Lymph Node Exam (OSCE)

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Lymph Node Groups[edit]

  • 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]

  • lymphedema
  • surgical scars from cancer excision
  • obvious masses

Palpation[edit]

  • 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]

  • 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]

  • ABNORMAL → (SLAP) - spleen, liver exam; associated lymph sites; search for a primary site

Other OSCE modules[edit]