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Neck Examination for Medical Student OSCE

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1. Introduce, identify patient, consent

2. Ask: pain in neck? Any lumps? Difficulty swallowing or breathing?

3. Inspection: from front and side

   1. Scars

   2. Lesions

   3. Distended neck veins

   4. Goitre

   5. Lumps:

      1. Site: anterior/posterior triangle; midline. Measure distance to nearest bony prominence

      2. Size: w x l

      3. Shape: circular / irregular

      4. Colour: skin redness

   6. Sip water: if lump moves on swallowing, may indicate thyroid swelling, thyroglossal cyst, or lymph nodes

   7. Ask Pt to stick tongue out: if lump moves upwards in midline, suggests thyroglossal cyst

   8. Look in mouth: inspect for enlarged tonsils (infection or malignancy)

4. Palpation

   1. Check for pain

   2. Palpate lump from behind pt. Feel anterior and posterior triangles.

   3. Lump:

      1. Temperature

      2. Tender (thyroiditis)

      3. Nodular

      4. Surface: smooth / rough / irregular

      5. Mobile or fixed

   4. Lymph nodes (malignancy)

   5. Trachea: central or deviated

5. Percussion: down midline of neck to determine lower limit of thyroid. Dull percussion note with retrosternal extension

6. Auscultation: thyroid bruits – thyrotoxicosis

7. Neck lump DD

   1. Lymphadenopathy: commonest cause of neck swellings. 4 categories:

      1. Infective – TB, glandular fever, tonsillitis

      2. Metastatic – secondary deposits

      3. Lymphomas

      4. Sarcoidosis

   2. Branchial cyst – remnant of ectodermal pouch from branchial cleft. Beneath upper part of SCM, presenting as a painless cyst. Smooth, ovoid lump 5-10 cm diameter. Fluctuates, not transilluminable, cannot be compressed or reduced

   3. Carotid body tumour (chemodectoma) – slowly growing painless lump, hard and ovoid, at bifurcation of common carotid – at upper border of thyroid cartilage, under anterior border of SCM. Moves side to side but not in vertical plane. Transmitted pulsations often present.

   4. Sternomastoid tumour – firm solid swelling caused by trauma at birth, in middle 1/3 of SCM. Only anterior and posterior margins distinct. May lead to later torticollis.

   5. Cystic hygroma – swelling of jugular lymph sac, at base of posterior triangle. Lobulated cyst with brilliant translucency

   6. Thyroglossal cyst – remnants of thyroglossal duct, seen in early childhood. Hard well-defined spherical lump, commonly just above hyoid bone, in midline. Pathognomonic – moving on swallowing + on tongue protrusion

   7. Thyrotoxicosis, hypothyroidism, thyroid carcinoma

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by: Admin
Total views: 0
Word Count: 631
Date: Fri, 22 Jan 2010 Time: 4:03 PM
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