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/