Neck Lymphadenopathy

HISTORY:

‍RightLeftBilateral ‍tendernon-tender enlarged lymph nodes in neck for ‍ ‍hoursdays

Treatments tried: ‍none, ‍effectiveineffect䁩ve

‍sore throat

‍difficulty swallowing

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍night sweats

‍fatigue

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍voice changes

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍shortness of breath

‍skin rash



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍normal

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Breasts: -R: ‍normal, -L: ‍normal

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM



ASSESSMENT:

‍Reactive lymphadenopathy ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Throat swab

- Neck ultrasound

- CT scan of the neck and chest

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍LDH, ‍HIV, ‍monospot, ‍EBV, ‍CMV, ‍Toxoplasmosis, ‍Tuber䁣ulosis

- Fine needle aspiration biopsy

- Excisional biopsy

- ‍Analgesics

- ‍Antibiotics

- Referral to ENT specialist

- Referral to hematologist/oncologist

- Referral to infectious disease specialist

- Follow-up in ‍ ‍weeksmonths

- Return if lymph nodes continue to 䁥nlarge, if new symptoms develop such as fever, night sweats, weight loss