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a bruit (a murmur heard when there is increased turbulence in a vessel). The finding of a systolic or a to-and-fro* thyroid bruit, particularly if heard over the superior pole, indicates an abnormally large blood flow and is highly suggestive of a toxic goiter.

Palpate for Supraclavicular Nodes

Palpation for supraclavicular nodes concludes the examination of the head and neck. The examiner stands behind the patient and places the fingers into the medial supraclavicular fossae, deep to the clavicle and adjacent to the sternocleidomastoid muscles. The patient is instructed to take a deep breath while the examiner presses deeply in and behind the clavicles. Any supraclavicular nodes that are enlarged are palpated as the patient inspires. This technique is shown in Figure 9-13.

The examination of the trachea is discussed in Chapter 13, The Chest. The examination of the carotid arterial and jugular venous pulsations is discussed in Chapter 14, The Heart.

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