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Head N Neck > Lecture 4 - Cervical Lymph Nodes, Lymphadenopathy And Neck Lumps > Flashcards

Lecture 4 - Cervical Lymph Nodes, Lymphadenopathy And Neck Lumps Flashcards

1
Q

What are the 3 general roles of the lymphatic system in the body?

A

Remove excess fluid from interstitial space

Returns small proteins and fluid leaked from capillaries back into venous circulation

Key role in immune defence and surveillance (physical and phagocytic barrier)

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2
Q

What is lymphadenopathy?

A

Enlarged lymph nodes due to either I infection/inflammation or malignancy

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3
Q

What is lymphoedema?

A

When theres a problem with lymphatics so excess lymph/interstitial fluid not removed very well

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4
Q

What is meant by lymph nodes being described as palpable or non-palpable?

A

Palpable (sometimes when normal but especially when enlarged)

Non-palpable (even if enlarged)

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5
Q

What are some locations of palpable lymph nodes?

A

Cervical lymph nodes (neck)

Axilla
Groin

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6
Q

What is important to note about cervical lymph nodes in children?

A

Can be palpable even in healthy children

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7
Q

What is Waldeyers Ring?

A

Essentially a group of tonsils, so groups of lymphoid tissue found submucosally in a ring in the upper aero digestive tract

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8
Q

What are the 4 lymphoid tissues found in Waldeyers ring?

A

Adenoid/pharyngeal tonsils

Tubal tonsil

Palatine tonsils

Lingual tonsil

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9
Q

What are tonsils?

A

Collection of lymphatic tissue associated with mucosal tissue (MALT)

Don’t have a fibrous capsule like nodes do

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10
Q

Where is the adenoids/pharyngeal tonsil?

A

Most superior

In the midline of the upper nasopharynx

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11
Q

Where are the Tubal tonsils located?

A

Surround openings of Eustachian tubes

Lateral walls of the nasopharynx

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12
Q

Where are the palatine tonsils?

A

Referred to as “The Tonsils”

Found in lateral oropharynx wall

Visible when you open the mouth

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13
Q

Where are the lingual tonsils?

A

At the base of the tongue (posterior third)

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14
Q

Why can enlargement of the pharyngeal tonsil (adenoids) be dangerous?

A

Can obstruct nasal breathing

Blockage of Eustachian tube (leads to middle ear problems)

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15
Q

What is tonsillitis?

A

Inflammation of the palatine tonsils

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16
Q

What is the most common type of organism causing tonsillitis?

A

Viral

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17
Q

If the cause of Tonsilitis is bacterial what is the most common causative organism?

A

Streptococcus

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18
Q

How does tonsilitis present?

A

Painful swallowing
Halitosis
Pyrexia
Tonsils erythematous, exudate and lymphadenopathy

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19
Q

What are the 2 groups of cervical lymph nodes?

A

Superficial cervical lymph nodes

Deep cervical lymph nodes

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20
Q

Where are the superficial cervical lymph nodes located?

A

In the superficial cervical fascia just beneath the skin

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21
Q

Where do the superficial cervical lymph nodes run/what structure do they form?

A

Forms a ring from chin to occiput

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22
Q

What do the superficial cervical lymph nodes drain into?

A

The deep cervical lymph nodes

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23
Q

Where are the deep cervical lymph nodes located?

A

Deep in the neck in the carotid sheath

Most are associated with the Internal Jugular Vein

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24
Q

What drains into the deep cervical lymph nodes?

A

Deep tissues like the thyroid, trachea and oesophagus

And superficial lymph nodes

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25
Q

What is the name of the structure that is the chin?

A

Mental protuberance (promince of the mandible

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26
Q

What are the important superficial cervical lymph nodes in the order you’d assess them?

A

Submental
Submandibular
Pre-auricular and parotid
Post-auricular
Superficial cervical
Anterior cervical
Posterior cervical
Occipital

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27
Q

Look at the last slide of the lecture:

What are the lymph nodes?

A

1 = submental
2 = submandibular
3 = pre-auricular and parotid
4 = post-auricular
5 = occipital
6 = superfical cervical
7 = posterior cervical
8 = anterior cervical

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28
Q

How are the superficial cervical lymph nodes associated with SCM and the route of what blood vessel?

A

On surface of SCM

Associated with External Jugular Vein

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29
Q

How are the posterior cervical lymph nodes associated with SCM and the route of what blood vessel?

A

Sits behind SCM in posterior triangle

External Jugular vein

30
Q

How are the anterior cervical lymph nodes associated with SCM and the route of what blood vessel?

A

Sits in front of SCM

Anterior Jugular Vein

31
Q

Generally what areas do the superficial cervical lymph nodes drain?

A

Skin and tissues of face, scalp and skin of neck

32
Q

What does the occipital lymph nodes drain?

A

Posterior scalp

33
Q

What do the submental lymph nodes drain?

A

Inferior and posterior chin
Floor of mouth
Tip of tongue
Lower teeth and gums

34
Q

Where should you definitely look if the submental lymph nodes enlarged?

A

Look in mouth at tongue and gums

35
Q

What do the submandibular lymph nodes drain?

A

Centre of face and cheek
Teeth and gingivae (gums)
Parts of front of tongue

36
Q

Where should you defo look if the submandibular lymph nodes are swollen?

A

In mouth

37
Q

What do the post auricular lymph nodes drain?

A

Posterolateral half of scalp

38
Q

What does the pre-auricular lymph nodes drain?

A

Most of the forehead
Anterolateral scalp
Upper half of face including eyelids (conjunctiva)
Cheeks

39
Q

Look at the last slide:

What superficial lymph nodes drain each area?

A

1 = submental
2 = submandibular
3 = pre-auricular
4 = post-auricular
5 = occipital

40
Q

How is the tongue divided?

A

Anterior 2/3 rds

Posterior 1/3 (can’t see)

41
Q

What lymph nodes drain the anterior 2/3rds of the tongue?

A

Submental nodes

Submandibular nodes

Deep cervical nodes

42
Q

What lymph nodes drain the posterior 1/3 of the tongue?

A

Deep cervical nodes

Retropharyngeal nodes

43
Q

What are the 3 sections of the deep cervical lymph nodes in relation to the Internal Jugular Vein?

A

Upper 1/3
Middle 1/3
Lower 1/3

44
Q

What is an important deep cervical lymph node found in the upper 1/3rd?

A

Jugulo-digastric

45
Q

When does the jugulo-digastric swell?

A

Bacterial tonsilitis

Jugular palatine cancer can metastasise here

46
Q

What is an important deep cervical lymph node in the lower 1/3?

A

Jugular-omohyoid

47
Q

What does the jugulo-omohyoid deep cervical lymph node drain?

A

Tongue
Oral cavity
Trachea
Oesophagus
Thyroid

Soo could be indicative of cancers here if it swells

48
Q

What are the supraclavicular lymph nodes?

A

Deep cervical lymph nodes found in the posterior triangle

49
Q

What does the supraclavicualr lymph nodes drain?

A

Thoracic and abdominal cavity

50
Q

Why is supraclavicular lymphadenopathy very concerning?

A

Usuallly indicative of gastric cancer (malignancy)

51
Q

What is lymphadenopathy of the left supraclavicular node called?

A

Virchow node

52
Q

What malignancy can present as supraclavicular lymphadenopathy?

A

Lymphoma

53
Q

Enlarged lymph nodes (lymphadenopathy) is usually down to 2 things, what are they?

A

Reactive due to infection

Malignancy

54
Q

How can you tell when an enlarged lymph node is due to an infection?

A

History

Tender and mobile when palpated and likely its recently rapidly enlarged

55
Q

What are the 2 possibilities for the cause of an enlarged lymph node if its due to malignancy?

A

Metastases

Or

Leukaemia/lymphoma

56
Q

How can you tell whether a lymphadenopathy is due to a metastases?

A

Hard and tethered to surrounding tissues and painless on palpation

57
Q

How can you tell whether a lymphadenopathy is due to a lymphoma?

A

On palpation lump is rubbery, painless and fast growing

58
Q

What are some red flags for lymphadenopathy??

A

Fixed hard and irregular

Rapidly growing in size

Systemic signs like weight loss, night sweats

Change in voice/hoarseness, difficulty swallowing

59
Q

Why is it more concerning seeing lymphadenopathy in adults?

A

In kids it can be normal to see enlargement

But adults its more likely pathological

60
Q

If a lump moves with swallowing what is the lump related to?

A

Thyroid gland

61
Q

If the lump moves with sticking out the tongue what is it related to?

A

Thyroglossal duct cyst

62
Q

What are some very superficial causes of a neck lump?

A

Benign lesions of skin or subcutaneous tissue

(Sebaceous cyst, lipoma)

63
Q

What are some congenital lesions that can cause neck lumps?

A

Thyroglossal duct cysts
Bronchial cyst
Dermoid cyst

64
Q

What are some possible causes of neck lumps that are not lymphadenopathy?

A

Thyroid gland pathology

Salivary gland pathology

Vascular

65
Q

What are some thyroid gland pathologies that could cause neck lumps?

A

Malignant or benign neoplasms

Graves’ disease

66
Q

What are some salivary gland pathologies?

A

Calculus (stone)

Inflammation or infection

Neoplasm - benign or malignant

67
Q

What are some vascular problems that can cause neck lumps?

A

Carotid body tumour
Carotid artery aneurysm

68
Q

What are the most common causes of neck lumps in the anterior midline?

A

Thyroid gland disease

Congential lesions like dermoid cyst
Thyroglossal duct cyst

69
Q

What are the most common causes of neck lumps in the anterior or posterior lateral side?

A

Salivary gland pathology (A)

Carotid body tumour

Congenital lesions
(Bronchial cyst (A))
Cystic hygroma (P))

70
Q

Where would a lump for a bronchial cyst be found?

A

In fun of the SCM muscle

71
Q

What is a cystic hygroma?

A

Lymphatic malformation mainly happening in the neck

A collection of fluid filled sacs found in the posterior triangle

Head N Neck (24 decks)

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