Lesson 5.7: Other Examination Stations
Thyroid Examination Checklist
- Inspect from front — neck swelling, position, skin changes
- Inspect from side — retrosternal extension
- Ask patient to swallow water — thyroid moves up; lymph nodes do not
- Ask patient to protrude tongue — thyroglossal cyst moves up
- Palpate from behind — size, shape, consistency, surface, tenderness, nodularity
- Pemberton sign — arms above head: facial plethora = retrosternal extension
- Tracheal deviation
- Auscultate over gland — systolic bruit (Graves disease)
- Systemic signs — pulse (AF in hyperthyroid), tremor, eye signs (exophthalmos, lid lag)
- Reflexes — brisk (hyperthyroid) / slow-relaxing (hypothyroid)
- Offer: TFTs, USS thyroid, radionuclide scan, FNA if nodule
Peripheral Vascular Examination Checklist
Used in intermittent claudication, rest pain, diabetic foot, or leg ulcer presentations.
- Inspect — hair loss, shiny skin, pallor, muscle wasting, ulcers, gangrene
- Buerger's test — raise leg to 45°: pallor = arterial insufficiency; dependency rubor = severe ischaemia
- Temperature gradient — warm proximally to cool distally
- Capillary refill — normal under 2 seconds
- Pulses — femoral, popliteal, posterior tibial, dorsalis pedis (both legs)
- Femoral bruits — auscultate for atherosclerosis / stenosis
- Diabetic foot — 10g monofilament sensation, vibration, neuropathy
- Venous assessment — varicosities, lipodermatosclerosis, venous ulcers (medial gaiter area)
- Offer: ABPI (ankle-brachial pressure index), Duplex USS, CT angiography
Breast Examination Checklist
Always offer a chaperone before starting. Ask the patient to remove clothing to the waist.
- Inspect — arms by sides: asymmetry, skin changes, nipple abnormality
- Inspect — hands on hips: tethering or dimpling more visible
- Inspect — hands behind head: skin puckering or retraction
- Skin signs: peau d'orange, dimpling, visible veins
- Nipple: discharge, Paget's change, new retraction vs longstanding
- Palpate — 4 quadrants systematically; axillary tail; subareolar tissue
- Any lump: size, shape, consistency, mobility, fixation, tenderness
- Axillary lymph nodes — anterior, posterior, medial, apical, infraclavicular
- Supraclavicular lymph nodes
- Offer: USS if under 35; mammogram if over 35; core biopsy of any suspicious mass
Triple assessment for any breast lump: clinical examination + imaging + core biopsy. No single element is sufficient alone.
Eye Examination
| Skill | What to Do |
|---|---|
| Visual acuity | Snellen chart at 6 metres. Each eye separately, with and without correction. |
| Visual fields | Confrontation — test all 4 quadrants against your own. |
| Pupils | Size, symmetry, direct and consensual light reflex. RAPD (swinging torch test). |
| Eye movements | H pattern — all 6 directions. Ask about diplopia. Cover test for latent squint. |
| Fundoscopy | Dim lights. Look for: diabetic retinopathy, hypertensive changes, papilloedema, optic atrophy. |
Ear Examination
- Inspect the pinna and post-auricular area — swelling, inflammation, scars.
- Pull pinna up and back (adults) to straighten the canal.
- Insert speculum gently — largest that fits comfortably.
- Examine canal — wax, discharge, foreign body, erythema.
- Examine the tympanic membrane — colour (pearly grey), light reflex, landmarks, perforation, retraction.
- Tuning fork tests (512 Hz): Rinne — AC > BC is normal; Weber — lateralises to bad ear in conductive loss, good ear in sensorineural loss.
Antenatal Abdominal Examination — Leopold Manoeuvres
- Confirm consent. Ensure the patient has emptied her bladder. Position supine with slight left lateral tilt.
- Inspect — uterine size, shape, fetal movements, linea nigra.
- Symphysis-fundal height (SFH) in centimetres — should equal gestational age ± 2 cm.
- Fundal grip (1st manoeuvre) — what is in the fundus? Breech (soft, irregular) vs head (hard, round, ballotable).
- Lateral grip (2nd manoeuvre) — fetal back? Smooth = back; irregular = limbs.
- Pelvic grip (3rd manoeuvre — Pawlik) — what is presenting? Is it engaged?
- Engagement: 5/5 = fully above pelvic brim; 0/5 = fully engaged.
- Auscultate fetal heart — Pinnard or Doppler (normal 110–160 bpm).
- Offer: urinalysis, BP, USS to confirm presentation if unclear.