occipital, preauricular, postauricular
submental, submandibular
cervical: anterior, posterior, deep
clavicular: supraclavicular, infraclavicular
axillary: anterior (pectoral), lateral, posterior (subscapular), apical, medial
epitrochlear
inguinal:superficial(horizontal,vertical),deep
popliteal
femoral
paraaortic
lymphedema
surgical scars from cancer excision
obvious masses
technique: use the pads of the index and middle finger(The "flat" of the fingers not the tip) to move the skin in circular motions over the underlying tissues in each area; palpate both sides of the neck simultaneously
small nodes (< size of distal phalanx of pinky finger) are normal unless in unusual location (preauricular).
in abnormal nodes, describe in terms of
location
size
delimination (discrete or matted together)
mobile or fixed
consistency (soft, hard, firm)
tenderness
edit
preauricular - in front of tragus of ear (eye)
postauricular - behind ear, over mastoid process (ear)
parotid- occipital - posterior to mastoid process, at base of skull submental - inside mentus of the mandible (floor of mouth)
submandibular - near submandibular salivary glands (oral cavity) angular-
submental-
pre-sternocleidomastoid
retro-sternocleidomastoid
retroauricular
suboccipital
supraclavicular
infraclavicular cervical chains
anterior chain runs along the SCM (pharynx, tonsils)
posterior chain runs along the trapezius clavicular (abdomen, thorax, breast)
supraclavicular - Virchow’s node (ominous finding in cancer patient) axillary
lateral (arm), medial
apical - need to push very hard
anterior (anterior chest wall, most of breast)
posterior (posterior chest wall, upper arm) epitrochlear - while shaking the patient’s hand, feel the epitrochlear area
inguinal - “shotty” nodes are small, mobile and discrete (normal)
ABNORMAL → (SLAP) - spleen, liver exam; associated lymph sites; search for a primary site
