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 Best of Five 243

 

   

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BOF: 243

 A 28-year-old Chinese architect presents with painless lumps in the neck. This has been present for the last 7 weeks. He also says he has lost about 8 kgs in weight over the last six months and he has had fever with night sweats. He smokes 20 cigarettes a day and consumes 24 units of alcohol a week. No relevant past illnesses or family history.

On examination there are several enlarged lymph nodes in the right supraclavicular fossa.

No other abnormal clinical findings.

Investigations are as follows:

Hb 10.9 g/dL

MCV 80 fl

WBC 15.0 x 109/L

Neutrophils 56%

Lymphocytes 35 %

Eosinophils 9%

ESR 54 mm in 1st hour

Biochemistry normal

In this patient which of the following tests would you arrange in order to make a diagnosis?

a)      Mantoux test

b)      Chest x-ray

c)     Toxoplasma serology

d)      Lymph node biopsy

e)      Serum angiotensin converting enzyme levels

 

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