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Lymphadenopathy — RACP Paediatrics MCQ

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ModerateInfectious DiseaseLymphadenopathyRACP Paediatrics

A 10-year-old boy presents with a painless, non-tender, enlarged cervical lymph node (3 cm) that has been present for 6 weeks. It is non-tender, rubbery, and mobile. There is no overlying skin change. He has had low-grade fevers and 2 kg weight loss. A Mantoux test is negative and CXR is normal. What is the most appropriate next step?

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Correct answer: D — Excisional biopsy of the lymph node

A persistent cervical lymph node >2 cm for >6 weeks with constitutional symptoms (fever, weight loss) and no response to observation or antibiotics requires excisional biopsy to exclude lymphoma. FNA may be insufficient for lymphoma diagnosis as architectural assessment is needed. CT imaging may be useful but does not replace tissue diagnosis.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Lymphadenopathy