Lymph Node Exam (OSCE)

Lymph Node Groups

 * 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

 * lymphedema
 * surgical scars from cancer excision
 * obvious masses

Palpation

 * 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)

 * 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

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