Pales PPT PArt I Flashcards
what constitutes lymphadenopathy in children and adults?
children- palpable nodes
adults- nodes larger than 1-2 cm in diameter(except in groin)
anterior cervical lymphadenopathy is usually caused by what?
local: strep staph, rubella, dental
systemic: EBC, CMV or toxo
posterior cervical lymphadenopathy is associated with what
malignancy
EBV, TB ,lymphoma, head/neck malignancy
supraclavicular lymphadenopathy is at high risk for
malignancy
right supraclavicular lymphadenopathy is significant for
cancer of mediastinum, lungs or esophagus
L supraclavicular lymphadenopathy is significant for
Virchows node abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries or prostate)
what infections can cause axillary lymphadenopathy
cat scratch disease
cellulitis
what cancers can cause localized axillary lymphadenopathy
breast
other metastasis
what can cause epitrochlear lymphadenopathy
infections of forearm of hand lymphoma sarcoidosis tularemia secondary syphilis
what can cause inguinal lymphadenopathy
infection
STD
cancer: skin of lower extremities and trunk, cervix, vulva, and ovary, rectum and anus, penis
causes of mediastinal lymphadenopathy
infection: TB, fungal infection, anthrax
Neoplastic: lymphoma, lung cancer, germ cell tumor
other: sarcoidosis
what can cause retroperitoneal lymphadenopathy
infection: TB
neoplastic: lymphoma, testicular cancer, kidney cancer, upper GI malignancy
other: sarcoidosis
what can cause mesenteric lymphadenopathy
infection: appendicitis, cholecystitis, diverticulitis, whipple’s disease
neoplastic: lymphoma, GI cancer
other: IBD, panniculitis
What will lymphadenopathy present like in HIV
nontender
primarily axillary, cervical and occipital
usually during 2nd week acute symptomatic patient
dec in size but moderate overall
what will lymphadenopathy present like in mycobacterial infection
lymphadenopathy alone (in neck) usually TB in adults and atypical mycobacteria in children nontender enlarge wks- months without systemic Sx can progress to matting and fluctuation
What will lymphadenopathy from infectious mononucleosis present like
triad: fever, pharyngitis, lymphadenopathy symmetric enlargement posterior more than anterior axillary and inguinal are common too peaks in 1st week then subsides 2-3 wks
what other mono-like diseases can cause generalized lymphadenopathy
CMV herpes virus 6 HIV adenovirus, herpes simplex strep pyogenes toxoplasma gondii
How does lymphadenopathy from SLE present
soft nontender
cervical, axillary and inguinal areas
develops onset of disease or in assoc with an exacerbation
what is serum sickness
fever, arthralgias, rash and generalized lymphadenopathy
what medication can cause generalized lymphadenopathy in absence of serum sickness reaction
phenytoin
What drugs have been known to cause lymphadenopathy
allopurinol atenolol captopril carbamazepine cephalosporins gold hydralazine penicillin phenytoin primidone pyrimethamine quinidine sulfonamides sulindac
how to Dx cause of generalized lymphadenopathy
biopsy
what is castlemans disease
uncommon lymphoproliferatic disorder
massive lymphadenopathy with fever, HSM, polyclonal hypergammaglobulinemia, amyloidosis
What is kikuchi’s disease
rare, benign condition of unknown cause
affects young women
cervical lymphadenopathy only or generalized
fever
What is Kawasaki disease
childhood vasculitis
cervical lymphadenopathy with fever, conjunctivitis, mucositis, rash and coronary artery aneurysms
what is mucositis
strawberry tongue
Describe presentation of angioimmunoblastic T cell lymphoma
generalized lymphadenopathy with fever HSM
hemolytic anemia
polyclonal hypergammaglobulinemia
What is an Inflammatory pseudotumor and signs
syndrome of lymphadenopathy in one or more node groups
systemic Sx
nodes show fibrosing and inflammatory process
What is amyloidosis
systemic disease with deposition of amyloid, can be in nodes
What is Kimura disease and characteristics
inflammatory condition of subcutaneous tissue and lymph nodes of head/neck
elevations in serum IgE and eos
What do you investigate in Hx for generalized lymphadenopathy
URI Sx
Dental pain
chest pain
Abdominal/pelvic pain
What exposures are key in Hx for generalized lymphadenopathy
cat undercooked meat tick bite travel high risk behavior
What constitutional Sx are assoc with lymphadenopathy
fever, night sweats, weight loss
firm rubbery nodes are characteristic in what conditions
lymphomas and chronic leukemia
tender lymph nodes tell you what
recent rapid enlargement with inflammation, hemorrhage, immunologic stimulation and malignancu
What labs do you do for generalized lymphadenopathy
CBC, heterophile test and CXR
if CBC heterophile test and CXR are normal what labs should you do for generalized lymphadenopathy
PPD HIV Ab determination
RPR
ANA
What imaging do you do for generalized lymphadeopathy
CXR US CT MRI PET
when is fine needle aspiration used over biopsy of nodes
recurrence of cancer
when open biopsy too risky
HIV infection patients
what is largest lymph node in body
spleen
what are causes of splenomegaly
congestive, malignancy, infection, inflammation, infiltrative, hematologic
causes of congestive splenomegaly
cirrhosis
heart failure
thrombosis of portal hepatic or splenic vv
malignant causes of splenomegaly
hematologic: lymphoma, acute and chronic leukemias, polycythemia vera, multiple myeloma, essential thrombythemia
primary splenic tumors
non-hematologic metastatic solid tumors
what are viral causes of splenomegaly
hepatitis, CMV, infecitous mononucleosis
bacterial causes of splenomegaly
salmonella, brucella TB
parasitic causes of splenomegaly
malaria, schistosomiasis, toxoplasmosis, leishmaniasis
what are inflammatory causes of splenomegal
sarcoid
serum sickness
SLE
RA(felty syndrome)
what are infiltrative nonmalignant causes of splenomegaly
gauchers disease Niemann Pick disease amyloid glycogen storage disease langerhans cell histiocytosis hemophagocytic lymphohistiocytosis
what are the hematologic causes of splenomegaly
acute and chronic hemolytic anemias
sicke cell disease
after use of g-CSF drugs
myelofibrosis
LUQ spain with splenomegaly means what
may be acute or chronic
if acute- splenic infarct or rupture
what are signs of splenic rupture
LUQ pain suddenly
dizziness, hypotension
What will CBC show with splenomegaly
neutropenia, anemia and or thrombocytopenia
what CBC suggests splenic infarct
absolute neutrophilia with or without left shift
splenomegaly
PS helps Dx
invading organisms, schistocytes and spherocytes
older adult complains of pruritis with ruddy complexion after getting out of bath and has splenomegaly
dx?
polycythemia vera
young adult with fatigue, fever, sore throat and splenomegaly
infectious mononucleosis or other viral infection
