OSCE

Question 1

Goitre general exam

Answer 1

• Agitation
  
  • Cachexia
  • Tired
  • Cold?
    Fidgety

Question 2

Goitre hands

Answer 2

- Thyroid acropachy 
		○ Clubbing
		○ Swelling of digits (periosteal reaction)
		○ Graves
	Tremor - paper
	Palms
		Palma erythema (hyper)
		Dry skin (hypo)
		Sweat (hyper
	Pulse - AF
BP

Question 3

Goitre head

Answer 3

• Hair - outer third of eyebrow/ dry skin
  
  • Sweating
  • Anaemia - both can cause
  • Lid lag
    ○ H test - obstruction of eye movement - pain
    ○ Up to down for lid lag
  • Exopthalmos - pick a point behind on wall
    ○ Lid retraction - sclera visible above iris
    ○ Inspect for anterior displacement
    ○ Look from behind with patient staring upwards
    Puffy face

Question 4

Neck Goitre Inspection

Answer 4

○ Scars - ectoma
		○ Skin changes - erythema
		○ Lumps -thyroid or lymp
		○ Swallow water - movement of mases
		○ Tongue out
			§ No movement = thyroid gland or lymph
Upward movement = thyroglossal cyst

Question 5

Neck Goitre palpation

Answer 5

○ Flex neck forwards and relax
○ Begin at thyroid cartilage (adams apple)
○ Down to superior edge of cricoid cartilage
○ (below is isthmus
○ Then each lobe seperately
○ Ask to stick out tongue (thyroglossal cyst will rise)
○ Swallow - asymettry = unilateral thyroid mass
○ Lymph nodes
Tracheal deviation

Question 6

Neck Goitre percussion

Answer 6

Percuss - retrosteronal dulness = x3 centrally (large goitre extending inferiorly)

Question 7

Neck goitre ausculation

Answer 7

Each lobe for bruit due to increased vasc in Graves

Question 8

Special tests goitre

Answer 8

Special tests
- Reflexes - hypo
- Pretibial myxoedema - Graves
Stand up (proximal myopathy) with arms folded - hyper