Lymph Node Exam (OSCE)

Lymph Node Groups

• occipital, preauricular, postauricular
• submental, submandibular
• cervical: anterior, posterior, deep
• clavicular: supraclavicular, infraclavicular
• axillary: anterior (pectoral), lateral, posterior (subscapular), apical, medial
• epitrochlear
• inguinal:superficial(horizontal,vertical),deep
• popliteal
• femoral
• paraaortic

Inspection

• lymphedema
• surgical scars from cancer excision
• obvious masses

Palpation

• technique: use the pads of the index and middle finger to move the skin in circular motions over the underlying tissues in each area; palpated both sides of the neck simultaneously
• small nodes (< size of distal phalanx of pinky finger) are normal unless in unusual location (preauricular).
• in abnormal nodes, describe in terms of
  • location
  • size
  • delimination (discrete or matted together)
  • mobile or fixed
  • consistency (soft, hard, firm)
  • tenderness

Location of Nodes (And what it drains)

• preauricular - in front of tragus of ear (eye)
• postauricular - behind ear, over mastoid process (ear)
• parotid-

• occipital - posterior to mastoid process, at base of skull

• submental - inside mentus of the mandible (floor of mouth)
• submandibular - near submandibular salivary glands (oral cavity)

• angular-
• submental-
• pre-sternocleidomastoid
• retro-sternocleidomastoid
• retroauricular
• suboccipital
• supraclavicular
• infraclavicular

• cervical chains
  • anterior chain runs along the SCM (pharynx, tonsils)
  • posterior chain runs along the trapezius

• clavicular (abdomen, thorax, breast)
  • supraclavicular - Virchow’s node (ominous finding in cancer patient)

• axillary
  • lateral (arm), medial
  • apical - need to push very hard
  • anterior (anterior chest wall, most of breast)
  • posterior (posterior chest wall, upper arm)

• epitrochlear - while shaking the patient’s hand, feel the epitrochlear area
• inguinal - “shotty” nodes are small, mobile and discrete (normal)

Misc

• ABNORMAL → (SLAP) - spleen, liver exam; associated lymph sites; search for a primary site

Other OSCE modules