USMLE STEP 3 FINAL PAPER
REVIEW VERIFIED QUESTIONS
AND ANSWERS
◉Hodgkin Lymphoma. Answer: Presentation: "B" Symptoms
- low-grade fever
- night sweats
- weight loss
- pruritus
- hepatosplenomegaly
- Pel-Ebstein fevers (alternating 1-2 weeks of fevers, 1-2 weeks
afebrile)
- alcohol-induced pain at nodal sites
Key Facts:
Localized, single group of nodes typically above the diaphragm
(cervical adenopathy)
Stage (Ann Arbor Staging System) = strongest predictor of prognosis
(better prognosis than NHL). Based on:
1. number of nodes
,2. presence of B symptoms
3. involvement of sites on both sides of the diaphragm
Bimodal distribution impacting young (nodular sclerosing) and old
(lymphocyte-depleted)
Male predominance in childhood
Associated with EBV
Diagnosis:
1. initial step- excisional lymph node biopsy showing Reed-
Sternberg cells
Reed-Sternberg cells- giant cells that are binucleated or bilobed
(OWL EYES), CD15+ and CD30+ B cells
Inflammatory cell infiltrates can distinguish HL from NHL.
Inflammatory cells are reactive to RS cells
◉Reed-Sternberg cells are characteristic of which disease?. Answer:
Hodgkin lymphoma
,Giant cells that are binucleated or bilobed (Owl Eyes)
CD15+ and CD30+
◉What are the four types of Hodgkin Lymphoma?. Answer: Nodular
Sclerosis- Most Common (typically in younger patients)
Lymphocyte Rich- best prognosis
Mixed Cellularity- characterized by eosinophilia, seen in
immunocompromised patients
Lymphocyte depleted- immunocompromised patients (typically
older)
◉Mixed cellularity and Lymphocyte depleted HL are both seen in
immunocompromised patients, what is a distinguishing feature?.
Answer: Mixed cellularity is characterized by eosinophilia
◉Which type of HL has the best prognosis?. Answer: Lymphocyte
rich
◉Which type of HL is the most common?. Answer: Nodular Sclerosis
, ◉Which types of lymphoma are associated with EBV. Answer: HL
and Burkitts
◉Which type of lymphoma is characterized by contiguous spread?.
Answer: HL
◉Which type of lymphoma is characterized by noncontiguous
spread. Answer: NHL
◉Tumor Lysis Syndrome- Treatment. Answer: 1. IV fluids
2. rasburicase (urate oxidase analog)
3. continuous telemetry
4. aggressive electrolyte monitoring and treatment
◉Tumor Lysis Syndrome-prophylaxis. Answer: 1. IV fluids
2. Xanthine oxidase inhibitor (allopurinol or febuxostat)
◉Rasburicase. Answer: Urate oxidase analogue
metabolizes uric acid to allantoin which is highly soluble and easily
excreted in the urine
REVIEW VERIFIED QUESTIONS
AND ANSWERS
◉Hodgkin Lymphoma. Answer: Presentation: "B" Symptoms
- low-grade fever
- night sweats
- weight loss
- pruritus
- hepatosplenomegaly
- Pel-Ebstein fevers (alternating 1-2 weeks of fevers, 1-2 weeks
afebrile)
- alcohol-induced pain at nodal sites
Key Facts:
Localized, single group of nodes typically above the diaphragm
(cervical adenopathy)
Stage (Ann Arbor Staging System) = strongest predictor of prognosis
(better prognosis than NHL). Based on:
1. number of nodes
,2. presence of B symptoms
3. involvement of sites on both sides of the diaphragm
Bimodal distribution impacting young (nodular sclerosing) and old
(lymphocyte-depleted)
Male predominance in childhood
Associated with EBV
Diagnosis:
1. initial step- excisional lymph node biopsy showing Reed-
Sternberg cells
Reed-Sternberg cells- giant cells that are binucleated or bilobed
(OWL EYES), CD15+ and CD30+ B cells
Inflammatory cell infiltrates can distinguish HL from NHL.
Inflammatory cells are reactive to RS cells
◉Reed-Sternberg cells are characteristic of which disease?. Answer:
Hodgkin lymphoma
,Giant cells that are binucleated or bilobed (Owl Eyes)
CD15+ and CD30+
◉What are the four types of Hodgkin Lymphoma?. Answer: Nodular
Sclerosis- Most Common (typically in younger patients)
Lymphocyte Rich- best prognosis
Mixed Cellularity- characterized by eosinophilia, seen in
immunocompromised patients
Lymphocyte depleted- immunocompromised patients (typically
older)
◉Mixed cellularity and Lymphocyte depleted HL are both seen in
immunocompromised patients, what is a distinguishing feature?.
Answer: Mixed cellularity is characterized by eosinophilia
◉Which type of HL has the best prognosis?. Answer: Lymphocyte
rich
◉Which type of HL is the most common?. Answer: Nodular Sclerosis
, ◉Which types of lymphoma are associated with EBV. Answer: HL
and Burkitts
◉Which type of lymphoma is characterized by contiguous spread?.
Answer: HL
◉Which type of lymphoma is characterized by noncontiguous
spread. Answer: NHL
◉Tumor Lysis Syndrome- Treatment. Answer: 1. IV fluids
2. rasburicase (urate oxidase analog)
3. continuous telemetry
4. aggressive electrolyte monitoring and treatment
◉Tumor Lysis Syndrome-prophylaxis. Answer: 1. IV fluids
2. Xanthine oxidase inhibitor (allopurinol or febuxostat)
◉Rasburicase. Answer: Urate oxidase analogue
metabolizes uric acid to allantoin which is highly soluble and easily
excreted in the urine
