Table of Contents
Introduction
- Wash hands
- Introduce self
- Ask Patient’s name, DOB and what they like to be called
- Explain examination and obtain consent
- Get a chaperone
- General inspection: well/unwell, pain/discomfort, cachexia
- For each lymph node group
- Local inspection: obvious lymphadenopathy, surgical scars, overlying skin (erythema, rashes)
- Palpation (technique discussed below): determine site, size (diameter <1cm is normal), shape, consistency (hard = malignancy; rubbery = lymphoma), tethering to other structures (malignancy)

Work down the body feeling each lymph node group:
Cervical lymph nodes
- Sit patient upright in a chair and stand behind them to palpate the following groups of nodes in order:
- Submental
- Submandibular
- Jugulodigastric/tonsillar (commonly palpable)
- Anterior cervical chain (shotty nodes common)
- Posterior cervical chain
- Occipital
- Postauricular
- Preauricular
- From in front of the patient, palpate the supraclavicular nodes with your fingertips in the supraclavicular fossae
Axillary lymph nodes
- To examine the right: ask the patient to hold your right biceps muscle while you support the weight of their right arm at the elbow with your right hand
- Now place your left arm over your right and place your left hand into the patient’s axilla
- Palpate the apical, lateral, medial, anterior and posterior lymph node groups by firmly pressing the soft tissues and rolling them over the underlying harder tissues
- Repeat on left
Epitrochlear lymph nodes
- To examine the right: hold the patient’s right wrist with your left hand and their right elbow in your right palm. Use your right thumb to feel for lymph nodes.
- Repeat on left
Inguinal lymph nodes
- Palpate horizontal chain (inferior and parallel to inguinal ligament) and vertical chain (alongside terminal great saphenous vein)
- Lymph nodes here are normal up to 1.5cm in diameter
Popliteal lymph nodes
- Flex knee and palpate in popliteal fossa
Finally
- Palpate for hepatosplenomegaly (see notes on abdominal examination)
- Examine any areas drained by palpable lymph nodes
To complete
- Thank patient and restore clothing
- Summarise and suggest further investigations you would consider after a full history
Try some viva style questions
What is Virchow’s node? What is the clinical significance?
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Please list some causes of localised lymphadenopathy
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Please list some causes of generalised lymphadenopathy
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