Lymphadenopathy

Question 1

Most common etiology of inguinal LAD

Answer 1

Lower extremity infxn
STD
Cancer

Question 2

LAD in this region is almost always pathologic

Answer 2

Epitrochlear LAD

Question 3

3 factors to determine need for Bx in LAD in young adult (up to 25 y/o)

Answer 3

Abnormal CXR
LAD > 2cm
ENT Sx

Question 4

LAD and animals

Answer 4

Cats? Other pets to cause infxn?

Question 5

LAD and diet

Answer 5

Undercooked meat?… Toxoplasmosis

Question 6

Insects and LAD

Answer 6

Ticks?… Lyme dz

Question 7

Constitutional Sx & LAD

Fever, night sweats, weight loss

Answer 7

TB
Lymphoma
Other malignancy

Question 8

Rx that cause LAD

Answer 8

Allopurinol 
Atenolol
Carbamazepine
Cephalosporins
Hydralazine
PCN
Sulfonamides

Question 9

Peripheral LAD appreciated. Why do abd exam?

Answer 9

Splenomegaly: lymphoma; CLL, acute leukemia, infectious mononucleosis

Question 10

Localized LAD should prompt search for local cause, but what are some systemic dz that may present with localized LAD?

Answer 10

Tularemia
Plague
Aggressive lymphomas

Question 11

LAD size

Answer 11

> 1 cm

Question 12

Clinical significance of Shotty LAD

Answer 12

No clinical significance

Question 13

Firm LAD

Answer 13

Found in cancers that induce fibrosis & when previous inflammation has left fibrosis

Question 14

Firm, rubbery nodes

Answer 14

Lymphomas

Chronic leukemia

Question 15

LAD in acute leukemia

Answer 15

Softer LAD

Question 16

Why do nodes become fixed

Answer 16

Cancer invasion or inflammation of tissue surrounding nodes

Question 17

Painful LAD

Answer 17

• Rapid growth from infxn or inflammation stretches capsule
• hemorrhage into node
• immunologic stimulation
• malignancy

Question 18

Generalized LAD of uncertain etiology w/u

Answer 18

• cbc
• CXR
• if normal, consider PPD, HIV, RPR, ANA, heterophile test

Question 19

Indication for Bx in LAD

Answer 19

• Not resolved after 4 weeks

* even can’t miss Dx like lymphoma, TB, head/neck CA should still be in window of treatment after 4 weeks of observation

Question 20

Unexplained LAD and empiric ABX

Answer 20

Empiric ABX not useful

Question 21

Common causes of cervical LAD

Answer 21

EBV/mono
CMV
Toxoplasmosis

Question 22

Posterior cervical LAD

Answer 22

EBV
TB
Lymphoma
Kikuchi's dz
Head/neck malignancy (lymphomas or metastatic squamous cell carcinoma)

Question 23

Fluctuant cervical LAD

Answer 23

Staph/strep

Question 24

Multiple enlarged cervical nodes develop over weeks-months, then become fluctuate or matted w/o significant inflammation or tenderness

Answer 24

Infxn with mycobacterium tuberculosis or atypical mycobacterium

Question 25

Tuberculous LAD: Local or general?

Answer 25

Localized... Usu of head & neck *exception is miliary TB--generalized LAD

Question 26

Multiple enlarged cervical lymph nodes, has pets

Answer 26

Cat scratch dz (bartonella henselae

Question 27

Older pt or a pt who smokes with hard LAD of neck. Suspect? Who to refer to?

Answer 27

ENT surgeon for fiber optic exam, possible triple endoscopy

Question 28

R supraclavicular LAD

Answer 28

Cancer: mediastinum, lungs, esophagus

Question 29

Left supraclavicular LAD (Virchow's node)

Answer 29

Abdominal cancer: stomach, gallbladder, pancreas, kidneys, testes, ovaries, prostate

Question 30

Axillary LAD. Pt has breast implants

Answer 30

Silicone breast implants can cause LAD in axillary or supraclavicular regions

Question 31

Palpable epitrochlear node size

Answer 31

THESE ARE NOT NORMALLY PALPABLE. PALPABLE EPITROCHLEAR NODES ARE ALWAYS PATHOLOGIC, IRRESPECTIVE OF SIZE DDx: local infxn; lymphoma; sarcoidosis; tularemia; secondary syphilis

Question 32

Generalized LAD, no tender, involves axillary, cervical, occipital nodes

Answer 32

Acute HIV

Question 33

TB LAD in neck alone

Answer 33

Scrofula

Question 34

Important consideration in generalized LAD that is often mistaken for malignancy

Answer 34

Miliary TB

Question 35

Posterior cervical node location

Answer 35

Posterior to SCM, but anterior to trapezius

Question 36

Anterior cervical node location

Answer 36

Superficial or deep to SCM

Question 37

TRIAD: 1. Moderate-high fever 2. LAD 3. Pharyngitis

Answer 37

Infectious mononucleosis **LAD mostly in posterior cervical chain, but can also be in axillary and groin, distinguishing ~ from other causes of pharyngitis

Question 38

Infectious causes of heterophile negative mononucleosis-like syndromes

Answer 38

``` CMV HHV 6 HIV Adenovirus HSV Strep pyogenes Toxoplasma gondii ```

Question 39

What percent of pt with SLE dvlp LAD

Answer 39

50% Typically, LAD is soft, no tender, discrete, vary in size Cervical, axillary, inguinal Usu @ onset of dz or w/exacerbation If tender, suspect infxn in addition to SLE

Question 40

Massive LAD, fevers, HSM, polyclonal hypergammaglobulinemia

Answer 40

Castleman Dz (angiofollicular LN hyperplasia) Localized dz treated by excision Generalized form is fatal w/o chemo

Question 41

Young woman with cervical LAD & Fever. Pathology showing findings suggestive of lymphoma

Answer 41

Kikuchi Dz (rare, benign condition of unknown cause)

Question 42

Most frequent cause of childhood vasculitis, associated with cervical LAD

Answer 42

Kawasaki

Question 43

Generalized LAD, Fever, HSM, hemolytic anemia, polyclonal hypergammaglobulinemia

Answer 43

Angioimmunoblastic T cell lymphoma (aka angioimmunoblastic lymphadenopathy) 80% follows aggressive course

Question 44

LAD of 1+ lymph node groups, systemic Sx. Bx shows fibrosing inflammatory process

Answer 44

Inflammatory pseudo tumor

Question 45

Amyloidosis & LAD

Answer 45

Amyloid is rare cause of LAD in absence of amyloid infiltration of other organs

Question 46

Inflamed SQ tissue of head & neck, LAD in these regions Mild elevation IgE Eosinophilia

Answer 46

Kimura Dz

Question 47

Unexplained, asymptomatic persistent or recurrent LAD in a male. LAD involves head/neck

Answer 47

Progressive Transformation of Germinal Center (PTGC) Uncommon May eventually dvlp Hodgkin lymphoma

Question 48

Rosai-Dorfman dz

Answer 48

Sinus histiocytosis with massive LAD. Dz usu self limited, but complications from compression