This document provides instructions for examining a patient's neck through inspection, palpation, and auscultation. It describes how to palpate the neck from behind by placing thumbs behind the neck and feeling the tracheal rings for masses. It also describes frontal palpation of the thyroid by pushing the trachea away with one thumb while feeling the lateral lobes with the other hand. The document notes that a systolic bruit heard over the thyroid may indicate diffuse toxic goiter.

1. Diagnostics
NECK

2. 
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Inspection
The neck is inspected for
Asymmetry
Limitation of motion
Abnormal pulsations
Goiter
Masses
Neck scar (thyroidectomy,tracheotomy)
Neck

3. Anatomy

4. Palpation of the neck
Should be done with the pt
seated in a chair while the
physician examines the
neck for both behind and in
front of the pt
Palpation

5. Palpation from behind
Have the patient seated in a chair and
stand behind her.
Instruct the patient to lower her chin
and relax her neck muscles.
Place your thumbs in back of the patient’s
neck, curling your fingers anteriorly
so their tips just touch while resting
over the upper tracheal rings.

6. Palpation from behind
Run the fingers up and down the tracheal rings,
feeling for any tissue on their anterior
surface.
If found, it is likely to be a hyperplastic thyroid
isthmus.
During the examination, shift the inclination of
the patient’s head to relax the neck
muscles, and have the patient swallow to
test the adherence of palpated masses to
the trachea.

7. Should be done with the pt
seated in a chair while the
physician examines the
neck for both behind and in
front
of the pt
Palpation of the
thyroid

9. Frontal palpation
Face your patient placing the fingers of one
hand at the back of the neck with your
extended thumb forward at the base of
the thyroid cartilage.
With the pulp of this thumb, push the trachea
gently away from the midline while the
fingers of the other hand are inserted
behind the sternocleidomastoid of the
opposite side, where they can feel the
posterior aspect of the displaced lateral
lobe.

10. Frontal palpation
Let the thumb feel medial to the muscle
for the anterior surface of the mass.
Having the patient swallow or depress
the chin may further assist in the
examination.
Palpate the other lateral lobe in the same
manner with the tasks of the two
hands reversed.
Ask the patient to swallow to test the
adherence of the masses to the

12. Goiter is divided into three
degrees

14. Bruit
Put the stethoscope over the thyroid
gland, and listen carefully. If a systolic
bruit heard over the thyroid is almost
diagnostic of diffuse toxic goiter (↑
blood flow to the thyroid).
Auscultation

16. A systematic approach to examination is
followed
First to have the pt’s nk relaxed by asking
that pt chin down. Then the posterior
lateral nk are palpated for lymph nodes
and masses

17. Followed by checking of the front cervical
triangle searching for enlarged lymph nodes and
tumors, then the parotid, salivary glands, and
the pre-auricular lymph nodes.Then, the tracheal
position is determined for deviation.

18. • THANKS