Reply To: CPHON “Question of the Day”

  • Rebecca Kolenik

    October 30, 2013 at 1:53 pm

    Great questions, Stephanie!

    Here’s mine for today:

    Question:: A patient who is receiving Doxorubicin (Adriamycin) is at risk for which of the following long-term side effects of treatment?

    A. Bronchospasm
    B. Cardiotoxicity
    C. Renal toxicity
    D. Neurotoxicity

     Answer: B is the correct answer; cardiotoxicity is a long-term side effect of treatment with Doxorubicin (Adriamycin).

    • è Doxorubicin (Adriamycin) is an anthracycline antibiotic; anthracyclines are a class of drugs which frequently cause cardiotoxicity (other examples of anthracyclines include daunorubicin and idarubicin).
    • è Cardiotoxicity may present as ECGchanges, arrhythmias, or heart failure and can present years after treatment (some studies have found that the effect of cardiotoxicity increases in long-term survivors, from 2% after 2 years to 5% after 15 years).
    • è Cardiotoxicity is related to a patient’s cumulative lifetime dose. To limit risk of cardiotoxicity, a patient’s lifetime dose of the anthracycline is continuously calculated and anthracycline treatment is usually stopped (or at least re-evaluated by the oncologist) upon reaching the maximum cumulative dose for the particular anthracycline. Besides keeping the cumulative dose low, Dexrazoxane (a cardioprotective agent) may be added to regimens or the anthracycline may be infused over a longer period of time.

    Rebecca Kolenik
    Clinical Nurse Specialist
    New York, NY
    United States

    Original Message:
    Sent: 10-21-2013 01:26 PM
    From: Stephanie Langevin
    Subject: CPHON “Question of the Day”

    Since it’s been a while since I have posted any questions I decided to post two 🙂 

    Also just as a suggestion we are now doing a “Book Club” in prep for the CPHON where we have assigned chapters and are discussing the reading in the “essential’s” book.  Just a thought for others to try. 

    1.) You are caring for a Ben, a 8 year old presenting with complaints of new onset seizures. In performing an H&P you learn that Ben has always been an honor roll student, but recently has not been turning in his homework and has been getting D’s on his tests. While looking at the MRI results you know that you will most likely see a brain tumor in which area related to these side effects?

    a. Brainstem
    b. Supratentorial region
    c. Midline-HPA
    d. Posterior Fossa

    1. B. Brain stem tumors present with Cranial nerve deficits. Supratentorial tumors present with hemiparesis, seizures, visual and intellectual problems. Midline tumors present with visual changes endocrine abnormalities and increased ICP. Posterior-Fossa tumors present with headache, vomiting, ataxia, nystagmus, diplopia, and increased ICP.

    2.)  Which of the following is true about the role of oncogenes in pediatric cancer?
    a. Controls the rate of cell growth.
    b. Produces proteins that block the activity of cyclin.
    c. Allows accumulation of DNA mutations to occur.
    d. Produces vascular endothelial growth factor.

    2.  A.) Oncogenes allow for the cell cycle to spin out of control and are described as “your foot being stuck on the accelerator”. An example is N-Myc amplification for NBM and BCR-ABL for ALL and CML. (The activity of tyrosine kinases is typically controlled by other molecules, but the mutant tyrosine kinase encoded by the BCR-Abl transcript results in a protein that is “always on” or continuously activated, which results in unregulated cell division ). Tumor Suppressor genes keep the cell cycle in check, when missing or damaged the cell ignores inhibitory sygnals. (Loss of the brakes) An example is hereditary Retnoblastoma and p53 mutations. Mutations to DNA Repair or Damage Response genes can allow for accumulations of mutations to result in cancer. (Fanconi anemia, Ataxia-telangisctasia). Tumor cells can switch on angiogensis by producing VEGF resulting in angiogensis. Tumors cannot expand past 1-2mm3 without blood supply.

    Stephanie Langevin
    Children’s Hosp of the Kings Daughters
    Virginia Beach, VA
    United States

    Original Message:
    Sent: 10-09-2013 03:22 PM
    From: Rebecca Kolenik
    Subject: CPHON “Question of the Day”

    Question: Goals of phase I clinical trials include all of the following except:

    A. Efficacy of treatment in a specific disease
    Determining the maximum tolerated dose
    Study of pharmacokinetics
    Evaluation of toxicities


    Answer: A is the correct answer; efficacy of treatment in a specific disease is not a goal of phase I clinical trials.

    è Note that this question asked which answer is not true of phase I clinical trials; there are questions like this on the CPHON exam, so be sure to read the entire question carefully before answering.

    è Answer A referred to a goal of phase II clinical trials.

    o Phase II clinical trials are carried out to determine the effectiveness of a treatment in a specific disease. The patient must have tumor (disease) that is measurable (e.g., by scan or bone marrow examination) so that the effectiveness of the treatment can be determined. Patients also need to have normal organ function, reasonable life expectancy and functional status. Many patients on Phase II trials have had prior cancer treatment with refractory disease, or have become refractory to standard treatment. Phase II trials also often include further evaluation of the treatment’s safety and toxicity profile.


    B, C, and D are not correct answers because they are goals of phase I clinical trials while this question asked what is not a goal of phase I clinical trials.



    Rebecca Kolenik
    Clinical Nurse Specialist
    New York, NY
    United States