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Y2S1 > CLIN ENDO Exam - Week 11 > Flashcards

CLIN ENDO Exam - Week 11 Flashcards

1
Q

ENDO (Thyroid) System Review Qs

A
  • Changes in appetite/weight
    o Have you noticed a change in appetite? More hungry or less hungry than usual? Is this associated with any increase/decrease in weight?
  • Heat/cold intolerance
  • Changes in bowel habits
    o Diarrhoea? Constipation?
  • Sweating
    o Have you noticed any increase in sweating?
  • Hair distribution
    o Have you noticed any increase in body hair (for females)? Loss of facial hair (males)? Temporal recession of the scalp hair (females)? Loss of axillary and/or pubic hair?
  • Lethargy
  • Changes in the skin & nails
    o
  • Changes in pigmentation
  • Changes in stature
    o Tallness? Shortness?
  • Erectile dysfunction
  • Galactorrhoea
  • Menstruation
    o When was your last period? How long have you not have a period for? Any changes to character of period – increase in length/heaviness? Anaemia?
  • Polyuria
    o Do you pass more than 3L urine/day?
  • CVS symptoms
    o Palpitations? SOB? Angina?
  • Head & neck symptoms
    o Brain fog? Slowed thinking? Slower speaking? Hearing deficits? Depression? Hoarse voice? Agitation/nervousness? Double vision? Eye changes?
  • MSK symptoms
    o Tremor? Carpal tunnel syndrome? Muscle cramps?
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2
Q

Qs which should be incl for suspected hypothyroidism?

A

Less hungry, increased weight, cold intolerance, constipation, lethargy, increased length/heaviness of period, amenhorrea, anaemia, SOB, angina, brain fog, slowed thinking, slower speaking, hearing deficits, depression, hoarse voice, CTS, muscle cramps.

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3
Q

Qs which should be incl for suspected hyperthyroidism?

A

More hungry, decreased weight, heat intolerance, diarrhoea, increase in sweating, amenhorrea, palpitations, agitation/nervousness, double vision, eye changes, tremor.

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4
Q

Hyperthyroidism Exam GI

A

a. ‘Noting body habitus’
b. Weight loss
c. Frightened facies/thyroid stare
d. Heat intolerance
e. Anxiety
f. Goitre
g. Emotional lability
h. Goitre
13. Vital signs

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5
Q

Hyperthyroidism Exam Fingers

A

a. Look
i. Clubbing/thyroid acropachy
ii. Swelling of the digits
iii. Oncholysis

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6
Q

Hyperthyroidism Exam Palm

A

a. Look
i. Erythema
b. Palpate
i. Warm
ii. Sweaty

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7
Q

Hyperthyroidism Exam Hands

A

a. Look
i. Fine tremor
1. Ask pt to stretch arms out straight
2. Place paper on top

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8
Q

Hyperthyroidism Exam Wrists

A

a. Assess
i. Pulse
1. Comment on rate & rhythm.

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9
Q

Hyperthyroidism Exam Arms

A

a. Assess
i. Proximal myopathy
1. Ask pt to raise arms above the head
2. Tap arm reflexes
3. Assess for abnormal briskness.

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10
Q

Hyperthyroidism Exam Eyes

A

a. Look
i. Exophthalmos/proptosis
ii. Chemosis
iii. Conjunctivitis
iv. Discharge
v. Redness
vi. Corneal ulceration
vii. Optic atrophy
viii. Lid retraction/Dalrymple’s sign
ix. Thyroid stare
x. Ptosis
b. Assess
i. Lid lag/von Graefe’s sign
1. Ask pt to follow finger as it descends at a moderate rate from the upper to lower part of the visual field
ii. Opthalmoplegia
1. Ask pt to follow finger as it moves up & low and side-to-side in the peripheral vision without moving their head.

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11
Q

Hyperthyroidism Exam Neck (excl thyroid).

A

a. Look
i. Tracheal deviation
ii. Scars
iii. Swelling
iv. Prominent veins
v. Redness
b. Palpate
i. Trachea
ii. Cervical lymph nodes
c. Perform
i. Pemberton’s sign
1. Ask pt to raise arms above head and hold for 60sec
2. Comment on presence/absence of signs of obstruction/congestion.

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12
Q

Hyperthyroidism Exam Thyroid

A

a. Look
i. Thyroid
1. Ask pt to swallow (should offer glass of water)
2. If abnormality, ask pt to poke tongue out
ii. Swelling
iii. Redness
iv. Scars
v. Dilated veins
b. Palpate
i. Size
ii. Shape
iii. Consistency
iv. Tenderness
v. Mobility
vi. Thrill
1. Warn pt first
2. Start from front
3. Place thumbs over the gland
4. Ask pt to slightly flex neck
5. Feel both lobes of the gland & isthmus unilaterally
6. Repeat assessment while pt swallows
7. Repeat from back w pulps of 3 x fingers.
vii. Carotid pulse
c. Percuss
i. Manubrium
d. Auscultate (use bell)
i. Bruit
1. Each lobe
a. Ask pt to hold breath
2. Carotid artery
a. Ask pt to hold breath
ii. Stridor (only if a goitre is present)
1. Apply mild compression to the lateral lobes.

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13
Q

Hyperthyroidism Exam Chest

A

a. Comment on presence/absence
i. Systolic murmurs.

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14
Q

Hyperthyroidism Exam Legs

A
  1. Legs
    a. Inspect
    i. Pre-tibial myxoedema
    b. Assess
    i. Proximal myopathy
  2. Ask pt to stand up from a sitting or squatting position
    ii. Achilles tendon reflex.
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15
Q

Hypothyroidism Exam GI

A
  1. General inspection
    a. ‘Noting body habitus’
    b. Weight gain
    c. Cold intolerance
    d. Mental/physical sluggishness
    e. Myxoedema madness
    f. Hypothyroid speech
    g. Hearing issues
    h. Puffy face appearance
    i. Goitre
    j. Voice changes
  2. Vital signs.
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16
Q

Hypothyroidism Exam Hands (excl palms).

A

a. Look
i. Peripheral cyanosis
ii. Dry, brittle nails
iii. Skin swelling/thickening
iv. Hypercarotenaemia
v. Xanthelasmata.

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17
Q

Hypothyroidism Exam Palms

A

a. Look
i. Pallor palmar crease
ii. Yellow discoloration
b. Palpate
i. Cold
ii. Dry.

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18
Q

Hypothyroidism Exam Wrists

A

a. Assess
i. Sensory function
ii. Pulse
1. Comment on rate & rhythm
b. Perform
i. Tinel’s tap
ii. Phalen’s sign.

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19
Q

Hypothyroidism Exam Arms

A

a. Assess
i. Proximal myopathy
1. Ask pt to raise arms above the head
2. Tap arm reflexes
3. Assess for abnormal briskness.

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20
Q

Hypothyroidism Exam Face

A

a. Look
i. Hypercarotenaemia
ii. Skin swelling/thickening
iii. Alopecia
iv. Vitiligo.

21
Q

Hypothyroidism Exam Eyes

A

a. Look
i. Periorbital oedema
ii. Thinning/loss of outer third of the eyebrow
iii. Xanthelasmata
iv. Thinning of the scalp hair
b. Palpate
i. Coolness of skin &/ hair.

22
Q

Hypothyroidism Exam Tongue

A

a. Look
i. Swelling.

23
Q

Hypothyroidism Exam Neck (excl thyroid).

A

a. Look
i. Tracheal deviation
ii. Scars
iii. Swelling
iv. Prominent veins
v. Redness
b. Palpate
i. Trachea
ii. Cervical lymph nodes
c. Perform
i. Pemberton’s sign
1. Ask pt to raise arms above head and hold for 60sec
2. Comment on presence/absence of signs of obstruction/congestion.

24
Q

Hypothyroidism Exam Thyroid

A

a. Look
i. Thyroid
1. Ask pt to swallow (should offer glass of water)
2. If abnormality, ask pt to poke tongue out
ii. Swelling
iii. Redness
iv. Scars
v. Dilated veins
b. Palpate
i. Size
ii. Shape
iii. Consistency
iv. Tenderness
v. Mobility
vi. Thrill
1. Warn pt first
2. Start from front
3. Place thumbs over the gland
4. Ask pt to slightly flex neck
5. Feel both lobes of the gland & isthmus unilaterally
6. Repeat assessment while pt swallows
7. Repeat from back w pulps of 3 x fingers.
vii. Carotid pulse
c. Percuss
i. Manubrium
d. Auscultate (use bell)
i. Bruit
1. Each lobe
a. Ask pt to hold breath
2. Carotid artery
a. Ask pt to hold breath
ii. Stridor (only if a goitre is present)
1. Apply mild compression to the lateral lobes.

25
Q

Hypothyroidism Exam Chest

A

a. Comment on presence/absence
i. Pericardial effusions
ii. Pleural effusions.

26
Q

Hypothyroidism Exam Legs.

A

a. Look
i. Non-pitting oedema
ii. Peripheral neuropathy
1. Light touch
2. Pain sensation
b. Assess
i. Achilles tendon reflex.

27
Q

Describe primary hypo/hyperthyroidism. Describe secondary.

A

Problem in the thyroid gland. Problem in the pituitary or hypothalamus.

28
Q

Example of TSH, T3, T4 levels corresponding to primary hyperthyroidism, secondary and primary hypothyroidism, secondary.

A

E.g., Primary hyperthyroidism -> low TSH, high T3/T4. Secondary hyperthyroidism -> high TSH, high T3/T4. Primary hypothyroidism -> high TSH, low T3/4. Secondary hypothyroidism -> low TSH, low T3/4.

29
Q

Hirsutism may indicate?

A

Increased androgen concentration (-> increased hair growth).

30
Q

Loss of facial hair may indicate?

A

Hypogonadism.

31
Q

Temporal recession of scalp hair may indicate?

A

Increased androgen concentration.

32
Q

Loss of axillary and/or pubic hair may indicate?

A

Hypogonadism, hypopituitarism, adrenal insufficiency.

33
Q

Erectile dysfunction may indicate?

A

Hypogonadism, hypopituitarism, endothelial dysfunction, emotional disorders.

34
Q

Polyuria may indicate?

A

DM, DI, central ADH deficiency, primary polydipsia, excessive water consumption, hypercalcaemia, tubulointerstitial or cystic renal disease.

35
Q

Clubbing may indicate what thyroid condition?

A

Rarely Graves’ disease.

36
Q

Bradycardia/tachycardia are indicative of what thyroid conditions?

A

Hypo & hyperthyroidism.

37
Q

Prominent neck veins may indicate

A

Retrosternal goitre.

38
Q

Redness around the neck may indicate

A

Suppurative thyroiditis.

39
Q

What is a mass likely to be if it moves upwards w tongue protrusion? If it doesn’t?

A

Thyroglossal cyst. Thyroid mass.

40
Q

Soft, rubbery, stony hard thyroid may indicate what conditions?

A

Normal. Simple goitre. HT. Carcinoma, calcification in a cyst, fibrosis, Riedel’s thyroiditis.

41
Q

Thrill over the thyroid may indicate

A

Abnormally high activity of the gland - thyrotoxicosis.

42
Q

Dullness to percussion of manubrium may indicate

A

Retrosternal goitre.

43
Q

Systolic murmur may indicate what thyroid condition?

A

Hyperthyroidism.

44
Q

What is pre-tibial myxoedema? What does this indicate?

A

Auto-immune extra-thyroid manifestation of Graves. Thyroid dermatopathy in which skin lesions of the pretibial regions are raised w waxy/orange-peel like appearance. Lesions can be flesh-coloured or yellow-brown.

45
Q

Characteristics of hypothyroid speech.

A

Slow, nasal, deep in pitch.

46
Q

Indicative findings on examination for hypoparathyroidism

A
  1. Chvostek’s sign
    a. Tap over facial nerve in front of the ear
    +ve result is twitching of the corner of the mouth on that side - indicative of hypocalcaemia.
  2. Trousseau’s sign
    a. Inflate sphygmomanometer cuff on arm to above systolic pressure
    b. Wait 4 mins.
    Carpopedal spasm observed, which resolves when cuff deflates.
47
Q

Key examination findings of Addison’s disease

A

(Hypoadrenalism)
* Postural hypotension
* Pigmentation

48
Q

Key examination findings of Addison’s disease

A

(Hypoadrenalism)
* Postural hypotension
* Pigmentation

49
Q

Most common cause of hypocalcaemia relating to the thyroid

A

Most commonly seen as a post-operative complication of a total thyroidectomy.

Y2S1 (72 decks)

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