Station Progress:

[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“Please examine this patient’s thyroid.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/149496581″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”8″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”2″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a normal thyroid gland and normal thyroid status.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

  1. Introduce yourself and ask the patient if they are in any pain;
  2. Ensure to explain if the patient does experience any pain, to inform you immediately;
  3. The best position for the patient to be in, is to be seated at the edge of the examination bed;
  4. First look at the patient in general:
    • are they overweight (hypothyroidism);
    • thick and coarse facial features (hypothyroidism);
    • dry skin (hypothyroidism);
    • peri-orbital oedema (hypothyroidism);
    • sweaty (hyperthyroidism).
  5. Then, look at the neck and face, from in front and at the side:
    • check for scars;
    • check for swellings;
    • check for any skin changes;
    • look at the eyes and check if there is any proptosis (exophthalmos) which will indicate Graves’ eye disease:
      • difficult to determine, but still a sign, look at the eyebrows, as the loss of the outer third of the eyebrows can be a sign of hypothyroidism.
  6. Always examine the thyroid from behind the patient, using the tips of your fingers in a gentle motion, from the midline anterior to posterior:
    • first check the isthmus (which is over the thyroid cartilage);
    • then move to the thyroid lobes;
    • if the gland is palpable, take note of the size, texture and whether there are any nodules;
    • feel for lymph nodes:
      • supraclavicular, submandibular, post-auricular and sub occipital;
      • the nature of the lymph nodes can help determine the cause of the thyroid mass, if present, for example tender lymph nodes that are separate are more likely to be reactive and from infection; hard lymph nodes which are together are more likely to be carcinomatous in origin whereas lymph nodes with a rubbery texture are more likely to be lymphomatous in origin.
  7. You can ask the patient to stick out their tongue to check for a thyroglossal cyst;
  8. You can ask the patient to hold some water in their mouth and then swallow to determine if there is a goitre:
    • if a goitre is obvious, you will notice that it moves with the swallowing action.
  9. Listen to the thyroid gland for bruits;
  10. Look at the hands for any signs of clubbing (thyroid acropachy);
  11. Feel the pulse:
    • it may be tachycardia and/or irregular in hyperthryoidism, however, in the PACES examine, you are unlikely to have someone who is actively hyperthyroid, and more likely to have a patient who is under treatment;
    • it may be bradycardia in hypothyroidism.
  12. Check for tremor, ideally with a piece of paper which will allow fine tremor to be more evident;
  13. Examine the legs for evidence of pretibial myxoedema;
  14. Test the ankle reflexes, which in hypothyroidism will be slow relaxing;
  15. Thank the patient and ensure their dignity is maintained throughout.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a normal thyroid gland and normal thyroid status.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]