Adenopathy

Question 1

what to do when a patient comes to u?

Answer 1

• Approaching the Patient
• Interviewing the Patient
• Inspection: pallor, jaundice, bleeding
• Examining the Patient: lymph nodes, spleen
• Keeping Patient Records

Question 2

What is an adenopathy?

Answer 2

• enlargement of a lymph node more than 1 cm

Question 3

cite the area of lymph node and its drainage?

Answer 3

• Cervical Region: ENT, thyroid
• Axillary Region: breast and upper limb
• Inguinal Region: the genitals and lower limb.
• Right Supraclavicular Region: anterosuperior mediastinum< thymus gland, the trachea and esophagus.
• Left Supraclavicular Region (Third): abdomen( left upper quadrant)
• The crural region: perineum

Question 4

cite the lymph nodes of cervical region?

Answer 4

• submental
• submandibular
• external jugular
• Anterior deep and superficial cervical
• Posterior supeficial cervical
• Posterior cervical spinal nerve chain
• Supraclavicular
• Posterior auricular
• Preauricular
• Parotid

Question 5

What are the differential diagnosis of adenopathy in the cervical region ?

Answer 5

▪ Lipoma: benign fatty tumor
▪ Parotid hypertrophy
▪ Thyroid swelling
▪ Carotid aneurysm: Thrill, murmur
✓Cervical ultrasound to guide diagnosis

Question 6

What are the differential diagnosis of adenopathy in the axillary region ?

Answer 6

▪ Hidrosadenitis: ski condition?
▪ Lipoma
▪ Aneurysm

Question 7

What are the differential diagnosis of adenopathy in the ingual region ?

Answer 7

▪ Lipoma
▪ Hernia
▪ Psoas sheath abscess
Systematic auscultation, ultrasound in case of doubt

Question 8

Isolated vs Polyadenopathy

Answer 8

Side and the site

Question 9

What are the steps to take when evaluating isolated adenopathy?

Answer 9

• Explore the original site: Clinical, radiological and biological examination (CBC+++)
• lymph node puncture biopsy: Ctological and histological study

Question 10

What are the steps to take when evaluating Polyadenopathy?

Answer 10

• CBC and smear test
• if CBC and smear are non-contributive: HIV serology, toxoplasmosis, TB
• Lymph node biopsy if no orientation

Question 11

what to consider in case of Mononucleosis syndrome?

Answer 11

• With angina: Epstein-Barr Virus (EBV) < MNI test
  -without angina: HIV < proinfection, viral hepatitis toxoplasmosis

Question 12

what to consider in case of Hyperlymphocytosis or atypical lymphoid cells

Answer 12

• chronic lympho-proliferative syndrome (chronic lymphocytic leukemia,
  Waldenstrom): immunophenotyping, myelogram

Question 12

what to consider in case of Blasts?

Answer 12

Acute leukemia (Myelogram)

Question 13

what to consider in case of Cytopenia?

Answer 13

• Bone marrow invasion: myelogram - Osteomedullary biopsy
• TB, ▪ Leishmaniasis, tuberculosis

Question 14

What to consider in case of Neutrophilic and/or eosinophilic polymorphism?

Answer 14

• Hodgkin’s lymphoma: biopsy

Question 15

What is special about deep Adenopathy

Answer 15

• Scan-guided or ultrasound-guided
• Mediastinoscopy if mediastinal ADP
• Laparoscopy or laparotomy if subdiaphragmatic
  adenopathy

Question 16

what to do in case of In the case of persistent adenopathy of unknown
origin?

Answer 16

• not to prescribe corticosteroids
  and to refer the patient for lymph node biopsy.

Question 17

What are the main etiologies of Adenopathy?

Answer 17

• Lymphoid malignancies:
• Acute leukemia
• Chronic lymphocytic leukemia
• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma
• metastases from solid tumors
• Lymph node tuberculosis
• HIV, Infectious mononucleosis,
• Cytomegalovirus
• rubella, toxoplasmosis
• Leishmaniasis
• Systemic disease: sarcoidosis, Lupus