Lymph Nodes Structure and Function

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Questions and Answers

Where is the preauricular lymph node located?

At the base of the skull

Behind the ear

In front of the ear (correct)

Under the angle of the mandible

What is the function of the fontanels in the neonatal skull?

To allow for muscle attachment

To allow for bone growth

To allow for brain growth during the first year (correct)

To protect the brain from injury

Where is the submental lymph node located?

Midline, behind the tip of the mandible (correct)

In front of the ear

At the base of the skull

Under the angle of the mandible

What is the shape of the posterior fontanel?

Triangle-shaped Signup and view all the answers

What is the normal shape and size of the skull?

Round and symmetric Signup and view all the answers

What is the percentage of final head size reached at 6 years old?

90% Signup and view all the answers

What is the purpose of palpating the temporal artery?

To identify the patient's pulse Signup and view all the answers

What is expected of facial structures during inspection?

They should be symmetric Signup and view all the answers

During which period does trunk growth predominate?

Infancy Signup and view all the answers

What is the normal head position in the midline?

Centered Signup and view all the answers

Where is the jugulodigastric lymph node located?

Under the angle of the mandible Signup and view all the answers

What is the characteristic of the facial bones in a toddler?

They are small and the nasal bridge is low Signup and view all the answers

What is evaluated during range of motion of the neck?

Limitations Signup and view all the answers

What is palpated in the neck to note location, size, shape, and tenderness?

Lymph nodes Signup and view all the answers

What is the main cause of hydrocephalus?

Obstruction of cerebrospinal fluid drainage Signup and view all the answers

What is the most common chromosomal abnormality with characteristic facial abnormalities?

Down syndrome Signup and view all the answers

What is the result of premature closing of one or more cranial sutures?

Craniosynostosis Signup and view all the answers

What is the characteristic of plagiocephaly?

Positional or deformational due to sleeping position Signup and view all the answers

What is the result of chronic allergies in children?

Atopic (allergic) facies Signup and view all the answers

What is the characteristic of fetal alcohol spectrum disorders (FASD)?

Narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia Signup and view all the answers

What is the result of chronically repeated use of hand to push the nose up and back?

Allergic salute and crease Signup and view all the answers

What is the characteristic facial feature of Down syndrome?

All of the above Signup and view all the answers

What is the normal sound auscultated in the skull of children under 4 or 5 years of age?

A resonant or 'cracked pot' sound Signup and view all the answers

What is the term for the blotchy, hyperpigmented area that appears on the face of a pregnant woman during the second trimester?

Chloasma Signup and view all the answers

What is a normal finding in the thyroid gland of a pregnant woman?

Palpability Signup and view all the answers

What is a characteristic of temporal arteries in an aging adult?

They become larger and more tortuous Signup and view all the answers

What is a type of tremor that is commonly seen in aging adults?

Senile tremor Signup and view all the answers

What is the term for the type of headaches diagnosed by patient history with no abnormal findings on exam or laboratory results?

Primary headaches Signup and view all the answers

What is a factor to review when assessing a patient with a primary headache?

Definition, location, character, duration, quantity, and severity Signup and view all the answers

What is the purpose of instructing an aging adult to perform ROM and position changes slowly?

To minimize potential for dizziness Signup and view all the answers

What is the likely cause of congenital torticollis?

Hematoma in one sternomastoid muscle due to intrauterine malposition Signup and view all the answers

A patient presents with a smooth, fluctuant swelling on the scalp. What is the likely diagnosis?

Pilar cyst (Wen) Signup and view all the answers

What is the characteristic physical presentation of Graves' disease?

Goiter, eyelid retraction, and exophthalmos Signup and view all the answers

What is the likely cause of a simple diffuse goiter?

Iodine deficiency Signup and view all the answers

What is the characteristic physical presentation of hypothyroidism?

Puffy edematous face, periorbital edema, coarse facial features, and coarse hair and eyebrows Signup and view all the answers

What is the likely cause of a rapidly painful enlargement of the parotid gland?

Mumps, blockage of duct, abscess, or tumor Signup and view all the answers

Study Notes

Lymph Nodes

Preauricular lymph nodes are located in front of the ear
Posterior auricular (mastoid) lymph nodes are located superficial to the mastoid process
Occipital lymph nodes are located at the base of the skull
Submental lymph nodes are located midline, behind the tip of the mandible
Submandibular lymph nodes are located halfway between the angle and tip of the mandible
Jugulodigastric lymph nodes are located under the angle of the mandible
Superficial cervical lymph nodes are located overlying the sternomastoid muscle
Deep cervical lymph nodes are located deep under the sternomastoid muscle
Posterior cervical lymph nodes are located in the posterior triangle along the edge of the trapezius muscle
Supraclavicular lymph nodes are located just above and behind the clavicle, at the sternomastoid muscle

Developmental Competence: Infants and Children

Bones of the neonatal skull are separated by sutures and fontanels, which are spaces where the sutures intersect
Fontanels allow for growth of the brain during the first year and gradually ossify
The triangle-shaped posterior fontanel closes by 1 to 2 months, and the diamond-shaped anterior fontanel closes between 9 months and 2 years
During the fetal period, head growth predominates
Head size is greater than chest circumference at birth and reaches 90% of final size at 6 years old
During infancy, trunk growth predominates, so that head size changes in proportion to body height
Facial bones grow at varying rates
In toddlers, the mandible and maxilla are small, and the nasal bridge is low

Inspection and Palpation of the Skull

The skull should be assessed for size and shape
Normocephalic skulls are round and symmetric
Cranial bones with normal protrusions include the forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind each ear
The temporal area should be palpated to assess the temporal artery above the zygomatic bone between the eye and top of the ear

Inspection of the Face

Facial structures should be symmetric
Note any abnormal facial structures, such as coarse facial features, exophthalmos, changes in skin color or pigmentation, or abnormal swellings
Note any involuntary movements (tics) in facial muscles; normally, none occur

Inspection and Palpation of the Neck

Head and neck symmetry should be assessed, with the head positioned centered in the midline and accessory neck muscles symmetric
Range of motion should be assessed, noting any limitations
Muscle strength should be tested
Observe for enlargement of glands and/or pulsations
Lymph nodes should be palpated, noting location, size, shape, delimitation, mobility, consistency, and tenderness

Abnormal Findings: Primary Headaches

Primary headaches are diagnosed by patient history with no abnormal findings on exam or laboratory results
Types of headaches include tension, migraine, and cluster headaches
Factors to review include definition, location, character, duration, quantity, and severity, and timing, as well as aggravating symptoms or triggers, associated symptoms, and relieving factors

Abnormal Findings: Pediatrics

Hydrocephalus is a condition where obstruction of the drainage of cerebrospinal fluid results in excessive accumulation, increasing intracranial pressure, and enlargement of the head
Down syndrome is a chromosomal abnormality with characteristic facial abnormalities, including upslanting eyes, flat nasal bridge, small, broad nose, protruding thick tongue, and ear dysplasia
Plagiocephaly is a positional or deformational condition due to sleeping position
Craniosynostosis is a premature closing of one or more cranial sutures that leads to head malformation
Atopic (allergic) facies present with a variety of symptoms, including exhausted face, allergic shiners, Morgan lines, central facial pallor, and allergic gaping
Fetal alcohol spectrum disorders (FASD) present with narrow palpebral fissures, epicanthal folds, thin upper lip, and midfacial hypoplasia
Allergic salute and crease present with a transverse line on the nose in response to chronically repeated use of the hand to push the nose up and back

Abnormal Findings: Swellings of Head and Neck

Congenital torticollis presents with a hematoma in one sternomastoid muscle, resulting in head tilt to one side and limited neck ROM to the opposite side
Simple diffuse goiter (SDG) presents with chronic enlargement of the thyroid gland due to iodine deficiency
Thyroid—multinodular goiter (MNG) presents with multiple nodules, indicating inflammation or multinodular goiter rather than a neoplasm
Pilar cyst (Wen) presents as a benign growth that appears as a smooth, fluctuant swelling on the scalp
Parotid gland enlargement presents with rapid, painful enlargement in response to mumps, blockage of duct, abscess, or tumor

Thyroid Disorders

Graves disease presents with a goiter, eyelid retraction, and exophthalmos
Hypothyroidism presents with a puffy, edematous face, periorbital edema, coarse facial features, coarse hair, and eyebrows

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Description

Identify and understand the different types of lymph nodes, including their locations and characteristics. Learn about preauricular, posterior auricular, occipital, submental, and submandibular lymph nodes.