Clinical skills: hyperthyroidism exam

Question 1

Parts of the hyperthyroid exam?

Answer 1

Initial approach
General inspection
Vital signs
Hands and arms
Face
Neck
Thyroid
Chest
Legs

Question 2

General inspection?

Answer 2

Goitre
Body build/signs of weight loss
Heat intolerance
Anxiety/frightened facies

Question 3

Vital signs?

Answer 3

BP, pulse, resp rate, temperature
Actually do check rate and rhythm of brachial pulse (for tachycardia and AF respectively)

Question 4

Hands and arms
- Inspection?

Answer 4

Question 5

Hands and arms
- Tests?

Answer 5

Proximal myopathy
Hyperreflexia - biceps tendon

Question 6

FACE
- Eyes: inspect and test?

Answer 6

Question 7

Neck
- 3 things to inspect for?

Answer 7

Trachea: look and palpate for deviation
Cervical lymph nodes
Pemberton’s sign

Question 8

Neck: Pemberton’s sign
- What is thoracic outlet syndrome? Why does raising arms (as when testing for Pemberton’s sign) make worse?
- How is Pemberton’s sign releant to thyroid?

Answer 8

• Thoracic outlet syndrome – compression of the airway or great vessels resulting in facial plethora, dilated veins, stridor (difficulty breathing)
• Raising arms further compresses these, exacerbating these symptoms
• Thyroid gland can grow into the thoracic outlet (retrosternal goitre) – can lead to thoracic outlet syndrome

Question 9

THYROID
- Components?

Answer 9

Inspect
Palpate
Percuss
Auscultate

Question 10

THYROID
Inspection?

Answer 10

Goitre + swelling (look at from side)
Redness
Scars (previous thyroid surgery)
Dilated veins

Ask patient to protrude tongue
Inspect while patient swallows a sip of water

Question 11

THYROID
Inspection
- Purpose of protruding tongue?
- Purpose of watching while swallowing water?

Answer 11

• Protruding tongue - only thyroglossal cysts will move forward
• Swallowing water: only goitre/thyroglossal cysts (not lymph nodes) will move up and down

Question 12

THYROID
- Palpation

Answer 12

• Palpate lobes and isthmus
• Palpate from behind and in front
• Repeat palpation while the patient swallows sips of water

Question 13

THYROID
Percussion

Answer 13

Over the manubrium of the manubrium of the sternum
- Retrosternal goitre will produce a dull percussion note

Question 14

THYROID
Ausculate

Answer 14

• Ask to hold breath for a moment, then listen
• Listen over each lobe with the bell, for bruits

Question 15

CHEST
- What are you ausculating for?

Answer 15

Systolic murmur and cardiac size

Question 16

LEGS
- Inspection?
- Test?

Answer 16

Inspection for pre tibial myxoedema
Test for proximal myopathy