OSCE - Endocrine
Card Set Information
OSCE - Endocrine
Endocrine study notes, from the OSCE and Clinical Skills Handbook
What are the signs of hyperthyroid?
- goiter (with or without bruit)
- atrial fibrillation/tachycardia
- proximal myopathy
- bowel frequency
- hot sweaty hands
What are the signs of hypothyroid?
delay in tendon relaxation time
The endocrine physical examination should include inspection of the skin for:
Inspection of skin
The endocrine physical examination should include inspection of the face for:
coarse facial features
"Queen Anne's eyebrows"
The endocrine physical exam should include inspection of body habitus for:
supraclavicular fat bad
large hands and feet
The endocrine physical exam of the neck includes:
Inspection of the neck - static and on swallowing
Palpation of the thyroid - static and on swallowing
palpation of the thyroid's isthmus and lobe margins, noting size, symmetry, consistency, nodularity, tenderness
auscultation of the thyroid for bruits
DDx to consider for galactorrhea
Metabolic - drugs, breast-feeding, acromegaly, hypothyroidism
idiopathic/iatrogenic - liver failure
neoplastic - prolactinoma
pregnancy (true or false)
How can the elderly's presentation of hyperthyroid differ from the average patient?
may present as an apathetic pt rather than in a hypermetabolic state
What is a thyroid storm? Signs and Symptoms? Precipitants?
life threatening emergency
caused by infection, trauma, surgery
Other physical exam skills to remember for endocrine stems
: CN - especially extra-occular mov'ts, reflexes, tremor, papilledema, peripheral senses for DM
consider breast exam and DRE depending on your DDx
Abdo exam - esp look for rebound tenderness, signs of functional liver changes
What are some complications to watch out for with DM?
Use the mnemonic BEANN
: retinopathy, cataracts, glaucoma
: HTN, ischemic heart disease, PVD, stroke, TIA
: altered proprioception, mononeuropathies, peripheral neuropathy, automic neuropathy
What is a myxedema coma? Signs and symptoms? Precipitants?
life threatening complication of hypothyroidism - state of hypometabolism, can cause tissues to be infiltrated by mucopolysaccharides
exposure to cold (plus more)
What should your DDx for Hypothyroidism include?
: radioactive thyroid ablation, thyroidectomy
: Hashimoto's thyroiditis
: Idiopathic thyroid atrophy
What should your DDx for Hirsutism include?
: cushing's syndrome, androgen-secreting ovarian tumors, PCOS, CAH, acromegaly, drugs
Signs/Symptoms of Virilization (as caused by PCOS, androgen secreting tumour, CAH)
male muscle pattern
signs/symptoms of pituitary edenoma
signs/symptoms of cushing's syndrome
signs/symptoms of acromegaly
thick, coarse, oily skin
increased space between teeth
increased shoe, hat, glove, ring sizes
symptoms of hypoglycemia
symptoms of hyperglycemia
What should your DDx of an anterior neck lump include?
: carotid aneurysm
: thyroid nodule
: thyroglossal cyst
enlarged lymph node
enlarge salivary gland
What features of a thyroid nodule would make you suspicious of malignancy?
age (<20, > 60)
associated hoarseness or dysphagia
hx of radiation to area
nodule is firm, fixed, nontender
'cold' on thyroid scan
complex cystic nodule
family hx of medullary ca of thyroid or MEN II
what are the clinical features of DKA?
young pt with DMI
what are the clinical precipitants of DKA?
give four helpful pieces of advice for a DM pt wrt exercise
use proper footwear and inspect feet daily
avoid exercise over periods of unstable metabolic control
take blood sugar readings b/f exercise and consume simple rapidly absorbed CHO if bs<5
avoid exercise in extreme hot or cold conditions
administer insulin in a site away from those muscle groups being exercised
describe EKG changes common to obese pts
leftward shift of p-waves, t-waves and qrs complexes
low qrs voltages
flattening of t-waves in the inferior and lateral leads
identify 3 advantages of wt loss
lowers elevated bp
improves lipid profiles (lowers total chol, LDL and TG and increases HDL)
lowers elevated BG levels and reduces insulin resistance
identify 4 disadvantages of wt loss
hypovitaminosis due to reduction of food intake
initial wt loss can cause dosing problems
rebound wt gain
medical complications of severe obesity (BMI>40)
renal vein thrombosis