Endocrine

Question 1

General Inspection

Answer 1

Overt signs of hypo/hyperthyroidism
Body habitus
Goitre
Facies

Question 2

Peripheries

Answer 2

Nail changes
Large hands
Phalen’s test

Skin

• Necrobiosis lipoidica
• Atrophy
• BSL checks
• Ulceration

Pulse
BP - BP drop, autonomic dysfunction

Question 3

Face & Neck

Answer 3

Face

• Hair: alopecia, thinning
• Eyes: Proptosis, stare, conjunctival injection
• Visual field defects
• Mouth: ulcers
• Acne
• Hirsutism
• Moon facies, plethora
• Frontal bossing
• Fundoscopy - papilloedema

Mouth - thrush, macroglossia
Hoarse voice

Neck:
- Visual: scars, sweeling, skin changes
- Swallow - notable lumps, mobile lesions
- Palpate
> Back: thyroid contours (size, shape, borders, lumps, pain, thrills), lymph nodes
> Front: repeat, carotid arteries, trachea, sternomastoid function
- Percuss over upper manubrium
- Auscultate: thyroid bruit, carotid bruit

Pemberton sign
JVP

Question 4

Causes of goitre

Answer 4

• Idiopathic
• Puberty, pregnancy, postpartum
• Graves
• Thyroiditis: Hashimoto, subacute
• Iodine deficiency
• Goitrogens: iodine excess, drugs (Li, phenylbutazone)
• Inborn errors of thyroid hormone synthesis

Question 5

Causes of thyrotoxicosis

Answer 5

PRIMARY

• Graves
• Toxic adenoma
• MNG
• Hashimoto
• Iodine induced
• Excess hormone replacement
• Postpartum thyroiditis
• Drugs (Amiodarone, Li)

SECONDARY

• Pit or ectopic TSH secretion
• Hydatidiform mole
• Choriocarcinome
• Struma ovarii
• Factitious lol u lie bish

Question 6

Cause of hypothyroidism

Answer 6

PRIMARY
Without goitre
- Idiopathic
- Treatment
- Agenesis
- Unresponsiveness to TSH
With goitre
- Chronic thyroiditis
- Drugs
- Endemic iodine deficiency
- Iodine induced
- Inborn enzyme errors

SECONDARY
- Pit lesions

TERTIARY
- Hypothalamic lesions

TRANSIENT

• Treatment withdrawn
• Subacute thyroiditis
• Postpartum

Question 7

Chest, Abdo, legs

Answer 7

Cardiac exam
Lungs
Telangiectasia

Acanthosis nigricans
Pigmentation

Abdo

• Signs of cushings
• Bruising
• Striae
• Injection sites

Legs

• Wasting
• Pretibial myxedema
• Skin changes
• Squat test
• Charcot joints
• Ulcers

PVD - temperature, pulses, oedema

Neuro exam

• Sensation
• Pain
• Strength

Urinanalysis

Question 8

Cause of Addisons

Answer 8

IATROGENIC

PRIMARY
- AI
- Polyglandular
TB
Infiltration: amyloid, sarcoid, mets
Demyelinating
Drugs: heparin, haemorrhage, aminogylcosides, ketoconazole
HIV

SECONDARY
Pit disease
Hypothalamus disease