Neck examination Flashcards
Intro and exposure
Wash hands
Introduce yourself
Gain verbal consent
Get adequate exposure
Parts of the neck examination
- Look
- Feel
- Move
Look - inspection
Scars Obvious neck mass Voice - weakness/ hoarseness Systemic signs: cachexia, pallow, proptosis/ exophthalmos Ask pt to swallow water Ask pt to protrude tongue
Feel - palpation
- Lymph nodes
- levels I to VI
- pre-auricular
- post-auricular
- occipital
Anterior neck triangle
Midline
Anterior to sternocleidomastoid
Posterior neck triangle
Trapezius
Posterior to sternocleidomastoid
Feel - palpation. Move thyroid
- Thyroid gland
- ask pt to swallow
- ask pt to protrude tongue (thyroglossal cyst would move as it is attached to base of tongue)
Diffuse hyperplastic goitre
Enlarged thyroid gland
- Graves disease
- iodine deficiency
- cancer
Feel - move
Neck lump
Size Location Consistency - smooth/ rubbery/ hard/ nodular Fluctuance? cyst Pulsatility Temp Skin changed: erythama/ punctum/ ulceration Relation to structures: tethering Ausculation: bruit, *
To complete examination
Thank pt
Wash hands
Summarise findings
Cancer
Risk factors: smoking, alcohol, > 35yrs
Tethering, hard
Symptoms: lethargy, weight loss, pain
Further assessment of suspicious lesion
Examine oral cavity, oropharynx, nasal cavity
USS lesion/ MRI neck
Fine needle aspiration
Thyroid status examination
What to do if you see something suspicious
Tell pt to go to GP
-2 week wait pathway for suspected malignancy to ENT/ max fax
Thyroid status exam
Obsere pt Inspect hands -clammy/ cold palm -irregular pulse -clubbing -tremor Inspect face Assess for lid lag Assess for proptosis Assess neck lump - as per neck exam Feel for tracheal deviation Percuss for retrosternal goitre *** Assess reflexes (biceps, patella) Inspect for pre-tibital myoxoedema Assess for proximal muscle wasting
Thyroid status exam
Obsere pt Inspect hands -clammy/ cold palm -irregular pulse -clubbing -tremor Inspect face Assess for lid lag Assess for proptosis Assess neck lump - as per neck exam Feel for tracheal deviation Percuss for retrosternal goitre Auscultate for thyroid bruits Assess reflexes (biceps, patella) Inspect for pre-tibital myoxoedema Assess for proximal muscle wasting
