Neck Examination

by Ihab Anbar
25 Comment(s)
Neck Examination

Neck Examination

Neck examination and questions for medical student exams, finals, OSCEs, and MRCP PACES.

 

Intro (WIIPPPPEE)

  • Wash your hands
  • Introduce yourself
  • Identity of patient – confirm
  • Permission (consent and explain examination)
  • Pain?
  • Position sitting in the chair with room behind the chair for the examiner to stand
  • Privacy
  • Expose neck and clavicles (patient may need to tie hair back/ remove necklace)
  • Equipment – have a glass of water to hand

 

General Inspection

  • Surroundings
    • Monitoring
    • Treatments
    • Paraphernalia
  • Patient
    • Note whether there is any dyspnoea on sitting/ lying down
  • Neck
    • Inspect
      • From front and sides
        • Lumps/ asymmetry
        • Scars (thyroidectomy/ parathyroidectomy scars using a pentorch)
        • Skin changes, facial plethora (SVC obstruction)
        • Distended neck veins (SVC obstruction)
      • If a neck lump is seen:
        • Ask patient to 1) take a sip of water, 2) hold it in their mouth 3) and swallow
          • The three-part command gives the examiner time to position themselves to watch the neck lump on swallowing
          • Any lump attached to the pretracheal fascia will move upwards on swallowing i.e. a thyroid lump or thyroglossal cyst
        • Ask patient to 1) open their mouth 2) and stick their tongue out
          • A midline lump that moves upwards on tongue protrusion is a thyroglossal cyst
    • Palpate: anterior
      • Trachea
        • For tracheal deviation (support back of neck whilst doing this and warn patient it may feel uncomfortable)
      • Carotid pulse (one side at a time)
    • Palpate: posterior
      • Explain to the patient that you will be moving behind them to palpate their neck. Take this opportunity to inspect the back of the neck.
      • Thyroid gland
        • Palpate one lateral lobe at a time then isthmus (nodules and thrills)
        • Ask the patient the swallow another sip of water whilst palpating the thyroid gland (thyroid masses that move upwards on swallowing)
      • Anterior and posterior triangles
      • Parotid glands
      • Lymph nodes
        • Cervical
        • Supraclavicular
    • Percuss
      • Over sternum for retrosternal goiter
    • Auscultate
      • Carotid bruits
      • Thyroid bruits
      • Any other neck lumps (if pulsatile with bruit suspect carotid artery aneurysm)

 

Closure

  • Thank patient
  • Is the patient comfortable?
  • Help getting dressed?
  • Wash hands
  • Turn to the examiner, hands behind back, holding stethoscope (try not to fidget!) before saying: “To complete my examination, I would like to…”
    • Further examination
      • Take a full history
      • Perform a thyroid status examination
      • Perform an ENT examination
    • Further Invx as indicated
      • Bloods including TFTs
      • Ultrasound lump
      • Fine needle aspiration/ core biopsy of lump
by Ihab Anbar

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