Lymphadenopathy

Question 1

parotid gland swelling that’s unilateral and painful

Answer 1

gland obstruction from sialolithiasis or infection (sialadenitis) Lymphoma will be painless swelling.

Question 2

acute sialadenitis presentation

Answer 2

see swelling, pain, erythema, systemic symptoms of fevers and chills and purulent drainage from affected gland.

Question 3

risk factors for parotid stones are

Answer 3

dehydration, smoking, trauma, gout, diuretics, and anticholinergic medications.

Question 4

initial management of sialolithiasis

Answer 4

conservative (lemon drops) to promote salivary secretion and moist heat to affected area massaging the gland to “milk” the duct and adequate hydration

Question 5

if pt has signs of sialolthiasis and secondary infection

Answer 5

should also treat with antibiotics

Question 6

When to get high res CT of parotid?

Answer 6

when there’s persistent disease and complete obstruction. Surgery is reserved for disease refractory to conservative measures

Question 7

pleomorphic adneoma

Answer 7

most common parotid tumor = they will have painless and focal swelling

Question 8

Sjogren’s syndrome will have

Answer 8

xerostomia and keratoconjunctivitis sicca.

Question 9

acute unilateral or bilateral parotid swelling with a prodrome of fever, malaise, headache and myalgias

Answer 9

viral sialadenitis (Mumps and HIV infections) See the viral prodrome

Question 10

worrisome features of LAD for malignancy:

Answer 10

non tender, firm or hard >2 cm in size persistent for 4 weeks or more progressively enlarging axillary nodes involved (in absence of local infection or dermatitis) supraclavicular nodes involved generalized lymphadenopathy abnormal chest radiographic findings other suggestive findings of malignancy (systemic complaints of fever, night sweats, weight loss and hepatosplenomegaly)

Question 11

B symptoms are:

Answer 11

fevers, night sweats, weight loss)

Question 12

LAD can be

Answer 12

localized or generalized Localized: one anatomical site generalized: >2 non contiguous anatomical sites

Question 13

pts who present with generalized LAD should get these tests:

Answer 13

CBC with diff CXR if abnormal then get: RPR, ANA, HIV, HBsAg, PPD, and heterophile testing. These tests are often low yield.

Question 14

If pt who has generalized LAD has negative initial screening tests what should be done next:

Answer 14

they should get a lymph node biopsy next

Question 15

If pt presents with localized LAD with a reassuring clinical picture then

Answer 15

a 3-4 week observation period should be done. Should get biopsy if abnormal lymph node does not resolve in 4 weeks or there’s other findings of malignancy.

Question 16

Once biopsy for LAD is chosen, need to identify which one to pick for biopsy: what kind of biopsy should be done?

Answer 16

the largest, most suspicious and accessible node and if no node predominants then need to pick supraclavicular, cervical, axillary or inguinal nodes. need a excisional biopsy for a intact node as it is more accurate and allows higher yield.

Question 17

When do we core needle biopsy for LAD?

Answer 17

if they have 1 or more of the following: supraclavicular LAD, rapidly progressive LAD, B symptoms reserved for suspected lymphoma whom an intact node is not easily accessible (retroperitoneal nodes)

Question 18

localized LAD could be due to

Answer 18

infection, rheumatic dx, malignancy and medications

Question 19

months of painless LAD that waxes and wanes but never fully resolves should be suspicious for:

Answer 19

indolent lymphoma or follicular lymphoma.

Question 20

mononucleosis

Answer 20

pharyngitis and tonsillar exudate and tender cervical LAD that lasts 203 weeks see malaise, fever, and lymphocytes

Question 21

Management of LAD

Answer 21