Final - Lymph Nodes

Question 1

What are lymph nodes

Answer 1

Small oval shaped clusters of WBCs covered by connective tissue capsule that filter lymphatic fluid

Question 2

Lymph nodes can swell and react in response to what 4 things

Answer 2

• infection
• Inflammation
• medication
• malignancy

99% of reactive lymph nodes in general practice are benign

Question 3

Lymphadenopathy (LAD) is

Answer 3

Enlarged lymph nodes

Lay term “swollen gland”

Question 4

Lymphadenitis is

Answer 4

Inflammation lymph nodes (tenderness common)

Lay term “swollen glands”

Question 5

What lymph nodes can we palpate on an exam

Answer 5

Superficial and deep cervical chain

Question 6

What are 5 characteristics to look for when examining lymph nodes

What indicates cancer?

Answer 6

Characteristic (could be cancer)

• consistency (rock hard)
• movable? (Immovable)
• tender? (tender)
• distinct borders? (Thick and no borders)
• size (>1cm is large, >2cm cold be cancer)

Question 7

Lymph nodes are “non-pathologic” if (

Answer 7

• soft or shotty (firm)
• mobile
• non-tender
• oil/flat with smooth borders
• small
• should go away/get smaller within about 4 weeks

Question 8

A small lymph node could be

Answer 8

Normal, inflammation, infection

Question 9

A firm lymph node could be

Answer 9

(Shotty)

Normal, post-infection

Question 10

Firm-rubbery lymph nodes could be

Answer 10

Lymphoma

Question 11

Rock hard lymph nodes could be

Answer 11

Metastatic cancer

Question 12

What is the malignancy prevalence? What age, duration, mobility and location increase the risk for malignancy

Answer 12

~1.1%

• > 40 years old
• 2-4 weeks
• fixed to surrounding tissue
• supraclavicular location

Question 13

Metastatic malignant lymph nodes are ___ cm, (hard/soft), (tender/not tender), (margins defined/not), (fixed/mobile), (bilateral/unilateral)

Answer 13

>1cm
Hard
Not tender
Margins less defined 
Fixed 
Often unilateral

Question 14

Lymphoma lymph nodes are ___cm, (soft/rubbery), (movable/immovable), (tender/not), (margins defined/not)

Answer 14

• > 1cm
• rubbery (to firm)
• not moveable
• not tender
• discrete margins

Question 15

What four associated symptoms might a reason with lymphoma have?

Answer 15

• Night sweats,
• Weight loss (10% body mass over 6 months)
• Fevers
• cough

Question 16

Infectious lymphadenopathy (aka lymphadenitis) is ___cm, (hard/soft), (movable/immovable), (tender/not), (defined margins/not), and _____

Answer 16

> 1cm

• soft
• movable
• tender
• discrete margins
• sometimes, overlying red skin

Question 17

Acute infections LAD (Mono) is due to the ________, most common in ________, and the symptoms (5)

Answer 17

• Epstein-Barr virus> transmission via saliva
• teens/young adults

Symptoms

• fatigue (extreme)
• body aches
• fever
• sore throat
• swollen lymph nodes in neck

Question 18

Which 3 lymph node areas are common for mono (LR?)

What other two signs are common with mono

Answer 18

• Posterior cervical lymphadenopathy (+LR 12)
• axillary lymphadenopathy (+LR 21)
• tonsil or pharyngeal exudates
• splenomegaly/hepatomegaly

Question 19

How do you make the dx for mono

Answer 19

• rule out strep throat
• monospot test (blood test)
• CBC with differential (blood test)
• liver function tests (blood test)

Question 20

What is the treatment for mono (2 things)

Answer 20

• Caution patients to avoid exercise/ intact sports for ~4 weeks to decrease risk of splenic rupture
• rest

Question 21

Shotty LAD: old infection (aka hyper plastic nodes) are ___cm, (hard/soft), (movable/ immovable), (tender/non-tender), (discrete margins) and ______

Answer 21

<1cm

• soft or firm
• movable
• non-tender
• discrete margins
• Eschar

Question 22

If you see a large lymph node in the occipital regions (Base of hairline)

Answer 22

• look in hair for ring worm, cut on scalp, lice)

Question 23

If you find lymph nodes in the post-auricular area, where do you look

Answer 23

Inside the ear

Question 24

If someone has pre-auricular nodes, where do you look

Answer 24

Conjunctiva (eyes) & skin of the cheek, eyelids, and temporal region

Question 25

If someone has submandibular submental nodes, where do you look?

Answer 25

Face and mouth

Question 26

If someone has anterior/posterior superficial cervical chains where do you look

Answer 26

All the scalp/ear/facial nodes

Question 27

if someone has Deep cervico - facial nodes, where do you look

Answer 27

Deep cervical nodes (typically not palpable)

Question 28

supraclavicular nodes have a high risk of _______. Left supraclavicular LAD = _____ = _____

Answer 28

GI or intra-thoracic malignancy Virchows node Sentinel node

Question 29

Localized lymphadenopathy without clear source should prompt ____

Answer 29

Evaluation for generalized LAD