Block 3 Path Exam -- Lymphadenopathy & Splenomegaly (#16)

Front 1

Sinus hyperplasia is frequently a normal finding in which nodes (2)?

Back 1

Mesenteric
Axillary

Front 2

What cells is a primary follicle composed of?

Back 2

Virgin B cells

Front 3

What cells is the interfollicular zone comprised of?

Back 3

T cells

Front 4

Lymphadenopathy in which nodes is almost always due to malignancy (2)?

Back 4

Supraclavicular
Retroperitoneal

Front 5

Occurence and extent of lymphadenopathy is greater in whom?

Children OR adults

Back 5

Children

Front 6

Biopsied LNs from infectious mono. can look like what other conditions (3)?

Back 6

Non-Hodgkin's lymphoma
Waldenstrom's macroglubilinemia
Lymphocyte-predominant Hodgkin's

Front 7

What pts. often have epitrochlear, axillary, and inguinal lymphadenopathy?

Back 7

Manual laborers

Repeated, minor injuries to extremities cause repeated small infections

NOTE: the nodes are usually non-tender

Front 8

What anti-epileptic drug is associated w/ lymphadenopathy?

Back 8

Dilantin

Front 9

How do NON-neoplastic nodes typically appear on exam?

Back 9

Enlarged
Flat
Relatively soft

Front 10

How do neoplastic nodes typically appear on exam?

Back 10

Enlarged
Irregular
Rubbery hard

Front 11

How do infected nodes typically appear on exam?

Back 11

Enlarged
Variable hardness
Tenderness
Redness
Heat
Pain

NOTE: Hodgkin's may occasionally present w/ tender LNs

Front 12

A LN larger than ____ should be considered enlarged

Back 12

1 cm

Front 13

Rubella has a tendency to affect which LNs?

Back 13

Posterior auricular

Front 14

Toxoplasmosis has a tendency to affect which LNs?

Back 14

Posterior cervical

Front 15

Intra-thoracic/abdominal carcinomas usually affect which LNs?

Back 15

Supraclavicular
Scalene

Front 16

Sarcoidosis usually affects which LNs?

Back 16

HILAR
Supraclavicular
Scalene

Front 17

Hodgkin's disease has a tendency to affect which LNs?

Back 17

Mediastinal

Front 18

Subacute necrotizing lymphadenitis has a tendency to affect which LNs?

Back 18

Posterior cervical

Front 19

What is sinus histiocytosis?

Back 19

Benign disorder of young adults

Painless, massive cervical lymphadenopathy (bilateral)
Histiocytic infiltration in the sinuses of the LN

Front 20

Secondary syphilis has a tendency to affect which LNs?

Back 20

Epitrochlear
(bliaterl)

Front 21

What are the charactertistics of Castleman's disease?
(w/ regards to lymphadenopathy)

Back 21

Large, solitary mediastinal mass
Atypical hyperplasia, w/ burned out germinal centers
Marked capillary proliferation

Front 22

Which important veneral disease does NOT produce lymphadenopathy?

Back 22

Gonorrhea

Front 23

Which lymphatic disease often mimics appendicitis?

Back 23

Acute mesenteric lymphadenitis

Front 24

Pts. w/ marked enlargement of the retroperitoneal LNs often present w/ what?

Back 24

Backache
(assoc. w/ other findings weight loss, sweats, etc.)

Front 25

Where are the epitrochlear LNs located?

Back 25

In the "elbow pit"

Front 26

Why is a LN biopsy NOT indicated in CLL?

Back 26

Peripheral blood and marrow findings are diagnostic

Front 27

Increased what in peripheral blood is diagnostic of infectious mono?

Back 27

Atypical lymphocytes

Front 28

What is the white pulp composed of (2)?

Back 28

Secondary lymph follicles
Periarterial lymphatic sheaths

Front 29

What is the red pulp composed of?

Back 29

Splenic cords and sinuses

Front 30

What cell type are the marginal zones of the spleen rich in?

Back 30

Monocytes

Front 31

Flow of venous drainage from the spleen

Back 31

Sinuses --> pulp veins --> trabecular veins --> splenic hilar veins

Front 32

What are splenic cords?

Back 32

Extravascular collections of hematopoietic cells (mostly red)

Front 33

Where does arterial blood flow of the spleen empty into?

Back 33

Splenic cords

Front 34

Lymphatic drainage of the spleen

Back 34

Confined to the white pulp
Lymphatics coalesce to form trabecular lymphatic vessels

Run adjacent to trabecular arteries

Front 35

What LNs does lymphatic drainage of the spleen drain into?

Back 35

Splenic hilar nodes
Celiac nodes

Front 36

Where are the marginal zones located in the spleen?

Back 36

At the junction of the white and red pulp

Front 37

% of cardiac output that is blood flow to the spleen

Back 37

5%

Front 38

What is chronic passive congestion?

Back 38

Splenomegaly due to an increase in portal vein pressure

NOTE: splenomegaly is due to expansion of the RED pulp

Front 39

Degree of splenic sequestration for RBCs, granulocytes, platelets

Back 39

RBCs - 1%

Granulocytes - 20%

Platelets - 30%

Front 40

With enlargement of the spleen, how much red cell pooling can occur?

Back 40

25%

Front 41

With enlargement of the spleen, how much platelet pooling can occur?

Back 41

Up to 90%

Front 42

What type of organisms is the spleen specialized for removing?

Back 42

Encapsulated organisms

Front 43

What is normal spleen size and weight?

Back 43

4 x 8 x 12 cm
<= 200 grams

Front 44

Normal size spleen is usually no longer palpabe after what age?

Back 44

3 - 4 years old

Front 45

What is primary splenic hyperplasia?

Back 45

Splenomegaly in which a specific underlying disorder is not found

Front 46

Most common causes of splenomegaly in the Western hemisphere (2)

Back 46

Hematologic disorders
Congestive splenomegaly

Front 47

7 clinical manifestations of splenomegaly

Back 47

LUQ pain, discomfort, fullness
Left supraclavicular pain
Early satiety
Weight loss
Excess sweating
Manifestations of cytopenias
Hematemesis from varices

Front 48

LUQ pain is not common in absence of what?

Back 48

Splenic infarction

Front 49

Left supraclavicular pain in splenomegaly is due to what?

Back 49

Irritation to the left diaphragm

Front 50

What is Felty's syndrome?

Back 50

Syndrome of Rheumatoid arthritis, splenomegaly, and neutropenia

Front 51

Organisms that can cause the "infectious mono symptom complex"

Back 51

EBV

CMV
Toxoplasmosis

Front 52

What do Rouleau formations indicate?

Back 52

Hypergammaglobulinemia
(can be either poly- or monoclonal)

Front 53

Type of gammaglobulin assoc. w/ Waldenstrom's macroglobulinemia

Back 53

Monoclonal IgM

Front 54

Hallmarks of an increased rate of RBC destruction (5)

Back 54

Poikilocytosis
Anisocytosis
Schistocytosis
Polychromatophilia
Nucleated RBCs

Front 55

Splenomegaly is more often seen in what pts. w/ ALL

Children or adults

Back 55

Children

NOTE: splenomegaly is DISTINCTLY UNUSUAL in adults w/ acute leukemia

Front 56

What is the most common cause of stomatocytosis?

Back 56

Heavy alcohol intake

Front 57

Charactertistic blood findings in the thalassemias

Back 57

Target cells
Hypochromic microcytes
Basophilic stippling

Front 58

How is diagnosis of hereditary pyropoikilocytosis confirmed?

Back 58

Demonstrating increased fragility to heat

Front 59

Most common cause of Autoimmune hemolytic anemia

Back 59

Drugs

Front 60

Charactertistic finding on the smear in AIHA

Back 60

Autoagglutination of RBCs

Front 61

Most common underlying disease process in congestive splenomegaly

Back 61

Intrinsic liver disease

Front 62

Splenectomy is often indicated in this condition
(even if spleen is NOT enlarged)

Back 62

Autoimmune thrombocytopenia