Question

A 25 year old graduate student complains of a "lump" under his clavicle for the past two weeks. He first noticed the lump after being hit in the shoulder during a rugby match. He has otherwise been well, and denies any other symptoms including fever, night sweats, weight loss, or recent infections or illnesses. On physical examination, the patient is comfortable and afebrile. There is a 4 cm, rubbery, nontender supraclavicular lymph node on the left, as well as numerous 1-2 cm enlarged cervical and axillary nodes. The clavicle is nontender, and there is full range of motion at both shoulders. There is no evidence of a draining abscess or resolving cellulitis. Laboratory evaluation shows the following. WBC 8.0 k/mcL (Normal: 4.5-11.0 k/mcL) Differential: 66% neutrophils, 30% lymphocytes, 3% monocytes, 1% eosinophils Hemoglobin 14.3 g/dL (Normal: 13.5-17.5 g/dL) Hematocrit 43% (Normal: 39-49%) Platelets 212 k/mcL (Normal: 150-450 k/mcL) Which of the following is the most likely diagnosis in this patient?

A. Acute myelogenous leukemia
B. Infectious mononucleosis
C. Hodgkin's lymphoma
D. Trauma
E. Felty's syndrome

Answer 1

A 25-year-old with painless enlarged lymph nodes without signs of infection or trauma is most likely to be diagnosed with Hodgkin's lymphoma.

Step-by-step explanation:

The most likely diagnosis for a 25-year-old graduate student who presents with a 4 cm, rubbery, nontender supraclavicular lymph node, alongside numerous 1-2 cm enlarged cervical and axillary nodes, with normal blood work and without signs of infection or fever, is C. Hodgkin's lymphoma. Hodgkin's lymphoma typically presents with painless lymph node enlargement and the absence of symptoms like fever, night sweats, and weight loss can still be compatible with this diagnosis. Considering the lack of any indication of trauma, infection, or other specific syndromes (like Felty's syndrome), the characteristics of these nodes and the clinical context are well-aligned with the typical presentation of Hodgkin's lymphoma.