Lymph

Question 1

Lymphadenopathy

Answer 1

• Body has 600 lymph nodes
• Can enlarge by proliferation of normal cells
• Infiltration by foreign or abnormal cells

Question 2

Lymph Nodes

Anatomy

Answer 2

• Bean-shaped
  
  • Covered thickly with the fibrous capsule
  • Inward pointing trabeculae

Question 3

Lymph Nodes

Two Parts

Answer 3

• Two Basic Parts
  
  • Cortex
    
    • Populated with lymphocytes
      
      • Primary resting place for B Cell
        
        • Undergo mitosis and divide
        • Produce immunoglobulins
      • T Lymphocytes
        
        • Circulate lymph nodes
        • Blood stream
        • Lymphatic ducts
  • Medulla
    
    • Made up of macrophages attached to reticular fibers

Question 4

Overview of Lymph Nodes

Answer 4

• Cervical Lymph Node
  
  • Tender on physical examination is reassuring
  • Diameter greater than 2cm or that are firm and matted
    
    • More likely to be malignant

Question 5

Size of the Node

Answer 5

• Normal for axillary and cervical region to have up to 1cm
• Inguinal region up to 1.5
• Epitrochlear region up to .5
• Risk of underlying malignancy
  
  • Greater than 2cm
    
    • Mononucleosis, epstein barr, and strep

Question 6

Location and Quality of the Nodes

Answer 6

• Palpable node in supraclavicular fossa
• Inguinal and axillary lymph nodes less likely of malignant disease
• Tender is more likely to be infection
• If there is hemorrhage in the node due to malignancy, may be painful
• Nodes that are fixed and matted to each others
  
  • Cancers
  • Invasive inflammations like TB or sarcoidosis

Question 7

Age of Patient

Answer 7

• Not palpable in newborn

Question 8

Congenital lesions that can be confused include

Answer 8

• Cystic hygroma
• Branchial cleft cyst
• Thyroglossal duct cyst “
• Cervical rib

Question 9

Shotty Node

Answer 9

Buckshot under the skin

Most common between 3-5

Question 10

Localized or Generalized

Answer 10

• Duration of lymphadenopathy
• Progression in size or number
• Hodgkin’s more indolent in course and there can be 6-12 months of lymphadenopathy
• Associated symptoms
  
  • Night sweats, fever, weight loss, pruritus, arthralgias, fatigue

Question 11

Lymph Nodes

The neck is divided into…

Answer 11

Two major anatomic triangles

SCM

Question 12

Anterior triangle

Answer 12

Bound superiorly by mandibular border and extends along the sternocleidomastoid muscle to the mid line of the neck anteriorly.

Question 13

Posterior triangle

Answer 13

Bounded by the sternocleidomastoid muscle, the distal two thirds of the clavicle and the posterior mid line of the neck.

Question 14

Palpating Lymph Nodes

Answer 14

Palpate with the pads of your index and middle fingers for the various lymph node groups

Question 15

Preauricular

Answer 15

In front of the ear

Drains anterior and temporal scalp, anterior ear canal and pinna, conjunctiva

Could be adenovirus or conjunctivitis of eye

Question 16

Postauricular

Answer 16

Behind the ear

Drains temporal and parietal scap

Head lice

Question 17

Occipital

Answer 17

At the base of the skull

Drains the posterior scalp

Seen on either side

Lice

Question 18

Tonsillar and superficial cervical nodes

Answer 18

At the angle of the jaw

Lower larynx, lower ear canal, and parotid

Question 19

Submandibular

Answer 19

Under the jaw on the side

Drain cheek, nose, lips, tongue, submandibular gland, buccal mucosa

Question 20

Submental

Answer 20

Under the jaw in the mid line

Drains lower lip and floor of the mouth

Dental Disease

Question 21

Supraclavicular

Answer 21

In the angle of the SCM and the clavicle

Drains the right side, mediastinum and lungs

Drains the left side abdomen

Question 22

Deep Cervical Chain

Answer 22

• Lies below the sternomastoid
• Cannot be palpated without getting underneath the muscle
• Hook your fingers under the anterior edge of the sternomastoid muscle
• Drains the tonsils, adenoids, posterior scalp and neck, tongue, larynx, thyroid, palate, nose, esophagus, paranasal sinuses

Question 23

SHOTTY NODES

Answer 23

Small

Mobile

Soft

Non-tender

Question 24

Axillary

Drainage site

Answer 24

Arm, breast, thorax, neck

Question 25

Inguinal Drainage

Answer 25

Lower extremities, genitalia, buttocks, abdominal wall below umbilicus

Question 26

Popliteal drainage

Answer 26

Lower leg

Question 27

Epitrochlear drainage

Answer 27

medial arm and below elbow

Question 28

Reactive Adenopathy

Answer 28

REaction to an infection in the drainage area

Pharyngitis

Otitis Media

Conjunctivitis

Question 29

Lymphadenitis

Answer 29

• Inflamed, enlarged, tender lymph node
• Acute onset
• Associated with tender, erythematous , warm lymph noces with fever
• Ultrasound identifies abscess

Question 30

Lymphadenopathy

Answer 30

• Less common than localized adenitis
• Can be a sign of serious underlying systemic disease
• Major causes of non infectious lymphadenopathy
  
  • Medication (as part of serum sickness
  • Malignancy
  • Autoimmune diseases

Question 31

Lymphadenopathy

Looking for…

Answer 31

• Abnormal in size
• Abnormal in number
• Abnormal in consistency
• Differential of Lymphadenopathy
  
  • Age of the patient
  • Size of the node
  • Location of the node
  • Quality of the node
  • Localized or generalized
  • Time course of the lymphadenopathy and associated symptoms