Lymphadenopathy

Question 1

Define lymphadenopathy?

Answer 1

Enlargement of one of more lymph nodes

Question 2

What are the 3 general causes of lymphadenopathy?

Answer 2

Infection

Neoplasm

Autoimmune disease

Question 3

What 4 types of infection can cause lymphadenopathy?

Answer 3

Bacterial

Fungal

Viral

Protozoal

Question 4

Give 5 types of bacterial infections that commonly cause lymphadenopathy?

Answer 4

Streptococcal

TB

Brucellosis

Typhoid fever

Cat scratch fever

Question 5

Give 2 types of viral infections that commonly cause lymphadenopathy?

Answer 5

HIV

EBV

Question 6

Give a type of fungal infection that commonly causes lymphadenopathy?

Answer 6

Histoplasmosis

Question 7

Give 2 types of protozoal infections that commonly cause lymphadenopathy?

Answer 7

Toxoplasmosis

Malaria

Question 8

How can someone acquire toxoplasmosis, and how can you identify this in a patient history?

Answer 8

Acquired from dogs

Ask patient if they have pets or have come into contact with any animals

Question 9

How can someone acquire cat scratch fever, and how can you identify this in a patient history?

Answer 9

Acquired from cats

Ask patient if they have pets or have come into contact with any animals

Question 10

If lymphadenopathy is caused by a primary tumour, what is the most likely origin of the tumour and why?

Answer 10

Haematological cancer, as the origin cell types directly involve lymphoreticular system

Question 11

If lymphadenopathy is caused by a primary tumour, is the tumour more likely to be a haematological cancer or solid organ cancer?

Answer 11

Haematological cancer, as the origin cell types directly involve lymphoreticular system

Solid organ cancer doesn’t directly involve lymphoreticular system

Question 12

Which 5 types of cancer are most likely to cause lymphadenopathy due to metastasis?

Answer 12

Lung

Breast

Thyroid

Melanoma

Stomach

Question 13

Give 4 examples of autoimmune diseases that commonly cause lymphadenopathy?

Answer 13

SLE

Sarcoidosis

RA

Connective tissue diseases

Question 14

What are the 2 presentations of lymphadenopathy, regarding the distribution of affected lymph nodes?

Answer 14

Generalised

Localised

Question 15

Define generalised lymphadenopathy?

Answer 15

Lymphadenopathy in 2 or more noncontiguous lymph node groups

Question 16

Define localised lymphadenopathy?

Answer 16

Lymphadenopathy in one lymph node group only

Question 17

What is often the general cause of generalised lymphadenopathy?

Answer 17

Underlying haematological malignancy (neoplasm)

Not common when secondary to infection or autoimmune disease

Question 18

What are the 2 common causes of localised lymphadenopathy?

Answer 18

Infection in the same region

Solid tumour which is draining into regional lymph node group

Question 19

When lymphadenopathy presents, what is usually the speed of onset?

Answer 19

Swells rapidly

Question 20

When a swollen lymph node is painful to touch, what are the 2 most likely underlying causes?

Answer 20

Infection or autoimmune disease flare up

Reactive lymphadenopathy

Question 21

When a swollen lymph node is painless to touch, what is the most likely underlying cause?

Answer 21

Malignancy (neoplasm)

Question 22

In lymphadenopathy, what fluid do enlarged lymph nodes usually drain?

Answer 22

Pus

Question 23

Give 5 associated symptoms of lymphadenopathy, and which of these 3 are red flag symptoms?

Answer 23

Weight loss (RED FLAG)

Fatigue

Shortness of breath

Night sweats that require changing clothes (RED FLAG)

Long-term fever (RED FLAG)

Question 24

What are the 3 common red flag symptoms of lymphadenopathy, and what is the most likely underlying cause?

Answer 24

Weight loss, drenching night sweats, long-term fever

Haematological malignancy

Question 25

What physical examination is done to assess lymphadenopathy?

Answer 25

Lymphoreticular exam

Question 26

What is the gold standard group of lab tests for diagnosis of lymphadenopathy origins?

Answer 26

Tissue diagnosis

Question 27

Give 5 underlying causes of lymphadenopathy that can be accurately diagnosed using FNA cytology?

Answer 27

Reactive hyperplasia Infections Granulomatous lymphadenopathies Lymphomas Metastatic malignancies

Question 28

How can FNA cytology be improved to accurately diagnose when metastasis has caused lymphadenopathy?

Answer 28

Ultrasound-guided to examine suspicious areas of lymph node such as where metastasis could have occurred

Question 29

How can FNA cytology be improved to accurately diagnose when lymphoma has caused lymphadenopathy?

Answer 29

Immunochemistry and flow cytometry

Question 30

Why is FNA cytology not the gold standard lab test for diagnosing Hodgkin's lymphoma as the cause of lymphadenopathy?

Answer 30

Has high rate of false-negative results for Hodgkin’s lymphoma

Question 31

Why is FNA cytology not the gold standard lab test for diagnosing Non-Hodgkin's lymphoma as the cause of lymphadenopathy?

Answer 31

Provides vague classification of non-Hodgkin’s lymphoma

Question 32

What lab test is completed to investigate if lymphadenopathy has originated from a skin lesion?

Answer 32

Skin biopsy

Question 33

What blood tests are done to diagnose infections and autoimmune diseases as the underlying cause of lymphadenopathy?

Answer 33

FBC Differential, complete metabolic panel Fungal serologies QuantiFERON: TB

Question 34

What mode of radiological investigation is ideally used for peripheral lymphadenopathy?

Answer 34

Ultrasonography

Question 35

What is the main reason for using Colour-doppler sonography to investigate lymphadenopathies?

Answer 35

Can distinguish between old and active lymphadenopathies

Question 36

CT and MRI are used to investigate lymphadenopathies in which 2 body regions?

Answer 36

Thoracic cavity Abdominopelvic cavity

Question 37

Give 2 examples of primary tumours that commonly cause lymphadenopathies?

Answer 37

Lymphoma Leukaemia

Question 38

Give 2 examples of drugs that cause lymphadenopathy and 1 example that doesn't?

Answer 38

Phenytoin, hydralazine Amiodarone