Minicase - Night Sweats, Neck Mass, and N/V

Question 1

Night sweats ddx (2)

Answer 1

Main: TB, hyperthyroidism
Other: lymphoma, leukemia, acute HIV infection, (pheo, carcinoid syndrome)

Question 2

W/u for night sweats (6)

Answer 2

1. PPD/quantiferon-TB gold
2. CBC
3. CXR
4. sputum gram stain, acid fast stain and culture
5. HIV antibody/RNA levels
6. TSH, free T4

Question 3

Hx of TB (3)

Answer 3

1. night sweats
2. cough
3. immigrant, incarcerated, homeless

Question 4

Questions for night sweats (5)

Answer 4

OPQRST

1. precipitants (food, meds)
2. constitutional symptoms
3. menstrual history
4. TB risk factors
5. assoc symptoms (diarrhea)

Question 5

Exam for night sweats (6)

Answer 5

1. HEENT (LAD, thyroid)
2. heart
3. lung
4. abdomen (HSM)
5. skin
6. MSK for jt pain

Question 6

Ddx for neck mass (5)

Answer 6

1. Hodgkin/non-Hodgkin lymphoma
2. TB
3. HIV
4. Thyroid nodule
5. Metastatic GI or head and neck malignancy

Question 7

Hx for Hodgkin/non-Hodgkin lymphoma (6)

Answer 7

1. unilateral, single 2cm neck mass
2. night sweats, fever, wt loss
3. loss of appetite, early satiety
4. painless and movable mass
5. no change in size
6. no symptoms of hyperthyroidism

Question 8

Hx for pregnancy (6)

Answer 8

1. N/V
2. worse in morning
3. fatigue
4. polyuria
5. missed menstrual cycle
6. sexually active (even with condom use)

(Ddx here includes DM, hypercalcemia, UTI)

Question 9

What are the symptoms of hypercalcemia?

Answer 9

“painful bones, renal stones, abdominal groans, and psychic moans,”

• increase thirst and urination, abd pan constipation, nausea, bone pain mc weakness, fatigue

Question 10

W/u for N/V (6)

Answer 10

1. Urine hCG
2. Pelvic exam
3. Transvaginal US
4. CBC
5. electrolytes, calcium, glucose (hypercalcemia, DM)
6. UA, Ux (UTI)

Question 11

W/u for neck mass (11)

Answer 11

1. CBC w/ diff
2. BMP
3. ESR, CRP
4. Lymph node biopsy
5. PDD/Quantiferon-TB GOLD
6. CXR
7. TSH
8. HIV antibody/RNA
9. US neck
10. upper endoscopy
11. FNA