Lymphadenopathy and organomegaly: diagnostic approach — viva

Opening (must-hit)

“I will assess whether the child is unwell, map all node stations plus liver and spleen, classify duration, distribution and character, then choose observation, targeted tests or tissue/specialty referral based on red flags.” [1] [2]

Branch A — Red flags

Examiner: Which findings stop pure observation?
Candidate: Supraclavicular, hard/fixed/matted, progressive growth, generalised nodes, B symptoms, cytopenia clues, mediastinal/airway symptoms, unexplained organomegaly. [2] [3]

Branch B — Persistent asymptomatic node

Examiner: The child is well; the node is unchanged at 6 weeks.
Candidate: Structured re-examination, selective labs/ultrasound, avoid endless antibiotics, and a timed plan for imaging or biopsy if still unexplained — aligned with persistent asymptomatic node management principles. [5] [6]

Branch C — NTM pattern

Examiner: Unilateral cervicofacial node with violaceous skin in a preschooler.
Candidate: Think NTM; involve ENT/ID; do not treat as ordinary bacterial abscess alone; use consensus-informed pathways. [4]

Branch D — Tissue diagnosis

Examiner: You suspect lymphoma. FNA or excision?
Candidate: Prefer architecture-preserving biopsy when lymphoma is likely; coordinate sample handling; assess mediastinal risk before anaesthesia. [2] [6]

Branch E — Communication

Examiner: Parents fear cancer.
Candidate: Explain base rate of reactive disease, the specific red flags we checked, the timeline for review, and exactly what would trigger escalation — without false certainty. [1] [5]

Close

State problem representation, plan owner, review date and safety-net. [1]