ENDOCRINOLOGY - COMMON SHORT CASES

Question 1

In a case of hyperthyroidism, how do you want to prove that it is an enlarged thyroid gland ?

Answer 1

Asked the patient :
-to take a sip of water and swallow it ,if it is enlarged thyroid it will moved with swallowing
-to protrude their tongue ,if it does not move it is an enlarged thyroid

Question 2

If the enlarge nodule move with tongue protrusion ,what do you suspect ?

Answer 2

Thyroglossal cyst

Question 3

After you confirm that it is thyroid , what do you want to do next ?

Answer 3

Palpation ,in order to determine :
The size (measuring tape)
The characteristics (single / multiple)
The consistency (firm / hard/ soft)
Tenderness
Mobility

Question 4

After palpation ,what else do you want to do ?

Answer 4

Percussion .
In order to detect superior mediastinal extension.
If there is , it should be dull during percussion
If not ,then it will be resonant

Question 5

After percussion , what do you want to do next ?

Answer 5

Auscultation .In order to detect the presence of bruit .

Question 6

For hyperthyroidism ,moving to upper limb , what features did you want to check ?

Answer 6

-Fine tremor
-Sweaty palm
-Pulse rate

Question 7

For hyperthyroidism ,after the upper limb ,moving to the eyes ,how you want to examine ?

Answer 7

Looking for exophthalmos (from back ,side and front)
-Lid lag
-Lid retraction
-Thyroid stare

Question 8

For hyperthyroidism, at the lower limb ,what did you try to look for ?

Answer 8

Pretibial myxedema
-a skin condition that causes plaques of thick, scaly skin and swelling of your lower legs

Question 9

On the limbs of Cushing’s syndrome patients , what do you look for

Answer 9

-Fungal infection
-Thin skin ,easy bruising
-Proximal myopathy
-Pedal edema

Question 9

What is the clinical features of Cushing’s syndrome ?

Answer 9

-round facies ,facial plethora
-hirsutism (female only)
-cataracts
-central obesity
-purple striae at unusual site
-supraclavicular fat pads
-dorsal cervical hump
-bony tenderness

Question 10

For CS ,apart from the physical examination , what else you want to examine ?

Answer 10

• Blood pressure - hypertension
• Urine dipstick for glycosuria
• Bedside glucose reading for hyperglycemia
• Enquire regarding chronic glucocorticoid

Question 11

For acromegaly , what is the facial clinical features you look for ?

Answer 11

• Coarse facial features
• Frontal bossing
• Look for transfrontal or transpenoidal scar
• Feel for greasy skin and hyperhidrosis
• Prognathism
• Macroglossia , teeth indentation on sides of tongue
• Wide teeth spacing
• Bitemporal hemianopia

Question 12

About the facial features , how you want to confirm that there is changes / abnormality ?

Answer 12

Ask for old photos or IC

Question 13

For acromegaly , instead of facial features , what else do you want to look for ?

Answer 13

Wide spade-like hands
Tinel sign
Skin tags (if there is , it tell us it is an active acromegaly )
Acanthosis nigricans
Goiter

Question 14

For acromegaly , other than the physical examination , what else you want to examine ?

Answer 14

• blood pressure for hypertension
• urine dipstick for glycosuria
• bedside glucometer for hyperglycemia
• visual field examination for visual field defect
• cardiovascular and abdominal examination for organomegaly