Tooltip
.tooltip {
position: relative;
cursor: pointer;
text-decoration: none;
border-bottom: 1px dashed rgba(0, 0, 0, 0.6);
}
.tooltip::before {
content: attr(data-tooltip);
position: absolute;
top: -40px; /* Trochę niżej nad słowem */
left: 50%; /* Wyśrodkowanie */
transform: translateX(-50%);
background-color: rgba(255, 255, 255, 0.9);
color: #333;
padding: 6px 12px;
border-radius: 8px;
white-space: nowrap;
opacity: 0;
visibility: hidden;
transition: opacity 0.3s ease, visibility 0.3s ease;
font-family: ‘Arial’, sans-serif;
font-size: 14px;
box-shadow: 0px 4px 8px rgba(0, 0, 0, 0.1);
z-index: 10;
}
.tooltip:hover::before {
opacity: 1;
visibility: visible;
}
document.addEventListener(‘DOMContentLoaded’, function () {
const wordsToTooltip = {
“Pads of fingers”: “Opuszki palców”,
“Lymph nodes”: “Węzły chłonne”,
“Underlying tissue”: “Tkanka leżąca u podstawy”,
“Anatomical landmarks”: “Punkty orientacyjne anatomiczne”,
“Size”: “Wielkość”,
“Shape”: “Kształt”,
“Consistency”: “Konsystencja”,
“Soft nodes”: “Miękkie węzły chłonne”,
“Rubbery nodes”: “Gumowate węzły chłonne”,
“Hard nodes”: “Twarde węzły chłonne”,
“Tenderness”: “Tkliwość”,
“Mobility”: “Ruchomość”,
“Overlying skin changes”: “Zmiany skórne na powierzchni”,
“Erythema”: “Rumień”,
“Benign lymph nodes”: “Łagodne węzły chłonne”,
“Reactive lymph nodes”: “Reaktywne węzły chłonne”,
“Malignant lymph nodes”: “Złośliwe węzły chłonne”,
“Metastatic lymph nodes”: “Węzły chłonne z przerzutami”,
“Diameter”: “Średnica”,
“Smooth borders”: “Gładkie granice”,
“Regular borders”: “Regularne granice”,
“Fibrosis”: “Zwłóknienie”,
“Infections”: “Infekcje”,
“Systemic diseases”: “Choroby układowe”,
“Systemic infections”: “Infekcje układowe”,
“Local infections”: “Infekcje miejscowe”,
“Tender nodes”: “Tkliwe węzły chłonne”,
“Irregular borders”: “Nieregularne granice”,
“Cancer cells”: “Komórki nowotworowe”,
“Invasive nature”: “Charakter inwazyjny”,
“Fibrotic response”: “Reakcja zwłóknieniowa”,
“Surrounding tissues”: “Otaczające tkanki”,
“Pathology”: “Patologia”,
“Immune response”: “Odpowiedź immunologiczna”,
“Primary tumor”: “Guz pierwotny”,
“Metastasis”: “Przerzut”,
“Lymphatic invasion”: “Inwazja limfatyczna”,
“Cervical Lymph Nodes”: “Węzły chłonne szyjne”,
“Submental Nodes”: “Węzły chłonne podbródkowe”,
“Submandibular Nodes”: “Węzły chłonne podżuchwowe”,
“Upper Cervical Nodes”: “Górne węzły chłonne szyjne”,
“Mid-Cervical Nodes”: “Środkowe węzły chłonne szyjne”,
“Lower Cervical Nodes”: “Dolne węzły chłonne szyjne”,
“Medial Supraclavicular Nodes”: “Przyśrodkowe węzły chłonne nadobojczykowe”,
“Posterior Triangle Nodes”: “Węzły chłonne trójkąta tylnego szyi”,
“Anterior Cervical Nodes”: “Przednie węzły chłonne szyjne”,
“Prelaryngeal, Pretracheal, and Paratracheal Nodes”: “Węzły chłonne przedkrtaniowe, przedtchawicze i przytchawicze”,
“Retropharyngeal Nodes”: “Węzły chłonne zagardłowe”,
“Lateral Retropharyngeal Nodes”: “Boczne węzły chłonne zagardłowe”,
“Parotid Nodes”: “Węzły chłonne przyuszne”,
“Buccal-Facial Nodes”: “Węzły chłonne policzkowo-twarzowe”,
“Retroauricular Nodes”: “Węzły chłonne zamałżowinowe”,
“Occipital Nodes”: “Węzły chłonne potyliczne”,
// Additional terms from the text
“Submental triangle”: “Trójkąt podbródkowy”,
“Submandibular triangle”: “Trójkąt podżuchwowy”,
“Internal jugular vein”: “Żyła szyjna wewnętrzna”,
“Hyoid bone”: “Kość gnykowa”,
“Cricoid cartilage”: “Chrząstka pierścieniowata”,
“Sternum”: “Mostek”,
“Sternocleidomastoid muscle”: “Mięsień mostkowo-obojczykowo-sutkowy”,
“Scalp”: “Skóra głowy”,
“Nasopharynx”: “Nosogardło”,
“Thyroid gland”: “Gruczoł tarczowy”,
“Larynx”: “Krtań”,
“Trachea”: “Tchawica”,
“Esophagus”: “Przełyk”,
“Soft palate”: “Podniebienie miękkie”,
“Mastoid process”: “Wyrostek sutkowaty”,
“Facial vessels”: “Naczynia twarzowe”,
“Nasal bridge”: “Grzbiet nosa”,
“Tonsils”: “Migdałki”,
“Sublingual glands”: “Gruczoły podjęzykowe”,
“Submandibular glands”: “Gruczoły podżuchwowe”,
“Axillary lymph nodes”: “Węzły chłonne pachowe”,
“Pectoral nodes”: “Węzły piersiowe”,
“Central nodes”: “Węzły centralne”,
“Subscapular nodes”: “Węzły podłopatkowe”,
“Humeral nodes”: “Węzły ramienne”,
“Apical nodes”: “Węzły szczytowe”,
“Inguinal lymph nodes”: “Węzły chłonne pachwinowe”,
“Horizontal chain”: “Łańcuch poziomy”,
“Vertical chain”: “Łańcuch pionowy”,
“Inguinal ligament”: “Więzadło pachwinowe”,
“Anterior superior iliac spine”: “Kolec biodrowy przedni górny”,
“Pubic tubercle”: “Guzek łonowy”,
“Femoral artery”: “Tętnica udowa”,
“Saphenous opening”: “Rozwór odpiszczelowy”,
“Great saphenous vein”: “Żyła odpiszczelowa wielka”,
“Benign”: “Łagodny”,
“Mobile”: “Ruchomy”,
“Immobile”: “Nieruchomy”,
“Malignancy”: “Złośliwość”,
“Non-tender”: “Nietkliwy”,
“Inflammatory”: “Zapalenie”,
“Swelling”: “Obrzęk”,
“Hallmark”: “Charakterystyczny objaw”,
“Tumor”: “Guz”,
“Metastatic disease”: “Choroba przerzutowa”,
“Acute”: “Ostry”,
“Palate”: “Podniebienie”,
“Sublingual”: “Podjęzykowy”,
“Nasal cavity”: “Jama nosowa”,
“Pharynx”: “Gardło”,
“Major salivary glands”: “Duże gruczoły ślinowe”,
“Thyroid”: “Tarczyca”,
“SCM”: “Mięsień mostkowo-obojczykowo-sutkowy”,
“Jugular foramen”: “Otwór szyjny”,
“Parotid gland”: “Ślinianka przyuszna”,
“Eyelids”: “Powieki”,
“Armpits”: “Pachy”,
“Lateral (Pectoral) Nodes”: “Węzły boczne (piersiowe)”,
“Pectoralis major muscle”: “Mięsień piersiowy większy”,
“Pectoralis minor”: “Mięsień piersiowy mniejszy”,
“Axillary vein”: “Żyła pachowa”,
“Lymphadenectomy”: “Limfadenektomia”,
“Lymphedema”: “Obrzęk limfatyczny”,
“Latissimus dorsi muscle”: “Mięsień najszerszy grzbietu”,
“Subscapular (Posterior) Nodes”: “Węzły podłopatkowe (tylne)”,
“Lateral Axillary (Humeral) Nodes”: “Boczne węzły pachowe (ramienne)”,
“Subclavicular (Apical) Nodes”: “Węzły podobojczykowe (szczytowe)”,
“Mastectomy”: “Mastektomia”,
“Axilla”: “Pacha”,
“Apex”: “Szczyt”,
“Sexually transmitted infections”: “Infekcje przenoszone drogą płciową”,
“Malignancies”: “Nowotwory złośliwe”,
“Inguinal region”: “Okolica pachwinowa”
};
// Normalize keys in the dictionary
const normalizedWordsToTooltip = {};
for (const [key, value] of Object.entries(wordsToTooltip)) {
const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses
normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value;
}
function processNode(node) {
if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) {
let content = node.nodeValue;
// Regex to match only the main words (ignores parentheses)
const regex = new RegExp(
`\b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})\b`,
‘gi’
);
if (regex.test(content)) {
const wrapper = document.createElement(‘span’);
wrapper.innerHTML = content.replace(regex, (match) => {
const tooltip = normalizedWordsToTooltip[match.toLowerCase().trim()];
return `
${match}`;
});
node.replaceWith(wrapper);
}
} else if (node.nodeType === Node.ELEMENT_NODE) {
Array.from(node.childNodes).forEach(processNode);
}
}
document.querySelectorAll(‘body *:not(script):not(style)’).forEach((element) => {
Array.from(element.childNodes).forEach(processNode);
});
});
Podświetlanie tekstu z notatkami
body {
margin: 0;
padding: 0;
font-family: Arial, sans-serif;
}
.highlight {
background-color: #cce7ff; /* Highlight color without notes */
position: relative;
display: inline;
}
.highlight.with-note {
background-color: #ffeb3b; /* Highlight color with notes */
}
.note-box {
position: absolute;
background-color: #f9f9f9;
color: #333;
font-size: 14px;
line-height: 1.6;
padding: 10px 15px;
border: 1px solid #ddd;
border-radius: 5px;
box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2);
max-width: 250px;
z-index: 1000;
white-space: normal;
text-align: left;
display: none; /* Hidden by default */
}
.note-controls {
position: absolute;
top: -30px;
right: -30px;
display: flex;
gap: 10px;
z-index: 10;
opacity: 0;
pointer-events: none;
transition: opacity 0.3s;
}
.note-controls.visible {
opacity: 1;
pointer-events: all;
}
.note-controls span {
cursor: pointer;
background-color: gray;
color: white;
padding: 5px 10px;
border-radius: 5px;
font-size: 16px;
font-weight: bold;
}
.note-controls span:hover {
background-color: darkgray;
}
document.addEventListener(“DOMContentLoaded”, () => {
/**
* Checks if an element is a header.
*/
const isHeaderElement = (node) => {
while (node) {
if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) {
return true;
}
node = node.parentNode;
}
return false;
};
/**
* Checks if an element is inside a table cell.
*/
const isInsideTable = (node) => {
while (node) {
if (node.tagName === “TD” || node.tagName === “TH”) {
return node;
}
node = node.parentNode;
}
return null;
};
/**
* Checks if an element belongs to the same list item.
*/
const isWithinSameListItem = (selection) => {
if (selection.rangeCount === 0) return false;
const range = selection.getRangeAt(0);
const startContainer = range.startContainer;
const endContainer = range.endContainer;
const getClosestListItem = (node) => {
while (node) {
if (node.nodeType === 1 && node.tagName === “LI”) {
return node;
}
node = node.parentNode;
}
return null;
};
const startListItem = getClosestListItem(startContainer);
const endListItem = getClosestListItem(endContainer);
// Ensure selection is within the same list item
return startListItem === endListItem;
};
/**
* Validates the selection.
* Ensures the selection is within a single header, table cell, or list item.
*/
const isSelectionValid = (selection) => {
if (selection.rangeCount === 0) return false;
const range = selection.getRangeAt(0);
const startContainer = range.startContainer;
const endContainer = range.endContainer;
const startInHeader = isHeaderElement(startContainer);
const endInHeader = isHeaderElement(endContainer);
// Block selection spanning headers
if (startInHeader !== endInHeader) {
return false;
}
const startCell = isInsideTable(startContainer);
const endCell = isInsideTable(endContainer);
// Block selection spanning table cells
if (startCell && endCell && startCell !== endCell) {
return false;
}
// Block selection spanning multiple list items
if (!isWithinSameListItem(selection)) {
return false;
}
return true;
};
/**
* Highlights the selected text.
*/
const wrapTextWithHighlight = (range) => {
const fragment = range.extractContents();
const highlight = document.createElement(“span”);
highlight.className = “highlight”;
highlight.appendChild(fragment);
range.insertNode(highlight);
const noteControls = document.createElement(“div”);
noteControls.className = “note-controls visible”;
const editNote = document.createElement(“span”);
editNote.textContent = “✎”;
editNote.title = “Edit note”;
noteControls.appendChild(editNote);
const removeHighlight = document.createElement(“span”);
removeHighlight.textContent = “x”;
removeHighlight.title = “Remove highlight”;
noteControls.appendChild(removeHighlight);
highlight.style.position = “relative”;
highlight.appendChild(noteControls);
let noteBox = null;
const updateNotePosition = () => {
const rect = highlight.getBoundingClientRect();
if (noteBox) {
noteBox.style.top = `${rect.height}px`;
noteBox.style.left = `${rect.width / 2}px`;
}
};
const hideControlsAndNoteAfterDelay = () => {
setTimeout(() => {
noteControls.classList.remove(“visible”);
if (noteBox) noteBox.style.display = “none”;
}, 3000);
};
// Show controls for 3 seconds after highlighting
hideControlsAndNoteAfterDelay();
highlight.addEventListener(“click”, () => {
noteControls.classList.add(“visible”);
if (noteBox) noteBox.style.display = “block”;
hideControlsAndNoteAfterDelay();
});
editNote.addEventListener(“click”, () => {
const noteText = prompt(“Add or edit a note:”, noteBox?.textContent || “”);
if (noteText) {
if (!noteBox) {
noteBox = document.createElement(“div”);
noteBox.className = “note-box”;
highlight.appendChild(noteBox);
}
noteBox.textContent = noteText;
noteBox.style.display = “block”;
highlight.classList.add(“with-note”);
updateNotePosition();
hideControlsAndNoteAfterDelay();
}
});
removeHighlight.addEventListener(“click”, () => {
const parent = highlight.parentNode;
while (highlight.firstChild) {
parent.insertBefore(highlight.firstChild, highlight);
}
parent.removeChild(highlight);
if (noteBox) noteBox.remove();
});
};
/**
* Handles the mouseup event to validate and apply highlighting.
*/
document.body.addEventListener(“mouseup”, () => {
const selection = window.getSelection();
if (selection.rangeCount > 0 && selection.toString().trim()) {
if (!isSelectionValid(selection)) {
alert(“Zaznaczenie musi być w obrębie jednego akapitu, komórki tabeli lub punktu listy!”);
selection.removeAllRanges();
return;
}
const range = selection.getRangeAt(0);
wrapTextWithHighlight(range);
selection.removeAllRanges();
}
});
});
Szacowany czas lekcji:
18 minut
.lesson-duration-container {
background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */
padding: 8px 15px; /* Wewnętrzny odstęp */
border-radius: 8px; /* Zaokrąglone rogi */
font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */
font-size: 16px; /* Rozmiar tekstu */
color: #6c757d; /* Ciemny szary kolor tekstu */
display: inline-block; /* Wyświetlanie jako element blokowy */
margin-bottom: 20px; /* Odstęp na dole */
border: none; /* Bez obramowania */
}
.lesson-duration-label {
font-weight: 700; /* Pogrubienie dla etykiety */
color: #6c757d; /* Ciemny szary kolor dla etykiety */
margin-right: 5px; /* Odstęp od wartości */
}
.lesson-duration-value {
color: #6c757d; /* Ciemny szary kolor dla wartości */
font-weight: 700; /* Pogrubienie dla wartości */
}
Palpation Technique
Use the pads of the second, third, and fourth fingers to gently press and roll the lymph nodes over the underlying tissue, assessing for the characteristics listed below:
Characteristics of Lymph Nodes
During palpation, it’s essential to assess the following characteristics of lymph nodes:
- Site: The location of the lymph node in relation to anatomical landmarks.
- Size: Normal lymph nodes are generally less than 1 cm in diameter; larger nodes may indicate pathology.
- Shape: Nodes should have regular, smooth borders.
- Consistency: Soft nodes are often insignificant, rubbery nodes may suggest lymphoma, and hard nodes can indicate malignancy.
- Tenderness: Tender nodes are commonly associated with infections.
- Mobility: Mobile nodes are usually benign, while immobile nodes may indicate malignancy.
- Overlying Skin Changes: Look for signs of erythema or other skin changes that could suggest underlying pathology.
Interpretation of Lymph Node Examination Findings
Interpreting the characteristics of lymph nodes is crucial in narrowing down potential diagnoses and guiding further clinical management. Below is a more detailed breakdown of the typical findings associated with benign, reactive, malignant, and metastatic lymph nodes.
Benign Lymph Nodes
- Size: Benign lymph nodes are usually small, typically measuring less than 1 cm in diameter. Their size does not generally change over time.
- Shape: These nodes are typically smooth and rounded, with well-defined borders that can be easily delineated during palpation.
- Consistency: Benign nodes feel soft to the touch, similar to the texture of a grape. Their softness indicates the absence of fibrosis or malignancy.
- Mobility: Benign lymph nodes are freely mobile, meaning they can be easily moved under the skin and are not attached to surrounding tissues.
- Tenderness: These nodes are generally non-tender, indicating that there is no active inflammation or infection.
Reactive Lymph Nodes
- Size: Reactive lymph nodes are often enlarged, typically exceeding 1 cm in diameter, as they respond to local or systemic infections or inflammatory conditions.
- Shape: The shape of reactive nodes is generally smooth and rounded, although they may be slightly irregular due to inflammatory swelling.
- Consistency: These nodes tend to be soft but can feel slightly rubbery, reflecting their reactive nature. The increased cellular activity within the node contributes to this rubbery texture.
- Mobility: Reactive nodes are mobile and are not fixed to surrounding structures, which distinguishes them from malignant nodes.
- Tenderness: Tenderness is a hallmark of reactive lymphadenopathy, often associated with signs of infection such as erythema or warmth over the node. The tenderness results from inflammation within the node.
Malignant Lymph Nodes
- Size: Malignant lymph nodes are often enlarged, and the size may progressively increase as the disease advances. These nodes are usually greater than 1 cm in diameter.
- Shape: The borders of malignant lymph nodes are often irregular, lacking the smooth, rounded contour seen in benign nodes. This irregularity reflects the invasive nature of cancer cells.
- Consistency: Malignant nodes typically feel hard and firm upon palpation, indicating the presence of fibrosis or direct invasion by malignant cells. The hardness is due to the fibrotic response of the tissue surrounding the invading cancer cells.
- Mobility: Unlike benign or reactive nodes, malignant lymph nodes may be immobile. This lack of mobility suggests the invasion of the cancer cells into nearby structures, making the node less mobile.
- Tenderness: Malignant nodes are generally non-tender, as the growth of cancer cells does not typically trigger the same inflammatory response seen in infections.
Metastatic Lymph Nodes
- Size: Metastatic lymph nodes are usually significantly enlarged as they become infiltrated by cancer cells from a primary tumor located in a nearby organ.
- Shape: The shape of metastatic nodes is often irregular, with poorly defined borders, reflecting the aggressive spread of cancerous cells.
- Consistency: Metastatic nodes are typically firm to hard, indicating a high level of cellularity and fibrosis within the node. This firmness can also be due to the scarring or fibrotic reaction that occurs in response to tumor invasion.
- Mobility: These nodes are often immobile – fixed to surrounding tissues, a characteristic feature of metastatic disease. The invasion of the surrounding tissue by cancer cells leads to a loss of the normal architecture and mobility of the node.
- Tenderness: Tenderness is not commonly associated with metastatic nodes, as the process of metastasis usually does not provoke an acute inflammatory response. However, tenderness may be present if there is associated inflammation or if the node is compressing surrounding nerves or tissues.
Examination of Lymph Nodes
Lymph nodes are located in specific regions, many of which can be palpated during a clinical examination. Each group of lymph nodes should be examined in a consistent, methodical manner to ensure no area is overlooked.
Cervical Lymph Nodes (Head and Neck)
The cervical lymph nodes are a primary focus during examination due to their frequent involvement in infections and systemic diseases. The examination is best performed with the patient seated upright, with their head slightly tilted downward to relax the neck muscles.
Group Ia – Submental Nodes: Located in the submental triangle beneath the chin, these nodes drain lymph from the chin, central lower lip, anterior tongue, and floor of the mouth.
Group Ib – Submandibular Nodes: Found in the submandibular triangle under the jaw, they drain the submental nodes, lips, cheeks, tongue, palate, and sublingual and submandibular glands.
Group II – Upper Cervical Nodes: Situated around the upper third of the internal jugular vein, they receive lymph from the face, submandibular and submental nodes, nasal cavity, pharynx, and major salivary glands.
Group III – Mid-Cervical Nodes: Located below the hyoid bone to the lower edge of the cricoid cartilage, they drain lymph from Groups II and V, the tongue base, tonsils, larynx, and thyroid.
Group IVa – Lower Cervical Nodes: Surrounding the lower third of the internal jugular vein, these nodes drain lymph from Group III, the larynx, pharynx, and thyroid.
Group IVb – Medial Supraclavicular Nodes: Found below Group IVa, near the sternum, they receive lymph from Groups IVa and Vc, the trachea, esophagus, and larynx.
Group V – Posterior Triangle Nodes: Located posterior to the sternocleidomastoid muscle, they drain lymph from the scalp, posterior neck, nasopharynx, and thyroid.
Group VIa – Anterior Cervical Nodes: Superficial nodes between the anterior borders of the SCM, draining lymph from the lower face and anterior neck.
Group VIb – Prelaryngeal, Pretracheal, and Paratracheal Nodes: Found deep to the anterior cervical nodes, they drain lymph from the anterior oral cavity, tongue tip, thyroid, and hypopharynx.
Group VIIa – Retropharyngeal Nodes: Located behind the pharynx from C1 to the hyoid bone, they drain lymph from the nasopharynx and soft palate.
Group VIIb – Lateral Retropharyngeal Nodes: Situated near the jugular foramen, they drain lymph from the nasopharynx.
Group VIII – Parotid Nodes: Found around the parotid gland, these nodes drain the scalp, eyelids, external ear, and nasal bridge.
Group IX – Buccal-Facial Nodes: Surrounding the facial vessels, they drain lymph from the nose, cheeks, and upper lip.
Group Xa – Retroauricular Nodes: Located near the mastoid process, these nodes drain lymph from the posterior ear and scalp behind the ear.
Group Xb – Occipital Nodes: Found at the base of the skull, they drain lymph from the posterior scalp.
Axillary Lymph Nodes (Armpits)
The axillary lymph nodes, located in the armpits, are examined with the patient lying at a 45° angle. This position helps relax the surrounding tissues, making palpation more effective
Support the patient’s arm to allow their muscles to relax, and then systematically palpate the different groups of axillary nodes:
Lateral (Pectoral) Nodes: These consist of 5–10 lymph nodes located along the lateral thoracic vessels, directly behind the pectoralis major muscle and below the pectoralis minor.
Lateral Axillary (Humeral) Nodes: Numbering 1–6, these nodes are situated along the posterior surface and outside the axillary vein, as well as the lower edge of the pectoralis minor muscle. They drain lymph from the upper limb. During surgical lymphadenectomy, these nodes should be preserved to prevent upper limb lymphedema. The lower edge of the axillary vein marks the boundary for proper lymphadenectomy.
Subscapular (Posterior) Nodes: Approximately 5 lymph nodes are located along the nerves and vessels leading to the latissimus dorsi muscle. They drain the lateral portion of the back and should be removed during lymphadenectomy due to their numerous connections to lymphatic pathways draining the lower lateral portions of the breast.
Central Nodes: Numbering 2–6, these nodes occupy the central part of the axilla and lie below and partially behind the pectoralis minor muscle. They receive lymph from the three preceding groups of lymph nodes. In the original mastectomy method described by Patey, detaching the pectoralis minor muscle facilitated access to this group of nodes.
Subclavicular (Apical) Nodes: Comprising 10–11 lymph nodes, these are located at the apex of the axilla. Due to their positioning, patients should be warned that palpation in this area may cause discomfort.
Inguinal Lymph Nodes Examination (Groin)
The inguinal lymph nodes, located in the groin, are important indicators of various conditions, including infections of the lower limbs, sexually transmitted infections, and malignancies. These nodes are divided into two groups: the horizontal and vertical chains.
Positioning the Patient: Begin by asking the patient to lie flat on the examination table, ensuring the inguinal region is fully exposed. This position allows for a thorough and accurate examination of the lymph nodes.
Palpation of the inguinal lymph nodes is performed in two distinct areas:
- Horizontal Chain: Start by palpating immediately below the inguinal ligament, which runs between the anterior superior iliac spine and the pubic tubercle. This chain runs parallel to the ligament and is best palpated with the patient’s skin relaxed.
- Vertical Chain: To examine the vertical chain, position your fingers approximately 3 cm lateral to the pubic tubercle, along the line of the femoral artery. Palpate vertically downwards over the saphenous opening and the proximal portion of the great saphenous vein.
