A 34-Year-Old African American Man Comes to the Office Due

question 525

Multiple Choice

A 34-year-old African American man comes to the office due to 2 months of fatigue and nonproductive cough.  During this time, the patient has also had mild achiness of the joints, a feverish feeling, and night sweats but is most bothered by the constant feeling of tiredness.  He has had no change in appetite or weight.  The patient served in Iraq and Afghanistan as a United States Marine and was discharged after a combat-zone trauma.  He underwent multiple surgeries after the injury and received blood transfusions.  While serving, he was also found to have a positive tuberculosis skin test and received treatment for latent tuberculosis.  He has no other medical problems and takes no medications.  The patient is in a monogamous relationship and does not use tobacco, alcohol, or illicit drugs.
Vital signs are within normal limits.  Physical examination reveals a well-built man in no acute distress.  There is no scleral icterus, lymphadenopathy, mucosal lesions, or skin rash.  The lungs are clear to auscultation and heart sounds are normal.  The abdomen is soft and nontender with no masses or hepatosplenomegaly.  Neurologic examination shows no abnormalities.
Blood cell counts and serum chemistry studies are within normal limits.  Chest imaging reveals right paratracheal and bilateral hilar lymphadenopathy with no parenchymal opacities.
Which of the following is the most appropriate next step in management of this patient?

• A)Empiric glucocorticoid therapy and follow-up
• B)Endobronchial ultrasonography and nodal aspiration
• C)Mediastinoscopy with excisional lymph node biopsy
• D)Peripheral blood flow cytometry
• E)Positron emission tomography

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Definitions:

Gender Gap

The differences in opinions, attitudes, behaviors, or attributes between men and women.

Women of Color

Refers to women who are not of white European descent and are often discussed in contexts concerning social, political, and economic inequalities.

White Women

Women identified or classified as white, referring to a racial or ethnic group primarily characterized by light skin pigmentation.

Earnings

Earnings refer to the income obtained from employment or investment, often measured for individuals, businesses, or investments over a specific period of time.