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/