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Old 06-21-2011
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Blood hematology case 2

A 22-year-old woman sees her family physician with a complaint of itching. Additional questioning reveals the woman also has had frequent fevers and abdominal pains over the last 4 months. She has no history of any serious injuries or illnesses. Vital signs are normal. Firm, discrete, nontender cervical and supraclavicular lymphadenopathy is present. Her abdominal exam reveals hepatosplenomegaly. There are no other findings on physical examination. A chest radiograph shows hilar lymphadenopathy. What is the patient’s most likely diagnosis?

Answer Choices
B. Hodgkin’s disease
C. Mononucleosis
D. Non-Hodgkin’s lymphoma
E. Tuberculosis
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Old 06-21-2011
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nswer B. Hodgkins
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Old 06-21-2011
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B. Hodgkin's
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Old 06-22-2011
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answer is b
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Old 06-22-2011
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Default Hodgkin's lymphoma indeed!

Hodgkin's lymphoma

The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.
The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases.


  • Fatigue
  • Fever and chills that come and go
  • Itching all over the body that cannot be explained
  • Loss of appetite
  • Soaking night sweats
  • Painless swelling of the lymph nodes in the neck, armpits, or groin
  • Weight loss that cannot be explained
Other symptoms that may occur with this disease:
  • Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
  • Excessive sweating
  • Pain or feeling of fullness below the ribs due to swollen spleen or liver
  • Pain in lymph nodes after drinking alcohol
  • Skin blushing or flushing
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Option B (Hodgkin’s disease) is correct. Hodgkin’s disease has a bimodal age distribution with two peaks: one around the third decade of life and the other in the advanced ages. Common symptoms include fatigue, weight loss, and night sweats. As in this case, fever tends to be cyclic and patients may relate that alcohol intake increases pain in involved lymph nodes.

Option A (AIDS) is incorrect. Lymphadenopathy is common in patients with AIDS, but usually this involves multiple areas. The inguinal area is the most common site, followed by the axillary and cervical regions. The lymphadenopathy seen in patients with AIDS can also be due to opportunistic infections, such as tuberculosis and toxoplasmosis, which should be ruled out in such patients.

Option C (Mononucleosis) is incorrect. Epstein-Barr virus infection can present with fevers, cervical lymphadenopathy, and occasionally hepatosplenomegaly. Hilar lymphadenopathy added to these symptoms in a young patient is highly suggestive for Hodgkin’s disease.

Option D (Non-Hodgkin’s lymphoma) is incorrect. Non-Hodgkin’s lymphoma can present quite similarly to Hodgkin’s lymphoma, but this tends to be much more common among the older population.

Option E (Tuberculosis) is incorrect. Hilar lymphadenopathy and fever are seen in tuberculosis. The lack of other findings on chest radiograph virtually rules out this diagnosis. Hepatosplenomegaly is also not associated with primary tuberculosis.

High-yield Hit 1

154. What are the common presentations of Hodgkin's disease?

Most patients often present with lymphadenopathy in the neck or axilla; lymph nodes are nontender, rubbery, and discrete. Sometimes the nodes wax and wane in size until attention is sought. Important symptoms in the staging of Hodgkin's disease are fever, weight loss (> 10% of body weight), and night sweats. Some patients are troubled by pruritus. Hodgkin's disease tends to originate in central lymph nodes, so that some patients present with mediastinal lymphadenopathy.

155. How does Hodgkin's disease spread?

Hodgkin's disease is thought to spread from a unifocal site to contiguous lymph nodes. There may be early hematogenous dissemination to the spleen, with subsequent spread to the splenic hilar and retroperitoneal nodes as well as the liver. If large tumor masses develop, there may be extension into adjacent organs. Often the spleen is significantly involved in the absence of palpable splenomegaly. Hence, some centers recommend staging laparotomy to avoid missing splenic and hepatic disease. The importance of staging in Hodgkin's disease is to determine the extent of disease and thereby decide on therapy.
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Hematology-, Internal-Medicine-, Step-2-Questions

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