Introduction

• Wash hands
• Introduce self
• Ask Patient’s name, DOB and what they like to be called
• Explain examination and obtain consent
• Expose neck and sit patient in centre of room
• General inspection: well/unwell, cachexia, lethargic, sweaty, signs of hypo-/hyperthyroidism, abnormal voice etc.
• Check that the examiner does not want you also to examine thyroid status (if so, see notes on thyroid exam)

Inspection

• Obvious masses or lymphadenopathy
• Surgical scars
• Overlying skin (erythema, rashes)
• Goitre
• Ask patient to swallow and then stick tongue out while watching thyroid gland (thyroid lumps and thyroglossal cysts rise on swallowing; thyroglossal cysts rise on tongue protrusion)

Palpation

• Check for any pain and explain you will be examining from behind initially

From posteriorly

• Anterior lymph nodes, salivary glands and thyroid:
  • Submental lymph nodes
  • Sublingual gland
  • Submandibular lymph nodes and gland (gland swelling may occur due to salivary duct calculi that may be palpable)
  • Jugulodigastric (tonsillar) lymph nodes
  • Parotid gland
  • Down anterior cervical chain of lymph nodes
  • Stop at thyroid gland (over 2^nd-4^th tracheal rings): note size, consistency and any abnormal masses. Feel the two lobes and isthmus. With your fingers over the thyroid gland:
    • Ask patient to swallow (thyroid masses and thyroglossal cysts will rise)
    • Ask patient to stick out tongue (thyroglossal cyst will rise)
  • Complete the anterior cervical chain
• Posterior lymph nodes
  • Feel posterior cervical chain of lymph nodes from the bottom of the posterior triangle to the mastoid process
  • Occipital lymph nodes
  • Postauricular lymph nodes
  • Preauricular lymph nodes

From anteriorly

• Supraclavicular lymph nodes: examine these from in front by placing fingertips in supraclavicular fossae (Virchow’s node is left supraclavicular)
• Palpate each carotid artery in turn

Percussion

• Percuss over sternum for retrosternal goitre

Auscultation

• Thyroid and carotid bruits

To complete

• Examine any areas drained by palpable lymph nodes
• Thank patient and restore clothing
• Summarise

Common pathology

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