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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="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> | <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> | ||
Line 11: | Line 11: | ||
:❑ 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}} | :❑ 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> | :❑ [[Temperature]]: High-grade / low-grade fever may demonstrate [[infection]]. <br> | ||
Line 26: | Line 26: | ||
❑ [[Limb (anatomy)|Extremities]] exam<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.}} | ❑ Skin exam: Evaluate for the lesions that indicate [[malignancy]] such as [[melanoma]]/ potential inoculation sites for germ such as traumatic lesions.}} | ||
{{familytree | | | | | | | | | |!| | | | | | |}} | {{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> | {{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> | ❑ Location: (Localized vs generalized)<br> | ||
:❑ For nodes involving several groups of nodes; suspect malignancy.<br> | :❑ For nodes involving several groups of nodes; suspect malignancy.<br> | ||
Line 35: | Line 35: | ||
:❑ Right [[supraclavicular lymph nodes|supraclavicular L.N]], suspect intra-thoracic carcinoma<br> | :❑ Right [[supraclavicular lymph nodes|supraclavicular L.N]], suspect intra-thoracic carcinoma<br> | ||
❑ Dimensions <br> | ❑ Dimensions <br> | ||
The aforementioned dimensions are abnormal for a palpable [[lymph node]] but do not lead to the | The aforementioned dimensions are abnormal for a palpable [[lymph node]] but do not lead to the suspicion of a [[neoplasm]]. | ||
:❑ [[Supraclavicular lymph nodes|supraclavicular]], [[iliac lymph nodes|iliac]], [[epitrochlear lymph nodes|epitrochlear]], and [[popliteal lymph nodes]] >0.5cm <br> | :❑ [[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> | :❑ [[Inguinal nodes]] > 1.5 cm <br> | ||
Line 52: | Line 52: | ||
:❑ Fixed [[Lymph node|L.N]] to surrounding tissue; suspect [[malignancy]]}}. | :❑ Fixed [[Lymph node|L.N]] to surrounding tissue; suspect [[malignancy]]}}. | ||
{{familytree | | | | | | | | | | |!| | | | | | | }} | {{familytree | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | |,|-|-|-|v|-|-|-|+|-|-|-|-|.| | |}} | {{familytree | | | | | | | | | | U01 | | | | | | | U01='''Labs'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"> | ||
{{familytree | ❑ [[CBC]] with differential<br> | ||
{{familytree | | | | | | | |! | ❑ [[ESR]]<br> | ||
{{familytree | | | | | | | | | | ❑ [[CMP]]<br> | ||
{{familytree | | | | | | | | |!| | |!| | | |!| | | | | |}} | ❑ [[Peripheral smaer]]<br> | ||
{{familytree | | | | | | ❑ [[Liver function tests|LFTs]]}} | ||
{{familytree | | | | | | | {{familytree | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | | | | | {{familytree | | | | | | | | | | |!| | | | | | | }} | ||
{{familytree | |,|-|-|-|v|-|-|-|-|+|-|-|-|-|.| | |}} | |||
{{familytree | Y01 | | Y02 | |,| Y03 | | | Y04 | | | |Y01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Diagnostic of self-limiting or benign disease'''<br> | |||
[[Pharyngitis]], [[URTI]], [[conjunctivitis]], [[cat-scratch disease]], etc|Y02='''Suggests infection/ serious infection'''|Y03='''unexplained'''|Y04='''Suggests malignancy'''}} | |||
{{familytree | |!| | | |!| | |!|!| | | | |!|}} | |||
{{familytree | K01 | | K02 | |!| K03 | | | | |!| | K01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> May require specific tests<div class="mw-collapsible mw-collapsed"><br> | |||
❑ Throat swab<br> | |||
❑ [[Sputum exam]]| K02=<div style="float: left; text-align: left; width: 20em; padding:1em;">Perform specific tests<div class="mw-collapsible mw-collapsed"><br> | |||
❑ [[Mononucleosis|IM]]: [[Mononucleosis laboratory findings|Heterophile Antibody]] and [[Mononucleosis laboratory findings|monospot test]] <br> | |||
❑ [[Syphilis]]: [[VDRL]], [[RPR]]<br> | |||
❑ [[HIV]]: [[HIV test#Antibody tests|HIV antibody test]] <br> | |||
❑ [[CMV]]: Anti CMV [[IgM]]<br> | |||
❑ [[Autoimmune disorders]]: [[ANA]], [[Rheumatoid factor]], etc<br> | |||
❑ [[Tuberculosis]]: [[PPD]]<br> | |||
❑ [[Cat scratch fever|Cat scratch disease]]: [[IgM]], [[IgG]]|K03=Positive}} | |||
{{familytree | |!| | | |!| | |!| | | | | |!|}} | |||
{{familytree | |!| | |,|^|-|.|!| | | | |!|}} | |||
{{familytree | |!| | B01 | | B02 | | | | | | |!| |B01=Positive|B02=Negative}} | |||
{{familytree | |!| | |!| | | | | | | | |!| | | | | |W01=Positive}} | |||
{{familytree | |!| | |!| | | | | | |!| | | |X02=}} | |||
{{familytree | |!| | |!| | | | | | |!| | |,|-|^|-|.|}} | |||
{{familytree | W01 | | W02 | | | | | |!| | | | | | | |W01=<div style="float: left; text-align: left; width: 20em; padding:1em;">❑ Treat<div class="mw-collapsible mw-collapsed">with [[antibiotics]] if required and/ or symptomatic treatment<br> | |||
❑ For an untreatable or disease with residual symptoms counsel the [[patient]]<br> | |||
❑ Follow up for advancing or persistent [[lymphadenopathy|LAD]]|W02=<div style="float: left; text-align: left; width: 20em; padding:1em;">Treat<div class="mw-collapsible mw-collapsed"><br> | |||
❑ [[Mononucleosis medical therapy|IM treatment]]<br> | |||
❑ [[Syphilis medical therapy|Syphilis treatment]]<br> | |||
❑ [[HIV medical therapy|HIV treatment]]<br> | |||
❑ [[Cytomegalovirus infection medical therapy|CMV treatment]]<br> | |||
❑ [[Autoimmunity#Treatments|Treatment of autoimmune disorders]]<br> | |||
❑ [[Tuberculosis medical therapy|Tuberculosis treatment]]<br> | |||
❑ [[Cat scratch fever medical therapy|cat scratch disease treatment]]}} | |||
{{familytree | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; padding:1em;">}} | {{familytree | | | | | | | | | | A01 | | | | | | | |A01=<div style="float: left; text-align: left; padding:1em;">}} | ||
{{familytree | | | | | | |,|-|-|-|^|-|-|.| | | | }} | {{familytree | | | | | | |,|-|-|-|^|-|-|.| | | | }} | ||
{{familytree | | | | | | W01 | | | | | W02 | | | | | | |W01= | {{familytree | | | | | | W01 | | | | | W02 | | | | | | |W01= <br> |W02='}} | ||
{{familytree | | | | | |!| | | | | | |!| | | | }} | {{familytree | | | | | |!| | | | | | |!| | | | }} | ||
{{familytree | | | | | L01 | | | | | |!| | | | L01=<div style="float: left; text-align: left; line-height: 150% ">}} | {{familytree | | | | | L01 | | | | | |!| | | | L01=<div style="float: left; text-align: left; line-height: 150% ">}} |
Revision as of 00:46, 22 August 2020
.
History
| |||||||||||||||||||||||||||||||||||||||||
Physical exam Appearance of the patient Cachexia or surgical scar marks demonstrating previous malignancy treatment
❑ HEENT
❑ Extremities exam | |||||||||||||||||||||||||||||||||||||||||
Palpable lymph node ❑ Location: (Localized vs generalized)
❑ Dimensions
❑ Tenderness or pain:
❑ Consistency
❑ Mobility
| |||||||||||||||||||||||||||||||||||||||||
Labs ❑ CBC with differential | |||||||||||||||||||||||||||||||||||||||||
Diagnostic of self-limiting or benign disease Pharyngitis, URTI, conjunctivitis, cat-scratch disease, etc | Suggests infection/ serious infection | unexplained | Suggests malignancy | ||||||||||||||||||||||||||||||||||||||
May require specific tests | Perform specific tests ❑ IM: Heterophile Antibody and monospot test | Positive | |||||||||||||||||||||||||||||||||||||||
Positive | Negative | ||||||||||||||||||||||||||||||||||||||||
❑ Treat with antibiotics if required and/ or symptomatic treatment ❑ For an untreatable or disease with residual symptoms counsel the patient | |||||||||||||||||||||||||||||||||||||||||
' | |||||||||||||||||||||||||||||||||||||||||
- ↑ 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.
- ↑ 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.
- ↑ 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.