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96 Cards in this Set
- Front
- Back
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What should you pay particular attention to in the patient hx when evaluating lymph nodes?
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1. Patient age
2. physical appearances of the lymph nodes 3. location 4. clinical setting in which the enlargement occurs |
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What age group are enlarged lymph nodes more significant in?
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Generally more significant in adults than in children who are more likely to respond to antigenic challenge or infection w/ lymphoid hyperplasia.
*Kids have hair-trigger immune systems. |
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What size of lymph nodes are considered clinically significant?
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Lymph nodes bigger than the distal phalanx of the little finger. This is ~2cm
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What do tender nodes indicate?
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Tender nodes indicate an acute inflammatory or infectious process.
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What are non-tender nodes characteristic of?
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Non-tender nodes are characteristic of malignancy.
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What are rock-hard nodes characteristic of?
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Metastatic cancer
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What are firm, rubbery nodes (like a pencil eraser) characteristic of?
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Hodgkin's disease or other lymphomas
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What are "shotty" nodes characteristic of? (nodes that feel like buckshot under the skin)
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The result of chronic inflammation and lymph node scarring.
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What are matted nodes? what are they characteristic of?
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Feel as if they are connected and when one is moved the others move too. They are typical of metastatic cancer and primary lymphatic malignancy.
They can also occur in chronic inflammation. |
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What do overlying cutaneous warmth and erythema suggest in lymph nodes?
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suggest lymph node enlargement secondary to infection. Underlying malignancy can also cause similar findings.
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Where are the occipital nodes?
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Midway b/e the external occipital protuberance and the mastoid process in close relation to the greater occipital nerve.
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What drains into the occipital nodes?
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The scalp
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What causes occipital node enlargement? what can be associated w/ occipital node enlargement?
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Benign enlargement in adults is usually due to scalp infection.
The occipital nodes are commonly enlarged in childhood illnesses (such as lice) Enlarged occipital nodes may compress the occipital nerve resulting in pain along its distribution. |
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Where are the posterior auricular (mastoid) nodes?
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Lie on the mastoid process posterior to the pinna of the ear.
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What drains into the posterior auricular (mastoid) nodes?
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The temporal region of the scalp, the posterior part of the pinna and the external auditory canal.
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What dz'es typically cause the posterior auricular nodes to enlarge?
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1. External otitis (swimmer's ear)
2. Rubella (german measles) 3. Rubeola (red measles) |
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Where are the anterior auricular nodes?
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Immediately in front of the tragus of the ear.
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What drains into the anterior auricular nodes?
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They receive drainage from the lateral portion of the eyelids and palpebral conjunctiva. As well as the temporal region, external auditory canal and the anterior portion of the pinna.
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What causes enlargement of the anterior auricular nodes?
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Viral infections of the conjunctiva (oculoglandular syndrome) and may become involved w/ lymphoma.
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Where are the tonsillar nodes?
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Below the angle of the mandible, b/e the internal jugular and common facial veins. They are part of the deep cervical chain.
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What do the tonsillar nodes drain?
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They drain the palatine tonsils and the posterior pharynx.
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Where are the deep cervical nodes?
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Beneath the sternocleidomastoid muscle.
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Where is the jugulodigastric node?
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Below the hyoid bone, near the bifurcation of the common carotid.
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What drains into the jugulodigastric node?
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Most of the tongue, and tonsillar tissue at the base of the tongue.
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What drains into the jugulo-omohyoid node?
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The tip of the tongue.
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What nodes are involved w/ metastatic carcinoma of the tongue?
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Deep cervical nodes
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Where are the posterior cervical nodes?
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Located in the occipital triangle and follow the course of the spinal accessory nerve.
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What causes enlargement of the posterior cervical nodes?
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They are commonly enlarged in scalp infections, including minor inflammations such as DANDRUFF. *flake, flake*
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What nodes are involved w/ nasopharyngeal carcinoma?
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Posterior cervical nodes
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What causes bilateral posterior cervical adenopathy?
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Rubella
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If both the posterior cervical nodes and the posterior auricular (mastoid) nodes are enlarged what can you dx?
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Rubella (german measles)
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What's the dx?
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Lymphedema
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What nodes are being tested?
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Occipital nodes
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What nodes are being tested?
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Posterior Auricular Nodes
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What nodes are being tested?
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Anterior Auricular Nodes
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What nodes are being tested?
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Deep Cervical Nodes
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Where are the superficial cervical nodes?
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Lie on the surface of the sternocleidomastoid muscle and follow the external jugular vein.
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What dz are superficial cervical lymph nodes commonly involved with?
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Lymphoma
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Where are the parotid lymph nodes?
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Lie superficial to the parotid gland.
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What drains into the parotid nodes? where do these nodes drain into?
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The anterior cheek and the lateral pharyngeal wall. The nodes empty into the superficial cervical group.
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Where are the submandibular (submaxillary) nodes?
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Lie adjacent to the submandibular gland.
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What drains into the submandibular (submaxillary) nodes?
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The side of the tongue, the gums, the teeth, the lateral lower lip, angle of the mouth, the cheek and the medial angle of the eye.
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What are the most common causes of submandibular (submaxillary) node enlargement?
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Infections of dental origin and cancers of the mouth.
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Where are the submental nodes located?
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In the midline of the submental triangle.
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What drains into the submental nodes?
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Central part of lower lip, the floor of the mouth, the tip of the tongue and the chin.
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What are the common causes of submental node enlargement?
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Infections of dental origin and cancers of the mouth.
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Where are the supraclavicular nodes?
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Located behind the clavicular insertion of the sternocleidomastoid muscle.
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What nodes are considered pathologic until proven otherwise?
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Supraclavicular nodes.
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Why are the supraclavicular nodes considered pathologic until proven otherwise?
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B/c the abdomen, thorax, head, breast arms and pelvis all drain into this nodal group. SO occult malignancies from remote sites often metastasize to this nodal group.
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How should you perform a palpation exam of the supraclavicular nodes?
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The pt should be sitting w/ head pointed straight forward, the pt should be straining w/ a held Valsalva maneuver.
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What pathologies drain into the right supraclavicular node?
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Metastasis of breast cancer, lung cancer or esophageal cancer.
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What pathologies are associated w/ an isolated left supraclavicular node?
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Suggests breast, kidney, ovarian, testicular, pancreatic or gastric cancer.
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What is a Virchow's node?
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An isolated enlarged left supraclavicular node suggesting breast, kidney, ovarian, testicular, pancreatic or gastric cancer.
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Where are the epitrochlear nodes?
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Lie just proximal to the medial epicondyle of the humerus.
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What drains into the epitrochlear nodes?
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The small, ring and ulnar part of the middle fingers as well as the ulnar side of the hand.
*remember the epitrochlear nerve is proximal to the medial epicondyle is, so the ulnar parts of the hand drain into the epitrochlear node which follows the ulnar nerve. |
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Where do the epitrochlear nodes drain into?
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The axillary node group.
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What nodes would "cat scratch dz" cause to enlarge?
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The epitrochlear nodes
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What dz'es cause the enlargement of the epitrochlear nodes? what kind of enlargement is considered serious in these nodes?
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1. lymphocytic lymphoma
2. sarcoidosis 3. infectious mononucleosis Unilateral enlargement is common in most minor injuries, but bilateral enlargement should be taken seriously. |
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Where are the superficial inguinal nodes?
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Lie w/in the superficial fascia and are oriented into an upper horizontal group and a lower horizontal group.
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Where is the horizontal group of the inguinal nodes? what drains into these nodes?
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Runs parallel to the inguinal ligament and drains the skin of the anterior abdominal wall below the umbilicus, the skin of the penis, scrotum, vulva, vagina, perineum and gluteal region. BUT NOT THE GLANS/CLITORIS
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Where is the vertical group of inguinal lymph nodes? what drains into them?
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Runs on either side of the greater saphenous vein and drains similar areas as the horizontal group.
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Where do the horizontal and vertical inguinal lymph nodes drain into?
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The deep inguinal nodes.
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Where are the deep inguinal nodes? (femoral nodes)
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Beneath the fascia lata on the medial side of the femoral vein below the femoral canal.
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Where is the node of Cloquet?
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W/in the fat of the femoral canal.
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What drains into the deep inguinal nodes?
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receives lymphatics accompanying the femoral vein, the Glans and the Clitoris as well as drainage from the superficial inguinal nodes.
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Where do the deep inguinal nodes empty into?
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The external iliac nodes.
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When should you evaluate the deep inguinal nodes carefully?
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A degree of adenopathy (<2cm in size) is normal, but you should investigate further when the nodes increase in size under observation, when >2cm, when painful or suppurating.
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Where do cancers of testicular, ovarian, uterine and prostate metastasize to?
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NOT the inguinal lymph nodes but to the retroperitoneal nodes
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Where are the superior group of mediastinal nodes?
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Run in front of the aortic arch and drain the thymus, pericardium, heart, esophagus and trachea.
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What do the tracheobronchial group of nodes include?
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The pulmonary nodes that lie in the hilum (hilar nodes) along the secondary branches of the pulmonary bronchi.
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What can enlarged hilar nodes cause?
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obstruction of the respiratory passages.
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Where are the lateral tracheobronchial nodes?
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Run along the trachea and infratracheal-bronchial nodes at the tracheal bifurcation.
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What do the tracheobronchial group of nodes receive lymph from?
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lungs, bronchi, trachea, heart, esophagus and liver.
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How is mediastinal node enlargement usually detected?
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By routine chest x-ray, they are usually asymptomatic.
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What symptoms do pts present with if they have mediastinal node enlargement?
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1. Cough - secondary to irritative processes around trachea/bronchi
2. Bronchial obstruction - results in obstructive local emphysema, atelectasis (collapse), acute and chronic pneumonia 3. hemoptysis - secondary to errosive processes 4. Hoarseness - secondary to compression of recurrent laryngal 5. Dysphagia - secondary to compression of esophagus 6. Superior Vena Cava syndrome - due to obstruction of the superior vena cava. |
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What do the retroperitoneal nodes consist of?
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Sacral, internal iliac, external iliac, common iliac and para-aortic nodal groups.
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What drains into the retroperitoneal nodes?
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Rectum, prostate, cervix, uterus, fallopian tubes, bladder, urethra, kidneys, adrenals, deep structures of anterior abdominal wall, ovaries and testes.
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Where are the intra-abdominal nodes located?
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Located along the lesser and greater omentum, gastrosplenic ligament, mesentary and at the root of the large visceral branches of the aorta (pre-aortic nodes)
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What drains into the intra-abdominal nodes?
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Lower esophagus, stomach, gallbladder, liver, spleen, pancreas and intestines.
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What symptoms do pts w/ abdominal lymphadenopathy present with?
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1. Dull, poorly localized abdominal pain
2. Backache 3. Ureteral obstruction 4. Peripheral lower extremity edema 5. Constipation |
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When can intraabdominal nodes be palpated?
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Not until they have very enlarged, ~3-4cm
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What causes the poorly localized abdominal pain in abdominal lymphadenopathy?
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Secondary to compression of ANS fibers that carry visceral pain.
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What causes backache in abdominal lymphadenopathy?
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Especially characterstic of compression of the lumbar and sacral plexi, pain may be first localized to the posterior hip or thigh stimulating sciatica.
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What causes ureteral obstruction in abdominal lymphadenopathy? what does this lead to?
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Extrinsic compression of the ureter, may lead to hydronephrosis (distention of renal pelvis/calyces)
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What causes peripheral lower extremity edema in abdominal lymphadenopathy?
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Compression of the iliac veins, scrotal/labial edema may also occur.
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What causes constipation in abdominal lymphadenopathy? diarrhea?
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Constipation is due to obstruction of the bowel, diarrhea is due to fat malabsorption from obstruction of small intestinal flow.
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How can swollen intraabdominal nodes be palpated on physical exam?
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By careful palpation through relaxed abdominal musculature over the iliac/abdominal aorta regions OR by rectal/vaginal exams.
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What is a common site of metastatic spread from cancers involving intra-pelvic and intra-abdominal organs?
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Lymph nodes surrounding the umbilicus.
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What is a Sister Mary Joseph Nodule?
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A periumbilical nodule or exfoliative mass w/in or replacing the umbilicus.
*basically an embryonic connection to a CA originating in the thorax. |
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What are the sources of metastasis in a sister mary joseph nodule?
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Usually stomach, colon, ovary or pancreas.
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What is the most important node for its drainage of the breast?
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Axillary nodes
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Where do axillary nodes drain to?
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The supraclavicular nodes
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What node does metastatic breast cancer typically involve?
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The axillary nodes
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Who am I?
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Sister Mary Joseph Nodule
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What is a generalized lymphadenopathy a manifestation of?
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Systemic dz. Idiopathic, infectious and neoplastic dz'es must be considered in any patient w/ generalized adenopathy.
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What typically occurs in conjunction w/ systemic adenopathy?
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Hepatomegaly and splenomegaly
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