Haematology for AMC MCQ

A 24 year old man has a painless, rubbery, enlarging lump in his neck for two months, with drenching night sweats and 7 kg of weight loss. He mentions the lump aches after he drinks alcohol. He is otherwise well with no sore throat. An excision node biopsy shows Reed-Sternberg cells. What is the most likely diagnosis?

1. Human immunodeficiency virus (HIV) Generalised lymphadenopathy with risk factors. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes testing matter.
2. Lymphoma correct Correct. Painless enlarging lymphadenopathy with B symptoms and Reed-Sternberg cells is Hodgkin lymphoma.
3. Leukaemia Marrow failure with lymphadenopathy and abnormal blood counts. Painless lymphadenopathy with B symptoms and alcohol-induced node pain suggests it.
4. Tuberculosis Lymphadenopathy with weight loss and night sweats, a key mimic. Painless lymphadenopathy with B symptoms and alcohol-induced node pain raises it.
5. Metastatic carcinoma A hard fixed node from a solid tumour. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it worth considering.

The point: Lymphoma presents with painless lymphadenopathy, often with B symptoms of fever, drenching night sweats and unexplained weight loss. Hodgkin lymphoma tends to occur in younger adults with contiguous nodal spread and Reed-Sternberg cells on biopsy, and pain in an affected node after drinking alcohol is a classic, if uncommon, clue. Non-Hodgkin lymphoma is more varied and can be aggressive or indolent. The diagnosis needs an excision lymph node biopsy, not a fine-needle aspirate, because the architecture is essential, and staging uses CT or PET imaging with the lactate dehydrogenase as a marker. Treatment is chemotherapy, sometimes with radiotherapy or targeted agents, and outcomes for Hodgkin lymphoma are good. Watch for oncological emergencies: superior vena cava obstruction from a mediastinal mass, and tumour lysis syndrome when a bulky, rapidly dividing lymphoma is treated. The differential for lymphadenopathy includes reactive nodes, infection such as tuberculosis, Epstein-Barr virus or HIV, leukaemia and metastatic carcinoma.

Source: Cancer Council Australia — lymphoma diagnosis and management Cancer Council Australia · tier 2, specialty society or college

A 24 year old man has a painless, rubbery, enlarging lump in his neck for two months, with drenching night sweats and 7 kg of weight loss. He mentions the lump aches after he drinks alcohol. He is otherwise well with no sore throat. An excision node biopsy shows Reed-Sternberg cells. What is the most appropriate initial investigation?

1. Full blood count and film Detects marrow involvement and excludes leukaemia. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it necessary.
2. Assessment for oncological emergencies Superior vena cava obstruction and tumour lysis. Painless lymphadenopathy with B symptoms and alcohol-induced node pain indicates it.
3. Screening for infective mimics Tuberculosis, Epstein-Barr virus and HIV. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it worthwhile.
4. Excision lymph node biopsy correct Correct. An excision biopsy preserved the architecture needed to identify the Reed-Sternberg cells and classify the lymphoma.
5. Staging CT or PET imaging Defines the extent of disease. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it key.

The point: Lymphoma presents with painless lymphadenopathy, often with B symptoms of fever, drenching night sweats and unexplained weight loss. Hodgkin lymphoma tends to occur in younger adults with contiguous nodal spread and Reed-Sternberg cells on biopsy, and pain in an affected node after drinking alcohol is a classic, if uncommon, clue. Non-Hodgkin lymphoma is more varied and can be aggressive or indolent. The diagnosis needs an excision lymph node biopsy, not a fine-needle aspirate, because the architecture is essential, and staging uses CT or PET imaging with the lactate dehydrogenase as a marker. Treatment is chemotherapy, sometimes with radiotherapy or targeted agents, and outcomes for Hodgkin lymphoma are good. Watch for oncological emergencies: superior vena cava obstruction from a mediastinal mass, and tumour lysis syndrome when a bulky, rapidly dividing lymphoma is treated. The differential for lymphadenopathy includes reactive nodes, infection such as tuberculosis, Epstein-Barr virus or HIV, leukaemia and metastatic carcinoma.

Source: Cancer Council Australia — lymphoma diagnosis and management Cancer Council Australia · tier 2, specialty society or college

A 24 year old man has a painless, rubbery, enlarging lump in his neck for two months, with drenching night sweats and 7 kg of weight loss. He mentions the lump aches after he drinks alcohol. He is otherwise well with no sore throat. An excision node biopsy shows Reed-Sternberg cells. What is the most appropriate next step in management?

1. Radiotherapy or targeted therapy in selected cases Added according to type and stage. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it targeted.
2. Emergency treatment of superior vena cava obstruction For a mediastinal mass causing obstruction. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it the emergency step.
3. Chemotherapy correct Correct. Chemotherapy is the mainstay of treatment, with excellent outcomes in Hodgkin lymphoma.
4. Treat an infective mimic where found Where tuberculosis or another infection is the cause. Painless lymphadenopathy with B symptoms and alcohol-induced node pain redirects it.
5. Multidisciplinary and haematology-oncology care Coordinated specialist management. Painless lymphadenopathy with B symptoms and alcohol-induced node pain makes it comprehensive.

The point: Lymphoma presents with painless lymphadenopathy, often with B symptoms of fever, drenching night sweats and unexplained weight loss. Hodgkin lymphoma tends to occur in younger adults with contiguous nodal spread and Reed-Sternberg cells on biopsy, and pain in an affected node after drinking alcohol is a classic, if uncommon, clue. Non-Hodgkin lymphoma is more varied and can be aggressive or indolent. The diagnosis needs an excision lymph node biopsy, not a fine-needle aspirate, because the architecture is essential, and staging uses CT or PET imaging with the lactate dehydrogenase as a marker. Treatment is chemotherapy, sometimes with radiotherapy or targeted agents, and outcomes for Hodgkin lymphoma are good. Watch for oncological emergencies: superior vena cava obstruction from a mediastinal mass, and tumour lysis syndrome when a bulky, rapidly dividing lymphoma is treated. The differential for lymphadenopathy includes reactive nodes, infection such as tuberculosis, Epstein-Barr virus or HIV, leukaemia and metastatic carcinoma.

Source: Cancer Council Australia — lymphoma diagnosis and management Cancer Council Australia · tier 2, specialty society or college