OSCE Checklist for Examination of the Neck Introduce yourself to the patient Wash your hands Briefly explain to the patient what the examination involves Approach the examination in a systematic way, yet be prepared to be instructed to move on quickly to certain sections by any examiner. Inspection Ensure adequate exposure of the entire neck and the patent is looking straight ahead Inspect for: Obvious lumps Scars or skin changes If any mass noted on inspection: Ask the patient to stick their tongue out Any mass in the midline that rises on tongue protrusion is likely to be a thyroglossal cyst Ask the patient to swallow (offer the patient a glass of water to use) Any mass(es) in the midline that rises on swallowing are likely to be thyroid mass(es) or a goitre By Drahreg01 (Own work) [CC BY-SA 3.0], via Wikimedia CommonsFigure 1A multinodular thyroid goitre, that rises upon swallowing Palpation Stand behind the patient to palpate the neck, informing the patient when you do this. Using the tips of the fingers, palpate lymph nodes of the head and neck: Submental, Submandibular, Pre-auricular, Anterior Cervical, Supraclavicular, Posterior Cervical, Post-Auricular, and Occipital Classification of Lymph Nodes in the Neck Lymph nodes of the neck can also be divided into 5 levels, useful when classifying their position: I – submental and submandibular triangles II – upper jugular nodes III – middle third jugular IV – lower jugular nodes V – posterior triangle lymph nodes Parotid Gland Palpate the parotid gland (between the sternocleidomastoid and the mandible) Palpate gently for any tenderness, swellings, or lumps Examine the other side Submandibular Gland Bimanually palpate the submandibular gland (inferior and posterior to the body of the mandible) Using a gloved hand, press the index finger onto the floor of the patients mouth Place your other index finger at the inferior body of the mandible, slightly away from the midline Ballot the submandibular gland between your fingers Repeat for the other side Thyroid Gland Palpate the thyroid gland Start at the midline, move your hands inferiorly to pass over the thyroid cartilage, until you feel the cricoid cartilage and the two inferior tracheal rings (the thyroid and thyroid isthmus overlies this area) Using the pads of your fingers, gently pass them over this area to palpate the isthmus and thyroid lobes Ask the patient to swallow (offer the patient a glass of water to use), assessing for equal rise of the thyroid Remember, if you have found any lump during the examination, ensure you have assessed for Size, Shape, Location, Consistency. Fluctuance, Trans-illumination, Pulsatility, Temperature, Overlying skin changes, Mobility, and Auscultation Completing the Examination Remember, if you have forgotten something important, you can go back and complete this. To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform: An ultrasound scan (USS) and fine needle aspirate (FNA) of any lump identified (unless pulsatile) An examination of the temporomandibular joint Rate This Article