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Welcome to issue #95 of The USMLE Times… This is the 95th straight week we’ve posted our USMLE Times Newsletter! Thank you to all of our supporters—new and old! As we cruise to our 100th issue, we’re getting ready to make a significant announcement about the future of The USMLE Guys—stay tuned!
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Here’s what’s on tap for issue #95 of the USMLE Times:
Question of the Week (Oncology)
This week’s video training (Pass Step 1: 50 Tips)
Question deep-dive & breakdown
Free subscribers have access for 48 hours after the post goes live.
Let’s dive in!
A 9-year-old male who recently immigrated to the United States from Africa presents with a rapidly enlarging neck lesion that has developed over the past 24 hours. The patient also reports experiencing fatigue, episodic fevers, and night sweats. On examination, the patient has a temperature of 101.5°F, blood pressure of 110/70 mmHg, pulse of 100/minute, and respiratory rate of 16/minute. Physical examination reveals a superficial mass located below the patient's left mandible, which the patient's mother reports has doubled in size since yesterday. The patient also exhibits painless generalized lymphadenopathy and hepatosplenomegaly. Biopsy and examination of the mass reveals the presence of numerous large histiocytes with abundant clear cytoplasm evenly dispersed throughout a background of basophilic tumor cells. Based on the patient's clinical presentation and biopsy findings, further evaluation will likely reveal which of the following?
A. Translocation t(8;14)
B. Translocation t(11;14)
C. Translocation t(11;18)
D. Translocation t(11;22)
E. Translocation t(14;18)
The answer & question breakdown is at the bottom of the post.
🔗 LINKS TO RECENT POSTS
USMLE Times Issue #94 - READ HERE
USMLE Practice Question #65 - TRY IT HERE
USMLE Practice Question #64 - TRY IT HERE
This week’s free video training 👇🏼
ANSWER + QUESTION BREAKDOWN
The Mental Model for this week’s question:
Step 1. Determine the question’s goal (Identify an additional finding expected based on the diagnosis). This is a 2nd order question: 1) Make a diagnosis, and 2) Determine which additional finding would be expected.
Step 2. Read the vignette and make your diagnosis.
Step 3. With the diagnosis in mind, and the potential for a wide variety of additional findings, the ideal situation is to look a the answer choices and find one that fits.
Step 4. Look at the answer choices to identify the option that fits in with your diagnosis.
GENERAL ANALYSIS
The clinical presentation and biopsy findings in this case are consistent with Burkitt lymphoma, which is characterized by a rapidly enlarging mass, often in the jaw or neck region, as well as systemic symptoms such as fever and night sweats. Burkitt lymphoma is associated with the translocation t(8;14), which involves the c-MYC oncogene.
ANSWER CHOICES:
ANSWER CHOICE A: Translocation t(8;14)
This translocation involves the c-MYC oncogene on chromosome 8 and the immunoglobulin heavy chain locus on chromosome 14. It is characteristic of Burkitt lymphoma.
ANSWER CHOICE B: Translocation t(11;14)
This translocation is associated with mantle cell lymphoma, involving the BCL1 gene.
ANSWER CHOICE C: Translocation t(11;18)
This translocation is associated with mucosa-associated lymphoid tissue (MALT) lymphoma.
ANSWER CHOICE D: Translocation t(11;22)
This translocation is associated with Ewing sarcoma, not lymphomas.
ANSWER CHOICE E: Translocation t(14;18)
This translocation is associated with follicular lymphoma, involving the BCL2 gene.
THE VERDICT…
The translocation t(8;14) is characteristic of Burkitt lymphoma, which presents with rapidly growing tumors and systemic symptoms. The biopsy findings of large histiocytes within a background of basophilic tumor cells further support this diagnosis. This translocation leads to overexpression of the c-MYC oncogene, driving the aggressive nature of Burkitt lymphoma.
FINAL ANSWER: A: Translocation t(8;14)
That’s it for issue #95 of The USMLE Times!
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See you next time 👋