Procedures Flashcards
Outline examination of thyroid gland?
Inspect - gland itself, swelling, distended neck veins, scars, neck contour etc
Assess clinical thyroid status - hypo, eu or hyperthyroid
Palpate neck, assess if discrete or diffuse swelling
Check with water swallow and tongue movements
Examine LN chains
Evaluate for retrosternal extension - percuss lower border of neck and upper chest
Pemberton’s manouevre
Auscultate gland for bruit
What other examination would you like to include in overtly hyperthyroid patients?
Cardiovascular examination - look for failure
Differentials for diffuse swelling thyroid + hypothyroidism?
Iodine deficiency
Hashimoto’s
Differentials for diffuse swelling thyroid + hyperthyroidism?
Graves, Hashimoto’s
Differentials for diffuse swelling thyroid + euthyroid?
Anaplastic cancer
Lymphoma
Medullary cancer
Differentials for discrete thyroid nodule and euthyroidism?
Follicular cancer
Papillary cancer
Non-functioning adenoma
Cyst
Differentials for discrete thyroid nodule and hyperthyroidism?
Functioning adenoma
Differentials for multiple thyroid nodules and euthyroidism/hyperthyroidism?
(toxic) multinodular goitre
Dominant nodule within MNG
Describe how to examine the parotid gland? Specific nerve to check?
Inspect from front to back of face, looking for obvious mass lesions
Lesion at angle of madible - consider parotd
Look at interior oral cavity - poor dentition, pharyngeal extension of mass, discharge from parotid duct
Palpate mass and comment on consistency, mobility etc
Palpate regional lymph nodes
Test facial nerve function
Most likely differential for mandibular angle swelling with no facial nerve involvement? What about with facial nerve invasion?
Pleomorphic adenoma
Facial nerve involvement suggests malignancy
Outline procedure for breast examination? Specific things to remember incl nerves?
Inspect with arms by sides and hands behind head
Palpate under areola and all regions of breast - normal then abnormal, express discharge if able
Examine axilla
Examine function of long thoracic (wing scapula - serratus anterior) and thoracodorsal nerves (lat dorsi)
Why is it important to examine the thoracodorsal nerve in breast exam? How do this?
Innervates latissimus dorsi - if considering latissimus dorsi pedicled flap but nerve impaired could cause atrophy of muscle and compromise prosthesis coverage
Why might there be impaired sensation in the axilla post-mastectomy?
Axillary node clearance - intercostobrachial nerves injured or divided
4 indications for mastectomy in treatment of breast cancer?
Patient choice
Large tumour where removal with conservation approach would give poor cosmesis
Multifocal lesions
Lobular cancers unless very small and focal
What scars may be easy to miss in breast examination?
Circumareolar, sentinel node scars, scars from reconstructive surgery e.g. lat dorsi (posterior), TRAM/DIEP at base of abdomen - may be hidden by underwear