Review lymph nodes and location.
o Label the lymph nodes on a diagram of the head and nec
o Where else can lymph nodes be found?
1. Tracheal
2. Mediastinal
3. Mesentery
4. Preaortic
5. Iliac
6. Inguinal
7. Bronchial
8. Lower extremity
9. Female internal genital tract
10. Epitrochlear
11. Axillary
12. Mammary (Rotter nodes)
Why do lymph nodes typically enlarge with these common conditions?
o Mononucleosis: Initially infects oral epithelial cells; after intracellular
viral replication and cell lysis with release of new virions, virus
spreads to contiguous structures such as the salivary glands, with
eventual viremia and infection of the entire lymphoreticular system,
including the liver & spleen
Objective: generalized lymphadenopathy most commonly in the
, anterior and posterior cervical nodes and the submandibular lymph
nodes (less common in axillary and inguinal lymph nodes)
Epitrochlear lymphadenopathy is particularly suggestive of
infectious mono
o Otitis media:
o Strep pharyngitis:
Thyroid
Describe the findings of the examination of a healthy thyroid: Enlarged thyroid
gland may be visible only from lateral aspect
What do the lobes feel like?
o Thyroid lobes should be small, smooth & free of nodules. It should rise
freely with swallow
o Thyroid tissue consistency should be firm yet pliable (coarse tissue or gritty
sensation suggest inflammatory process)
Symmetrical versus asymmetrical?
o Nodules and asymmetry will be more difficult to detect if pressing too
hard; palpate for size, shape, config, consistency, tenderness, and presence
of nodules
o If enlarged, auscultate for vascular sounds with bell (may hear a bruit)
Hypothyroidism: underactive thyroid
Primary: thyroid gland produces insufficient amounts of thyroid hormone
Secondary: insufficient secretion of thyroid hormone due to inadequate secretion of TSH
from pituitary gland or TRH from hypothalamus
SXS: Weight gain, lethargic/complacent/disinterested, prefers warm climate
Hair: coarse, with tendency to break
Skin: coarse, scaling, dry
Fingernails: thick
Eyes: Puffiness in periorbital region
Neck: no goiter
Cardiac: no change
GI: constipation
Menstrual: menorrhagia
Neuromuscular: lethargic, but good muscular strength
, Myxedema: skin & tissue disorder usually due to severe prolonged hypothyroidism
-Decreased in metabolic rate, resulting in accumulation of hyaluronic acid & chondroitin
sulfate in the dermis
-Depositions of glycosaminoglycan in all organ systems leading to mucinous edema of
facial features
SUBJECTIVE: cog impairment, slowed mentation, poor concentration, decreased short-
term memory, social withdrawal, psychomotor retardation, depressed mood, apathy;
constipation, muscle pains, hearing problems
OBJECTIVE: coarse thick skin, thickening nose, swollen lips, puffiness around eyes; slow
speech, mental dullness, lethargy, mental problems, thin brittle hair with bald patches
Hyperthyroidism: overactive thyroid
Excessive thyroid hormone causes increase in metabolic rate
Associated with increased total body heat production and increased heart contractility,
heart rate, and vasodilation
SXS: Weight loss, nervous/easily irritated/highly energetic, prefers cool weather
Hair: fine, with hair loss; failure to hold a permanent wave
Skin: warm, fine, hyperpigmentation at pressure points
Fingernails: thin, with tendency to break; may show onycholysis, brittleness
Eyes: bilat or unilat exophthalmos, lid retractions, double vision
Neck: goiter, change in shirt neck size, pain over thyroid
Cardiac: tachy, arrhythmias, palpitations
GI: increased freq of BM, diarrhea rare
Menstrual: scant flow, amenorrhea
Neuromuscular: increasing weakness, esp of proximal muscles
Which of these indicate hyperthyroidism and which indicate hypothyroidism?
o Anxiety: hyperthyroidism
o Dry skin: hypothyroidism
o Exophthalmos: hyperthyroidism
o Fatigue: hypothyroidism
o Insomnia: hyperthyroidism
o Thinning hair: hyperthyroidism
o Weight gain: hypothyroidism
o Weight loss: hyperthyroidism
1. Describe the usual order of the respiratory exam and normal exam findings
Inspect 2. Palpate 3. Percuss 4. Auscultate
Inspect the chest; front, back & sides, noting thoracic landmarks for: size &
shape (AP-to-lateral diameter); symmetry; color; superficial venous
patterns; prominence of ribs
Evaluate respirations for: rate & rhythm/pattern
o Label the lymph nodes on a diagram of the head and nec
o Where else can lymph nodes be found?
1. Tracheal
2. Mediastinal
3. Mesentery
4. Preaortic
5. Iliac
6. Inguinal
7. Bronchial
8. Lower extremity
9. Female internal genital tract
10. Epitrochlear
11. Axillary
12. Mammary (Rotter nodes)
Why do lymph nodes typically enlarge with these common conditions?
o Mononucleosis: Initially infects oral epithelial cells; after intracellular
viral replication and cell lysis with release of new virions, virus
spreads to contiguous structures such as the salivary glands, with
eventual viremia and infection of the entire lymphoreticular system,
including the liver & spleen
Objective: generalized lymphadenopathy most commonly in the
, anterior and posterior cervical nodes and the submandibular lymph
nodes (less common in axillary and inguinal lymph nodes)
Epitrochlear lymphadenopathy is particularly suggestive of
infectious mono
o Otitis media:
o Strep pharyngitis:
Thyroid
Describe the findings of the examination of a healthy thyroid: Enlarged thyroid
gland may be visible only from lateral aspect
What do the lobes feel like?
o Thyroid lobes should be small, smooth & free of nodules. It should rise
freely with swallow
o Thyroid tissue consistency should be firm yet pliable (coarse tissue or gritty
sensation suggest inflammatory process)
Symmetrical versus asymmetrical?
o Nodules and asymmetry will be more difficult to detect if pressing too
hard; palpate for size, shape, config, consistency, tenderness, and presence
of nodules
o If enlarged, auscultate for vascular sounds with bell (may hear a bruit)
Hypothyroidism: underactive thyroid
Primary: thyroid gland produces insufficient amounts of thyroid hormone
Secondary: insufficient secretion of thyroid hormone due to inadequate secretion of TSH
from pituitary gland or TRH from hypothalamus
SXS: Weight gain, lethargic/complacent/disinterested, prefers warm climate
Hair: coarse, with tendency to break
Skin: coarse, scaling, dry
Fingernails: thick
Eyes: Puffiness in periorbital region
Neck: no goiter
Cardiac: no change
GI: constipation
Menstrual: menorrhagia
Neuromuscular: lethargic, but good muscular strength
, Myxedema: skin & tissue disorder usually due to severe prolonged hypothyroidism
-Decreased in metabolic rate, resulting in accumulation of hyaluronic acid & chondroitin
sulfate in the dermis
-Depositions of glycosaminoglycan in all organ systems leading to mucinous edema of
facial features
SUBJECTIVE: cog impairment, slowed mentation, poor concentration, decreased short-
term memory, social withdrawal, psychomotor retardation, depressed mood, apathy;
constipation, muscle pains, hearing problems
OBJECTIVE: coarse thick skin, thickening nose, swollen lips, puffiness around eyes; slow
speech, mental dullness, lethargy, mental problems, thin brittle hair with bald patches
Hyperthyroidism: overactive thyroid
Excessive thyroid hormone causes increase in metabolic rate
Associated with increased total body heat production and increased heart contractility,
heart rate, and vasodilation
SXS: Weight loss, nervous/easily irritated/highly energetic, prefers cool weather
Hair: fine, with hair loss; failure to hold a permanent wave
Skin: warm, fine, hyperpigmentation at pressure points
Fingernails: thin, with tendency to break; may show onycholysis, brittleness
Eyes: bilat or unilat exophthalmos, lid retractions, double vision
Neck: goiter, change in shirt neck size, pain over thyroid
Cardiac: tachy, arrhythmias, palpitations
GI: increased freq of BM, diarrhea rare
Menstrual: scant flow, amenorrhea
Neuromuscular: increasing weakness, esp of proximal muscles
Which of these indicate hyperthyroidism and which indicate hypothyroidism?
o Anxiety: hyperthyroidism
o Dry skin: hypothyroidism
o Exophthalmos: hyperthyroidism
o Fatigue: hypothyroidism
o Insomnia: hyperthyroidism
o Thinning hair: hyperthyroidism
o Weight gain: hypothyroidism
o Weight loss: hyperthyroidism
1. Describe the usual order of the respiratory exam and normal exam findings
Inspect 2. Palpate 3. Percuss 4. Auscultate
Inspect the chest; front, back & sides, noting thoracic landmarks for: size &
shape (AP-to-lateral diameter); symmetry; color; superficial venous
patterns; prominence of ribs
Evaluate respirations for: rate & rhythm/pattern
