L2: cervical lymph nodes, lymphadenopathy and neck lumps

Question 1

Outline common pathology affecting the lymphatic system which may give rise to lymphadenopathy

Answer 1

Infection (lump is tender & mobile)

Malignancy

Question 2

What is lymphoedema and lymphadenopathy?

Answer 2

Lymphoedema – tissue swelling due to problem in lymphatic system
Lymphadenopathy – swollen lymph node(s) due to infection or malignancy (primary & secondary)

Question 3

What is the difference in a benign and malignant neck lump?

Answer 3

Benign – hard, matted & non-tender

Malignant – rubbery, mobile & fast-growing

Question 4

Describe the differences between regional and terminal lymph nodes

Answer 4

Regional – drain specific areas, lie SUPERFICIALLY within the superficial cervical fascia, can be readily palpated
Terminal – receive all the lymph from the head and neck

Question 5

List the 7 superficial lymph nodes

Answer 5

Submental
Submandibular 
Occipital
Pre-auricular 
Post-auricular
Anterior cervical
Posterior cervical

Question 6

List the 3 deep cervical lymph nodes

Answer 6

Jugulo-digastric
Jugulo-omohyoid
Supraclavicular (within supraclavicular fossa)

Question 7

Lymph from where drains into the 3 deep cervical lymph nodes?

Answer 7

Jugulo-digastric – palatine tonsil, oral cavity & posterior tongue
Jugulo-omohyoid – tongue, oral cavity, trachea, oesophagus & thyroid gland
Supraclavicular – abdomen & thorax
(SUPERFICIAL LYMPH NODES DRAIN INTO DEEP CERVICAL LYMPH NODES)

Question 8

Which tonsils form Waldeyer’s ring of lymphoid tissue? What are their locations?

Answer 8

Lingual tonsils – posterior base of the tongue
Palatine tonsils – located on each side & seen within the oral cavity
Tubal tonsils – where each eustachian tube opens into the nasopharynx
Pharyngeal tonsils – roof of the nasopharynx

Question 9

What is the general role of the Waldeyer’s ring?

Answer 9

Responds to pathogens that may be ingested or inhaled

Question 10

What are different causes of neck lumps which are in the midline? How do you differentiate between them?

Answer 10

Goitre: enlargement of the thyroid gland
-will move whilst swallowing
Thyroglossal duct cyst (congenital)
-will move when you stick your tongue out
Dermoid cyst (congenital)

Question 11

What are the different causes of neck lumps which are lateral?

Answer 11

Brachial cyst (congenital) 
Submandibular salivary gland enlargement: blocked duct/cancer 
(REMEMBER A LUMP ANYWHERE IN THE NECK -> ALWAYS INCLUDE LYMPHADENOPATHY AS A POTENTIAL CAUSE)

Question 12

List the red flags for lymphadenopathy

Answer 12

Persisting > 6 weeks
Fixed, hard & irregular
Rapidly growing in size
Associated with generalised lymphadenopathy
Associated systemic signs/symptoms eg. weight loss, night sweats
Associated with a persistent (unexplained) change in voice/hoarseness or difficulty swallowing