Doxorubicin vs. Bleomycin

[thinkenergy]

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Question:

A patient treated for Hodgkin's lymphoma develops dyspnea & cough, there are rales bilaterally on PE, ABG shows hypoxia, and bilateral infiltrate are seen on CXR, what is most likely drug that caused his symptoms?

A. Bleomycin
B. Cyclophosphamide
C. Doxorubicin
D. Etoposide
E. 5-Fluorouracil

Answer given is Bleomycin (pulmonary fibrosis, which is obvious), but can't doxorubicin cause dilated cardiomyopathy & subsequent pulmonary edema (which will produce similar findings)? I don't see how one can distinguish between pulmonary fibrosis & edema in this case, at least not w/ the information presented. Can anyone explain why bleomycin is the convincing answer here?

 

[AndyRSC]

Going by the description alone, without the suggestion that these symptoms developed chronically and not acutely, it certainly sounds like CHF. I suppose the only part of the question that works against it is the lack of dilated cardiomyopathy findings on PE and CXR.

 

[MrBeauregard]

That's a pretty crappy question. The treatment protocol for Hodgkin's consists of both Bleomycin and Doxorubicin, so you can't narrow it down based upon first-line therapy. I agree with AndyRSC that the clinical picture sure sounds like CHF, but I'll second that the absence of cardiomyopathy (or any similar descriptors) on CXR is probably the distinguishing factor. I'd chalk this one up to poor question writing.

 

[iCY]

Question:

A patient treated for Hodgkin's lymphoma develops dyspnea & cough, there are rales bilaterally on PE, ABG shows hypoxia, and bilateral infiltrate are seen on CXR, what is most likely drug that caused his symptoms?

A. Bleomycin
B. Cyclophosphamide
C. Doxorubicin
D. Etoposide
E. 5-Fluorouracil

Answer given is Bleomycin (pulmonary fibrosis, which is obvious), but can't doxorubicin cause dilated cardiomyopathy & subsequent pulmonary edema (which will produce similar findings)? I don't see how one can distinguish between pulmonary fibrosis & edema in this case, at least not w/ the information presented. Can anyone explain why bleomycin is the convincing answer here?

bleomycin fits better because the other signs & symptoms of dilated cardiomyopathy are missing here. My guess would be that if doxorubicin caused the dilated cardiomyopathy, then it would affect both the left side & right side, & would show signs of lower leg edema or JVD, etc... on the right side.

Here the problem seems to be localized to the lungs, they don't give any indication that it could be involving the cardiovascular system.

always go with the simplest answer that fits all the points, don't try to get creative, unless you are really clueless Lol

 

[thinkenergy]

Dilated cardiomyopathy is different from CHF, it is one of the many causes of CHF, only in CHF can one see signs of left & right heart failure such as those you mentioned.

Looking back I think this is a really a BAD question, all the information provided in question stem could really go either way. I guess the only thing that gave it away was that CXR didn't show a dilated heart (we have to assume so otherwise it would be pointed out).

 

[iCY]

Dilated cardiomyopathy is different from CHF, it is one of the many causes of CHF, only in CHF can one see signs of left & right heart failure such as those you mentioned.

Looking back I think this is a really a BAD question, all the information provided in question stem could really go either way. I guess the only thing that gave it away was that CXR didn't show a dilated heart (we have to assume so otherwise it would be pointed out).

???? explain to me how you expect to have signs of pulmonary edema (left sided CHF) without signs of right sided CHF with dilated cardiomyopathy. Am i missing something here????

 

[thinkenergy]

???? explain to me how you expect to have signs of pulmonary edema (left sided CHF) without signs of right sided CHF with dilated cardiomyopathy. Am i missing something here????

Distinction b/t DCM and CHF is not always clear. In DCM, there is increased compliance and decreased contractility b/c muscles are stretched. CHF contractility is dramatically reduced such as EF is usually < 25% or so. This is the case w/ late stage DCM. But I guess DCM can be considered as CHF in the sense that there is a systolic dysfunction, which is responsible for development of pulmonary edema.

 

[iCY]

Distinction b/t DCM and CHF is not always clear. In DCM, there is increased compliance and decreased contractility b/c muscles are stretched. CHF contractility is dramatically reduced such as EF is usually < 25% or so. This is the case w/ late stage DCM. But I guess DCM can be considered as CHF in the sense that there is a systolic dysfunction, which is responsible for development of pulmonary edema.

lol? I think you are missing the point here. If DCM is bad enough to cause pulmonary edema, it will also cause signs on the right side, like lower leg edema. I don't understand how you would expect an isolated pulmoary edema from DCM. Please explain this to me if I am misunderstanding.

I don't think the question is bad, it shows only pulmonary symptoms, so pick the drug with only pulmonary side effects.... then again I could be COMPLETELY missing something here & would like to know it before my test in 10 days

 

[OveractiveBrain]

Question:

A patient treated for Hodgkin's lymphoma develops dyspnea & cough, there are rales bilaterally on PE, ABG shows hypoxia, and bilateral infiltrate are seen on CXR, what is most likely drug that caused his symptoms?

A. Bleomycin
B. Cyclophosphamide
C. Doxorubicin
D. Etoposide
E. 5-Fluorouracil

Answer given is Bleomycin (pulmonary fibrosis, which is obvious), but can't doxorubicin cause dilated cardiomyopathy & subsequent pulmonary edema (which will produce similar findings)? I don't see how one can distinguish between pulmonary fibrosis & edema in this case, at least not w/ the information presented. Can anyone explain why bleomycin is the convincing answer here?

Your illness script is out of wack.

CHF = Dyspnea on exertion, Orthopnea, Paroxysmal nocturnal dyspnea, Jugular Venous Distention, Peripheral Edema. Those are not present in the vignette.

"Rales" does not equal CHF. "Cough" is meager. The absence of the need-to-have for diagnosis of CHF means, for test taking purposes, that they aren't there. This is a fine question and is how pulmonary fibrosis would present. They could have said cyanotic lips instead of ABG... they certainly aren't going to give you a High Rez CT and say "which one of these causes pulmonary fibrosis" now are they?