Lymph Nodes and Neck Lumps.

Question 1

Describe the lymph nodes commonly palpated on examination. (8)

Answer 1

Supraclavicular 
Anterior triangle 
Superficial (on SCM)
Submandibular
Submental
Pre-auricular
Post-auricular
Posterior triangle.

Question 2

Explain the presentations of 3 common causes of lymphadenopathy. (4)

Answer 2

Infection - tender and mobile.
Malignancy - hard, fixed, non-tender.
Lymphoma - rubbery, mobile, fast growing.
Lymph nodes swell when immune cells collect here so they can attack the pathogens in the lymph.

Question 3

Explain why deep lymph nodes are not commonly palpated. (1)

Answer 3

They exist under an investing layer of fascia, which can squish them even if they are swollen.

Question 4

List the deep lymph node groups and where they drain. (7)

Answer 4

Jugulo-digastric : tonsils
Jugulo-omohyoid : tongue, pharynx, larynx
Supreclavicular : Virchov’s node - GI malignancy.

Question 5

Describe Waldeyer’s ring. (5)

Answer 5

A collection of lymphoid tissue surrounding the upper aerodigestive tract.
One large pharyngeal tonsil in top centre, two tiny tubal tonsils at 2 and 10, two medium sized pharyngeal tonsils at 4 and 8 (only ones you can see) and a large lingual tonsils at the bottom.

Question 6

Describe three differentials for a midline neck lump. (3) Explain how you would differentiate between them. (3)

Answer 6

Dermoid cyst - congenital, high, fluid filled
Thyroglossal duct cyst - congenital, lower than dermoid, moves with tongue protrusion.
Thyroid - moves with swallowing, could be malignant or benign.

Question 7

Describe four differentials for a lateral neck lump. (4) Explain how you would differentiate between them. (4)

Answer 7

Salivary gland swelling - could be caused by stones, infection, tumour - worse with eating as saliva is released.
Branchial cyst - congenital, on the anterior SCM border.
Lymph nodes - infection, primary or secondary malignancy - mobile.
Carotid artery aneurysm - pulsation.