Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE - examinations > Thyroid status + neck examination > Flashcards

Thyroid status + neck examination Flashcards

1
Q

What are the parts of a thyroid examination?

A
  1. General inspection
  2. Neck inspection
  3. Neck palpation
  4. Palpation of nodes
  5. Percussion
  6. Auscultation
  7. Special tests
  8. Hands and wrists
  9. Face
  10. Limbs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is part of the general inspection of a thyroid and neck examination?

A
  1. Hyperthyroidism -> think, fidgety, tremulous, sweaty, flushed, restless
  2. Hypothyroidism -> fat, warmly dressed, hair loss, dry skin, deep voice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is part of the specific inspection of a thyroid and neck examination?

A
  1. “Where is the area of concern”
  2. Look from front and sides; defines locations
  3. Swallowing (ask patient to take sip of water and hold in mouth, instruct to swallow as you look from front. Look from other angles)
  4. Stick out tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is part of the palpation of the neck of a thyroid and neck examination?

A

“Do you have any pain the neck”

  1. Start behind the patient and use both hands to examine the lump, or feel for swelling if that’s the concern
  2. Palpate from behind when patient swallows water
  3. Attempt to transilluminate lump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What parameters would you consider when examining the lump?

A
  1. Size/shape/symmetry
  2. Surface
  3. Consistency
  4. Edge
  5. Fluctuance (e.g. lipoma)
  6. Pulsation
  7. Temperature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are Graves’ lumps like?

A

Soft, smooth and symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are multinodular lumps like?

A

Firm, nodular, asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you describe the edge of a lump?

A

Well defined, indistinct, irregular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can pulsation of a lump imply?

A

Carotid body tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is the temperature of a lump important?

A

Increased warmth may suggest an inflammatory or infective cause (e.g. infected epidermoid cyst)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you assess thyroid swelling?

A
  1. Diffuse enlargement or single nodule?
  2. If diffuse, is it smooth or multi nodular?
  3. Lower extent - can you get below the thyroid?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is part of the percussion of the neck of a thyroid and neck examination?

A

Both sides of the lump

A retrosternal goitre may cause a dull percussion note

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is part of the auscultation of the neck of a thyroid and neck examination?

A

Both sides of the lump while patient holds their breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is auscultation important in a neck exam?

A

Bruits are virtually diagnostic of Graves’!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is part of the special tests that can be performed in a thyroid and neck examination?

A

Pemberton’s test (if large goitre): raise both hands above head and take slow breath in

Listen for stridor which is indicative of tracheal compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is part of the hands and wrist assessment of a thyroid and neck examination?

A 
Clubbing
Palms
Palmar erythema
Paper (put on hands to detect fine tremor)
Pulse
17
Q

What can you see in hypo versus hyperthyroidism in the following:

Clubbing
Palms
Palmar erythema
Paper (put on hands to detect fine tremor)
Pulse
A

Clubbing: a sign of Graves; none for hypo

Palms: hot and sweaty in hyper, cold and dry in hypo

Palmar erythema: yes in hyper, no in hypo

Tremor: yes in hyper, no in hypo

Pulse: tachycardia and AF in hyper, bradycardia in hypo

18
Q

What is part of the face assessment of a thyroid and neck examination?

A 
Facial appearance 
Hair and eyebrows
Eyes
Eye movement 
Lid lag
19
Q

What can you see in hypo versus hyperthyroidism in the following:

Facial appearance 
Hair and eyebrows
Eyes
Eye movement 
Lid lag
A

Facial appearance: flushed in hyper, peaches and cream in hypo

Hair and eyebrows: thin and brittle in hypo

Eyes: exophthalmos in Graves! Eyelids may be retracted in hyper, and may be puffy in hypo

Eye movement (H movement): ophthalmoplegia (upwards gaze) in Graves’

Lid lag (move finger upwards, then downwards quickly): present in hyper

20
Q

What is part of the limbs assessment of a thyroid and neck examination?

A
  1. Knee and biceps reflexes
  2. Carpal tunnel syndrome (median nerve power and sensation, Tinel/Pathen tests)
  3. Proximal myopathy (shoulder abduction, stand up with arms crossed)
  4. Oedema (pre-tibial myxoedema, generalised non-pitting peripheral oedema)
21
Q

What can you see in hypo versus hyperthyroidism in the following:

  1. Knee and biceps reflexes
  2. Carpal tunnel syndrome (median nerve power and sensation, Tinel/Pathen tests)
  3. Proximal myopathy
  4. Oedema
A
  1. Knee and biceps reflexes: brisk in hyper, slow-relaxing in hypo
  2. Carpal tunnel syndrome: common in hypo
  3. Proximal myopathy: yes in hyper
  4. Oedema: myxoedema in Graves’, pitting oedema in hypo
22
Q

What would you suggest after a thyroid and neck examination?

A

TFTs, USS, FNA

23
Q

What are the different types of lumps based on the location:

  1. Midline
  2. Anterior triangle
  3. Posterior triangle
  4. Anywhere
A
  1. Midline: goitre, thyroglossal cyst
  2. Anterior triangle: branchial cyst, carotid body tumour, lymph node
  3. Posterior triangle: cystic hygroma, lymph node
  4. Anywhere: lipoma, sebaceous cyst
24
Q

What are causes of a goitre?

A
  1. Multinodular goitre
  2. Graves’ disease
  3. Solitary nodule
  4. Hashimoto’s thyroiditis
  5. Subacute thyroiditis
25
Q

What are causes of hypothyroidism?

A
  1. Autoimmune: hashimoto’s
  2. Acquired:
    a. Iodine deficiency
    b. subacute
    c. iatrogenic: surgery, radioiodine, carbimazole, lithium, amiodarone
26
Q

What are the classic features of graves?

A
  1. Goitre
  2. Thyrotoxicosis
  3. Eye disease: exophthalmos, ophthalmoplegia
  4. Pre-tibial myxoedema
  5. Thyroid acropachy
27
Q

What differentiates Graves from multinodular goitres?

A

Graves: smooth, has unique clinical features and TSH-receptor antibodies

28
Q

What are indications for surgery in Graves’?

A

Cosmetic
Local compression
Failed medical treatment
Intolerant to medication

29
Q

What is a multinodular goitre (MNG)?

A

Most common large goitre

Normal thyroid levels (unless toxic MNG)

30
Q

What are causes of hyperthyroidism?

A
  1. Graves
  2. MNG
  3. Toxic nodule (adenoma)
31
Q

What are causes of bilateral parotid swelling?

A 
Viral or bacterial parotitis 
TB
Alcohol
Pleomorphic adenoma 
Sarcoidosis
32
Q

What are causes of unilateral parotid swelling?

A

Duct blockage

Unilateral pleomorphic adenoma

33
Q

What medication would you give in hyperthyroidism?

A

Symptomatic: beta blockers
Thyroid: carbimazole

Also radioiodine or surgery

34
Q

What are contraindications for radio iodine?

A

Pregnancy
Young children at home
Incontinent

OSCE - examinations (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions