Thyroid Status Examination - OSCE Guide | UKMLA | CPSA | PLAB 2

Summary

In this transcript, Andrew, a final-year medical student, conducts a thorough thyroid examination on Simon, a 24-year-old patient. The examination involves a general inspection of Simon’s neck, palpation of the thyroid, and assessment of his reflexes and breathing. Notable findings include a fine tremor in Simon’s hands, though no other symptoms of thyroid disease are present. The examination is completed with some additional tests, and Andrew recommends blood tests to further investigate Simon’s thyroid function, particularly focusing on T4 and TSH levels.

Takeaways

• 😀 A final-year medical student named Andrew conducted a thyroid examination on Simon, a 24-year-old male.
• 😀 The examination began with Andrew asking Simon for confirmation of his name and age.
• 😀 The primary focus of the examination was Simon's thyroid gland, which was inspected through both visual and physical assessment.
• 😀 Simon was instructed to extend his arms and splay his fingers to facilitate a pulse check.
• 😀 The eye examination involved Simon following Andrew's finger to assess his eye movements and look for any signs of double vision or pain.
• 😀 A detailed neck inspection was performed, including Simon swallowing water and sticking out his tongue.
• 😀 The neck glands were palpated to assess for enlargement or any abnormalities.
• 😀 Andrew felt Simon's windpipe, which may have caused mild discomfort, and tapped on his chest for further evaluation.
• 😀 A series of reflex tests were performed on Simon’s arms, and he was asked to roll up his trousers for inspection of his shins.
• 😀 The examination ended with Simon standing and crossing his arms to complete the postural test.
• 😀 The examination revealed a fine tremor in Simon’s outstretched hands, but no signs of thyroid eye disease or goiter were found, prompting further investigation through blood tests for T4 and TSH levels.

Q & A

What is the purpose of Andrew's examination of Simon?

Andrew is conducting a thyroid examination on Simon to assess his thyroid health, including checking for signs of thyroid disease such as goiter, eye disease, or tremors.

How does Andrew begin the examination?

Andrew begins the examination by confirming Simon's age and obtaining consent to examine his thyroid gland, ensuring Simon is comfortable before proceeding.

Why does Andrew ask Simon to bring his arms out in front and splay his fingers?

Andrew asks Simon to bring his arms out and splay his fingers to observe if there is any tremor in his hands, which could be a sign of thyroid issues.

What is the purpose of Andrew feeling Simon's pulse?

Andrew feels Simon's pulse to check for any abnormalities, as changes in pulse rate can sometimes indicate thyroid dysfunction.

What does Andrew look for when inspecting Simon's eyes?

Andrew inspects Simon's eyes for signs of thyroid eye disease, which can be a common manifestation of thyroid problems.

Why does Andrew ask Simon to follow his finger with his eyes during the examination?

Andrew asks Simon to follow his finger to assess the movements of Simon's eyes and check for any signs of double vision or difficulty in eye movement, which could indicate thyroid-related issues.

What is the purpose of Simon swallowing water during the examination?

Simon is asked to swallow water to help Andrew assess the functioning of his thyroid gland and to check for any abnormal swellings or issues in the neck area.

Why does Andrew feel Simon's neck during the examination?

Andrew feels Simon's neck to check for any enlargement or lumps in the thyroid gland, which could indicate a goiter or other thyroid conditions.

What special tests does Andrew perform on Simon at the end of the examination?

At the end of the examination, Andrew performs reflex tests on Simon's arms, inspects his shins, and checks his posture and movements by having him stand and cross his arms.

What additional tests does Andrew suggest to complete the examination?

Andrew suggests conducting blood tests to check Simon's T4 and TSH levels, which are important indicators of thyroid function.