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Lymphoma — MCCQE Part 1 MCQ

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ModerateLymphadenopathyLymphomaMCCQE Part 1

26-year-old man presents with painless neck swelling. He has drenching night sweats, weight loss and rubbery supraclavicular nodes. Which of the following is the most appropriate next step?

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Correct answer: B — Arrange urgent excisional-node biopsy or specialist referral

Arrange urgent excisional-node biopsy or specialist referral is best because B symptoms and supraclavicular lymphadenopathy suggest lymphoma. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Excisional biopsy often preserves architecture better than FNA for lymphoma.

Reference: Canadian lymphoma diagnostic guidance