Lymph Node Examination and Organomegaly — DCE Clinical Case

Clinical Case — Station 3 Lymph Node and Abdominal Examination

Patient brief (for the candidate)

Mr David K is a 34-year-old man. He is known to the haematology service. The examiner asks you to examine his lymph nodes. [1]

The examination (candidate performs the head-to-toe routine)

The candidate introduces themselves, positions the patient sitting upright at 45 degrees for the head and neck and then supine for the remaining regions, and performs the systematic routine: [1]

End of bed. The patient is pale but not cachectic or jaundiced. He is comfortable at rest. [1]

Head and neck nodes. Bilateral, rubbery, mobile, non-tender nodes in the anterior and posterior cervical chains, the largest 2 by 2 centimetres. The submental, submandibular, pre-auricular, post-auricular, and occipital nodes are unremarkable. The tonsillar nodes are enlarged bilaterally. In the left supraclavicular fossa, examined from behind with the neck flexed and shoulders relaxed, there is a rubbery (not hard) node of 1.5 cm — rubbery rather than stony, favouring lymphoma over a Virchow node from carcinoma. The right supraclavicular fossa has a similar smaller node. [1]

Axillary nodes. In both axillae, matted, firm, mobile masses up to 3 centimetres in the central and anterior groups. The posterior and lateral groups are also involved. [1]

Epitrochlear nodes. Palpable bilaterally, rubbery, 1 cm. [1]

Inguinal nodes. Small, mobile, shotty nodes up to 1 cm bilaterally in both the horizontal and vertical groups — consistent with reactive change. [1]