Pales PPT PArt I Flashcards by Amanda Beach

what constitutes lymphadenopathy in children and adults?

children- palpable nodes

adults- nodes larger than 1-2 cm in diameter(except in groin)

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anterior cervical lymphadenopathy is usually caused by what?

local: strep staph, rubella, dental
systemic: EBC, CMV or toxo

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posterior cervical lymphadenopathy is associated with what

malignancy

EBV, TB ,lymphoma, head/neck malignancy

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supraclavicular lymphadenopathy is at high risk for

malignancy

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right supraclavicular lymphadenopathy is significant for

cancer of mediastinum, lungs or esophagus

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L supraclavicular lymphadenopathy is significant for

Virchows node
abdominal malignancy (stomach, gall bladder, pancreas, kidneys, testicles, ovaries or prostate)

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what infections can cause axillary lymphadenopathy

cat scratch disease

cellulitis

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what cancers can cause localized axillary lymphadenopathy

breast

other metastasis

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what can cause epitrochlear lymphadenopathy

infections of forearm of hand
lymphoma
sarcoidosis
tularemia
secondary syphilis

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what can cause inguinal lymphadenopathy

infection
STD
cancer: skin of lower extremities and trunk, cervix, vulva, and ovary, rectum and anus, penis

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causes of mediastinal lymphadenopathy

infection: TB, fungal infection, anthrax
Neoplastic: lymphoma, lung cancer, germ cell tumor
other: sarcoidosis

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what can cause retroperitoneal lymphadenopathy

infection: TB
neoplastic: lymphoma, testicular cancer, kidney cancer, upper GI malignancy
other: sarcoidosis

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what can cause mesenteric lymphadenopathy

infection: appendicitis, cholecystitis, diverticulitis, whipple’s disease
neoplastic: lymphoma, GI cancer
other: IBD, panniculitis

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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

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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

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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

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what other mono-like diseases can cause generalized lymphadenopathy

CMV
herpes virus 6
HIV
adenovirus, herpes simplex
strep pyogenes
toxoplasma gondii

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How does lymphadenopathy from SLE present

soft nontender
cervical, axillary and inguinal areas
develops onset of disease or in assoc with an exacerbation

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what is serum sickness

fever, arthralgias, rash and generalized lymphadenopathy

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what medication can cause generalized lymphadenopathy in absence of serum sickness reaction

phenytoin

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What drugs have been known to cause lymphadenopathy

allopurinol
atenolol
captopril
carbamazepine
cephalosporins
gold
hydralazine
penicillin
phenytoin
primidone
pyrimethamine
quinidine
sulfonamides
sulindac

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how to Dx cause of generalized lymphadenopathy

biopsy

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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