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