WBR0692

Author	[[PageAuthor::Twinkle Singh, M.B.B.S. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category
Sub Category	SubCategory::Hematology, SubCategory::Oncology
Prompt	[[Prompt::54 year old female comes with complaints of cough from 2 weeks with fever and shortness of breath. She has no other significant complaints other than joint pains for which she takes over the counter analgesics. Her past medical history is significant for hodgkin’s disease, which was treated with radiation and chemotherapy 20 years ago. Which of the following adverse effects are most likely to present now as a result of hodgkin’s disease treatment?]]
Answer A	AnswerA::Radiation induced fibrosis
Answer A Explanation	AnswerAExp::Radiation induced fibrosis presents as shortness of breath and persists up to 6-24 months after treatment. It is unlikely that dyspnoea because of radiation induced fibrosis presents 20 years after the treatment.
Answer B	AnswerB::Pneumonia
Answer B Explanation	[[AnswerBExp::Pneumonia can occur during or after the treatment because of immunosuppression caused by chemotherapy, however, it is unlikely for pneumonia to occur as a late complication of cancer treatment. Pulmonary function tests can also be affected because of radiation and chemotherapy, but recovery usually occurs within 3 years.]]
Answer C	AnswerC::Leukemia
Answer C Explanation	AnswerCExp::Leukemia is one the common secondary malignancies that occur because of cancer treatment. Peak incidence of leukemia occurs up to 10 years after the treatment.
Answer D	AnswerD::Breast cancer
Answer D Explanation	AnswerDExp::Breast cancer and lung cancer are the most common solid tumors that occur after radiation and chemotherapy. They usually present 15-20 years after the treatment of Hodgkin’s disease with radiation and chemotherapy.
Answer E	AnswerE::Fatigue
Answer E Explanation	AnswerEExp::Fatigue due to cancer treatment usually lasts for 6 months or longer. It is highly unlikely that fatigue as a result of cancer treatment presents 20 years after cancer treatment.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Hodgkin’s disease is a curable malignancy, however, patients are at an increased risk of developing secondary malignancies such as solid tumours, leukaemia and non Hodgkin’s lymphoma even after 20 years of follow up. Lung and breast cancers are the most common among solid tumors. Other late complications of radiation and chemotherapy treatment for Hodgkin’s disease are cardiac involvement and hypothyroidism. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Secondary neoplasms, WBRKeyword::Hodgkin's disease
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::