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Review of Clinical Signs Review Questions

Approach to the Patient with Lymphadenopathy

Author: Bernard Karnath, MD

1. Which of the following is the most important consideration when evaluating a patient with lymphadenopathy?
  1. Age of the patient
  2. Location of lymph nodes
  3. Systemic symptoms
  4. Presence or absence of splenomegaly
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2. Tender, warm and erythematous lymph nodes are likely to be associated with which of the following?

  1. Immunologic disorder
  2. Infection
  3. Lymphoma
  4. Metastatic malignancy
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3. A 57-year-old man with a 20 pack-year history of smoking presents with a persistent cough and 10-lb weight loss over the past 2 months. Which of the following lymph nodes is likely to reveal a malignant process in this case?

  1. Axillary
  2. Epitrochlear
  3. Inguinal
  4. Supraclavicular
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4. A 47-year-old horticulturist presents with complaints of left arm pain with noted erythematous streaks from the hand to the elbow. She reports having trimmed some roses a few days ago and sustaining a deep scratch on her hand from one of the thorns. Physical examination reveals a tender epitrochlear lymph node. Which of the following is the likely causative organism?

  1. Bartonella henselae
  2. Francisella tularensis
  3. Sporothrix schenckii
  4. Yersinia pestis
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5. A 23-year-old woman presents with a 10-day history of fever and a sore throat. Physical examination reveals a fever of 101° F, cervical lymphadenopathy, and a mildly erythematous pharynx with enlarged tonsils. Complete blood count with peripheral smear is remarkable for large atypical lymphocytes. Which of the following is the most likely cause of this woman’s illness?
  1. Hodgkin’s lymphoma
  2. Infectious mononucleosis
  3. Plague
  4. Tularemia
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6. A 35-year-old man presents to clinic with a penile lesion that developed 1 week ago. He admits to having unprotected insertive anal intercourse with 2 different men approximately 2 weeks ago. The penile lesion is painless. On physical examination, the lesion measures 0.6 cm and has a shallow smooth ulcer base with firm margins. Also noted are some small palpable bilateral inguinal lymph nodes. The lesion in this case is most likely due to which of the following sexually transmitted diseases?

  1. Herpes simplex virus
  2. Primary syphilis
  3. Chancroid
  4. Granuloma inguinale
  5. Lymphogranuloma venereum
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7. One month later, the patient in question 6 returns with symptoms of “swollen neck glands" and generalized fatigue and malaise. At his previous visit 1 month ago, the patient was treated with intramuscular penicillin for his primary syphilis. His rapid plasma reagin test was reactive at 1:1 dilutions. HIV serology was negative. On physical examination, there is palpable lymphadenopathy of the neck. The lymph nodes measure 1.0 cm in diameter. What is the next step in evaluation of this patient?

  1. Lymph node biopsy
  2. Lymph node aspiration
  3. Repeat serologic testing for syphilis
  4. Repeat serologic testing for HIV
  5. Reassurance
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