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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
•Due to retro-orbital inflammation and lymphocyte infiltration.
ExopthalmosProptosis
Is This a Thyroid?
•Ask patient to stick tongue out while palpating:
•Ask patient to swallow water:
Should NOT move
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 EyebrowsRaise EyebrowsScrew up eyesScrew up eyes
Show teethShow teethBlow out cheeksBlow out cheeks
Offer to test taste (ant 2/3)Offer to test taste (ant 2/3)
Any Questions?
Podcast available
http://web.mac.com/timcoughlin/