Thyroid OSCE

Question 1

first step

Answer 1

wash hands, introduce self, identify patient and gain informed consent

Question 2

second step

Answer 2

general inspection
-weight, mood, hair, skin

Question 3

will weight be increased or decreased in hypothyroidism

Answer 3

increased

Question 4

will weight be increased or decreased in hyperthyroidism

Answer 4

decreased

Question 5

what is being assessed in the hands?

Answer 5

temperature, sweaty, nail health, clubbing

Question 6

what is shown by placing paper on the hands outstretched?

Answer 6

tremor

Question 7

what is being assessed in the radial pulse?

Answer 7

rate, rhythm

Question 8

how to assess the eyes?

Answer 8

front, side and above.
looking for exopthalmos, retraction of lid, lid lag.
H movement
Offer acuity and fundoscopy

Question 9

what is assessed in the mouth (on inspection)

Answer 9

back of tongue, lingual thyroid?

Question 10

what is assessed in the neck in inspection?

Answer 10

goitre, movement on swallow

Question 11

what is assessed on palpation?

Answer 11

is the trachea central?
are lymph nodes enlarged?
palpate thyroid gland and feel on swallow

Question 12

what is assessed on percussion

Answer 12

retrosternal goitre

Question 13

what is assessed on auscultation

Answer 13

get pt to hold breath, use bell to listen for thyroid bruits

Question 14

what extra tests are there?

Answer 14

proximal myopathy- get pt to stand with arms crossed
ankle reflexes (delayed in hypothyroidism)
inspect legs for pretibial myoxedema