Module A/B OSCE Flashcards
Label the anatomy of the neck
Most lymph nodes are found in the neck in the anterior triangle and posterior triangle.
What are the three borders of the:
- anterior triangle?
- posterior triangle?
Anterior triangle bordered by:
- Midline
- Mandible
- Anterior border of sternocleidomastoid
Posterior triangle bordered by:
-Posterior border of sternocleidomastoid
- Clavicle
- Trapezius muscle
Label the lymph node groups of the head and neck
What is a good order in which to examine the head and neck lymph nodes? Where do you start?
Start by standing behind patient with your hands under their chin
1. Submental (under chin)
2. Submandibular (under jaw)
3. Parotid
4. Pre-auricular
5. Post-auricular
6. Anterior chain
7. Posterior chain
8. Occipital
9. Supraclavicular
Examining the axilla - can you identify these muscles?
Pectorals major
Deltoid
Biceps
Coracobrachialis
Groove for axillary vessels and nerves
Long head of triceps
Teres major and latissimus dorsi
What are the steps for assessing a lump found during head & neck lymph node examination?
SSS,CCCC,TT
Site
Size
Shape
Compare to other side of neck
Consistency
Colour of skin
Contours
Tenderness
Tethered to other structures?
Examining the lymphoreticular system.
What are the main steps?
Lymphoreticular system = examining the lymph nodes, liver and spleen.
INTRO
Wash/gel hands
Greet patient
Introduce yourself - full name and role
Ask patient name & DOB and preferred name
Explain procedure and gain consent
Exposure / chaperone
Check for pain
GENERAL
Comment on general appearance
CERVICAL (NECK) LYMPH NODES
Start behind patient with fingers under chin
- Submental
- Submandibular
- Anterior chain
- Posterior chain
- Occipital
- pre- & post- auricular
- Supra & Infra-clavicular
INGUINAL (won’t usually be asked to do these)
AXILLA
LIVER
SPLEEN
FINISH
Thank patient, allow to dress
Wash/gel hands
Summarise findings
What are some adverse/worrying features of lymph nodes?
Swollen lymph nodes could mean
- Infection
- Inflammation
- Malignancy
Fixed/tethered to deep structures or skin suggest malignancy
Describe the process/steps of palpating the axillary lymph nodes
Sit patient upright
Examine from the front
‘Palm to pit’ support patients left arm with your left arm, and use your right arm to examine the left armpit
Five areas to palpate
1. ANTERIOR axillary border (palpate behind the lateral edge of pectorals major)
2. MEDIAL axillary border (thoracic wall)
3. POSTERIOR axillary border (palpate the inside lateral edge of latissimus doors)
4. LATERAL axillary border (palpate the inner aspect of the arm within the axilla)
5. APEX (palpate the apex of axilla with your fingertips)
REPEAT on axilla on other side
Where to feel for inguinal lymph nodes?
What groups of lymph nodes are there to feel in the groin and what are they called?
Causes of lymphadenopathy?
Infective
- local bacterial infection
- EBV (infective mononucleosis)
- TB, HIV
Neoplastic
- Primary: lymphoma
- Secondary: metastatic tumours
Immunological
- Sarcoidosis
Metabolic
- Thyrotoxicosis
How to conduct an abdomen examination?
What are the names and locations of the 9 regions of the abdomen?
How do you palpate the liver?
How do you examine the spleen?
Where is the spleen located? Normal size?
Normal functions? What is the result of having a splenectomy?
Upper left quadrant. Under the 10th rib, so not palpable if normal size.
12 x 7 x 7cm
What does the spleen do?
- it fights invading germs in the blood (the spleen contains infection-fighting white blood cells)
- it controls the level of blood cells (white blood cells, red blood cells and platelets)
- it filters the blood and removes any old or damaged red blood cells.
More vulnerable to infection, reduced immune response. Need lifelong antibiotics.
Causes of splenomegaly? Different categories for the surgical sieve approach?
Surgical sieve approach
- Infective : Bacterial - TB, endocarditis. Viral - infective mononucleosis (glandular fever/ EBV). Protozoal - malaria, leishmaniasis.
- Vascular : portal hypotension (cirrhosis)
- Neoplastic : lymphoma, leukaemia, myeloproliferative disorders
- Haematological : haemolytic disorders
- Immunological : RA, sarcoidosis
- Metabolic : Rare eg. Gaucher’s.
NB. Alcoholic end stage, causes enlarged spleen, but liver small and nobbly.
