Thyroid examination Flashcards
A … will move upwards on tongue protrusion.
Thyroglossal cyst
What will a Graves’ goitre feel like (3)
Smooth, symmetrical, soft
What will a MNG feel like (3)
Nodular, asymmetrical, firm
A pulsatile mass is likely to be what
Carotid body tumour
A fluctuant mass is likely to be what
Lipoma
The thyroid gland moves … on swallowing
Upwards
Name 2 indications that the goitre may be retrosternal
1) Cannot get under when patient swallows
2) Dull percussion note from xiphisternum to suprasternal notch
An goitric bruit is essentially diagnostic of what
Graves’
When listening for a bruit you must ask the patient to what
Hold their breath
Describe Pemberton’s test
Arms above head, large retrosternal goitre blocks thoracic inlet.
In what 2 ways might Pemberton’s test clinically manifest as positive?
Facial plethora (obstructed venous return) Stridor (tracheal compression)
How do you remember what to look for in the hands
The 4 PPPPs (+acropachy!)
What are the 4 Ps
Palmar erythema
Pulse
Paper (beta tremor)
Palms (temperature/sweat)
What pulses are associated with Hyperthyroidism (2)
AF
Tachycardia
What is the nail manifestation of Graves’
Acropachy
What are the 3 cardinal clinical manifestations of graves’
Eyes (exophthalmus + ophthalmoplegia)
Pretibal myxoedema
Acropachy
Describe pretibial myxoedema
Brown oedematous swelling above lateral malleolus
How would you clinically test for ophthalmoplegia
Double vision/pain when drawing an H
Where would you look from for exophthalmous
Sides and directly above
How would you check for exophthalmic goitre. Describe the test.
Lid lag (move finger quickly down when the pt is looking up)
… may also be present in the calfs. It is due to lymphoedema.
Non-pitting oedema
To finish this exam I would like to check.. and do these investigations (3)
Thyroid status
TFTs
USS
FNA (fine needle aspirate)
