Lymph Nodes

Question 1

Lymph Nodes

Answer 1

Swollen Lymph Nodes - sign of infection, malignancy
It is important to note where the chain drains

If right tonsillar inflamed lymph node, where do you look? –> Head (HEENT)

Question 2

Risk factors for Lymphoma (Hodgkins)

Answer 2

Age: 15-30, 55+
Family Hx
Male gender
Hx of Epstein Barr Virus (EBV)
Immunoccompromised

Question 3

Risk factors for Lymphoma (Non-Hodgkins)

Answer 3

Age: 60+
Exposure to pesticides and herbicides (migrant workers)
HIV, EBV, h pylori
Immunosuppressive Medications (steroids. COPD, asthma, transplants, autoimmune)

Question 4

Infection vs. Malignancy?

Answer 4

Associated symptoms
Generally, infection of shorter duration

Vietnam Vets - a lot have been exposed to chemicals overseas.

Infection - find an infected area upstream of lymph node chain

Malignancy - 2 or more chains, weight loss

Question 5

General Respiratory Exam

Answer 5

General: fever, weight loss, night sweats, visible trauma, fatigue (rapid weight loss - more malignancy)
GI: splenomegaly (Mono, cancer)

Question 6

Lymph: Localized vs. Generalized

Answer 6

Localized: within 2 regions or less

Question 7

Lymph Warning Signs

Answer 7

Size: 1cm+
"shotty"
Hard, soft firm, rubbery
Matted
Tender - less worried (cancer is usually NOT tender)

Question 8

Virchow’s Node / Sentinel Node

Answer 8

Located on neck, supraclavicular

Sign of GI cancer

Question 9

Generalized vs. Localized: Differentials

Answer 9

Generalized: HIV (early sign of infection), Mononucleosis (posterior cervical), SLE, Mycobacterium Infection (TB), Medications (anti-seizure medications). If 2+ regions, suspect systemic illness (HIV, lymphoma, mono)

Localized.
Axillary - arm, thoracic wall, and breast infections

Epitrochlear - pathologic, infection of the forearm or hand (examples: lymphoma, sarcoidosis, tularemia, and secondary syphilis)

Inguinal - lower extremity infection, STD, cancer

• *Supraclavicular - often malignancy
• *Hard, fixed = concerning

Question 10

What should you do if someone presents with enlarged lymph nodes?

Answer 10

Start him/her on antibiotic, and recheck (in a couple weeks)

If haven’t changed: CBC, CXR (PPD, HIV, RPR, ANA)

Biopsy: 4 weeks no resolution, systematic complaints, suspicion for malignancy

Question 11

“Someone comes in with left inguinal lymph nodes”

Answer 11

Ask about GU symptoms: urinalysis

Look at skin all the way down to the feet!! Inguinal nodes drain down to everything below I️t