467. A 32yo pt presents with cervical lymphadenopathy and splenomegaly. What is the single most
appropriate option?
a. Hemophilus
b. Streptococcus
c. Toxoplasmosis
d. NHL
e. Pneumocystis jerovcii
answer: D
Severe Toxoplasmosis is much rare and associated with other problems: chorioretinitis, encephalitis
NHL
• painless superficial lymphadenopathy, usually >1 lymph node region
• usually presents as widespread disease (exception is aggressive lymphoma)
• constitutional symptoms not as common as in Hodgkin lymphoma
• cytopenia: anemia ± neutropenia ± thrombocytopenia can occur when bone marrow is involved
• abdominal signs
- hepatosplenomegaly
- retroperitoneal and mesenteric involvement (second most common site of involvement)
• oropharyngeal involvement in 5-10% with sore throat and obstructive apnea
• extranodal involvement: most commonly GI tract; also testes, bone, kidney
• CNS involvement in 1% (often with HIV)
Toxoplasmosis
• immunocompromised (most commonly AIDS with CD4 <200)
encephalitis with focal CNS lesions seen as single or multiple ring-enhancing masses on CT
(H/A and focal neurological signs)
lymph node, liver, and spleen enlargement and pneumonitis
chorioretinitis
Pneumocystitis jiroveci
• symptoms of pneumonia: fever, nonproductive cough, progressive dyspnea
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