Haem Exam

 
 
 

The Patient

The Hands

The Arms

The Face

The Neck

The Chest

The Abdomen

The Pelvis

The Back

The Legs

 
 
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Axillary Lymphadenopathy

 
 
    • How to Assess
    • Using the pulps of the fingers, gently palpate each of the lymph node groups within axillary region.
    • Feel For
    • Size - normally <10mm
    • Tenderness
    • Consistency - hard (metastasis), rubbery (lymphoma), soft (reactive)
    • Mobility - mobile or tethered to underlying structures
    • Causes of Lymphadenopathy
    • Bacterial infection - localised infection, skin infection, tuberculosis / MAC, syphilis, cat-scratch disease
    • Viral infection - EBV, CMV, HIV, herpez simplex, rubella
    • Parasitic infection - toxoplasmosis
    • Malignancy - lymphoma, leukaemia, metastasis
    • Inflammatory disorders - lupus, rheumatoid arthritis
    • Sarcoidosis
    • Medications - allopurinol, atenolol, cephalosporins, penicillin, phenytoin, carbemazepine
    • Storage disorders
    • Benign idiopathic lymphadenopathy
Axillary Lymph Nodes
  • Pectoral nodes - anteriorly, behind the pectoralis major muscleAnterolateral chest wall, central / lateral breast
  • Subscapular nodes - posteriorly, in front of the subscapularis musclePosterior neck and chest wall
  • Lateral nodes - lateral aspect of armpitMedial hand, forearm and arm
  • Central nodes - within the centre of the axillaDrainage from pectoral, subscapular and lateral nodes
  • Infraclavicular nodes - below the distal aspect of the clavicleLateral hand, forearm and arm
  • Apical nodes - medially, at the lateral border of the 1st ribDrainage from all axillary lymph nodes
 
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