ABSTRACT
LYMPHADENOPATHY This 49-year-old gentleman is presenting with a mass in his right axilla. Please take a short history and conduct an appropriate examination of the mass and relevant systems.
Introduces self and seeks permission to take a history and examine Confirms patient’s name and age
History
Enquires about onset and duration of the mass Enquires about changes to the mass over time Enquires about how the mass troubles the patient (pain, tenderness) Asks if patient is currently in any pain
Examination
Exposes and positions patient appropriately Inspects for any obvious lymphadenopathy Examines hands for clubbing and arms for any lesions which may give rise to axillary lymphadenopathy Inspects conjunctivae for signs of clinical anaemia Inspects tonsils Examines cervical lymph nodes Examines supraclavicular lymph nodes Examines axillary lymph nodes, including specific examination of the mass If cervical/supraclavicular/axillary lymphadenopathy is present, appropriately examines above the umbilicus for any skin, lung, breast, intra-abdominal, ear, mouth or throat lesions which could be the cause Examines for hepatomegaly and splenomegaly Examines inguinal nodes If inguinal lymphadenopathy is present, examines inguinal lymph node drainage areas for possible cause
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY The instructions opposite clearly inform you that a full systems examination is required; however, you may not benefit from such clear instructions in your final OSCE. Remember that in addition to an examination of the enlarged node you should also conduct a full examination of the lymphatic system.
