Case 1
Mr. Hernandez is a 59-year-old Hispanic man who presents for an annual physical exam. He has no complaints or concerns at the visit.
He has a past medical history of hypertension. He takes lisinopril 10 mg orally every day. He is allergic to penicillin (cause hives). Social history: truck driver, divorce. Quit smoking 5 years ago after smoking one pack per day for 20 years, drinks three to four beers a week.
Vital signs: temperature 98.6°F; pulse 74 beats per minute; respirations 18 per minute; blood pressure 124/76 mmHg; body mass index 31. Health maintenance: refuses the influenza shot; has never had a colonoscopy. Family history: he is adopted. His physical exam is unremarkable. Mr. Hernandez’s complete metabolic profile was within normal limits and his complete blood count with differential revealed the following results:
WBC 12X10/ml
Hgb 8.0g/dl
Hct 25%
RBC 5.0×10/ml
MCV 90 x U/mL/red cell
MCH 32 pg/red cell
MCHC 31 g/l
Platelets 45,000/ml
Blasts 85%
Provide responses to the three (3) items below based on this scenario.
- Describe the type of anemia present (e.g., microcytic, macrocytic, normocytic) and list the results that support your decision.
- Describe additional diagnostic tests to be ordered and explain why they will be ordered.
- Describe the top two most likely diagnoses and explain why you made these choices.
Case 2
A 22-year-old man comes in because he was shaving and felt a lump on his neck. He states the lump is not painful and he noticed it about 2 weeks ago. He states he’s been more tired than usual for the past month and attributes this to his hectic schedule with work and school. He has not noticed any other changes in his health and denies other symptoms such as fever, weight loss, and difficulty swallowing.
The remainder of his history is as follows:
Past medical and surgical history: tonsillectomy and adenoidectomy; mononucleosis; Medications: none; Allergies: none; Social history: smokes pot two to three times a week and uses no other drugs: drinks four to five beers on weekends; denies tobacco use; business major in college; not in a relationship for the past 6 months.
A complete physical exam was done and is unremarkable except for the presence of a cervical lymph node that is 2 centimeters, rubbery, and fixed. Hodgkin lymphoma is suspected.
Answer the following questions based on this scenario.
- What other clinical manifestations are consistent with Hodgkin lymphoma?
- What are other possible diagnoses to explain these manifestations?
- What diagnostic tests (e.g., CBC) will be done, and what are the expected findings if the diagnosis is Hodgkin lymphoma?
