Will put summaries from tutorials for the benefit of everyone. If you got anything to share, mail me! then everyone will benefit. Let's all work together yah?

Approach to the neck (medicine)

There is only one case that will overlap both medical and surgical tracts and that is thyroid.

Medical thyroid case is usually a diffuse goitre, whereas the surgical thyroid is usually a thyroid nodule.

Approach the patient from the front. Take off the shirt.

Look for:
-Fullness->is it symmetrical or asymm
does it cross the midline or can you still see the tracheal notch? If you can see the tracheal notch, then the bilateral fullness prob not the thyroid cos the thyroid will be in the midline.
-Scars
-Distended veins-> look at the location. Is it external jug or the internal jug? Look for waveforms. If absent, there is something in the svc within or without that blocks the transmission of the impulse from the heart. If it's present consider a pathology on the right side of the heart.
->check the patient's eyes and look at his fingers for tremors.

->nex check in case got thyroid by asking the patient to swallow and to stick out tongue.
->check for tracheal deviation first, then go on to the back.
->after you are done looking, feel the mass from the back, not the front or you will fail! Remember to describe site size shape surface sound(bruit?) surroundings(LNs) colour consistency mobility tenderness
->check LNs. one of the most common causes of SVC obstruction is enlarged LNs due to lymphoma. Know that hodgkin's is contiguous LNs and non Hodgkin's is non contiguous. So check the pattern of LN involvement and offer to palpate the spleen and other LNs.
->percuss for retrosternal thyroid, LNs, masses.
->auscultate the carotid or the mass if found.

Know what can give you svc obstruction: inside will be thrombus, outside will be stuff like LNs, retrosternal thyroid.

Differentiate between svc obstruction and thoracic inlet obstruction which will produce additional signs like dysphagia, SOB. Causes of thoracic inlet obstruction are many, and include Pancoast tumour, cervial ribs, mediastinal LNs.

Pemberton's sign actually exaggerates both svc obstruction and the thoracic inlet symptoms.
->if you suspect that is some svc obstruction or TI obstruction involved cos the dude looks plethoric, dyneic, sneak a look at the arms if you haven't already done so from the foot of the bed during that 15 sec of staring, and note the swollen hands. Also look at the dilated veins on the arms and the chest. Check the flow in the chest veins and say that it is downwards. Remember that it will be upwards in the case of portal hypertension.