1. Cervical Lymph Nodes And Neck Lumps

Question 1

What are the general roles of the lymphatic system?

Answer 1

Remove excess fluid from interstitial space
Key role in immune defence and surveillance
Returns small proteins (inc. pathogens) and fluid that leaked from capillaries

Question 2

What are some clinical manifestations of disease involving the lymphatic system?

Answer 2

Lymphoedema

Lymphadenopathy - swollen lymph nodes due to infection or malignancy

Question 3

What are some characteristics of a lymph node?

Answer 3

Physical filter
Phagocytic filter
Full of lymphocytes (T and B cells): activate and proliferate in response to antigens

Question 4

What does lymphadenopathy present as in an infection?

Answer 4

Tender
Mobile
History of infection symptoms

Question 5

How is malignancy presented in lymphadenopathy?

Answer 5

Hard, matted, non-tender
Rubbery, mobile, fast-growing, non-tender
Possible cancer symptoms

Question 6

If a lymph node is found to be enlarged what are the next steps?

Answer 6

Comprehensive history
Examine the area of tissue it drains
If systemic disease/malignancy suspected, examine other lymph nodes and body systems

Question 7

Name the superficial lymph nodes that drain the face and scalp into lymph nodes in the neck

Answer 7

Occipital
Post auricular
Pre auricular
Submental
Superficial cervical
Submandibular

Question 8

Which structures in the neck drain directly into the deep cervical lymph nodes?

Answer 8

Thyroid

Posterior tongue

Question 9

Name the deep cervical lymph nodes

Answer 9

Jugulo-digastric
Jugulo-omohyoid
Supraclavicular lymph nodes

Question 10

Which superficial lymph node may be enlarged with an mouth ulcer on the inside of the bottom lip?

Answer 10

Submental

Question 11

Which lymph node may be enlarged with an ulcer on the tongue?

Answer 11

Submental

Question 12

Which lymph node may be enlarged with conjunctivitis?

Answer 12

Pre-auricular

Question 13

Which lymph node may be enlarged with tonsillitis?

Answer 13

Deep cervical (jugulo-digastric)

Question 14

What is Waldeyer’s ring?

Answer 14

An annular collection of lymphoid tissue which surrounds the upper aerodigestive and provide a first line of defence against pathogens

Question 15

Which tonsils form Waldeyers ring?

Answer 15

Palatine tonsils (visible)
Pharyngeal tonsil (adenoids)
Tubal tonsils
Lingual tonsil

Question 16

What should be asked in the history of a patient presenting with neck lumps?

Answer 16

Age

Duration, progression, associated symptoms/signs

Question 17

What should you look for in examination of neck lumps?

Answer 17

Relate location to knowledge of underlying structures
Movement with swallowing and sticking out tongue
Palpation

Question 18

What should you look for when palpating a neck lump?

Answer 18

Does it feel superficial?
Hard/soft/smooth/irregular
Fixed to surrounding tissue?
Tender
Overlying skin changed e.g. red

Question 19

What could a superficial/within superficial fascia/skin lump suggest?

Answer 19

Sebaceous cyst, dermoid cyst, lipoma, skin abscess

Question 20

What could an inflammatory/infective lymph node suggest?

Answer 20

Tonsillitis

Mouth ulcer

Question 21

What could a congenital lesion suggest?

Answer 21

Thyroglossal cysts

Branchial cyst

Question 22

What could salivary gland pathology suggest?

Answer 22

Calculus
Infection
Tumour

Question 23

What lumps usually present in the midline of the neck?

Answer 23

Dermoid cyst - pea size
Thyroglossal duct cyst - lump moves with swallowing and tongue protrusion
Thyroid gland pathology - lump moves with swallowing

Question 24

What lumps usually present in the neck laterally?

Answer 24

Submandibular pathology (cancer, blockage)
Branchial cyst

Question 25

What are the red flags for lymphadenopathy?

Answer 25

Persisting > 6 weeks
Fixed, hard and irregular
Rapidly growing in size
Associated with generalised lymphadenopathy (HIV, lymphomas)
Associated systemic signs/symptoms such as weight loss, night sweats
Associated with a persistent change in voice/hoarseness or difficulty swallowing