Examination: Lymph Nodes


  • Wash hands
  • Introduce yourself
  • Ask permission to examine patient
  • Expose patient down to underwear
  • Reposition lying flat

Inspect
  • Around patient - e.g.: for medications
  • Patient as a whole - do they look well? Cachectic? Any obvious swelling of limbs (suggestive of possible lymphoedema?

Examination of Lymph Node groups:
  • Lymph node groups to examine:
    • Head and neck
      • Submental
      • Submandibular
      • Pre-auricular
      • Anterior cervical
      • Supraclavicular
      • Infraclavicular
      • Posterior auricular
      • Occipital
    • Axillary
      • Apical
      • Anterior
      • Posterior
      • Lateral (on the medial aspect of humerus)
    • Inguinal (between pubic tubercle and anterior superior iliac spine)
    • Popliteal fossa
  • If you feel a lymph node or lump anywhere, you must know how to describe it in an OSCE scenario.
    • Everyone has their own methods for describing lumps. I like to remember what to include by remembering them as the 3 S's, 3 T's, and 3 C's:
      • 3 S's: site, size, shape
      • 3 T's: temperature, tenderness, tethering
      • 3 C's: colour, contour, consistency

To end my examination, I would like to:
  • Take a full history from the patient
  • Examine this patient's vascular system (and any other relevant/local system to check for cause of lymphadenopathy - see below).


Causes of Lympadenopathy

  • Idiopathic
  • Infiltration
    • Primary carcinoma: lymphoma, leukaemia
    • Secondary carcinoma: e.g.: due to melanoma, thyroid carcinoma, breast, bowel, lung, prostate, kidney, or head and neck cancers
  • Non-infective
    • Sarcoidosis
    • Amyloidosis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
    • Eczema, psoriasis
    • Drugs, e.g.: phenytoin
  • Inflammation and infection
    • Local infection e.g.: pharyngitis
    • Bacterial: tuberculosis, syphillis, brucella
    • Viral: EBV, HIV, HSV, hepatitis
  • Other: toxoplasmosis

written by: celine_lakra, first posted on: 1/03/12, 17:00

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