Examination Of Lymph Nodes Of Head And Neck Pdf

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A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving.

A more recent article on lymphadenopathy is available.

Lymphoreticular Examination – OSCE Guide

A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes.

A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn.

Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Last updated: January 5, Table of Contents. This guide provides an overview of performing a lymphoreticular examination in an OSCE setting.

Examination of the lymphoreticular system is often performed when there is clinical suspicion of haematological malignancy. The purpose of the examination is to assess whether a patient has evidence of lymphadenopathy or hepatosplenomegaly which are common clinical features in conditions such as lymphoma and leukaemia. Introduce yourself to the patient including your name and role. Explain what the examination will involve using patient-friendly language.

Ask the patient if they have any pain before proceeding with the clinical examination. It is important to examine for lymphadenopathy in a systematic manner.

There are several chains that can be easily palpated on clinical examination. Reactive lymph nodes: typically smooth, rounded, tender, mobile and associated with infective symptoms e.

Lymphadenopathy associated with haematological malignancy: widespread enlarged rubbery lymph nodes. Lymphadenopathy associated with metastatic cancer: regional lymphadenopathy in lymph node groups draining the affected organ. Lymph nodes typically feel hard, firm, irregular and are often tethered to local structures. Position the patient sitting upright and examine from behind if possible.

Ask the patient to tilt their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes. You should also ask them to relax their hands in their lap. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes.

By using both hands one for each side you can note any asymmetry in size, consistency and mobility of lymph nodes. Start in the submental area and progress through the various lymph node chains. Any order of examination can be used, but a systematic approach will ensure no areas are missed:.

Take caution when examining the anterior cervical chain that you do not compromise cerebral blood flow due to carotid artery compression. It may be best to examine one side at a time here. Start under the chin submental lymph nodes , then move posteriorly palpating beneath the mandible submandibular , turn upwards at the angle of the mandible tonsillar and parotid lymph nodes and feel anterior preauricular lymph nodes and posterior to the ears posterior auricular lymph nodes.

Follow the anterior border of the sternocleidomastoid muscle anterior cervical chain down to the clavicle, then palpate up behind the posterior border of the sternocleidomastoid posterior cervical chain to the mastoid process. Ask the patient to tilt their head bring their ear towards their shoulder each side in turn, and palpate behind the posterior border of the clavicle in the supraclavicular fossa supraclavicular and infraclavicular lymph nodes. Begin by inspecting each axilla for evidence of scars, masses, or skin changes.

This allows the axillary muscles to relax. Palpation should then be performed with the left hand. The reverse is applied when examining the left axilla. Examination of axilla should cover the pectoral anterior , central medial , subscapular posterior , humoral lateral , and apical groups of lymph nodes. An example of a systematic routine you could follow is listed below:.

Epitrochlear lymphadenopathy is rare, but usually very obvious when present the patient will often point this out. Hold the wrist of the side to be examined with your corresponding hand i. Using your opposite hand, grasp behind the olecranon with your fingers. Your thumb should reach across the crease of the elbow to palpate the inner aspect of the arm just above the medial epicondyle of the humerus.

Assess for the presence of lymphadenopathy which can be associated with metastatic melanoma affecting the arm or conditions causing generalised lymphadenopathy. You are unlikely to be expected to perform an inguinal lymph node assessment in an OSCE, however, it is important to understand how to carry out the examination.

Ask your patient to lower their trousers and underwear to expose the inguinal region. Palpate immediately inferior to the inguinal ligament which runs between the anterior superior iliac spine and pubic tubercle to assess the horizontal group of superficial inguinal lymph nodes. Position your fingers approximately 3cm lateral to the pubic tubercle and then palpate vertically downwards over the saphenous opening and the proximal portion of the great saphenous vein to assess the vertical group of superficial inguinal lymph nodes.

Both lymphomas and leukaemias can cause hepatomegaly and splenomegaly , so a thorough abdominal examination is essential. Position the patient lying flat on the bed, with their arms by their side s and legs uncrossed for abdominal inspection and subsequent palpation. Lightly palpate each of the nine abdominal regions , assessing for clinical signs suggestive of gastrointestinal pathology:.

Palpate each of the nine abdominal regions again, this time applying greater pressure to identify any deeper masses. Warn the patient this may feel uncomfortable and ask them to let you know if they want you to stop. If any masses are identified during deep palpation, assess the following characteristics:.

Begin palpation in the right iliac fossa, starting at the edge of the superior iliac spine, using the flat edge of your hand the radial side of your right index finger. Ask the patient to take a deep breath and as they begin to do this palpate the abdomen. Feel for a step as the liver edge passes below your hand during inspiration a palpable liver edge this low in the abdomen suggests gross hepatomegaly.

Repeat this process of palpation moving cm superiorly from the right iliac fossa each time towards the right costal margin. As you get close to the costal margin typically cm below it the liver edge may become palpable in healthy individuals. If you are able to identify the liver edge , assess the following characteristics:. There is a wide range of possible causes of hepatomegaly including but not limited to:.

Ask the patient to take a deep breath and as they begin to do this palpate the abdomen with your fingers aligned with the left costal margin. Feel for a step as the splenic edge passes below your hand during inspiration the splenic notch may be noted. Repeat this process of palpation moving cm superiorly from the right iliac fossa each time towards the left costal margin. In healthy individuals, you should not be able to palpate the spleen.

A palpable spleen at the edge of the left costal margin would suggest splenomegaly for the spleen to be palpable at this location it would need to be approximately three times its normal size. Dispose of PPE appropriately and wash your hands. On general inspection , the patient appeared comfortable at rest, with no evidence of cachexia, pallor, rashes, bruising or bleeding. Clinical Examination. Heart Murmurs. Eye Drops Overview. Shoulder X-ray Interpretation. Sudden Painless Loss of Vision.

Sick Sinus Syndrome. A collection of surgery revision notes covering key surgical topics. Laryngeal Cancer. Peritonsillar Abscess Quinsy. A man with penile swelling. Visual Pathway and Visual Field Defects. Muscles of the Lower Leg. Bones of the Lower Limb. A man with blood in his urine.

PSA Question Bank. Medical Student Finals Question Bank. ABG Quiz. Share Tweet. Last updated: January 5, Table of Contents. General inspection. Palpate the submental and submandibular lymph nodes. Palpate the lateral edge of pectoralis major.

Palpate the epitrochlear lymph nodes. Inguinal lymph nodes. Inspect the abdomen. Perform light abdominal palpation. Palpate the liver. Causes of splenomegaly There is a wide range of possible causes of splenomegaly including but not limited to: Portal hypertension secondary to liver cirrhosis Haemolytic anaemia Leukaemia Lymphoma Congestive heart failure Splenic metastases Glandular fever. Palpate the spleen. Bromberg, M.

Lymphadenopathy and Malignancy

NCBI Bookshelf. Boston: Butterworths; Infrequently, patients will note enlarged lymph nodes and present with the chief complaint of having a nodule, a swollen gland, a "knot," or enlarged lymph nodes; more commonly, patients do not recognize that they have significantly enlarged lymph nodes, and the lymphadenopathy is discovered by the physician. Since lymphadenopathy can be associated with a wide range of disorders spanning relatively benign medical problems such as streptococcal pharyngitis to life-threatening diseases such as malignancies, the discovery of enlarged nodes represents an important physical finding that demands a systematic evaluation. In searching for lymph nodes, one must be gentle; otherwise, lymph nodes that are only minimally enlarged or embedded in tissue may not be apparent.

Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. K 1 and k 2 did not show any statistically significant difference.


Despite the availability of advanced diagnostic aids, a precise clinical examination remains to be the most ideal tool for assessing head and neck.


Management of cervical lymph nodes in patients with head and neck cancer

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Lymphatic Drainage of the Head and Neck

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