NECK LYMPH NODES CASE PROFORMA OTHER SYSTEMS:

CVS- Normal S1 S2 heard, No murmurs.

Name: Age: Sex: Occupation: Address: Respiratory: Normal vesicular breath sounds, No adventitious
HISTORY sounds, GIT- Per Abdomen
CNS- No Facial asymmetry, all reflexes are normal
Chief Complaints:
PROVISIONAL DIAGNOSIS:
Swelling in the Rt/Lt side of neck since __
Anatomical: Lymph nodes swelling of the neck (with the level)
History of Present Illness:
Pathological: Benign (Infective or not)/ Malignant
Patient was apparently asymptomatic __ days back when he developed
Inflammatory/Traumatic/Neoplastic/Congetital?
1. Swelling- Onset, site, duration, progression (of size), any H/O of rapid
Clinical: TB Cervical lymphadenitis?
size increase, any other associated swelling, any seoncdary changes
NOTES:
(Ulcer, satellite nodules, sinus, discharge), Pain associated with swelling
Levels of Neck Lymph Nodes:
(Alcohol) [duration, site, character, relation with swelling], if multiple
Level I - Submaxillary and submental
swellings ask in detail which came first to last, any associated fever, night
Level II - Upper jugular
sweats [Pel Ebstein, evening rise], Any loss of appetite, significant loss of
Level III - Middle jugular
weight, pressure effects due to swelling
Level IV - Lower jugular
Other sites of metastasis:
Level V - Posterior triangle
H/O Cough, haemoptysis, chest pain
Level VI - Central neck nodes
H/O abdominal pain, jaundice, abdominal distention
Level VII - Anterior mediastinal
H/O pain in end of long bones, back ache
H/O headache, vomitings, convulsions
PAST HISTORY:
H/O similar complaints
-Any H/O HTN, DM, CAD , Hypo/Hyperthyroidism/ Epilepsy/
Asthma/COPD/ / Blood transfusions
H/O irradiation to neck, syphilis, cancer, TB
Drug and Treatment History + Allergic History:

FAMILY HISTORY:
None of the patient’s parents, siblings or first degree relatives have or have had
similar complaints or any significant co morbidities VIRCHOW’S NODE: The left supraclavicular lymph node lying
H/O Lymphomas, TB history contact. between the two heads of sternocleidomastoid is called the
PERSONAL HISTORY: Virchow’s lymph node. This lymph node may be involved by
Diet, Appetite, Bowel, Bladder, Sleep, Addictions (Alcohol and Smoking), metastasis from carcinoma stomach, testicular tumour,
carcinoma oesophagus and bronchogenic carcinoma
PHYSICAL EXAMINATION
Differential Diagnosis:
1. GENERAL SURVEY
Chronic pyogenic lymphadenitis, Tubercular cervical
- General assessment of Illness- ECOG (Zubroad scale)/Karnofsky score)
lymphadenitis, Metastatic cervical lymph node, Hodgkin’s
-Mental state and intelligence (CCC)
lymphoma, Chronic lymphatic leukaemia
-Build, state of nutrition [weight loss and cachexia]
Pathological changes in tubercular lymphadenitis:
-Decubitus and Attitude, Any facies
Stage I: Stage of inflammation: There is solid enlargement of
A __ year old patient, supine decubitus who is __ built __ nourished is
the affected lymph node.
conscious, coherent, cooperative, and comfortably seated/lying on the
Stage II: Stage of abscess formation:
bed, well oriented to time, place and person.
Stage III: Stage of collar stud abscess
There is No Pallor, Icterus, cyanosis, koilonychias, generalised
Stage IV: Stage of sinus formation
lymphadenopathy and no pedal edema.
Depending on the location of the lymph nodes in relation to
VITALS: Temperature: Pulse, RR, BP.
the investing layer of deep cervical fascia the cervical lymph
LOCAL EXAMINATION-Thyroid nodes may be:
Superficial: Lymph nodes lying superficial to the investing
After taking informed consent, patient is examined by exposure of the layer of the deep cervical fascia
neck region. Deep: Lymph nodes lying deep to the investing layer of deep
INSPECTION: cervical fascia
1. Swellings: Number, Position, size, surface, margins and extent Palpation of Cervical lymph nodes:
2. Skin over swelling: condition, sinuses, ulcers etc. The cervical lymph nodes may be palpated both from front
3. Pressure effects: edema, facial swelling, respiratory distress. and the back the clinician stands behind the patient. The
neck is slightly flexed and turned to the side of examination.
PALPITATION:
The different groups of lymph nodes levels 1 to 7 are then
Confirm inspection findings
palpated systematically with one hand.
- Local rise of Temperature - Skin tenderness (local tenderness)
Level 1A are palpated at the submental triangle with the pulp
- SWELLINGS: Number, Site size, surface, margins, consistency,
of the fingers directed upwards with the neck slightly flex and
fluctuation, matted or not and fixity
turned to the same side.
DRAINAGE AREAS: Scalp, Face, Ears, Lips, Cheek, Tongue, Oropharynx,
Level 1B are palpated at the submandibular triangle.
floor of mouth, Parotid, Submandibular, Thyroid gland.
OTHER LYMPH NODE SITES: Axilla, Epitrochlear, Inguinal, Popliteal.
Level 2, 3, 4 are palpated along the line of internal jugular vein with the
pulp of the fingers
Level 5 nodes are palpated at the posterior triangle with the pulp of
the fingers
The supraclavicular nodes (Level 5) are palpated with the pulp of the
fingers kept at the supraclavicular fossa and asking the patient to shrug
the shoulder up
Level 6 nodes are palpated at the pre- and para-laryngeal and tracheal
region