Chemotherapy: ATRA in APL: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Chemotherapy: ATRA in APL

Sample item

A young woman with acute promyelocytic leukaemia receives all-trans retinoic acid and, on day 8, develops fever, weight gain, dyspnoea and pulmonary infiltrates. What is the diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Differentiation syndrome, treated with dexamethasone

ATRA and arsenic trioxide induce differentiation of promyelocytes, and the resulting cytokine release causes differentiation syndrome with fever, effusions and pulmonary infiltrates. Prompt dexamethasone is life saving.

Option by option

  • A. Pulmonary embolism, treated with alteplase

    PE does not explain fever and weight gain on ATRA.

  • B. Differentiation syndrome, treated with dexamethasone (correct)

    Correct. This is differentiation syndrome.

  • C. Tumour lysis syndrome, treated with rasburicase

    Tumour lysis causes metabolic abnormalities rather than weight gain with infiltrates.

  • D. Pneumocystis pneumonia, treated with cotrimoxazole

    No immunosuppression context is given.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Differentiation syndrome, treated with dexamethasone. ATRA and arsenic trioxide induce differentiation of promyelocytes, and the resulting cytokine release causes differentiation syndrome with fever, effusions and pulmonary infiltrates.

Why is "Pulmonary embolism, treated with alteplase" not the answer?

PE does not explain fever and weight gain on ATRA.

Why is "Tumour lysis syndrome, treated with rasburicase" not the answer?

Tumour lysis causes metabolic abnormalities rather than weight gain with infiltrates.

Why is "Pneumocystis pneumonia, treated with cotrimoxazole" not the answer?

No immunosuppression context is given.

What concept does this question test?

It tests Chemotherapy: ATRA in APL in Pharmacology. Prompt dexamethasone is life saving.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chemotherapy: ATRA in APL?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.