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HEME/ONC Shapcott > Lymphadenopathy > Flashcards

Lymphadenopathy Flashcards

1
Q

Most common etiology of inguinal LAD

A

Lower extremity infxn
STD
Cancer

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2
Q

LAD in this region is almost always pathologic

A

Epitrochlear LAD

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3
Q

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

A

Abnormal CXR
LAD > 2cm
ENT Sx

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4
Q

LAD and animals

A

Cats? Other pets to cause infxn?

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5
Q

LAD and diet

A

Undercooked meat?… Toxoplasmosis

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6
Q

Insects and LAD

A

Ticks?… Lyme dz

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7
Q

Constitutional Sx & LAD

Fever, night sweats, weight loss

A

TB
Lymphoma
Other malignancy

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8
Q

Rx that cause LAD

A 
Allopurinol 
Atenolol
Carbamazepine
Cephalosporins
Hydralazine
PCN
Sulfonamides
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9
Q

Peripheral LAD appreciated. Why do abd exam?

A

Splenomegaly: lymphoma; CLL, acute leukemia, infectious mononucleosis

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10
Q

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

A

Tularemia
Plague
Aggressive lymphomas

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11
Q

LAD size

A

> 1 cm

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12
Q

Clinical significance of Shotty LAD

A

No clinical significance

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13
Q

Firm LAD

A

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

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14
Q

Firm, rubbery nodes

A

Lymphomas

Chronic leukemia

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15
Q

LAD in acute leukemia

A

Softer LAD

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16
Q

Why do nodes become fixed

A

Cancer invasion or inflammation of tissue surrounding nodes

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17
Q

Painful LAD

A
  • Rapid growth from infxn or inflammation stretches capsule
  • hemorrhage into node
  • immunologic stimulation
  • malignancy
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18
Q

Generalized LAD of uncertain etiology w/u

A
  • cbc
  • CXR
  • if normal, consider PPD, HIV, RPR, ANA, heterophile test
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19
Q

Indication for Bx in LAD

A
  • 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

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20
Q

Unexplained LAD and empiric ABX

A

Empiric ABX not useful

21
Q

Common causes of cervical LAD

A

EBV/mono
CMV
Toxoplasmosis

22
Q

Posterior cervical LAD

A 
EBV
TB
Lymphoma
Kikuchi's dz
Head/neck malignancy (lymphomas or metastatic squamous cell carcinoma)
23
Q

Fluctuant cervical LAD

A

Staph/strep

24
Q

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

A

Infxn with mycobacterium tuberculosis or atypical mycobacterium

25
Q

Tuberculous LAD: Local or general?

A

Localized… Usu of head & neck

*exception is miliary TB–generalized LAD

26
Q

Multiple enlarged cervical lymph nodes, has pets

A

Cat scratch dz (bartonella henselae

27
Q

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

A

ENT surgeon for fiber optic exam, possible triple endoscopy

28
Q

R supraclavicular LAD

A

Cancer: mediastinum, lungs, esophagus

29
Q

Left supraclavicular LAD (Virchow’s node)

A

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

30
Q

Axillary LAD. Pt has breast implants

A

Silicone breast implants can cause LAD in axillary or supraclavicular regions

31
Q

Palpable epitrochlear node size

A

THESE ARE NOT NORMALLY PALPABLE. PALPABLE EPITROCHLEAR NODES ARE ALWAYS PATHOLOGIC, IRRESPECTIVE OF SIZE

DDx: local infxn; lymphoma; sarcoidosis; tularemia; secondary syphilis

32
Q

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

A

Acute HIV

33
Q

TB LAD in neck alone

A

Scrofula

34
Q

Important consideration in generalized LAD that is often mistaken for malignancy

A

Miliary TB

35
Q

Posterior cervical node location

A

Posterior to SCM, but anterior to trapezius

36
Q

Anterior cervical node location

A

Superficial or deep to SCM

37
Q

TRIAD:

  1. Moderate-high fever
  2. LAD
  3. Pharyngitis
A

Infectious mononucleosis

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

38
Q

Infectious causes of heterophile negative mononucleosis-like syndromes

A 
CMV
HHV 6
HIV
Adenovirus
HSV
Strep pyogenes
Toxoplasma gondii
39
Q

What percent of pt with SLE dvlp LAD

A

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

40
Q

Massive LAD, fevers, HSM, polyclonal hypergammaglobulinemia

A

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

41
Q

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

A

Kikuchi Dz (rare, benign condition of unknown cause)

42
Q

Most frequent cause of childhood vasculitis, associated with cervical LAD

A

Kawasaki

43
Q

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

A

Angioimmunoblastic T cell lymphoma (aka angioimmunoblastic lymphadenopathy)

80% follows aggressive course

44
Q

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

A

Inflammatory pseudo tumor

45
Q

Amyloidosis & LAD

A

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

46
Q

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

A

Kimura Dz

47
Q

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

A

Progressive Transformation of Germinal Center (PTGC)
Uncommon

May eventually dvlp Hodgkin lymphoma

48
Q

Rosai-Dorfman dz

A

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

HEME/ONC Shapcott (1 decks)

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