34 Year old lady, Mrs Saridha, House maid, coming from Mugappair belongs to low socio economic class
C/O : Swelling in the front of neck for 3 month
H/O Presenting illness
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The patient was apparently normal 3 month ago after which she developed a swelling in front of the neck which was insidious in onset, initially smaller in size.
Gradually progressive attain a current size
No H/O pain
No H/O sudden increase in size
No H/O breathlessness, difficulty in swallowing, hoarseness of voice
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No H/O Syncopal attacks
No H/O Indrawing of eyeball
No H/O ipsilateral loss of sweating
No H/O excessive sweating
No H/O loss of weight / weight gain
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No H/O diarrhea / Constipation
No H/O oligomenorrhea/ menorrhagia
No H/O heat / cold intolerance
No H/O diplopia
No H/O tremor, Insomnia
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No H/O Chest pain, Pedal edema, palpitations, breathlessness
NO H/O jaundice, bone pain, cough with hemoptysis
No H/O swelling elsewhere in the body
PAST HISTORY
No H/O similar complaints in the past
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No H/O previous surgery
No H/O DM, HT, TB, Asthma, Epilepsy, Jaundice
No H/O irradiation
PERSONAL HISTORY
Consumes mixed diet
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No H/O excessive iodine intake
No H/O excessive consumption of brassica group of vegetables
Normal bowel and bladder habits
Not a smoker / alcoholic
No H/O allergic to food & drugs
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MENSTRUAL HISTORY
Age at menarche : 15 years, regular cycle 3/30, no clots
LMP : 21 nov 2017
no pads soaking for a day : 2
FAMILY HISTORY
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No relevant family history
GENERAL EXAMINATION
The patient is conscious, oriented, well built & nourished
No pallor / icterus / cyanosis / no clubbing / no pedal edema / generalised lymphadenopathy
No eye signs
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no tremor
skin normal
No signs of hyper/hypothyroidism
Vital signs
Pulse: 74/min, normal in rhythm, volume, no specific character, no radio radial / radio femoral delay, all peripheral pulse felt
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Blood pressure : 110/70 mmHg measured in right arm in sitting position
Respiratory rate : 16/min, thoraco abdominal type
Temperature : Afebrile
Examination of Thyroid region
After getting consent from the patient, explaining the procedure, the patient was examined in sitting position under bright light
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INSPECTION :
A single swelling of size 4 * 4 cm, hemispherical in shape present in the front of neck region of thyroid extending from 3cm below from thyroid cartilage, 2cm above from sternal end of clavicle, medically upto midline, laterally along anterior border of sternoclenomastoid muscle on right side
smooth surface
skin over the swelling normal
swelling moves with deglutination, does not moves with protrusion of tongue
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lower border is seen
trachea appears to be midline
no scars / sinus / visible pulsation / dilated vein / no visible node enlargement
PALPATION
After asking the patient to slightly flex the neck, palpation is done standing behind the patient & then from front
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not warmth / non tender
inspectory finding of site, size, shape, extent - confirmed
margins well defined
smooth surface, skin over swelling normal
firm in consistency, which is mobile
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skin pinchable
plane of swelling deep to deep cervical facia
lower border is palpable
caratoid pulsation felt equally on both sides
Trachea is in midline
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kocher's test – no stridor
no palpable thrill
PERCUSSION
normal resonant over sternum
AUSCULATION
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no bruit heard
Examination of lymph node :
No nodes are palpable
OTHER SYSTEM EXAMINATION
RS : Normal vesicular breath sounds heard, no added sounds
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CVS: S1, S2 heard, no murmur
Abdomen : soft, non tender, no organomegaly
CNS : no focal neurological deficit
Spine & Cranium : Normal
Diagnosis :
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Non toxic Solitary nodule of thyroid involving the right side in euthyroid state with no pressure symptoms
MANAGEMENT
Investigation :
Routine investigation
complete hemogram : TC/DC/ ESR / Hb /
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Blood grouping and typing
Blood sugar, urea, creatinine, serum cholesterol
Urine sugar, albumin
X ray chest - PA view
ECG
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This download link is referred from the post: MBBS Final Year Case Presentation (Clinical Case Examination, Discussion and Treatment)
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