Lymphadenopathy Examination

Approach to the Case (WIPECS):

1. Wash your hands: Begin by ensuring proper hand hygiene.
2. Introduce yourself: Politely introduce yourself to the patient.
3. Pain and position: Inquire if the patient is experiencing any pain or discomfort and note their position.
4. Exposure: Request the patient to expose the relevant area for examination.
5. Chaperone: Ensure the presence of a chaperone, especially for genital and rectal examinations.
6. Stability: Assess the patient’s stability and general condition.

Examination Steps:

2. General Appearance:

• Observe the patient’s overall appearance.
• Note any signs of distress, cachexia, pallor, jaundice, or scratch marks.
• Measure the patient’s temperature to assess for fever.

3. Regional Sequential Examination:

A. Hand:

• Inspect for pallor in the palmar creases.
• Check for nail changes associated with iron deficiency anemia.
• Assess for clubbing (loss of the diamond-shaped space between nails).
• Evaluate the pulse, noting any tachycardia, which can be seen in anemia.
• Examine the epitrochlear lymph nodes.

B. Axillary Lymph Nodes:

• Identify and assess the lateral, medial (subscapular), anterior (lateral pectoral), apical (infraclavicular), and central axillary lymph nodes.

C. Head and Neck:

• Inspect the eyes for pallor in the bulbar conjunctiva and icterus in the sclera.
• Examine the mouth for gum hypertrophy, gum bleeding, and enlargement of Waldeyer’s ring.
• Describe Waldeyer’s ring and its significance (enlarged in Non-Hodgkin lymphoma).
• Assess the cervical lymph node group.

D. Bone Tenderness:

• Test for bone tenderness by pressing on the sternum or tapping on the spine.

E. Abdomen:

• Check for any abdominal distension.
• Perform a bimanual examination to assess for splenomegaly.

F. Inguinal Region:

• Identify the two groups of inguinal lymph nodes:
  • Horizontal group along the inguinal ligament.
  • Vertical group around the femoral vein.
• Evaluate the size, shape, consistency (rubbery, soft, firm, hard), mobility, and tenderness of these nodes.
• Proceed to genitalia examination in the presence of a chaperone.

G. Genitalia (In the presence of a chaperone):

• Inspect the genitalia for ulcers, rashes, redness, discharge, or any suspicious skin lesions.
• Repeat inspection by elevating the penis and scrotum and checking their underside.
• Examine by retracting the foreskin of the penis (if applicable).
• Palpate the genitalia for increased temperature or tenderness (as seen in epididymo-orchitis).
• Feel for any lumps or masses, especially in the case of invasive testicular malignancies.

H. Lower Limb:

• Inspect the lower limb for signs of infection, including rash, ulcers, swelling, or redness.
• Look for signs of malignancy, such as skin lesions of melanoma or squamous cell carcinoma.

I. Anal Region Examination:

• Conduct an examination of the anal region if indicated.

4. If You Have Extra Time:

• Consider a differential diagnosis of inguinal lymphadenopathy if time permits.