Salam alikum my name is Dr Talha and today we'll be doing a thyroid examination so I've washed my hands already and I've introduced myself to the patient we'll make sure that the environment we've provided to the patient is private and safe and comfortable after this we've put the patient in a sitting position as so and we'll also ask permission from the patient so can I examine you all right for the exposure of this examination which is the thyroid exam we will make sure that the the face the neck and the upper chest is exposed for the patient all right and we're standing on the right side of the patient so for the first part of thyroid examination we'll be doing inspection so for inspection you're looking for any generalized swellings that may be there or any localized swelling at the thyroid so you're looking for any swellings you're also looking for any scars that may be seen and you're also looking for any dilated veins that you may be seeing and and you're also looking for any redness after you're done with this you will ask the patient to swallow right swallow um swallow some water and then assess the movement of the thyroid gland all right and this you're doing to rule out any thyroglossal sifts for example so we're going to ask the patient to drink uh some water okay and swallow okay and you're looking at the movement of the of the thyroid gland for the pulation part of this exam what we're going to go for is we're going to be starting by asking the patient that we're going to be pulpa the thyroid gland from the back of the patient so the patient doesn't get startled when we do so so let the patient know that you're going to be pulpa from the back so we'll move behind the patient as so and we'll place our hands behind the patient's neck like so so place your thumbs together behind the patient's neck and wrap your fingers around the patient's thyroid gland now what you're going to go for is or wrap your fingers around the neck so that you can feel for the thyroid gland now we're going to begin by palpating the thyroid gland what you need to go for is when we're palpating the right side of the thyroid gland of the patient we're going to be retracting the sternal cloid muscle on the left side to relax the muscles of the patient right and then you're going to palpate on the right as so you're palpating for the lobe on the on the right side and you're also palpating the ismus of the which is the central point of the thyroid gland after this you're going to do the same thing on the other side so retract the stal pooid muscle on the right side and your feeling on the right side of the patient and make sure that the patient's neck is flexed while you're doing this examination to relax the head further so again we'll repeat the exam make sure that the muscle is relaxed over here and you are palpating the thyroid gland area over here and we'll repeat the same way relaxing the stal pooid muscle on the right side and palpating on the left side now you need to repeat this very examination while you're asking the patient to drink some water so again we'll ask the patient to drink some water and we'll be doing the same process to Pulpit the thyroid gland while the patient swallows all right next we'll ask him to drink some water again okay and we'll Pulpit again so you're pulpa the lobe and the ismus on the right and the left side so normally the thyroid gland is not palpable so you're common will be the thyroid gland is not palpable in case you do have you do palpate a mass you need to comment on the size of the mass the shape of the mass the consistency of the mass if the mass is painful or not if it's tender or not and you also have to comment on the mobility and whether there's a thrill or not what's a thrill of a thyroid gland a thrill would be an audible murmur so these vibrations that you feel with your fingers so now you're done with the pulp part of this exam next we're going to move towards the percussion part of this exam so why exactly are we percussing the patient well we're percussing for any thyroid enlargement all right so you're going to be P percussing along the manubrium sternum to check for any dull notes normally it should all be resonant so you'll just uncover the patient a little bit and you are you're at the manubrium sternum here so you'll just start percussing make sure your hand is in complete contact with the patient's uh chest all right and then your finger hyper extended and we'll percuss all right and then you're going to move to the side and move to the side normally it will all be resonant after this we'll move on towards the oscilation for the thyroid gland so for the oscilation of the thyroid gland we'll just wear our stethoscope simply and make sure your stethoscope is warm so as to avoid any discomfort for the patient and then we'll place or stethoscope at the loes of the thyroid gland you're hearing for any sorts of murmurs or any additional sounds that you may hear at the thyroid gland which may indicate certain types of pathologies after we're done with the oscilation we will do a special test which is called the pton sign so what is the pton sign you might ask we'll ask the patient to raise both their hands above their head and we'll be assessing for any congestion so we'll ask ask the patient to raise both their hands above their head like so and we'll ask them to keep it so for a minute after a whole minute you'll be looking at the face for any signs of congestion for any signs of cyanosis and and in general any signs of discomfort respiratory discomfort after this we'll ask the patient to lower their hands and to conclude this examination we'll do a lymph node examination so that will consist of firstly the submental nodes the submental nodes as the name suggests are underneath the chin then we'll move on towards the submandibular nodes which are below the jaw right below the angle of the jaw then we'll move on towards the jugular chain which are just anterior to the sternal cloid muscle then we'll be dealing with the posterior triangle nodes which are posterior to the sternal cloid muscle then we'll move on towards the occipital nodes which as the name suggests are in the occipital region then we'll be left with posterior oracular which is behind the ear and then pre- oric which is in front of the ear lastly we'll move on towards the front of the patient to Pulpit the uh the supraclavicular lymph nodes and for this this is the only part of the lymph node examination in which we'll be in front of the patient for all of the other lymph node examinations that we've mentioned we'll be behind the patient and now allow me to demonstrate so firstly we'll begin with the submental lymph notes right which are just underneath the chin then we're going to move on towards the subil lymph nodes as so then we're going to drop down towards the jugular chain which is anterior to the sternomastoid muscle so we're going towards the anterior all the way down then we're going to shift towards the uh the for the posterior triangle nodes so now we'll be pulpa the occipital lymph nodes we'll be using our two fingers to Pulpit near the occipital region as so then we're going to move on towards the posterior oric lymph nodes okay so just behind the ear then we're going to move on towards the the pre- oric lymph nodes okay and so now we're done with the posterior part of this examination okay so our last lymph nodes will be the supraclavicular lymph nodes and for them we'll be moving in front of the patient we'll ask the patient to shrug their shoulders so can you shrug your shoulders there you go we'll be feeling around the Supra in the supraclavicular fosa for the supraclavicular lymph nodes after this our comment will be normally the lymph nodes aren't palpable so that will be our comment so ultimately thank the patient help the patient cover up wash your hands and that concludes your examination