Masses, Lymphadenophathy, Splenomegaly - Hubbard

Question 1

Infection with EBV, CMV or toxoplasma localizes to which lymph nodes?

Answer 1

anterior cervical

Question 2

lymphoma, CLL, head/neck cancer localizes to which lymph nodes?

Answer 2

anterior cervical

Question 3

infection with EBV or Tb localizes to which lymph nodes?

Answer 3

posterior cervical

Question 4

lymphoma, CLL, head/neck cancer localize to which lymph nodes?

Answer 4

posterior cervical

Question 5

what is a high risk area for malignancy?

Answer 5

supraclavicular

• 35-50% incidence
• increased risk in >40 years of age

Question 6

right supraclavicular lymphadenopathy means what?

Answer 6

cancer in mediastinum, lung, esophagus

Question 7

left supraclavicular (Virchow’s node) means what?

Answer 7

abdominal malignancy

Question 8

axillary lymphadenopathy most likely means what kind of infection?

Answer 8

cat scratch disease

Question 9

axillary lymphadenopathy most likely means what kind of malignancy?

Answer 9

skin or breast cancer

Question 10

axillary lymphadenopathy most likely means what kind of inflammation?

Answer 10

silicone breast implants

Question 11

palpable epitrochlear noes always mean what kind of infection?

Answer 11

forearms/hand, tularemia, strep infection, cat scratch dz, secondary syphilis
- always pathologic!

Question 12

epitrochlear lymphadenopathy most likely means what kind of inflammation?

Answer 12

sarcoid

Question 13

epitrochlear lymphadenopathy most likely means what kind of malignancy?

Answer 13

lymphoma

Question 14

inguinal lymphadenopathy most likely means what kind of infection?

Answer 14

lower extremity or STI

Question 15

inguinal lymphadenopathy most likely means what kind of malignancy?

Answer 15

lymphoma, melanoma, non-melanoma skin cancer, GU, anus/rectum

Question 16

palpable nodule in the umbilicus (not truly a lymph node)

• represents a metastasis from intraabdonimal or intrapelvic malignancy
• most commonly GI cancer, but in 25% women can be GYN cancer

Answer 16

sister mary joseph nodule

- bad prognostic sign

Question 17

what should always be on your DDX for lymphadenopathy?

Answer 17

• HIV
• mycobacterium
• infectious mononucleosis
• SLE

Question 18

what should always be on your DDX for cervical adenopathy?

Answer 18

• infection
• lymphoma
• unusual disorders (Kikuchi disease, Tb)

Question 19

what does localized lymphadenopathy usually suggest?

Answer 19

local causes

Question 20

what does generalized adenopathy usually manifest as?

Answer 20

systemic disease

Question 21

abnormal nodes are generally larger than what?

Answer 21

1cm

Question 22

what is the term “shotty” used to describe?

Answer 22

multiple, small nodes

- has no particular diagnostic significance

Question 23

when do you usually find hard nodes?

Answer 23

cancers that induce fibrosis and when previous inflammation has left fibrosis

Question 24

what do you usually find firm, rubbery nodes?

Answer 24

lymphomas and chronic leukemia

Question 25

nodes in acute leukemia tend to be what consistency?

Answer 25

soft

Question 26

what is fixation?

Answer 26

abnormal nodes become fixed to adjacent tissues by invading cancers or inflammation in tissue surrounds the nodes - NL LN's are freely movable in the subQ space

Question 27

what should be kept in mind with tenderness of LN's?

Answer 27

typically occurs with inflammatory processes, but can also result from hemorrhage into a node, immunologic stimulation, and malignancy - suggests **recent, rapid enlargement** that has put pain receptors in the capsule under tension

Question 28

pt with pre-exsistent CLL developing a diffuse large B-cell lymphoma - represents clonal evolution with additional cytogenic abnormalities - tough to kill

Answer 28

Richter's syndrome

Question 29

fever, drenching night sweats, 10% wt loss in 6 months | - likely paraneoplastic and assoc with worse prognosis

Answer 29

B symptoms

Question 30

what pts are at increased risk for primary CNS lymphoma?

Answer 30

immunosuppressed pts | - HIV, organ transplant, etc

Question 31

what lab tests should be run for generalized lymphadenopathy?

Answer 31

CBC, CXR

Question 32

what if CBC and CXR are clear on pt w/ generalized lymphadenopathy?

Answer 32

consider - PPD - HIV - RPR - ANA - serologies for EBV, CMV

Question 33

what are the benign causes of splenomegaly?

Answer 33

- congestive - inflammation - infection - infiltration - hypersplenism

Question 34

what are the malignant causes of splenomegaly?

Answer 34

- lymphoma - leukemia (acute and chronic) - myeloproliferative neoplasm - primary splenic tumors - metastatic solid tumors

Question 35

what are the common complaints of splenomegaly?

Answer 35

- heaviness/pain in LUQ - early satiety - fullness or mass in LUQ

Question 36

primary myeoproliferative disorder characterized by marrow fibrosis and extramedullary hematopoiesis

Answer 36

myelofibrosis

Question 37

what is the triad of myelofibrosis?

Answer 37

- leukoerythroblastic anemia - poikilocytosis - splenomegaly