In collaboration with the Warwick Medical School’s very own Clinical Skills Society, MedGuide proudly presents another OSCE-like quiz.  Best of luck! 

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Clinical Skills - Introduction to the Thyroid Examination

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Question 1
On examination the patient appears to be perspiring, flushed in the face and agitated.  They complain repeatedly about a short wait and seem eager to leave.  They complain of being too hot all the time despite wearing a T-shirt on a cold day.

What do you expect the patient's Achilles' tendon reflex may be?
A
Normal
B
Hyperreflexive
C
Hyporeflexive
D
Areflexive
E
Either normal or absent
Question 2
During palpation of the neck from a posterior approach, the clinician feels about the cricoid cartilage level.  What is the clinician palpating?
A
Thyroid lobules
B
Thyroid lobe
C
Thyroid isthmus
D
Parathyroid gland
E
Trachea (for deviation)
Question 3
During history, a patient states they are concerned that their hair has become rather thin recently. They also stated worry about diarrhoea and unexpected weight loss.
What is the most likely diagnosis?
A
Primary Hyperthyroidism
B
Primary hypothyroidism
C
Hyperparathyoridism
D
Hypoparathyroidism
E
Secondary hypothyroidism
Question 4
During examination the patient is asked to protrude their tongue,  In doing so a visible swelling in the anterior neck ascends superiorly.  What is the most likely diagnosis of those listed below?
A
Cervical lymphadenopathy
B
Thyroid carcinoma
C
Hashimoto thyroiditis
D
Pituitary adenoma
E
Thyroglossal cyst
Question 5
A patient with tachycardia, increased agitation, sweating and heat intolerance presents.  During examination, whilst palpating the manubrium, a dullness is noted unexpectedly. What is the most likely diagnosis?
A
Mediastinitis
B
Sternal fracture
C
Retrosternal goitre
D
Tracheobronchial lymphadenopathy
E
Internal mammary artery aneurysm
Question 6
The clinician auscultates the lateral lobes of the thyroid gland (bilaterally) to ascertain ...
A
Decreased blood flow
B
Increased blood flow
C
Signs of parathyroid goitre
D
Thyrotoxicosis
E
To assess myxoedema
Question 7
The cold intolerance, bradycardic thyroid deranged patient will be notable for which changes to their biceps reflex?
A
Slightly increased
B
Slightly decreased
C
Absent
D
Significantly increased
E
Significantly decreased
Question 8
In routine special tests for thyroid pathology, which of the following results are ordered?  Choose all that may apply.
A
T3
B
T4
C
TRH
D
TSH
E
TBG
Question 9
Fine tremor, exemplified by an outstretched pair of hands with a piece of paper on top, would be indicative of which most likely?  Choose all that may apply. 
A
Lithium toxicity
B
Graves' disease
C
Hashimoto thyroiditis
D
Secondary hypothyroidism
E
None of the above
Question 10
On superoinferior examination of the sitting patient, a partial exophthalmos is noted.   In which of the below examples is this least likely?
A
Hashimoto thyroiditis
B
Germ cell tumour of thyroid gland
C
Toxic adenoma of thyroid gland
D
Ectopic production of thyroid hormone
E
Graves' disease
Question 10 Explanation: 
Exophthalmos (proptosis) is associated with hyperthyroidism. Only Hashimoto thyroiditis (of the list above) is a hypothyroidism state, thus is the answer in this case.
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