Thyroid/Neck exam Flashcards
(12 cards)
Introduction
- Wash hands
- Introduce
- Patient details
- Permission: Today I have been asked to perform a thyroid examination - this will involve me having a look, a feel and a listen to your neck. We have our examiner here as chaperone. Does that sound okay?
- Exposure - N/A
- Reposition - sat opposite
- Any questions? Any pain?
General inspection
Hyperactivity: agitation/anxiety/fidgety
Hands and arms
Hand inspection - dry skin, increased sweating, thyroid acropachy, palmar erythema
Peripheral tremor - arms in front and paper on back of hands
Radial pulse - rate (tachy/brady), rhythm (regular/irregular)
Face inspection
Dry skin, sweating, loss of outer 1/3 of eyebrow
Eyes inspection
Exophthalmos (front, side and back)
Lid retraction (sclera visible above iris?)
Redness/inflammation of conjunctiva
Eye movements
H test - any blurred/restricted/painful vision?
Lid lag - follow finger high to low, watching upper eyelids
Neck inspection
Inspect midline - scars/erythema?
Swallow water - thyroid mass/thyroglossal cyst should move with swallowing, unlike lymph nodes
Protrude tongue - thyroglossal cyst should move up (unlike thyroid gland mass of lymph nodes)
Neck palpation
Stand behind patient and palpate using three middle fingers (assess size, symmetry, consistency, masses, palpable thrill)
-upper border of thyroid, cricoid cartilage
-isthmus
-thyroid lobes
-drink water, feel for elevation of thyroid lobes
-protrude tongue - cyst will rise
-lymph nodes
-tracheal deviation
Percussion
Percuss down praecordium to sternal notch
Auscultation
Auscultaste for thyroid bruit
Special tests
Reflexes - biceps
Inspect for pre-tibial myxoedema
Ask to stand with arms across chest - proximal myopathy
To conclude
THANK, WASH HANDS AND STETHOSCOPE
To conclude - TFTs, ECG, thyroid ultrasound/uptake scan
