doyoudig
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A 66-year-old Italian-American male sees his primary care physician with a history of recurrent attacks of “sore throat.” He states that over the years he has been active in outdoor sports but of late has been getting tired, which he states because of getting old. The patient does not smoke, drinks a glass of wine with dinner, and indulges in pasta and cheese. He takes no medications other than multivitamins and an aspirin a day to “maintain a healthy heart.” Other than surgery for a right inguinal hernia 20 years ago, his past medical history is noncontributory. Both his parents lived to a ripe old age and died of natural causes. There is no family history of medical illness. His exercise routine includes biking, hiking, trekking, and water sports. Physical examination reveals a muscular 186 cm (6 ft 1 in) tall male, weighing 75 kg (165 lb, 6 oz), with normal vital signs. He has no pallor of the conjunctival mucosa, no icterus, and no clubbing or cyanosis. He has a solitary mobile, nontender lymph node in the left anterior triangle of the neck. On examination, the throat is normal; there is no thyromegaly. Cardiovascular and respiratory systems are normal. The abdomen is soft and nontender. The liver and spleen are just palpable. No masses are felt, and bowel sounds are present. His white cell count is 120,000/μL (normal range, 4.8 to 10.8 × 103/µL), 80% of which are lymphocytes. The hematocrit and platelet counts are normal. The bone marrow is filled with small lymphocytes, and this is reflected in the lymph node biopsy as well. Based on the clinical findings his condition is best treated by which of the following?
A: Alemtuzumab
B: Chlorambucil
C: Prednisone
D: Intravenous infusion of fludarabine
E: A combination of fludarabine and prednisone
F: Intravenous infusion of a combination of fludarabine and rituximab or of fludarabine and cyclophosphamide
G: Intravenous infusion of a combination of fludarabine, rituximab, and cyclophosphami
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| Justice
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D: Intravenous infusion of fludarabine
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| NE
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CLL stage 2; the treatment could be either chlorambucil or fludarabine but fludarabine has a greater efficacy.
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| webjeee
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why not b first
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| doyoudig
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The ans is DDDDD
You asked why not chlormabucil? b/c if both options are given Fludarabine has better efficiacy so choose that over chlormab. (other wise it is not a wrong answer, got it)
And when would you have choosen E? When there is presence of Hemolysis and/or Thrombocytopenia, you have to add steroids. But in this case Hct and Platetelt are Normal
Hope U enjoyed this question
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| webjeee
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thanks,
Kaplan says chlormabucil not working, then Fludarabine
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| doyoudig
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yes but kaplan unfortunatelly does not give detailed info. This is from UW n I think most agree that UW q's makes a nice and logic explanation by bridging the missing info not seen in kapaln at times. U can also check other sources on that net which all confrim that Fldarabine is the DOC compared to chlorambucil. GL
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| usmle12
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no if u read just kaplan books its not enough...in videos it tells clearly that fludrabine is doc n cchlormabucil is 2nd line so not used commonly n is palliative
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| robin082006
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Good q
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| webjeee
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thanks doyoudig
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| ssrpk
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yes, its D, good question
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| dr in trouble
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D
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| young_doc
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D. (it's also in FA)
Of note, although Fludarabine is the DOC here... it should be avoided if there is autoimmune hemolytic anemia.
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| ram3
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The answer is D Intravenous infusion of fludarabine which is used to treat Chronic Lymphocytic Leukemia
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