Softer nodes are the result of infectious or inflammatory conditions and when suppuration is present, these nodes may tend to be fluctuant. Very firm, rubbery nodes suggest lymphoma. Stony-hard nodes are usually a sign of malignancy. A thorough examination must include the location of lymphadenopathy including an evaluation of all accessible lymph node-bearing areas, the size and consistency of palpated nodes, whether they are discrete or matted and whether tenderness is present and, if so, at what level of severity.Īs a general rule, a node larger than 1 cm should be considered abnormal. Possibility of tuberculosis (TB).Important elements of the history should also include the presence or absence of pain, occupational and animal exposures, geographic residence, travel history, sexual and drug use behavior, trauma and presence or absence of systemic symptoms, and/or history of underlying disease. If you practice in an urban area, consider the Picions of toxoplasmosis or cat-scratch fever. The pa- tient's symptoms may be striking and trou- blesome to them, however. Even the definition of the syndrome remains controversial. Most experts believe that this syn-ĭrome is overdiagnosed and is preferably a di-Īgnosis of exclusion. Yuppie flu) may manifest itself with lymphade. Has there been a recent community outbreak of strep- tococcal pharyngitis? Chronic fatigue syn- drome (previously called chronic mononucleo- sis, Epstein-Barr virus syndrome, and Osis or cytomegalovirus (CMV) infection in aįamily member or roommate is a tip-off to Somewhat more concern and should at least beįestation of a viral infection, it is appropri-Īte to ask about any recent exposures the The patient has no recollection-is cause for Or that you have just observed-and of which HIV infection are an exception many experi. Uals have some slightly enlarged nodes thatĪre residuals of old infections. Unless it has recently changed most individ. Swollen for years is probably inconsequential Hairy leukoplakia in a patient with diffuse Has the individual had dif-įiculty seeing recently? Uveitis is a frequentĬoncomitant of sarcoidosis the symptoms, in-Ĭluding hazy vision and black floating spots,Īre often subtle. The enlarged nodes ache after a few alcoholicĭrinks and that he or she often has pruritusĪnd night sweats. Tient with Hodgkin's disease may notice that (GI) bleeding, and recurrent cough or pneu. Ized itching, a history of gastrointestinal The possibility of malignancy or HIV-associ-Īted lymphadenopathy. Pany a systemic viral infection, but also raise Weight loss, malaise, and fatigue may accom. Infection or paharyngitis particularly if the Does the patient have other signs or symptoms? Few clinicians would be alarmed by swollen submandibular nodes with con- comitant symptoms of an upper respiratory A history of theĬurrent symptoms is a logical place to start. Since lymphadenopathy in an adult can her-Īld a number of conditions-a cold, infection with the human immunodeficiency virus (HIV), sarcoidosis, lymphoma, to name aįew-it is essential to glean clues from as HIV infection, lymphadenopathy in an adult merits the most coherent Since it can announce any of a multitude of disorders, including

Multiple shotty cervical lymph nodes