11/24/12

Toronto Notes - Case 1: Feeling Slow

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General OSCE Tips Respirology Cardiovascular Gastroenterology Musculoskeletal Urology Pediatrics Peripheral Vascular Women's Health Neurology Psychiatry Ophthalmology and Otolaryngology Geriatrics Case 1: Feeling Slow Case 2: Uncontrolled Blood Pressure/Elder Abuse Case 3: Sleep Problems Case 4: Diabetes

Case 1: Feeling Slow

You are seeing Mrs. Rostov, a 61 year old woman, because she feels slow. Take a focused history, and perform a physical exam pertinent to her complaint.

History
Clarifies patients recent symptoms of fatigue Onset and duration of symptoms Asks about sleep habits Cold intolerance Dry skin Weight gain Hair loss Abnormal vaginal bleeding Muscle cramping Exercise intolerance Constipation Mood changes Poor focus Smoking and alcohol history Personal history of thyroid disorders Radiation to Head and Neck Family history of thyroid disorders Family history of auto-immune disorders (Type I Diabetes, Celiac Disease, Addisons Disease, Rheumatoid Arthritis) Current medications Effect on daily activities

Physical Examination
Vitals Comments on bradycardia Assesses for orthostatic changes in vitals States that temperature should be measured, and it may show hypothermia Note Pad Info Inspection Comments on hair changes (thin) Assesses for skin changes, including dryness, and pretibial myxedema Edema (face and lower extremities) Comments on nail changes (brittle nails) Hair loss Assesses swallowing Proximal muscle wasting Thyroid Examination Inspects for enlarged thyroid Observes thyroid while swallowing Palpates both thyroid lobes Comments on size, texture, and nodularity Palpates anterior cervical nodes for abnormality Neurological Examination Reflexes (may be hyporeflexive) Proximal muscle power (may be decreased)

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11/24/12

Toronto Notes - Case 1: Feeling Slow

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