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62 Cards in this Set

  • Front
  • Back
Sinus hyperplasia is frequently a normal finding in which nodes (2)?
Mesenteric
Axillary
What cells is a primary follicle composed of?
Virgin B cells
What cells is the interfollicular zone comprised of?
T cells
Lymphadenopathy in which nodes is almost always due to malignancy (2)?
Supraclavicular
Retroperitoneal
Occurence and extent of lymphadenopathy is greater in whom?

Children OR adults
Children
Biopsied LNs from infectious mono. can look like what other conditions (3)?
Non-Hodgkin's lymphoma
Waldenstrom's macroglubilinemia
Lymphocyte-predominant Hodgkin's
What pts. often have epitrochlear, axillary, and inguinal lymphadenopathy?
Manual laborers

Repeated, minor injuries to extremities cause repeated small infections

NOTE: the nodes are usually non-tender
What anti-epileptic drug is associated w/ lymphadenopathy?
Dilantin
How do NON-neoplastic nodes typically appear on exam?
Enlarged
Flat
Relatively soft
How do neoplastic nodes typically appear on exam?
Enlarged
Irregular
Rubbery hard
How do infected nodes typically appear on exam?
Enlarged
Variable hardness
Tenderness
Redness
Heat
Pain

NOTE: Hodgkin's may occasionally present w/ tender LNs
A LN larger than ____ should be considered enlarged
1 cm
Rubella has a tendency to affect which LNs?
Posterior auricular
Toxoplasmosis has a tendency to affect which LNs?
Posterior cervical
Intra-thoracic/abdominal carcinomas usually affect which LNs?
Supraclavicular
Scalene
Sarcoidosis usually affects which LNs?
HILAR
Supraclavicular
Scalene
Hodgkin's disease has a tendency to affect which LNs?
Mediastinal
Subacute necrotizing lymphadenitis has a tendency to affect which LNs?
Posterior cervical
What is sinus histiocytosis?
Benign disorder of young adults

Painless, massive cervical lymphadenopathy (bilateral)
Histiocytic infiltration in the sinuses of the LN
Secondary syphilis has a tendency to affect which LNs?
Epitrochlear
(bliaterl)
What are the charactertistics of Castleman's disease?
(w/ regards to lymphadenopathy)
Large, solitary mediastinal mass
Atypical hyperplasia, w/ burned out germinal centers
Marked capillary proliferation
Which important veneral disease does NOT produce lymphadenopathy?
Gonorrhea
Which lymphatic disease often mimics appendicitis?
Acute mesenteric lymphadenitis
Pts. w/ marked enlargement of the retroperitoneal LNs often present w/ what?
Backache
(assoc. w/ other findings weight loss, sweats, etc.)
Where are the epitrochlear LNs located?
In the "elbow pit"
Why is a LN biopsy NOT indicated in CLL?
Peripheral blood and marrow findings are diagnostic
Increased what in peripheral blood is diagnostic of infectious mono?
Atypical lymphocytes
What is the white pulp composed of (2)?
Secondary lymph follicles
Periarterial lymphatic sheaths
What is the red pulp composed of?
Splenic cords and sinuses
What cell type are the marginal zones of the spleen rich in?
Monocytes
Flow of venous drainage from the spleen
Sinuses --> pulp veins --> trabecular veins --> splenic hilar veins
What are splenic cords?
Extravascular collections of hematopoietic cells (mostly red)
Where does arterial blood flow of the spleen empty into?
Splenic cords
Lymphatic drainage of the spleen
Confined to the white pulp
Lymphatics coalesce to form trabecular lymphatic vessels

Run adjacent to trabecular arteries
What LNs does lymphatic drainage of the spleen drain into?
Splenic hilar nodes
Celiac nodes
Where are the marginal zones located in the spleen?
At the junction of the white and red pulp
% of cardiac output that is blood flow to the spleen
5%
What is chronic passive congestion?
Splenomegaly due to an increase in portal vein pressure

NOTE: splenomegaly is due to expansion of the RED pulp
Degree of splenic sequestration for RBCs, granulocytes, platelets
RBCs - 1%

Granulocytes - 20%

Platelets - 30%
With enlargement of the spleen, how much red cell pooling can occur?
25%
With enlargement of the spleen, how much platelet pooling can occur?
Up to 90%
What type of organisms is the spleen specialized for removing?
Encapsulated organisms
What is normal spleen size and weight?
4 x 8 x 12 cm
<= 200 grams
Normal size spleen is usually no longer palpabe after what age?
3 - 4 years old
What is primary splenic hyperplasia?
Splenomegaly in which a specific underlying disorder is not found
Most common causes of splenomegaly in the Western hemisphere (2)
Hematologic disorders
Congestive splenomegaly
7 clinical manifestations of splenomegaly
LUQ pain, discomfort, fullness
Left supraclavicular pain
Early satiety
Weight loss
Excess sweating
Manifestations of cytopenias
Hematemesis from varices
LUQ pain is not common in absence of what?
Splenic infarction
Left supraclavicular pain in splenomegaly is due to what?
Irritation to the left diaphragm
What is Felty's syndrome?
Syndrome of Rheumatoid arthritis, splenomegaly, and neutropenia
Organisms that can cause the "infectious mono symptom complex"
EBV

CMV
Toxoplasmosis
What do Rouleau formations indicate?
Hypergammaglobulinemia
(can be either poly- or monoclonal)
Type of gammaglobulin assoc. w/ Waldenstrom's macroglobulinemia
Monoclonal IgM
Hallmarks of an increased rate of RBC destruction (5)
Poikilocytosis
Anisocytosis
Schistocytosis
Polychromatophilia
Nucleated RBCs
Splenomegaly is more often seen in what pts. w/ ALL

Children or adults
Children

NOTE: splenomegaly is DISTINCTLY UNUSUAL in adults w/ acute leukemia
What is the most common cause of stomatocytosis?
Heavy alcohol intake
Charactertistic blood findings in the thalassemias
Target cells
Hypochromic microcytes
Basophilic stippling
How is diagnosis of hereditary pyropoikilocytosis confirmed?
Demonstrating increased fragility to heat
Most common cause of Autoimmune hemolytic anemia
Drugs
Charactertistic finding on the smear in AIHA
Autoagglutination of RBCs
Most common underlying disease process in congestive splenomegaly
Intrinsic liver disease
Splenectomy is often indicated in this condition
(even if spleen is NOT enlarged)
Autoimmune thrombocytopenia