TBL-5b PDF Case Study - King Salman International University

Faculty of Medicine Medicine Program TBL-5 Medicine staff Date : 3/ 11 /2022  “I have fever & neck swelling” ❑ A 26-year-old woman presented to the outpatient clinic complaining of fever & excessive sweating at night for 3 weeks. ❑ The patient also noted that...

Faculty of Medicine Medicine Program TBL-5 Medicine staff Date : 3/ 11 /2022  “I have fever & neck swelling” ❑ A 26-year-old woman presented to the outpatient clinic complaining of fever & excessive sweating at night for 3 weeks. ❑ The patient also noted that she had a painless swelling on the left side of the neck above her left clavicle. ❑ The patient also reported that she lost about 35 kg of her body weight over the past 3 months without intention. ❑ The patient had also heaviness in her left hypochondrium for one week. ❑ She didn’t have any chronic medical diseases and have no history of chronic drug use. ❑ Her family history was unremarkable. 1. Explain the significance of night fever & night sweating in this patient. 2. Analyse the complaint of weight loss in this patient. 3. Explain the significance of abdominal heaviness in this patient. 4. Describe anatomical distribution of neck lymph nodes. 5. List 5 causes of lymph nodes swelling. Explain the significance of night fever & night sweating in this patient. Toxic features of malignancy or TB Analyse the complaint of weight loss in this patient. Gradual onset, progressive course over 3 months. Non-intentional (involuntary) Alarm sign ( red flag) of malignancy Explain the significance of abdominal heaviness in this patient. Indicate enlargement of spleen ( splenomegaly) Describe anatomical distribution of neck lymph nodes. List 5 causes of lymph nodes swelling. Infection: viral (EBV, CMV, HIV) , bacterial ( TB), protozoal ( syphilis, toxoplasmosis) Storage disorders: lipid & glycogen storage diseases Hematological Malignancy : Lymphoma, ALL, CLL Neoplastic: metastases Drug –induced: Isoniazid, Allopurinol , phenytoin Autoimmune:SLE, Graves disease Infiltrative: Sarcoidosis, amyloidosis  “ I have generalized lymphadenopathy” ❑ General medical examination showed toxic appearance with decreased body built. ❑ Pulse was 110bpm, blood pressure 37.9 erutarepmet ,110/75c, respiratory rate.nim/22 ❑ There were hard, non-tender, enlarged & variable-sized lymph nodes in supraclavicular , axillary and inguinal areas. ❑ Abdominal examination showed hepatosplenomegaly 1- List the most common causes of enlarged left supraclavicular lymph nodes. 2- Explain the significance of hard consistency and painless enlarged lymph nodes. 3- Explain the significance of hepatosplenomegaly with lymphadenopathy. 1- List the most common causes of enlarged left supraclavicular lymph nodes. Hodgkins lymphoma, Cancer left lung, cancer stomach 2- Explain the significance of hard consistency and painless enlarged lymph nodes. High possibility of malignancy 3- Explain the significance of hepatosplenomegaly with lymphadenopathy. Systemic disorder not localized e.g: autoimmune, hematological malignancy, acute viral infection Cervical lymphadenopathy 4- Describe this neck swelling. Left supraclavicular lymphadenopathy The hematologist told the patient that he should undergo a surgical procedure and perform blood work-up as well as chest X-ray, abdominal CT and bone scan to confirm his diagnosis. 1- What is the surgical procedure that would help in diagnosis of this patient? 2- List the blood work up that help diagnosis of this condition. 3- Explain the significance of chest X-ray, abdominal CT and bone scan in this patient. 1- What is the surgical procedure that would help in diagnosis of this patient? Lymph node excisional biopsy 2- List the blood work up that help diagnosis of this condition. - CBC: increased WBCs, may be decreased RBCs & PLT - Blood film - Bone marrow aspirate/biopsy 3- Explain the significance of chest X-ray, abdominal CT and bone scan in this patient. - Metastatic work up for malignancy, to detect distant spread & metastases in lung, liver & bones 5- Identify the abnormal findings in this bone marrow aspirate. 1- What is the most probable diagnosis of this patient? Hodgkin lymphoma 2- List the treatment options for this patient. ❑ Chemotherapy: the mainstay of treatment ▪ ABVD (doxorubicin [adriamycin], bleomycin, vinblastine, dacarbazine) ▪ BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, Vincristine [oncovin], procarbazine, prednisone) ❑ Autologous hematopoietic stem cell transplantation