06 May 2009

Are you smarter than a first year?

A 33yo woman comes to your clinic with bilateral cervical lymph node swelling and fatigue.

Examination: Afebrile. Several bilateral 1-2cm cervial lymph nodes that were soft, non-tender and freely movable. No other lymphadenopathy. Her chest was clear, heart sounds normal, but she had mild tenderness at the right costal margin on deep inspiration.

Lab studies: Hct 37% WBC 5,200/uL, ALT 75 units, AST 70 units, AlkPhos 140 units. UA nml.

What is the (infectious) differential? What testing do you want?

1 comment:

Henry said...

X-Rays would be nice.

Viral hepatitis A or B or C, most likely C, are possible. But first I want AFB, a CMV (mononucleosis) and a bx. of the cervical nodes for sarcoidosis. If these are negative then I want cultures for Atypical mycobateria, mycoplasma infection, a cultures for brucellosis, actinomycosis, cat-scratch fever, blastomycosis, histoplasmosis, cyptococcosis.