Immersion: Neck & thyroid
Landmarks & structures
Hotspots identify lymph node chains and key thyroid landmarks: thyroid cartilage, cricoid cartilage and thyroid isthmus
Exam steps
Step 1. Inspect the neck for symmetry and masses
Step 2. Palpate the lymph nodes
Moving the pads of your fingertips in small circular motions, attempt to roll the nodes under your fingertips, checking the area of the anterior and posterior cervical chains and the supraclavicular nodes. Normal lymph nodes are mobile and less than 1 centimeter in size but it is common to have mildly enlarged nodes in the anterior and posterior cervical chains.
Step 3. Inspect and palpate the thyroid
Inspect the lower neck. The outline of the lobes of the thyroid may be visible, more often in females than in males.
Because the thyroid exam can be triggering for those with a history of trauma, provide a clear explanation of what you will do, ensure comfort and perform the exam from beside or in front of your patient rather than from behind. You may also skip this exam in those with a history of trauma and no symptoms of thyroid disease.
Identify the thyroid and cricoid cartilages. The isthmus of the thyroid lies just below the cricoid. With the neck flexed slightly, place your index finger just below the cricoid and as your patient swallows a sip of water, feel for the isthmus. After locating the isthmus, move the fingers to either side of the trachea. As the patient swallows again, palpate each lobe of the thyroid gland, observing for enlargement or masses.
Each lobe of the thyroid is normally about the size of the distal phalanx of the thumb. Because it lies partly under the sternocleidomastoid, the thyroid may be difficult to feel in some people. If you palpate carefully and cannot identify it, move on.
Step 4. Palpate and auscultate each carotid artery
Gently palpate each carotid artery one at a time, assessing the strength of the pulse. As the patient briefly breath-holds, place your stethoscope lightly over each carotid artery, listening for radiation of heart murmurs or bruits, which can indicate narrowing of the artery.