IB CSL SURGERY

H&N / THYROID BEDSIDE

Dr NG Patil

Surgery

Thu 19-09-02

H&N

HISTORY

"Mr/ Mrs Chiu, a 70 yo gentleman/ lady, presented with a _____ (eg. Lump on L side of neck). Due to hoarseness + difficulty speaking, I wasn't able to obtain a detailed Hx"

Hx of presenting complaint (OPD - Out-Patient Department)

"On general examination of the Pt…"

  1. General condition
  2. Vital signs
  3. O/E of nails, conjunctiva, tongue ® jaundice, pallor cyanosis (JPC)
  4. Ankle oedema
  5. LN (in this Pt w/ neck exam)

Can add on:

 

INSPECTION
    1. Give explanation as to why you cannot exposure adequately (eg. Pt reluctant, embarrassed)
    2. "Ideally I'd like to expose ___, but due to the reluctance of the Pt, there was inadequate exposure"
    1. Anterior ® eg. Thyroid: 4 S's (Swelling, Swallow, Scar, Symmetry)
    2. Lateral
    3. Posterior
    1. Congenital
    2. Trauma
    3. Tumour
    4. Inflammation
    5. Other

 

PALPATION
    1. Examine from behind Pt (cervical spine fixed, bimanual palpation)
    2. Use flat of fingers
    3. Purposeful movements (or else looks like massage!)
    4. If you feel something, investigate further with fingers
    1. Fix cervical spine (eg. Pt leaning against wall)
    2. Explain "Patient cannot move because ___ (eg. Catheters) so use anterior approach"
    1. "On superficial palpation there was marked tenderness, so I did not continue with deep palpation"
    2. Further description ® consistency, attachment to skin, etc.

 

PERCUSSION

 

AUSCULTATION

 

THYROID

3 D's

Signs & Symptoms of Functional Problems

Pathological Considerations

Cosmetic