Pales CIS

Question 1

anterior cervical lymphadenopathy?

Answer 1

– usually benign
Localized strep or staph infections, rubella, dental

Systemic infections: Epstein-Barr virus (EBV), cytomegalovirus infection, or toxoplasmosis

Question 2

posterior cervical lymphadenopathy?

Answer 2

– could be benign, but malignancy is more common than with anterior lymph nodes

EBV infection, tuberculosis, lymphoma, or head and neck malignancy

Question 3

supraclavicular lymphadenopathy?

Answer 3

drain from abdomen and chest, not from the neck (lungs, esophagus, mediastinum)

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)

Question 4

axillary lymphadenopathy?

Answer 4

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)

Question 5

epitrochlear lymphadenopathy?

Answer 5

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

Question 6

Inguinal lymphadenopathy?

Answer 6

• Lower extremity infection
• Sexually transmitted diseases

Cancer: 
Skin of the lower extremities and trunk
Cervix, vulva, and ovary
Rectum and anus 
Penis

Question 7

Mediastinal lymphadenopathy?

Answer 7

Infectious: TB, fungal infection, anthrax

Neoplastic: Lymphoma, lung cancer, germ cell tumor

Other
Sarcoidosis

Question 8

Retroperitoneal lymphadenopathy?

Answer 8

Infectious
TB

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

Other
Sarcoidosis

Question 9

mesenteric lymphaenopathy?

Answer 9

Infectious
Appendicitis, cholecystitis, diverticulitis, Whipple’s disease

Neoplastic
Lymphoma, GI cancer

Other
Inflammatory bowel disease, panniculitis
(cellulitis of abdominal wall)

Question 10

generalized lymphadenopathy? HIV

Answer 10

1. HIV infection: see nontender, primarily axillary, cervical and occipital nodes - develops during second week of acute symptomatic HIV infection

Question 11

generalized lymphadenopathy? Mycobacterium?

Answer 11

2. Mycobacterial infection:
   - TB and atypical mycobacterial infections
   - nontender
   - enlarge over weeks to months w/out prominent sx
   - can present with lymphadenopathy alone, esp. in the neck “scrofula”

Question 12

generalized lymphadenopathy? Infectious mononucleosis:

Answer 12

triad of fever, pharyngitis, and lymphadenopathy

• symmetric enlargement
• posterior cervical more than anterior (axillary and inguinal are also common too)
• Lymphadenopathy peaks in the first week and then gradually subsides over two to three weeks

Question 13

generalized lymphadenopathy? SLE

Answer 13

Systemic lupus erythematosus:

• 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.

Question 14

generalized lymphadenopathy? medications

Answer 14

Some drugs may cause serum sickness
fever, arthralgias, rash, and generalized lymphadenopathy

** Phenytoincan cause generalized lymphadenopathy in the absence of a serum sickness reaction

Question 15

Kawasaki disease

Answer 15

Type of generalized lymphadenopathy

Childhood vasculitis

Cervical lymphadenopathy with :
Fever
Conjunctivitis
Mucositis (strawberry tongue)
Rash “slapped cheeks”
Coronary artery aneurysms (can get heart attacks at young age, need to take aspirin at a young age)

Question 16

Amyloidosis

Answer 16

Congo red stain

Systemic disease with deposition of specific type of protein called Amyloid.

Most often will have amyloid deposition in other organs, but occasionally can be deposited only in lymph nodes

Question 17

Pt/PTT changes?

Answer 17

no changes in PT/PTT: think vWD, bernard-soulier, glanzmann thrombasthenia, storage disease

prolonged PTT: factors VIII, IX, XI
prolonged PT: factor VII

both prolonged PTT and PT: Factors V, X, prothrombin, fibrinogen, warfarin, Vit K deficiency, liver disease, DIC, fibrinolysis

Question 18

low plasma fibrinogen

Answer 18

think DIC (elevated D-dimer/fibrin split products as well, just not as predictive)

Question 19

heterophile test

Answer 19

for mono

Question 20

RPR

Answer 20

(rapid plasma reagin) test for syphilis

Question 21

elevated PFA-100

Answer 21

indicative of platelet disorder such as vWD

Question 22

Mixing study

Answer 22

differentiation b/w factor deficiencies and factor inhibitor problem

– add 50% patient and 50% normal, if have deficiency in the factor then PTT will normalize, if you give it and it doesn’t normalize then there is an inhibitor in the pts. blood and it will cause PTT to still be prolonged.

Question 23

genetic disorder predisposing to DVT?

Answer 23

Factor V Leiden is most common cause of genetically assoc. cause of DVT

Question 24

primary hypercoaguable state?

Answer 24

1. defic. of anti-thrombotic factors:
   - Antithrombin deficiency
   - protein C/S defieicny
2. excess of prothrombotic factors:
   - factor V Leiden
   - Prothrombin mutation

Question 25

secondary hypercoagulable states?

Answer 25

cancer
pregnancy
anti-phospholipid syndrome (seen in both arteries and vv.)
trauma, surgery, immobilization