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    PACES 16 - Endocrine - General

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    DrShamshad Khan
    1) The document describes the steps for examining a patient's endocrine system, including general inspection, examination of specific body areas, identification of signs, and discussion of associated findings. 2) Key signs of common endocrine conditions like thyrotoxicosis, hypothyroidism, acromegaly, Cushing's, and Addison's are provided for each body area. 3) The examination process involves a systematic visual survey, identification of abnormalities, matching signs to possible diagnoses, and examination for additional associated findings.

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    PACES 16 - Endocrine - General

    Uploaded by

    DrShamshad Khan
    168 views4 pages
    1) The document describes the steps for examining a patient's endocrine system, including general inspection, examination of specific body areas, identification of signs, and discussion of associated findings. 2) Key signs of common endocrine conditions like thyrotoxicosis, hypothyroidism, acromegaly, Cushing's, and Addison's are provided for each body area. 3) The examination process involves a systematic visual survey, identification of abnormalities, matching signs to possible diagnoses, and examination for additional associated findings.

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    PACES 16 _Endocrine- General

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    1) The document describes the steps for examining a patient's endocrine system, including general inspection, examination of specific body areas, identification of signs, and discussion of associated findings. 2) Key signs of common endocrine conditions like thyrotoxicosis, hypothyroidism, acromegaly, Cushing's, and Addison's are provided for each body area. 3) The examination process involves a systematic visual survey, identification of abnormalities, matching signs to possible diagnoses, and examination for additional associated findings.

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    © All Rights Reserved
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    168 views4 pages

    PACES 16 - Endocrine - General

    Uploaded by

    DrShamshad Khan
    1) The document describes the steps for examining a patient's endocrine system, including general inspection, examination of specific body areas, identification of signs, and discussion of associated findings. 2) Key signs of common endocrine conditions like thyrotoxicosis, hypothyroidism, acromegaly, Cushing's, and Addison's are provided for each body area. 3) The examination process involves a systematic visual survey, identification of abnormalities, matching signs to possible diagnoses, and examination for additional associated findings.

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    Pearls in PACES (Endocrine- General)

    Adel Hasanin
    EXAMINATION OF ENDOCRINE SYSTEM
    CLINICAL MARK SHEET
    Examiners are required to make a judgement of the candidate's performance in each of the following
    sections by filling in the appropriate box then record the overall judgement (a fail or clear fail grade must
    be accompanied by clearly written explanatory comments)
    1. Physical examination

    2. Identification and interpretation of physical signs

    3. Discussion related to the case

    Overall judgement

    Clear
    Pass

    Clear
    Pass

    Clear
    Pass

    Clear
    Pass

    Pass

    Fail

    Pass

    Fail

    Pass

    Fail

    Pass

    Fail

    Clear
    Fail

    Clear
    Fail

    Clear
    Fail

    Clear
    Fail

    Pearls in PACES (Endocrine- General)


    Adel Hasanin
    STEPS OF EXAMINATION
    Step 1: Approach the patient
    Read the instructions carefully for clues
    Shake hands, introduce yourself
    Ask permission to examine him
    Step 2: General inspection: you may have been given a lead in the instructions such as look at the hands
    or look at the face, however always start your visual survey systematically (Composure and complexion
    hands & arms head & face eyes mouth neck, axilla & trunk legs & feet), asking yourself at
    each stage, is the hands normal?, is the face normal?, etc. if it is abnormal describe the abnormality to
    yourself in the mind trying to match it up with one of the common five diagnoses in endocrine station
    (thyrotoxicosis, hypothyroidism, acromegaly, Cushings, Addisons)

    Pearls in PACES (Endocrine- General)


    Adel Hasanin
    Thyrotoxicosis Hypothyroidism
    (see Ch 17.
    (see Ch 17.
    Endocrine
    Endocrine
    Neck)
    Neck)
    Under/average
    Average
    built or
    General
    overweight,
    appearance built, anxious,
    (uncover
    restless
    apathetic,
    the hair)
    thinning hair,
    peaches and
    cream
    complexion
    Face (look Lid retraction Thickened and
    in the
    coarse facial
    (staring eyes)
    mouth)
    features
    Graves
    ophthalmopathy Periorbital
    (exophthalmos, puffiness, loss of
    periorbital
    outer third of
    oedema,
    eyebrows
    (unreliable),
    conjunctival
    injection,
    xanthelasma
    chemosis)
    Thyroid
    Hands
    Dry and cold
    (dorsum
    acropachy,
    Pulse:
    check for
    warm and
    bradycardia
    tremors,
    sweaty hands,
    palmar
    palm - feel
    for warmth
    erythema
    and
    Pulse:
    sweating,
    tachycardia
    and finally
    (note
    feel the
    specifically the
    pulse)
    presence or
    absence of AF)
    Fine tremors
    Obvious goitre
    Obvious goitre
    Neck &
    (nodular or
    (nodular or
    trunk
    (including
    symmetrical),
    symmetrical),
    the breasts,
    scars
    scars (hemi/total
    Pubic hair,
    (hemi/total
    thyroidectomy)
    axillae and
    thyroidectomy)
    the back)

    Legs & feet Pretibial


    myxoedema
    (Graves)

    Non pitting
    pretibial oedema

    Acromegaly

    Cushings

    Addisons

    Coarse features

    Centripetal
    obesity, bruised
    thin skin, with
    purple striae

    Medica alert bracelet,


    generalized
    hyperpigmentation

    Prominent
    supra-orbital
    ridges
    Large nose and
    lips
    Prognathism,
    widely spaced
    teeth and
    macroglossia

    Moon face,
    hirsute, with
    acne
    Mouth
    (superimposed
    thrush)

    Buccal mucosa
    (hyperpigmentation)

    Large spade
    Thin skin
    like, tight rings,
    coarse skin and
    sweaty

    Goitre
    Skin tags
    (molluscum
    fibrosum)
    Acanthosis
    nigricans (black
    velvety
    papillomas)
    Hirsutism
    Gynaecomastia,
    galactorrhoea
    Kyphosis
    Large feet

    Increase pad
    fats above
    supraclavicular
    fossae (more
    specific for
    Cushings)
    Excess
    interscapular
    fat (buffalo
    hump)
    Purple striae
    Kyphosis
    (osteoporosis)
    Wasting (lemon
    on sticks body
    shape) and
    oedema

    Hyperpigmentation
    (palmar creases)

    Hyperpigmentation
    (nipples and scars)
    Sparse axillary and
    pubic hair
    Abdominal scar
    (bilateral
    adrenalectomy)

    Hyperpigmentation

    N.B. Words in Bold Italic font indicates signs of disease activity

    Pearls in PACES (Endocrine- General)


    Adel Hasanin
    Step 3: Once you have the diagnosis look for associated features:
    Thyrotoxicosis (see Ch
    17. Endocrine Neck)
    Lid lag: see Ch 17.
    Endocrine Neck
    Examine the thyroid:
    see Ch 17. Endocrine
    Neck
    Lymphadenopathy: see
    Ch 17. Endocrine
    Neck
    Check for tracheal
    displacement: see Ch
    17. Endocrine Neck
    If there is a
    thyroidectomy scar,
    test for Chvosteks sign
    (hypoparathyroidism):
    see Ch 17. Endocrine
    Neck
    Additional findings: see
    Ch 17. Endocrine
    Neck
    (brisk ankle jerk,
    proximal myopathy,
    carpal tunnel,
    ophthalmoplegia, visual
    field defects, fundus,
    HTN & urine dipstick)

    Hypothyroidism (see
    Ch 17. Endocrine
    Neck)
    Examine the thyroid:
    see Ch 17. Endocrine
    Neck
    Lymphadenopathy: see
    Ch 17. Endocrine
    Neck
    Check for tracheal
    displacement: see Ch
    17. Endocrine Neck
    If there is a
    thyroidectomy scar,
    test for Chvosteks sign
    (hypoparathyroidism):
    Ch 18. Endocrine
    Neck
    Additional findings: see
    Ch 17. Endocrine
    Neck
    (slow relaxing ankle
    jerk, proximal
    myopathy, carpal tunnel,
    ophthalmoplegia, visual
    field defects, fundus,
    HTN & urine dipstick)

    Acromegaly

    Additional
    findings:
     Proximal
    myopathy
     Carpal tunnel
    syndrome
     Visual field
    defect
    (bitemporal
    hemianopia)
     BP (HTN) 15%
     Urine dipstick for
    sugar
     Abdominal
    examination:
    enlarged organs
     Cardiac
    examination:
    cardiomegaly,
    CCF
     Joint arthropathy
    (osteoarthrosis,
    chondrocalcinosi
    s)

    N.B. Words in Bold Italic font indicates signs of disease activity


    Step 4: Thank the patient and cover him (her)

    Cushings

    Addisons

    Additional
    Additional
    findings:
    findings:
     BP
     Proximal
    myopathy
    (supine
    (stand from
    and
    sitting or test
    standing)
     Chest
    shoulder
    (TB)
    abduction)
     Urine
     Visual field
    dipstick
    defect:
    bitemporal
    hemianopia
    and
    pigmentation
    (pituitary
    tumour)
     Fundus: optic
    atrophy,
    papilloedema,
    hypertensive
    or diabetic
    retinopathy
     Signs of RA or
    asthma
    requiring
    steroids
    (iatrogenic
    Cushings)
     BP and urine
    dipstick

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