Lymph Node Examination and Organomegaly — Viva Defence

Viva — The Lymph Node and Organomegaly Short-Case Defence

The routine (examiner: "Examine this patient's lymph nodes")

I would introduce myself, confirm the patient's identity, request permission, and position the patient sitting upright at 45 degrees for the head and neck nodes, then supine with one pillow for the remaining regions. I would ensure good lighting, warm my hands, and stand on the patient's right side for the abdominal examination. ^[1]

I perform the head-to-toe lymph node routine: ^[1]

Head and neck. I palpate the head and neck nodes systematically with the pads of my index and middle fingers, the patient's neck slightly flexed: submental, submandibular, pre-auricular, post-auricular, occipital, tonsillar, the anterior cervical chain along the anterior border of sternocleidomastoid, the posterior cervical chain along the posterior border. I move behind the patient to palpate the supraclavicular fossae, placing my fingers deep into the angle between the clavicle and the sternocleidomastoid with the shoulders relaxed, on each side. I then palpate the pre-tracheal nodes. In this patient there are bilateral, rubbery, mobile, non-tender nodes in the anterior and posterior cervical chains, the largest 2 by 2 centimetres. There is a similar rubbery node in the left supraclavicular fossa — rubbery rather than hard, more consistent with lymphoma than a Virchow node from carcinoma. ^[1]

Axillary. I support the patient's arm to relax the axillary muscles and place my examining hand high into the axillary apex, drawing it downward against the chest wall. I examine all five groups: the apical, the anterior (pectoral), the posterior (subscapular), the lateral (humeral), and the central. In this patient there are matted, firm, mobile masses up to 3 centimetres in both axillae. ^[1]