Physical Exam

Head and Neck Lymph Node Palpation

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Video coming September 2026

How to Perform

With the patient seated and the neck muscles relaxed, use the pads of the fingers and gentle circular pressure to palpate the cervical node groups systematically — preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, the anterior and posterior cervical chains, and the supraclavicular fossae — comparing the two sides. Note the size, consistency, tenderness, and mobility of any node.

How to Interpret

Infectious Mononucleosis

Posterior cervical lymphadenopathy in an adolescent or young adult

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

References

Cai X, Ebell MH, Haines L. Accuracy of Signs, Symptoms, and Hematologic Parameters for the Diagnosis of Infectious Mononucleosis: A Systematic Review and Meta-Analysis. J Am Board Fam Med. 2021 Nov-Dec;34(6):1141-1156. doi:10.3122/jabfm.2021.06.210217. PMID 34772769. PROSPERO CRD42021246280. PRISMA + QUADAS-2; bivariate random-effects meta-analysis (mada/R) for findings reported by >=3 studies, single-study point estimates (Stata diagti) where only 1 study reported the operating characteristic. Open access at jabfm.org.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.