1. Cervical Lymph Nodes And Neck Lumps Flashcards
What are the general roles of the lymphatic system?
Remove excess fluid from interstitial space
Key role in immune defence and surveillance
Returns small proteins (inc. pathogens) and fluid that leaked from capillaries
What are some clinical manifestations of disease involving the lymphatic system?
Lymphoedema
Lymphadenopathy - swollen lymph nodes due to infection or malignancy
What are some characteristics of a lymph node?
Physical filter
Phagocytic filter
Full of lymphocytes (T and B cells): activate and proliferate in response to antigens
What does lymphadenopathy present as in an infection?
Tender
Mobile
History of infection symptoms
How is malignancy presented in lymphadenopathy?
Hard, matted, non-tender
Rubbery, mobile, fast-growing, non-tender
Possible cancer symptoms
If a lymph node is found to be enlarged what are the next steps?
Comprehensive history
Examine the area of tissue it drains
If systemic disease/malignancy suspected, examine other lymph nodes and body systems
Name the superficial lymph nodes that drain the face and scalp into lymph nodes in the neck
Occipital Post auricular Pre auricular Submental Superficial cervical Submandibular
Which structures in the neck drain directly into the deep cervical lymph nodes?
Thyroid
Posterior tongue
Name the deep cervical lymph nodes
Jugulo-digastric
Jugulo-omohyoid
Supraclavicular lymph nodes
Which superficial lymph node may be enlarged with an mouth ulcer on the inside of the bottom lip?
Submental
Which lymph node may be enlarged with an ulcer on the tongue?
Submental
Which lymph node may be enlarged with conjunctivitis?
Pre-auricular
Which lymph node may be enlarged with tonsillitis?
Deep cervical (jugulo-digastric)
What is Waldeyer’s ring?
An annular collection of lymphoid tissue which surrounds the upper aerodigestive and provide a first line of defence against pathogens
Which tonsils form Waldeyers ring?
Palatine tonsils (visible)
Pharyngeal tonsil (adenoids)
Tubal tonsils
Lingual tonsil
What should be asked in the history of a patient presenting with neck lumps?
Age
Duration, progression, associated symptoms/signs
What should you look for in examination of neck lumps?
Relate location to knowledge of underlying structures
Movement with swallowing and sticking out tongue
Palpation
What should you look for when palpating a neck lump?
Does it feel superficial? Hard/soft/smooth/irregular Fixed to surrounding tissue? Tender Overlying skin changed e.g. red
What could a superficial/within superficial fascia/skin lump suggest?
Sebaceous cyst, dermoid cyst, lipoma, skin abscess
What could an inflammatory/infective lymph node suggest?
Tonsillitis
Mouth ulcer
What could a congenital lesion suggest?
Thyroglossal cysts
Branchial cyst
What could salivary gland pathology suggest?
Calculus
Infection
Tumour
What lumps usually present in the midline of the neck?
Dermoid cyst - pea size
Thyroglossal duct cyst - lump moves with swallowing and tongue protrusion
Thyroid gland pathology - lump moves with swallowing
What lumps usually present in the neck laterally?
Submandibular pathology (cancer, blockage) Branchial cyst
