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Final Score 35%
66
124
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Anatomy
Head and Neck
Question 180 of 190
A 73 year old man presents to ED with a longstanding ulceration to the tip of his tongue. Biopsy demonstrates squamous cell carcinoma. Which lymph nodes will most likely be involved in spread of the cancer cells:
Answer:
The tip of the tongue drains either directly into or via superficial submental nodes into the jugulo-omohyoid deep cervical lymph node.Deep Cervical Lymph Nodes
Anatomy / Head and Neck / Neck
Last Updated: 11th April 2019
The deep cervical nodes form a chain along the internal jugular vein and are divided into upper and lower groups.
Jugulodigastric Node
The most superior node in the upper group (lying where the posterior belly of the digastric muscle crosses the internal jugular vein) is the jugulodigastric node which receives lymphatic drainage from the tonsils and tonsillar region.
Jugulo-omohyoid Lymph Node
The most superior node in the lower group (lying just inferior to the intermediate tendon of the omohyoid muscle) is the jugulo-omohyoid node which receives lymphatic drainage from the tongue.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Cervical-lymph-nodes.png)
Deep Cervical Lymph Nodes. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
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