36 Questions
Match the following terms with their definitions:
Lymphadenopathy = Enlargement of 1 or more lymph nodes Supraclavicular fossa = A region where lymph node palpability is not normal Nephertiti Efeovbokhan, MD = One of the authors of The Patient History: An Evidence-Based Approach to Differential Diagnosis, 2e Palpability = Ability to feel or touch something, such as lymph nodes
Match the following symptoms with their association with the 19-year-old man's case:
Fever, headache, sore throat, fatigue = Complained symptoms Rhinorrhea, cough = Symptoms denied by the man Multiple swollen lymph glands in the front of his neck = Noticed by the man Sore lymph glands, symptoms not improving = Man's concerns
Match the following actions with their purposes in the diagnosis process:
Establish a presumptive diagnosis using open-ended questions = Initial step in the diagnosis process More focused history taking = Follow-up to open-ended questions Classify lymphadenopathy = Categorization of the lymph node enlargement Distinguish benign causes of lymphadenopathy from more serious ones = Differentiation for further evaluation
Match the following regions with their usual palpability of lymph nodes:
Neck and groin regions = Normal palpability Supraclavicular fossa, axilla, epitrochlear, or popliteal regions = Generally not palpable Multiple swollen lymph glands in the front of his neck = Region affected by the man in the case scenario Enlargement of 1 or more lymph nodes = Definition of lymphadenopathy
Match the lymphadenopathy mnemonic with its corresponding major causes of lymphadenopathy:
CINEMA DIVITT = Congenital, infectious, neoplastic, endocrine, metabolic, allergic, degenerative, inflammatory/immunologic, vascular, idiopathic or iatrogenic, traumatic, toxic MIAMI = Malignancies, infections, autoimmune disorders, miscellaneous and unusual conditions, and iatrogenic causes Congenital syphilis, upper respiratory infections, bacterial and viral infections, fungi, parasites, rickettsiae, and neoplastic conditions = Differential diagnosis for lymphadenopathy Actinomycosis, brucellosis, cat-scratch disease, chancroid, and others = Specific bacterial causes of lymphadenopathy
Match the specific viral cause with its associated lymphadenopathy:
Adenovirus = Viral causes Cytomegalovirus = Viral causes Epstein-Barr virus = Viral causes Hepatitis B and C, herpes simplex, human immunodeficiency virus = Viral causes
Match the parasitic cause with its associated lymphadenopathy:
Chagas disease, filariasis, kala-azar, leishmaniasis, toxoplasmosis, and trypanosomiasis = Parasitic causes Toxoplasmosis = Parasitic causes Kala-azar = Parasitic causes Leishmaniasis = Parasitic causes
Match the percentage of neoplastic causes of lymphadenopathy with its representation:
0.8%-1% = Neoplastic causes Less than 1% = Neoplastic causes Over two-thirds = Neoplastic causes 63% = Neoplastic causes
Match the potential causes of lymphadenopathy with their associated conditions:
Bacterial or mycobacterial infections = Tuberculosis, upper respiratory infections Metastatic cancer = Breast cancer, lung cancer, melanoma Autoimmune disorders = Connective tissue diseases Medication-associated serum sickness = Specific symptoms like joint pain, mouth ulcers, rashes after sun exposure, dry mouth, or dry eyes
Match the symptoms of lymphadenopathy with their descriptions:
Swollen, hard, tender, or draining lymph glands = Physical symptoms of lymphadenopathy Fevers, rashes, fatigue, unintentional weight loss = Associated symptoms of lymphadenopathy Genital herpes, sporotrichosis, herpes zoster, mumps = Specific symptoms associated with lymphadenopathy Changes over time and factors that make it better or worse = Modifying symptoms of lymphadenopathy
Match the considerations in the diagnostic approach for lymphadenopathy with their descriptions:
Patient's medical history and thorough physical examination = Initial steps in the diagnostic approach for lymphadenopathy Diagnostic algorithms and alarm symptoms suggestive of malignancy = Additional tools in the diagnostic approach for lymphadenopathy Time course and modifying symptoms = Important factors to consider in the diagnostic approach for lymphadenopathy Emotional impact on patients and their families = Psychosocial aspect to consider in the diagnostic approach for lymphadenopathy
Match the cautionary measures for lymphadenopathy with their descriptions:
Consideration of conditions that mimic lymph node swelling = Important cautionary step in evaluating lymphadenopathy Repeated evaluation, patient education, and shared decision making = Steps to take for nonspecific lymphadenopathy that persists or progresses Addressing the emotional impact and providing reassurance = Supportive measures for patients and their families Prognosis and observation in primary care settings = Reassurance and observation for specific patient demographics
Match the following conditions with their potential causes of lymphadenopathy:
Lymphoma = Can cause lymphadenopathy Adrenal insufficiency = Can lead to lymphadenopathy Allergic factors = Can contribute to lymphadenopathy Cat-scratch disease = Infectious cause of lymphadenopathy
Match the following primary sites with their potential for causing metastatic solid tumors and lymphadenopathy:
Breast = Can cause metastatic solid tumors and lymphadenopathy Head and neck = Can lead to metastatic solid tumors and lymphadenopathy Ovary = Can contribute to metastatic solid tumors and lymphadenopathy Stomach = Can result in metastatic solid tumors and lymphadenopathy
Match the following conditions with their potential to lead to lymphadenopathy:
Hyperthyroidism = Can cause lymphadenopathy Multiple endocrine neoplasia = Can lead to lymphadenopathy Lipid storage diseases = Can contribute to lymphadenopathy Severe hypertriglyceridemia = Can result in lymphadenopathy
Match the following factors with their potential contribution to lymphadenopathy:
Traumatic causes = Can contribute to lymphadenopathy Vascular factors = Can lead to lymphadenopathy Degenerative factors = Can cause lymphadenopathy Inflammatory/immunologic factors = Can result in lymphadenopathy
Match the following conditions with their potential to increase the risk of malignancy and lymphadenopathy:
Age over 50 = Increases the risk of malignancy and lymphadenopathy Leukemia = Can lead to increased risk of malignancy and lymphadenopathy Esophagus cancer = Can result in increased risk of malignancy and lymphadenopathy Melanoma = Can cause increased risk of malignancy and lymphadenopathy
Match the following causes with their potential prevalence in causing lymphadenopathy:
Endocrine conditions = May have varying prevalence in causing lymphadenopathy Metabolic causes = May have varying prevalence in causing lymphadenopathy Infectious causes = May have varying prevalence in causing lymphadenopathy Toxic causes = May have varying prevalence in causing lymphadenopathy
Match the following interview techniques with their potential for gathering information about lymphadenopathy:
Open-ended questions = Can help in obtaining information about lymphadenopathy Structured interview framework = Can assist in obtaining information about lymphadenopathy Visual aid = Can help in understanding and discussing lymphadenopathy symptoms Thorough history review = Can assist in gathering information about lymphadenopathy
Match the following characteristics with their potential for being gathered through an interview for lymphadenopathy:
Onset = Can be gathered through an interview for lymphadenopathy Duration = Can be gathered through an interview for lymphadenopathy Location = Can be gathered through an interview for lymphadenopathy Triggers = Can be gathered through an interview for lymphadenopathy
Match the following conditions with their potential to lead to secondary infections and lymphadenopathy:
Cuts = Can lead to secondary infections and lymphadenopathy Bites = Can result in secondary infections and lymphadenopathy Abrasions = Can cause secondary infections and lymphadenopathy Burns = Can contribute to secondary infections and lymphadenopathy
Match the following conditions with their potential to contribute to lymphadenopathy:
Gaucher's disease = Can contribute to lymphadenopathy Niemann-Pick disease = Can lead to lymphadenopathy Fabry's disease = Can result in lymphadenopathy Tangier's disease = Can cause lymphadenopathy
Match the following factors with their potential to assist in diagnosing the cause of lymphadenopathy:
Reviewing patient's history = Crucial for diagnosing the cause of lymphadenopathy Conducting a thorough interview = Crucial for diagnosing the cause of lymphadenopathy Gathering information on symptoms = Crucial for diagnosing the cause of lymphadenopathy Obtaining information on exposures = Crucial for diagnosing the cause of lymphadenopathy
Match the following conditions with their potential to cause lymphadenopathy:
Certain prescribed medications = Can cause lymphadenopathy Chemicals = Can lead to lymphadenopathy Lung cancer = Can contribute to lymphadenopathy Prostate cancer = Can result in lymphadenopathy
Match the following conditions with their association with lymphadenopathy:
Metastatic cancer of the mediastinum, esophagus, or thorax = Right supraclavicular lymphadenopathy Breast cancer = Lymphadenopathy Sarcoidosis = Lymphadenopathy HIV infection = Lymphadenopathy
Match the following symptoms with their association with lymphadenopathy:
Persistence or growth over several weeks or months = Alarm symptom Systemic inflammation/infection = Alarm symptom "Hard" lymph node = Alarm symptom Malaise, fatigue, fever, unintentional weight loss, and night sweats = Linked to lymphadenopathy
Match the following infectious diseases with their potential association with lymphadenopathy:
Cat-scratch disease = Infectious disease associated with lymphadenopathy Toxoplasmosis = Infectious disease associated with lymphadenopathy Tuberculosis = Infectious disease associated with lymphadenopathy Lyme disease = Infectious disease associated with lymphadenopathy
Match the following risky behaviors with potential causes of lymphadenopathy:
Unprotected sexual intercourse = Potential cause of lymphadenopathy Injection drug use = Potential cause of lymphadenopathy Consumption of unpasteurized milk or cheese = Potential cause of lymphadenopathy Hunting and eating wild animals = Potential cause of lymphadenopathy
Match the following diagnostic questions with their potential impact on subsequent decision making:
Cancer history = Influence on subsequent diagnostic decision making Recent travel = Influence on subsequent diagnostic decision making Family history of head and neck cancer = Influence on subsequent diagnostic decision making Exposure to undercooked meats = Influence on subsequent diagnostic decision making
Match the following conditions with their relative prevalence in primary care settings:
Cancer = 1%-4% Local infections for which antimicrobial therapy may be beneficial = 10%-30% Systemic infection = <1% Severe autoimmune disease = <1%
Match the following symptoms with their link to lymphadenopathy:
Fatigue = Linked to lymphadenopathy Fever = Linked to lymphadenopathy Night sweats = Linked to lymphadenopathy Unintentional weight loss = Linked to lymphadenopathy
Match the following conditions with their potential association with lymphadenopathy:
Systemic infection = Associated with lymphadenopathy Autoimmune connective tissue disease = Associated with lymphadenopathy Medications = Associated with lymphadenopathy Radiation exposure = Associated with lymphadenopathy
Match the following exposures with their potential impact on identifying causes of lymphadenopathy:
TB skin test = Impact on identifying potential causes of lymphadenopathy Exposure to infectious diseases = Impact on identifying potential causes of lymphadenopathy Changes in moles and skin lesions = Impact on identifying potential causes of lymphadenopathy Tick bites in Lyme disease-endemic areas = Impact on identifying potential causes of lymphadenopathy
Match the following conditions with their potential association with lymphadenopathy:
Autoimmune diseases = Associated with lymphadenopathy Severe autoimmune disease = Associated with lymphadenopathy Lymphoma = Associated with lymphadenopathy Tuberculosis = Associated with lymphadenopathy
Match the following exposures with their potential impact on identifying causes of lymphadenopathy:
Alcohol and tobacco use = Impact on identifying potential causes of lymphadenopathy Exposure to undercooked meats = Impact on identifying potential causes of lymphadenopathy Tick bites = Impact on identifying potential causes of lymphadenopathy Risky behaviors = Impact on identifying potential causes of lymphadenopathy
Match the following symptoms with their link to lymphadenopathy:
Persistence or growth over several weeks or months = Linked to lymphadenopathy Systemic inflammation/infection = Linked to lymphadenopathy "Hard" lymph node = Linked to lymphadenopathy Malaise = Linked to lymphadenopathy
Study Notes
Understanding Lymphadenopathy and Alarm Symptoms
- Lymphadenopathy can have benign causes, but it can also be due to serious conditions such as cancer, systemic infection, and autoimmune connective tissue disease.
- The relative prevalence of serious diagnoses in primary care settings includes cancer (1%-4%), local infections for which antimicrobial therapy may be beneficial (10%-30%), systemic infection (<1%), and severe autoimmune disease (<1%).
- Alarm symptoms to consider include persistence or growth over several weeks or months, systemic inflammation/infection, and the description of a "hard" lymph node.
- Specific locations of lymphadenopathy can indicate different conditions, such as right supraclavicular lymphadenopathy indicating metastatic cancer of the mediastinum, esophagus, or thorax.
- Other conditions associated with lymphadenopathy include breast cancer, lymphoma, sarcoidosis, HIV infection, tuberculosis, and autoimmune diseases.
- Medications and constitutional symptoms like malaise, fatigue, fever, unintentional weight loss, and night sweats can also be linked to lymphadenopathy.
- Focused questions should be asked to determine the likely cause of lymph node enlargement, with particular attention to alarm symptoms that greatly influence subsequent diagnostic decision making.
- Questions to consider include inquiries about cancer history, recent travel, family history of head and neck cancer, alcohol and tobacco use, radiation exposure, TB skin test, exposure to undercooked meats, and tick bites.
- Other questions should cover exposure to infectious diseases, such as cat-scratch disease, toxoplasmosis, and HIV, as well as changes in moles and skin lesions.
- Inquiring about specific exposures can help in identifying potential causes of lymphadenopathy, such as unpasteurized milk or cheese consumption, hunting and eating wild animals, and tick bites in Lyme disease-endemic areas.
- Questions about risky behaviors, such as unprotected sexual intercourse and injection drug use, can also aid in diagnosing potential causes of lymphadenopathy, including HIV, hepatitis B and C, and syphilis.
- Detailed questioning can help in identifying the underlying cause of lymphadenopathy and guide subsequent diagnostic and therapeutic decisions.
Test your knowledge of lymphadenopathy and its alarm symptoms with this quiz. Learn about the potential causes, associated conditions, and key questions to ask to determine the underlying cause of lymph node enlargement.
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