Thyroid - or use oscestop?

Question 1

What is the position for a thyroid exam?

Answer 1

45degrees

Question 2

What are you looking for on general inspection (thyroid)?

Answer 2

Hyperactivity: agitation/anxiety/fidgety

Question 3

What must be done when moving onto the hands/arms (thyroid)?

Answer 3

1) Inspection of Hands

• Dry skin,
• increased sweating
• Thyroid acropachy
• Palmar erythema

2) Peripheral tremor:

Arms in front & paper on back of hands (observe if paper quivers)

3) Radial pulse:

• Rate: Tachycardia, bradycardia?
• Rhythm: irregular/AF?

Question 4

What must be done when moving onto the face (thyroid)?

Answer 4

1) Inspection face:

• dry skin, sweating, loss eyebrows (outer 1/3)

2) inspect eyes

• Exophthalmos(front/side/back)
• Lid retraction (sclera visible above iris?)
• Redness/inflammation of conjunctiva

3) Examine eyes movements:

• H TEST
• observe for restricted movements, or reports double vision/pain?

4) Examine for Lid lag:

• Keep head still & follow finger (high to low), observing upper eyelids lagging behind eyes

Question 5

What must be done when moving onto the neck (thyroid)?

Answer 5

1) Inspection

• a) midline: Scars/ Skin changes (e.g. erythema)?
• b) for masses: Swallow water: observe movement (thyroid mass/thyroglossal cyst should move with swallowing but not lymph nodes)
• c) protrude tongue: thyroglossal cyst should move up (but not thyroid gland mass or lymph nodes)

2) Palpation

using middle 3 fingers

• a) general: Upper border of thyroid, cricoid cartilage, Isthmus,Thyroid lobes
• b) drink water – feel for elevation of thyroid lobes
• c) protrude tongue (thyroglossal cyst will rise)
• d) Palpate for lymphadenopathy
• e) Tracheal deviation

Question 6

What must be done on percussion (thyroid)?

Answer 6

sternal notch –> down praecordium

Question 7

What must be done on auscultation?

Answer 7

listen for thyroid bruit

Question 8

What quick things must be done before the end of the thyroid exam?

Answer 8

• reflexes e.g. biceps
• Inspect for pre-tibial myxoedema
• Proximal myopathy