B. Lymphoma – Explanation
The two main contenders for an answer to this question are tuberculosis
and lymphoma.
Tuberculosis is improbable because New York City (USA) is not a tuberculosis prone
area. The main TB prone areas that you have to take note of for the PLAB exam is a
patient travelling to or from South Asia or sub-Saharan Africa.
While it is true that the signs and symptoms of tuberculosis and lymphoma are very
similar, the following table makes is easy to differentiate between tuberculosis and
lymphoma if you are having difficulty choosing either as an answer:
| Tuberculosis | Lymphoma |
| Fatigue, malaise, fever, weight loss, anorexia |
Drenching night sweats, fever, weight loss |
| Hilar, paratracheal or superficial node involvement. Palpable nodes may be initially tender, firm and discrete |
Enlarged but otherwise asymptomatic lymph node, typically in the lower neck or supraclavicular region |
| Chronic, productive cough with purulent +/- bloodstained sputum |
Patients might complain of chest discomfort with a cough or dyspnoea |
| May result in lobar collapse, bronchiectasis, pleural effusion and pneumonia |
Mediastinal masses are frequent and are sometimes discovered on a routine CXR |
| Erythema nodosum | Findings on examination include lymphadenopathy, hepatomegaly, splenomegaly, and superior vena cava syndrome |
