Throat Examination Flashcards
Throat red flags
Hard and fixed mass 35+ Mucosal lesion in H/N Persistent hoarseness, dysphagia Trismus Unilateral ear pain referred from tongue base
Intro
Hi, I’m An Nakamura, a 3rd year medical student.
I’ve been asked to do an examination of your throat.
This will involve me feeling your neck and asking you to drink some water
Will this be ok?
Do you have any questions?
Do you have any pain?
General inspection
Scars - past neck surgery (thyroidectomy, LN removal, radiotherapy related)
Cachexia - underlying malignancy
Hoarse voice - compressed larynx (thyroid malignancy
SOB, stridor - URTI compression
Behaviour and clothing - hypo/hyperthyroidism
Exopthalmos - Graves
Neck lump assessment
Site - anterior triangle? posterior triangle? midline
Size
Shape - regular/irregular borders
Consistency - soft (cyst), hard (malignancy), rubbery (LN)
Mobility - mobile or tethered to other structures (malignancy?)
Fluctuance - cyst
Temperature - warm (inflammatory, infective cause)
Overlying skin changes - redness (inflammatory, infective)
Pulsatility and bruits - vascular origin (aneurysm)
Tenderness - inflammatory, infective cause
Assessment of lymph nodes
Cervical lymph nodes
- benign - U1cm, smooth, round, non tender, mobile
- reactive - same as benign but with infective symptoms
- haematological malignancy - widespread, enlarged rubbery LN
- metastasis => regional LNs draining affected organ - hard, firm, irregular, non mobile
Assessing the thyroid gland
-palpate
Stand behind patient, ask them to tilt their chin down
Place 3 middle fingers of each hand along midline of neck
Locate upper edge of thyroid cartilage at Adam’s apple
Locate lower edge of cricoid cartilage - thyroid isthmus just under cartilage
Palpate isthmus
Move fingers laterally from isthmus => palpate each lobe
Ask patient to swallow water whilst you feel for thyroid elevation
-asymmetrical elevation => unilateral thyroid mass?
Ask patient to stick out their tongue
-elevation of thyroglossal cyst
What are you assessing in the thyroid gland
Size
Symmetry - asymmetry (thyroid nodule, malignancy?)
Consistency - irregularities (widespread - multinodular goitre?)
Masses - palpable masses (solitary nodule, malignancy)
Palpable thrill - increased vascularity of thyroid due to hyperthyroidism
Assessing the submandibular gland
Move inwards from the inferior border of the mandible near the angle with patient’s head tilted downwards
Submandibular gland swellings are usually singular
Salicary duct calculi - firm mass within gland
LN swelling often involves many nodes
Outro and further assessments
General neck inspection
Mass findings
Palpation of thyroid findings
Palpation of submandubular findings
Thyroid function tests Routine bloods - infection, malignancy US and imaging of mass FNA - histological assessment Lymphatic system assessment Oral cavity, oropharynx, nasal cavity assessment
Causes of midline neck lump
Lymph node - multiple, underlying infection, malignancy
Lipoma - lone, painless, rubbery, smooth
Dermoid cyst - formed along the lines of embryological fusion
-painless, do not move with tongue protrusion
Epidermoid cyst - lesions tethered to epidermis containing keratin
-lone, painless mass with epidermal punctum
Enlarged thyroid gland - found below thyroid cartilage
Thyroid nodule - adenomas, cysts, malignancy?
Thyroglossal cysts - painless, smooth, fluctuant mass that rises of tongue protrusion
Causes of neck lumps in the anterior triangle
LN - multiple, underlying infection/malignancy
Lipoma - lone, rubbery, smooth
Epidermoid cyst - lone, mass with punctum, may have overlying erythema if infected
Submandibular gland swelling - caused by salivary gland stone or gland infection
Branchial cyst - present from birth, often found in teens when swollen from infection
Carotid artery aneurysm - pulsatile mass with audible bruit on auscultation
Laryngocele - reducible tense mass which increases in size during sneezing/nose blowing
Causes of neck lumps in the posterior triangle
LN - multiple, underlying infection/malignancy
Lipoma - lone, rubbery, smooth
Epidermoid cyst - lone, mass with punctum, may have overlying erythema if infected
Subclavian artery aneurysm - pulsatile mass with audible bruit on auscultation
Branchial cyst - present from birth, often found in teens when swollen from infection
Pharyngeal pouch - reducible mass
Cystic hygroma - fluctuant mass, transilluminates on left side of neck
