Cervical Lymphadenopathy

What this deck covers

Cervical Lymphadenopathy in ten clinical teaching cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

Diagnoses and management options tested

Across the ten cases you are asked to choose between options such as: Viral upper respiratory infection, Group A Streptococcal pharyngitis, Acute bacterial lymphadenitis, Cat scratch disease, Reactive lymphadenopathy, Infectious mononucleosis, Malignancy (e.g., Lymphoma), Viral lymphadenitis, Nontuberculous mycobacteria, Acute unilateral bacterial lymphadenitis, Ultrasound of the neck, Contrast-enhanced CT scan, Magnetic Resonance Imaging (MRI), Plain X-ray of the neck.

Clinical pearls from this deck

• Bilateral, small ( nodes with URI symptoms in a well, afebrile child = reactive viral lymphadenopathy — by far the most common cause. No antibiotics or workup are needed; reassure that the nodes can take weeks to shrink. The benign signature is “bilateral + soft + mobile + non-tender.”
• A supraclavicular node is malignant until proven otherwise. Here the red flags stack up: >2 cm, hard, fixed, supraclavicular, plus systemic “B symptoms” (night sweats, unexplained weight loss). These mandate prompt imaging (CXR for mediastinal widening) and biopsy — not watchful waiting.
• Acute ( node with fever points to bacterial lymphadenitis — usually Staphylococcus aureus or group A Streptococcus. Treat empirically (e.g., cephalexin/clindamycin), reassess in 48–72 h, and image with ultrasound if it becomes fluctuant.
• Ultrasound is the first-line imaging for a pediatric neck mass — bedside, no radiation, and it reliably separates a phlegmon (treat medically) from a drainable abscess (needs drainage). Reserve contrast CT for deep/complex infections or surgical planning; plain films and MRI are not the initial step.
• Cat-scratch disease (Bartonella henselae) — subacute regional lymphadenopathy (axillary or cervical most common), kitten exposure, and an inoculation papule at the scratch site. Diagnosis is clinical + serology; most cases are self-limiting, and azithromycin can speed nodal resolution.
• Nontuberculous mycobacterial (NTM) lymphadenitis — a toddler with a painless, chronic (weeks) node and a classic violaceous (purplish) overlying skin hue. Complete surgical excision is the treatment of choice (diagnostic and curative). Avoid incision & drainage, which causes chronic draining sinus tracts.
• Kawasaki disease = fever ≥5 days PLUS ≥4 of: bilateral non-exudative conjunctivitis, oral changes (cracked lips / strawberry tongue), polymorphous rash, extremity changes, and cervical lymphadenopathy (>1.5 cm, often unilateral). Adenopathy is the least common criterion but can be the presenting sign — recognize early and give IVIG to prevent coronary aneurysms.
• Infectious mononucleosis (EBV) — an adolescent with symmetric posterior cervical adenopathy, exudative pharyngitis, splenomegaly, and palatal petechiae; the smear shows atypical lymphocytes. Avoid contact sports for 3–4 weeks (splenic rupture risk), and avoid amoxicillin (causes a morbilliform rash).
• Failure of a first-line beta-lactam (cephalexin) in acute lymphadenitis suggests community-acquired MRSA — switch to clindamycin (or TMP-SMX). A node that has become fluctuant needs drainage (needle aspiration or I&D) for source control; antibiotics alone won’t clear a walled-off abscess.

The deck above is free and needs no sign-in. Work through it once for recognition, then again a week later to test yourself — each question has one best answer and a worked explanation.

More from this system: all ent decks and question sets · pediatric reference values.