Enlarged Neck Lymph Nodes

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍rightleftbilateral ‍tendernon-tender enlarged neck lymph nodes

Alleviating factors: ‍none, ‍effectiveineffect䁩ve



Associated symptoms: *Try using right-click for negatives*

‍sore throat

‍difficulty swallowing

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍night sweats

‍fatigue

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍voice changes

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍shortness of breath

‍skin rash

‍history of infection

‍䁓ymptoms of cancer



Contributing factors:

‍smoking

‍heavy alcohol consumption

‍IV drug use

‍high-risk sexual behavior

‍recent travel

no history of: ‍HIV/AIDS, ‍cancer, ‍autoimmune disease

no use of: ‍antibiotics, ‍corticosteroids

no family history of: ‍lymphoma





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM





ASSESSMENT:

‍Reactive lymphadenopathy ‍likelysuspectedpossible

DDx: reactive lymphadenopathy, infectious lymphadenitis, viral infection, acute pharyngitis, mononucleosis, HIV, tuberculosis, throat cancer, lymphoma, leukemia, lung cancer, gastric cancer, metastatic cancer, autoimmune diseases, sarcoidosis, medication reactions, Kawasaki disease, thyroiditis, salivary gland infection, dental infections, skin infections, cat scratch disease





PLAN:

Investigations:

- 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

Treatments:

- ‍Analgesics

- ‍Antibiotics

Further care:

- 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