WBR0207

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology, SubCategory::Oncology, SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::A 48 year old male come to the office with a complaint that he experiences gritty and burning sensation in both eyes. He does not wear contact lens. He also says swallowing dry food without water is difficult. He says he had these symptoms for a year and now need some relief of these symptoms. He has been diagnosed with depression and is on fluoxetine. His vitals are normal and reviews of systems are remarkable for muscle pains. Which of the following condition is most likely associated with later stages of the disease?]]
Answer A	AnswerA::Esophageal dysmotility
Answer A Explanation	[[AnswerAExp::Incorrect : Scleroderma manifest with CREST symptoms. Calcinosis cutis, raynauds phenomenon, esophageal dysmotility, sclerodactyly and telengectasias.]]
Answer B	AnswerB::B cell lymphoma
Answer B Explanation	[[AnswerBExp::Correct : Sjögren’s syndrome has an established association with the development of lymphoproliferative malignancy. B cell lymphoma are commonly associated with Sjogren's syndrome.]]
Answer C	AnswerC::T cell lymphoma
Answer C Explanation	[[AnswerCExp::Incorrect : T cell lymphoma are associated with HTLV virus infection.]]
Answer D	AnswerD::Carcinoma of the parotids
Answer D Explanation	[[AnswerDExp::Incorrect : Viral infections may be associated with an increased risk of salivary gland cancers. Epidemiologic studies have reported an increased incidence of these tumors in individuals infected with HIV. Lymphoepithelial carcinoma is an undifferentiated carcinoma that accounts for less than 1 percent of salivary gland tumors; lymphoepithelial carcinoma has been strongly associated with Epstein Barr virus (EBV) in areas where EBV is endemic.]]
Answer E	[[AnswerE::Lung carcinoma : The most pronounced association between scleroderma disorders and malignancy has been with lung cancer. Patients with systemic sclerosis of either the diffuse or limited cutaneous types appear to be at higher risk of lung cancer than those with morphea or other localized sclerodermatous skin changes.]]
Answer E Explanation	AnswerEExp::'''Incorrect''' :
Right Answer	RightAnswer::B
Explanation	[[Explanation::Sjögren’s syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function. SS occurs in a primary form not associated with other diseases and in a secondary form that complicates other rheumatic conditions. The most common disease associated with secondary SS is rheumatoid arthritis. Sjögren’s syndrome has an established association with the development of lymphoproliferative malignancy. The spectrum of malignant lymphoproliferation extends from an increased frequency of circulating monoclonal immunoglobulins, free light chains, and mixed cryoglobulins (type II mixed cryoglobulinemia) to non-Hodgkin lymphoma of the mucosa-associated lymphoid tissue (MALT) type. Educational Objective: References: ]]
Approved	Approved::Yes
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Linked Question	Linked::
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