2 - Lymph Nodes of the Head Flashcards
What are some diseases involving the lymphatic system?
- Lymphoedema: not in head due to gravity
- Lymphadenopathy: due to infection or malignancy
What should you do when you are presented with an enlarged lymph node and how could you tell the lymphadenopathy was due to a malignancy?
What sort of areas will drain into the superficial and deep lymph nodes of the neck?
- Anything within the investing layer will drain straight into deep and so will the superficial
- Superficial only palpable when enlarged
- Deeps follow rout of IJV in carotid sheath
Where are the main groups of superficial lymph nodes that drain the face, scalp and neck?
Which areas of the face and the scalp are drained by each superficial group of lymph nodes?
- Tip of the tongue: submental so if swelling under chin ask patient to open mouth and check for infection here
- Back of the tongue: submandibular or straight to deep
- Conjunctivitis or forehead: Preauricular
Where are the deep lymph nodes and when may they display lymphadenopathy?
- In carotid sheath along IJV
- Jugulodigastric: tonsilitis, oral cavity and tongue
- Jugulo-omohyoid: thyroid, tongue, trachea, oesophagus, oral cavity
- Supraclavicular (in pos triangle): Chest and Abdomen cancers, e.g lung, stomach, bowel
Looking at the following pictures, which lymph node would be most swollen?
What is Waldeyer’s ring and why do they cause pain when swollen?
Painful as capsule stretched when swollen
What should you look for in a history when being present with a neck lump?
- Cancers mainly in adults
- Lymphomas get big FAST
- Associated symptoms, e.g weight loss, night sweats, rash
Why does the thyroid move up when we swallow?
Surrounded by pre-tracheal fascia which is also attached to the hyoid bone which moves up when we swallow
What are some possible differentials for a neck lump?
If someone presented with a lump in the midline of their neck what differentials could we suspect and how do we rule out each one?
- Look if in midline or lateral and check which triangle it is in
If someone presented with a lateral neck lump what differentials could we suspect?
What are some red flags for lymphadenopathy?
What is the initial imaging choice for a neck lump and why?
- Ultrasound
- Can see superficial
- No radiation
- Can biopsy
What areas do each of the supraclavicular nodes drain?
What are some potential differentials for a neck lump apart from lymphoma?
- Lipoma
- Thymoma
What are some tests you could do on a patient when they present with a neck lump?
- FBC
- Viral serology e.g EBV
- Chest X-ray
- Throat swab
- FNAB
- Ultrasound
What are some differentials for lateral neck lumps, not including branchia cysts and submandibular gland disease?
What is the posterior auricular nerve a branch of?
Facial Nerve
Where would a branchial cysts be?
Anterior SCM - Fluid filled
How could you tell the difference between this being a lipoma and a goitre?
- Can’t get fingers around a goitre
- Moves up when swallowing if a goitre
What is the typical ‘history’ of the following haemorraghes:
- Extra Dural
- Subdural
- Subarachnoid
- Subaponeurotic
- Extradural: any age, lose consciousness initially but then wake up and fine, lucid interval, deterioration
- Subdural: old, minor head injury days before as venous blood slow, confusion
- Subarachnoid: worst headache ever had, nauseous/vomiting , meningism, patient often has hypertension, sudden
- Subaponeurotic: scalp
What are some differentials for an old person with confusion?
- Infections like UTI
- Dementia
- Intracranial Haemorraghe
- Medications
- Diabetic hypo
- Hypoxic confusion
Do tests to rule each out
What is the most likely cause of a subarachnoid hameorraghe and how do you diagnose this?
- Ruptured aneurysm
- CT
- Lumbar puncture to find presence of blood in CSF or rule out meningitis
Why has Arnold had a TIA and why has he had transient vision loss?
- AF as irregularly irregular so a thromboemboli has come up and blocked the brain
