Physical Finding

Physical Findings

1 Hypertension

For further discussion, see:
More than 90% of hypertension is idiopathic and so investigation is not recommended until there is resistant hypertension (i.e. elevated blood pressure while on 3 anti-hypertensive medications).
The three commonest causes of resistant hypertension are:
  • 1° hyperaldosteronism
  • Renal artery stenosis
  • Chronic renal failure (starting at Stage 4)

2 Neck mass (water swallow test)

2 Neck mass (water swallow test)

For further discussion, see:
  • Thyroid (see below for investigation algorithm)
    • Multinodular goiter
    • Cyst
    • Nodule
      • Adenoma
      • Neoplasm
  • Non-thyroid
    • Lymph node
    • Thyroglossal duct cyst
    • Branchial cleft cyst
    • Paraganglioma (rare)
Non-thyroidal Neck Masses: The Rule of 80’s
In a patient > 50 years of age:
  • 80% of neck masses will be lymph nodes
    • Of these, 80% will be malignant
      • Of these, 80% will be squamous cell carcinoma of the head & neck

3 Skin, pigmented skin lesions

4 Skin, rashes

5 Skin, nodules

6 Thyroid nodule

For further discussion, see:
This is a subset of “Neck Masses” (see above), which are divided into “thyroid” and “non-thyroid” by the water swallow test.