Cervicofacial Lymphadenopathy Question And Answers

Cervicofacial Lymphadenopathy Essay Questions

Question 1. Outline the various causes of cervicofacial lymphadenopathy.
Answer:

Cervicofacial lymphadenopathy Infection:

• Bacterial
  • Streptococcus and Staphylococcus infection.
  • Cat-scratch disease
  • Tuberculosis
  • Atypical mycobacterial infection
  • Primary and secondary syphilis
  • Diphtheria
  • Leprosy

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• Viral
  • Herpes simplex infection
  • Herpes zoster infection
  • Rubella
  • Measles
  • Infectious mononucleosis
  • Adenovirus infection
  • Acquired immune deficiency syndrome
• Fungal
  • Rhinocerebral mucormycosis
  • Histoplasmosis
• Parasitic
  • Toxoplasmosis
  • Leishmaniasis

Cervicofacial lymphadenopathy Immunologic Diseases:

• Rheumatoid arthritis
• Systemic lupus erythematosus
• Sjogren’s syndrome
• Mikulicz’s disease
• Serum sickness
• Drug hypersensitivity
• Graft-versus-host disease

Cervicofacial lymphadenopathy Malignant Diseases:

• Leukemia
• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma
• T-cell lymphoma
• Multiple myeloma
• Metastatic tumors of the head and neck

Cervicofacial lymphadenopathy Lipid Storage Disease:

• Gaucher’s disease
• Niemann-Pick disease

Cervicofacial lymphadenopathy Other Disorders:

• Castleman’s disease (giant lymph node hyperplasia)
• Sarcoidosis
• Lymphomatoid granulomatosis
• Kawasaki’s disease (mucocutaneous lymph node syndrome)
• Histiocytosis X
• Severe hypertriglyceridemia

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Cervicofacial lymphadenopathy Drugs:

• Allopurinol
• Atenolol
• Captopril
• Carbamazepine
• Gold
• Hydralazine
• Phenytoin
• Primidone
• Quinidine.

Question 2. Clinical evaluation of cervical lymphadenopathy.
Answer: The following features need to be checked:

• Location: Anatomical site of involvement. (cervical, submandibular, submental, supraclavicular, occipital, preauricular, auricular, axial inguinal).
• A number of nodes—Single or multiple.
• Enlargement of nodes—Localized or generalized.
• Involvement—Unilateral or bilateral, if bilateral nodes are present, the symmetry should be checked.
• Consistency—Firm, soft, rubbery, rock hard, and bone hard.
• Nature—Movable or fixed.
• Size: <1 cm, or >1 cm
• Symptoms: Tenderness and associated systemic symptoms.

Cervical lymph-adenopathy Diagnosis:

• Complete blood count
• Lymph node biopsy and fine needle aspiration cytology
• Ultrasonography
• Computed tomography
• Magnetic resonance imaging
• Positron emission tomography.

Cervicofacial Lymphadenopathy Short Notes

Question 1. Write a simplified numerical classification system for cervical lymph nodes.
Answer:

Question 2. Enumerate the conditions that cause generalized lymphadenopathy.
Answer:

• Generalized lymphadenopathy occurs in systemic conditions where the symptoms are widespread.
  • AIDS-related complex due to severe immune deficiency by HIV infection results in unexplained, generalized lymphadenopathy.
  • Disseminated carcinomatosis and lymphomas can cause generalized adenopathy.
  • Inherited metabolic disorders (Gaucher disease) and endocrine disorders (Graves’ disease—hyperthyroidism, and Addison’s disease hypocortisolism).
  • Immunological disorders like serum sickness and sarcoidosis also produce widespread adenopathy.
  • Connective tissue disorders like rheumatoid arthritis and systemic lupus erythematosus also tend to cause generalized lymphadenopathy.
  • Infectious diseases like tuberculosis, hepatitis, toxoplasmosis, and infectious mononucleosis lead to generalized lymph node enlargement.

Cervicofacial Lymphadenopathy Multiple Choice Questions

Question 1. A lymph node of <1cm size denotes

1. Anatomical nodes
2. Inflammatory response nodes
3. Nonspecific reactive nodes
4. Granulomatous disease

Answer: 3. Nonspecific reactive nodes

Question 2. A lymph node of >2 cm2 size is probably due to

1. Malignancy
2. Tuberculosis
3. Parasite infection
4. Reactive lesions
   (Note: Lymph node of >2 cm2 size is probably due to malignant or granulomatous disorders).

Answer: 1. Malignancy

Question 3. Metastatic nodes are

1. Soft and tender
2. Tender and mobile
3. Mobile and hard
4. Hard and non-tender

Answer: 4. Hard and non-tender

Question 4. The approximate total number of lymph nodes in a body is 600.

1. 300
2. 1200
3. 600
4. 80

Answer: 3. 600

Question 5. The organ devoid of lymphatic supply is

1. Brain
2. Liver
3. Kidney
4. Limbs
   (Note: Bone, cartilage, brain, spinal cord, and retina are the organs that do not have lymphatic vessels).

Answer: 1. Brain

Question 6. During development, the lymphatic system is the derivative of

1. Endoderm
2. Mesoderm
3. Bone marrow
4. Spleen
   (Note: During development, the lymphatic system is the derivative of mesoderm but the adult progenitor cells are derived from bone marrow).

Answer: 2. Mesoderm

Question 7. Stone hard consistency of lymph nodes suggests

1. Tuberculosis
2. Lymphoma
3. Metastasis
4. Syphilis

Answer: 3. Metastasis

Question 8. Firm and rubbery nodes are characteristic for

1. Tuberculosis
2. Lymphoma
3. Metastasis
4. Syphilis

Answer: 2. Lymphoma

Question 9. Buckshot nodes are the cervical nodes in children with

1. Primary complex
2. Malnutrition
3. Congenital syphilis
4. Viral infection

Answer: 4. Viral infection

Question 10. The cartilage-like consistency of lymph nodes denotes

1. Tuberculosis
2. Lymphoma
3. Metastasis
4. Syphilis

Answer: 4. Syphilis

Question 11. Inflammatory lymph nodes are

1. Soft and mobile
2. Hard and mobile
3. Soft and fixed
4. Hard and fixed

Answer: 1. Soft and mobile

Question 12. A group of coalesced nodes that move as a single unit is denoted as

1. Buckshot nodes
2. Matted nodes
3. Caseous nodes
4. Granulomatous nodes

Answer: 2. Matted nodes

Question 13. Matted nodes are seen in

1. Tuberculosis
2. Syphilis
3. Hodgkin’s disease
4. Non-Hodgkin’s disease
   (Note: Matted nodes are seen in tuberculosis, sarcoidosis, and lymphomas).

Answer: 1. Tuberculosis

Question 14. A positive mono spot test confirms

1. Hodgkin’s lymphoma
2. kaposi’s sarcoma
3. Sarcoidosis
4. Infectious mononucleosis
   (Note: Monospot test is a positive heterophilic antibody test that confirms infectious mononucleosis).

Answer: 4. Infectious mononucleosis

Question 15. Localized lymphadenopathy with constitutional symptoms should be advised for biopsy when persisting more than

1. 6 days
2. 3-4 weeks
3. 6 months
4. 2-3 weeks

Answer: 2. 3-4 weeks

Question 16. In benign lymphadenopathy, the nodes are

1. Freely mobile
2. Fixed
3. Nonpalpable
4. Nonenlarged

Answer: 1. Freely mobile

Question 17. Left-side supraclavicular nodes are known as

1. Virchow’s nodes
2. Sentinel nodes
3. Waldeyer’s ring
4. Castleman’s nodes

Answer: 1. Virchow’s nodes

Question 18. Lymphadenopathy that indicates dangerous signs is

1. Sacral lymphadenopathy
2. Subclavian lymphadenopathy
3. Supraclavicular lymphadenopathy
4. Inguinal lymphadenopathy
   (Note: Supraclavicular lymphadenopathy is an alarming sign for the clinician).

Answer: 3. Supraclavicular lymphadenopathy

Cervicofacial Lymphadenopathy Viva Voce

Question 1. What are Virchow’s nodes?
Answer:

• Left supraclavicular lymph nodes are called as Virchow’s nodes, by the name of a German pathologist “Rudolf Virchow, and enlargement of these nodes is called as Troisier’s sign.
• The enlargement of these nodes denotes malignant metastasis from distant organs like the stomach, esophagus, testis, and breasts; hence they are also called as signal nodes.

Question 2. What is lymph?
Answer: Lymph is an interstitial fluid composed of cellular fluids, extravasated leukocytes, extracellular substances, protein, and fat.

Question 3. What are the functions of the lymphatic system?
Answer: The lymphatic system delivers the lymphocytes and antigen-presenting cells to regional nodes and encounters the pathogens, maintaining the homeostasis of tissue fluid, and transport of cell debris and extracellular substances.

Cervicofacial Lymphadenopathy Highlights

• Lymphadenopathy is the term used to denote the enlargement of lymph nodes. It may be a primary or secondary manifestation of various disorders and may be a presenting sign or symptom of a patient’s illness. The involvement of nodes may be localized or generalized.
• Lymphadenitis is an acute infectious condition where lymph nodes are swollen, tender, soft, and isolated, while chronic infection gives firm, non-tender, and freely mobile nodes.
• Lymph nodes that are gradually enlarging, hard in consistency, and fixed to the underlying or adjacent tissues are malignant.
  Soft, flat palpable submandibular nodes which are smaller than 1 cm size are normal in children.
• This chapter highlights the reasons for cervicofacial lymphadinopathy and diagnostic clues for various diseases based on lymph node examination.