• A 63 year old male Mr.mani, who is a farmer by occupation presenting with chief complaints of multiple swellings in both sides of neck and axilla for 2 months
History of presenting illness
--- Content provided by FirstRanker.com ---
• Patient was apparently normal 2 months back after which he developed multiple swellings in both sides of neck and axilla
insidious in onset, initially small in size, gradually progressive and to attain current size,
not associated with discharge and pain
• h/o fever for 2 days, low grade, continuous, not associated with chills and rigor, relieved by medication
• No h/o night sweats
--- Content provided by FirstRanker.com ---
• No h/o loss of weight and loss of appetite
• No h/o itching
• No h/o chronic cough, swelling of face, breathlessness
• No h/o abdominal pain, swelling of legs
• No h/o evening rise of temperature
--- Content provided by FirstRanker.com ---
• No h/o oral ulcers
• No h/o ear pain, ear discharge,
• No h/o bleeding from nose, nasal block
• No h/o abdominal pain, hematemesis, melena
• No h/o swollen testis
--- Content provided by FirstRanker.com ---
• no h/o hoarseness of voice
• No h/o difficulty in turning head
• No h/o deviation of tongue
• No h/o frequent fainting
• No h/o difficulty in shrugging of shoulders
--- Content provided by FirstRanker.com ---
• No h/o swelling elsewhere in the body
Past history
• No h/o similar complaints in the past
• No h/o TB, DM, HT, asthma, epilepsy, jaundice, IHD, STD
• No h/o any drug allergy
--- Content provided by FirstRanker.com ---
• No h/o previous surgeries
Personal history
• Patient consumes non-veg diet
• No addictive habits
• Normal bowel and bladder habits
--- Content provided by FirstRanker.com ---
• Patient denies h/o extra marital contact
Family history
• No relevant family history
General examination
• Patient is conscious, oriented, moderately built, moderately nourished
--- Content provided by FirstRanker.com ---
• pallor+
• No icterus
• No cyanosis
• No clubbing
• No pedal edema
--- Content provided by FirstRanker.com ---
• Significant lymphadenopathy (neck, axilla, inguinal)
Vital signs:
• PR-76/min, regular in rhythm, normal volume, no specific character, no radiofemoral, radioradial delay, equally felt on both sides in all palpable peripheral vessels, no vessel wall thickening
• RR-18/min, abdominothoracic type
• BP-130/80 mm Hg in right upper limb, sitting posture
--- Content provided by FirstRanker.com ---
• Afebrile.
Examination of neck nodes:
• Inspection
Multiple neck nodes involving cervical nodes upto level V, on both sides, which includes submental, submandibular, upper, middle and lower deep cervical and posterior cervical nodes
Each node measuring 2x2cm, hemispherical in shape, largest node in upper deep cervical node of 3x3 cm.
--- Content provided by FirstRanker.com ---
• Smooth surface
No scars, sinuses, dilated veins, visible pulsations
Palpation
• Not warm, not tender,
• Inspectory findings of site, size, shape are confirmed
--- Content provided by FirstRanker.com ---
• Rubbery in consistency
• Freely mobile,
• Discrete,
• Not fluctuant
• Skin over the swelling pinchable
--- Content provided by FirstRanker.com ---
• Plane of swelling – deep to deep fascia
Examination of axillary nodes:
Inspection
• Multiple axillary nodes involving central group of nodes on both sides
• Each node measuring 2x2cm, hemispherical in shape
--- Content provided by FirstRanker.com ---
• Smooth surface
No scars, sinuses, dilated veins, visible pulsations
Palpation
• Not warm, not tender,
• Inspectory findings of site, size, shape are confirmed
--- Content provided by FirstRanker.com ---
• Rubbery in consistency
• Freely mobile,
• Discrete,
• Not fluctuant,
• Skin over the swelling pinchable
--- Content provided by FirstRanker.com ---
• Plane of the swelling- deep to deep fascia
Examination of inguinal nodes:
Inspection
Multiple inguinal nodes involving superficial horizontal group of nodes on both sides
• Each node measuring 2x2cm, hemispherical in shape
--- Content provided by FirstRanker.com ---
Smooth surface
• No scars, sinuses, dilated veins, visible pulsations
Palpation
• Not warm, not tender,
• Inspectory findings of site, size, shape are confirmed,
--- Content provided by FirstRanker.com ---
• Rubbery in consistency
• Freely mobile,
• Discrete,
• Not fluctuant,
• Skin over the swelling pinchable.
--- Content provided by FirstRanker.com ---
• No other palpable lymph nodes elsewhere in the body (epitrochlear, para-aortic, popliteal)
• Oral cavity- no tonsillar enlargement
OTHER SYSTEMS
• Examination of abdomen : soft, not tender, no palpable mass, no organomegaly, no free fluid, hernial orifices are free, external genitalia normal.
• Examination of RS : Normal vesicular breath sounds heard. No added sounds
--- Content provided by FirstRanker.com ---
• Examination of CVS: S1 S2 heard, no murmurs
• Examination of CNS: No focal neurological deficit
• Examination of Spine and Cranium: Normal
• Perrectal examination to be done
Diagnosis
--- Content provided by FirstRanker.com ---
• Generalised lymphadenopathy for evaluation involving cervical group of lymph nodes from level I to level V, central group of axillary lymph nodes, superficial horizontal group of inguinal lymph nodes probably Hodgkin's lymphoma of stage IIIB
Differential diagnosis
• Non hodgkin's lymphoma
• Tuberculous lymphadenitis
• Secondaries neck
--- Content provided by FirstRanker.com ---
• HIV(AIDS Complex)
• Leukemia
• syphilis
MANAGEMENT
INVESTIGATIONS
--- Content provided by FirstRanker.com ---
• Routine:
• Blood: TC, DC, ESR, Hb%, Blood grouping/typing, urea, sugar, creatinine.
• Urine: sugar, albumin, deposits
• X ray chest
• ECG
--- Content provided by FirstRanker.com ---
Specific investigations:
• USG Neck
• FNAC of lymph node
• Excision biopsy of lymph node
• Mantoux test
--- Content provided by FirstRanker.com ---
• CT head and neck
• MRI
• PET scan
• Triple endoscopy
• Colonoscopy
--- Content provided by FirstRanker.com ---
Treatment
• Since it belongs to stage IIIB Hodgkin's lymphoma(according to cotswold's staging), the treatment is chemotherapy-ABVD regimen
--- Content provided by FirstRanker.com ---
This download link is referred from the post: PGI Chandigarh Last 10 Years 2011-2021 Solved Question Papers (PGIMER Previous Papers)