Thyroid examination in a woman with weight loss
PLAB 2 practice station

The task

You are a doctor in a medical clinic. Ms Natalia Kowalska, aged 34, has had weight loss, palpitations and a lump in her neck for three months. She is sitting on a chair. Perform a thyroid examination. Say aloud what you are doing at each step, and the examiner will report the findings. At the end, summarise your findings, say what you think is going on and what you would do next.

What this station tests

• Examine the thyroid from behind and ask the patient to swallow water, then protrude the tongue to distinguish a thyroglossal cyst.
• In suspected thyrotoxicosis check the pulse for atrial fibrillation.
• A diffuse goitre with a bruit and eye signs suggests Graves disease.
• Ask about eye and visual symptoms, and advise on smoking cessation.
• Request thyroid function tests and explain the plan, addressing the fear of cancer.

Sources for the clinical content

• NICE NG145: Thyroid disease: assessment and management
• NICE NG12: Suspected cancer: recognition and referral
• NHS: Overactive thyroid (hyperthyroidism)

An original practice scenario with invented patients. Not an exam question.

Practise next

• Cardiovascular examination in a breathless man
• Respiratory examination in a woman with cough and fever
• Abdominal examination with a painful groin lump
• Neurological examination of the legs after back pain
• Examination of a swollen painful knee