Lecture 4 - Cervical Lymph Nodes, Lymphadenopathy And Neck Lumps

Question 1

What are the 3 general roles of the lymphatic system in the body?

Answer 1

Remove excess fluid from interstitial space

Returns small proteins and fluid leaked from capillaries back into venous circulation

Key role in immune defence and surveillance (physical and phagocytic barrier)

Question 2

What is lymphadenopathy?

Answer 2

Enlarged lymph nodes due to either I infection/inflammation or malignancy

Question 3

What is lymphoedema?

Answer 3

When theres a problem with lymphatics so excess lymph/interstitial fluid not removed very well

Question 4

What is meant by lymph nodes being described as palpable or non-palpable?

Answer 4

Palpable (sometimes when normal but especially when enlarged)

Non-palpable (even if enlarged)

Question 5

What are some locations of palpable lymph nodes?

Answer 5

Cervical lymph nodes (neck)

Axilla
Groin

Question 6

What is important to note about cervical lymph nodes in children?

Answer 6

Can be palpable even in healthy children

Question 7

What is Waldeyers Ring?

Answer 7

Essentially a group of tonsils, so groups of lymphoid tissue found submucosally in a ring in the upper aero digestive tract

Question 8

What are the 4 lymphoid tissues found in Waldeyers ring?

Answer 8

Adenoid/pharyngeal tonsils

Tubal tonsil

Palatine tonsils

Lingual tonsil

Question 9

What are tonsils?

Answer 9

Collection of lymphatic tissue associated with mucosal tissue (MALT)

Don’t have a fibrous capsule like nodes do

Question 10

Where is the adenoids/pharyngeal tonsil?

Answer 10

Most superior

In the midline of the upper nasopharynx

Question 11

Where are the Tubal tonsils located?

Answer 11

Surround openings of Eustachian tubes

Lateral walls of the nasopharynx

Question 12

Where are the palatine tonsils?

Answer 12

Referred to as “The Tonsils”

Found in lateral oropharynx wall

Visible when you open the mouth

Question 13

Where are the lingual tonsils?

Answer 13

At the base of the tongue (posterior third)

Question 14

Why can enlargement of the pharyngeal tonsil (adenoids) be dangerous?

Answer 14

Can obstruct nasal breathing

Blockage of Eustachian tube (leads to middle ear problems)

Question 15

What is tonsillitis?

Answer 15

Inflammation of the palatine tonsils

Question 16

What is the most common type of organism causing tonsillitis?

Answer 16

Viral

Question 17

If the cause of Tonsilitis is bacterial what is the most common causative organism?

Answer 17

Streptococcus

Question 18

How does tonsilitis present?

Answer 18

Painful swallowing
Halitosis
Pyrexia
Tonsils erythematous, exudate and lymphadenopathy

Question 19

What are the 2 groups of cervical lymph nodes?

Answer 19

Superficial cervical lymph nodes

Deep cervical lymph nodes

Question 20

Where are the superficial cervical lymph nodes located?

Answer 20

In the superficial cervical fascia just beneath the skin

Question 21

Where do the superficial cervical lymph nodes run/what structure do they form?

Answer 21

Forms a ring from chin to occiput

Question 22

What do the superficial cervical lymph nodes drain into?

Answer 22

The deep cervical lymph nodes

Question 23

Where are the deep cervical lymph nodes located?

Answer 23

Deep in the neck in the carotid sheath

Most are associated with the Internal Jugular Vein

Question 24

What drains into the deep cervical lymph nodes?

Answer 24

Deep tissues like the thyroid, trachea and oesophagus

And superficial lymph nodes

Question 25

What is the name of the structure that is the chin?

Answer 25

Mental protuberance (promince of the mandible

Question 26

What are the important superficial cervical lymph nodes in the order you’d assess them?

Answer 26

Submental Submandibular Pre-auricular and parotid Post-auricular Superficial cervical Anterior cervical Posterior cervical Occipital

Question 27

Look at the last slide of the lecture: What are the lymph nodes?

Answer 27

1 = submental 2 = submandibular 3 = pre-auricular and parotid 4 = post-auricular 5 = occipital 6 = superfical cervical 7 = posterior cervical 8 = anterior cervical

Question 28

How are the superficial cervical lymph nodes associated with SCM and the route of what blood vessel?

Answer 28

On surface of SCM Associated with External Jugular Vein

Question 29

How are the posterior cervical lymph nodes associated with SCM and the route of what blood vessel?

Answer 29

Sits behind SCM in posterior triangle External Jugular vein

Question 30

How are the anterior cervical lymph nodes associated with SCM and the route of what blood vessel?

Answer 30

Sits in front of SCM Anterior Jugular Vein

Question 31

Generally what areas do the superficial cervical lymph nodes drain?

Answer 31

Skin and tissues of face, scalp and skin of neck

Question 32

What does the occipital lymph nodes drain?

Answer 32

Posterior scalp

Question 33

What do the submental lymph nodes drain?

Answer 33

Inferior and posterior chin Floor of mouth Tip of tongue Lower teeth and gums

Question 34

Where should you definitely look if the submental lymph nodes enlarged?

Answer 34

Look in mouth at tongue and gums

Question 35

What do the submandibular lymph nodes drain?

Answer 35

Centre of face and cheek Teeth and gingivae (gums) Parts of front of tongue

Question 36

Where should you defo look if the submandibular lymph nodes are swollen?

Answer 36

In mouth

Question 37

What do the post auricular lymph nodes drain?

Answer 37

Posterolateral half of scalp

Question 38

What does the pre-auricular lymph nodes drain?

Answer 38

Most of the forehead Anterolateral scalp Upper half of face including eyelids (conjunctiva) Cheeks

Question 39

Look at the last slide: What superficial lymph nodes drain each area?

Answer 39

1 = submental 2 = submandibular 3 = pre-auricular 4 = post-auricular 5 = occipital

Question 40

How is the tongue divided?

Answer 40

Anterior 2/3 rds Posterior 1/3 (can’t see)

Question 41

What lymph nodes drain the anterior 2/3rds of the tongue?

Answer 41

Submental nodes Submandibular nodes Deep cervical nodes

Question 42

What lymph nodes drain the posterior 1/3 of the tongue?

Answer 42

Deep cervical nodes Retropharyngeal nodes

Question 43

What are the 3 sections of the deep cervical lymph nodes in relation to the Internal Jugular Vein?

Answer 43

Upper 1/3 Middle 1/3 Lower 1/3

Question 44

What is an important deep cervical lymph node found in the upper 1/3rd?

Answer 44

Jugulo-digastric

Question 45

When does the jugulo-digastric swell?

Answer 45

Bacterial tonsilitis Jugular palatine cancer can metastasise here

Question 46

What is an important deep cervical lymph node in the lower 1/3?

Answer 46

Jugular-omohyoid

Question 47

What does the jugulo-omohyoid deep cervical lymph node drain?

Answer 47

Tongue Oral cavity Trachea Oesophagus Thyroid Soo could be indicative of cancers here if it swells

Question 48

What are the supraclavicular lymph nodes?

Answer 48

Deep cervical lymph nodes found in the posterior triangle

Question 49

What does the supraclavicualr lymph nodes drain?

Answer 49

Thoracic and abdominal cavity

Question 50

Why is supraclavicular lymphadenopathy very concerning?

Answer 50

Usuallly indicative of gastric cancer (malignancy)

Question 51

What is lymphadenopathy of the left supraclavicular node called?

Answer 51

Virchow node

Question 52

What malignancy can present as supraclavicular lymphadenopathy?

Answer 52

Lymphoma

Question 53

Enlarged lymph nodes (lymphadenopathy) is usually down to 2 things, what are they?

Answer 53

Reactive due to infection Malignancy

Question 54

How can you tell when an enlarged lymph node is due to an infection?

Answer 54

History Tender and mobile when palpated and likely its recently rapidly enlarged

Question 55

What are the 2 possibilities for the cause of an enlarged lymph node if its due to malignancy?

Answer 55

Metastases Or Leukaemia/lymphoma

Question 56

How can you tell whether a lymphadenopathy is due to a metastases?

Answer 56

Hard and tethered to surrounding tissues and painless on palpation

Question 57

How can you tell whether a lymphadenopathy is due to a lymphoma?

Answer 57

On palpation lump is rubbery, painless and fast growing

Question 58

What are some red flags for lymphadenopathy??

Answer 58

Fixed hard and irregular Rapidly growing in size Systemic signs like weight loss, night sweats Change in voice/hoarseness, difficulty swallowing

Question 59

Why is it more concerning seeing lymphadenopathy in adults?

Answer 59

In kids it can be normal to see enlargement But adults its more likely pathological

Question 60

If a lump moves with swallowing what is the lump related to?

Answer 60

Thyroid gland

Question 61

If the lump moves with sticking out the tongue what is it related to?

Answer 61

Thyroglossal duct cyst

Question 62

What are some very superficial causes of a neck lump?

Answer 62

Benign lesions of skin or subcutaneous tissue (Sebaceous cyst, lipoma)

Question 63

What are some congenital lesions that can cause neck lumps?

Answer 63

Thyroglossal duct cysts Bronchial cyst Dermoid cyst

Question 64

What are some possible causes of neck lumps that are not lymphadenopathy?

Answer 64

Thyroid gland pathology Salivary gland pathology Vascular

Question 65

What are some thyroid gland pathologies that could cause neck lumps?

Answer 65

Malignant or benign neoplasms Graves’ disease

Question 66

What are some salivary gland pathologies?

Answer 66

Calculus (stone) Inflammation or infection Neoplasm - benign or malignant

Question 67

What are some vascular problems that can cause neck lumps?

Answer 67

Carotid body tumour Carotid artery aneurysm

Question 68

What are the most common causes of neck lumps in the anterior midline?

Answer 68

Thyroid gland disease Congential lesions like dermoid cyst Thyroglossal duct cyst

Question 69

What are the most common causes of neck lumps in the anterior or posterior lateral side?

Answer 69

Salivary gland pathology (A) Carotid body tumour Congenital lesions (Bronchial cyst (A)) Cystic hygroma (P))

Question 70

Where would a lump for a bronchial cyst be found?

Answer 70

In fun of the SCM muscle

Question 71

What is a cystic hygroma?

Answer 71

Lymphatic malformation mainly happening in the neck A collection of fluid filled sacs found in the posterior triangle