You should also ask them to relax their hands in their lap.Ģ. Inspect for any evidence of lymphadenopathy or irregularity of the neck.ģ. Stand behind the patient and use both hands to start palpating the neck.Ĥ. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over the surrounding tissue to assess the various characteristics of the lymph nodes. Cervical lymph nodesġ. Position the patient sitting upright and examine from behind if possible. Ask the patient to tilt their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes. Lymph nodes typically feel hard, firm, irregular and are often tethered to local structures. Lymphadenopathy associated with metastatic cancer: regional lymphadenopathy in lymph node groups draining the affected organ. Lymphadenopathy associated with haematological malignancy: widespread enlarged rubbery lymph nodes. Reactive lymph nodes: typically smooth, rounded, tender, mobile and associated with infective symptoms (e.g. Overlying skin changes: note any overlying skin changes such as erythema.īenign lymph nodes: typically less than 1cm, smooth, rounded, non-tender and mobile.Mobility: assess if the lymph node feels mobile or is tethered to other local structures.Tenderness: note if the lymph node is tender on palpation.Consistency: determine if the lymph node feels soft, hard or rubbery.Shape: assess the lymph node’s borders to determine if they feel regular or irregular.Size: assess the size of the lymph node.Site: assess the lymph node’s location in relation to other anatomical structures.Remember, there are chains of lymph nodes which cannot be palpated on clinical examination such as mediastinal or mesenteric nodes (these can only be identified using CT/MRI scans).įor any palpable lymph node, it’s important to assess the following characteristics to help narrow the differential diagnosis: There are several chains that can be easily palpated on clinical examination. It is important to examine for lymphadenopathy in a systematic manner. Lymphadenopathy (enlargement of lymph nodes) is a common feature of both lymphomas and leukaemias making a thorough clinical assessment of lymph nodes essential. Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications.Vital signs: charts on which vital signs are recorded will give an indication of the patient’s current clinical status and how their physiological parameters have changed over time.Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: Cachexia is commonly associated with underlying malignancy (e.g. Cachexia: ongoing muscle loss that is not entirely reversed with nutritional supplementation.Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g.Abdominal distention: may suggest the presence of underlying hepatosplenomegaly.Bleeding or bruising/petechiae: may indicate underlying thrombocytopenia.Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology: You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of clinical examination stations ✨ General inspection Clinical signs Gain consent to proceed with the examination.Īdjust the head of the bed to a 45° angle.Īdequately expose the patient for the assessment.Īsk the patient if they have any pain before proceeding with the clinical examination. Introduce yourself to the patient including your name and role.Ĭonfirm the patient’s name and date of birth.Įxplain what the examination will involve using patient-friendly language.Įxplain the need for a chaperone: “One of the ward staff members will be present throughout the examination, acting as a chaperone, would that be ok?” Wash your hands and don PPE if appropriate.
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