A research team develops a new monoclonal antibody checkpoint inhibitor for advanced melanoma that has shown promise in animal studies as well as high efficacy and low toxicity in early phase human clinical trials. The research team would now like to compare this drug to existing standard of care immunotherapy for advanced melanoma. The research team decides to conduct a non-randomized study where the novel drug will be offered to patients who are deemed to be at risk for toxicity with the current standard of care immunotherapy, while patients without such risk factors will receive the standard treatment. Which of the following best describes the level of evidence that this study can offer?
ALevel 1
BLevel 3
CLevel 5
DLevel 4
ELevel 2
A patient with HCC and a long history of alcohol dependence and chronic hepatitis C has been using the mTOR inhibitor sirolimus 100 mg for cancer treatment. Her cancer has shown a partial response. She also has a history of hypertension and poorly controlled type 2 diabetes mellitus complicated by diabetic retinopathy. Current medications include enalapril and insulin. She asks her oncologist and hepatologist if she could try everolimus for its purported survival benefit in treating HCC. Based on clinical considerations, which of the following statements is most accurate?
AThe patient should start everolimus 50 mg because of the survival benefit relative to sirolimus 100 mg
BThe patient is not a good candidate for everolimus due to her history of hypertension
CThe patient should start everolimus 100 mg because of the survival benefit relative to sirolimus 100 mg
DThe patient should start everolimus 50 mg because of her history of alcohol use disorder and hepatitis C
EThe patient is not a good candidate for everolimus due to her history of diabetes
A 61-year-old man with hypertension and hyperlipidemia comes to the physician for a 4-month history of recurrent episodes of retrosternal chest pain, shortness of breath, dizziness, and nausea. The episodes usually start after physical activity and subside within minutes of resting. He has smoked one pack of cigarettes daily for 40 years. He is 176 cm (5 ft 9 in) tall and weighs 95 kg (209 lb); BMI is 30 kg/m2. His blood pressure is 160/100 mm Hg. Coronary angiography shows an atherosclerotic lesion with stenosis of the left anterior descending artery. Compared to normal healthy coronary arteries, increased levels of platelet-derived growth factor (PDGF) are found in this lesion. Which of the following is the most likely effect of this factor?
ACalcification of the atherosclerotic plaque core
BInvasion of T-cells through the disrupted endothelium
CIncreased expression of vascular cell-adhesion molecules
DIngestion of cholesterol by mature monocytes
EIntimal migration of smooth muscle cells
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