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Lau - Clinical Skills
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History
Derm
Cardiac
Peripheral vascular
Resp
Occupational Health
Diabetes
Thyroid
Physical Exam
Vitals
Oral Cavity & Oropharynx
Precordial exam
JVP
Peripheral vascular
Respiratory exam
Diabetes foot exam
Thyroid exam
Lymph Node exam
Abdo exam
OSCE Checklists
Lau - Clinical Skills
Home
History
Derm
Cardiac
Peripheral vascular
Resp
Occupational Health
Diabetes
Thyroid
Physical Exam
Vitals
Oral Cavity & Oropharynx
Precordial exam
JVP
Peripheral vascular
Respiratory exam
Diabetes foot exam
Thyroid exam
Lymph Node exam
Abdo exam
OSCE Checklists
More
Home
History
Derm
Cardiac
Peripheral vascular
Resp
Occupational Health
Diabetes
Thyroid
Physical Exam
Vitals
Oral Cavity & Oropharynx
Precordial exam
JVP
Peripheral vascular
Respiratory exam
Diabetes foot exam
Thyroid exam
Lymph Node exam
Abdo exam
OSCE Checklists
Thyroid exam
Preparation
Wash hands
Get water for patient
Exposure: chin to manubrium and clavicles
Inspection (extend neck slightly, use tangential light, can inspect with swallowing water)
Scars (thyroidectomy scar)
Masses, lesions
Swelling, discolouration, muscle atrophy/hypertrophy
Goitre (diffusely enlarged thyroid)
Swallow water - comment on size, contour, symmetry, movement of thyroid gland
Palpation (anterior approach)
Landmark
Thyroid cartilage (Adam’s apple)
Cricoid cartilage (below thyroid cartilage)
Thyroid isthmus
Below cricoid cartilage, overlying 2nd, 3rd and 4th tracheal rings
Feel between cricoid cartilage & suprasternal notch
Swallow - palpate for enlargement, masses as it moves up
Thyroid lobes
Fingers move laterally into gutter between trachea and SCM
Ensure SCM relaxed (head slightly tilted toward side to be examined)
One hand stabilize the trachea
Other hand - palpate thyroid lobe
Comment on enlargement, masses
Findings to describe:
Palpable vs non-palpable
Size of gland
Texture
Tenderness
masses/nodules - single/multiple
Regional lymph nodes
Auscultation
Listen for thyroid bruit
Use bell
Listen for low-pitched sound
Post-encounter questions:
List 5 sign/symptoms of hyperthyroidism
List 5 sign/symptoms of hypothyroidism
Rational Clinical exam
Does this patient have a goiter (1995)
Rational Clinical exam update (2009)
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