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Old 11-19-2012
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Arrow Billy Step 1 Questions # 89

A 57-year-old smoker presents to her primary care physician with a lump in the upper outer quadrant of her right breast. Mammography confi rms a 2.5-cm lesion and core needle biopsy yields invasive ductal carcinoma. The patient undergoes lumpectomy with axillary lymph node dissection, and is referred to an oncologist to begin chemotherapy. Which of the following should be coadministered with the chemotherapy that this patient will most likely receive?


(A) Leucovorin
(B) Mesna
(C) Thymidine
(D) Vitamin B12
(E) Vitamin B6
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Old 11-19-2012
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I am confused between A and B. But I think the physician will go for cyclophosphamide and hence should go with Mesna. So I would choose B
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B. Mesna
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Default my answer :)

(B) Mesna - cyclophosphamide
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i have a question ,do we have to memorize every cancer therapy indication ?
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Old 11-19-2012
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(B) Mesna ?????
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One day i will infect these microbes and they will search for "Anti-MEbiotic"....
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i would choose B
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Old 11-20-2012
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Correct Answer

The patient has invasive ductal carcinoma, which must be resected and then treated with chemotherapy. There are many chemotherapy combinations used to treat breast cancer, two of the most common being (1) cyclophosphamide, methotrexate, and 5-fl uorouracil (5-FU) and (2) cyclophosphamide, doxorubicin, and 5-FU. Almost all of the regimens use the drug cyclophosphamide, an alkylating agent, which is commonly also used to treat non-Hodgkin’s lymphoma and ovarian cancer. The most important toxicity of this drug is hemorrhagic cystitis, which can lead to transitional cell carcinoma. Hemorrhagic cystitis is prevented by coadministration of mesna. This is especially important in this patient because she is a smoker, which is independently a significant risk factor for transitional cell carcinoma
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