Neck and Lymphatic System

Question 1

(1) For descriptive purposes, divide the neck into two triangles bound by ______ muscle.
(2) Anterior triangle of the neck: (3)
(3) For the posterior triangle: (3)
(4) Do not mistake this muscle for a mass on the clavicle
(5) What structures are you identifying for the midline of the neck?

Answer 1

(1) Sternomastoid
(2) Mandible, sternomastoid laterally, midline of the neck
(3) Sternomastoid muscle, trapezius, clavicle.
(4) Omohyoid muscle
(5)
1. Hyoid bone (below the mandible)
2. Thyroid cartilage
3. Cricoid cartilage
4. Tracheal rings
5. Thyroid gland

Question 2

(1) In the supraclaviclar fossa, greater than ___cm is significant*
(2) In the axilla and inguinal areas, less than ___cm is insignificant
(3) Every other palpable lymph node, less than ___ cm is insignificant

Answer 2

(1) 1cm* [enlargement can suggest possible metastasis from a thoracic or abdominal malignancy]
(2) 3cm [Can be bigger in the axilla due to fat]
(3) 2cm

Question 3

Where shouldn’t you feel lymph nodes? [Indicating malignancy]

Answer 3

1. L Supraclavicular fossa [abdominal disease] have them bend their neck forward. Push down over the clavicle.
2. Infraclavicular fossa [breast cancer, malignant lymphoma]

Question 4

In some people the parotid gland can be felt where?

Answer 4

Angle of the mandible. Also feel submandibular glands.

Question 5

Palpating lymph nodes, location.

Answer 5

Posterior auricular lymph nodes [infection]
Preauricular lymph nodes [infection]
Occipital
Down sternocleidomastoid muscle, palpate for jugular lymph nodes. Go up and down gently. Down to the clavicle.

Question 6

Palpable lymph node areas

Answer 6

• epitrochlear
• axillary
• cervical and occipital
• supraclavicular
• para-aortic (rarely palpable)
• inguinal
• popliteal

Question 7

8 groups of cervical / supraclavicular nodes

Answer 7

Submental (below chin) 
Submandibular (below jaw) 
Julgular chain (anterior to sternomastoid) 
Posterior triangle nodes (posterior sternomastoid) 
Occiptal nodes
Postauricular node
Preauricular node 
Supraclavicular fossa

Question 8

Contraindications to treating lymphatics (3)

Answer 8

1. Fractures
2. Cancer
3. Severe infection
   (Don’t want to spread it around)

Question 9

Septal hematoma is a…

Answer 9

Medical emergency

Question 10

Thyroid cyst vs. nodule

Answer 10

A nodule does not move when the patient sticks out their tongue, but a cyst will.

Question 11

Which structures in the neck are NOT palpable?

Answer 11

Hyoid bone (not usually palpable midline) 
Thyroihoid membrane

Question 12

The first palpable structure on the neck is the

Answer 12

Thyroid cartilage (Adam’s apple)

Question 13

The small groove below is the thyroid cartilage is

Answer 13

Cricothyroid ligament

Question 14

The structure below the Cricothyroid ligament

Answer 14

Cricoid cartilage

Question 15

The _____ below the cricoid cartilage is not always palpable

Answer 15

Thyroid isthmus

Question 16

When a patient swallows, what happens to the thyroid gland?

Answer 16

The thyroid gland goes up, and if there’s a nodule, it also goes up. If it doesn’t, the nodule is in the subcutaneous tissue.

Question 17

What to chart with lumps/swelling

Answer 17

Size
Position
Attachments
Consistency 
Edge 
Surface and shape
Pulsation/Thrills/Bruits
Inflammation 
Transillumination 
(SPACEPIT)

Question 18

Malignant masses commonly infiltrate adjacent tissues, causing them to feel

Answer 18

Fixed and immobile.

Question 19

Unlike a muscle or an artery, you should be able to roll a node

Answer 19

In 2 directions, up/down and side/side

Question 20

Enlarged or tender lymph nodes call fo

Answer 20

Reexamination of the regions they drain

Question 21

Tender lymph nodes suggest

Answer 21

Inflammation

Question 22

Hard/fixed lymph nodes suggest

Answer 22

Malignancy

Question 23

Elderly population: Lymph nodes

Answer 23

Decrease with age in size and number

Question 24

In the pediatric population, when do sinuses develop?

Answer 24

7 years old