Home
Print Friendly, PDF & Email

Neck Examination

Neck examination and questions for medical student exams, finals, OSCEs and MRCP PACES

 

Intro (WIIPPPPEE)

  • Wash your hands
  • Introduce yourself
  • Identity of patient – confirm
  • Permission (consent and explain examination)
  • Pain?
  • Position sitting in chair with room behind the chair for the examiner to stand
  • Privacy
  • Expose neck and clavicles (patient may need to tie hair back/ remove necklace)
  • Equipment – have a glass of water to hand

 

General Inspection

  • Surroundings
    • Monitoring
    • Treatments
    • Paraphernalia
  • Patient
    • Note whether there is any dyspnoea on sitting/ lying down

 


Video from oxford medical school demonstrating how to do a neck exam

 

  • Neck
    • Inspect
      • From front and sides
        • Lumps/ asymmetry
        • Scars (thyroidectomy/ parathyroidectomy scars using a pentorch)
        • Skin changes, facial plethora (SVC obstruction)
        • Distended neck veins (SVC obstruction)
      • If a neck lump is seen:
        • Ask patient to 1) take a sip of water, 2) hold it in their mouth 3) and swallow
          • The three part command gives the examiner time to position themselves to watch the neck lump on swallowing
          • Any lump attached to the pretracheal fascia will move upwards on swallowing i.e. a thyroid lump or thyroglossal cyst
        • Ask patient to 1) open their mouth 2) and stick their tongue out
          • A midline lump that moves upwards on tongue protrusion is a thyroglossal cyst
    • Palpate: anterior
      • Trachea
        • For tracheal deviation (support back of neck whilst doing this and warn patient it may feel uncomfortable)
      • Carotid pulse (one side at a time)
    • Palpate: posterior
      • Explain to the patient that you will be moving behind them to palpate their neck. Take this opportunity to inspect the back of the neck.
      • Thyroid gland
        • Palpate one lateral lobe at a time then isthmus (nodules and thrills)
        • Ask the patient the swallow another sip of water whilst palpating the thyroid gland (thyroid masses that move upwards on swallowing)
      • Anterior and posterior triangles
      • Parotid glands
      • Lymph nodes
        • Cervical
        • Supraclavicular
    • Percuss
      • Over sternum for retrosternal goitre
    • Auscultate
      • Carotid bruits
      • Thyroid bruits
      • Any other neck lumps (if pulsatile with bruit suspect carotid artery aneurysm)

 

Closure

  • Thank patient
  • Patient comfortable?
  • Help getting dressed?
  • Wash hands
  • Turn to examiner, hands behind back, holding stethoscope (try not to fidget!) before saying: “To complete my examination, I would like to…”
    • Further examination
      • Take a full history
      • Perform a thyroid status examination
      • Perform an ENT examination
    • Further Invx as indicated
      • Bloods including TFTs
      • Ultrasound lump
      • Fine needle aspiration/ core biopsy of lump

 

Click here for medical student OSCE and PACES questions about the neck examination

Common Neck Examination exam questions for medical students, finals, OSCEs and MRCP PACES

 

Click here to download free teaching notes on Neck Examination: Neck Examination

Perfect revision for medical students, finals, OSCEs and MRCP PACES