Dr. Beth Martin led this week’s Stanford 25 session by teaching our residents how she exams for enlarged lymph nodes and an enlarged spleen. Thank you to our wonderful Stanford/Palo Alto VA hematologist/oncologist, Dr. Martin!
We asked Dr. Martin for a few tips on the lymph node exam. Here’s what she said:
“Gowning is essential for an adequate and speedy lymph node exam and enhancing appropriate interpersonal boundaries. Use a light touch with fingertips and alternate pill rolling with sweeping motions with a creep of fingertips for the axillae. Axillary examination optimally done by a two handed method. Determine your own technique for evaluating the subpectoral region. The width of your fingers and hands typically cover any measurements that you need to make on routine exam. Money nodes (i.e. high yield) in the routine exam: submental, supraclavicular.”
More words from Dr. Martin:
“One useful position of fingers when at the angle of the jaw is to use the opportunity with your index finger to palpate the fossa-like triangular high cervical area with your finger pads in a pill rolling maneuver.
Tilting the head laterally can enhance finger pad pill rolling palpation of the SCM muscle area for deeper or very mobile nodes. Similarly, head tilt forward in search of thyroid masses.
Very rarely is a mediastinal mass or node in the sternal notch, but gentle index finger pad probing should only detect a deep empty fossa.
The curled fingered gentle squeezing massage of the large surface are of the posterior cervical region can compress small nodes and a second exam with a rapid finger pad pill roll combined with circular massage can detect the small or very mobile nodes.
I encourage everyone to examine their own floor of the mouth to find how delicately tender this area is but also the potential for the bimanual exam when the submandibular area is difficult to examine or findings suspicious.”