Sunday, July 19, 2009

Question 14

22 year old Hispanic male was brought to the ER with breathlessness and swelling in the neck. On history he says he has these symptoms for some time now. He does not have any history of fever, weight loss, night sweats or hemoptysis. He has never been in contact with anyone suffering from TB and he says he is an electrician by profession. His mother was diagnosed with TB long ago for which she took Anti-TB medicines for an year. His father is a smoker and has DM. He stays along with his girlfriend since last six years, and his parents stay by themselves. He studies part time, and has a healthy baby from his present girlfriend. He has never been ill, and was completely immunized as a child. he does not smokes and drinks beer on weekends. On examination his vitals and systemic examination is unremarkable, except his non tender lymph node swelling in the supraclavicular area. The physician orders him a Complete blood count and X ray Chest. On chest X ray he is found to have hilar swellings. Lymph node biopsy suggest cells having CD15 and CD30. What is the most likely diagnosis?

A) Squamous Cell Ca of Lymph node
B) Squmaous Cell Ca of lung with mets
C) Small Cell Ca of lung with mets
D) Large Cell Ca of lung with mets
E) Nodular Sclerosing B cell malignancy
F) Nodular Sclerosing T Cell malignancy
G) Lymphocyte depleted B Cell malignancy
H) Lymphocyte depleted T Cell malignancy
I) Non hodgkins lymphoma
J) Non smokers lung Ca
K) Hairy Cell Leukemia

Please solve questions 15 & 16 alonwith before reading the answer in the comment section.

1 comments:

Usmle Challenger July 21, 2009 at 8:43 AM  

Answer: E) Nodular Sclerosing B cell malignancy

Hodgkin’s disease has a bimodal occurrence (Peaks seen in young adults and old age). It is Characterized by presence of Reed Sternberg Cells (Owl’s eye) which are CD 15 and CD 30 and of B cell origin. There are 4 types of HD: 1) Nodular sclerosing, 2) Mixed cellularity, 3) Lymphocyte predominant, & 4) lymphocyte depleted.
Nodular Sclerosing is the most common type (65 – 75 %) Cases, most often seen in young adults, females > males. There may be presence of “B Symptoms” along with nodular swellings. B symptoms are weight loss, night sweats, & low grade fever (Think TB like)
Lymphocyte depleted are the rarest and seen usually in old age.
Nodular sclerosing is more common in females and rest three types are more common in males.
50 % of cases of HD are associated with CMV. (Answer 15)
Treatment depends on Staging of disease:
Stages 1, 2, (without B symptoms): ChemoRx
Stages 3, 4, B symptoms: Radiation

ChemoRx used: ABVD regimen
Adriamycin, Bleomycin, Vinblastine, & Dacarbazine

Side effect profile:
Adriamycin: Congestive Cardiomyopathy
Bleomycin: Pulmonary Fibrosis, Alopecia, & Raynauds (Answer 16)
Vinblastine: Peripheral neuropathy, bone marrow suppression.

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