L4: Cervical lymph nodes and neck lumps

Question 1

What are the functions of the lymphatic system?

Answer 1

• remove excess fluid from iterstitial space
• key role in immune defence and surveillance (physical/phagocytic barrier and source of lymphocytes) to tackle any infections that enter via the lymphatic system
• returns small proteins (including pathogens) and fluid that leaked from capillaries

Question 2

What are some clinical manifestations of disease involving the lymphatic system?

Answer 2

• lymphoedema

- lymphadenopathy (swollen lymph nodes due to infection/malignancy)

Question 3

How many lymph nodes do substances transported in lymph pass through?

Answer 3

> /= 1 so if you have an infection, it may not be uncommon to have one or more lymph nodes involved

Question 4

What is the normal size range for lymph nodes?

Answer 4

Microscopic -> 2.5cm

Question 5

How many afferent/efferent lymphatic vessels does a lymph node have?

Answer 5

Afferent: many lymphatic vessels (drain into it)
Efferent: one singular vessel (exiting)
Lots of channels feeding in, and one channel out= slows down the flow, important to allow the lymphnodes to filter/react to any antigens/pathogens

Question 6

What is the structure of lymph nodes?

Answer 6

• Inner contents of soft reticular connective tissue is surrounded by a tough outer fibrous capsule-physical filter
• Within the lymphnodes we have a phagocytic filter (full of lymphocytes, which activate and proliferate in reponse to antigens) = swelling/enlarge of node

Question 7

Where are the majority of the body’s lymph nodes found?

Answer 7

Neck (cervical), nearly 1/2 the body’s lymph nodes are found in this region

Question 8

What is another name for an enlarged lymph node?

Answer 8

Lymphadenopathy

Question 9

What causes lymphadenopathy?

Answer 9

• infection (most common)

- malignancy (primary/secondary)

Question 10

How can you tell the cause for lymphadenopathy?

Answer 10

• what the lump feels like (infection- lump is tender and mobile: not stuck to any surrounding features//cancer (metastases-hard, matted, not tender OR lymphomas- rubbery/mobile/fast-growing/not tender)
• previous history (e.g.previous infection)

Question 11

What do you do when a lymph node is found to be enlarged?

Answer 11

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

Question 12

How are lymph nodes organised in the neck?

Answer 12

• superficial cervical lymph nodes are found in the subcutaneous tissue (within superficial fascia): easily palpible when enlarged
• deep cervical nodes, beneath the first deep cervical fascial layer (investing layer) (may/may not cause palpable lump)

Question 13

Where are many deep nodes found?

Answer 13

Within the carotid sheath, associated with the routeof the internal jugular vein

Question 14

Where do the deep nodes take drainage from?

Answer 14

The superficial nodes

Question 15

What are some of the names of the superficial lymph nodes? (all in the same plane)

Answer 15

1- Submental (below mental protuberance)
2- Submandibular (below the mandible- don’t confuse these with the submandibular salivary gland)
3- Preauricular (in front of your ear)
4- Postauricular (behind your ear, near mastoid process)
5- Occipital (base of skull)
These 5 groups can form a ring around the skull- take drainage from the face
6- Superficial cervical
7- Anterior cervical (near anterior jugular veins which are found in this superficial region of neck)
8- Posterior cervical (near external jugular vein)
(7/8 relative to to the SCM)
Mirrored on both sides of the face

Question 16

What is the mental protuberance?

Answer 16

Pointed part of your chin

Question 17

When are the lymp nodes of the neck palpable?

Answer 17

• in some healthy individuals

- especially if they are slightly enlarged

Question 18

What is another name for superficial/deep lymph nodes?

Answer 18

Superficial: regional
Deep: terminal