Swollen Right Carotid Artery

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cervical chain;along the sternocleidomastoid muscle to feel for the superficial cervical chain; hooking around the sternocleidomastoid muscle to feel for the deep cervical chain deep to the muscle;into the anterior triangle region;up to the jaw margin to feel for the tonsillar group; along the jaw to feel the submaxillary chain;to the tip of the jaw for the submental nodes;and up to the anterior auricular chain in front of the ear. This sequence of examination is shown in Figure 9-9.

Enlarged posterior auricular and posterior cervical nodes are pictured in Figure 9-10. Any nodes that are palpated should be observed for mobility, consistency, and tenderness. Tender lymph nodes are suggestive of inflammation, whereas fixed, firm nodes are consistent with a malignancy.

Palpate the Thyroid Gland

There are two approaches to palpating the thyroid gland. The anterior approach is carried out with the patient and examiner sitting face to face. By flexing the patient's neck or turning the chin slightly to the right, the examiner can relax the sternocleidomastoid muscle on that side, making the examination easier to perform. The examiner's left hand should displace the larynx to the left, and during swallowing, the displaced left thyroid lobe is palpated between the examiner's right thumb and the left sternocleidomastoid muscle. This is demonstrated in Figure 9-11.

Gland Left HandCarotid Artery Swollen Neck

After the left lobe has been evaluated, the larynx is displaced to the right, and the right lobe is evaluated by reversing the hand positions.

At this point in the examination, the examiner should stand behind the patient to palpate the thyroid by the posterior approach. In this approach, the examiner places two hands around the patient's neck, which is slightly extended. The examiner uses the left hand to push the trachea to the right. The patient is asked to swallow while the examiner's right hand rolls over the thyroid cartilage. As the patient swallows, the examiner's right hand feels for the thyroid gland against the right sternocleidomastoid muscle. The patient is again asked to swallow as the trachea is pushed to the left, and the examiner uses his or her left hand to feel for the thyroid gland against the patient's left sternocleidomastoid muscle. The patient should be given water to drink, to facilitate swallowing. The posterior approach is shown in Figure 9-12.

Although both the anterior and the posterior approaches of palpation are usually performed, the examiner can rarely feel the thyroid gland in its normal state.

The consistency of the gland should be evaluated. The normal thyroid gland has a consistency of muscle tissue. Unusual hardness is associated with cancer or scarring. Softness, or sponginess, is often observed with a toxic goiter. Tenderness of the thyroid gland is associated with acute infections or with hemorrhage into the gland.

If the thyroid is enlarged, it should also be examined by auscultation. The bell of the stethoscope is placed over the lobes of the thyroid while the examiner listens for the presence of

Inspection Thyroid Gland
Figure 9-12 Posterior approach for palpation of the thyroid gland.

Figure 9-13 Technique for palpation of the supraclavicular lymph nodes.

Figure 9-13 Technique for palpation of the supraclavicular lymph nodes.

Protruding Carotid Artery

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