Which is the best way to position a patients neck for palpation of the thyroid?

Last updated: March 23, 2022

Summary

Examination of the head

• Inspect the skull and face.
• Inspect the skin and scalp.
• Palpate skull (especially if patient complains of tenderness or recent trauma).
• Assess facial sensation and motor function.
  • Trigeminal nerve function: Lightly touch the forehead of the patient on both sides and the upper and lower areas of the cheek with the index finger. Ask the patient whether this feels the same on both sides of the face.
  • Facial nerve function: Ask the patient to furrow their forehead, close their eyes, show their teeth, and inflate their cheeks.
  • See examination of cranial nerves and cranial nerve palsies.

[1][2]

Examination of the ears

Otoscopy is an integral part of all pediatric examinations. It is usually only performed in adults if they have mentioned ear discomfort.

Screening assessments

Tuning fork tests

• Performed in order to distinguish between conductive hearing loss and sensorineural hearing loss. See also hearing loss.
• Weber test: tests for lateralization (sound is heard louder in one ear than the other)
  • Place the base of a vibrating tuning fork on the middle of the forehead and ask the patient from which ear the sound is louder.
  • The sound is normally heard equally in both ears.
  • Interpretation
    • Lateralization → asymmetric hearing loss
    • No lateralization → normal hearing or bilateral hearing loss
• Rinne test: tests for air conduction vs bone conduction in the examined ear
  • Place the base of a vibrating tuning fork on the mastoid process of the ear. Once the patient no longer hears a tone, immediately hold the “U” part of the fork over the outer ear and ask the patient if they can still hear it.
  • Air conduction is normally greater than bone conduction, so the patient should still be able to hear the tuning fork next to the outer ear after they can no longer hear it when placed on the mastoid process.
  • Interpretation
    • Unable to hear the tuning fork; → there is conductive hearing loss (bone conduction > air conduction) in the examined ear (Rinne test is negative)
    • Still able to hear tuning fork over the outer ear; → there is no conductive hearing loss (Rinne test is positive); possible sensorineural hearing loss (air conduction > bone conduction) if there is diminished hearing in the examined ear

Overview of possible findings

Gelle test

Additional tests

• Audiogram, speech audiometry, impedance audiometry
• See hearing loss.

When screening for hearing loss, examine each ear individually in a quiet room.

References:[1][2]

Focused examination of the eyes

Inspection and palpation

• Inspect for symmetry of the eyes and eyelids.
• Note any swelling or redness around the eyelids, and assess whether the eyelids can fully close.
• Inspection of the sclera (normal sclerae are white) and inspection of the conjunctivae
  • Ask the patient to look up while you hold lower lids with your thumb.
  • Inspect for color, vascular pattern, and whether there is any swelling.

Pupils

• Assess the pupillary size, location, shape, and reactivity to light (indirect and direct pupillary light reflex)
• For further information, see “Pupillary examination” in “Examination of the eye.”

Visual acuity

• Determine the clarity or sharpness of central vision at various distances by using an ophthalmological chart (e.g., Snellen chart).
• For further information, see “Visual acuity” in “Examination of the eye.”

Visual field testing

• Assess light sensitivity and identify patterns of vision loss using a finger or pen.
• For further information, see “Visual field examination” “Examination of the eye.”

Examination of extraocular muscles

• Assess the movement and alignment of the eyes using a finger or a pen.
• For further information, see “Extraocular movements” and “Examination of extraocular muscles.”

References:[1][2]

Examination of the neck

Examination of the thyroid

• Inspection
  • The thyroid gland is located below the thyroid cartilage and is normally not visible.
  • Enlargement should prompt further evaluation.
• Palpation
  • Stand behind the patient.
  • Place your finger pads below the thyroid cartilage and assesses the size and consistency of the thyroid.
  • Ask the patient to swallow.
    • The thyroid should slide beneath the fingers.
    • The normal thyroid is usually not palpable.
  • Note any asymmetry or enlargement.

References:[1][2]

Examination of the nose and throat

Signs and differential diagnosis

Red flag symptoms of the head and neck

References:[1][2]

References

What is the appropriate position to examine the thyroid?

Which is the best way to position a patient's neck for palpation quizlet?

What position is used in a thyroid ultrasound?