GENERAL:
- Calm/figity/agitated
- Dressed appropriately
- Obese/underweight
- Voice-hoarse
HANDS:
- Tremor (arms outstretched)
- Nails a. Acropachy- like clubbing. Only seen in graves b. Onycholysis- “plummers nails”; separation of nail from its bed. (graves, trauma, psoriasis)
- Warm/moist/sweaty
- Pulse- rate & rhythm (AF ?)
EYES: 5 SIGNS
- Exopthalmos a. Look from front/side/above b. Eyes pushed forward due to oedema from tissues behind eyes
- Lid retraction a. Can see sclera above superior limbus
- Lid lag
- Chemosis- + corneal ulcers oedema of conjuctiva
- Opthalmoplegia (esp SR + IO- cant look up and out; get double vision)
NECK:
- observe a. masses/scars/neck veins b. swallow c. tongue protrusion
- Palpate (from behind + slightly flexed) a. Thyroid i. Size ii. Tenderness iii. Nodules iv. Mobility v. Surface b. Trachea c. Nodes d. Parotid e. Submandibular
- Percuss (retrosternal)
- Ausculate - Thyroid bruits
- Permbertons Sign a. Thoracic inlet obstruction b. Lift both arms c. Signs occur within seconds d. Facial plethora e. Distended veins f. Cyanosis g. stridor
NECK DIFFERENTIAL Midline
- thyroid
- thyroglossal cyst
- lymph node Lateral
- thyroid nodule
- branchial cyst
- carotid body tumour
- carotid a aneurysm
- abscess (bacterial/viral)
- epidermoid cyst
- lipoma/sarcoma
- sternomastoid ‘tumour’ muscle contracure
- Neoplasm-benign vs malignant
- Primary vs secondary
- Epithelail vs mesenchymal
Causes of Parotid Enlargement: Bilateral:
- Mumps
- Sarcoidosis
- Lymphoma
- Mikulicz syndroma
- Malnutrition
- Severe drhydration Unilateral:
- tumour
- stone blocking duct
OTHERS:
- Pretibial myxedema a. infiltrative dermatopathy b. seen in graves
- Reflexes
- PAROTID: a. Facial nerve b. Forehead wrinkle c. Eye closing d. Blow out cheeks e. Show teeth f. Tense neck g. Raise corner mouth
- SUBMANDUBULAR a. Bi-manual feel b. Test tongue protrusion - CN XII c. Test sensation - Ant 2/3 tongue is Lingual nerve
- THYROGLOSSAL CYST a. Tranluminate
- Indirect laryngoscopy