Lymphadenopathy

Question 1

anterior cervical

Answer 1

usually benign
strep or staph, rubella, dental

EBV, CMV, Toxo

Question 2

posterior cervical

Answer 2

possibly benign, more often malignant

EBV, TB, lymphoma, head or neck malignancy

Question 3

R supraclavicular

Answer 3

High risk for malignancy
Right
Cancer of mediastinum, lungs or esophagus

Question 4

L supraclavicular

Answer 4

Abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries, or prostate)

Question 5

Axillary

Answer 5

Infections:
Cat scratch disease
Cellulitis

Cancer:
Breast
Other metastasis

Silicone breast implants:
( may cause both supraclavicular and axillary lymphadenopathy)

Question 6

epitrochlear

Answer 6

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

Question 7

Inguinal

Answer 7

Lower extremity infection
Sexually transmitted diseases
Cancer:
Skin of the lower extremities and trunk
Cervix, vulva, and ovary
Rectum and anus 
Penis

Question 8

Mediastinal

Answer 8

Infections: TB, fungal, antrax

Neoplasms: lymphoms, lung cancers, germ cell

Sarcoidosis

Question 9

Retroperitoneal

Answer 9

Infectious
TB 
Neoplastic
Lymphoma, testicular cancer, kidney cancer, upper GI malignancy 
Other
Sarcoidosis

Question 10

Mesenteric

Answer 10

Infectious
Appendicitis, cholecystitis, diverticulitis, Whipple's disease
Neoplastic
Lymphoma, GI cancer 
Other
Inflammatory bowel disease, panniculitis

Question 11

HIV

Answer 11

Nontender, axillary , cervical, occipital during week 2

decrease in size

Question 12

Mycobacterial infection

Answer 12

non-tender, enlarge slowly in weeks or months
can present w/ LA alone in neck (scrofula)
TB in adults, MAC in kids

matting and fluctuation

Question 13

Infectious mononucleosis

Answer 13

Triad: Fever+pharyngitis+LA
symmetrical LA
posterior cervical 
axillary and inguinal (unique)
peaks at 1 week, then reduces

Question 14

SLE

Answer 14

50% of patients
soft, nontender
cervical, axillary, inguinal

begins at disease onset and during flare-ups

Question 15

Medications

Answer 15

some cause serum sickness:
fever, arthralgias, rash, gen LA

Phenytonin can cause it w/o serum sickness

Question 16

diagnostic approach to generalized LA

Answer 16

CBC, heterophile, CXR

then:
PPD, HIV, RPR, ANA

Question 17

congestive SM

Answer 17

cirrhosis
CHF
Thrombosis of portal, hepatic, splenic veins

Question 18

Malignant SM

Answer 18

L/L, Polycythemia vera, MM, ET

primary splenic tumors, mets

Question 19

Infectious SM

Answer 19

hepatitis, mono, CMV
Salmonella, brucella, TB
malaria, schisto, toxo, leishmaniasis
IBE

Question 20

Inflammatory SM

Answer 20

Sarcoid, serum sickness, SLE, RA (Felty Syndrome)

Question 21

Infilatrative SM

Answer 21

Gaucher’s and Glycogen storage disease
Niemann PIck
Amyloid
Langerhans

Question 22

Hematologic Sm

Answer 22

acute and chronic IHAs
SCD (kids) 
Thalassemia major
EMH (myelofibrosis) 
recombinant HGCSF