Examining the neck involves inspection, palpation, and auscultation to assess various structures and identify any abnormalities. Here's a breakdown:
1. Inspection:
- Overall Appearance: Observe the neck's symmetry, posture, skin condition (rashes, lesions, scars), and any visible masses or swelling.
- Thyroid Gland: Look for enlargement or asymmetry of the thyroid gland, especially while the patient swallows.
- Jugular Venous Distension (JVD): Observe the jugular veins for distension, which can indicate increased central venous pressure. The patient should be positioned at a 45-degree angle.
- Carotid Pulsations: Note the presence and character of carotid pulsations.
2. Palpation:
- Lymph Nodes: Systematically palpate the lymph nodes in the neck, using gentle circular motions with your fingertips. Assess for size, shape, consistency, tenderness, and mobility. Key areas to palpate include:
- Preauricular: In front of the ear.
- Postauricular: Behind the ear.
- Occipital: At the base of the skull.
- Tonsillar: At the angle of the mandible.
- Submandibular: Under the mandible.
- Submental: Under the chin.
- Superficial cervical: Along the sternocleidomastoid muscle.
- Deep cervical: Deep to the sternocleidomastoid muscle.
- Posterior cervical: In the posterior triangle of the neck.
- Supraclavicular: Above the clavicle.
- Thyroid Gland: Palpate the thyroid gland. There are several techniques:
- Posterior Approach: Stand behind the patient and use both hands to palpate the thyroid as the patient swallows.
- Anterior Approach: Stand in front of the patient and use one hand to displace the trachea while palpating the thyroid with the other hand as the patient swallows.
- Assess for size, shape, consistency, tenderness, and nodules.
- Trachea: Palpate the trachea to ensure it is midline. Deviation can indicate a mass or pneumothorax.
- Carotid Arteries: Gently palpate the carotid arteries one at a time to assess the pulse. Avoid simultaneous palpation, as this can reduce cerebral blood flow.
3. Auscultation:
- Carotid Arteries: Use the bell of the stethoscope to listen for bruits over the carotid arteries. Bruits may indicate carotid artery stenosis.
- Thyroid Gland: Auscultate the thyroid gland for a bruit, which may indicate a hypervascular thyroid (e.g., Graves' disease).
Specific Areas Mentioned in the Reference:
- Posterior Triangle of the Neck (Level 5): This area contains lymph nodes that should be palpated.
- Central Area of the Neck (Level 6): This area contains the trachea, thyroid gland, and other structures that need to be examined.
- Swallowing Assessment: Have the patient take a mouthful of water and hold it, then swallow, to assess thyroid movement and any associated symptoms.
Important Considerations:
- Always explain the procedure to the patient and obtain consent.
- Maintain a professional and respectful demeanor.
- Use proper technique to avoid causing discomfort or injury.
- Document your findings accurately and completely.
- If you find any abnormalities, consider further investigations, such as imaging studies or biopsies.
