ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular...
Transcript of ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular...
![Page 1: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/1.jpg)
ENDOCRINE CLINICAL
EXAMINATION
M.A. Keshavarz M.D.Assistant of Professor of Endocrinology
Qazvin University of Medical Sciences
![Page 2: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/2.jpg)
• Before you begin the physical examination, take time to prepare for the tasks
ahead…
• Organize your comprehensive or focused examination around three general
goals:
●● Maximize the patient’s comfort.
●● Avoid unnecessary changes in position.
●● Enhance clinical efficiency.
• In general, move from “head to toe.”
![Page 3: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/3.jpg)
![Page 4: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/4.jpg)
• Read carefully this “head-to-toe” sequence, the techniques for examining each
region of the body, and how to optimize patient comfort …
General Survey…
Vital Signs…
Skin, Nails…
Head, Eyes, Ears, Nose, Throat …
Neck…
Posterior Thorax and Lungs…
Breasts, Axillae…
Anterior Thorax and Lungs….
Cardiovascular System...
Abdomen...
Lower Extremities…
Nervous System…
Additional Examinations...
Overview OF The Physical Examination
![Page 5: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/5.jpg)
GENERAL APPEARANCE &
VITAL SIGNS…
Pulse
(Hyperthyroidism, Hypoglycemia…)
(Hypothyroidism, Hypopituitarism…)
BP
(Hyperaldosteronism, Pheochromocytoma…)
(Addison’s disease, Hypopituitarism…)
RR Hyperventilation DKA
Height
Weight
BMI
&…
![Page 6: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/6.jpg)
![Page 7: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/7.jpg)
SKIN & HAND & HEAD & EYES & MOUTH
o Oversized hands (acromegaly).
o Tongue enlargement (acromegaly).
o Chin enlargement (acromegaly).
o Eye fundus:(DM , acromegaly).
o Exophthalmos (hyperthyroid).
o Acne, oily skin (Cushing's).
o Buccal pigmentation (Addison's).
o Hirsutism...
Heat (hyperthyroid).
Tremor (hyperthyroid).
Palmar erythema (hyperthyroid).
Pigmentation of palmar crease
(Addison's).
3rd, 5th metacarpals shortened
(pseudohypoparathryoid).
Pulse: rate (hyper-, hypothyroid), rhythm,…
![Page 8: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/8.jpg)
NECK & THYROID
Inspect buffalo hump (Cushing's).
Palpate supra-clavicular fat pads (Cushing's).
Inspect webbed neck (Turner's).
Inspect for goiter…
![Page 9: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/9.jpg)
![Page 10: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/10.jpg)
![Page 11: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/11.jpg)
![Page 12: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/12.jpg)
![Page 13: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/13.jpg)
AXILLAE & ARMS
o Acanthosis nigricans (acromegaly).
o Axillary hair loss (hypopituitary).
o Skin tags (acromegaly).
o Blood pressure for hypertension (Cushing'),
o Trousseau's sign (hypercalcemia):
1) Occlude brachial artery for 3 min using BP cuff...
2) See if carpal spasm is induced.
o Muscle weakness (hypothyroid, Cushing's).
![Page 14: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/14.jpg)
CHEST & ABDOMEN
Pigmented nipple (Addison's).
Loss or gain of chest hair…
Male gynecomastia...
Reduced female breast size (panhypopituitary).
Pt. lies down, one pillow under head.
Purple striae (Cushing's).
Disproportionate abdominal fat (Cushing's).
![Page 15: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/15.jpg)
GENITALIA
Peripheral neuropathy (DM).
Toe nails and foot showing same symptoms…
Atrophy…
Virilisation...
LEGS
![Page 16: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/16.jpg)
BODY SIZE AND PROPORTIONS
Eunuchoidism
![Page 17: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/17.jpg)
SKIN AND NAILS
Thyroid achropachy Hypoparathyroidism
Cushing’s Hyperthyroid…
![Page 18: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/18.jpg)
![Page 19: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/19.jpg)
FACE AND EYES
Hypothyroid Cushing’s AcromegalyHyperthyroid
![Page 20: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/20.jpg)
![Page 21: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/21.jpg)
HAIR
Adrenal Insuff.
Hypogonadism
Hypothyroidism Virilization
![Page 22: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/22.jpg)
![Page 23: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/23.jpg)
Grading of severity of hirsutism in women
• Hirsutism scoring standards at different sites showing the spectrum from minimal hirsutism (grade 1) to frank virilization (grade 4)…
![Page 24: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/24.jpg)
Typical clinical features
Acromegaly
![Page 25: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/25.jpg)
![Page 26: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/26.jpg)
Typical clinical features
Hypothyroidism
![Page 27: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/27.jpg)
![Page 28: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/28.jpg)
![Page 29: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/29.jpg)
Typical clinical features
Hyperthyroidism
Graves ophthalmopathy
![Page 30: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/30.jpg)
![Page 31: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/31.jpg)
Typical clinical features
Facio-truncal obesity
Cushing´s syndrome
Moon face
![Page 32: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/32.jpg)
![Page 33: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/33.jpg)
![Page 34: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/34.jpg)
![Page 35: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/35.jpg)
![Page 36: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/36.jpg)
![Page 37: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/37.jpg)
![Page 38: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/38.jpg)
![Page 39: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/39.jpg)
![Page 40: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/40.jpg)
![Page 41: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/41.jpg)
![Page 42: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/42.jpg)
![Page 43: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/43.jpg)
![Page 44: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/44.jpg)
![Page 45: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/45.jpg)
![Page 46: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/46.jpg)
DIABETIC FOOT EXAMINATION
Introduction
1. Wash hands
2. Introduce yourself
3. Confirm patient details – name / DOB
4. Explain the examination
5. Gain consent
6. Position patient on bed at 45°
7. Expose patient’s lower legs & feet
Gather equipment
1. Monofilament
2. Tuning fork (128hz)
3. Tendon hammer
![Page 47: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/47.jpg)
INSPECTION
Colour – pallor / cyanosis /erythema (e.g. cellulitis / ischaemia)
Inspect legs & feet thoroughly, lifting legs up to see underneath & ensuring to
look between toes…
Inspect behind legs for ulcers…
![Page 48: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/48.jpg)
Skin: Dry / shiny / hair loss – peripheral vascular disease - Eczema /
haemosiderin staining – venous disease
Venous ulcers – moderate to no pain – larger /shallow – associated with
venous insufficiency / varicose veins
Arterial ulcers – very painful – deep punched out appearance – associated
with diabetes mellitus / peripheral vascular disease
![Page 49: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/49.jpg)
Swelling:
Oedema – – e.g. venous insufficiency / heart failure
Deep vein thrombosis – tender on palpation
Calluses – may indicate incorrectly fitting shoes
Venous filling – guttering of veins / reduced visibility suggests PVD
Deformity caused by neuropathy (e.g. Charcot arthropathy)
![Page 50: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/50.jpg)
Palpation
Temperature – cool (e.g. PVD) / hot (e.g. cellulitis)
Capillary refill – normal = < 2 seconds – prolongation suggests PVD
![Page 51: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/51.jpg)
Pulses:
Dorsalis pedis artery – lateral to EHL tendon
Posterior tibial artery – posterior & inferior to medial malleolus
![Page 52: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/52.jpg)
... Compare between feet
Sensation
Monofilament
![Page 53: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/53.jpg)
Vibration sensation
o Ask patient to close their eyes
o Tap a 128hz tuning fork…
o Place onto patient’s sternum & confirm patient can feel it buzzing
o Ask patient to tell you when they can feel it on their foot & to tell you
when it stops buzzing
o Place onto the distal phalanx of the great toe on each leg in turn
o If sensation is impaired, continue to assess more proximally –
e.g. proximal phalanx…
![Page 54: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/54.jpg)
Proprioceptiono Hold the distal phalanx of the great toe by its sides…
o Demonstrate movement of the toe “upwards” & “downwards” to the
patient (whilst they watch)o Then ask patient to close their eyes & state if you are moving the toe up
or down…
o If the patient is unable to correctly identify direction of movement, move
to a more proximal joint ( ankle > knee > hip)
Other tests to considerIf abnormalities in monofilament or vibration sensation are identified, consider carrying out further tests shown below…
![Page 55: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/55.jpg)
Ankle jerk reflex
Dorsi-flex the foot
Tap tendon hammer over the achilles tendon…
Observe the calf for contraction – normal reflex
• Ankle jerk reflex may be absent in advanced peripheral neuropathy…
Gait
Symmetry / balance
Turning – quick / slow / staggered
Abnormalities – broad based gait / foot drop / antalgia
![Page 56: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/56.jpg)
Examine footwear:
Note pattern of wear on soles – asymmetrical wearing – gait abnormality
Ensure the shoes are the correct size for the patient
Note holes / material inside the shoes that could cause foot injury
![Page 57: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/57.jpg)
![Page 58: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/58.jpg)
![Page 59: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/59.jpg)
:ذكر جنبه هاي زير الزامي استمعاينه تيروئيد در انتها در گزارش
ل لمس آيا تيروئيد قابل لمس است؟ آيا علاوه بر قاب)اندازه تيروئيد، ابعاد لوبها
(بودن بزرگ مي باشد؟
يا در صورت بزرگي تيروئيد، به چه صورتي بزرگ مي باشد؟ آيا منتشر است و
بصورت ندولر و غيريكنواخت مي باشد؟
(نرم، سفت و يا سخت؟)قوام تيروئيد چگونه است؟
آيا تيروئيد به راحتي با بلع حركت مي كند يا خير؟
آيا در لمس تيروئيد مناطق دردناك و حساس به دست مي خورند؟
در صورت بزرگي تيروئيد آيا در سمع بررسي شنيده مي شود؟
در صورت لمس ندول، مشخصات ندول شامل اندازه، قوام، قابليت حركت يا
.چسبندگي و دردناكي مي بايست ذكر شوند
![Page 60: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/60.jpg)
نها هم چنين در صورت وجود لنفادنوپاتي و يا انحراف تراشه ثبت آ
وص كمك فراواني به فرآيند تشخيص بيماريهاي تيروئيد به خص
.ندولهاي تيروئيد خواهد نمود
افزايش خفيف تا متوسط درجه حرارت بدن در : درجه حرارت بدن
يم زمينه طوفان تيروئيدي، بيماري آديسون و اختلالات مركز تنظ
درجه حرارت هيپوتالاموس به وجود خواهد آمد، بلعكس
. شوندهيپوتيروئيديسم شديد و هيپوگليسمي باعث هيپوترمي مي
![Page 61: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/61.jpg)
حي هيپرپيگمانتاسيون پوستي مخاطي به خصوص در نوا: پوست
چين ها و مناطق تحت فشار و مخاط لب و دهان و چشم قوياً شك به
كه مشاهده آكانتوزيس نيگريكانس. بيماري آديسون را برمي انگيزد
ل و پشت مناطق هيپرپيگمانته و هيپرتروفيه پوستي در نواحي زير بغ
ت گردن مي باشد نشانه اي از چاقي، كوشينگ، آكرومگالي و يا دياب
. خواهد بودIIتيپ
![Page 62: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/62.jpg)
در صورت و بدن خانم ها نيز مي تواند به موهاي زبر مردانه وجود
نفع بعضي اختلالات غددي مانند تومورهاي تخمداني يا آدرنال كه
ترشحات آندروژني دارند، هيپرپلازي مادرزادي آدرنال، كوشينگ و
.يا سندرم تخمدان پلي كيستيك باشد
حاكي از اختلالات هورموني مانند خشكي و خشن شدن پوست
پوست گرم و هيپوتيروئيديسم و يا هيپوپاراتيروئيديسم بوده و بلعكس
. مرطوب و تعريق فراوان حاكي از پركاري غده تيروئيد مي باشد
مشاهده استرياهاي بنفش رگ روي پوست شكم و پهلوها، پوست
ز نازك و شكننده، وجود خونريزي هاي زيرپوستي به نام اكيموز ني
.مطرح كننده سندرم كوشينگ مي باشد
![Page 63: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/63.jpg)
ا و هيپرتروفي و بزرگي زبان، سينوس ه: گوش، حلق و بيني
بان استخوان هاي پيشاني و چانه در زمينه آكرومگالي و بزرگي ز
.همچنين در بيماري هيپوتيروئيديسم ديده مي شود
![Page 64: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/64.jpg)
ي، شدت معاينه كامل چشم شامل حركات، ميدان بيناي: سيستم بينايي
بينايي، بررسي لنز و شبكيه و فشار چشم از اهميت ويژه اي
.برخوردار است
تاري ديد، خيرگي، قرمزي، التهاب و تورم چشم، پروپتوز يا
بيرون زدگي چشم، فلج عضلات حركتي چشم، درد و حتي كاهش
فتالموپاتي بينايي و نهايتاً از دست رفتن بينايي تماماً تحت عنوان ا
گريوز از مشكلات عمده مبتلايان به اين نوع خاص پركاري غدذه
ر چشم بلعكس كم كاري تيروئيد سبب تورم نسج دو. تيروئيد است
.و ريزش موهاي قسمت خارجي ابروها خواهد شد( ادم پره اربيتال)
![Page 65: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/65.jpg)
چشم ، سردرد، دوبيني و يا فلج حركتي عضلاتاختلالات ميدان بينايي
وس مي توانند نشانه اي از تومورهاي بزرگ ناحيه هيپوفيز، هيپوتالام
. رندبه علاوه اين تومورها مي توانند رفلكس مردمك را از بين بب. باشند
يابت مشاهده كاتاراكت در معاينه مي تواند به نفع هيپوتيروئيديسم، د
.كنترل نشده و يا هيپوپاراتيروئيديسم باشد
يابت به دنبال سندرم كوشينگ و به خصوص دافزايش فشار داخل چشم
مشاهده شبكيه نيز اطلاعات . قندي به طور شايع به وجود خواهد آمد
زيادي در مورد بعضي بيماري ها مانند فشارخون مزمن يا حاد، و يا
ك ديابت قندي به دست خواهد داد، به ويژه محو بودن حدود ديسك اپتي
نشانه اي از افزايش فشار داخل جمجمه و به عنوان يك ( ادم پاپي)
.اورژانس پزشكي محسوب مي شود
![Page 66: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/66.jpg)
صبي معاينه سيستميك كامل سيستم ع:سيستم عصبي، عضلاني
حسي و حركتي و رفلكس ها و همچنين عضلات از اهميت بالايي
يار وجود نوروپاتي در زمينه ديابت قندي يافته بس. برخوردار است
ند به شايعي است، ضعف عضلاني و وجود ميوپاتي در معاينه مي توا
شينگ و نفع اختلالاتي مانند كم كاري يا پركاري تيروئيد، بيماري كو
.يا اختلالات متابوليسم كلسيم، فسفر باشد
![Page 67: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/67.jpg)
ندي به نفع كم كاري تيروئيد، ديابت قكاهش رفلكس هاي وتري عمقي
و يا كاهش سديم خون باشد، بلعكس به دنبال پركاري تيروئيد
در صورت مشاهده لرزش . رفكس هاي عمقي تشديد خواهند يافت
در دست ها كه به حالت كشيده و به طرف (fine tremor)خفيف
جلو موازي با هم و كف دست به طرف زمين باشد، شك به پركاري
.غده تيروئيد خواهيم كرد
![Page 68: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/68.jpg)
دو معاينه سيستم ادراري تناسلي در هر: سيستم ادراري تناسليم جنس براي يافته اختلالات هورمون هاي جنسي و نيز وجود يا عد
در خانم ها نشانه هاي افزايش. وجود نشانه هاي بلوغ ضروري استهورمون هاي جنسي مردانه به صورت ريزش موهاي سر به فرم
مردانه، كلفت شدن صدا، آكنه، عضلاني شدن بدن و بزرگي .كليتوريس بروز خواهد كرد
در آقايان كاهش هوزمون هاي مردانه به صورت كاهش رشد موهاي واهد و آتروفي بيضه ها خ( ژينكوماستي)صورت، بزرگي پستان ها
.بود
![Page 69: ENDOCRINE CLINICAL EXAMINATION · 2018. 6. 17. · with diabetes mellitus / peripheral vascular disease. ... Calluses –may indicate incorrectly fitting shoes Venous filling –guttering](https://reader035.fdocuments.in/reader035/viewer/2022071412/6107f94c3cf567468c0f1561/html5/thumbnails/69.jpg)
دان افزايش بيش از اندازه رشد قدي به علت فق: سيستم اسكلتيترشح هورمون هاي جنسي و يا افزايش ترشح هورمون رشد و
كاهش رشد قدي به دليل فقدان يا كمبود هورمون رشد، كم كاري . واهد دادغده تيروئيد و يا اختلالات متابوليسم كلسيم و فسفر رخ خبزرگي رشد انتهاها، چانه، بيني و پيشاني به نفع بيماري آكرومگالي و عدم تناسب رشد تنه به اندام ها نشانه اي از
ديسژنزي هاي استخواني، ديسژنزي هاي گنادال و هيپوپاراتيروئيديسم كاذب مي باشد، به علاوه درد در لمس
ز استخوان ها و به خصوص فقرات كمري و لگن مي تواند نشانه اي ا.استئومالاسي باشد