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heme lymph exam 2 > Lymphadenopathy > Flashcards

Lymphadenopathy Flashcards

1
Q

Lymph nodes. Found generally where? Contain what? Do what?

A

Found throughout the body along the course of the lymphatic vessels
Lymph nodes are populated by macrophages, dendritic cells, B lymphocytes, and T lymphocytes.
Participate in antigen processing, antigen presentation, antigen recognition, and proliferation of effector B and T lymphocytes as part of the normal immune response

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2
Q

Lymph nodes enlargement

A

Proliferation of WBCs inside of lymph nodes leads to lymph node enlargement.
In young children, palpable lymphadenopathy is the rule.
In adults, lymph nodes larger than 1 to 2cm in diameter are generally considered abnormal. (except for groin, where they can be bigger normally)

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3
Q

2 types of lymphadeonopathy

A

Local lymphadenopathy reflects the area those lymph nodes drain
Generalized lymphadenopathy occur with a systemic disorders

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4
Q

Cervical lymphadenopathy

A

Anterior– usually benign
Localized strep or staph infections, rubella, dental
Systemic infections: Epstein-Barr virus (EBV), cytomegalovirus infection, or toxoplasmosis

Posterior – could be benign, but malignancy is more common than with anterior lymph nodes
EBV infection, tuberculosis, lymphoma, or head and neck malignancy

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5
Q

Supraclavicular

lymphadenopathy

A

High risk for malignancy

Right:
Cancer of mediastinum, lungs or esophagus

Left (Virchow’s node):
Abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries, or prostate)
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6
Q

Axillary

lymphadenopathy

A

Drain arm, thoracic wall, and breast.

Infections

  • Cat scratch disease
  • Cellulitis

Cancer

  • Breast
  • Other metastasis

Silicone breast implants
( may cause both supraclavicular and axillary lymphadenopathy)

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7
Q

Epitrochlear

lymphadenopathy

A 
Not normally palpable
Infections of the forearm or hand
Lymphoma 
Sarcoidosis
Tularemia
Secondary syphilis.
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8
Q

Inguinal lymphadenopathy

A

Lower extremity infection
Sexually transmitted diseases

Cancer

  • Skin of the lower extremities and trunk
  • Cervix, vulva, and ovary
  • Rectum and anus
  • Penis
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9
Q

Mediastinal.

lymphadenopathy

A

Infectious
- TB, fungal infection, anthrax

Neoplastic
- Lymphoma, lung cancer, germ cell tumor

Other
- Sarcoidosis

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10
Q

Retroperitoneal.

lymphadenopathy

A

Infectious
- TB

Neoplastic
- Lymphoma, testicular cancer, kidney cancer, upper GI malignancy

Other
-Sarcoidosis

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11
Q

Mesenteric lymphadenopathy

A

Infectious
- Appendicitis, cholecystitis, diverticulitis, Whipple’s disease

Neoplastic
- Lymphoma, GI cancer

Other
- Inflammatory bowel disease, panniculitis

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12
Q

GENERALIZED LYMPHADENOPATHY: HIV

A

Nontender.
Primarily axillary, cervical, and occipital nodes
Usually develops during the second week of acute symptomatic HIV infection.
The nodes then decrease in size but a modest degree of adenopathy persists.

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13
Q

GENERALIZED LYMPHADENOPATHY: mycobacterial infection

A

Can present with lymphadenopathy alone, especially in the neck (scrofula)
M. tuberculosis in adults
Atypical mycobacteria (M. avium complex and M. scrofulaceum) in kids
Nontender
Enlarge over weeks to months without prominent systemic symptoms
Can progress to matting and fluctuation

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14
Q

GENERALIZED LYMPHADENOPATHY Infectious Mono

A

Triad of fever, pharyngitis, and lymphadenopathy.
Symmetric enlargement
Posterior cervical more than anterior cervical
Axillary and inguinal are common too (as opposed to other causes of pharyngitis
Lymphadenopathy peaks in the first week and then gradually subsides over two to three weeks

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15
Q

GENERALIZED LYMPHADENOPATHY: other mono-like diseases

A 
Cytomegalovirus
human herpes virus 6
human immunodeficiency virus
adenovirus, herpes simplex virus
Streptococcus pyogenes
Toxoplasma gondii
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16
Q

GENERALIZED LYMPHADENOPATHY: systemic lupus

A

In approximately 50 percent of patients
Lymph nodes are soft, nontender
Cervical, axillary, and inguinal areas
Usually develops at the onset of disease or in association with an exacerbation.

17
Q

GENERALIZED LYMPHADENOPATHY: medications

A

Some drugs may cause serum sickness
fever, arthralgias, rash, and generalized lymphadenopathy
Phenytoincan cause generalized lymphadenopathy in the absence of a serum sickness reaction

allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, sulindac

18
Q

zebras

A

not getting tested on them

but diagnosed by biopsy only

19
Q

Diagnostic approach: History

A 
Localizing signs or symptoms suggesting infection or malignancy
URI symptoms
Dental pain
Chest pain
Abdominal/pelvic pain

Exposures
Cat [cat scratch disease]
Undercooked meat [toxoplasmosis]
Tick bite [Lyme disease]
Travel (should extend the differential diagnosis to diseases)
High risk behavior (sexual behavior, injection drug use)

20
Q

diagnostic approach: physical exam

A

Location
- Localized vs. generalized adenopathy

Size
- Greater than 1 cm in diameter.

Consistency

  • Hard in cancers that induce fibrosis and when previous inflammation has left fibrosis.
  • Firm, rubbery nodes in lymphomas and chronic leukemia

Fixation
- fixed to adjacent tissues by invading cancers or inflammation

Tenderness
- Suggests recent, rapid enlargement with inflammation, hemorrhage, immunologic stimulation, and malignancy.

21
Q

Labs for generalized lymphadenopathy

A

Complete blood count, Heterophile test, and chest x-ray.

If above normal:
PPD
HIV antibody determination
RPR
ANA
22
Q

Imaging

A 
CXR
US
CT
MRI
PET
23
Q

Open biopsy

A

The best for diagnosis

Choose the most accessible and/or biggest node

24
Q

Fine needle aspiration for cytology

A

most useful when searching for recurrence of cancer
substantial false-negative rate due to sampling error
Used in areas where open biopsy is not available or risky
Good in patients with HIV infection for evaluating lymph nodes that are believed to harbor other disease

25
Q

Spleen

A

Largest lymph node in the body.

Functions
Participates in the primary immune response
Acts as a filter for the blood
Responsible for removing from the circulation red blood cells, that are old, sick or if they are coated with immunoglobulins.

26
Q

causes of splenomegaly

A

congestive (cirrhosis, heart failure, thrombosis of portal, hepatic, or splenic veins)

  • infection
  • infiltrative
  • malignancy (Hematologic malignancies, Lymphoma, Acute and chronic leukemias, Polycythemia vera, Multiple myeloma, Essential thrombocythemia, Primary splenic tumors, Non-hematologic metastatic solid tumors)
  • inflammation (Sarcoid
    Serum sickness
    Systemic lupus erythematosus
    Rheumatoid arthritis (Felty syndrome)
  • hematologic
27
Q

infectious causes of splenomegaly

A

Viral - hepatitis, infectious mononucleosis, cytomegalovirus
Bacterial - salmonella, brucella, tuberculosis
Parasitic -malaria, schistosomiasis,toxoplasmosis, leishmaniasis
Infective endocarditis (embolic)
Fungal

28
Q

Hematologic (hypersplenic) states

A

Acute and chronic hemolytic anemias, all etiologies
Sickle cell disease (children)
Following use of recombinant human granulocyte colony-stimulatingfactor
Myelofibrosis

29
Q

Symptomatology

of splenomegaly

A

LUQ pain

  • May be acute or chronic depending on the disease
  • Acute if splenic infarct or rupture present

Dizziness/hypotension with splenic rupture

Signs of the disease causing splenomegaly

  • Fever, chills etc with infections
  • Fatigue, weight loss with cancer
  • Jaundice, ascitis with cirrhosis
30
Q

spleen labs

A

CBC

  • Neutropenia, anemia, and/or thrombocytopenia may be present without abnormal morphology (hypersplenism
  • Absolute neutrophillia with or without Left shift suggest presence of splenic infarction
  • Atypical lymphocytes
  • Blasts/young cells

Peripheral smear

  • Invading organisms (bartonellosis, babesiosis, and malaria)
  • Schistocytes
  • Abnormal cell morphology (spherocytes)

Infectious Mononucleosis serology

31
Q

A patient with chronic alcoholism or hepatitis and ascites –

A

splenomegaly secondary to cirrhosis and portal hypertension.

32
Q

A young adult with fatigue, fever, sore throat, and splenomegaly –

A

infectious mononucleosis or other viral infection.

33
Q

An older adult complaining of post-bath pruritus with a ruddy complexion and splenomegaly –

A

polycythemia vera.

heme lymph exam 2 (14 decks)

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