following drugs?

A 57-year-old woman with non-small cell lung cancer comes to the physician 4 weeks after her tumor was resected. She takes no medications. The physician starts her on a treatment regimen that includes vinblastine. This treatment puts the patient at highest risk for which of the following?

A 60-year-old female presents to her primary care physician complaining of bloating and fatigue over the past year. On examination, she has abdominal distension and ascites. Abdominal imaging reveals a mass-like lesion affecting the left ovary. A biopsy of the lesion demonstrates serous cystadenocarcinoma. She is subsequently started on a chemotherapeutic medication known to stabilize polymerized microtubules. Which of the following complications should this patient be monitored for following initiation of this medication?

An 84-year-old man comes to the emergency department because of lower back pain and lower extremity weakness for 3 weeks. Over the past week, he has also found it increasingly difficult to urinate. He has a history of prostate cancer, for which he underwent radical prostatectomy 8 years ago. His prostate-specific antigen (PSA) level was undetectable until a routine follow-up visit last year, when it began to increase from 0.8 ng/mL to its present value of 64.3 ng/mL (N < 4). An MRI of the spine shows infiltrative vertebral lesions with a collapse of the L5 vertebral body, resulting in cord compression at L4–L5. The patient receives one dose of intravenous dexamethasone and subsequently undergoes external beam radiation. Which of the following cellular changes is most likely to occur as a result of this treatment?

A 7-year-old boy presents to an urgent care clinic from his friend’s birthday party after experiencing trouble breathing. His father explains that the patient had eaten peanut butter at the party, and soon after, he developed facial flushing and began scratching his face and neck. This has never happened before but his father says that they have avoided peanuts and peanut butter in the past because they were worried about their son having an allergic reaction. The patient has no significant medical history and takes no medications. His blood pressure is 94/62 mm Hg, heart rate is 125/min, and respiratory rate is 22/min. On physical examination, his lips are edematous and he has severe audible stridor. Of the following, which type of hypersensitivity reaction is this patient experiencing?

Antituberculosis treatment is started. Two months later, the patient comes to the physician for a follow-up examination. The patient feels well. She reports that she has had tingling and bilateral numbness of her feet for the past 6 days. Her vital signs are within normal limits. Her lips are dry, scaly, and slightly swollen. Neurologic examination shows decreased sensation to pinprick and light touch over her feet, ankles, and the distal portion of her calves. Laboratory studies show: Leukocyte count 7400 /mm3 RBC count 2.9 million/mm3 Hemoglobin 10.8 g/dL Hematocrit 30.1% Mean corpuscular volume 78 fL Mean corpuscular hemoglobin 24.2 pg/cell Platelet count 320,000/mm3 Serum Glucose 98 mg/dL Alanine aminotransferase (ALT) 44 U/L Aspartate aminotransferase (AST) 52 U/L Administration of which of the following is most likely to have prevented this patient's neurological symptoms?

A 1-year-old boy presents to the emergency department with weakness and a change in his behavior. His parents state that they first noticed the change in his behavior this morning and it has been getting worse. They noticed the patient was initially weak in his upper body and arms, but now he won’t move his legs with as much strength or vigor as he used to. Physical exam is notable for bilateral ptosis with a sluggish pupillary response, a very weak sucking and gag reflex, and shallow respirations. The patient is currently drooling and his diaper is dry. The parents state he has not had a bowel movement in over 1 day. Which of the following is the pathophysiology of this patient’s condition?

A 57-year-old man is brought to the emergency department by his son for odd behavior. The patient and his son had planned to go on a hike today. On the drive up to the mountain, the patient began acting strangely which prompted the patient's son to bring him in. The patient has a past medical history of constipation, seasonal allergies, alcohol abuse, and IV drug abuse. His current medications include diphenhydramine, metoprolol, and disulfiram. The patient's son states he has been with the patient all morning and has only seen him take his over the counter medications and eat breakfast. His temperature is 102.0°F (38.9°C), blood pressure is 147/102 mmHg, pulse is 110/min, and oxygen saturation is 98% on room air. The patient appears uncomfortable. Physical exam is notable for tachycardia. The patient's skin appears dry, red, and flushed, and he is confused and not responding to questions appropriately. Which of the following is the best treatment for this patient's condition?

A 27-year-old male arrives to your walk-in clinic complaining of neck pain. He reports that the discomfort began two hours ago, and now he feels like he can’t move his neck. He also thinks he is having hot flashes, but he denies dyspnea or trouble swallowing. The patient’s temperature is 99°F (37.2°C), blood pressure is 124/76 mmHg, pulse is 112/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. You perform a physical exam of the patient's neck, and you note that his neck is rigid and flexed to the left. You are unable to passively flex or rotate the patient's neck to the right. There is no airway compromise. The patient's past medical history is significant for asthma, and he was also recently diagnosed with schizophrenia. The patient denies current auditory or visual hallucinations. He appears anxious, but his speech is organized and appropriate. Which of the following is the best initial step in management?

A 50-year-old woman presents with acute onset fever and chills for the past hour. She mentions earlier in the day she felt blue, so she took some St. John’s wort because she was told by a friend that it helps with depression. Past medical history is significant for hypertension, diabetes mellitus, and depression managed medically with captopril, metformin, and fluoxetine. She has no history of allergies. Her pulse is 130/min, the respiratory rate is 18/min, the blood pressure is 176/92 mm Hg, and the temperature is 38.5°C (101.3°F). On physical examination, the patient is profusely diaphoretic and extremely irritable when asked questions. Oriented x 3. The abdomen is soft and nontender with no hepatosplenomegaly. Increased bowel sounds are heard in the abdomen. Deep tendon reflexes are 3+ bilaterally and clonus is elicited. The sensation is decreased in the feet bilaterally. Mydriasis is present. Fingerstick glucose is 140 mg/dL. An ECG shows sinus tachycardia but is otherwise normal. Which of the following is the most likely cause of this patient’s condition?