USMLE PRACTICE QUESTION OF THE WEEK
Question for December 19, 2025
A 45-year-old woman presents with intermittent fevers, night sweats, and weight loss over the past 3 months. She recently returned from rural Central America, where she worked on a farm. Physical exam shows enlarged, nontender cervical lymph nodes and hepatosplenomegaly. Laboratory studies reveal anemia, elevated LDH, and peripheral blood smear with atypical lymphocytes. Lymph node biopsy demonstrates Reed-Sternberg cells.
Which of the following is the most likely diagnosis?
Which of the following is the most likely diagnosis?
Correct Answer:
D. Hodgkin lymphoma
Correct Answer Explanation:
The presence of Reed-Sternberg cells, systemic “B” symptoms, and contiguous nodal spread strongly support Hodgkin lymphoma. Follicular and diffuse large B-cell lymphomas usually lack Reed-Sternberg cells. Multiple myeloma presents with bone pain, hypercalcemia, and renal dysfunction.
Further Insight:
- Hodgkin lymphoma often shows bimodal age distribution (young adults, older adults).
- Associated with EBV infection in some cases.