Lymphadenopathy and organomegaly: diagnostic approach — formative SAQs

SAQ 1 (10)

A well 5-year-old has a soft tender 2 cm cervical node on day 5 of a viral URI. Growth is normal. No supraclavicular nodes. Abdomen soft without organomegaly. [1] [2]

1. Give a one-sentence problem representation. (2)
2. List four classification axes you use at the bedside. (4) [2]
3. Outline your plan including safety-net features that would change management. (4) [2] [3]

Model answer

Problem representation. Acute localised tender cervical lymphadenopathy after URI in a well preschool child — most likely reactive. [1] [2]

Axes. Duration; distribution (localised vs generalised); character (soft/tender/mobile vs hard/fixed); systemic context (fever pattern, B symptoms, cytopenia clues, exposures). [2]

Plan. Observe with review; treat source if needed; avoid endless blind antibiotics; safety-net rapid growth, hardness/fixation, supraclavicular spread, bruising, breathing difficulty, night sweats, weight loss — then escalate imaging/labs/specialty. [2] [3]

SAQ 2 (10)

A 15-year-old has pharyngitis, fatigue, bilateral cervical lymphadenopathy and a palpable spleen tip. Monospot/EBV testing supports infectious mononucleosis. They play school rugby. [4]

1. What organomegaly complication concerns you for sport? (2) [4]
2. List three other differentials you still keep in mind if the course is atypical. (3) [2]
3. Structure your counselling and follow-up plan. (5) [4]

Model answer

Sport risk. Splenic enlargement raises traumatic rupture risk with contact/collision sport. [4]

Differentials if atypical. Bacterial pharyngitis complications; acute HIV or other viral syndromes as contextually relevant; leukaemia/lymphoma if progressive nodes, cytopenias or atypical course; CMV and other mononucleosis-like illnesses. [2] [4]

Counselling. Supportive care; hydration; red-flag return advice; restrict high-impact contact until clinical recovery and spleen risk acceptable under guidance; staged return to activity; school fatigue plan; follow-up if not improving. [4]