Head And Neck Examination

Head and Neck Examination Dr Tim Coughlin

Aims / Objectives • The aim is to make you all pass

your head and neck station in the OSCE

• Objectives: • Understand what is in the exam • Examination of the Thyroid • Examination of the Parotid

What to Expect • The head and neck station has 2 main possibilities

• Examination of the Thyroid • Examination of the Parotid

Beginning all Examinations • Introduce yourself to the patient • Ask Permission to perform the examination

• Explain what you want to do • Expose the patient adequately • Position the patient correctly + PAIN

Thyroid Examination

General Inspection

• Inspect from the front

• BMI • Tremor / Restless / Agitation

• Eyes • Hair and

Eyebrows

• SCARS

Inspection of Hands • Temperature • Palmar Erythema • Thyroid Acropachy

• Tremor • Pulse (AF / Tachy)

Eye Signs • Inspect from front lid retraction

• EOM + lid lag • Inspect from side / above ....

Eyes - Graves’ Disease

Proptosis

Exopthalmos

• Due to retro-orbital inflammation and lymphocyte infiltration.

Is This a Thyroid? • Ask patient to stick tongue out while palpating:

Should NOT move

• Ask patient to swallow water: Should move

Palpation

Palpation • Palpate from behind • Ask about pain! • Use bimanual palpation • Note character of swelling (one lump / multiple lumps / diffuse enlargement)

Extras • Ask examiner if

they would like to you palpate major drainage nodes of the neck

• Palpate trachea • Percuss chest • Auscultate thyroid

To Complete ... • Say you would like to: • Ask questions relating to thyroid function

• Blood tests: TFTs, Thyroid Auto-Ab

Thyroid Questions

• 1. Have you noticed any weight change?

• 2. Heat or cold intolerance? • 3. Change in bowel habit? • 4. Become anxious or irritable? • 5. Any palpitations? • 6. Any problems with stairs? • 7. Numbness or tingling in hands? • 8. New tremor?

Parotid Examination

Inspection • Identify the swelling • Ask patient to open mouth

• Does the swelling

extend into mouth / under tongue

Inspection

Palpate • Palpate from behind • Determine characteristics • Ask patient to open jaw to

determine if it is attached to mandible

• Assess for neck nodes

CN VII

• If you are assessing a parotid

swelling DO NOT FORGET to assess CN VII (Facial)

• Facial Movements: Raise Eyebrows Screw up eyes Show teeth Blow out cheeks Offer to test taste (ant 2/3)

Any Questions?

Podcast available

http://web.mac.com/timcoughlin/