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  #1  
Old 02-20-2012
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Question Generalized Lymphadenopathy, Fever, and Weight Loss!

An otherwise healthy 17-year-old complains of swollen glands in his neck and groin for the past 6 months and an increasing cough over the previous 2 weeks. He also reports some fevers, especially at night, and possibly some weight loss. On examination, you notice that he has nontender cervical, supraclavicular, axillary, and inguinal nodes, no hepatosplenomegaly, and otherwise looks to be fairly healthy. Which of the following would be the
appropriate next step?


a. Biopsy of a node
b. CBC and differential
c. Trial of antituberculosis drugs
d. Chest radiograph
e. Cat-scratch titers

please give reason along.
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  #2  
Old 02-20-2012
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chest radiograph?
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  #3  
Old 02-20-2012
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it seems like hodgkins .........for any non tender lymphadenopathy next step in management is DO EXCISIONAL BIOPSY!!..
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  #4  
Old 02-20-2012
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chest radiograph...without going thru chest x ray or blood profile how can we jump onto biopsy directly??
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  #5  
Old 02-20-2012
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Default Ans.

a.Biopsy of a node; chronic non-tender nodes point to neoplasm etiology.
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  #6  
Old 02-20-2012
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cbc first.tosee twbc,then ln biobs for histo @confirm.ithink ches=use for staging.
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  #7  
Old 02-20-2012
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i think A. biopsy of node
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  #8  
Old 02-20-2012
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A. biopsy of the lymph node....
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  #9  
Old 02-20-2012
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CBC and CXR only done if cause of lymphadenopathy is uncertain.

Here, s/s are suggestive of Lymphoma - So specific test Biopsy must be done.

Last edited by drnrpatel; 02-20-2012 at 06:56 PM.
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  #10  
Old 02-20-2012
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LN Biopsy

History is suggestive of Lymphoma
Considering SS, DD wud include

1-Lymphoma - (HD is more consisntent with age and symptoms here)
Diagnosis - Excisional biopsy with microscopic examination
30% pts shows splenomegaly and 5% with hepatomegaly (roughly)

2-TB (unless he is HIV +) u dont find G.Lymadenopathy

3-Cat Scratch (usually Regional Lymadenopathy is seen)

Please feel free to correct this
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  #11  
Old 02-20-2012
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cbc and a differential
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  #12  
Old 02-20-2012
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diagnose of such a problem shoud be done step by step so first test must be CBC and differentiate.
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  #13  
Old 02-21-2012
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Info

:sorry:

STEP BY STEP

CBC and differential FIRST.
__________________
Andres Santana I.M.G
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  #14  
Old 02-21-2012
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this is what i get as explanations...

Although a biopsy of the node may prove to be necessary
at some point, the first step would involve a radiograph, which may show
mediastinal mass suspicious for Hodgkin disease. Depending on the results
of the radiograph, a biopsy of a node may be indicated
, especially if the question
of Hodgkin (or other malignancy) remained high.


In Hodgkin disease, the CBC is not diagnostic, but may show nonspecific findings
of anemia, neutropenia, or thrombocytopenia; they are useful in the staging
process after the diagnosis has been confirmed by biopsy
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  #15  
Old 02-21-2012
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Quote:
Originally Posted by tyagee View Post
this is what i get as explanations...

Although a biopsy of the node may prove to be necessary
at some point, the first step would involve a radiograph, which may show
mediastinal mass suspicious for Hodgkin disease. Depending on the results
of the radiograph, a biopsy of a node may be indicated
, especially if the question
of Hodgkin (or other malignancy) remained high.


In Hodgkin disease, the CBC is not diagnostic, but may show nonspecific findings
of anemia, neutropenia, or thrombocytopenia; they are useful in the staging
process after the diagnosis has been confirmed by biopsy
Where did you get this information?

According to Kaplan Lecture Notes 2008 - 2009; Internal Medicine pg. 178 "excisional lymph node biopsy is the essential first step in determining diagnosis" next step would be to stage the disease in which chest x-ray, CT scan, abdominal CT scan or MRI are used.

Harrison's Principles of Internal Medicine 17th edition, pg. 699:
"The diagnosis of Hodgkin's disease is established by review of an adequate biopsy specimen by an expert hematopathologist"....."The staging evaluation for a patient with Hodgkin's disease would typically include a careful history and physical examination; complete blood count; erythrocyte sedimentation rate; serum chemistry studies including LDH; chest radiographs; CT scan of the chest, abdomen, and pelvis; and bone marrow biopsy."
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  #16  
Old 02-21-2012
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Quote:
Originally Posted by NGaleas View Post
Where did you get this information?

According to Kaplan Lecture Notes 2008 - 2009; Internal Medicine pg. 178 "excisional lymph node biopsy is the essential first step in determining diagnosis" next step would be to stage the disease in which chest x-ray, CT scan, abdominal CT scan or MRI are used.

Harrison's Principles of Internal Medicine 17th edition, pg. 699:
"The diagnosis of Hodgkin's disease is established by review of an adequate biopsy specimen by an expert hematopathologist"....."The staging evaluation for a patient with Hodgkin's disease would typically include a careful history and physical examination; complete blood count; erythrocyte sedimentation rate; serum chemistry studies including LDH; chest radiographs; CT scan of the chest, abdomen, and pelvis; and bone marrow biopsy."
Hey thats what i said its also is in usmle step 1 book pathology
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  #17  
Old 02-21-2012
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Quote:
Originally Posted by NGaleas View Post
Where did you get this information?

According to Kaplan Lecture Notes 2008 - 2009; Internal Medicine pg. 178 "excisional lymph node biopsy is the essential first step in determining diagnosis" next step would be to stage the disease in which chest x-ray, CT scan, abdominal CT scan or MRI are used.

Harrison's Principles of Internal Medicine 17th edition, pg. 699:
"The diagnosis of Hodgkin's disease is established by review of an adequate biopsy specimen by an expert hematopathologist"....."The staging evaluation for a patient with Hodgkin's disease would typically include a careful history and physical examination; complete blood count; erythrocyte sedimentation rate; serum chemistry studies including LDH; chest radiographs; CT scan of the chest, abdomen, and pelvis; and bone marrow biopsy."
thats true for hodgkin disease...

is question presentation that typical for hodgkins? i mean there is no Hepatosplenomegaly...if we do chest xray as first step, it may show enlarged mediastinal nodes which will add to suspicion for hodgkins...what say? confusing indeed...

i got info from pretest pedo...
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Old 02-21-2012
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Quote:
Originally Posted by tyagee View Post
thats true for hodgkin disease...

is question presentation that typical for hodgkins? i mean there is no Hepatosplenomegaly...if we do chest xray as first step, it may show enlarged mediastinal nodes which will add to suspicion for hodgkins...what say? confusing indeed...

i got info from pretest pedo...
Patient is 17 years old (Hodgkin lymphoma most seen in 15-19 yo). The giveaway in this case are the nontender cervical, supraclavicular, axillary, and inguinal nodes. Which are the most common initial signs of Hodgkin disease.

Hodgkin's disease is localized to lymph nodes most of the time, while Non Hodgkin Lymphoma is far more likely to involve extralymphatic sites, therefore, hepatosplenomegaly is more a sign of NHL than HL.

Kaplan lectures; "Supraclavicular lymph nodes involved, always think malignancy" Best next step: Excisional biopsy of node.
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  #19  
Old 02-25-2012
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wats the final answer guys?

what does the book say from where u got this question????
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  #20  
Old 02-26-2012
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the book says chest xray
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  #21  
Old 02-27-2012
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Quote:
Originally Posted by qurat21 View Post
chest radiograph...without going thru chest x ray or blood profile how can we jump onto biopsy directly??
If we do chest x ray it will only show lymph node ....biopsy is most accurate...
if there is chronic lymphnode enlargement or many number of lymphnodes enlarged would not we should do biopsy as best initial step.

If we have to go for best initial step at all then we should begain with cbc right
why not chest x ray?.......
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  #22  
Old 02-27-2012
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Quote:
Originally Posted by tyagee View Post
this is what i get as explanations...

Although a biopsy of the node may prove to be necessary
at some point, the first step would involve a radiograph, which may show
mediastinal mass suspicious for Hodgkin disease. Depending on the results
of the radiograph, a biopsy of a node may be indicated
, especially if the question
of Hodgkin (or other malignancy) remained high.


In Hodgkin disease, the CBC is not diagnostic, but may show nonspecific findings
of anemia, neutropenia, or thrombocytopenia; they are useful in the staging
process after the diagnosis has been confirmed by biopsy
If we did chest x ray first but if it is negative then what should be the next step?
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