C09 - Thyroid history taking PDF

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Thyroid history taking...

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Chapter 9 Thyroid Checklist HELP: H: ‘Hello’ (introduction and gains consent) E: Exposure (neck) L: Lighting P: Positions correctly (supine), asks if the patient is in any pain Washes hands Inspects from end of bed: • Relevant paraphernalia (e.g. drugs: levothyroxine, propranolol, amiodarone)

P MP F

• Auscultates for bruits over thyroid lobes • Auscultates over aortic area to rule out radiated aortic stenosis murmur • Attempts/states intension to examine for Pemberton’s sign Examination of peripheral signs of thyroid disease: • Examines hands: • Inspects for palmar erythema, warmth, tar staining and acropachy • Checks pulse for rate and rhythm • Examines for a tremor • Examines legs:

• Body habitus

• Inspects for pretibial myxoedema

• Clothing (e.g. suggestion of heat or cold intolerance)

• Correctly tests for proximal myopathy

Examination of thyroid gland: • Identifies neck swelling • Examines for JVP, distended neck veins • Palpates lobes of thyroid: • At rest • During swallowing • During tongue protrusion • Appropriate technique for palpating thyroid gland (e.g. stabilises ipsilateral lobe while palpating contralateral lobe)

• Examines for slow-relaxing knee reflex • Examines eyes: • Inspects from front, sides and above for proptosis, lid retraction and exophthalmos • Ensures patient is able to shut eyes completely (if appropriate) • Correctly tests for lid lag • Correctly tests for ophthalmoplegia Thanks patient Offers to help patient get dressed

• Assesses tracheal deviation

Washes hands

• Palpates carotid pulses

Presents findings

• Palpates cervical lymph nodes

Offers appropriate differential diagnosis

• Percusses downwards from sternal notch to detect retrosternal extension of goitre

Suggests appropriate further investigations and management OVERALL IMPRESSION:

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran. © 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd....