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Semester 3 - Head and neck > 2. Cervical Lymph Nodes and Neck Lumps. > Flashcards

2. Cervical Lymph Nodes and Neck Lumps. Flashcards

1
Q

What are the functions of the lymphatic system?

A

• Remove excess fluid from interstitial space
• Returns small proteins (inc. pathogens) and fluid that leaked from capillaries
• Key role in immune defence and surveillance
- Physical and phagocytic barrier
- Source of lymphocytes

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2
Q

What are the main causes of Clinical manifestations of disease involving the lymphatic system?

A

– Lymphoedema

– Lymphadenopathy: swollen lymph node(s) due to infection or malignancy (primary and secondary)

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3
Q

In infections, why do the lymph nodes swell?

A

lymphocytes Activate and proliferate in response to antigens

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4
Q

How many lymph nodes do All substances transported in lymph travel through?

A

• All substances transported in lymph pass through ≥ 1 lymph node

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5
Q

In which regions of the body are lymph nodes mainly found in?

A
  • neck
  • armpit
  • groin
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6
Q

Where are most of the lymph nodes found?

A

Nearly ½ of all the body’s lymph nodes are found in the neck

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7
Q

What aspect of lymph nodes slows the flow of lymph?

A

many afferent vessels but single efferent vessel - allows lymph node to filter and react to any antigens

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8
Q

What are the characteristics of enlarged lymph nodes in lymphadenopathy caused by infection?

A

Tender, mobile

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9
Q

What are the characteristics of lymph nodes in lymphadenopathy caused by malignancy?

A

Hard, matted, non-tender,

rubbery, mobile, fast growing

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10
Q

If lymph node is found to be enlarged what needs to be done?

A
  • Comprehensive history
  • Examine the area of tissue it drains
  • If systemic disease/malignancy suspected examine other lymph nodes and body systems
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11
Q

Where are the superficial and deep lymph nodes in the neck found?

A

Superficial within the superficial fascia.

Deep lymph nodes deep to the investing layer of fascia (and deep to SCM).

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12
Q

Where are many of the deep lymph nodes in the neck found?

A

Associated with the route of the IJV in the carotid sheath

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13
Q

Which lymph nodes do the superficial lymph nodes of the neck drain into to?

A

The deep lymph nodes of the neck

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14
Q

Where do structures invested within the investing layer of fascia drain into?

A

Deep lymph nodes of the neck

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15
Q

Which type of lymph node is more readily palpable?

A

superficial

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16
Q

What are the superficial lymph nodes of the neck and where are they found?

A

superficial cervical (superficial to SCM), anterior cervical (anterior triangle) and posterior cervical (posterior triangle)

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17
Q

Which structures are the superficial lymph nodes of the neck associated with?

A

EJV or AJV

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18
Q

What are the superficial lymph nodes draining face and scalp?

A

1) submental lymph nodes
2) submandibular lymph nodes
3) pre auricular lymph nodes
4) post-auricular lymph nodes
5) occipital lymph nodes

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19
Q

what does the superficial lymph nodes draining the face and scalp drain into?

A

deep lymph nodes in the neck

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20
Q

Which lymph nodes are most likely to swell in conjunctivitis?

A

Preauricular

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21
Q

What are the deep lymph nodes of the neck?

A

Jugulo-digastric, jugulo-omohyoid, supraclavicular

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22
Q

Which lymph nodes swell in tonsillitis?

A

Jugulodigastric

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23
Q

Which lymph nodes drain which part of the tongue?

A

Anterior = Submental, middle = submandibular, posterior = directly to deep lymph nodes

24
Q

Where is the supraclavicular lymph nodes found and which part of the body do they drain?

A

In the supraclavicular fossa in the posterior triangle. Drain chest and abdomen

25
Q

which lymph node is affected if mouth ulcer on inner surface of lower lip?

A

submental

26
Q

what needs to be examined if lump below mandible of chin?

A

inside mouth

27
Q

which lymph node is affected if mouth ulcer on tip of tongue?

A

submental

28
Q

in tonsilitis, why does the neck need to be palpated?

A

as they drain into deep cervical lymph nodes - jugular digastric

29
Q

What structures make up Waldeyer’s ring

A

Pharyngeal (adenoid) tonsil (top), tubal tonsils, palatine tonsils, lingual tonsil

30
Q

Which lymph nodes do palatine tonsils drain to?

A

Jugulodigastric lymph nodes

31
Q

Which lymph nodes do pharyngeal tonsil drain to?

A

Upper deep cervical and retropharyngeal lymph nodes

32
Q

What other symptoms can an enlarged pharyngeal tonsil present with in children?

A

middle ear complications as the eustachian tube can be compressed

nasal onstruction

33
Q

What is the most likely cause of lymphadenopathy in children?

A

Secondary to infection

34
Q

What are 4 things to ask as part of history when considering neck lumps?

A

age, Duration, progression, associated symptoms/signs

35
Q

What is important to note in examination of neck lumps?

A

• Anterior or posterior triangle? Midline or laterally placed?
• Movement with swallowing and sticking out tongue?
• Palpation features
o Does it feel superficial, just beneath skin and quite mobile… or deeper?
o Hard/soft/ smooth/irregular
o Fixed to surrounding tissue?
o Tender (inflamed/infected lumps likely painful)?
o Overlying skin changes e.g. red

36
Q

vWhy is it important to note if neck lumps are tender?

A

Inflamed or infected lumps likely painful.

37
Q

What are possible causes of neck lumps?

A
  • Inflammatory/ Infective lymph node
  • Congenital lesions
  • Thyroid pathology
  • Primary (e.g. lymphoma) or secondary malignant (metastatic) disease involving a lymph node
  • Salivary gland pathology`
38
Q

Give examples of superficial neck lumps.

A

Sebaceous cysts, dermoid cysts, lipoma, skin abscess.

39
Q

What is a dermoid cyst?

A

congenital defect - occurs dung embryonic development when skin layers don’t properly grow together - cyst line with epithelium become filled with fluid from glands

40
Q

Give examples of inflammatory/infective neck lumps.

A

Tonsillitis, mouth ulcer

41
Q

Give examples of congential neck lumps.

A

Thyroglossal cysts, branchial cysts, laryngocoele, pharyngeal pouch

42
Q

Give examples of thyroid neck lumps.

A

Malignant or benign neoplasia

43
Q

Give examples of neoplastic neck lumps.

A

Primary - Lymphoma or secondary malignant - (supraclavicular LN drain thorax and abdomen too)

44
Q

Give examples of salivary gland neck lumps.

A

Calculus, infection, tumour

45
Q

give examples of other neck lumps

A 
chronic infection (tuberculosis, HIV) can cause
lymphadenopathy, carotid artery aneurysm
46
Q

Give examples of neck lumps that occur in the midline in the anterior border.

A

Thyroglossal cyst, dermoid cyst, thyroid (goitre)

47
Q

Give examples of neck lumps that occur laterally in the anterior border.

A

Branchial cyst, submandibular salivary gland

48
Q

What are the characteristics of a dermoid cyst?

A
  • Congenital,
  • pea size,
  • high in midline,
  • in superficial fascia,
  • doesn’t move on swallowing or tongue protrusion
  • not painful to palpate
49
Q

What are the characteristics of a thyroglossal duct cyst?

A
  • Congenital,
  • high in midline,
  • persistence of duct attaching tongue to thyroid gland,
  • moves on swallowing and sticking tongue out
50
Q

What are the characteristics of a thyroid pathology?

A
  • Low in midline,

* moves on swallowing

51
Q

What are the characteristics of a branchial cyst?

A
  • Congenital,
  • high laterally,
  • anterior border of the SCM
  • fluctuance when palpated - fluid filled
  • may transilluminate
  • painful if become infected
  • can become apparent after URT infection
52
Q

What are the characteristics of a submandibular salivary gland lump?

A

High laterally, anterior border of the SCM

  • cancer, blockage
53
Q

what should be included as a potential cause when a lump anywhere in the neck?

A

lymphadenopathy

54
Q

is lymphadenopathy a diagnosos?

A

no it is a sign of an underlying disease

55
Q

What are the red flags for lymphadenopathy? (6)

A

• Persisting > 6 weeks
• Fixed, hard and irregular
• Rapidly growing in size
• Associated with generalised lymphadenopathy
• Associated systemic signs/symptoms such as weight loss,
night sweats
• Associated with a persistent (unexplained) change in
voice/hoarseness or difficulty swallowing

Semester 3 - Head and neck (17 decks)

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