Examination of Mouth, Throat and Neck

Question 1

How do you prepare for this exam?

Answer 1

Get glass of water nearby

Expose neck down to clavicles

Ask the patient to remove jewellery

Question 2

How to inspect mouth

Answer 2

Use pen torch and tongue depressor

Lips (cyanosis, angular stomatitis, other lesions)

Dentition

Floor of mouth

Hard and soft palate

Inside cheeks

Parotid duct opening (2nd upper molar)

Oropharynx, uvula and tonsillar folds and tonsils (ask patient to stick tongue out and move it side to side)

Tongue - dorsal surface, both lateral borders (dryness/fasculation/wasting)

Underside of tongue, floor of mouth, frenulum, submandibular duct and opening

Question 3

What comes after inspection of the mouth

Answer 3

BITE

Question 4

What comes after bite?

Answer 4

Inspection of the neck

Question 5

What is involved in the inspection of the neck?

Answer 5

Scars

Swelling

Lump - observe site, size, skin changes

Movement with tongue protrusion and swallowing

Question 6

What do you palpate in the neck?

Answer 6

Tracheal position

Palpate potential swellings in neck sing Z pattern

If swelling is present dertermine;

• Location (midline/lateral, anterior/posterior triangle? move with swallow? clinical level 1-5)
• Mobile
• Cystic
• Vascular
• Nodular

Question 7

What do you palpate in the mouth?

Answer 7

Floor of mouth

Inside cheeks

Salivary glands

Substance of tongue

Feeling for:

• cystic swellings, irregular roughened areas, or stones in the parotid duct

Question 8

What do you percuss?

Answer 8

If there is a palpable thyroid swelling, then consider percussion of the manubrium for a retrosternal thyroid

Question 9

What do you auscultate?

Answer 9

Carotid artery bruit

Listen over an enlarged thyroid - use diaphragm of the stethoscope and ask the patient to hold their breath - listen over both lobes of the thyroid - in graves disease a soft bruit may be heard