Endocrine Flashcards
describe the steps of a thyroid exam
explain procedure; examine from behind them position patient; sitting down inspection palpation percussion auscultation
describe the inspection section of a thyroid exam
look from the front and from the side
swelling; goitre, localised or generalised
scars; thyroidectomy
ask them to take a sip of water and hold it in their mouth, then swallow; will not rise if fixed to underlying structures
protrude their tongue; a cyst will move upwards
describe the palpation section of a thyroid exam
neck slightly flexed
ask if they have any pain or discomfort
stabilise one lobe while palpating the other
size shape; uniformly enlarged or regular surface; smooth or nodular nodules; location, size, tenderness, mobility, consistency, more than one consistency; soft, rubbery, hard tenderness mobility thrill; thyrotoxicosis, malignancy
should also palpate for cervical lymphadenopathy
describe the percussion section of a thyroid exam
not routinely practiced
percuss for any retrosternal extension of a goitre; dull percussion note
describe the auscultation section of a thyroid exam
diaphragm; each lobe of the thyroid for bruits
ask the patient to hold their breath
describe an assessment of thyroid status
general inspection; under/overweight, irritable, anxious, slow, sluggish movements
in/appropriate clothing
hands; warm, dry, fine tremor, palmar erythema, onycholysis
pulse; tachy/bradycardia, AF
skin and face; diffuse alopecia, dry skin, dry/thin hair
eyes; exopthalmos, lid retraction, periorbital oedema, lid lag, thinning of loss of outer 1/3 of eyebrows
chest; systolic flow murmur
muscle power; proximal myopathy
reflexes; hyper-reflexia, hung up reflexes
legs; pretibial myxoedema
what questions should be asked in the presenting complaint in a thyroid history?
weight loss/gain
appetite increased/reduced
heat/cold intolerance
irritability, agitation, anxiety, poor concentration, memory loss, sleeping difficulties
low mood, poor concentration, memory loss, confusion, sleeping a lot
reduced energy levels, leathery, easily fatigued
diarrhoea/constipation
reduced/more frequent menstruation, lighter/heavier periods
fine tremor of hands
palpitations
brittle nails
eye changes; protrusion, double vision, muscle weakness
dry/pale skin, dry eyes, hair loss, brittle nails
hoarseness/deep voice
pain/pins and needles in the hand
what questions should be asked in the PMHx or FHx in a thyroid history?
thyroid problems thyroid surgery radioiodine treatment endocrine conditions; diabetes other autoimmune disease; RA, OA
what questions should be asked in the DHx in a thyroid history?
thyroxine
carbimazole
lithium
amiodarone
what questions should be asked in the presenting complaint of a diabetes history?
thirst; duration, volume, frequency polyuria; frequency, volume, nocturia energy levels; alteration, fatigue, duration weight alteration; amount, timing dry, itchy skin headache visual problems tingling/burning in the feet, legs, hands extreme hunger frequent/recurring infections
what questions should be asked in PMHx in a diabetes history?
gestational diabetes
cardiovascular conditions
hypertension
pancreatitis
what questions should be asked in FHx in a diabetes history?
diabetes; what time, what control do they use
heart disease
stroke
hypertension
