1.2- Cervical Lymph Nodes And Neck Lumps

Question 1

What are the 3 main functions of the lymphatic system?

Answer 1

1. Remove excess fluid from interstitial space
2. Immune defence and surveillance (lymphocytes)
3. Returns small proteins, pathogens and fluid that leaked from capillaries

Question 2

What is lymphoedema?

Answer 2

Swelling as a result of obstruction of lymphatic vessels or lymph nodes and the accumulation of large amounts of lymph in the affected region

Question 3

What is lymphadenopathy?

Answer 3

Swollen lymph nodes due to infection or malignancy ( primary or secondary)

Question 4

How is the flow of lymph affected as it passes through a lymph node?

Answer 4

Lymph slows down. There are many afferent lymph vessels leading to the lymph node and only one efferent vessel. The lymph node acts as a bottle neck, restricting the flow and reducing the speed of the travel of the lymph.

Question 5

Why is it important for the speed of lymph to change as it enters the lymph node?

Answer 5

Must slow down to give time for the the lymph node to act as an effective physical and phagocytic filter, and give time to react by proliferating lymphocytes such as T and B cells in response to antigens.

Question 6

Why do lymph nodes swell and enlarge during infections?

Answer 6

As pathogens are carried back to lymph nodes, b lymphocytes detect their foreign antigens, and activate and proliferate T and B cells.

Question 7

In which body regions might lymph nodes be palpable during infection?

Answer 7

Cervical
Axillary
Femoral

Question 8

What are the most common causes for lymphadenopathy?

Answer 8

Infection
Malignancy
Congenital/ developmental conditions (cysts)

Question 9

What 2 different regions can lymph nodes be organised into?

Answer 9

Regional ( or superficial )

Terminal ( or deep )

Question 10

Where are regional lymph nodes located in the neck?

Answer 10

Superficially, within the superficial cervical fascia

Question 11

Where are terminal lymph nodes located in the neck?

Answer 11

Deep to the investing layer of the deep cervical fascia

most associated with IJV along its length within the carotid sheath

Question 12

What drains into deep cervical nodes?

Answer 12

All lymph from the head and neck, from:

• tissues and structures deep to the investing layer of fascia
• regional lymph nodes

Question 13

What vascular structures are the deep cervical lymph nodes related to?

Answer 13

Carotid sheath

Internal jugular vein

Question 14

How does lymphadenopathy vary depending on cause?

Answer 14

Infection : tender, mobile, soft
Metastatic malignant cancers: hard, matted, non-tender
Lymphoma : rubbery, mobile, fast-growing, non-tender

Question 15

What is lymphoma?

Answer 15

Blood cancer that develops when white blood cells (lymphocytes) grow out of control.

Question 16

what investigations are done if a patient has an enlarged cervical lymph node?

Answer 16

• comprehensive history
• examine area of tissue it drains
• if systemic disease/malignancy suspected then examine other lymph nodes and body systems

Question 17

what are the 8 palpable lymph nodes in the head and neck?

Answer 17

8 superficial lymph nodes. 
5 in head are:
- submental ln
- submandibular ln
- preauricular ln
- postauricular ln
- occipital ln
3 in neck
- superficial cervical (EJV)
- posterior cervical (EJV)
- anterior cervical (AJV)

Question 18

what structures drain directly into the deep lymph nodes of the neck?

Answer 18

thyroid

posterior tongue

Question 19

what are the deep cervical lymph nodes of the neck?

Answer 19

jugulo-digastric
jugulo-omohyoid
supraclavicular lymph nodes

Question 20

what structures are deep cervical lymph nodes of the neck associated with?

Answer 20

IJV

carotid sheath

Question 21

which lymph nodes may be enlarged in infections of the eye?

Answer 21

pre-auricular lymph nodes

Question 22

which lymph node might be swollen in ulcers on the gums?

Answer 22

sub-mental

Question 23

which lymph node might be enlarged in tonsilitis?

Answer 23

jugulodigastric lymph node

Question 24

what is Waldeyer’s ring?

Answer 24

an annular collection of lymphoid tissue that surrounds the back of the of the throat/ upper aerodigestive

Question 25

what lymphoid tissue forms Waldeyer’s ring?

Answer 25

pharyngeal tonsil/adenoid
tubal tonsils
palatine tonsils
lingual tonsil

Question 26

what are the possible causes of a superficial neck lump?

Answer 26

sebaceous cyst
dermoid cyst
lipoma
skin abscess

Question 27

what are common benign causes of lymphadenopathy?

Answer 27

tonsillitis

mouth ulcer

Question 28

what congenital lesions can cause a neck lump?

Answer 28

thyroglossal cyst
brachial cyst
laryngocoele
pharyngeal pouch

Question 29

what are the 7 main reasons for a neck lump?

Answer 29

superficial
inflammatory / infective lymph node
congenital lesions
thyroid pathology
primary or secondary malignant disease involving a lymph node
salivary gland pathology
other (chronic infection/carotid artery aneurysm)

Question 30

what are red flags for lymphadenopathy?

Answer 30

persisting more than 6 weeks
fixed, hard, irregular lump
rapidly growing in size
associated with generalised lymphadenopathy
associated with systemic signs/symptoms such as weight loss/night sweats
associated with change in voice/hoarseness or difficulty swallowing

Question 31

what is Virchow’s node?

Answer 31

left supraclavicular lymph nodes. accept drainage of lymph from abdomen and thorax

Question 32

what structures drain into the right supraclavicular node

Answer 32

mid section chest
oesophagus
lungs

Question 33

what structures drain into the jugulo-digastric lymph node?

Answer 33

palatine tonsil
oral cavity
tongue

Question 34

what structures drain into the jugulo-omohyoid?

Answer 34

tongue
oral cavity
trachea
oesophagus
thyroid gland

Question 35

how can ramsey hunt syndrome be distinguished from Bell’s palsy?

Answer 35

both cause paralysis of the facial nerve

only Ramsey hunt syndrome causes vestibular rash in the ear and hearing loss.

Question 36

where can the carotid pulse be felt?

Answer 36

Palpate the carotid artery by placing your fingers near the upper neck between the sternomastoid and trachea roughly at the level of cricoid cartilage.