LAD for adultz Flashcards
What could anterior cervical LAD mean?
Infection - EBV, CMV, toxoplasma
Malignancy - lymphoma, CLL, head/neck cancer
What could posterior cervical LAD mean?
Infection - EBV or TB
Malignancy - lymphoma, CLL, head/neck cancer
Supraclavicular LAD
big chance of malignancy!! esp if over 40!
Right side - mediastinum, lung, esophagus
left side - abdominal malignancy (Virchow’s node)
Axillary LAD
infection - cat scratch disease
Malignancy - cancer of skin or breast
Inflammation - silicone breast implants
Epitrochlear LAD
palpable nodes here is always pathological!
Infection - forearm, hand, tularemia, streptococcal infection, cat-scratch dz, 2* syphillis
Inflammation - sarcoid
Malignancy - lymphoma
Inguinal LAD
infection - LE or STD
Malignancy - lymphoma, melanoma, non-melanoma, skin cancer, GU, anus/rectum
What is a nodule in the umbilicus called? What can it mean?
Sister Mary Joseph nodule
Means there is metastasis from intra abdominal or intrapelvic malignancy
bad prognostic sign ):
most commonly GI cancer but 25% are gyn cancer
What could generalized LAD be a sign of ?
HIV, mycobacterial, viral, inflammatory (SLE)
To look like a rockstar at rounds, what should be in DDx for cervical adenopathy?
Infection, lymphoma, and unusual disorders like TB
What are some things to look out for in LAD hx?
Infection, undercooked meat, tick bite, travel to areas w high rate of endemic infection, high risk behavior
Medications
Excisions of prior skin lesions
Constitutional sx suggesting tb, lymphoma, malignancy
FEVER is typical for infectious
Splenomegaly on PE w LAD suggests…
Lymphoma, CLL, acute leukemia, or mononucleosis
What does the term shotty suggest?
multiple, small nodes w no particular diagnostic significance
Hard nodes v frim, rubbery nodes
Hard nodes are normally from cancers that induce fibrosis or when previous inflammation has left fibrosis
Rubbery is found in lymphomas and chronic leukemia
-acute leukemia usually has softer nodes
Abnormal LNs are fixed or movable?
fixed
What does tender LAD signify?
acute causes, bc its due to recent, rapid enlargement putting pain receptors under tension
normally inflammatory process, but can be from hemorrhage, immunologic stimulation, or malignancy
Richter’s syndrome
Patients w CLL develop a DLBCL
Which symptoms are associated with a worse prognosis?
Fever, drenching night sweats, 10% weight loss in previous 6 months
Which patients have increased risk for primary CNS lymphoma?
immunosuppressed (HIV, organ transplant)
Normal lab testing (CBC and CXR) for generalized LAD should make you consider
PPD, HIV, RPR, ANA, serologies for EBV and CMV
Benign causes of splenomegaly
congestive, inflammation, infection, infiltration, hyperspelnism
Malignant causes of splenomegaly
lymphoma, leukemia, myeloproliferative neoplasms, primary splenic tumors, metastatic solid tumors
Common complaints of splenomegaly
Heaviness or pain in LUQ, early satiety, fullness or mass in LUQ
Myelofibrosis
Primary myeloproliferative disorder characterized by marrow fibrosis and extramedullary hematopoiesis
Myelofibrosis triad
Leukoerythroblastic anemia
Poikilocytosis
Splenomegaly
What are non-neoplastic causes of supraclavicular adenopathy?
TB, sarcoidosis, and toxoplasmosis
DDx of mediastinal and hilar adenopathy
Primary lung disorders Systemic illness (infectious mono and sarcoidosis in young and histoplasmosis in endemic areas) Older pt - primary lung cancer, lymphomas, metastatic carcinoma, TB, fungal infection, sarcoidosis
Which imaging techniques are good for malignant LAD?
CT and MRI are good for diagnosing metastases to cervical LN
When is a prompt biopsy indicated of a LN?
PE suggests malignancy; solitary, hard, non-tender cervical node in older tobacco user, any supraclavicular adenopathy, and any solitary or general adenopathy that is firm, movable, and suggest lymphoma
When should fine needle aspiration be performed?
only for thyroid nodules and for confirmation of relapse in pt who has a known primary diagnosis
When is the only instance CS should be used with LAD patients?
life threatening pharyngeal obstruction by enlarged lymphoid tissue in Waldeyer’s ring (seen in mono sometimes)
How do children in sickle cell crisis normally present?
Vascular occlusion w infarction and pain
what is the best way to visualize a spleen?
Ultrasound!
What characteristic of Hodgkin’s disease is not easily detectable in visualizing techniques used?
Patchy infiltrate
DDx of splenomegaly
Hyperplasia or hypertrophy - related to spleen function or thalassemia syn.
Immune hyperplasia to systemic infection
Passive congestion - from portal HTN
Infiltrative dz
DDx of massively (>1000 g) splenomegaly
NHL, CLL, hairy cell leukemia, CML, myelofibrosis w myeloid metaplasia, or PV
What might indicate hypersplenism?
CBC with cytopenia of one or more blood cell types.
Have normal or hyperplastic BM
Responds to splenectomy (cytopenia might not tho sometimes. bc medicine is fun)
