Lymphoreticular examination: Head, neck, axilla, abdomen Flashcards
What does pallor in a patient’s complexion indicate?
Anaemia
Pallor is a common clinical sign that can suggest underlying conditions such as anaemia.
What are bruising and petechiae indicative of?
Thrombocytopenia
Bruising and petechiae are signs of low platelet levels, which may lead to bleeding disorders.
What should be assessed for obvious lymphadenopathy?
Head and neck
Lymphadenopathy can indicate infection or malignancy.
What position should a patient assume to check for axillary lymphadenopathy?
Hands behind their head
This position helps to better visualize the axillary region for lymph nodes.
What is Koilonychia?
Indented, spoon-shaped nails
Koilonychia is often associated with iron-deficiency anaemia.
What nail changes are associated with B12 deficiency?
Hyperpigmentation with blue-black discolouration and dark longitudinal streaks or entirely blue/brown-grey
These changes can be indicative of systemic conditions affecting the nails.
What is glossitis?
Inflammation with depapillation of the dorsal surface of the tongue
Glossitis can be a sign of nutritional deficiencies, particularly iron or vitamin B12.
What should you ask the patient to do to check for tonsillitis?
Open mouth and look at tonsils for signs of tonsillitis
Use a pen torch and tongue depressor to examine the dorsal surface of the tongue for better visibility.
What are signs of tonsillitis?
Enlarged or asymmetrical tonsils
Tonsillitis often presents with these physical changes in the tonsils.
What does conjunctival pallor indicate?
Anaemia
The inside of the lower eyelid should appear white or pale pink instead of the normal dark pink/red color.
What examination technique is used to check for abdominal distention?
Stand at the foot of the bed when the patient is lying down
This position helps in assessing hepatosplenomegaly.
What does glossitis look like?
Erythematous (darker red compared to normal pink) and smooth, shiny
Glossitis can indicate conditions such as iron-deficiency anaemia, pernicious anaemia, and folate deficiency.
What indicates jaundice during an examination?
Yellow sclera
Yellow sclera occurs due to increased bilirubin, associated with conditions like haemolytic anaemia and Gilbert’s syndrome.
True or False: Glossitis is always a sign of a serious condition.
False
While glossitis can indicate nutritional deficiencies, it may not always signify a serious condition.
What should be observed in the patient’s eyes during a physical examination?
Look for yellow sclera
This can indicate underlying issues such as jaundice.
How to assess head and neck lymph nodes?
Stand behind the sitting patient and assess both sides at the same time.
How to assess axillary lymph nodes?
Stand at the sitting patient’s side and use pads of fingers to roll around lymph nodes.
Where are the submental nodes located?
Under the chin, in the middle of the neck.
Where are the submandibular nodes located?
Along the underside of the mandible/jawbone towards the ears.
Where are the tonsillar nodes located?
Behind the jaw angle, inferior to the ear.
Where are the parotid nodes located?
On the cheek under sideburns, inferior to the ear.
Where are the preauricular nodes located?
In front of the ears.
Where are the postauricular nodes located?
Behind the ears.
How to palpate anterior superior and deep cervical nodes?
Palpate down and in front of the anterior border of the sternocleidomastoid muscle to the clavicle.
How to palpate posterior superior and deep cervical nodes?
Palpate up and behind the posterior border of the sternocleidomastoid muscle to the mastoid process.
Where are the occipital nodes located?
In line with the bottom of the ear lobe, at the bottom of the skull and near the hairline.
How to assess supraclavicular and infraclavicular nodes?
Ask the patient to shrug up shoulders, palpate in supraclavicular fossa (supra) and in front of clavicle (infra).
How to palpate axillary lymph nodes?
Rest the patient’s right forearm on your right forearm and palpate with your left hand, then do the same for the patient’s left forearm. Ask the patient to completely relax their arm.
How to assess the pectoral/anterior group of axillary nodes?
Use the medial border (pinky finger to wrist) of your hand with palm facing towards you.
How to assess the central/medial group of axillary nodes?
Use the palmar surface of your fingers.
How to assess the subscapular/posterior group of axillary nodes?
Face your palm away from you.
How to assess the humeral/lateral group of axillary nodes?
Use the underside of the arm.
How to assess the apical group of axillary nodes?
In the armpit, warn the patient that this could be uncomfortable.
What additional lymph nodes should be examined?
Epitrochlear and inguinal lymph nodes.
What is hepatosplenomegaly?
Hepatosplenomegaly refers to the enlargement of the liver and spleen.
How to palpate the liver and spleen?
Start at the right iliac fossa, place flat palm on abdomen angled to fit liver and spleen tips in the 1st dorsal webspace. Ask the patient to take a deep breath in, press palms downwards and inwards, then ask them to breathe out while moving hands closer to the organs.
What is the purpose of percussion in abdominal examination?
Percussion identifies the amount and distribution of gas and masses that are solid or fluid-filled. Dull areas indicate underlying mass, while tympanic areas indicate gas.
How to perform percussion for the liver?
Start at the right iliac fossa, percuss in a straight line up towards the mid-clavicular line/right hypochondriac region. The percussion sound should change from resonant to dull (liver) and then back to resonance.
What does it indicate if the liver can be percussed below the costal margin?
If the liver can be percussed below the costal margin, this can indicate hepatomegaly.
How to perform percussion for the spleen?
Start at the right iliac fossa, percuss in a diagonal line up towards the left hypochondrium.
What is Castell’s sign?
Dullness at full inspiration when percussing the lowest intercostal space at the left anterior axillary line indicates Castell’s sign of splenomegaly.
What are the borders of the anterior cervical triangle?
Inferior border of the mandible
Midline of the neck
Anterior border of SCM muscle
What are the borders of the posterior cervical triangle?
Posterior border of the SCM muscle
Trapezius muscle
Base: Clavicle
