Page 1 of 1: OSCE-Buster: Thyroid Gland Examination Notes

sajida · Credits: 105747 My Scrapbook My Reading List 6 Books

Hello Mr/Mrs…………….I am Dr. …………………………SHO in this department. I am here to examine your neck is that okay with you?…………………………thanks.

‘I want to start by looking at your hands, could you please give me your hands’

Check for:

Skin, warm-sweaty (hyperthyroidism) or coarse-dry (hypothyroidism).

Any nail changes.

Fine tremor (use a paper):

‘Could you please outstretch both your arms and spread your fingers’

‘Now, I want to check your pulse and blood pressure’

‘I come to examine your face, please’

Inspect for:

Excessive sweating
Hair changes (e.g. loss of hair in the lateral 3rd of the eyebrows in hypo)
Ptosis
Chemosis
Lid retraction
Lid lag (ask to follow your finger up and down –not too slowly, Graafe’s sign)
Ophalmoplagia (ask to follow your finger up, down, right and left)
Exophthalmos (Joffroy’s sign: tilt the head down and ask to look upward, look for the absence of forehead wrinkling)(from the back: tilt the head back and support it with right hand and remove the hair with the left hand and see if present)

‘Now, I would like to examine your neck’

Inspect if there is obvious lump, goitre or enlarged lymph node. Tip patient’s head back a bit and ask:

‘Could you please swallow your saliva or take a sip of water’

For thyroglossal duct or cyst and lingual thyroid ask:

‘Could you please stick your tongue out’

‘Mr/Mrs…………….Now, I am going to touch your neck from behind, okay’

Stand behind the patient and gently palpate thyroid lobes, again ask to swallow his/her saliva or to take a sip of water. Palpate both lobes first, then stabilise one lobe and palpate the other.

Afterthat, palpate for regional lymph nodes.

For any lump, mass or enlargement note and describe the following:

Anatomical boundaries (i.e. site)
Size (about ……………x………………cm)
Consistency ( soft, firm or stony hard)
Surface texture (smooth-regular or irregular)
Mobility (freely mobile or fixed to surrounding tissues)
Temperature

Ask the patient to breathe in deeply and palpate (to check for stridor)

Check tracheal position

Percuss the upper sternum for retrosternal extension.

Auscultate for bruit:

‘Now, I want to listen to your gland’

Finally, you might want to rule out recurrent laryngeal nerve palsy by asking the patient:

‘Could you please cough’

Check for:

Pretibial myxoedema

Knee and ankle reflexes

Thank the patient for the co-operation

Summarise your findings for the examiner.

sangy · Credits: 2202 My Scrapbook

thanks

sepplabber · Credits: 9540 My Scrapbook

keep it up

James444 · Credits: 932 My Scrapbook

Comprehensive! Thanks.

d_razaq · Credits: 528 My Scrapbook

Comprehensive! Thanks but no ptosis.

danny5blue · Credits: 422 My Scrapbook

1) Introduce
2) Adequately expose – general look
3) LOOK
a. From front and sides for hyperaemia, distended veins, scars, obvious swellings
b. Drink water and swallow
c. Stick out tongue
4) FEEL
a. Is it painful
b. Stand behind – hard/soft, multinodular, single nodule, diffuse
c. Swallow + protrude tongue
d. Feel lymph nodes: Submental, Submandibular, Peri- and post- auricular, Occipital, Deep cervical, Supraclavicular
e. Look over head for proptosis
5) Percuss
a. Percuss for retrosternal extension
b. Palpate tracheal deviation
c. Listen for bruits

Specific Thyroid Signs
6) EYES
a. Loss of outer 1/3 eyebrow
b. Exopthalmos
c. Opthalmoplegia, lid lag, lid retraction, chemosis, papilloedema, loss of colour, corneal ulceration
7) HANDS
a. Thyroid acropachy
b. Fine tremor with paper
c. Palmar erythema + sweaty and warm
d. Pulse – tachy/brady/AF
8) SHINS- pretibial myxoedema – red/purple
9) Talk about appropriate clothing
10) To conclude exam would ask pt to stand up for proximal muscle weakness and check for slow relaxing reflexes
11) Tx: Conservative or surgical (thyroidectomy)
12) Carbimazole (agranulocytosis)  iodination of thyroxine
13) Complications: HF, angina, osteoporosis, gynaecomastia

d_razaq · Credits: 528 My Scrapbook

one more thing to add
exophthalmos has nothing to do with wrinkling of forehead. If u can see the sclera above the cornea when pt. is looking straight ahead, u can say that exophthalmos is present.

babo7511 · Credits: 200 My Scrapbook

thanks for the good info

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