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Apr 24th, 2019
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  1. F with single enlarged firm mobile rubbery lymph left inguinal lymph node <1cm tender to palpation but not painful at rest. No risk factors for malignancy, no systemic sxs, no recent travel to areas of concern, no recent trauma. No vaginal, rectal, abdominal, or lower extremity symptoms, no suspicion of respiratory disease or active TB, no constitutional symptoms, no exposure to vector of disease, and no daily medication use. Examination of drainage basin revealed no abnormalities. Discussed with pt the possible etiologies of localized enlarged lymph nodes. Reassured pt that she does not have any revealing risk factors or recent exposure that would indicate concerning cause of lymphadenopathy. Discussed that features of node are reassuring and lend to suspicion of benign cause. A study addressing likelihood of malignancy in unexplained lymphadenopathy presenting to primary care showed 1.1% rate of malignancy found among presenting cases (PubMed id 3049914). Given age and risk factors it is likely that any further workup at this time would be unrevealing and expose pt to greater risk through infection. Discussed with pt that it is reasonable and recommended to observe lymph node for a period of 3-4 weeks. If it persists beyond that I will obtain CBC, possibly other lab work, and refer for biopsy. Discussed concerning sxs to watch out for: rapid change in size, development of systemic sxs, development of any vaginal sxs, skin changes. Pt to RTC ASAP if anything new develops. Patient verbalized agreement and understanding.
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