American Board of Internal Medicine (ABIM) Certification Practice Exam

In evaluating neck pain, which patient presentation would suggest potential malignancy or infection?

1. Patient with a recent sports injury

2. Patient reporting gradual onset of pain

3. Patient with localized painful swelling

4. Patient exhibiting significant weight loss

The correct answer is: Patient exhibiting significant weight loss

The patient presentation that would suggest potential malignancy or infection is significant weight loss. Unintentional weight loss can be a red flag symptom indicative of serious underlying conditions, such as malignancy or an infectious process. In patients with neck pain, especially when it is accompanied by weight loss, there is a heightened concern for potential malignancy, such as lymphatic or thyroid cancers, or infection, particularly in the context of conditions like cervical osteomyelitis or abscesses. Weight loss occurring without intent or lifestyle changes often warrants further investigation to rule out serious diseases and is considered a classic "alarm" feature in clinical evaluations. Other symptoms, such as night sweats or fever, may accompany this and further raise suspicion for malignancy or infection. In contrast, a recent sports injury typically indicates a trauma-related cause for neck pain, while gradual onset of pain could represent a degenerative process or muscular strain rather than a malignancy or infection. Localized painful swelling can suggest a variety of conditions, including benign ones, and is less specific than significant weight loss in indicating a more severe pathology.