ask the patient to lift both arms as high as possible.
watch the patient's face for signs of congestion - plethora - and cyanosis. Respiratory distress and inspiratory stridor may occur. Venous congestion may be apparent as distension of the neck veins.
listen for stridor whilst the patient takes in a deep breath. This is a test for thoracic inlet obstruction due to a retrosternal goitre or any other causes including lung carcinoma, other tumours - lymphomas, thymomas, dermoid cysts - or an aortic aneurysm.
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