Sandbox:Javaria

❑ Extremities exam
❑ Skin exam: Evaluate for the lesions that indicate malignancy such as melanoma/ potential inoculation sites for germ such as traumatic lesions.}}

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History ❑Patient age (specific demographic characteristics (age) of certain malignancies) ❑ Duration of lymphadenopathy (<2 weeks or >1 year without an increase in size has low malignant potential) ❑ Past medical history of underlying disease, suggestive of immunodeficiency, or recurrent infections ❑ Sexual history suggestive of infection transmission ❑ Family history of certain malignant disorders (breast cancer, or melanoma) ❑ Exposure to communicable infectious diseases/ travel to high-risk areas ❑ Environmental exposure such as UV (skin cancer risk)/ animals/ occupational exposure ❑ Social history such as tobacco use, alcohol use (head and neck cancers risk) ❑ Associated symptoms such as pain, fever, weight loss, anorexia, cough, or recurrent UTIs

Physical exam Appearance of the patient Cachexia or surgical scar marks demonstrating previous malignancy treatment ❑ Vital signs ❑ Temperature: High-grade / low-grade fever may demonstrate infection. ❑ Heart rate: Tachycardia with regular pulse may demonstrate infection. ❑ Respiratory rate: Tachypnea may demonstrate respiratory system involvement (infection\ metastasis). ❑ Blood pressure: Chronic hypertension or hypotension (may indicate sepsis as a complication). ❑ Oxygen saturation: may be low if the respiratory system is affected. ❑ HEENT ❑ Cardiovascular examination ❑ Respiratory examination ❑ Gastrointestinal system exam includes oral examination, abdominal examination, and digital rectal exam. ❑ Splenomegaly) may demonstrate IM, hodgkin's/ non-Hodgkin's lymphoma, and sarcoidosis

Palpable lymph node ❑ Location: (Localized vs generalized) ❑ For nodes involving several groups of nodes; suspect malignancy. ❑ An enlarged node in a lymphatic rich region; suspect local disease. ❑ Associated red streaking, suspect lymphangitis. ❑ Left supraclavicular L.N (Virchow's nodes); suspect gastric carcinoma ❑ Right supraclavicular L.N, suspect intra-thoracic carcinoma ❑ Dimensions The aforementioned dimensions are abnormal for a palpable lymph node but do not lead to the suspician of a neoplasm. ❑ supraclavicular, iliac, epitrochlear, and popliteal lymph nodes >0.5cm ❑ Inguinal nodes > 1.5 cm ❑ Other area lymph nodes >1 cm ❑ Tenderness or pain: ❑ Suspect infection. ❑ A neoplastic node may also demonstrate pain due to hemorrhage associated with central necrosis or a brisk growing tumor. ❑ Consistency ❑ Hard on palpation; suspect chronic inflammation ❑ consistent- acute inflammation ❑ Stony-hard and painless nodes-metastatic cancer/ granuloma ❑ Firm and rubbery nodes- lymphoma ❑ Matted L.N suspect mycobacterium / sarcoidosis/ lymphoma / metastatic carcinoma) ❑ Mobility ❑ Freely movable; suspect infections and collagen vascular disease ❑ Fixed L.N to surrounding tissue; suspect malignancy

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Do's

Patients with immunodeficiency should have a wide differential diagnosis consideringnon-Hodgkin's lymphoma and Kaposi’s sarcoma.

Dont's

• Physical examination should not be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and unnecessary delays.
• Fine-needle aspiration biopsy (FNAC) or excisional biopsy is the gold standard for tissue diagnosis and evaluation for LAD.

common causes

Lymphadenopathy involving supraclavicular L.N poses the highest risk of malignancy (90% among patients >40 years of age) and 25% among < 40 years old.