Clinical test shown in the photograph below is used to assess which among the following?
Cervical Lymph nodes
Technique shown is Lahey’s method.
LOCAL EXAMINATION OF THYROID GLAND
- Pizzilo’s method: hands are placed behind the head and the patient is asked to push her head backwards against her clasped hands on the occiput.
- Ask the patient to swallow and watch for the most important physical sign- a thyroid swelling moves upwards on deglutition.
- Pemberton’s sign– The patient should be asked to raise both the arms over his head until they touch the ears.
- Congestion of face and distress become evident in case of retrosternal goitre due to obstruction of the great veins at the thoracic inlet.
- The thyroid gland should always be palpated with the patients’s neck slightly flexed.
- Lahey’s Method:Palpation of each lobe is best carried out by Lahey’s method.
- In this case the examiner stands in front of the patient. To palpate the left lobe properly, the thyroid gland is pushed to the left from the right side by the left hand of the examiner.
- Crile’s method:Slight enlargement of the thyroid gland or presence of nodules in its substance can be appreciated by simply placing the thumb on the thyroid gland while the patient swallows.
- Mobility should be noted in both horizontal and vertical planes. Fixity means malignant tumour or chronic thyroiditis.
- To get below the thyroid gland is an important test to discard the possibility of retrosternal extension. Clinician’s index finger is placed on the lower border of the thyroid gland. The patient is asked to swallow, the thyroid gland will move up and the lower border is palpated carefully for any extension downwards.
- Pressure effect from the thyroid swelling should be carefully looked for.
- Kocher’s test : If pressure on trachea is suspected, slight push on the lateral lobes will produce stridor.
- Is there any pulsation or thrill in the thyroid?
- Palpation of cervical lymph nodes– Papillary carcinoma of thyroid is notorious for early lymphatic metastasis when the primary tumour remains quite small.
- This is employed over the manubrium sterni to exclude the presence of a retrosternal goitre.