Lymphoreticular examination: Head, neck, axilla, abdomen

Question 1

What does pallor in a patient’s complexion indicate?

Answer 1

Anaemia

Pallor is a common clinical sign that can suggest underlying conditions such as anaemia.

Question 2

What are bruising and petechiae indicative of?

Answer 2

Thrombocytopenia

Bruising and petechiae are signs of low platelet levels, which may lead to bleeding disorders.

Question 3

What should be assessed for obvious lymphadenopathy?

Answer 3

Head and neck

Lymphadenopathy can indicate infection or malignancy.

Question 4

What position should a patient assume to check for axillary lymphadenopathy?

Answer 4

Hands behind their head

This position helps to better visualize the axillary region for lymph nodes.

Question 5

What is Koilonychia?

Answer 5

Indented, spoon-shaped nails

Koilonychia is often associated with iron-deficiency anaemia.

Question 6

What nail changes are associated with B12 deficiency?

Answer 6

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.

Question 7

What is glossitis?

Answer 7

Inflammation with depapillation of the dorsal surface of the tongue

Glossitis can be a sign of nutritional deficiencies, particularly iron or vitamin B12.

Question 8

What should you ask the patient to do to check for tonsillitis?

Answer 8

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.

Question 9

What are signs of tonsillitis?

Answer 9

Enlarged or asymmetrical tonsils

Tonsillitis often presents with these physical changes in the tonsils.

Question 10

What does conjunctival pallor indicate?

Answer 10

Anaemia

The inside of the lower eyelid should appear white or pale pink instead of the normal dark pink/red color.

Question 11

What examination technique is used to check for abdominal distention?

Answer 11

Stand at the foot of the bed when the patient is lying down

This position helps in assessing hepatosplenomegaly.

Question 12

What does glossitis look like?

Answer 12

Erythematous (darker red compared to normal pink) and smooth, shiny

Glossitis can indicate conditions such as iron-deficiency anaemia, pernicious anaemia, and folate deficiency.

Question 13

What indicates jaundice during an examination?

Answer 13

Yellow sclera

Yellow sclera occurs due to increased bilirubin, associated with conditions like haemolytic anaemia and Gilbert’s syndrome.

Question 14

True or False: Glossitis is always a sign of a serious condition.

Answer 14

False

While glossitis can indicate nutritional deficiencies, it may not always signify a serious condition.

Question 15

What should be observed in the patient’s eyes during a physical examination?

Answer 15

Look for yellow sclera

This can indicate underlying issues such as jaundice.

Question 16

How to assess head and neck lymph nodes?

Answer 16

Stand behind the sitting patient and assess both sides at the same time.

Question 17

How to assess axillary lymph nodes?

Answer 17

Stand at the sitting patient’s side and use pads of fingers to roll around lymph nodes.

Question 18

Where are the submental nodes located?

Answer 18

Under the chin, in the middle of the neck.

Question 19

Where are the submandibular nodes located?

Answer 19

Along the underside of the mandible/jawbone towards the ears.

Question 20

Where are the tonsillar nodes located?

Answer 20

Behind the jaw angle, inferior to the ear.

Question 21

Where are the parotid nodes located?

Answer 21

On the cheek under sideburns, inferior to the ear.

Question 22

Where are the preauricular nodes located?

Answer 22

In front of the ears.

Question 23

Where are the postauricular nodes located?

Answer 23

Behind the ears.

Question 24

How to palpate anterior superior and deep cervical nodes?

Answer 24

Palpate down and in front of the anterior border of the sternocleidomastoid muscle to the clavicle.

Question 25

How to palpate posterior superior and deep cervical nodes?

Answer 25

Palpate up and behind the posterior border of the sternocleidomastoid muscle to the mastoid process.

Question 26

Where are the occipital nodes located?

Answer 26

In line with the bottom of the ear lobe, at the bottom of the skull and near the hairline.

Question 27

How to assess supraclavicular and infraclavicular nodes?

Answer 27

Ask the patient to shrug up shoulders, palpate in supraclavicular fossa (supra) and in front of clavicle (infra).

Question 28

How to palpate axillary lymph nodes?

Answer 28

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.

Question 29

How to assess the pectoral/anterior group of axillary nodes?

Answer 29

Use the medial border (pinky finger to wrist) of your hand with palm facing towards you.

Question 30

How to assess the central/medial group of axillary nodes?

Answer 30

Use the palmar surface of your fingers.

Question 31

How to assess the subscapular/posterior group of axillary nodes?

Answer 31

Face your palm away from you.

Question 32

How to assess the humeral/lateral group of axillary nodes?

Answer 32

Use the underside of the arm.

Question 33

How to assess the apical group of axillary nodes?

Answer 33

In the armpit, warn the patient that this could be uncomfortable.

Question 34

What additional lymph nodes should be examined?

Answer 34

Epitrochlear and inguinal lymph nodes.

Question 35

What is hepatosplenomegaly?

Answer 35

Hepatosplenomegaly refers to the enlargement of the liver and spleen.

Question 36

How to palpate the liver and spleen?

Answer 36

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.

Question 37

What is the purpose of percussion in abdominal examination?

Answer 37

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.

Question 38

How to perform percussion for the liver?

Answer 38

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.

Question 39

What does it indicate if the liver can be percussed below the costal margin?

Answer 39

If the liver can be percussed below the costal margin, this can indicate hepatomegaly.

Question 40

How to perform percussion for the spleen?

Answer 40

Start at the right iliac fossa, percuss in a diagonal line up towards the left hypochondrium.

Question 41

What is Castell’s sign?

Answer 41

Dullness at full inspiration when percussing the lowest intercostal space at the left anterior axillary line indicates Castell’s sign of splenomegaly.