Lymphadenopathy

Question 1

normal lymph nodes in children

Answer 1

become palpable and visbile during infection

as acute repsonse subsides nodes decrease in size although may not completeely disappear

majority of children ahve palpable lymph nodes (<1cm) in neck and groin and are normal, reflecting past infections

Question 2

lymphadenopahty definitino in children

Answer 2

described as localsied or generalised ± systemic ysmpotms

lymph nodes >1cm

v common finding in children

multitude of causes-
-systematic apporach w careful history and exam

Question 3

hisotry in lymphadenopathy 4

Answer 3

timing of appeaence

rate of progression

site- localsied /generalised

assoc syx- cough, coryzal syx, sore throat, trauma

Question 4

syx of lymphadenopathy that suggest possible oncological diagnosis 5

Answer 4

fever

night sweats

anorexia/weight loss

pruritis

malaise/lethargy

Question 5

what should be considered in examiantion of lymphadenopathy

Answer 5

site

size and no

tenderness
overlyign skin changes

fluctuance

Question 6

what should be considered in systemic examination of lymphadenopathy 8

Answer 6

sepsis in region drained by lymph node

bruising/petechiae

anaemia

HSM

palpable masses

evidence of BCG immunisation

other lymph node groups
-cervical
-occipital
-suprclavicular
-axillary
-epitrhochlear
=inguinal

Question 7

features that suggest malignancy in lymphadenopathy 5

Answer 7

site

assoc systemic syyx

HSM

other palpable masses

signs of bone marrow infiltration (anaemia, brusuing, peteechiae)

Question 8

which sites of lymphadenopathy are of particular concern for malignancy 2

Answer 8

supraclavicular

epitrochlear

Question 9

malignant causes of lymphadenopathy 5

Answer 9

1. Acute leukaemia (ALL, AML)
2. Lymphoma
3. Hodgkin’s disease
4. Neuroblastoma
5. Rhabdomyosarcoma

Question 10

infectious causes of lymphadenopathy 5

Answer 10

1. Bacterial lymphadenitis e.g staph, strep
2. Viral infection (viral URTI’s, EBV, CMV, Adeno, VZV, HIV, roseola, rubella)
3. Cat scratch disease (Bartonella henselae)
4. TB
5. Atypical mycobacterium

Question 11

autoimmune causes of lymphadenopathy 5

Answer 11

1. Kawasaki’s disease
2. Juvenile Idiopathic Arthritis
3. SLE
4. Sarcoidosis
5. Drug reactions

Question 12

investigations for lymphadenopathy 5

Answer 12

1. Bloods: FBC and film, ESR, CRP, B/Cult
2. Virology: Throat swab, serology
3. Mantoux test
4. Radiology: CXR, USS, CT,
5. Surgical: lymph node biopsy