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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Important aspects of the history and examination in a child with cervical lymphadenopathy

Important aspects of the history and examination in a child with cervical lymphadenopathy
Clinical feature Potential significance
History
Onset, laterality, and duration Helps to narrow etiology
Constitutional symptoms (eg, weight loss, fatigue, malaise) Malignancy, Kikuchi disease, Castleman disease, sarcoidosis
Recurrent/chronic cough, hemoptysis Tuberculosis
Arthritis/arthralgia Juvenile idiopathic arthritis, systemic lupus erythematosus
Nasal, aural, or sinus obstruction without drainage Rhabdomyosarcoma
Immunizations status Measles, mumps, rubella, diphtheria (if unimmunized); postvaccination lymphadenitis (if recently immunized, particularly with diphtheria-tetanus-pertussis, polio, or typhoid fever vaccine)
Exposures
  • Ill contacts
Supports infectious etiology
  • Unpasteurized milk
Brucellosis, Mycobacterium bovis
  • Undercooked meats
Toxoplasmosis
  • Animals
Cats (cat scratch disease, Pasteurella multocida, toxoplasmosis); dogs (P. multocida) rabbits (tularemia); hamster (tularemia); goats (brucellosis); prairie dogs (plague)
  • Flea or tick bites
Plague, tularemia
  • Phenytoin, carbamazepine
Medication-related
  • Geographic location or travel
May need to consider less common causes (eg, tularemia, plague, tuberculosis)
Examination
Lymph node qualities
  • Soft, small, round, discrete, mobile, minimally tender
Suggestive of "reactive" lymphadenopathy
  • Isolated, asymmetric, tender, warm, erythematous
Suggestive of infection
  • Hard, nontender, fixed, matted to underlying structures
May indicate malignancy
Hepatosplenomegaly and involvement of noncervical nodes Systemic infection (eg, EBV, CMV, HIV, histoplasmosis, tuberculosis, syphilis), juvenile idiopathic arthritis, Castleman disease
Conjunctivitis Cat scratch disease, tularemia, adenovirus, Kawasaki disease, measles
Poor dental hygiene, periodontal disease, dental caries Anaerobic infection
Loose teeth Langerhans cell histiocytosis
Mouth sores/lesions HSV, enterovirus, PFAPA, Kawasaki disease, Langerhans cell histiocytosis
Pharyngitis GAS, EBV, PFAPA, diphtheria
Localized skin lesion

More common: Staphylococcus aureus, GAS, cat scratch disease, tularemia, HSV

Less common: Nocardia, actinomycosis, sporotrichosis, plague, cutaneous diphtheria
Generalized rash Systemic viral illness (eg, roseola, EBV, measles, rubella, parvovirus B19), Kawasaki disease, juvenile idiopathic arthritis, systemic lupus erythematosus, Langerhans cell histiocytosis, hemophagocytic lymphohistiocytosis
EBV: Epstein-Barr virus; CMV: cytomegalovirus, HIV: human immunodeficiency virus; HSV: herpes simplex virus, PFAPA: periodic fever with aphthous stomatitis, pharyngitis, and adenitis; GAS: group A Streptococcus.
Graphic 97722 Version 4.0

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