Lymph Node exam

• Preparation

  • Wash hands

  • Positioning: sitting

  • Draping: expose neck

• Inspection

  • Masses, scars, lesions, discolouration, swelling

  • Muscle bulk: atrophy, hypertrophy, asymmetry

• Palpation (neck slightly flexed): roll pads of fingers in circular motion

  • Lymph nodes:

    • Occipital

    • Postauricular (posterior auricular)

    • Preauricular

    • Tonsillar (inferomedial to angles of jaw)

    • Submandibular (along and underneath jawline)

    • Submental (beneath chin)

    • Palpate breadth of sternocleidomastoid muscles

      • Superficial anterior cervical chains

      • Deep cervical chains (hook fingers around SCMs)

    • Posterior cervical chain

    • Supraclavicular (ask pt to take deep breath)

  • If palpable, describe:

    • Location

    • Size (N < 2 cm)

    • Shape (N = round or ovoid)

    • Contour (N = discrete borders, not matted to other nodes)

    • Consistency (N = rubbery)

    • Mobility (N = mobile, not fixed)

    • Tenderness (N= non-tender)

Rational Clinical exam