Cervical Lymph Nodes and Neck Lumps

Question 1

What are the main functions of the lymphatic system?

Answer 1

1. Remove excess fluid from interstitial space 2. Return small proteins (including pathogens) and fluid that leaked from capillaries and can’t be taken up at venule end 3. Key role in immune defence and surveillance

Question 2

Why do lymph nodes swell and englarge during infection?

Answer 2

Proliferation of lymphocytes in response to antigen presentation

Question 3

Give 3 features of lymph nodes

Answer 3

1. Physcial barrier 2. Phagocytic barrier 3. Full of lymphocytes (T&B cells)

Question 4

Where are nearly 1/2 of all the body’s lymph nodes found?

Answer 4

In the neck

Question 5

Which 3 regions are lymph nodes most palpable?

Answer 5

Neck (cervical) Armpit (axillary) Groin (femoral)

Question 6

What is lymphadenopathy?

Answer 6

An enlarged lymph node

Question 7

What are the 2 different reasons for lymphadenopathy? How would you differentiate between the two?

Answer 7

1. infection (most common) 2. Malignancy Can be differentiated by comprehensive history, examination of the node

Question 8

How do all lymph nodes drain?

Answer 8

From Superficial to deep

Question 9

Where are superficial lymph nodes found?

Answer 9

In the superficial fascia

Question 10

Where are deep lymph nodes found?

Answer 10

Associated with the IJV along its length, in the carotid sheath

Question 11

Name the superficial lymph nodes 1-8

Answer 11

1. Submental 2. submandibular 3. Pre-auricular 4. Post-auricular 5. Occipital 6. Superficial cervical 7. Posterior cervical 8. Anterior cervical

Question 12

Which areas of the head and neck drain to each lymph node?

Answer 12

Question 13

Name deep lymph nodes 9-11

Answer 13

9. Jugulo-digastric
10. Jugulo-omohyoid
11. Supraclavicular lymph nodes

Question 14

Which lymph node may swell in tonsillitis?

Answer 14

Jugulo- Digastric

Question 15

When might the Jugulo-omohyoid lymph node swell?

Answer 15

tongue cancers

Question 16

When might supraclavicular lymph nodes swell?

Answer 16

In GI cancers (receives draining from chest and upper GI)

Question 17

Which lymph node may swell in conjunctivitis?

Answer 17

Pre-auricular lymph node

Question 18

What is Waldeyer’s Ring?

Answer 18

An annular collection of lymphoid tissue surrounding the upper aerodigestive tract

Question 19

Which tonsils are visible at the back of the throat?

Answer 19

Palatine Tonsils

Question 20

If a neck lump moves up and down when swallowing, what is the most likely reason for the lump?

Answer 20

Related to the thyroid gland

Question 21

Name some reasons for superficial neck lumps

Answer 21

• sebaceous cyst - dermoid cyst - lipoma (fatty lump) - skin abcess

Question 22

What things may cause an inflammatory/ infected lymph node?

Answer 22

Tonsillitis or mouth ulcers

Question 23

Where is a branchial cyst most likely to be located?

Answer 23

In the lateral aspect of the anterior triangle

Question 24

Name some congenital causes of neck lumps

Answer 24

• Branchial cyst - Dermoid cyst - Thyroglossal duct cyst

Question 25

Where is a dermoid cyst most likely to be located and what is it?

Answer 25

Along the midline of the anterior triangle, high in the neck

It is an epithelial lined cyst

Question 26

Where is a thryoglassal duct more likely to be located and what is it?

Answer 26

Along the midline of the anterior triangle, high in the neck

A cyst filled with fluid

Question 27

What is a distinguishing feature between diagnosing dermoid cysts and thyroglossal duct cyst?

Answer 27

A thryoglossbal duct cyst will move with swallowing and when sticking out the tongue

Question 28

What are some red flag signs for lymphadenopathy?

Answer 28

• Persisting longer than 6 weeks
• fixed, hard and irregular
• rapidly growing in size
• associated generalised lymphadenopathy - associated systemic signs of weight loss and night sweats
• persistent unexplained change in voice/ difficulty swallowing

Question 29

Typically what is the 1st line imagine choice for investigating a lump in the neck and why?

Answer 29

Ultrasound

Cheap and no radiation, will give enough info to decide on next steps