OSCE - Endocrine

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schulichbeliever
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58223
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OSCE - Endocrine
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2011-01-07 03:15:59
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OSCE
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Endocrine study notes, from the OSCE and Clinical Skills Handbook
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  1. What are the signs of hyperthyroid?
    • - goiter (with or without bruit)
    • - atrial fibrillation/tachycardia
    • - proximal myopathy
    • - bowel frequency
    • - hot sweaty hands
    • - tremor
  2. What are the signs of hypothyroid?
    • gruff voice
    • dry skin
    • coarse features
    • goiter without bruit
    • pericardial effusion
    • ascites
    • bradycardia
    • carpal tunnel
    • hypothermia
    • delay in tendon relaxation time
  3. The endocrine physical examination should include inspection of the skin for:
    • Inspection of skin
    • hirsutism
    • dry/oily skin
    • sallow skin
    • striae
    • foot ulcers
  4. The endocrine physical examination should include inspection of the face for:
    • facial edem
    • moon facies
    • coarse facial features
    • prognathism
    • exophthalmos
    • "Queen Anne's eyebrows"
  5. The endocrine physical exam should include inspection of body habitus for:
    • central obesity
    • supraclavicular fat bad
    • "buffalo hump"
    • large hands and feet
  6. 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
  7. DDx to consider for galactorrhea
    • Metabolic - drugs, breast-feeding, acromegaly, hypothyroidism
    • idiopathic/iatrogenic - liver failure
    • neoplastic - prolactinoma
    • pregnancy (true or false)
  8. 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
  9. What is a thyroid storm? Signs and Symptoms? Precipitants?
    • life threatening emergency
    • profound thyrotoxicosis
    • fever
    • weakness
    • cardiovascular collapse
    • shock

    caused by infection, trauma, surgery
  10. Other physical exam skills to remember for endocrine stems
    • Vitals
    • Neuro: CN - especially extra-occular mov'ts, reflexes, tremor, papilledema, peripheral senses for DM
    • Peripheral pulses
    • consider breast exam and DRE depending on your DDx
    • lymphatics
    • Abdo exam - esp look for rebound tenderness, signs of functional liver changes
  11. What are some complications to watch out for with DM?
    • Use the mnemonic BEANN
    • Bugs: infections
    • Eyes: retinopathy, cataracts, glaucoma
    • Arteries: HTN, ischemic heart disease, PVD, stroke, TIA
    • Nephropathy
    • Nerves: altered proprioception, mononeuropathies, peripheral neuropathy, automic neuropathy
  12. 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

    • hypothermia
    • coma
    • resp depression

    • infection
    • trauma
    • exposure to cold (plus more)
  13. What should your DDx for Hypothyroidism include?
    • Traumatic: radioactive thyroid ablation, thyroidectomy
    • Autoimmune/Allergic: Hashimoto's thyroiditis
    • Metabolic: Hypopituitarism
    • Idiopathic/Iatrogenic: Idiopathic thyroid atrophy
  14. What should your DDx for Hirsutism include?
    • metabolic: cushing's syndrome, androgen-secreting ovarian tumors, PCOS, CAH, acromegaly, drugs
    • idiopathic/iatrogenic: obesity
    • congenital/genetic: familial
  15. Signs/Symptoms of Virilization (as caused by PCOS, androgen secreting tumour, CAH)
    • acne
    • oligo/amenorrhea
    • deepened voice
    • breast atrophy
    • male muscle pattern
    • temporal balding
    • clitoral enlargement
  16. signs/symptoms of pituitary edenoma
    • h/a
    • galactorrhea
    • bitemporal hemianopsia
  17. signs/symptoms of cushing's syndrome
    • truncal obesity
    • menstrual irregularity
    • moon facies
    • striae
  18. signs/symptoms of acromegaly
    • thick, coarse, oily skin
    • acne
    • prognathism
    • increased space between teeth
    • increased shoe, hat, glove, ring sizes
  19. symptoms of hypoglycemia
    • pallor
    • sweating
    • anxiety
    • tachycardia
    • palpitations
    • tremor
    • h/a
    • hunger/abdo pain
    • decreased LOC
    • syncope
  20. symptoms of hyperglycemia
    • polyuria
    • polydypsia
    • fatigue
    • polyphagia
    • blurred vision
  21. What should your DDx of an anterior neck lump include?
    • vascular: carotid aneurysm
    • neoplastic: thyroid nodule
    • congenital/genetic: thyroglossal cyst
    • enlarged lymph node
    • enlarge salivary gland
  22. What features of a thyroid nodule would make you suspicious of malignancy?
    • age (<20, > 60)
    • male
    • rapid growth
    • associated hoarseness or dysphagia
    • hx of radiation to area
    • nodule is firm, fixed, nontender
    • nodule >2cm
    • associated lymphadenopathy
    • 'cold' on thyroid scan
    • complex cystic nodule
    • family hx of medullary ca of thyroid or MEN II
  23. what are the clinical features of DKA?
    • polyuria
    • young pt with DMI
    • polydipsia
    • LOC
    • anorexia
    • nausea
    • vomiting
    • fatigue
    • abdo pain
    • Kussmaul's breathing
  24. what are the clinical precipitants of DKA?
    • infection
    • noncompliance
    • initial presentation
    • idiopathic causes
  25. 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
  26. describe EKG changes common to obese pts
    • leftward shift of p-waves, t-waves and qrs complexes
    • low qrs voltages
    • LVH
    • LAH
    • flattening of t-waves in the inferior and lateral leads
  27. 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
  28. identify 4 disadvantages of wt loss
    • hypovitaminosis due to reduction of food intake
    • initial wt loss can cause dosing problems
    • gallstones
    • rebound wt gain
  29. medical complications of severe obesity (BMI>40)
    • sudden death
    • OSA
    • CHF
    • nephrotic syndrome
    • renal vein thrombosis
    • immobility

    • Pickwickian syndrome:
    • somnolence
    • polycythemia
    • daytime hypoventilation
    • cor pulmonale

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