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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 _______

24
Q

_____ infection is associated with undercooked meat

A

Toxoplasmosis

25
LAD + constitutional symptoms (fever, night sweats, WL) suggest what?
1. TB | 2. Lymphoma or other cancers
26
Fever usually accompanies LAD in a majority of _____ etiologies
Infectious. Thus, no fever may mean cancer.
27
"Shotty LN" =
Multiple, small LN, with no diagnostic significance
28
Ddx for hard LN
Cancers that cause fibrosis or previous inflammation that has caused fibrosis.
29
Ddx for fixed LN
Invading cancers or inflammation in tissue surrounding nodes
30
What is the diagnostic approach to a patient with Generalized LAD (involvement of 3 or more noncontiguous LN)?
1. CBC + CXR If NL, 1. PPD 2. HIV 3. RPR 4. ANA 5. Serology for EBV and CMV
31
CBC is useful for diagnosing...
1. Acute/chronic Leukemia, | 2. EBV/CMV
32
Serology is useful for diagnosing
1. EBV/CMV/HIV | 2. Toxoplasma gondii
33
What imaging studies are useful to diagnose metastases to the cervical LN?
CT and MRI
34
Prompt biopsy of a LN should be done when?
H&P suggest cancer.
35
Primary head or neck cancer is suspected based on the a solitary, hard cervical LN. What should be done?
ENT exam
36
Most LAD do NOT require what?
Biopsy and labs
37
If H&P suggests a benign cause of LAD, what should be done?
2-4 week F/U.
38
PEARL: What are B-symptoms and what do they suggest?
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
What is the only time glucocorticoids should be used to treat LAD?
When enlarged lymphoid tissue in Waldeyers ring causes life-threatening pharyngeal obstruction, commonly seen in infectious mono.
40
PEARL: Immunocompromised patients are at increased risk for what?
Primary CNS lymphoma
41
Patient presents with LUQ pain and heavy sensation + early satiety. This suggests...
Splenomegaly
42
What imaging tool is used for routine assessment of the size of the spleen?
Ultrasound: high sensitivity and specificity
43
What are the 3 mechanisms for splenomegaly?
1. Hyperplasia/hypertrophy 2. Passive congestion due to decreased BF 3. Infiltrative diseases
44
What conditions can cause hyperplasia/hypertrophy of spleen?
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
What conditions can cause passive congestion of spleen?
Conditions that cause portal HTN 1. Cirrhosis 2. Budd Chiari 3. CHF
46
What are infiltrative diseases of the spleen?
1. Lymphoma 2. Metastatic cancers 3. Myeloproliferative diseases
47
Ddx for a "massively enlarged spleen" (palpable, >8cm, >1000g)
Massively enlarged spleens have fewer Ddx 1. NHL 2. CLL 3. Hairy cell leukemia 4. CML 5. MYelofibrosis 6. Polycythemia vera
48
Splenomegaly + decreased granulocyte counts
1. Felty syndrome 2. Congestive splenomegaly 3. Leukemia
49
Splenomegaly + decreased platelet counts
1. Sequestration | 2. Destruction of platelets (congestive splenomegaly, Gaucher, immune thrombocytopenia)
50
Splenomegaly + increased platelet counts
1. Myeloproliferative disorders (polycythemia vera)
51
Splenomegaly + CBC that suggests cytopenias is characterized by what?
Splenomegaly Cytopenias NL or hyperplastic BM Response to splenectomy.

SBL Test 2 (11 decks)

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