que---- - targt250 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: que---- - targt250 (/showthread.php?tid=764083) |
que---- - targt250 - ArchivalUser - 01-14-2014 A 23-year-old woman is diagnosed with stage IIIA Hodgkin’s lymphoma after an extensive work-up. As her physician is explaining the recommended treatment regimen for her disease, the patient confesses she has been hoping to become pregnant in the next few years. However, she states she is willing to wait until she has completed her treatment. She wants to know the consequences of both her primary disease of Hodgkin’s lymphoma and her treatment regimen, as well as what effects they may have on a potential pregnancy. Which of the following complications is the least likely? (A) An increased risk of second malignancy (B) Ovarian failure that will preclude pregnancy © Pericarditis that may cause congestive heart failure during the pregnancy (D) Recurrence of the patient’s disease due to increased estrogen (E) Restrictive lung disease that may be exacerbated by pregnancy 0 - ArchivalUser - 01-14-2014 D? 0 - ArchivalUser - 01-15-2014 D...I don't think Hodgkin's has anything to do with increased estrogen... 0 - ArchivalUser - 01-15-2014 BBB 0 - ArchivalUser - 01-15-2014 B. it's from uworld 0 - ArchivalUser - 01-15-2014 some chemotherapy drugs can damage the ovary 0 - ArchivalUser - 01-15-2014 b 0 - ArchivalUser - 01-15-2014 The correct answer is D. The patient is presenting with stage IIIA disease, which implies that her disease has spread to nodal sites on both sides of her diaphragm. This disease stage will require therapy with both systemic chemotherapy and radiation to the mediastinum, and potentially the abdomen and pelvis. This patient should be concerned about many effects of her disease and its treatment that may prevent or complicate her pregnancy; however, there is no evidence that the hormonal milieu of pregnancy promotes recurrence of Hodgkin’s disease. Importantly, this type of evidence does exist in breast cancer, where increased estrogen may promote the growth of tumor cells. Answer A is incorrect. The risk of a second cancer is substantially increased in patients with Hodgkin’s lymphoma, particularly if systemic chemotherapy is required as treatment. The risk of leukemia may be elevated almost 100-fold in this case. Answer B is incorrect. Ovarian failure is a risk for this patient who will receive systemic chemotherapy. In some cases, ovarian tissue can be removed surgically and frozen to preserve a patient’s fertility. Should the patient need to undergo pelvic irradiation, her risk of ovarian failure would be almost 100%. Answer C is incorrect. Mediastinal irradiation that is required to treat Hodgkin’s lymphoma may cause pericarditis that can result in fi brosis and congestive heart failure. Because pregnancy requires increased cardiac output, heart failure or worsening of underlying heart failure may result. Answer E is incorrect. Patients treated with radiation to the mediastinum are at risk for restrictive lung disease that may follow radiation pneumonitis. During pregnancy, when the diaphragm is displaced superiorly and breathing is somewhat restricted, asymptomatic lung disease may become clinically important. 0 - ArchivalUser - 01-15-2014 Thank you for very nice Qs |