Batul Kaj & Samreen Rizvi 4th year medics

Outline of Session
Neck and thyroid exam Endocrine histories Interpretin E!"s

Greet, introduce yourself, gain consent Expose and seat patient appropriately, ask about

pain INSPECT

Paraphenalia, scars, lumps, skin changes, neck veins Mouth tonsillitis, uvular deviation, thyroglossal cyst,

gag reflex Swallowing pain discomfort, thyroid

PALPATE !rom front trachea, carotids, " #P !rom behind anterior and posterior triangles, thyroid and $%MP& '()ES

PERCUSS Sternum retrosternal goitre AUSCULTATE *ruits carotids and thyroid +hank patient, say they can get dressed +o conclude, +hyroid exam if you-ve found a thyroid. +est movements of neck

1 few 2uestions333
/hat are the margins of the neck triangles0 /hat are the lymph node groups0 /hich node is most important to check for in

neck thyroid exam and why0

Greet, introduce yourself, gain consent Expose and seat patient appropriately, ask about pain INSPECT
1ppearance agitated0 1ppropriate clothing0 &ands temperature, tremor, palmar erythema, thyroid

acropachy, clubbing Pulse rate and rhythm and mention *P !ace eyebrows, features, skin Eyes chemosis, anaemia, exopthalmos, lidlag, opthalmoplegia Mouth tonsillitis, thyroglossal cyst Swallowing pain discomfort, thyroid 'eck scars, swellings, skin changes, distended veins

PALPATE !rom behind

+hyroid3

4f you find a goitre, characterise by,

Si5e Shape Site Single or multiple swellings0 6onsistency soft, firm0 7niform, varied0 Surface smooth or nodular0 +enderness $ocation retrosternal0 6heck on swallowing

$ymph nodes

esp3 8ugulodigastric at 8aw angle

!rom front trachea, carotids

PERCUSS Sternum retrosternal goitre AUSCULTATE *ruits carotids and thyroid 4f you have time to conclude, 9eflexes Proximal myopathy Pretibial myxoedema +hank patient, say they can get dressed

6ommon endocrine symptoms

6hanges in, 1ppetite and weight *owel habits Sweating &air distribution Skin texture and pigmentation Menstrual cycle Micturition $ethargy agitation Stature 4mpotence 'eck lumps

History 1
#ou are a medical student at an endocrine outpatients clinic$ %he next patient is a &'(yr(old man) *ho has +een re,erred +y his "- *ith a *orsenin ,rontal headache$ -lease take a history o, the presentin complaint *ith a vie* to makin a dia nosis$

History 2
%he next patient is a '4(yr(old *oman) *ho has +een re,erred to outpatients *ith a croaky voice and *ei ht ain$ -lease take a history o, the presentin complaint *ith a vie* to makin a dia nosis$

History 3
#ou are a medical student at a "- sur ery$ %he next patient is a .4(yr(old *oman) *ho has come in to et sleepin ta+lets and says she also cant get out of bed in the morning$ -lease take a history o, the presentin complaint *ith a vie* to makin a dia nosis$

6ommon endocrine syndromes

Thyrotoxicosis &eat intolerance, weight loss, increased appetite, palpitations, increased sweating, nervousness, irritability, diarrhoea, amenorrhea, muscle weakness, exertional dyspnoea Hypothyroidism 6old intolerance, lethargy, eyelid swelling, hoarse voice, constipation, coarse skin, hypercarotenaemia Diabetes Mellit s Polyuria, polydipsia, thirst, blurred vision, weakness, infections, weight loss, fatigue, lethargy

6ommon endocrine syndromes

Acrome!aly !atigue, weakness, increased sweating, weight gain, enlarging hands and feet, enlarged and coarsened facial features, headaches, visual impairment, impotence Addiso"s !atigue, weakness, weight loss, increased skin pigmentation :at skin creases esp;, faintness, low *P, ' < #, salt cravings C shi"!s 6entripetal weight gain, moon face, excess hair growth, high *P, sleep disturbance, easy bruising, thin skin, poor healing, striae, mood changes, proximal myopathy, impotence

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Samreen Rizvi

Electrical conduction in the heart

Electrode positions

Basic details

Reporting an ECG
Intro) pt name) /0B) symptoms 1de2uate cali+ration & paper speed 3eart rate and rhythm) re ular4irre ular !ardiac axis Intervals5
- *ave 6RS complex S% se ment % *ave 6% interval Bundle +ranch +lock

Normal 12 lead ECG

1mV Paper speed 25mm/s

!our turn"""

Mr J Smith,13.12.1952, 10.3.2008, 1pm No symptoms

#trial fi$rillation

1mV Paper speed 25mm/s

Mrs !hite,10.11.19"0, 01.0#.2008, 3pm Pa$pitatio%s

Atrial flutter

Sawtooth waves
1mV Paper speed 25mm/s

#nterior %&

Mr J &$o''s, 5.08.19"(, 15.0#.2008, 3pm )hest pai%, S*&

&nferior %&

Mr &row%, 01.01.1959, 15.0#.2008, 3pm )hest pai%, S*&

ST elevation in the inferior leads II, III and aVF Reciprocal ST depression in the anterior leads

'(H

Mr & +ree%, 15.02.19"9, 15.0#.2008, #pm Pa$pitatio%s, ,hest pai%

1mV Paper speed 25mm/s

'BBB Summary
-.S./

7r 1 "rey !hest pain

i% $ead V1

1mV

Paper speed 25mm/s

()

Mr & Jo%es, 5.08.19"(, 15.0#.2008, 3pm Pa$pitatio%s

1mV Paper speed 25mm/s

Heart $loc*
8irst de ree 19 +lock

Pro$o%'ed P. i%terva$

Heart $loc*
Second degree AV Block Type 1 (Mobitz) Mobitz I or Wenckebach.

Pro'ressive$y $e%'the%i%' P. with a dropped P wave

Heart $loc*
Type II Second degree AV Block

)o%sta%t P. i%terva$ with dropped P waves

Third Degree

o!plete "eart Block

No re$atio%ship 0etwee% P a%d 1.S ,omp$e2es

%y turn+

,)his is a 12 lead ECG of %r -ones. date of $irth. 1 st -anuary 1/01." )his ECG 2as ta*en on 12 th %arch 2334 and there 2as no chest pain or other symptoms at the time of the ECG" )he sensiti5ity of the ECG sho2s that 1m( is represented $y 13mm and the paper speed is 20mm6s 2hich is appropriate" )o comment on the Rate. 733368$s9: is ;0 $eats per minute and is regular" & am loo*ing for < 2a5es $efore each =RS comple> 2hich there is so & can say that this patient is in sinus rhythm" 'oo*ing at the a>is. lead & appears to ha5e an o5erall positi5e deflection as does a(? so & can conclude that this is a normal a>is 2ith no a>is de5iation" ?or the inter5als. the < 2a5e is less than 0 small s9uares and the =RS comple> is less than 3 small s9uares 2hich are $oth normal" )he S) segments appear to $e normal. there is no o$5ious S) ele5ation or depression & can see" )he ) 2a5es appear to $e normal" )here does not appear to $e any e5idence of $undle $ranch $loc* in the chest leads"

Ne>t 2ee*"""
"1:S Examination; <rolo ical 3istories Explanation to a ne*ly dia nosed patient Session = > .pm in "lenister !ontact5 +k?4@ sr=?4 See *e+site5 union$ic$ac$uk4medic4muslim ,or all slides)

handouts and timeta+les Become a 77 mem+er i, you *ant priority in the mock 0S!E;