LAD for adultz

Question 1

What could anterior cervical LAD mean?

Answer 1

Infection - EBV, CMV, toxoplasma

Malignancy - lymphoma, CLL, head/neck cancer

Question 2

What could posterior cervical LAD mean?

Answer 2

Infection - EBV or TB

Malignancy - lymphoma, CLL, head/neck cancer

Question 3

Supraclavicular LAD

Answer 3

big chance of malignancy!! esp if over 40!
Right side - mediastinum, lung, esophagus
left side - abdominal malignancy (Virchow’s node)

Question 4

Axillary LAD

Answer 4

infection - cat scratch disease
Malignancy - cancer of skin or breast
Inflammation - silicone breast implants

Question 5

Epitrochlear LAD

Answer 5

palpable nodes here is always pathological!
Infection - forearm, hand, tularemia, streptococcal infection, cat-scratch dz, 2* syphillis
Inflammation - sarcoid
Malignancy - lymphoma

Question 6

Inguinal LAD

Answer 6

infection - LE or STD

Malignancy - lymphoma, melanoma, non-melanoma, skin cancer, GU, anus/rectum

Question 7

What is a nodule in the umbilicus called? What can it mean?

Answer 7

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

Question 8

What could generalized LAD be a sign of ?

Answer 8

HIV, mycobacterial, viral, inflammatory (SLE)

Question 9

To look like a rockstar at rounds, what should be in DDx for cervical adenopathy?

Answer 9

Infection, lymphoma, and unusual disorders like TB

Question 10

What are some things to look out for in LAD hx?

Answer 10

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

Question 11

Splenomegaly on PE w LAD suggests…

Answer 11

Lymphoma, CLL, acute leukemia, or mononucleosis

Question 12

What does the term shotty suggest?

Answer 12

multiple, small nodes w no particular diagnostic significance

Question 13

Hard nodes v frim, rubbery nodes

Answer 13

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

Question 14

Abnormal LNs are fixed or movable?

Answer 14

fixed

Question 15

What does tender LAD signify?

Answer 15

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

Question 16

Richter’s syndrome

Answer 16

Patients w CLL develop a DLBCL

Question 17

Which symptoms are associated with a worse prognosis?

Answer 17

Fever, drenching night sweats, 10% weight loss in previous 6 months

Question 18

Which patients have increased risk for primary CNS lymphoma?

Answer 18

immunosuppressed (HIV, organ transplant)

Question 19

Normal lab testing (CBC and CXR) for generalized LAD should make you consider

Answer 19

PPD, HIV, RPR, ANA, serologies for EBV and CMV

Question 20

Benign causes of splenomegaly

Answer 20

congestive, inflammation, infection, infiltration, hyperspelnism

Question 21

Malignant causes of splenomegaly

Answer 21

lymphoma, leukemia, myeloproliferative neoplasms, primary splenic tumors, metastatic solid tumors

Question 22

Common complaints of splenomegaly

Answer 22

Heaviness or pain in LUQ, early satiety, fullness or mass in LUQ

Question 23

Myelofibrosis

Answer 23

Primary myeloproliferative disorder characterized by marrow fibrosis and extramedullary hematopoiesis

Question 24

Myelofibrosis triad

Answer 24

Leukoerythroblastic anemia
Poikilocytosis
Splenomegaly

Question 25

What are non-neoplastic causes of supraclavicular adenopathy?

Answer 25

TB, sarcoidosis, and toxoplasmosis

Question 26

DDx of mediastinal and hilar adenopathy

Answer 26

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

Question 27

Which imaging techniques are good for malignant LAD?

Answer 27

CT and MRI are good for diagnosing metastases to cervical LN

Question 28

When is a prompt biopsy indicated of a LN?

Answer 28

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

Question 29

When should fine needle aspiration be performed?

Answer 29

only for thyroid nodules and for confirmation of relapse in pt who has a known primary diagnosis

Question 30

When is the only instance CS should be used with LAD patients?

Answer 30

life threatening pharyngeal obstruction by enlarged lymphoid tissue in Waldeyer’s ring (seen in mono sometimes)

Question 31

How do children in sickle cell crisis normally present?

Answer 31

Vascular occlusion w infarction and pain

Question 32

what is the best way to visualize a spleen?

Answer 32

Ultrasound!

Question 33

What characteristic of Hodgkin’s disease is not easily detectable in visualizing techniques used?

Answer 33

Patchy infiltrate

Question 34

DDx of splenomegaly

Answer 34

Hyperplasia or hypertrophy - related to spleen function or thalassemia syn.
Immune hyperplasia to systemic infection
Passive congestion - from portal HTN
Infiltrative dz

Question 35

DDx of massively (>1000 g) splenomegaly

Answer 35

NHL, CLL, hairy cell leukemia, CML, myelofibrosis w myeloid metaplasia, or PV

Question 36

What might indicate hypersplenism?

Answer 36

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)