Lymph Node Examination and Organomegaly — Short Answer Question

SAQ 1 — The Lymph Node and Organomegaly Short Case (20 marks, 30 minutes)

Model Answer

(a) The systematic head-to-toe lymph node routine (3 marks): ^[1]

The lymph node examination is performed in a fixed, reproducible order so that no region is omitted: head and neck, then axillary, then epitrochlear, then inguinal, then popliteal. The head and neck nodes are palpated in the following order, using the pads of the index and middle fingers with the patient's neck slightly flexed: submental, submandibular, pre-auricular, post-auricular, occipital, tonsillar (jugulodigastric), anterior cervical chain, posterior cervical chain, supraclavicular, and pre-tracheal. The supraclavicular fossae are palpated from behind the patient, with the neck flexed forward and the shoulders relaxed, placing the fingers deep into the angle between the clavicle and the sternocleidomastoid. The axillary nodes are examined as five groups — apical, anterior (pectoral), posterior (subscapular), lateral (humeral), and central — by supporting the patient's arm and placing the examining hand high into the axillary apex. The epitrochlear node is palpated above and 3 cm proximal to the medial epicondyle, between biceps and triceps, with the elbow flexed. The inguinal nodes are examined as horizontal (along the inguinal ligament) and vertical (along the saphenous vein) groups. The popliteal node is palpated deeply in the popliteal fossa. ^[1]

(b) The five characteristics of a node and the interpretation of consistency (4 marks): ^[1]

Every palpable node is described by five characteristics: (1) Site — the anatomical group precisely named, and the distribution (localised versus generalised); (2) Size — measured in centimetres, with nodes over 1 cm generally abnormal (inguinal up to 1 to 2 cm may be normal); (3) Consistency — the single most discriminating feature; (4) Mobility and matting — mobile, matted, or fixed to skin or deep structures; (5) Tenderness and the overlying skin — tender (infection) versus non-tender (chronic or malignant), with examination for erythema, sinus tract, and ulceration. ^[1]