Question 137
During a routine appointment, a 60-year-old man’s dentist palpates some lymph nodes on the right side of the neck. A follow-up physical with a family practitioner reveals additional lymph nodes in the right axilla and the left femoral region. The lymph nodes are painless but rubbery to palpation. Biopsy of the lymph nodes is most likely to reveal which of the following?
A. A starry sky pattern
B. Reed-Sternberg cells
C. Granulomas
D. Nodular effacement of the architecture
E. Metastatic glioblastoma multiforme
Answer for Question 137
Answer: D (Nodular effacement of the architecture)
Explanation: The clinical presentation (painless enlargement of lymph nodes in non-contiguous locations) is consistent with non-Hodgkin lymphoma. Nodular effacement of the architecture describes follicular lymphoma, which is a common non-Hodgkin lymphoma in older patients. A starry sky pattern is characteristic of Burkitt lymphoma, which normally presents in a younger population. Reed-Sternberg cells are characteristic of Hodgkin lymphoma, which involves contiguous groups of lymph nodes. CNS tumors very rarely metastasize. The history does not support a granulomatous process, such as tuberculosis or a non-typical infection, and sarcoid just involving a group of lymph nodes without additional organ involvement would be unlikely.
Question 138
During a yearly physical examination, the primary care physician for a 60-year-old man palpates lymph nodes on both sides of the neck and in the right femoral region. A subsequent biopsy of the lymph nodes is most likely to reveal a nodular effacement of the architecture. Genetic testing would reveal which of the following?
A. t(8;14)
B. t(8;21)
C. t(9;22)
D. t(14;18)
E. t(12;21)
F. t(15;17)
Answer for Question 138
Answer: D (t(14;18))
Explanation: The involvement of non-contiguous lymph nodes is consistent with a non-Hodgkin lymphoma. Nodular effacement of the architecture is a description that is consistent with a follicular lymphoma, which involves older adults. Follicular lymphoma is associated with a t(14;18), which moves the bcl-2 gene adjacent to the Ig heavy chain gene. t(8;14) is associated with Burkitt lymphoma; t(8;21) and t(15;17) with acute myeloid leukemia; t(9;22) with CML and ALL; and t(12;21) with ALL.
Question 139
A 61-year-old male for the past year has had multiple infections, including two episodes of pneumonia and two abscesses in the skin requiring drainage. Prior to that, he had been very healthy, only requiring treatment for hypertension that developed 5 years ago. A physical examination reveals palpable lymph nodes in the left femoral region and right axilla. Of the following, which test is likely to disclose the cause for his repeated infections?
A. Serum ferritin
B. Serum protein electrophoresis
C. CT scan of the chest to assess the thymus
D. EKG
E. Thyroid function testing
Answer for Question 139
Answer: B (Serum protein electrophoresis)
Explanation: The finding of enlarged lymph nodes in non-contiguous locations is consistent with a non-Hodgkin lymphoma. Non-Hodgkin lymphoma of certain types (e.g., SLL) can be associated with a hypogammaglobulinemia. Patients with a hypogammaglobulinemia can be at risk for serious bacterial infections. A serum protein electrophoresis or a urine protein electrophoresis can identify a hypogammaglobulinemia.