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SBL Test 2 > Lymphadenopathy and Splenomegaly > Flashcards

Lymphadenopathy and Splenomegaly Flashcards

1
Q

More than 2/3 if patients with LAD have what?

A

URI (Viral or bacterial) and

<1% have malignancy

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2
Q

Ddx of Anterior cervical LAD

A

Infections: EBV, CMV, toxoplasma

Malignancy: Lymphoma, CLL, head/neck cancer

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3
Q

Ddx of Posterior cervical LAD

A

Infection: TB***, EBV

Malignancy: Lymphoma, CLL, head/neck cancer

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4
Q

What age should you start to take into consideration malignant causes of LAD?

A

> 50YO

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5
Q

Ddx of generalized LAD

A

Cause is most often non-malignant and systemic disease.

  1. HIV
  2. CMV
  3. Other viral (esp infectious mono/EBV)
  4. Inflammatory disorders (SLE)
  5. Toxoplasmosis

Other: acute/chronic lymphocytic leukemia and lymphoma.

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6
Q

What is important to note if a patient presents with Supraclavicular LAD?

A

HIGH RISK AREA FOR MALIGNANCY (35-50%).

Risk INC >40YO.

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7
Q

Right Supraclavicular LAD

A

Cancer in mediastinum, lung and esophagus

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8
Q

Virchows node (L Supraclavicular LAD)

A

Metastatic cancer from GI

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9
Q

Enlarged ______ and _____ is ALWAYS abnormal.

A
  1. Supraclavicular

2. Scalene

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10
Q

Axillary LAD

A

Usually due to injuries/localized infection of ipsilateral UE.

Infection: Cat Scratch Disease

Malignancy: Skin/breast cancer

Inflammation: Silicone breast implants

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11
Q

Palpable Epitrochlear LN is always ____

A

Pathologic

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12
Q

Epitrochlear LAD

A

Infection: Infection of forearm/hand, tularemia, Strep, Cat scratch disease, 2’ syphillis ***

Inflammation: sarcoid

Malignancy: lymphoma (rare)

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13
Q

Inguinal LAD

A

Infection: LE infection, STD

Malignancy: lymphoma, skin cancer, GU, anus/rectal cancer

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14
Q

Sister Mary Joseph Node/Nodule *

Prognosis of this?

A

Palpable nodule in the BB (not a true LN) that represents metastasis from intraabdominal/intrapelvic cancer..

Most often, GI cancer, but in women 25% are GYN cancer.

Bad prognostic sign.

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15
Q

You will look like a rockstar if you a patient presents with Cervical LAD and your Ddx is…

A
  1. Infections
  2. Lymphoma
  3. Uncommon disorders (Kikuchi, TB)
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16
Q

Nodes ____cm2 are almost alway due to benign, nonspecific reactive causes.

When should these patients be under observation?

A

< 1cm2
ABNL LN are generally greater than 1cm.

Observe after excluding infectious mono or toxoplasmosis, unless sx and signs of underlying systemic illness.

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17
Q

Ddx for tender LN

A

Usually inflammatory process.

Malignancies: acute leukemia

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18
Q

Describe the LN in lymphomas/chronic leukemia

How is this different from LN in Acute Leukemias?

A

Large, discrete, symmetric, rubbery, firm, mobile and non-tender

In Acute Leukemias, LN tend to be softer.

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19
Q

Describe the LN in metastatic cancers

A

Hard, non-tender, non-moveable

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20
Q

LAD + splenomegaly suggests

A

Systemic illness:

  1. Infectious mono
  2. Lymphoma
  3. CLL/acute leukemia
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21
Q

Ddx Mediastinal/Hilar adenopathy in young patients

A

Infectious mono

Sarcoidosis

22
Q

In endemic regions, histoplasmosis can cause ______

A

Unilateral paratracheal LAD, which mimics lymphoma.

23
Q

Enlarged intra-abdominal or retroperitoneal LN are usually _______

A

Malignant

24
Q

_____ infection is associated with undercooked meat

A

Toxoplasmosis

25
Q

LAD + constitutional symptoms (fever, night sweats, WL) suggest what?

A
  1. TB

2. Lymphoma or other cancers

26
Q

Fever usually accompanies LAD in a majority of _____ etiologies

A

Infectious. Thus, no fever may mean cancer.

27
Q

“Shotty LN” =

A

Multiple, small LN, with no diagnostic significance

28
Q

Ddx for hard LN

A

Cancers that cause fibrosis or previous inflammation that has caused fibrosis.

29
Q

Ddx for fixed LN

A

Invading cancers or inflammation in tissue surrounding nodes

30
Q

What is the diagnostic approach to a patient with Generalized LAD (involvement of 3 or more noncontiguous LN)?

A
  1. CBC + CXR
    If NL,
  2. PPD
  3. HIV
  4. RPR
  5. ANA
  6. Serology for EBV and CMV
31
Q

CBC is useful for diagnosing…

A
  1. Acute/chronic Leukemia,

2. EBV/CMV

32
Q

Serology is useful for diagnosing

A
  1. EBV/CMV/HIV

2. Toxoplasma gondii

33
Q

What imaging studies are useful to diagnose metastases to the cervical LN?

A

CT and MRI

34
Q

Prompt biopsy of a LN should be done when?

A

H&P suggest cancer.

35
Q

Primary head or neck cancer is suspected based on the a solitary, hard cervical LN.

What should be done?

A

ENT exam

36
Q

Most LAD do NOT require what?

A

Biopsy and labs

37
Q

If H&P suggests a benign cause of LAD, what should be done?

A

2-4 week F/U.

38
Q

PEARL: What are B-symptoms and what do they suggest?

A
  1. Fever
  2. Nigh sweats
  3. WL >10% in 6 months

Suggest a paraneoplastic syndrome or worse prognosis of HL/NHL (DLBL or Burkitt)

39
Q

What is the only time glucocorticoids should be used to treat LAD?

A

When enlarged lymphoid tissue in Waldeyers ring causes life-threatening pharyngeal obstruction, commonly seen in infectious mono.

40
Q

PEARL: Immunocompromised patients are at increased risk for what?

A

Primary CNS lymphoma

41
Q

Patient presents with LUQ pain and heavy sensation + early satiety. This suggests…

A

Splenomegaly

42
Q

What imaging tool is used for routine assessment of the size of the spleen?

A

Ultrasound: high sensitivity and specificity

43
Q

What are the 3 mechanisms for splenomegaly?

A
  1. Hyperplasia/hypertrophy
  2. Passive congestion due to decreased BF
  3. Infiltrative diseases
44
Q

What conditions can cause hyperplasia/hypertrophy of spleen?

A

Disorders that require removal of large number of RBC:

  1. Hereditary spherocytosis
  2. Thalassemia

Immune hyperplasia due to systemic infection

  1. Infectious mono, subacute bacterial endocarditis
  2. AI
45
Q

What conditions can cause passive congestion of spleen?

A

Conditions that cause portal HTN

  1. Cirrhosis
  2. Budd Chiari
  3. CHF
46
Q

What are infiltrative diseases of the spleen?

A
  1. Lymphoma
  2. Metastatic cancers
  3. Myeloproliferative diseases
47
Q

Ddx for a “massively enlarged spleen” (palpable, >8cm, >1000g)

A

Massively enlarged spleens have fewer Ddx

  1. NHL
  2. CLL
  3. Hairy cell leukemia
  4. CML
  5. MYelofibrosis
  6. Polycythemia vera
48
Q

Splenomegaly + decreased granulocyte counts

A
  1. Felty syndrome
  2. Congestive splenomegaly
  3. Leukemia
49
Q

Splenomegaly + decreased platelet counts

A
  1. Sequestration

2. Destruction of platelets (congestive splenomegaly, Gaucher, immune thrombocytopenia)

50
Q

Splenomegaly + increased platelet counts

A
  1. Myeloproliferative disorders (polycythemia vera)
51
Q

Splenomegaly + CBC that suggests cytopenias is characterized by what?

A

Splenomegaly
Cytopenias
NL or hyperplastic BM
Response to splenectomy.

SBL Test 2 (11 decks)

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