Sandbox:Javaria

History ❑Patient age (specific demographic characteristics (age) of certain malignancies) ❑ Duration of lymphadenopathy (<2 weeks or >1 year without an increase in size has low malignant potential) ❑ Past medical history of underlying disease, suggestive of immunodeficiency, or recurrent infections ❑ Sexual history suggestive of infection transmission ❑ Family history of certain malignant disorders (breast cancer, or melanoma) ❑ Exposure to communicable infectious diseases/ travel to high-risk areas ❑ Environmental exposure such as UV (skin cancer risk)/ animals/ occupational exposure ❑ Social history such as tobacco use, alcohol use (head and neck cancers risk)

Physical exam Appearance of the patient Cachexia or surgical scar marks demonstrating previous malignancy treatment Vital signs Temperature: High-grade / low-grade fever may demonstrate infection. Heart rate: Tachycardia with regular pulse may demonstrate infection. Respiratory rate: Tachypnea may demonstrate respiratory system involvement (infection\ metastasis). Blood pressure: Chronic hypertension or hypotension (may indicate sepsis as a complication). Oxygen saturation: may be low if the respiratory system is affected.

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Patient is unstable

Patient is stable

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Do's

Patients with immunodeficiency should have a wide differential diagnosis consideringnon-Hodgkin's lymphoma and Kaposi’s sarcoma.

Dont's

• Physical examination should not be missed as a finding may change the course of differential diagnosis. Missing the physical exam may lead to unnecessary investigations and unnecessary delays.
• Fine-needle aspiration biopsy (FNAC) or excisional biopsy is the gold standard for tissue diagnosis and evaluation for LAD.