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medical school midcomp 5 > Approach To Lymphendemopathy > Flashcards

Approach To Lymphendemopathy Flashcards

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USMLE® Step 1 flashcards
1
Q

What is a lymph node

A

Aggregate of lymph tissue that collects antigens via lymph in order to develop an immune response

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2
Q

What is lymphadenopathy

A

Defined as enlarged or abnormal qualities . Degree of enlargement depends on location

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3
Q

How does patients age and duration effect diagnosis of lymphadenopathy

A
  1. 50% of children have lymph nodes are palpatable
  2. lymphadenopathy less than 2 weeks of more than a year with no change is most likely benign..exception is low grade higher Hodgkin lymphoma or indolent non Hodgkin syndrome ( will have associated symptoms of fatigue and malaise, and fever)
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4
Q

Lymphadenopathy causes

A 
Alcohol
Radiation
Travel
Animal: cats rabbits sheep
Tobacco
Medications-serum sickness like reaction (I.e.allopurinol, atenolol,captopril)
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5
Q

Diagnosing lymphadenopathy via associated sx

A
  1. Auto immune- arthralgias, muscle weakness, rash
  2. Infectious- fever, chills, fatigue, weight loss
  3. Lymphoma- weight loss>10% , fever with drenching sweats

Location ; generalized will have systemic conditions
Localized will have drainage pattern

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6
Q

Head and neck supply/ drain of lymph nodes

A
  1. Preauricular- scalp/skin
  2. posterior-cervical scalp,neck,upper thoacic(skin)
  3. supraclavicular-GI/GU tract, pulmonary
  4. submandibular- oral cavity
  5. Anterior cervical- larynx , tongue, oropharynx, anterior neck
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7
Q

Palpating technique head / neck

A

Can be behind or front

Palpate bilaterally

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8
Q

Infection vs malignancies head/neck

A
  1. viral- self-limiting : mononucleosis
  2. Bacterial- inflames, progress more quickly: staphylococcal/streptococcal
  3. Supraclavicular node associated with GI malignancy; virchows node
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9
Q

Axilla lymph supply and drain

A
  1. Axillar- breast, upper extremity, thoracic wall
  2. Epitrochlear- ulnar forearm, hand
  3. Infraclavicular- concern for non Hodgkin lymphoma
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10
Q

Palpating axilla

A
  1. Axillary node: palpate anterior and posterior folds, bilateral exam, note skin change, warmth, tenderness
  2. Epitrochlear- palpate medial surface of humerus 3 cm above elbow, bilateral..noting erythema and texture change
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11
Q

Axilla infection vs malignancies

A
  1. Infection: cat scratch disease, tularemia,sporotrichosis
  2. Malignancies : lymphoma : epitrochlear node>5mm. Mestasis of lung, thyroid, stomach

Could also be leaking breast implant

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12
Q

Inguinal supply/drain and palpitation technique

A
  1. All nodes - lower abdomen, external genitalia, lower extremity, anus, lower vagina

Palpitation: wear gloves, palpate anterior thigh below inguinal ligament, bilateral

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13
Q

Infection and malignancy inguinal

A
  1. Infection- STD, skin infection
  2. Malignancies- squamous cell carcinoma of penis, vulva, anus
  3. Benign - inguinal lymphadenopathy up to 2 cm present in healthy adults
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14
Q

Mononucleosis description

A
  1. Bilateral tender anterior cervical lymphadenopathy
  2. Fever
  3. and pharyngitis
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15
Q

Toxoplasmosis description

A
  1. Bilateral non tender cervical lymphadenopathy
  2. Fever chills sweats
  3. Sometimes have rash

20-30% develop generalized lymphadenopathy

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16
Q

Cat scratch disease

A
  1. Tender , erythematous, enlarged regional lymphadenopathy

Typically solitary

17
Q

Sporotrichosis

A
  1. Modular ulcerative lesions along lymphatic tract from original inoculation
  2. tender erythematous enlarge regionsl lymphendonapathy

Mild pain

18
Q

Streptococcal pharyngitis

A

Enlarged tender anterior cervical lymphadenopathy

Pharyngitis

Fever

Tonsillar enlargement with or without exudate

19
Q

When should lymphadenopathy be concerning

A
  1. Risk factors for malignancy
  2. Must consider lymphatic are most common initial dissemination for carcinomas
  3. Hard matted lymph nodes
  4. Supraclavicular , epitrochlear > 5 mm
20
Q

Approaches to unexplained lymphadenopathy

A
  1. Unexplained localized LAD: if low risk can observe up to 4 weeks ( reactive lymph node)
  2. Unexplained generalized LAD:proceed with further testing
  3. Unexplained generalized LAD- if testing is negative then biopsy
21
Q

Imaging lymph nodes

A
  1. Children under 14- ultrasonography
  2. Over 14- computed tomography

Avoid corticosteroids until cause identified, continue to follow for changes

22
Q

Surgical technique

A
  1. Biopsy- largest,most suspicious most accessible
  2. fine needle aspiration- quick and accurate, false negative concern with lymphoma, minimally invasive
  3. Core needle
  4. Open excisional

medical school midcomp 5 (11 decks)

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