Final answer:
The next step for a patient with B symptoms and an unresponsive, enlarged lymph node is to perform a biopsy of the lymph node, which can confirm if the issue is lymphoma or another condition. Lack of response to antibiotics is an indicator that biopsy is warranted. Once lymphoma is diagnosed, further staging and treatment decisions can be made.
Step-by-step explanation:
If a patient presents with B symptoms and a firm and rubbery neck lymph node, the next step should typically be to perform a biopsy of the lymph node. B symptoms are systemic symptoms of fever, night sweats, and weight loss that often occur in conjunction with lymphomas and other conditions. A lymph node biopsy can provide a definitive diagnosis by revealing whether cancerous cells are present in the lymph node tissue. This is important because the presence of cancerous lymphocytes indicates that the patient may have lymphoma, as was the case with patient Wei mentioned in the provided scenario.
While an initial course of antibiotics might be appropriate if an infection is suspected, the lack of response to antibiotics—as described in Wei's case—warrants further investigation through a biopsy. Dr. Bouazizi's decision to order a biopsy in response to persistent swelling after antibiotic treatment aligns with standard medical practice. Once a diagnosis is confirmed, additional tests might include imaging, such as CT scans, and tests to determine the specific type and stage of lymphoma, which will guide the treatment plan. The treatment could include chemotherapy, radiation therapy, targeted therapy, or a combination of these approaches.