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Z Year3 Clinical Examinations > Thyroid Exam > Flashcards

Thyroid Exam Flashcards

1
Q

How do you explain the thyroid exam?

A
  1. asked to perform an examination of your thyroid which is a gland in you neck
  2. involve me having a look and feel of you hands face neck and leg and then a listen of your neck and asking you to do a few movements does that sound ok?
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2
Q

How do you explain exposure?

A

I will need you to be able to see your neck region so is it ok if I move your shirt slightly when we come to that part and for this examination my examiner will be acting as a chaperone

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3
Q

What position is needed for the exam?

A

lay on the bed at 45 degrees and for this examination I need to be able to see your neck, the top of your chest and your legs – is that ok?

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4
Q

What do you look at after general inspection?

A

hands

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5
Q

What are you looking for on the hands?

A
  1. Inspect hands and clubbing
  2. Feel for temperature
  3. Hands out and piece of paper for fine tremor
  4. Pulse Offer BP
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6
Q

What would hypothyroidism look like on inspection?

A
  1. Overweight
  2. Low mood
  3. Signs of being cold, shivering, clothes
  4. Swollen face
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7
Q

What would hyperthyroidism look like on inspection?

A
  1. Underweight, muscle wasting
  2. Anxiety/hyperactivity
  3. Hot: sweating, clothes
  4. Flushing
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8
Q

What other things do you look for on inspection?

A
  1. Hoarse voice

2. Look for medication + mobility aids

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9
Q

What would you look for on the hands on thyroid exam?

A
  1. Thyroid acropachy
  2. Palmar erythema
  3. Dry skin
  4. Onycholysis
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10
Q

What would red hands and onycholysis suggest?

A

hyperthyroidism

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11
Q

What else do you check on the hands?

A

tremor

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12
Q

How do you test tremor?

A
  1. Now I would like you to stretch your arms out like this, and separate your fingers’
  2. Now could you close your eyes for me, please’
  3. I’m going to place this paper on your hands (if have paper available)’
  4. Tremor in hyperthyroidism
  5. Look at their hands to assess tremor
  6. Feel for the pulse at the same time (next slide)
  7. ‘Ideally I would do this for 30 seconds to assess for tremor’
  8. You can open your eyes now, and relax your arms by your sides again, thank you’
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13
Q

What is the radial pulse like in hypothyroidism?

A

bradycardia

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14
Q

What is the radial pulse like in hyperthyroidism?

A

tachycardia and rhythm irregular/AF

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15
Q

What is done after hands on the thyroid exam?

A

face

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16
Q

How do you explain the face for the thyroid exam?

A

‘I am going to have a look at your face now, so just look straight ahead for me. I will look from the front, both sides and above’

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17
Q

What do you look for on the face?

A
  1. Lid retraction
  2. proptosis
  3. conjunctival redness
  4. Missing outer 1/3 of eyebrow
  5. Look from the side and from above
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18
Q

How do you test eye movement?

A
  1. H test

2. Lid lag

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19
Q

What are you looking for on eye movement?

A

look for restricted movement

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20
Q

How do you explain the H test?

A
  1. am going to assess your eye movement now – do you have any pain in your eyes at the minute, or any double vision?’
  2. can you look at the tip of my finger, keeping your head still and follow my finger with your eyes’
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21
Q

How do you explain lid lag?

A
  1. ‘Now look straight ahead again’
  2. ‘And follow my finger downwards, keeping your head still’
  3. Move finger downwards slowly
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22
Q

What is lid lag?

A

Eyelid mover slower than eye

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23
Q

When is lid lag seen?

A

hypothyroidism

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24
Q

What eye signs are there in hypothyroidism?

A
  1. Dry skin
  2. Loss of outer 1/3 of eyebrow
  3. Myxoedema
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25
Q

What eye signs are seen in hyperthyroidism?

A
  1. Sweating
  2. Expothalamos/Proptosis
  3. Lid retraction
  4. Conjunctival redness
  5. Double vision
  6. Pain on eye movement
  7. Restricted eye movement
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26
Q

What is after face?

A

neck/thyroid inspection

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27
Q

What do you look for on inspection of the thyroid or neck?

A
  1. Goitre

2. Scar: thyroid surgery

28
Q

What do you do after neck inspection?

A

neck/thyroid movement

29
Q

How do you test neck/tnyroid inspection?

A
  1. Now please can you swallow
  2. Now stick out your tongue
  3. You can relax against
30
Q

What does it mean if there is a movement on swallowing?

A
  1. thyroid nodule/mass

2. thyroglossal cysts

31
Q

What does it mean if there is no movement of the lump on swallowing?

A

lymph node

32
Q

What does it mean if there is movement of the neck lump when you stick out your tongue?

A

thyroglossal cyst

33
Q

What does it mean if there is no movement on tongue protusion?

A

thyroid nodule/mass and lymph node

34
Q

What is after neck inspection?

A

palpitation

35
Q

How do you explain neck palpitation?

A

I am just going to stand behind you

Swing legs around

36
Q

How do you find the thyroid gland?

A
  1. Stand behind
  2. Use 1st 3 fingers
  3. Feel adam’s apple
  4. Move hands down gently: cricoid cartilage an thyroid isthmus
  5. Move laterally: wings of thyroid gland
37
Q

When you are feeling the thyroid what do you ask them to do?

A

swallow and stick out there tongue

38
Q

What do you look for when feeling the thyroid and swallowing?

A

symmetrical rising

39
Q

What do you look for when feeling the thyroid and sticking out tongue?

A

if rise-thyroglossal cyst

40
Q

If you feel a lump what do you comment on?

A
  1. Size
  2. Symmetry
  3. Consistency
  4. Masses
  5. Thrill
41
Q

What would a diffuse goitre feel like?

A

all enlarged

42
Q

What would a uninodular goitre feel like?

A

single lump

43
Q

What would a multinodular goitre feel like?

A

multiple lumps

44
Q

After feeling the thyroid what do you feel for?

A

lympahdenopathy

45
Q

After lymphadenopathy what do you feel for?

A

trachea

46
Q

How do you feel for the trachea?

A
  1. I need to feel for your windpipe now
  2. This might be uncomfortable but should not be painful
  3. Place 1st and 3rd fingers on end of clavicles
  4. Place middle finger centrally above the other 5. fingers
  5. Move it from side to side looking for deviation
47
Q

What would deviation of the trachea suggest?

A

goitre

48
Q

After feeling the trache what do you do?

A

percussion

49
Q

How do you explain percussion?

A

‘I am going to tap on your chest now, this won’t be painful, let me know if it is’

50
Q

How do you do percussion of the chest?

A
  1. Percuss down from sternal notch
  2. Place hand on chest: middle finger on sternal notch
  3. Use middle finger of other hand to tap middle finger on chest
  4. . Repeat down sternum
51
Q

What are you listening for on percussion?

A

dullness and retrosternal goitre

52
Q

After percussion what is done?

A

auscultation

53
Q

What side of steth do you use for auscultation?

A

bell

54
Q

How do you explain auscultation?

A

‘I am going to listen to your throat with this stethoscope now’

55
Q

How do you auscultate the thyroid?

A
  1. USE THE BELL
  2. Listen to both lobes
  3. Deep breath in and our and hold it
56
Q

What are you listening for on auscultation and what would it suggest?

A

Listening for bruits which would mean increased vascularity: GRAVE’s

57
Q

What is done after auscultation?

A

reflexes

58
Q

How are reflexes done?

A
  1. Make sure FLOPPY
  2. Flex first
  3. Jendrassik manoeuvre – clench teeth after 2 hits
  4. Max 3 hits
59
Q

What would reflexes be like in hyperthyroidism?

A

hyperreflexia

60
Q

What would reflexes be like in hypothyroidism?

A

hyporeflexia

61
Q

What is done after reflexes?

A

legs

62
Q

How are legs examined?

A

Would it be ok now to look at your legs please

Can you roll you trousers up

63
Q

What are you looking for in Graves?

A

pretibial myxedema: seen in Grave’s

64
Q

What is done after legs?

A

proximal myopathy

65
Q

How do you examine proximal myopathy?

A
  1. ‘I am going to test the muscles in your legs now’
  2. ‘Do you think you will be able to stand up?’
  3. ‘Can you cross your arms like this for me please’
  4. ‘Now stand up without using your hands’
  5. Put your arms either side of them so they do not fall
66
Q

When is proximal myopathy seen?

A

hyperthyroidism

67
Q

How do you complete the exam?

A
  1. A full history
  2. Blood test – thyroid function tests
  3. Ultrasound of the neck
  4. ECG – looking for rate and AF

Z Year3 Clinical Examinations (33 decks)

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