Hodgkin lymphoma US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Hodgkin lymphoma. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Hodgkin lymphoma US Medical PG Question 1: A 35-year-old man presents with a mass on the central part of his neck. He reports it has been growing steadily for the past 2 weeks, and he has also been experiencing fatigue and recurrent fevers. No significant past medical history. The patient denies any smoking history, or alcohol or recreational drug use. He denies any recent travel in the previous 6 months. On physical examination, there are multiple enlarged submandibular and cervical lymph nodes that are firm, mobile, and non-tender. A biopsy of one of the lymph nodes is performed and shows predominantly lymphocytes and histiocytes present in a pattern ‘resembling popcorn’. A flow cytometry analysis demonstrates cells that are CD19 and CD20 positive and CD15 and CD30 negative. Which of the following is the most likely diagnosis in this patient?
- A. Nodular sclerosis classical Hodgkin lymphoma
- B. Nodular lymphocyte-predominant Hodgkin lymphoma (Correct Answer)
- C. Lymphocyte depleted Hodgkin lymphoma
- D. Mixed cellularity classical Hodgkin lymphoma
- E. Lymphocyte rich classical Hodgkin lymphoma
Hodgkin lymphoma Explanation: ***Nodular lymphocyte-predominant Hodgkin lymphoma***
- The key features are **lymphohistiocytic (L&H) cells**, also known as **popcorn cells**, which are large, multilobed Hodgkin-Reed-Sternberg (HRS) cell variants.
- Immunophenotypically, these cells are typically **CD19+, CD20+, CD45+, and CD30-, CD15-**, consistent with the flow cytometry findings.
*Nodular sclerosis classical Hodgkin lymphoma*
- Characterized by **lacunar cells** (a variant of HRS cells) and broad bands of **collagen fibrosis**, which are not described.
- HRS cells in classical Hodgkin lymphoma (cHL) are typically **CD15+ and CD30+**, and usually **CD20-**, which contradicts the flow cytometry results.
*Lymphocyte depleted Hodgkin lymphoma*
- This is a rare form of cHL with **few lymphocytes** and abundant atypical HRS cells, often seen in older, immunosuppressed patients.
- The flow cytometry profile (CD15+, CD30+) and the histological description of "popcorn cells" do not fit this subtype.
*Mixed cellularity classical Hodgkin lymphoma*
- This subtype of cHL features a heterogeneous cellular infiltrate and classic **HRS cells (CD15+, CD30+)**, which differ from the described immunophenotype.
- It lacks the "popcorn cell" morphology and the nodal sclerosis seen in other cHL subtypes.
*Lymphocyte rich classical Hodgkin lymphoma*
- While it has abundant lymphocytes, the characteristic cells are still **classic HRS cells (CD15+, CD30+)**, not the popcorn cells described.
- The immunophenotype **CD20+ and CD15-, CD30-** is inconsistent with any form of classical Hodgkin lymphoma.
Hodgkin lymphoma US Medical PG Question 2: A 5-year-old male is brought to his pediatrician after recurrent, prolonged upper respiratory infections over a period of several months. Physical exam reveals petechiae on the patient's legs and arms. Laboratory studies show hemoglobin: 10 g/dL, platelet count: 35,000/mm^3, leukocyte count: 6,600/mm^3. A bone marrow aspiration shows an abundance of lymphoblasts indicative of acute lymphoblastic leukemia (ALL). Positive immunostaining for which of the following would support a diagnosis of precursor B-cell leukemia?
- A. CD2, CD8
- B. TdT, HER-2
- C. CD4, CD5
- D. CD19, CD10 (Correct Answer)
- E. CD30, CD15
Hodgkin lymphoma Explanation: ***CD19, CD10***
- **CD19** is a pan B-cell marker, expressed on almost all B-lymphocytes from early pre-B-cells through mature B-cells. Its presence, along with **CD10**, is highly characteristic of **precursor B-cell ALL (B-ALL)**.
- **CD10**, also known as common acute lymphoblastic leukemia antigen (CALLA), is typically expressed on **early B-cell progenitors** and is a reliable marker for differentiating B-ALL from other leukemias.
*CD2, CD8*
- **CD2** and **CD8** are markers primarily associated with **T-lymphocytes**. While CD2 is a pan T-cell marker, CD8 identifies cytotoxic T cells.
- Their positivity would suggest a **T-cell ALL (T-ALL)**, not the precursor B-cell type indicated by the clinical scenario.
*TdT, HER-2*
- **Terminal deoxynucleotidyl transferase (TdT)** is an enzyme found in immature lymphocytes (both B and T cells) and is positive in most ALL cases, but it is not specific for B-cell lineage.
- **HER-2** is an oncogene and a growth factor receptor overexpressed in certain solid tumors (especially breast cancer) but is not a marker used for leukemia classification.
*CD4, CD5*
- **CD4** is a marker for helper T cells, while **CD5** is expressed on a subset of T cells and some B-cell malignancies (e.g., chronic lymphocytic leukemia/small lymphocytic lymphoma).
- These markers are primarily associated with **T-cell lineages** and would not support a diagnosis of precursor B-cell leukemia in this context.
*CD30, CD15*
- **CD30** and **CD15** are classical markers for **Hodgkin lymphoma** (specifically the classical type).
- Their presence would point towards a lymphoproliferative disorder different from acute lymphoblastic leukemia.
Hodgkin lymphoma US Medical PG Question 3: A 29-year-old man comes to the physician because of a 3-month history of fatigue, weight loss, and multiple painless swellings on his neck and axilla. He reports that his swellings become painful after he drinks alcohol. Physical examination shows nontender cervical and axillary lymphadenopathy. A lymph node biopsy specimen shows giant binucleate cells. Which of the following is the most likely diagnosis?
- A. Diffuse large B-cell lymphoma
- B. Acute retroviral syndrome
- C. Hodgkin lymphoma (Correct Answer)
- D. Acute lymphocytic leukemia
- E. Adult T-cell lymphoma
Hodgkin lymphoma Explanation: ***Hodgkin lymphoma***
- The presence of **fatigue, weight loss, and painless lymphadenopathy** (B symptoms) in a young man is highly suggestive of Hodgkin lymphoma.
- The **lymph node biopsy showing giant binucleate cells** (Reed-Sternberg cells) is pathognomonic for Hodgkin lymphoma, and **alcohol-induced lymph node pain** is a classic, though uncommon, symptom.
*Diffuse large B-cell lymphoma*
- This is an **aggressive non-Hodgkin lymphoma** that can present with rapidly enlarging lymph nodes and B symptoms.
- However, the characteristic **Reed-Sternberg cells** found on biopsy are not seen in diffuse large B-cell lymphoma.
*Acute retroviral syndrome*
- This syndrome typically presents with **flu-like symptoms, fever, sore throat, and generalized lymphadenopathy** within weeks of HIV infection.
- It is usually **self-limiting** and does not feature the specific histopathology of giant binucleate cells on lymph node biopsy.
*Acute lymphocytic leukemia*
- This is a **hematologic malignancy** characterized by the proliferation of immature lymphoid cells.
- It often presents with symptoms of **bone marrow failure** (anemia, bleeding, infections) and can have lymphadenopathy, but the diagnostic lymph node biopsy features are not consistent with Reed-Sternberg cells.
*Adult T-cell lymphoma*
- This rare lymphoma is associated with **human T-lymphotropic virus type 1 (HTLV-1) infection** and is more common in endemic regions.
- It can present with lymphadenopathy, skin lesions, and hypercalcemia, but the histopathology would show **pleomorphic T-cells**, not Reed-Sternberg cells.
Hodgkin lymphoma US Medical PG Question 4: A 37-year old man is being evaluated due to a recent history of fatigue that started 3 weeks ago. The patient presents with a history of HIV, which was first diagnosed 7 years ago. He has been on an antiretroviral regimen and takes it regularly. His CD4+ count is 350 cells/mm3. According to the patient, his partner passed away from a "blood cancer", and he is worried that his fatigue might be connected to a similar pathology. The physician clarifies that there is an increased risk for HIV patients to develop certain kinds of lymphomas. Which one of the conditions below is the patient more likely to develop based on his medical history?
- A. Diffuse large B cell lymphoma (Correct Answer)
- B. Follicular lymphoma
- C. Burkitt’s lymphoma
- D. Extranodal marginal zone lymphoma
- E. Small lymphocytic lymphoma
Hodgkin lymphoma Explanation: ***Diffuse large B cell lymphoma***
- **Diffuse large B-cell lymphoma (DLBCL)** is the most common type of lymphoma diagnosed in HIV-positive patients, accounting for about 50% of cases.
- The increased risk of DLBCL in HIV patients is related to chronic immune stimulation and dysregulation, often exacerbated by co-infection with viruses like **Epstein-Barr virus (EBV)**.
*Follicular lymphoma*
- **Follicular lymphoma** is generally *less common* in HIV-positive patients compared to the general population.
- Its incidence does not significantly increase in the context of HIV infection.
*Burkitt’s lymphoma*
- **Burkitt's lymphoma** is also more common in HIV patients, but typically presents in those with *more severe immunosuppression* (lower CD4 counts) and is specifically associated with **Epstein-Barr virus (EBV)** co-infection.
- While a possibility, DLBCL is the *overall most likely* lymphoma.
*Extranodal marginal zone lymphoma*
- **Extranodal marginal zone lymphoma** is *not typically associated* with an increased incidence in HIV-positive individuals.
- It often correlates with chronic inflammation or specific infections (e.g., *H. pylori* in gastric MALT lymphoma).
*Small lymphocytic lymphoma*
- **Small lymphocytic lymphoma (SLL)**, which is essentially the nodal form of chronic lymphocytic leukemia (CLL), is *not increased* in incidence in HIV-positive patients.
- CLL/SLL is generally considered to be *less common* or have no increased risk in HIV-infected individuals.
Hodgkin lymphoma US Medical PG Question 5: A 67-year-old woman comes to the physician because of a 3-week history of fatigue and worsening back and abdominal pain. During this period, she has also had excessive night sweats and a 4.6-kg (10-lb) weight loss. She has had swelling of the neck for 3 days. She does not smoke or drink alcohol. Vital signs are within normal limits. Physical examination shows a 4-cm, supraclavicular, nontender, enlarged and fixed lymph node. The spleen is palpated 2 cm below the left costal margin. Laboratory studies show:
Hemoglobin 10.4 g/dL
Mean corpuscular volume 87 μm3
Leukocyte count 5,200/mm3
Platelet count 190,000/mm3
Serum
Lactate dehydrogenase 310 U/L
A CT scan of the thorax and abdomen shows massively enlarged paraaortic, axillary, mediastinal, and cervical lymph nodes. Histopathologic examination of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?
- A. Hairy cell leukemia
- B. Adult T-cell lymphoma
- C. Diffuse large B-cell lymphoma (Correct Answer)
- D. Marginal zone lymphoma
- E. Follicular lymphoma
Hodgkin lymphoma Explanation: ***Diffuse large B-cell lymphoma***
- The patient presents with **B symptoms** (fever, night sweats, weight loss), rapid progression, generalized **lymphadenopathy** (cervical, supraclavicular, paraaortic, axillary, mediastinal), **splenomegaly**, and elevated **LDH**.
- **Histopathologic examination** showing lymphocytes with a **high proliferative index** and positive **CD20 staining** confirms a B-cell lymphoma with aggressive features, highly characteristic of DLBCL.
*Hairy cell leukemia*
- This condition typically presents with **splenomegaly** and **pancytopenia**, but **lymphadenopathy** is rare and often absent.
- The characteristic "hairy cells" are identified by specific markers (CD103, CD123, CD25), and a **high proliferative index** is not a feature.
*Adult T-cell lymphoma*
- This lymphoma is associated with **HTLV-1 infection** and often presents with hypercalcemia, skin lesions, and generalized lymphadenopathy, but it is a **T-cell lymphoma**.
- The **CD20 positivity** in the histology rules out a T-cell lineage lymphoma.
*Marginal zone lymphoma*
- This is an **indolent B-cell lymphoma** that typically progresses slowly and is often associated with chronic inflammation or autoimmune diseases.
- The patient's aggressive symptoms, rapid progression, significant **B symptoms**, and **high proliferative index** are not consistent with indolent lymphoma.
*Follicular lymphoma*
- This is also an **indolent B-cell lymphoma** characterized by a follicular growth pattern and usually presents with painless lymphadenopathy.
- The rapid onset of symptoms, significant **B symptoms**, and elevated **LDH** indicate an aggressive lymphoma, which is not typical of follicular lymphoma.
Hodgkin lymphoma US Medical PG Question 6: A 65-year-old man presents with painless swelling of the neck over the past week. He also has noted severe night sweats, which require a change of clothes and bed linens the next day. His medical history is significant for long-standing hypertension. He received a kidney transplant 6 years ago. His current medications include amlodipine, metoprolol, furosemide, aspirin, tacrolimus, and mycophenolate. His family history is significant for his sister, who died last year from lymphoma. A review of systems is positive for a 6-kg (13.2-lb) unintentional weight loss over the past 2 months. His vital signs include: temperature 37.8°C (100.0°F) and blood pressure 120/75 mm Hg. On physical examination, there are multiple painless lymph nodes, averaging 2 cm in diameter, palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is palpated on the right side. Abdominal examination is significant for a spleen of 16 cm below the costal margin on percussion. Laboratory studies are significant for the following:
Hemoglobin 9 g/dL
Mean corpuscular volume 88 μm3
Leukocyte count 12,000/mm3
Platelet count 130,000/mm3
Creatinine 1.1 mg/dL
Lactate dehydrogenase (LDH) 1,000 U/L
A peripheral blood smear is unremarkable. Which of the following is the most likely diagnosis in this patient?
- A. Multiple myeloma
- B. Non-Hodgkin’s lymphoma (NHL) (Correct Answer)
- C. Drug-induced lymphadenopathy
- D. Chronic lymphocytic leukemia (CLL)
- E. Cytomegalovirus infection
Hodgkin lymphoma Explanation: ***Non-Hodgkin’s lymphoma (NHL)***
- This patient presents with **B symptoms** (**unintentional weight loss**, **night sweats**, fever), diffuse **lymphadenopathy**, and **splenomegaly**, which are classic signs of lymphoma. Elevated **LDH** and a history of kidney transplant requiring immunosuppression (tacrolimus, mycophenolate) significantly increase the risk of **post-transplant lymphoproliferative disorder (PTLD)**, a type of NHL.
- The **anemia**, **thrombocytopenia**, and **leukocytosis** (with an otherwise unremarkable peripheral smear) are consistent with bone marrow involvement or chronic disease in lymphoma.
*Multiple myeloma*
- Multiple myeloma is a plasma cell dyscrasia characterized by **bone pain**, **renal failure**, **hypercalcemia**, and **anemia**. While anemia and potential renal impairment are present, the widespread lymphadenopathy and splenomegaly are not typical features.
- The elevated LDH and presence of B symptoms are more indicative of lymphoma than multiple myeloma.
*Drug-induced lymphadenopathy*
- While some medications can cause lymphadenopathy, it is typically less severe, often without systemic B symptoms, and usually resolves upon discontinuation of the causative drug.
- The combination of severe B symptoms, impressive splenomegaly, and significantly elevated LDH points to a more aggressive underlying malignancy rather than a drug reaction.
*Chronic lymphocytic leukemia (CLL)*
- CLL is characterized by a persistent **lymphocytosis** (often >5,000 mature lymphocytes/µL) on peripheral smear, which is not described here ("unremarkable").
- While CLL can cause lymphadenopathy and splenomegaly, the rapid onset of severe B symptoms and the extremely high LDH are more suggestive of an aggressive lymphoma rather than indolent CLL.
*Cytomegalovirus infection*
- CMV infection can cause lymphadenopathy, fever, and fatigue, particularly in immunocompromised patients. However, the degree of **weight loss**, **splenomegaly**, and elevated **LDH** seen here are uncharacteristic of CMV infection and point towards a more serious underlying malignancy.
- CMV typically presents with a more acute, mononucleosis-like illness and often lymphocytosis with atypical lymphocytes on peripheral smear.
Hodgkin lymphoma US Medical PG Question 7: An 82-year-old man presents with painless swelling of the neck for the past week. He reports no recent fever, night sweats, or weight loss. He has no significant medical history, and his only medication is daily aspirin. His temperature is 36.8℃ (98.2℉). On physical examination, there are several non-tender lymph nodes, each averaging 2 cm in diameter, which are palpable in the right anterior cervical triangle. No other palpable lymphadenopathy is noted. The remainder of the physical exam is unremarkable. Laboratory studies show the following:
Hemoglobin 10 g/dL
Leukocyte count 8000/mm3 with a normal differential
Platelet count 250,000/mm3
Erythrocyte sedimentation rate
30 mm/h
An excisional biopsy of a cervical lymph node reveals the presence of Reed-Sternberg (RS) cells. Computed tomography (CT) scans and positron emission tomography (PET) scans reveal no mediastinal mass or signs of additional disease. Which of the following aspects most strongly indicates a good prognosis for this patient?
- A. Erythrocyte sedimentation rate (ESR)
- B. Leukocyte count and differential
- C. Absence of B symptoms
- D. Stage of the disease (Correct Answer)
- E. Hemoglobin level
Hodgkin lymphoma Explanation: ***Stage of the disease***
- The **stage of Hodgkin lymphoma** is the most significant prognostic factor, with **earlier stages (I and II)** having a much better prognosis than advanced stages (III and IV). The prompt indicates **no mediastinal mass or additional disease**, suggesting an early stage.
- Absence of widespread disease in CT and PET scans is a critical indicator of **localized disease**, which is associated with higher cure rates.
*Absence of B symptoms*
- While the **absence of B symptoms** (fever, night sweats, weight loss) is a favorable prognostic indicator, it is secondary to the overall disease stage in predicting long-term outcomes in Hodgkin lymphoma.
- The patient's lack of B symptoms is positive, but the *extent of disease spread* (stage) remains the primary determinant of prognosis.
*Erythrocyte sedimentation rate (ESR)*
- An **elevated ESR** (30 mm/h in this case) is a known adverse prognostic factor in Hodgkin lymphoma, indicating systemic inflammation.
- While important, it is a **secondary indicator** and does not outweigh the significance of disease stage in determining prognosis.
*Hemoglobin level*
- A **hemoglobin level below 10.5 g/dL** is an adverse prognostic factor in Hodgkin lymphoma according to the International Prognostic Score, and this patient's hemoglobin is 10 g/dL.
- This factor suggests a potentially **worse prognosis**, making it an incorrect answer for "good prognosis."
*Leukocyte count and differential*
- An **elevated leukocyte count** (above 15,000/mm³) and a **lymphopenia** (absolute lymphocyte count less than 600/mm³ or less than 8% of the white cell count) are adverse prognostic factors in Hodgkin lymphoma.
- This patient has a normal leukocyte count and differential (8000/mm³ with normal differential), which is **neutral to good** but less impactful than the disease stage.
Hodgkin lymphoma US Medical PG Question 8: A 15-year-old girl comes to the physician because of a sore throat and subjective fevers for the past 2 weeks. She has been feeling lethargic and is unable to attend school. She has a history of multiple episodes of streptococcal pharyngitis treated with amoxicillin. She immigrated with her family to the United States from China 10 years ago. She appears thin. Her temperature is 37.8°C (100°F), pulse is 97/min, and blood pressure is 90/60 mm Hg. Examination shows pharyngeal erythema and enlarged tonsils with exudates and palatal petechiae. There is cervical lymphadenopathy. The spleen is palpated 2 cm below the left costal margin. Her hemoglobin concentration is 12 g/dL, leukocyte count is 14,100/mm3 with 54% lymphocytes (12% atypical lymphocytes), and platelet count is 280,000/mm3. A heterophile agglutination test is positive. The underlying cause of this patient's symptoms is most likely to increase the risk of which of the following conditions?
- A. Kaposi sarcoma
- B. Glomerulonephritis
- C. Pneumonia
- D. Nasopharyngeal carcinoma (Correct Answer)
- E. Necrotizing retinitis
Hodgkin lymphoma Explanation: ***Nasopharyngeal carcinoma***
- The patient's symptoms (sore throat, fatigue, pharyngeal erythema, enlarged tonsils with exudates, palatal petechiae, cervical lymphadenopathy, splenomegaly, atypical lymphocytosis, and positive heterophile agglutination test) are classic for **infectious mononucleosis**, caused by the **Epstein-Barr virus (EBV)**.
- EBV infection is a significant risk factor for developing **nasopharyngeal carcinoma**, especially in individuals of Chinese descent, making this the most likely long-term complication.
*Kaposi sarcoma*
- **Kaposi sarcoma** is associated with **human herpesvirus 8 (HHV-8)**, not EBV.
- It is typically seen in immunocompromised individuals, such as those with HIV/AIDS, or in specific endemic regions.
*Glomerulonephritis*
- **Glomerulonephritis** can be a complication of **Streptococcus pyogenes infections** (post-streptococcal glomerulonephritis) or other autoimmune diseases, but it is not directly linked to EBV infection.
- The patient's history of streptococcal pharyngitis is relevant for this, but her current presentation points to EBV.
*Pneumonia*
- While pneumonia can occur as a secondary complication in severely ill patients with infectious mononucleosis, it is not a direct long-term increased risk associated with the underlying EBV infection itself.
- EBV primarily affects lymphoid tissues.
*Necrotizing retinitis*
- **Necrotizing retinitis** is most commonly associated with **cytomegalovirus (CMV)** infection, particularly in immunocompromised patients (e.g., HIV/AIDS).
- It is not a typical complication or long-term risk of EBV infection.
Hodgkin lymphoma US Medical PG Question 9: A 71-year-old man comes to the physician for a routine health maintenance examination. He has occasional fatigue but otherwise feels well. He has a history of hypertension and type 2 diabetes mellitus. He is a retired chemist. His only medication is ramipril. His temperature is 37.8°C (100°F), pulse is 72/min, respirations are 18/min, and blood pressure is 130/70 mm Hg. Physical examination shows nontender cervical and axillary lymphadenopathy. The spleen is palpated 7 cm below the costal margin. Laboratory studies show a leukocyte count of 12,000/mm3 and a platelet count of 210,000/mm3. Further evaluation is most likely to show which of the following?
- A. Smudge cells (Correct Answer)
- B. Ringed sideroblasts
- C. Rouleaux formation
- D. Teardrop cells
- E. Polycythemia
Hodgkin lymphoma Explanation: ***Smudge cells***
- The patient's presentation with **fatigue**, **lymphadenopathy**, **splenomegaly**, and a **leukocytosis** (12,000/mm³) is classic for **chronic lymphocytic leukemia (CLL)**.
- **Smudge cells** (also known as Gumprecht shadows) are characteristic findings on a peripheral blood smear in CLL, resulting from the fragile lymphocytes being crushed during slide preparation.
*Ringed sideroblasts*
- **Ringed sideroblasts** are immature red blood cells with iron granules accumulated in a ring around the nucleus, seen in **myelodysplastic syndromes** and **sideroblastic anemia**.
- This patient's symptoms and labs, particularly the significant lymphocytosis, do not support these conditions.
*Rouleaux formation*
- **Rouleaux formation** refers to red blood cells stacking up like coins, commonly seen in conditions with increased plasma proteins such as **multiple myeloma** or **macroglobulinemia**.
- The clinical picture here, with prominent lymphadenopathy and splenomegaly, is not typical for these disorders.
*Teardrop cells*
- **Teardrop cells** (dacryocytes) are red blood cells with a characteristic teardrop shape, often associated with **myelofibrosis** due to their deformation as they squeeze through fibrotic marrow.
- The patient's presentation lacks other key features of myelofibrosis, such as significant anemia, extremely high leukocyte counts, or symptoms of marrow failure.
*Polycythemia*
- **Polycythemia** refers to an abnormally high concentration of red blood cells (or hemoglobin) in the blood, often associated with conditions like **polycythemia vera**.
- While fatigue can be a symptom, the patient's leukocyte count is elevated, not the erythrocyte count, and the presence of lymphadenopathy and splenomegaly points away from isolated polycythemia.
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