WBR0821

Author	Vendhan Ramanujam
Exam Type	USMLE Step 3
Main Category	Community Medical Health Center, Primary Care Office
Sub Category	Hematology, Oncology
Prompt	[[Prompt::A 49 year old Caucasian male presents to his physicians office with complaints of intermittent fever, night sweats, fatigue and itching for the past 2 months. He denies similar illness in his past or among any family members and any recent history of travel. He smokes one pack of cigarette and drinks a glass of wine everyday. His vital signs are heart rate 88 beats/min, respiratory rate 16/minute, blood pressure 120/80 mm Hg and oral temperature 36.8 C. On physical exam there is diffuse, nontender lymphadenopathy, including small supraclavicular, epitrochlear, and scalene nodes. Spleen is non palpable. Liver function tests are normal. Chest x-ray revealed a bilateral hilar lymphadenopathy is shown below. A biopsy of the lymph nodes was done and it revealed a mixed cellularity Hodgkin’s lymphoma. The next step in evaluation is]]
Answer A	Abdominal CT or MRI
Answer A Explanation	Correct-After diagnosis, staging of Hodgkin’s lymphoma with CT or MRI scan of the abdomen will be the next best step before planning the appropriate treatment.
Answer B	Liver biopsy
Answer B Explanation	Incorrect-Liver biopsy will be unnecessary to this patient.
Answer C	Erythrocyte sedimentation rate
Answer C Explanation	[[AnswerCExp::Incorrect-Erythrocyte sedimentation rate might be elevated. But it is not the appropriate best step while evaluating this patient.]]
Answer D	A repeat node biopsy
Answer D Explanation	Incorrect-Diagnosis of Hodgkin’s lymphoma through lymph node biopsy carries an accuracy rate of 98%. So a repeat node biopsy will be unnecessary.
Answer E	Laparotomy
Answer E Explanation	Incorrect-Staging laparotomy is not as necessary as in the past because CT and MRI have replaced them and can usually identify or exclude disease of the abdomen.
Right Answer	A
Explanation	[[Explanation::After diagnosis Hodgkin’s lymphoma through lymph node biopsy, staging of Hodgkin’s disease is important so that the appropriate treatment can be planned. To determine whether the patient has stage 3 or 4 disease, the presence or absence of disease in the abdomen must be known. A CT or MRI scan of the abdomen would be the test of choice. Educational Objective: After diagnosing Hodgkin’s lymphoma through lymph node biopsy, staging of Hodgkin’s disease, which includes CT or MRI scan of the abdomen to rule out the disease in the abdomen, is the next important step before planning the appropriate treatment. Educational Objective: References: ]]
Approved	Yes
Keyword	Lymphoma, Hodgkins lymphoma
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