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
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examine thyroid
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place the hands mid line
ask patient to swollow
as the patient swollows move laterally towards STM
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from the same position, examine the LN –
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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 )
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try to get under the thyroid –
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from front –
purcuss on sternum for dullness
auscultate on bruits on both sides
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check for pretiboial myxedema, for pretibial myxedema for hyperthyroidism, non pitting edema with hypothyroidism –
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check for reflrxus
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check for proximal muscle weakness ( sit with arms crossed )
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CVS – for murmer
Respi for plural effushions