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=" | The algorathmn illustrates the approach to management of [[lymphadenopathy]]<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="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="pmid28348622">{{cite journal |vauthors=Ramadas AA, Jose R, Varma B, Chandy ML |title=Cervical lymphadenopathy: Unwinding the hidden truth |journal=Dent Res J (Isfahan) |volume=14 |issue=1 |pages=73–78 |date=2017 |pmid=28348622 |pmc=5356393 |doi=10.4103/1735-3327.201136 |url=}}</ref>. Borrowed from:<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="pmid9803196">{{cite journal |vauthors=Ferrer R |title=Lymphadenopathy: differential diagnosis and evaluation |journal=Am Fam Physician |volume=58 |issue=6 |pages=1313–20 |date=October 1998 |pmid=9803196 |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> | ||
{{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;"> | ||
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{{familytree | |!| | |!| | | | | |!| |`| J01 | | J02 | |J01=Negative|J02=Positive}} | {{familytree | |!| | |!| | | | | |!| |`| J01 | | J02 | |J01=Negative|J02=Positive}} | ||
{{familytree | |!| | |!| | | | | |!| | | | | | | |!| | | |}} | {{familytree | |!| | |!| | | | | |!| | | | | | | |!| | | |}} | ||
{{familytree | K04 | | K05 | | | |!| | | | | | K03 | |K04=<div style="float: left; text-align: left; width: 20em; padding:1em;">❑ '''Treat'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; padding:1em;">with [[antibiotics]] if required and/ or symptomatic treatment<br> | {{familytree | K04 | | K05 | | | |!| | | | | | | K03 | |K04=<div style="float: left; text-align: left; width: 20em; padding:1em;">❑ '''Treat'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; padding:1em;">with [[antibiotics]] if required and/ or symptomatic treatment<br> | ||
❑ For an untreatable or disease with residual symptoms counsel the [[patient]]<br> | ❑ For an untreatable or disease with residual symptoms counsel the [[patient]]<br> | ||
❑ Follow up for advancing or persistent [[lymphadenopathy|LAD]]|K05=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Treat'''<div class="mw-collapsible mw-collapsed"><br> | ❑ Follow up for advancing or persistent [[lymphadenopathy|LAD]]|K05=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Treat'''<div class="mw-collapsible mw-collapsed"><br> | ||
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❑ [[Autoimmunity#Treatments|Treatment of autoimmune disorders]]<br> | ❑ [[Autoimmunity#Treatments|Treatment of autoimmune disorders]]<br> | ||
❑ [[Tuberculosis medical therapy|Tuberculosis treatment]]<br> | ❑ [[Tuberculosis medical therapy|Tuberculosis treatment]]<br> | ||
❑ [[Cat scratch fever medical therapy|cat scratch disease treatment]]|K01=Low risk|K02=High risk|K03= | ❑ [[Cat scratch fever medical therapy|cat scratch disease treatment]]|K01=Low risk|K02=High risk|K03=Staging}} | ||
{{familytree | | | | | | | | | | |!| | | | | |!|}} | {{familytree | | | | | | | | | | |!| | | | | | |!|!|}} | ||
{{familytree | | | | | | |,|-|-|-|^|-|-|.| | |!|}} | {{familytree | | | | | | |,|-|-|-|^|-|-|.| | | |!|V01 |V01='''Treat'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; padding:1em;"><br>Surgical resection/ [[chemotherapy]]/ [[radiotherapy]]}} | ||
{{familytree | | | | | | A01 | | | | | A02 | |!| | | |A01= Low risk<br> |A02=High risk}} | {{familytree | | | | | | A01 | | | | | A02 | | |!| | | |A01= Low risk<br> |A02=High risk}} | ||
{{familytree | | | | | | |!| | | | | | |!| | |!|}} | {{familytree | | | | | | |!| | | | | | |!| | | |!| | | }} | ||
{{familytree | | | | | | |!| | | | | | B01 |-|'| | B01=<div style="float: left; text-align: left; line-height: 150% ">Specific tests/ [[biopsy]]}} | {{familytree | | | | | | |!| | | | | | B01 |-|-|'| | B01=<div style="float: left; text-align: left; line-height: 150% ">Specific tests/ [[biopsy]]}} | ||
{{familytree | | | | | | |! | {{familytree | | | | | | |!| | | | | | | | }} | ||
{{familytree | | |,|-|-|-|^|-|-|.| | | | | | | | L01=Treatment}} | {{familytree | | |,|-|-|-|^|-|-|.| | | | | | | | L01=Treatment}} | ||
{{familytree | | C01 | | | | | | C02 | | | | | | | | |C01=Localized|C02=Generalized}} | {{familytree | | C01 | | | | | | C02 | | | | | | | | |C01=Localized|C02=Generalized}} | ||
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{{familytree |!| | | |!| | | H01 | | H02 | | | | | | | | | |H01=Positive|H02=Negative }} | {{familytree |!| | | |!| | | H01 | | H02 | | | | | | | | | |H01=Positive|H02=Negative }} | ||
{{familytree |!| | | |!| | | |!| | | |!| | | | | | | | | |}} | {{familytree |!| | | |!| | | |!| | | |!| | | | | | | | | |}} | ||
{{familytree |!| | | |!| | | I01 | | I02 | | | | | | | | | |I01= | {{familytree |!| | | |!| | | I01 | | I02 | | | | | | | | | |I01=Staging|I02= Follow-up}} | ||
{{familytree |G01 | |!| | | | | | | | | | | | | | | | |G01=Biopsy}} | {{familytree |G01 | |!| | | | |!| | | | | | | | | | | |G01=Biopsy}} | ||
{{familytree |!| | | |!| | | | | | | | | | | | | | | | | | {{familytree |!| | | |!| | | J01 | | | | | | | | | | | | | |J01=Treatment}} | ||
{{familytree |)|-|-| Q01 | | | | | | | | | | | | | | | | | | Q01=Negative|}} | {{familytree |)|-|-| Q01 | | | | | | | | | | | | | | | | | | Q01=Negative|}} | ||
{{familytree |!| | | | | | | | | | | | | | | | | | | | | |}} | {{familytree |!| | | | | | | | | | | | | | | | | | | | | |}} | ||
{{familytree |`|-|-| X01 | | | | | | | | | | | | | | | | | | | | | |X01=Positive}} | {{familytree |`|-|-| X01 | | | | | | | | | | | | | | | | | | | | | |X01=Positive}} | ||
{{familytree | | | | |!| | | | | | | | | | | | | | | | | |}} | {{familytree | | | | |!| | | | | | | | | | | | | | | | | |}} | ||
{{familytree | | | | Y01 | | | | | | | | | | | | | | | | | Y01=Treatment}} | {{familytree | | | | Y01 | | | | | | | | | | | | | | | | | Y01=Staging}} | ||
{{familytree | | | | |!| | | | | | | | | | | | | | | | | |}} | |||
{{familytree | | | | E01 | | | | | | | | | | | | | | | | | |E01=Treatment}} | |||
{{familytree/end}} | {{familytree/end}} |
Revision as of 14:14, 22 August 2020
The algorathmn illustrates the approach to management of lymphadenopathy[1][2][3][4]. Borrowed from:[5][6][7]
.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 | Risk factors for malignancy Family history, age, exposure, etc | Perform specific tests | ||||||||||||||||||||||||||||||||||||||||||||||||||
Excisional biopsy | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Negative | Positive | ||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Treat with antibiotics if required and/ or symptomatic treatment ❑ For an untreatable or disease with residual symptoms counsel the patient | Staging | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Treat | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Low risk | High risk | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Specific tests/ biopsy | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Localized | Generalized | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Review history and clues suggesting malignancy | Review history and clues suggesting malignancy | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Observe 3-4 weeks | Specific tests such as CXR, ultrasound, CT, lab workup, biopsy The US findings that help differentiate benign lAD from malignant include: | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Undiagnostic | Diagnostic | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Progress/persists | Regress | ||||||||||||||||||||||||||||||||||||||||||||||||||||
No follow-up | Biopsy | Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||
Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Staging | Follow-up | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Biopsy | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Negative | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Positive | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Staging | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||
- ↑ 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.
- ↑ 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.
- ↑ Ramadas AA, Jose R, Varma B, Chandy ML (2017). "Cervical lymphadenopathy: Unwinding the hidden truth". Dent Res J (Isfahan). 14 (1): 73–78. doi:10.4103/1735-3327.201136. PMC 5356393. PMID 28348622.
- ↑ 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.
- ↑ Ferrer R (October 1998). "Lymphadenopathy: differential diagnosis and evaluation". Am Fam Physician. 58 (6): 1313–20. PMID 9803196.
- ↑ Bazemore AW, Smucker DR (December 2002). "Lymphadenopathy and malignancy". Am Fam Physician. 66 (11): 2103–10. PMID 12484692.