1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.2.1. basal metabolic rate
1.2.1.1. Thyroid gland
1.2.1.1.1. physiology & relevant anatomy
1.2.1.1.2. dysfunction
1.2.2. diagnosis of anxiety and relation to BMR
1.3. 30 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. Hyperthyroidism - grave's
2.2. Mechanism
2.2.1. autoimmune antibodies causing over activity of thyroid gland
2.3. Presentation
2.3.1. anxiety, sweating, tremor, exophalmos, warmness, led lag, enlarged thyroid
2.4. Supporting data
2.4.1. thyroid function and scan
2.4.2. history and physical examination
2.4.3. family history
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complaint
3.1.1.1. lost 3 kg in the last month
3.1.1.2. breathlessness and muscle weakness on exertion, feeling unfit
3.1.1.3. normal apatite
3.1.1.4. feeling anxious for the last month
3.1.1.5. perspires when nervous and develops tremor
3.1.1.6. irritable
3.1.1.7. eyes feeling gritty and a little puffy
3.1.2. Previous medical / surgical history
3.1.2.1. asthma as a child, no attacks since early teens
3.1.3. Drug history / allergy
3.1.3.1. non, just asthma history
3.1.4. Family history
3.1.4.1. maternal grandmother had thyroid condition
3.1.4.2. no family history of psychiatric disorders
3.1.5. Social / occupational history
3.1.5.1. no smoking
3.1.5.2. occasional glass of wine
3.1.5.3. married for 18 months
3.1.5.4. no kids
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. vitals
3.1.7.1.1. BMI
3.1.7.1.2. pulse is 110 regular
3.1.7.1.3. BP 140/50
3.1.7.1.4. temp 37
3.1.7.2. inspection
3.1.7.2.1. anxious
3.1.7.2.2. fine tremor in the hands
3.1.7.2.3. moderate proximal muscle weakness
3.1.7.2.4. eye lid have some puffiness, lid lag on testing
3.1.7.2.5. no pretibial myxoedema
3.1.7.3. palpation
3.1.7.3.1. moderately enlarged thyroid gland
3.1.7.3.2. warm hands
3.1.7.3.3. some palpable lymph nodes on both sides of the neck
3.1.7.4. cardiovascular exam
3.1.7.4.1. JVB normal
3.1.7.4.2. auscultation
3.1.7.5. chest
3.1.7.5.1. clear
3.1.7.6. abdomen
3.1.7.6.1. normal
3.1.7.7. nervous system
3.1.7.7.1. brisk and symmetrical
3.1.8. tests results
3.1.8.1. thyroid function
3.1.8.1.1. thyrotoxicosis
3.1.8.2. thyroid scan
3.1.8.2.1. increased uptake
3.1.8.3. CBC
3.1.8.4. pregnancy
3.1.8.5. liver function
3.1.8.6. renal function
3.1.8.7. calcium, creatinin