Clin- Lymphadenopathy & Splenomegaly Pales

Question 1

Lymph node contents

Answer 1

Macrophages
Dendritic cells
B lymphocytes
T lymphocytes

Question 2

lymph node functions

Answer 2

Antigen processing
Antigen presentation
Antigen recognition
Effector B and T cell proliferation are part of normal immune response

Question 3

localized bacterial causes of lymphadenopathy

Answer 3

Strep pharyngitis, skin infection, tularemia, plague, cat scratch disease, diphtheria, chancroid, rat bite fever

Question 4

generalized bacterial causes of lymphadenopathy

Answer 4

Brucellosis, leptospirosis, lymphogranuloma venereum, typhoid fever

Question 5

viral causes of lymphadenopathy

Answer 5

HIV, EBV, HSV, CMV, mumps, measles, rubella, Hep B, Dengue fever

Question 6

mycobacterial causes of lymphadenopathy

Answer 6

Mycobacterium tuberculosis, atypical mycobacteria

Question 7

fungal causes of lymphadenopathy

Answer 7

Histoplasmosis ,coccidiodomycosis, cryptococcosis

Question 8

protozoal causes of lymphadenopathy

Answer 8

Toxoplasmosis, leishmaniasis

Question 9

spirochetal causes of lymphadenopathy

Answer 9

Secondary syphilis, Lyme disease

Question 10

lymphoproliferative causes of lymphadenopathy

Answer 10

Angioblastic lymphadenopathy with dysproteinemia, autonimmune lymphoproliferative disease, Rosai-Dorfman disease, Hemophagocytic lymphohistiocytosis

Question 11

immunologic causes of lymphadenopathy

Answer 11

Serum sickness, drug reactions (i.e. phenytoin)

Question 12

endocrine causes of lymphadenopathy

Answer 12

Hypothyroidism, Addison’s disease

Question 13

miscellaneous causes of lymphadenopathy

Answer 13

Sarcoidosis, Lipid storage diseases, Amyloidosis, Histiocytosis, Chronic granulomatous disease, Kikuchi’s disease, Kawasaki disease, Inflammatory Pseudotumor, SLE, RA, Still’s disease, Dermatomyositis, Churg-Strauss Syndrome

Question 14

anterior cervical lymphadenopathy

Answer 14

Localized: Strep or staph infection, Rubella, Dental
Systemic: EBV, CMV, Toxoplasmosis

Question 15

posterior cervical lymphadenopathy

Answer 15

EBV, TB, Lymphoma, Head/neck malignancy

Question 16

supraclavicular lymphadenopathy

Answer 16

Right: CA of medastinum, lungs, or esophagus

Left (Virchow’s node): Abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries, prostate)

Question 17

axillary lymphadenopathy

Answer 17

Infectious: Cat scratch disease, Cellulitis
Cancer: Breast, Other metastases
Silicone breast implants (may cause both supraclavicular and axillary lymphadenopathy)

Question 18

epitrochlear lymphadenopathy

Answer 18

Infections of forearm or hand
Lymphoma
Sarcoidosis
Tularemia
Secondary syphilis

Question 19

inguinal lymphadenopathy

Answer 19

Lower extremity infection
STD
Cancer: skin of LE or trunk, cervix, ovary, vulva, rectum, anus, penis

Question 20

mediastinal lymphadenopathy

Answer 20

Infectious: TB, Fungal infection, Anthrax
Neoplastic: Lymphoma, Lung CA, Germ cell tumor
Other: Sarcoidosis

Question 21

retroperitoneal lymphadenopathy

Answer 21

Infectious: TB
Neoplastic: Lymphoma, Testicular CA, Kidney CA, Upper GI malignancy
Other: Sarcoidosis

Question 22

mesenteric lymphadenopathy

Answer 22

Infectious: Appendicitis, Cholecystitis, Diverticulitis, Whipple’s disease
Neoplastic: Lymphoma, GI cancer
Other: IBD, Panniculitis

Question 23

generalized lymphadenopathy with HIV

Answer 23

Non-tender
Primarily axillary, cervical, occipital nodes
Usually develops during 2nd week of acute symptomatic HIV
Decrease in size, but modest degree of adenopathy persists

Question 24

generalized lymphadenopathy with mycobacteria

Answer 24

Can present with lymphadenopathy alone, especially in neck (scrofula)
M. tuberculosis in adults
Atypical mycobacteria in kids
Non-tender
Enlarge over weeks to months without prominent systems symptoms
Can progress to matting and fluctuation

Question 25

generalized lymphadenopathy with infectious mononucleosis

Answer 25

Triad: fever, pharyngitis, lymphadenopathy Symmetric enlargement Posterior > anterior cervical nodes Axillary and inguinal are common too (as opposed to other causes of pharyngitis) Lymphadenopathy peaks in 1st week and then gradually subsides over 2-3 weeks

Question 26

generalized lymphadenopathy with SLE

Answer 26

Seen in ~50% of patients Soft, non-tender Cervical, axillary, inguinal nodes Usually develops at onset of disease, or in association with exacerbation

Question 27

generalized lymphadenopathy with medications

Answer 27

Drugs causing serum sickness (fever, arthralgias, rash) Phenytoin can cause generalized lymphadenopathy in absence of serum sickness reaction Other drugs that cause lymphadenopathy: allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, PCN, primidone, pyrimethamine, quinidine, sulfonamides, sulindac

Question 28

Cattleman's syndrome

Answer 28

Uncommon lymphoproliferative disorder | Massive lymphadenopathy with fever, hepatosplenomegaly polyclonal hypergammaglobulinemia, amyloidosis

Question 29

Other causes of mono-like disease

Answer 29

CMV, HHV6, HIV, Adenovirus, HSV, S. pyogenes, Toxoplasma gondii

Question 30

Kikuchi's disease

Answer 30

Rare, benign condition of unknown cause Affects young women Cervical lymphadenopathy only or generalized Fever

Question 31

Kawasaki disease

Answer 31

Childhood vasculitis | Cervical lymphadenopathy with fever, conjunctivitis, mucositis (strawberry tongue), rash, coronary artery aneurysms

Question 32

angioimmunoblastic T cell lymphoma

Answer 32

Systemic disease | Generalized lymphadenopathy with fever, hepatosplenomegaly, hemolytic anemia, polyclonal hypergammaglobulinemia

Question 33

inflammatory pseudotumor

Answer 33

Syndrome of lymphadenopathy in 1+ node groups Systemic symptoms Nodes usually show a fibrosing and inflammatory process

Question 34

amyloidosis

Answer 34

Systemic disease with deposition of amyloid protein. | Most often will have amyloid deposition in other organs, but occasionally can be deposited only in nodes

Question 35

Kimura disease

Answer 35

Inflammatory condition of subQ tissue and lymph nodes of head/neck Associated with elevated serum IgE and eosinophilia.

Question 36

firm, rubbery lymphadenopathy

Answer 36

lymphomas, chronic leukemia

Question 37

causes of splenomegaly

Answer 37

``` congestive malignancy infiltrative infectious inflammation hematologic ```

Question 38

congestive causes of splenomegaly

Answer 38

Cirrhosis CHF Thrombosis of portal, hepatic, or splenic veins

Question 39

malignant causes of splenomegaly

Answer 39

``` Hematologic malignancies (lymphoma, acute and chronic leukemias, polycythemia vera, multiple myeloma, essential thrombocythemia) Primary splenic tumors Non-hematologic metastatic solid tumors ```

Question 40

infiltrative (non-malignant) causes of splenomegaly

Answer 40

``` Gaucher's disease Niemann-Pick disease Amyloid Glycogen storage disease Langerhans cell histiocytosis Hemophagocytic lymphohistiocytosis ```

Question 41

infectious causes of splenomegaly

Answer 41

Viral (hepatitis, infectious mononucleosis, CMV) Bacterial (salmonella, brucella, TB) Parasitic (malaria, schistosomiasis, toxoplasmosis, leishmaniasis) Infective endocarditis (embolic) Fungal

Question 42

inflammatory causes of splenomegaly

Answer 42

Sarcoid Serum sickness SLE RA (Felty syndrome)

Question 43

hematologic causes of splenomegaly

Answer 43

Acute and chronic hemolytic anemias, all etiologies Sickle cell disease (children) Following use of recombinant human granulocyte colony-stimulating factor Myelofibrosis

Question 44

Chronic ETOH or hepatitis & ascites

Answer 44

splenomegaly secondary to cirrhosis and portal HTN

Question 45

Young adult with fatigue, fever, sore throat, splenomegaly

Answer 45

infectious mononucleosis or other viral infection

Question 46

Older adult c/o post-bath pruritis with ruddy complexion and splenomegaly

Answer 46

polycythemia vera