Lymph Node Exam (OSCE)
Lymph Node Groups
[edit | edit source]- occipital, preauricular, postauricular
- submental, submandibular
- cervical: anterior, posterior, deep
- clavicular: supraclavicular, infraclavicular
- axillary: anterior (pectoral), lateral, posterior (subscapular), apical, medial
- epitrochlear
- inguinal:superficial(horizontal,vertical),deep
- popliteal
- femoral
- paraaortic
Inspection
[edit | edit source]- lymphedema
- surgical scars from cancer excision
- obvious masses
Palpation
[edit | edit source]- technique: use the pads of the index and middle finger(The "flat" of the fingers not the tip) to move the skin in circular motions over the underlying tissues in each area; palpate both sides of the neck simultaneously
- small nodes (< size of distal phalanx of pinky finger) are normal unless in unusual location (preauricular).
- in abnormal nodes, describe in terms of
- location
- size
- delimination (discrete or matted together)
- mobile or fixed
- consistency (soft, hard, firm)
- tenderness
Location of Nodes (And what it drains)
[edit | edit source]- preauricular - in front of tragus of ear (eye)
- postauricular - behind ear, over mastoid process (ear)
- parotid-
- occipital - posterior to mastoid process, at base of skull
- submental - inside mentus of the mandible (floor of mouth)
- submandibular - near submandibular salivary glands (oral cavity)
- angular-
- submental-
- pre-sternocleidomastoid
- retro-sternocleidomastoid
- retroauricular
- suboccipital
- supraclavicular
- infraclavicular
- cervical chains
- anterior chain runs along the SCM (pharynx, tonsils)
- posterior chain runs along the trapezius
- clavicular (abdomen, thorax, breast)
- supraclavicular - Virchow’s node (ominous finding in cancer patient)
- axillary
- lateral (arm), medial
- apical - need to push very hard
- anterior (anterior chest wall, most of breast)
- posterior (posterior chest wall, upper arm)
- epitrochlear - while shaking the patient’s hand, feel the epitrochlear area
- inguinal - “shotty” nodes are small, mobile and discrete (normal)
Misc
[edit | edit source]- ABNORMAL → (SLAP) - spleen, liver exam; associated lymph sites; search for a primary site