NBME 21 Bleomycin (NBME Answers)

NBME 21 Answers

nbme21/Block 3/Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin 🔍 / 📺 / 🌳 / 📖
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submitted by ∗lilmonkey(63)

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

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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

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submitted by infundibidum6(0)

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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?

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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. +

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submitted by ∗dr.xx(176)

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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/

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