An early sign of Hodgkin's disease is?

Appeared in: KPSC Staff Nurse - 2016

Explanation

The most common initial presentation of Hodgkin's lymphoma is a painless, enlarged lymph node.
This lymphadenopathy is most frequently found in the cervical (neck) and supraclavicular (above the collarbone) regions, occurring in about 80% of cases.
On physical examination, the affected nodes are typically described as firm and rubbery in consistency, and are not tender to palpation.

Option A: Difficulty in breathing (dyspnea) is generally a symptom of advanced disease, not an early sign. It occurs when large lymph node masses in the mediastinum (chest) compress the trachea or bronchi.
Option C: Difficulty in swallowing (dysphagia) is also a later symptom caused by compression of the esophagus from an enlarged mediastinal lymph node mass.
Option D: A feeling of fullness over the liver suggests hepatomegaly (enlarged liver) or splenomegaly. These are signs of disseminated, systemic disease (Stage III or IV) and are not characteristic of early-stage Hodgkin's lymphoma.

Clinical Relevance

Nursing practice connection: Knowing Early clinical manifestations of Hodgkin's lymphoma helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a key role in identifying potential signs of lymphoma during physical assessment by carefully palpating lymph nodes for size, consistency (firm, rubbery), mobility, and tenderness.
It is crucial to screen for and document the presence or absence of "B symptoms" (unexplained fever, drenching night sweats, significant weight loss) at each patient encounter, as they have important prognostic implications.
Patient education is vital. Nurses should advise patients to seek medical evaluation for any persistent, painless, swollen lymph node.

How to Approach the Question

First, identify the keywords in the question: "early sign" and "Hodgkin's disease."
This is a factual recall question that tests your knowledge of the classic presentation of a specific cancer.
Recall that Hodgkin's lymphoma is a cancer of the lymphatic system. Therefore, the most direct and earliest sign is likely to involve the lymph nodes themselves.
Evaluate the options by differentiating between early (localized) and late (systemic or compressive) symptoms.
Options like difficulty breathing, difficulty swallowing, and liver fullness all suggest a large tumor burden or spread of the disease, which are characteristic of later stages.
Conclude that a swollen lymph node is the most logical and well-known early sign.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 629-631

E6 Medicine Harrison 22e Part 1 pp. 910-912, 518-520

Practise the full KPSC Staff Nurse - 2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.