Thyroid/Head & Neck Lymph Nodes Exam
Thyroid and Lymph Nodes Exam
Please assess the student performing an exam of the thyroid gland, and the lymph nodes of the head & neck.
Student's Email:

GENERAL - Observe the student doing the following:

Washes hands
       
Introduces self and exam to patient
               
Appropriate draping of patient

Drape such that the patient's neck is exposed. Intermittant draping will be required to examine the supra- and intra-clavicular lymph nodes

               

INSPECTION - The student should comment on the following:

Patient's general appearance

Ex: Well, not well

               
Masses, scars, lesions

Ex: Goiter, scars from previous thyroid surgery

               

INSPECTION FOR SIGNS OF HYPERTHYROIDISM - The student should comment on the following:

Hair loss/thinning
               
Eye changes

Ex: Proptosis, exophthalmos, lid lag

               
Tremor

Best noticed in the extremities

               
Increased perspiration
               
Thin skin
               

INSPECTION FOR SIGNS OF HYPOTHYROIDISM - The student should comment on the following:

Weight gain
               
Coarse/dry skin
               
Cool extremities
               
Peripheral edema
               

PALPATION - Observe the student performing the following manoeuvers:

Palpates the thyroid isthmus

Finds the thyroid cartilage, palpates inferiorly to the cricoid, and down to the isthmus

               
Palpates both lobes of the thyroid

Asks patient to swallow while palpating

               
Comments on presence/absence of nodules
               
Measures reflexes

May be hyperreflexic in hyperthyroidism, hyporeflexic in hypothyroidism

               
Checks heart rate

May be tachycardic in hyperthyroidism, bradycardic in hypothyroidism

               
Proximal muscle weakness

May be muscle weakness in hyperthyroidism

               

AUSCULTATION - Observe the student performing the following manoeuvers:

Auscultates for thyroid bruits
               

LYMPH NODE INSPECTION - The student should comment on the following:

Masses, scars, lesions

Ex: Lymphadenopathy (enlarged lymph nodes)

               
Edema
               

LYMPH NODE PALPATION - Observe the student performing the following manoeuvers:

Occipital nodes
               
Posterior auricular nodes
               
Preauricular nodes
               
Submental nodes
               
Submandibular nodes
               
Tonsillar nodes
               
Superficial cervical nodes
               
Posterior cervical nodes
               
Deep cervical nodes
               
Supraclavicular nodes
               
Infraclavicular nodes
               
Comments on size, shape, mobility, tenderness, texture of nodes

A single enlarged left supraclavicular node = Virchow's node (drain's from abdomen)

               

GLOBAL RATING SCALES - Please rate the student on their overall performance:

Understands rational of manoeuvers and findings
                   
Organized approach
                   
Sensitivity toward patient concerns and comfort during the examination