neck lump

Gain consent to proceed with the examination.

Ask the patient to sit on a chair for the assessment.
Adequately expose the patient’s neck to the clavicles.
Ask the patient if they have any pain before proceeding with the clinical examination.

general inspection: I will be checking for any

scars , cachexia , hoarseness of voice , stridor , behaviour , clothing

neck lump examination:

Ask the patient to point out the neck lump’s location if relevant.
Inspect the neck lump from the front and side, noting its location (e.g. anterior triangle, posterior
triangle, midline).

Ask the patient to swallow some water and observe the movement of the mass:
Thyroid gland masses (e.g. a goitre) and thyroglossal cysts typically move upwards with
swallowing.
Lymph nodes will typically move very little with swallowing.
An invasive thyroid malignancy may not move with swallowing if tethered to surrounding tissue.

Palpate the neck lump and access,

size, consistency, mobility,shape,fluctuance , temperature

Palpation of cervical lymph nodes

1. Position the patient sitting upright and examine from behind if possible. Ask the patient to tilt
their chin slightly downwards to relax the muscles of the neck and aid palpation of lymph nodes.
You should also ask them to relax their hands in their lap.

2. Inspect for any evidence of lymphadenopathy or irregularity of the neck.

3. Stand behind the patient and use both hands to start palpating the neck.

4. Use the pads of the second, third and fourth fingers to press and roll the lymph nodes over
the surrounding tissue to assess the various characteristics of the lymph nodes. By using both
hands (one for each side) you can note any asymmetry in size, consistency and mobility of
lymph nodes.

5. Start in the submental area and progress through the various lymph node chains. Any order
of examination can be used, but a systematic approach will ensure no areas are missed:

Submental
Submandibular
Tonsillar
Parotid
Preauricular
Post-auricular
Superficial cervical
Deep cervical
Posterior cervical
Occipital
Supraclavicular

Palpation of the thyroid gland

Palpate each of the thyroid’s lobes and the isthmus:

1. Stand behind the patient and ask them to tilt their chin slightly downwards to relax the
muscles of the neck to aid palpation of the thyroid gland.
2. Place the three middle fingers of each hand along the midline of the neck below the chin.
3. Locate the upper edge of the thyroid cartilage (“Adam’s apple”) with your fingers.
. Move your fingers inferiorly until you reach the cricoid cartilage. The first two rings of the
trachea are located below the cricoid cartilage and the thyroid isthmus overlies this area.
5. Palpate the thyroid isthmus using the pads of your fingers.
6. Palpate each lobe of the thyroid in turn by moving your fingers out laterally from the isthmus.
7. Ask the patient to swallow some water, whilst you feel for the symmetrical elevation of the
thyroid lobes (asymmetrical elevation may suggest a unilateral thyroid mass).
8. Ask the patient to protrude their tongue (if a mass represents a thyroglossal cyst, you will feel
it rise during tongue protrusion).

now I will palpate the submandibular gland

thanks the Patient and give summary

thyroid exam

general inspection:
weight, behaviour, clothing
onycholysis , palmar erythema , asses for any peripheral tremors
check if dry skin , excessive sweating, eyebrow loss ,
check in the eye for Lid retraction(note if sclera is visible between the upper lid margin and the
corneal limbus)
check for exophthalmos, any inflammation
access for Lid lag
Lid lag refers to a delay in the descent of the upper eyelid in relation to the eyeball when looking
downward.

inspect and palpate for tracheal deviations

then percussion of the sternum
then we will ascultate the thyroid gland , check for any brute

now I will inspect the thyroid gland by asking patient to swallow water and I will check for any
movement in mass
then I will ask the patient to protrude tongue out and observe the mass movement
then I will palpate the gland
then I will access and palpate the lymph nodes
Submental
Submandibular
Preauricular
Post-auricular
Superficial cervical
Deep cervical
Posterior cervical
Supraclavicular

then Reflexes are assessed to screen for hyporeflexia, which is associated with hypothyroidism.
The most commonly tested reflexes are the biceps reflex or the knee jerk reflex (you only need
to assess one).

Biceps reflex
1. With the patient’s arm relaxed, locate the biceps brachii tendon which is typically found at the
medial aspect of the antecubital fossa.
2. Place the thumb of your non-dominant hand over the tendon and then tap your thumb with
the tendon hammer.
3. Observe for a contraction of the biceps muscle and associated flexion of the elbow.

thank the patient