que---- - targt250

[ArchivalUser]

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

[ArchivalUser]

D?

[ArchivalUser]

D...I don't think Hodgkin's has anything to do with increased estrogen...

[ArchivalUser]

BBB

[ArchivalUser]

B. it's from uworld

[ArchivalUser]

some chemotherapy drugs can damage the ovary

[ArchivalUser]

b

[ArchivalUser]

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.

[ArchivalUser]

Thank you for very nice Qs