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Lymphadenopathy

Sataion 5

BY DR SADEK AL-ROKH

SENARIO:

Multiple masses in the body


Neck lump
DD :

Infection (HIV,TB,EBV,CMV ,Typhoid fever,


Toxoplasmosis ,Brucellosis ,cat scratch disease)
Neoplastic and proliferative disorder
Acute leukemia.
Lymphomas (Hodgkin's, non-Hodgkin).
Drug reactions (e.g. phenytoin, allopurinol )
Others i.e. sarcoidosis , SLE

HISTORY (multiple masses in the body)


Onset, course, duration, progression, site i.e Arm pit
Is it painful? ( painful in infectious causes ) __ painless in (
Neoplastic and proliferative disorder , sarcoidosis)
constituanal symptoms(high temperature,, fatigue pale than
before,sweating , loss of weight , how many KG , what about diet) ,
itching (lymphoma)
Any skin rash ( in sarcoidosis ,HIV , Lyme )
Any Joint pain (sarcoidosis , lyme , HIV)
Respiratory symptoms : cough , phlegm , noisy chest , SOB
(Sarcoidosis)
Hx of surgical operations , blood transfusion , sharing needles ( risk of
HIV and other infections)
Hx of travelling abroad ( when , for how long ,rural or urban , is it
epidemic area for certain disease , any relation w local girls)
Any contact with animals or ingestion of any animal products ? ( cat
scratch disease , brucellosis )

Social history:
Patient job? -- How much the symptoms do impaction on his job
& usual daily activity? If do say: I am sorry I will refer u to a
social worker to solve this problem for you (very important)
With whom Patient is living with, Married or not, any
relationship outside marriage? (Risk of HIV)?
Financial support?
Smoking & alcohol history.

Medical history: D.M, HTN, Cardiac problem, surgical operations

Family history:similar problem or medical disease.


Drug history: What is your drug list?

Concern
EXAMINATION

Lymph node examination :

From behind of the patient : anterior auricular , posterior auricular , mental ,


submandibular , cervical , supraclavicular , occipital , Axillary .. take
permission for inguinal lymph node exam.

Abdominal examination:inspection , palpation for organomegaly , percussion for


ascites

N.B: if the scenario is Neck Lump , you have to take hyper and hypothyroidism hx.

Concerns
What it could be doctor ( lymphoma )?
Most probably you have nasty growth in your lymph node, we have to admit
you and do further blood test and imaging to confirm our diagnosis and
stating of the disease, we may need a snip from one of your lymph node under
anathesia and aseptic measures to confirm our diagnosis too , and we will
arrange another meeting to discuss the results with you , if diagnosis is
confirmed we will refer you to a blood doctor to give you the plan of
management .

Is it curable doctor ?
Treatment is available in the form of chemotherapy , to suppress the disease
activity , response for treatment is variable from one patient to another.

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