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    2 - Endocrine Assessment 2023

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    Mohned Alhababi
    This document contains summaries of examinations for several endocrine conditions: 1) A thyroid mass examination involving inspection, palpation, percussion, and auscultation of the neck and thyroid function assessment. 2) Cushing's syndrome examination focusing on the head, neck, upper and lower limbs, and abdominal examination. 3) Acromegaly examination assessing features of the head, neck, upper and lower limbs. 4) Diabetic foot examination with inspection, palpation to assess arteriopathy and neuropathy, and recommended investigations.

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    2 - Endocrine Assessment 2023

    Uploaded by

    Mohned Alhababi
    44 views5 pages
    This document contains summaries of examinations for several endocrine conditions: 1) A thyroid mass examination involving inspection, palpation, percussion, and auscultation of the neck and thyroid function assessment. 2) Cushing's syndrome examination focusing on the head, neck, upper and lower limbs, and abdominal examination. 3) Acromegaly examination assessing features of the head, neck, upper and lower limbs. 4) Diabetic foot examination with inspection, palpation to assess arteriopathy and neuropathy, and recommended investigations.

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    2- Endocrine assessment 2023

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    This document contains summaries of examinations for several endocrine conditions: 1) A thyroid mass examination involving inspection, palpation, percussion, and auscultation of the neck and thyroid function assessment. 2) Cushing's syndrome examination focusing on the head, neck, upper and lower limbs, and abdominal examination. 3) Acromegaly examination assessing features of the head, neck, upper and lower limbs. 4) Diabetic foot examination with inspection, palpation to assess arteriopathy and neuropathy, and recommended investigations.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    44 views5 pages

    2 - Endocrine Assessment 2023

    Uploaded by

    Mohned Alhababi
    This document contains summaries of examinations for several endocrine conditions: 1) A thyroid mass examination involving inspection, palpation, percussion, and auscultation of the neck and thyroid function assessment. 2) Cushing's syndrome examination focusing on the head, neck, upper and lower limbs, and abdominal examination. 3) Acromegaly examination assessing features of the head, neck, upper and lower limbs. 4) Diabetic foot examination with inspection, palpation to assess arteriopathy and neuropathy, and recommended investigations.

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    Medicine Clinic 2023 ‫ عبدالرؤوف محمد عبداللطيف‬.

    ‫د‬
    Endocrine assessment Edah learning Platform

    Thyroid mass
    A-Communication with patient(Introduction):
    1-Wash & sterilize your hands,
    2-Introduce yourself + take permission and explain process to patient
    3- Good position = sitting position & exposure = all of neck

    General Inspection:
    1-Inspection of mass site
    midline ( DD= Goiter, TGC, lymph node,
    tymoma, lipoma, sebaceous cyst.
    To differentiate:
    A- ask the patient to swallow=
    If the mass moves its goiter or TGC.
    Why does goiter & TGC move with swallowing?
    Because it’s attached to the trachea by the para tracheal fascia
    B- ask the patient to protrude the tong = if moved TGC but goiter does not move
    Why does the TGC move with protrusion of tong?
    Because it’s attached to foramen cecum (ant.2/3 and post. 1/3 of tong)

    2-Inspection of Size, shape, surface and skin (scars= collar scar, redness which
    indicates thyroiditis, visable pulsation if pulsation= Graves disease

    2- Palpation
    A- Tenderness= from front ( ask if any pain before)
    B- Temperature = dorsum of hand +ve thyroiditis
    C- Confirm site, size, shape, surface
    D- Consistency
    E- Attached to underlying structure = SCM muscle, skin, supra-sternal notch,
    trachea ( confirmed by Kocher test)

    3- Percussion= done on sternum directly = indicates retrosternal extension

    4-Auscultation= bruie over upper pole due to hyper vascularity (Graves)


    Medicine Clinic 2023 ‫ عبدالرؤوف محمد عبداللطيف‬.‫د‬
    Endocrine assessment Edah learning Platform

    To complete neck examination do:


    JVP measurement (45 degree) = raised due compression
    Lymph node examination = thyroiditis

    How to assess the thyroid function?


    General Inspection:
    patients state= * irritable, angry (Hyper)
    . * Drowsy disoriented (Hypo)
    Clothes = *low clothing = heat intolerance (Hyper)
    . *over clothing = Cold intolerance (Hypo)
    Weight = *Thin (Hyper)
    . *Obese (Hypo)

    Head:
    Inspection of Hair=alopecia
    Inspection of eye loss of outer 1/3 of eyebrow (Hypo)
    . Exophthalmos (Hyper) Xanthelasma (Hypo)
    Inspection of Cheeks = Malar rash ( Grany Tan) (Hypo)
    Inspection of mouth inside by torch & tong depressor = Tong Atrophy = Hyper
    . Bulky purple = Hypo

    Upper limb:
    Hand: Hot & sweaty = Hyper
    . Cold & dry = Hypo
    Clubbing (Acropatchy)= hyper graves
    Tremor = Fine = hyper
    Examine pulse: Brady = Hypo
    . tachy =Hyper
    BP = increased systolic in Hyper
    . increased Diastolic in Hypo then systolic due to arteriosclerosis
    Temperature = High in Hyper
    . Low in Hypo
    Lower limb:
    Reflexes = exaggerated reflex in Hyper
    . Delay in relaxation phase in Hypo
    Medicine Clinic 2023 ‫ عبدالرؤوف محمد عبداللطيف‬.‫د‬
    Endocrine assessment Edah learning Platform

    Cushing syndrome
    General Inspection:
    Surrounding (at side = Oxygen, inhalers , Medications,) used by chronic respiratory
    disease
    patients state= *Stable, Comfortable,
    Alert, Breathless,
    *dismorphic features =Moon face, central
    obesity, shoulder pads & buffalo hump

    Head:
    Inspection of hair thin
    Inspection of face moon face , hirsutism, acne
    Inspection of eye Cataract
    Inspection of cheeks malar rash
    Inspection of mouth inside by torch & tong
    depressor = oral thrush, pigmentation

    Neck:
    Infra & supra scapular fat pads

    Upper limb
    Hand: capillary glucose stick marks Pigmentation
    Skin: thin skin & bruising
    BP = HTN

    Lower limb:
    Proximal myopathy = ask patient to stand from sitting position

    To complete my examination I would like to do:


    1- Abdominal examination: Purple stria, thin skin, Lipodystrophy due to insulin
    injections
    2- Asses visual fields, dip stick for urine and measure blood sugar level
    Acromegaly

    General Inspection:
    Patients state= *Stable, Comfortable, Alert, Breathless,
    *dismorphic features = increased head, hand & foot size + kyphosis
    Medicine Clinic 2023 ‫ عبدالرؤوف محمد عبداللطيف‬.‫د‬
    Endocrine assessment Edah learning Platform

    Head:
    Inspection of hair = thick shiny
    Inspection of face = Coarse facial features , acne,
    Inspection of eyes = prominent supra orbital ridges
    visual field examination = bi-temporal hemianopia
    Inspection of Nose & ears = enlarged
    Inspection of mandible = progantisim
    Inspection of mouth inside by torch & tong depressor =
    large tong and separated teeth, also look for
    hypophysectomy scar under upper lip

    Neck:
    Thyroid goiter JVP measurement (45 degree) = raised due to cardiomyopathy

    Upper limb
    Multiple thick skin tags
    Pigmentation =achantosis nigricans in axilla
    BP = HTN

    Lower limb:
    Proximal myopathy = ask patient to stand from sitting position Gait= tolling gait
    with bowed legs

    Diabetic foot Examination


    Communication with patient(Introduction):
    1-Wash & sterilize your hands,
    2-Introduce yourself + take permission and explain process to patient
    3-Good position = flat position
    4- Good exposure of feet

    General Inspection:
    Surrounding: walking aid
    patients state= *Stable, Comfortable, Alert
    Medicine Clinic 2023 ‫ عبدالرؤوف محمد عبداللطيف‬.‫د‬
    Endocrine assessment Edah learning Platform

    Local Inspection:
     Symmetrical or not (to detect any muscle
    wasting) as result of diabetic myelopathy
     deformity ( claw toe, bony prominease)
     Nails = dystrophic , ingrown nail
     webspaces= cracked, infected, ulcers
     Skin changes = hair loss, pallor, rubor,
    callous at pressure area , cellulites, gangrene
     ulcers= describe ( site, size, shape, edge, floor)

    Palpation (Arteriopathy):
     Temperature changes
     Tenderness
     Pulses: Dorsalis pedis, posterior tibial , popliteal, femoral
     Capillary refilling time

    Palpation (Neuropathy):
     Sensory system examination (Described in sensory examination)
     Motor examination (LMNL)
    Autonomic nerve system = sweaty, dry cracked skin

    What are the investigations would you like to preform?


    1-CBC 2-FBG & HbA1c 3- RFT
    4-Doppler 5- Ophthalmic examination 6- if ulcer do biopsy
    If ulcer associated with peripheral neuropathy, what is the cause? DM

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