get the patient seated – 
examine for – 
body habitus, obese patient/ emaciated – 
anxious and agitated or apathic 
inspect for – selling,s scar, skin changes – wasting or deformity, 
ASk to drink a glass of warter – inspect the movement of thyroid – 
if lump – ask to protrude toung 
hands on pillow – inspect  -scar, swellign , skin changes deformity or wasting – dry or clammy / sweaty – tremor on extended hands 
look for wrist tenderness 
pulse – rate and rhythem, volume and caracter 
Eye signs – exopthalmus, lid lag, lid retraction , lid lag, chemosis , opthalmoplegia – if any positive look for fileds 
see for trachea being central 
Anterior examination of thyroid
push the trachea to one side and mounding the thyroid to the opposite STM – moiving the fingers towards the STM
Posterior examination of thyroid 
    • examine thyroid 
place the hands mid line
ask patient to swollow 
as the patient swollows move laterally towards STM 
    • from the same position, examine the LN – 
start with supra clavicular LN with rolling movement just posterior and over the clavicle and ask the patient to inhale 
palpate for all LN – submental, submandibuler, pre auriculer and cervical ( posterior/ anterior ) 
    • try to get under the thyroid – 
from front – 
purcuss on sternum for dullness 
auscultate on bruits on both sides 
      • check for pretiboial myxedema, for pretibial myxedema for hyperthyroidism, non pitting edema with hypothyroidism – 
      • check for reflrxus 
      • check for proximal muscle weakness ( sit with arms crossed )
CVS – for murmer 
Respi for plural effushions 
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