SURGERY CLINICAL

CASE PRESENTATION
MENTOR: Prof. DR. PRESENTED BY: SIDHARTH SKANDHA
FINAL YEAR MBBS
SRINIVASAN SIR COIMBATORE MEDICAL COLLEGE
AND HOSPITAL
CASE HISTORY

■ NAME : Mrs. ABC

■ AGE : 55 years
■ SEX : Female
■ OCCUPATION : Homemaker
■ ADDRESS : Coimbatore
■ DATE OF EXAMINATION : 24/10/2021
CHIEF COMPLAINTS

■ Swelling in front of the neck since 3 years

HISTORY OF PRESENTING ILLNESS
■ Patient was apparently normal 3 years ago.
■ She noticed a swelling in front of the neck incidentally, 3 years
ago.
■ The swelling was insidious in onset and progressive in nature and
rapidly increasing in size since 1 year, and attained the present size
■ Associated with difficulty in swallowing since 3 month
■ History of pain in the swelling since 3 months – dull aching in
nature
■ Associated with hoarseness in voice since 1 month
■ No H/O difficulty in breathing
■ No history of Bone pain,
■ No history of cough and hemoptysis
■ No history suggestive of Hypo or hyperthyroidism
■ No history suggestive of horner’s syndrome
■ Presently not a COVID 19 positive patient
PAST HISTORY

■ No similar complaints in the past

■ No history of Diabetes , Hypertension , TB
■ No history of epilepsy
■ No history of previous exposure to radiation
■ No history of previous surgical intervention
TREATMENT HISTORY

■ Not on any medications

■ No history of any Drug allergy
FAMILY HISTORY

■ No similar complaints in the family

■ No history suggestive of thyroid diseases in the family
MENSTRUAL HISTORY

■ Patient had attained menopause 10 years ago

PERSONAL HISTORY

■ DIET : vegetarian diet on iodized salt , No excessive

consumption of brassica group of vegetables.
■ APPETITE : Normal
■ SLEEP : Adequate
■ BOWEL AND BLADDER MOVEMENTS : Normal
■ NO History of Smoking and drinking
SUMMARY
■ A 55 Year old woman has presented with the complaint of
swelling in front of the neck since 3 years, suddenly increasing
in size for 1 year, which is Associated with dull aching pain,
dysphagia and hoarseness of voice, probably it could be a
malignant swelling arising from thyroid
GENERAL EXAMINATION
■ An Informed Consent was taken from the patient and the
examination was done in the presence of a female attender, in
adequate natural light and exposure of the neck .

■ Patient was moderately built and nourished

■ She is comfortable in sitting position .
■ Conscious, well oriented to time ,place and person and
responds verbally
■ PALLOR- Absent
■ ICTERUS- Absent
■ CYANOSIS- Absent
■ CLUBBING- Absent
■ GENERALIZED LYMPHADENOPATHY- Absent
■ EDEMA- Absent
VITALS

■ PULSE : 78 beats/min , regular , with Normal character and

volume , No radioradial and radiofemoral delays , all the
peripheral pulses are felt and are Normal
■ RESPIRATORY RATE : 16 breaths/min
■ SPO2 : 98 %
■ TEMPRATURE : 98.6 F
■ BLOOD PRESSURE : 110/70 mmHg
LOCAL EXAMINATION
■ INSPECTION :
 Swelling in front of the neck involving the left lobe and
extending onto the isthmus
 Looks hemispherical
 Swelling moves with Deglutition, restricted mobility
 Approximately 12x12cm in size
 Lower border of the swelling is not appreciable on inspection
 Skin over the swelling is normal
 No engorged veins
 Pemberton sign negative
 No surgical scars
PALPATION
■ No warmth or tenderness over swelling
■ Inspectory findings are confirmed on palpation
■ Uneven surface with distinct margins
■ Variegated Consistency
■ Lower Border of swelling is palpable
■ Trachea is palpable in the midline
■ Skin pinchable
■ Lymph nodes not appreciable on the left side and not palpable
on the right side.
■ Kocher’s test is negative.
■ Carotid pulsation is felt on both sides equally. (Berry’s Sign
Negative)
■ No pulsation or thrill on the thyroid gland
AUSCULTATION

■ No appreciable Bruit on the thyroid gland

SYSTEMIC EXAMINATION

■ Cardiovascular system: 1st and 2nd heart sounds heard, no

murmurs
■ Respiratory system: Normal vesicular breath sounds heard,
No added sounds
■ Central Nervous system: Clinically Normal
■ Per Abdomen: Normal
■ Skeletal System: normal
PROVISIONAL DIAGNOSIS

■ Malignant thyroid swelling

THANK YOU