Sandbox:Javaria: Difference between revisions
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<ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref><ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid12484692">{{cite journal |vauthors=Bazemore AW, Smucker DR |title=Lymphadenopathy and malignancy |journal=Am Fam Physician |volume=66 |issue=11 |pages=2103–10 |date=December 2002 |pmid=12484692 |doi= |url=}}</ref> | <ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref><ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid12484692">{{cite journal |vauthors=Bazemore AW, Smucker DR |title=Lymphadenopathy and malignancy |journal=Am Fam Physician |volume=66 |issue=11 |pages=2103–10 |date=December 2002 |pmid=12484692 |doi= |url=}}</ref><ref name="pmid10549745">{{cite journal |vauthors=Soldes OS, Younger JG, Hirschl RB |title=Predictors of malignancy in childhood peripheral lymphadenopathy |journal=J. Pediatr. Surg. |volume=34 |issue=10 |pages=1447–52 |date=October 1999 |pmid=10549745 |doi=10.1016/s0022-3468(99)90101-x |url=}}</ref><ref name="pmid10189390">{{cite journal |vauthors=Ghirardelli ML, Jemos V, Gobbi PG |title=Diagnostic approach to lymph node enlargement |journal=Haematologica |volume=84 |issue=3 |pages=242–7 |date=March 1999 |pmid=10189390 |doi= |url=}}</ref> | ||
{{familytree/start |summary=Management of lymphadenopathy}} | {{familytree/start |summary=Management of lymphadenopathy}} | ||
{{familytree | | | | | | | | | | | | | | Z01 | | | | | | | |Z01='''History'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br><div style="float: left; text-align: left; width: 20em; padding:1em;"> | {{familytree | | | | | | | | | | | | | | Z01 | | | | | | | |Z01='''History'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br><div style="float: left; text-align: left; width: 20em; padding:1em;"> | ||
❑[[Patient]] [[age]] (specific demographic characteristics ([[age]]) of certain [[malignancy|malignancies]])<br> | :❑[[Patient]] [[age]] (specific demographic characteristics ([[age]]) of certain [[malignancy|malignancies]])<br> | ||
❑ Duration of [[lymphadenopathy]] (<2 weeks or >1 year without an increase in size has low malignant potential)<br> | :❑ Duration of [[lymphadenopathy]] (<2 weeks or >1 year without an increase in size has low malignant potential)<br> | ||
❑ Past medical history of underlying disease, suggestive of [[immunodeficiency]], or recurrent [[infections]]<br> | :❑ Past medical history of underlying disease, suggestive of [[immunodeficiency]], or recurrent [[infections]]<br> | ||
❑ Sexual history suggestive of infection transmission<br> | :❑ Sexual history suggestive of infection transmission<br> | ||
❑ Family history of certain malignant disorders ([[breast cancer]], or [[melanoma]])<br> | :❑ Family history of certain malignant disorders ([[breast cancer]], or [[melanoma]])<br> | ||
❑ Exposure to communicable [[infectious disease]]s/ travel to high-risk areas<br> | :❑ Exposure to communicable [[infectious disease]]s/ travel to high-risk areas<br> | ||
❑ Environmental exposure such as [[ultraviolet radiation|UV]] (skin cancer risk)/ animals/ occupational exposure <br> | :❑ Environmental exposure such as [[ultraviolet radiation|UV]] (skin cancer risk)/ animals/ occupational exposure <br> | ||
❑ Social history such as tobacco use, alcohol use (head and neck cancers risk)<br>}} | :❑ Social history such as tobacco use, alcohol use (head and neck cancers risk)<br> | ||
:❑ Associated symptoms such as [[pain]], [[fever]], [[weight loss]], [[anorexia]], [[cough]], or recurrent [[UTI]]s}} | |||
{{familytree | | | | | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | | | | | | | | | M01 | | | | | | | M01='''[[Physical exam]]'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br>'''Appearance of the [[patient]]'''<br>[[Cachexia]] or surgical scar marks demonstrating previous malignancy treatment<br> | {{familytree | | | | | | | | | | | | | | M01 | | | | | | | M01='''[[Physical exam]]'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br>'''Appearance of the [[patient]]'''<br>[[Cachexia]] or surgical scar marks demonstrating previous malignancy treatment<br> | ||
[[Vital signs]]<br> | ❑ [[Vital signs]]<br> | ||
:❑ [[Temperature]]: High-grade / low-grade fever may demonstrate [[infection]]. <br> | |||
:❑ [[Heart rate]]: [[Tachycardia]] with regular pulse may demonstrate [[infection]]. <br> | |||
:❑ [[Respiratory rate]]: [[Tachypnea]] may demonstrate [[respiratory system]] involvement ([[infection]]\ [[metastasis]]).<br> | |||
:❑ [[Blood pressure]]: [[Chronic hypertension]] or [[hypotension]] (may indicate [[sepsis]] as a complication).<br> | |||
:❑ [[Oxygen saturation]]: may be low if the [[respiratory system]] is affected.<br> | |||
❑ HEENT<br> | |||
❑ [[Cardiovascular examination]]<br> | |||
❑ [[Respiratory examination]]<br> | |||
❑ [[Gastrointestinal system]] exam includes [[oral examination]], [[abdominal examination]], and [[digital rectal exam]]. <br> | |||
:❑ [[Splenomegaly]]) may demonstrate [[infectious mononucleosis|IM]], [[Hodgkin's lymphoma|hodgkin's]]/ [[non-Hodgkin's lymphoma]], and [[sarcoidosis]]}}<br> | |||
❑ [[Limb (anatomy)|Extremities]] exam<br> | |||
❑ Skin exam: Evaluate for the lesions that indicate [[malignancy]] such as [[melanoma]]/ potential inoculation sites for germ such as traumatic lesions.}} | |||
{{familytree | | | | | | | | | | | | | | |!| | | | | | |}} | |||
{{familytree | | | | | | | | | | | | | | N01 | | | | | | | N01='''Palpable [[lymph node]]'''<div style="float: left; text-align: left; width: 20em; padding:1em;"><div class="mw-collapsible mw-collapsed"><br> | |||
❑ Location: (Localized vs generalized)<br> | |||
:❑ For nodes involving several groups of nodes; suspect malignancy.<br> | |||
:❑ An enlarged node in a lymphatic rich region; suspect local disease.<br> | |||
:❑ Associated red streaking, suspect [[lymphangitis]].<br> | |||
:❑ Left [[supraclavicular lymph nodes|supraclavicular L.N]] ([[Virchow's nodes]]); suspect [[gastric carcinoma]]<br> | |||
:❑ Right [[supraclavicular lymph nodes|supraclavicular L.N]], suspect intra-thoracic carcinoma<br> | |||
❑ Dimensions <br> | |||
The aforementioned dimensions are abnormal for a palpable [[lymph node]] but do not lead to the suspician of a [[neoplasm]]. | |||
:❑ [[Supraclavicular lymph nodes|supraclavicular]], [[iliac lymph nodes|iliac]], [[epitrochlear lymph nodes|epitrochlear]], and [[popliteal lymph nodes]] >0.5cm <br> | |||
:❑ [[Inguinal nodes]] > 1.5 cm <br> | |||
:❑ Other area [[lymph nodes]] >1 cm <br> | |||
❑ Tenderness or pain: <br> | |||
:❑ Suspect [[infection]]. <br> | |||
:❑ A [[neoplastic]] node may also demonstrate [[pain]] due to [[hemorrhage]] associated with central necrosis or a brisk growing tumor.<br> | |||
❑ Consistency <br> | |||
:❑ Hard on palpation; suspect [[chronic inflammation]]<br> | |||
:❑ consistent- acute inflammation<br> | |||
:❑ Stony-hard and painless nodes-metastatic cancer/ [[granuloma]] <br> | |||
:❑ Firm and rubbery nodes- lymphoma<br> | |||
:❑ Matted [[lymph nodes|L.N]] suspect [[mycobacterium]] / [[sarcoidosis]]/ [[lymphoma]] / [[metastatic carcinoma]])<br> | |||
❑ Mobility<br> | |||
:❑ Freely movable; suspect [[infections]] and [[collagen vascular disease]]<br> | |||
:❑ Fixed [[Lymph node|L.N]] to surrounding tissue; suspect [[malignancy]]}}. | |||
{{familytree | | | | | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | | | | | | | | | |,|^|.| | | | | | |}} | {{familytree | | | | | | | | | | | | | |,|^|.| | | | | | |}} | ||
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*Physical examination should not be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and unnecessary delays.<ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref> | *Physical examination should not be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and unnecessary delays.<ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref> | ||
*Fine-needle aspiration biopsy (FNAC) or excisional biopsy is the gold standard for tissue diagnosis and evaluation for LAD.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> | *Fine-needle aspiration biopsy (FNAC) or excisional biopsy is the gold standard for tissue diagnosis and evaluation for LAD.<ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref> | ||
common causes | |||
Lymphadenopathy involving [[supraclavicular lymph nodes|supraclavicular L.N]] poses the highest risk of [[malignancy]] (90% among patients >40 years of age) and 25% among < 40 years old. <ref name="pmid3049914">{{cite journal |vauthors=Fijten GH, Blijham GH |title=Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup |journal=J Fam Pract |volume=27 |issue=4 |pages=373–6 |date=October 1988 |pmid=3049914 |doi=10.1080/09503158808416945 |url=}}</ref> |
Revision as of 13:28, 21 August 2020
❑ Extremities exam
❑ Skin exam: Evaluate for the lesions that indicate malignancy such as melanoma/ potential inoculation sites for germ such as traumatic lesions.}}
History
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical exam Appearance of the patient Cachexia or surgical scar marks demonstrating previous malignancy treatment
❑ HEENT
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Palpable lymph node ❑ Location: (Localized vs generalized)
❑ Dimensions
❑ Tenderness or pain:
❑ Consistency
❑ Mobility
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{Y02 }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
'❑ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patient is unstable | Patient is stable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
' | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ W02 }}} | {{{ W03 }}} | {{{ W04 }}} | {{{ W05 }}} | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
S | {{{ V02 }}} | {{{ V04 }}} | {{{ V05 }}} | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ C01 }}} | {{{ C03 }}} | {{{C01}}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ M02 }}} | {{{ M03 }}} | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ H02 }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ K02 }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
{{{ I01 }}} | {{{ I02 }}} | {{{I01}}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
Patients with immunodeficiency should have a wide differential diagnosis consideringnon-Hodgkin's lymphoma and Kaposi’s sarcoma.[3]
Dont's
- Physical examination should not be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and unnecessary delays.[1]
- Fine-needle aspiration biopsy (FNAC) or excisional biopsy is the gold standard for tissue diagnosis and evaluation for LAD.[2]
common causes
Lymphadenopathy involving supraclavicular L.N poses the highest risk of malignancy (90% among patients >40 years of age) and 25% among < 40 years old. [6]
- ↑ 1.0 1.1 Garg PK, Jain BK, Dubey IB, Sharma AK (2013). "Generalized lymphadenopathy: physical examination revisited". Ann Saudi Med. 33 (3): 298–300. doi:10.5144/0256-4947.2012.01.7.1525. PMC 6078537. PMID 22750769.
- ↑ 2.0 2.1 Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (March 2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
- ↑ 3.0 3.1 Bazemore AW, Smucker DR (December 2002). "Lymphadenopathy and malignancy". Am Fam Physician. 66 (11): 2103–10. PMID 12484692.
- ↑ Soldes OS, Younger JG, Hirschl RB (October 1999). "Predictors of malignancy in childhood peripheral lymphadenopathy". J. Pediatr. Surg. 34 (10): 1447–52. doi:10.1016/s0022-3468(99)90101-x. PMID 10549745.
- ↑ Ghirardelli ML, Jemos V, Gobbi PG (March 1999). "Diagnostic approach to lymph node enlargement". Haematologica. 84 (3): 242–7. PMID 10189390.
- ↑ Fijten GH, Blijham GH (October 1988). "Unexplained lymphadenopathy in family practice. An evaluation of the probability of malignant causes and the effectiveness of physicians' workup". J Fam Pract. 27 (4): 373–6. doi:10.1080/09503158808416945. PMID 3049914.