Step 1 Question of the Week – 10/6/20

This week’s USMLE Step 1 question looks at a patient who is referred to an oncologist.  See if you can answer the question and then watch the video to learn the correct answer as well as the rationales for all of the options.  The video comes from a recent edition of the Rx Question Lab, so if you like it, we encourage you to register and tune in every Tuesday.

A 24-year-old man comes to the physician for a routine physical examination before beginning a new job. The physician notes a small, firm nodule on the patient’s left testicle, and he is subsequently diagnosed with a testicular seminoma and referred to an oncologist. Soon after beginning high-dose chemotherapy, the patient returns to his primary care physician because of a 1-week history of dry cough and shortness of breath. His temperature is 98.7°F (37°C), and his pulse is 82/min. His respiratory rate is 17/min. A cardiac examination discloses no murmurs or gallops, and both lungs are clear to auscultation without wheezes; there is no dullness to percussion. Imaging results are shown.

Which of the following is the major mechanism of the chemotherapeutic agent that was most likely used to treat this patient’s seminoma?
A. Alkylation of DNA
B. Formation of superoxide or hydroxide radicals
C. Inhibition of microtubule polymerization
D. Inhibition of topoisomerase II
E. Stabilization of microtubules against depolymerization

We invite you to leave a comment with your answer as well as your rationale.  When you’re ready to check your work, watch the video.

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