Acromegaly Examination
Acromegaly examination and questions for medical student exams, finals, OSCEs and MRCP PACES
Intro (WIIPPPPE)
- Wash your hands
- Introduce yourself
- Identity of patient – confirm
- Permission (consent and explain examination)
- Pain?
- Position at 45°
- Privacy
- Expose chest fully
General Inspection
- Surroundings
- Monitoring (possible arrhythmia secondary to cardiomyopathy); sliding scale (diabetes); walking aids (arthropathy)
- Patient
- Well or unwell?
- Voice (deep and slow)
Systemic examination
- Hands
- Inspect
- Large hands; coarse, sweaty skin
- Diabetic finger prick marks
- Clubbing
- Signs of carpal tunnel syndrome (scars of decompressive surgery or clinical signs – e.g. wasting of thenar eminence)
- Palpate
- Pulse
- Inspect
- Arms
- BP (hypertension)
- Ulnar nerve thickening
- Neck
- Goitre (increased thyroid vascularity)
- Acanthosis nigricans
- Face
- Prominent supraorbital ridges; large nose and lips
- Prognathism (prominent mandible)
- Splaying of teeth
- Macroglossia
- Scars from previous surgery
- Eyes
- Visual fields (looking for bitemporal hemianopia)
- Fundoscopy (papilloedema secondary to raised ICP)
- Chest
- Feel for displaced apex
- Listen for murmur
- Listen to lung bases if any suspicion of heart failure
- Abdomen
- Organomegaly
- Legs
- Proximal myopathy (ask patient to stand with arms crossed)
- Peripheral oedema (if associated heart failure heart failure)
Closure
- Thank patient
- Patient comfortable?
- Help getting dressed?
- Wash hands
- Turn to examiner, hands behind back, holding stethoscope (try not to fidget!) before saying: “To complete my examination, I would like to…”
- Take a full history and possibly look at old photos of the patient
- Bedside Investigations
- Capillary blood glucose
- Urine dip
- ECG
- Further Investigations
- See questions