American Board of Internal Medicine (ABIM) Certification Practice Exam

What defines B symptoms in Hodgkin lymphoma patients?

1. Fatigue and weight gain

2. Fever, night sweats, and weight loss

3. Localized pain and swelling

4. None of the above

The correct answer is: Fever, night sweats, and weight loss

B symptoms in Hodgkin lymphoma are a specific group of systemic symptoms that are clinically significant in the diagnosis and staging of the disease. They are defined as fever, night sweats, and weight loss, and their presence is particularly important for determining prognosis and treatment strategies. Fever may be persistent or intermittent, often classified as a temperature greater than 38ºC (100.4ºF). Night sweats generally refer to excessive sweating during the night that soaks clothing or bed linens, which can lead patients to wake up uncomfortable. Weight loss is typically quantified as a loss of more than 10% of body weight over the previous six months without a known cause, further indicating disease activity. The presence of these symptoms suggests a more advanced disease state and influences clinical decision-making. This triad is a hallmark of Hodgkin lymphoma that helps differentiate it from other lymphomas and conditions, where the presence of such symptoms could indicate a more aggressive disease or a greater burden of disease within the body. In contrast, the other options do not accurately reflect the defining characteristics of B symptoms in Hodgkin lymphoma, as fatigue and weight gain, or localized pain and swelling do not align with the established definition of B symptoms.