Far Eastern University

Nicanor Reyes Medical Foundation

Institute of Medicine
Batch 2020

CLINICAL DIAGNOSTICS A - PD LYMPH NODES

THE NECK  Round or ovoid, smooth and smaller than
glands (in order to identify submandibular
ANATOMY nodes from submandibular gland)

 DEEP CERVICAL CHAIN is obscured by the

STERNOMASTOID MUSCLE overlying sternomastoid.
o Divides the neck into two triangles  Tonsilar and supraclavicular nodes may be
OMOHYOID MUSCLE palpable
o Crosses the lower portion of posterior triangle  When you detect a malignant or inflammatory
o During palpation, it can be mistaken for a lymph lesion, look for enlargement of the regional
node or a mass lymph nodes that drain it
 When nodes is enlarged  the source of
MIDLINE STRUCTURES AND THYROID GLAND infection is nearby the drainage

Swollen glands or lumps

in the neck commonly
accompany pharyngitis

Sequence in Palpating Lymph Nodes:

1. Preauricular – front of the ears
2. Posterior auricular – superficial to the mastoid
process
3. Occipital – base of the skull posteriorly
4. Tonsillar – at the angle of the mandible
 Thyroid cartilage is readily identified by the 5. Submandibular
notch on its superior edge 6. Submental – near the tip of mandible
 Thyroid GLAND is usually located above the 7. Superficial cervical – superficial to the
suprasternal notch sternomastoid
 Thyroid ISTHMUS spans the 2nd-4th tracheal 8. Posterior cervical – along the anterior edge of
rings below the cricoid cartilage the trapezius
9. Deeps cervical chain – often inaccessible (hook
the thumb and fingers to the sternomastoid to
find them
10. Supraclavicular

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**A scar of past thyroid surgery is often a clue to SIGNS IN THYROID GLAND
unsuspected thyroid disease
**Physical characteristics of the gland are important for
SIGNS IN LYMPH NODES the assessment of thyroid function but the diagnosis
 Tonsillar nodes that pulsates is really the depends upon the COMBINATION of symptoms, signs
carotid artery and laboratory tests.
 Enlargement of a supraclavicular node,
especially on the left  possible metastasis A. Retrosternal thyroid gland is often not palpable:
from a thoracic or an abdominal malignancy  Retrosternal Goiters can cause
 Hard or fixed nodes  malignancy o Hoarseness
 Tender nodes  inflammation o Shortness of breath
 Generalized lymphadenopathy is seen in: o Stridor
o HIV or AIDS o Dysphagia
o Infectious mononucleosis  Pemberton sign
o Lymphoma o Flushing during neck hyperextension
o Leukemia and arm elevation due to
o Sarcoidosis compression of the thoracic inlet
from the gland itself or from
**Masses in the neck may push the trachea to one side clavicular movement
 TRACHEAL DEVIATION and may denote:
o Mediastinal mass B. Soft Thyroid  Graves’ disease
o Atelectasis C. Firm Thyroid  Hashimoto’s thyroiditis and
o Large pneumothorax malignancy
D. Tenderness  thyroiditis
TANGENTIAL LIGHTING IS USED DURING E. Localized or continuous bruit  hyperthyroidism
INSPECTION OF THE NECK
THYROID ENLARGEMENT AND FUNCTION
 Upon swallowing  the thyroid cartilage,
cricoid cartilage and the thyroid gland all rise
1. Diffuse enlargement
and then fall to their resting position
 Includes the isthmus and
 Palpate afterwards to confirm your visual
lateral lobes
observation
 No discretely PALPABLE
 Palpate the thyroid gland
nodules
o Landmarks would be the thyroid
 Causes:
cartilage and cricoid cartilage
 Graves’ dx
 Palpate the thyroid Isthmus
 Hashimoto’s thyroidits
 Endemic goiter
GOITER
2. Single nodule
 Enlargement of the thyroid gland to twice its
 May be cyst, a benign
normal size
tumor, or one nodule
 May be:
within multinodular
o Simple
gland
o Without nodules
 Raises the question of
o Multinodular
malignancy
 USUALLY EUTHYROID
 Risk factors:
 Prior irradiation
 Hardness
 Rapid growth
 Fixation to surrounding tissues
 Enlarged cervical nodes
 Occurrence in men
3. Multinodular Goiter
 Enlarged thyroid gland
Thyroid gland should be described as to:
with two or more nodules
 Size
 suggests a metabolic
 Shape
rather than a neoplastic
 Symmetry
process
 Consistency
 Risk factor for malignancy:
 Presence of nodule
 Positive family history
 Tenderness
 Continuing nodular
 Bruit (auscultation)
enlargement

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**Remember that a hypothyroid patient may also
present an enlarged thyroid gland

SOURCE: Outlined BATES’ GUIDE TO PE AND

HISTORY TAKING (11th and 12th ed.)

BATE’s
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