Surgery OSCE Flashcards

Frank Jones Rt Sided Thyroid Nodules

1
Q

Presenting Complaint

A

Right Sided Thyroid Nodule

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2
Q

Presenting Situation

A

A 45-year-old male presented to surgery with right-sided thyroid masses by PCP (primary care physician). I have been feeling tired for the past few months and is very concerned

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3
Q

Opening Statement

A

I have been feeling tired and my PCP found a mass on my thyroid

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4
Q

How long have you been feeling tired?

A

2 months

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5
Q

Any weight gain

A

gained 5 pounds

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6
Q

Any trouble waking up

A

Have trouble waking up despite getting 8 hours of sleep

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7
Q

Have any pain

A

No

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8
Q

Have difficulties swallowing

A

No

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9
Q

Pain in the ears

A

No

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10
Q

Any anxiety or depression

A

No

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11
Q

Any tremors

A

No

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12
Q

Changes in neck over the past month

A

No

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13
Q

Noticed any changes in vision

A

No

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14
Q

Any sensitivity to temperature

A

I am sensitive to cold temperature

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15
Q

How often you have a bowel movement

A

Once a day

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16
Q

Any vomiting or diarrhea

A

No

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17
Q

Any weight loss

A

No

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18
Q

Any changes in the color of bowel movement

A

No changes

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19
Q

Any past skin disorders

A

Had radiation for acne as a teenager

20
Q

Any changes in hair

A

Barber mentioned that my hair is getting thinner

21
Q

Any allergies

22
Q

Are you able to feel the mass in neck

23
Q

Any chronic medical conditions

24
Q

Any long term medications the patient is on

25
Any surgical history
pilonidal cyst removal at 16 and wisdom teeth removed at 17
26
Are you married
Yes been married for 15 years
27
Do you have children
No
28
Any unprotected sexual encounters in the past two years.
No
29
Do you drink?
Yes I drink a glass of wine with meals on the weekend mostly dinner
30
Do you smoke currently
No
31
Do you have a smoking history
Yes I smoke a pack of cigarettes a day for 10 years.
32
Do you do illicit drugs
No
33
Any family medical history
Your mother had a goiter in her teens but was treated with medications a long time ago. The father has no medical history. Both parents are currently healthy.
34
How old are you
45 year old
35
Date of birth
January 7th 1979
36
Differential diagnosis
Benign Thyroid Nodule with Goiter Malignant Thyroid Nodule Hypothyroidism Anemia
37
Question regarding the malignant mass can be suspected for cancer
Can this be cancer?
38
Question testing the empathy of suspected malignant mass
Doc tell me straight I am going to die from this?
39
Thyroid Exam Finding
A firm 2.0 cm nodule is noted in the lower Rt. Lobe of the thyroid.
40
Size of the thyroid (Thyroid Exam Finding)
The thyroid is approximately 27 gms in size (slightly enlarged)
41
Neck Exam Finding
No masses or enlarged lymph nodes are identified in the posterior auricular, preauricular, submandibular, sternocleidomastoid, supraclavicular or posterior triangle lymph nodes
42
Cardiac Exam Finding
Tachycardic, regular rate and rhythm without murmurs, gallops, or regurgitation
43
Any lab work that was done by the PCP
No
44
When was the right-sided thyroid nodule discovered by the PCP
4 weeks ago and referral was made 3 1/2 weeks ago
45
Pulmonary Exam Finding
Tachypneic, breath sounds, equal bilaterally and clear without rales or Ronchi
46