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Phase 2b Medicine > Thyroid Examination > Flashcards

Thyroid Examination Flashcards

1
Q

What should be included in the introduction of a thyroid examination?

A
  • Wash hands
  • Introduce yourself
  • Identify the patient
  • Explain the exam
  • Gather consent
  • Place the patient sat in a chair
  • Expose the neck
  • Confirm well being
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2
Q

What 6 things should be noted on general inspection of the patient?

A
  • Build
  • Clothing
  • Activity
  • Mental state
  • Quality of skin/hair
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3
Q

Weight loss and an increase in appetite is typical in which thyroid condition?

A

Hyperthyroidism

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4
Q

Weight gain and a decrease in appetite is typical in which thyroid condition?

A

Hypothyroidism

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5
Q

What may be significant with the clothing of someone with hyperthyroidism?

A
  • Prefer a cooler environment due to increase in temperature
  • Wear less clothes than appropriate for the weather
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6
Q

What may be significant with the clothing of someone with hypothyroidism?

A
  • Prefer a warmer environment due to a decrease in temperature
  • Wear more clothes than appropriate for the weather
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7
Q

What may hyperactivity indicate and what may be included in this (in a thyroid context)?

A
  • May indicate hyperthyroidism

- Agitation, anxiety, restless

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8
Q

What is a ‘typical’ mental state for someone who is hypothyroid?

A

State of lethargy & depression

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9
Q

Confusion can occur in both hyperthyroid & hypothyroid - true or false?

A

True

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10
Q

What may fine hair/hair loss indicate in a thyroid exam?

A

Hyperthyroidism

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11
Q

What ,may a hoarse voice indicate in a thyroid exam?

A

Thyroid gland enlargement because of compression to the larynx

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12
Q

What are the three main things to be inspected on the hands in a thyroid exam?

A
  • Hands & nails
  • Peripheral tremor
  • The radial pulse
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13
Q

What may dry skin & brittle nails indicate in a thyroid exam?

A

Hypothyroidism

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14
Q

What may increased sweating and & palmar erythema indicate in a thyroid exam?

A

Hyperthyroidism

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15
Q

What is palmar erythema?

A

Reddening of the palms of the hands

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16
Q

Name two non-thyroid causes of palmar erythema

A
  • Chronic liver disease

- Pregnancy

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17
Q

What is thyroid acropachy?

A

Phalangeal bone overgrowth

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18
Q

In which condition do you see thyroid acropachy?

A

Grave’s disease

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19
Q

In which thyroid condition does onycholysis occur?

A

Hyperthyroidism

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20
Q

What is onycholysis?

A

Separation of the nail from the nail bed

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21
Q

How do you inspect the hands for a peripheral tremor in a thyroid exam?

A
  • Place a piece of paper across the back of the patient’s hands to assess tremor
  • Paper quivering = indicates tremor
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22
Q

What is the significance of a peripheral tremor on a thyroid exam?

A

May indicate hyperthyroidism

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23
Q

What are the three findings to measure for in a radial pulse in a thyroid exam?

A
  • Bradycardia
  • Tachycardia
  • Atrial Fibrillation
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24
Q

What does bradycardia indicate in the context of a thyroid exam?

A

Sign of hypothyroidism

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25
Q

What does tachycardia indicate in the context of a thyroid exam?

A

Sign of hyperthyroidism

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26
Q

What does atrial fibrillation indicate in the context of a thyroid exam?

A

Thyrotoxicosis

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27
Q

If a pulse is irregular, how long should it be measured for?

A

60 seconds

28
Q

What should be inspected on the face when doing at a thyroid exam?

A
  • Dryness of skin
  • Sweating
  • Eyebrow fullness
29
Q

What may dry skin indicate in the context of a thyroid exam?

A

Hypothyroidism

30
Q

What may sweating indicate in the context of a thyroid exam?

A

Hyperthyroidism

31
Q

What may the loss of the outer third of the eyebrows indicate in a thyroid exam?

A

Rare sign of hypothyroidism

32
Q

What causes bilateral exophthalmos?

A

Abnormal deposition of connective tissue in the orbit and extra-ocular muscles

33
Q

Name the eye pathologies associated with thyrotoxicosis

A
  • Lid retraction
  • Eye inflammation
  • Exophthalmos
  • Eye movement abnormalities
  • Lid lag
34
Q

What is exophthalmos?

A

Bulging of the eye anteriorly out of the orbit

35
Q

What eye inflammation may be present in thyrotoxicosis?

A
  • Conjunctival oedema (chemoses)
  • Conjunctivitis
  • Corneal ulceration
36
Q

What issues with eye movement may arise in a thyroid exam?

A
  • Evidence for ophthalmoplegia

- Pain during eye movement

37
Q

What is ophthalmoplegia?

A

Paralysis or weakness of one or more of the eye muscles

38
Q

How do you assess the eye movements in a thyroid exam?

A
  • The ‘H’ test

- Create a H shape in the air, and get the patient to follow with their eyes

39
Q

What is lid lag?

A

A delay in the descent of the upper eyelid in relation to the eyeball when looking down

40
Q

How do you test lid lag?

A
  • Place your finger high in the air

- Move it downwards and observe the patients upper eyelids

41
Q

What should be noted on a general inspection of the thyroid?

A
  • Inspect the midline of the neck
  • Masses e.g. goitre
  • Scars e.g. previous thyroidectomy
42
Q

Should the thyroid gland be visible?

A

No

43
Q

How is a thyroid gland further inspected?

A

By swallowing and tongue protrusion

44
Q

How is swallowing used to assess the thyroid?

A

Watch the movement of the mass when swallowing water

45
Q

What happens to thyroid gland masses & thyroglossal cysts when swallowing?

A

They move upwards

46
Q

What happens to lymph nodes in the neck when swallowing?

A

They move very little

47
Q

What happens to an invasive thyroid malignancy on swallowing?

A

May not move is tethered to surrounding tissue

48
Q

What will happen when the tongue is protruded with a thyroglossal cyst?

A

Will move upwards noticeably

49
Q

What will happen when the tongue is protruded with a thyroid gland mass/lymph node?

A

Will not move

50
Q

How is the thyroid palpated?

A
  • Chin down, approach from behind
  • Place 3 middle fingers of each hand along the midline of the neck
  • Locate upper edge of thyroid cartilage (Adam’s apple)
  • Move fingers inferiorly until you reach cricoid cartilage
  • Palpate the thyroid isthmus
  • Palpate each lobe
  • Ask the patient to swallow water while palpating
  • Ask the patient to raise their tongue
51
Q

What are the important characteristics of the thyroid?

A
  • Size
  • Symmetry
  • Consistency
  • Masses
  • Palpable thrill
52
Q

What is important about the size of the thyroid?

A

If it feels enlarged

53
Q

What is important about the symmetry of the thyroid?

A
  • Look for asymmetry

- Unilateral enlargement may be caused by a thyroid nodule or malignancy

54
Q

What is important about the consistency of the thyroid?

A
  • Note any widespread irregularities

- Widespread irregularity may indicate multi nodular goitre

55
Q

Why is it important to assess for a palpable thrill in a thyroid exam?

A

Indicates increased vascularity due to hyperthyroidism

56
Q

What needs to be assessed if a thyroid mass is noted?

A

Position, shape, consistency and mobility

57
Q

Why are the lymph nodes palpated in a thyroid exam?

A

To assess for local lymphadenopathy which may indicate metastatic spread of primary thyroid malignancy

58
Q

Which lymph nodes should be felt in a thyroid exam?

A

Around the jawline, back of the neck and the collarbones

59
Q

What is the significance of tracheal deviation in a thyroid exam?

A

May be caused by a large goitre

60
Q

Why is the sternum percussed in a thyroid exam?

A
  • To assess for retrosternal dullness

- This may indicate a large thyroid mass, extending posteroinferiorly to the manubrium

61
Q

Why should the thyroid gland be auscultated?

A
  • To listen for a bruit

- This indicates increased vascularity, which usually occurs in Graves’

62
Q

Why is a biceps reflex performed in a thyroid exam?

A

Due to hyporeflexia occurring due to hypothyroidism

63
Q

How is a biceps reflex carried out?

A
  • Relax the patient’s arm, locate the biceps brachia tendon
  • Place the thumb of your non-dominant hand over the tendon and then tap your thumb with the tendon hammer
  • Observe for a contract
64
Q

What is the thyroid condition which may cause proximal myopathy?

A

A complication of mulitnodular goitre and Graves’ disease

65
Q

How do you screen for proximal myopathy?

A
  • Ask the patient to stand from a sitting position with their arms crossed
  • An inability to stand up would suggest proximal muscle weakness
66
Q

What further tests would be done after a thyroid exam?

A
  • Thyroid function tests

- ECG to rule out AF if irregular pulse noted

67
Q

What further imaging would be done after a thyroid exam?

A

An ultrasound of the neck to further assess any thyroid lumps

Phase 2b Medicine (17 decks)

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