Exam 2 scores are back and are posted on Canvas.
You did extremely well…here are the numbers:
Total points: 34
Mean: 32.41 (seriously.)
There were 3 extra credit points – those are included in Canvas in a separate row, just to keep them out of the total # of points for the course.
I’ve entered your scores for quiz 2 – but I haven’t entered quiz 1 yet. Also – we’re still working through your answers to the SUD questions – everyone completed them, but some of you asked some questions for Dustin Chapman – so I’ll forward you those when he’s completed them, and post your scores at that time 🙂
I promised to post the story of imatinib (trade name: Gleevec), the wonderdrug for chronic myeloid leukemia (CML) that we talked about in class last week.
Before the discovery of imatinib, CML was basically a death sentence. Although CML is a chronic leukemia, and therefore has a relatively good prognosis (compared to acute leukemias), it is more aggressive than most other chronic leukemias, with an overall prognosis on the order of a few years. Before imatinib, the best treatment available was bone marrow transplant, and the results were pretty grim.
Enter imatinib. Imatinib is a tyrosine kinase inhibitor – but a really specific tyrosine kinase inhibitor, and it happens to act on the tyrosine kinase made by the hybrid bcr-abl gene in CML (the gene that results from the translocation between chromosomes 9 and 22). This is important, because you can’t just go around inhibiting any and all tyrosine kinases, because we have tons of normal tyrosine kinases in all different types of cells in our body!
So imatinib blocks the tyrosine kinase made by the malignant cells in CML, preventing it from stimulating cell growth. This means that the tumor cells no longer have the capacity to proliferate uncontrollably, and the disease is held in check. The results were so amazing in early clinical trials that the drug was released for use in record time, because it would have been inhumane to withhold the drug for bureaucratic purposes.
Now, imatinib is standard, first-line therapy for CML, and it works incredibly well in most patients. It is being used for other malignancies that have similar tyrosine kinases, with excellent results. And it has sparked interest (and research) around chemotherapeutic agents that act against unique tumor cell features like the mutated tyrosine kinase in CML. This is a whole different way of attacking tumors, and it’s so much more selective and effective than the method used by traditional chemotherapeutic agents, which involves simply killing all dividing cells.
When you have time, you might want to check out this New York Times article about the inventor of imatinib. It’s rare to see such a happy story in the area of leukemia therapy – so I wanted to be sure you knew about it!
Hi everyone – just thought I’d let you know how many questions there will be on each lecture topic on the exam. There are a total of 34 questions, and here’s the breakdown:
- Anemia: 11
- Benign leukocytoses: 3
- Acute leukemia: 3
- Chronic leukemia: 3
- Lymphoma: 4
- Myeloma: 1
- Hemostasis: 5
- Bleeding and thrombotic disorders: 4
Also, I made a couple new Kahoots you can use as you study: one on hematopathology (anemia, benign leukocytoses, acute leukemia, chronic leukemia, lymphoma, and myeloma), and one on hemostasis and bleeding/thrombotic disorders.
Here’s the Exam Review Kahoot we did in class yesterday, in case you want to run through it as you’re studying for the exam.
In case you worked your way through the questions in the heme coloring book, I wanted to let you know that I posted all the answers on our Coloring Book page. Let me know if you have any questions! Also just a reminder, this is totally optional.
Since we’re talking about blood stuff this week and next week, I thought I’d let you know that I have a few books that students have found helpful in the past:
- One on hematopathology (anemias, leukemias, other diseases)
- One on coagulation (clotting, bleeding disorders, thrombotic disorders)
- One that includes most of the hematology posts on Pathology Student
- A little one that just covers the most important anemias for you to know.
These are all for sale but I don’t want you guys to have to buy them. If you would like a copy, drop me an email and I’ll send you a link so you can download them for free. They are NOT required – so just use them to help you study (if you feel you need help).
The scores for exam 1 are posted on Canvas. You guys did really well, as usual. Here are the stats:
Total points: 37
You’re welcome to come look at your exam any time – just drop me an email and we’ll find a time that works.
I’m still working on uploading the scores for quizzes 1 and 2…there are some weird glitches. I’ll let you know when they’re up.
I hope you guys got a lot out of the lecture on substance use disorder. We talk about the opioid crisis from the standpoint of the prescriber quite a bit – but we don’t have a lot of places in our curriculum where we actually talk about addiction itself.
I ask Dustin to come give this lecture every year so you can understand a bit about what the disease is like from the patient’s point of view. We’ve had a lot of great feedback on this lecture, and some students have even found it profoundly useful in their own lives. If you weren’t in lecture that day, I’d encourage you to watch the Mediasite presentation when you get a chance.
Another reason I want to talk about addiction is to dispel some of the myths around this disease. If we had more time, I’d love to talk about how recent (as in last couple years) research disproves some of these myths.
Why willpower doesn’t work
For example, a common misperception about addiction is that the addict simply lacks willpower or isn’t trying hard enough. But that isn’t true – and recent functional MRI studies are beginning to explain why.
As an addiction develops, the brain links three things together: a precipitating factor/ trigger (anxiety, for example), a behavior (such as drinking), and the result/reward (diminished anxiety). There’s an actual anatomic pathway in the brain called the reward pathway that lights up during this trigger/behavior/reward cycle.
The more times you go through the cycle, the stronger the neural connections in the reward pathway become. There’s a saying: “neurons that fire together wire together.” It’s kind of like a cross-country skiing trail: the more you use it, the deeper it becomes.
It turns out that as this reward pathway is growing stronger, the part of the brain that mediates logical thought (the prefrontal cortex) actually goes offline (becomes disconnected from the rest of the brain). This makes it all the more difficult to break the trigger -> behavior -> reward pathway. You may really want to quit that behavior, and you may even be alarmed by all the consequences that are piling up as a result of that behavior, but it feels like all the willpower in the world is no match for the power of the reward circuit in the brain.
You may have experienced a mild version of this if you’ve overindulged in something sugary, then felt like crap and said “never again” (and meant it!) – only to find yourself staring at an empty pint of Ben and Jerry’s while stressed out studying for an exam. What happened?!
Short answer questions
We won’t have test questions on this lecture because the material doesn’t really lend itself to multiple choice questions. Instead, I’ve posted a few short-answer questions (link below) for you to work through. I’ll read through them and add 10 points to your total course score for thoughtfully going through this exercise (if you miss something big I’ll let you know). The questions will be open until Sunday, October 13 (I’ll nag you if you haven’t finished the questions by then).
Your answers don’t need to be long or perfect – I’m just interested to hear what you think, and I want to give you the chance to ask any questions you may not have felt comfortable bringing up in lecture. I hope you came away from the lecture with a little deeper understanding about what substance use disorder is (and isn’t). I’d love to hear your thoughts and suggestions for this area of the course.
Hi all – just a quick heads up: we won’t be having class on November 27th. Our lecture on Diabetes that day didn’t work out this year – so all we would have had is the quiz. Since it’s the day before Thanksgiving, and many of you will be traveling, I’m just going to make that quiz an online, take-home quiz, and we won’t have class that day. Let me know if you have questions.