07 - Head and Neck, Parathyroid and Thyroid Flashcards
1
Q
Identify: PNS cells that produce myelin sheath:
A
Schwann cells
2
Q
Head and Neck TNM staging:
Describe T staging
A
3
Q
Head and Neck TNM staging:
Describe N staging
A
4
Q
Identify the cervical lymph nodes:
level VI
A
Anterior compartment nodes
5
Q
Identify the cervical lymph nodes:
level IV
A
lower jugular lymph nodes
6
Q
Identify the cervical lymph nodes:
level VII
A
superior mediastinal lymph nodes
7
Q
Identify the cervical lymph nodes:
level VA
A
occipital lymph nodes
8
Q
Identify the cervical lymph nodes:
level VB
A
supraclavicular lymph nodes
9
Q
Identify the cervical lymph nodes:
level IIA
A
jugulo-digastric lymph nodes
10
Q
Identify the cervical lymph nodes:
level IIB
A
submuscular lymph nodes
11
Q
Identify the cervical lymph nodes:
level IA
A
submental lymph nodes
12
Q
Identify the cervical lymph nodes:
level IB
A
submandibular lymph nodes
13
Q
Identify the cervical lymph nodes:
level III
A
middle jugular lymph nodes
14
Q
Enumerate: (3) what structures are spared in MRND? (compared to RND)
A
- internal jugular vein
- spinal accessory nerve
- sternocleidomastoid muscle
15
Q
- Enumerate (4): infrahyoid muscles
- another name for this group of muscles:
A
- sternohyoid
- sternothyroid
- thyrohyoid
- omohyoid
-strap muscles
16
Q
Weight of the thyroid gland:
A
20 g
17
Q
blood supply of the thyroid gland:
A
- superior thyroid artery <- external carotid
- inferior thyroid artery <-thyrocervical trunk
- thyroidea ima
18
Q
venous drainage of the thyroid gland:
A
- superior thyroid vein -> internal jugular vein
- middle thyroid vein -> internal jugular vein
- inferior thyroid vein -> brachiocephalic vein
19
Q
Left vs Right: recurrent laryngeal nerve
A
- L: crosses arch of aorta, loops around ligamentum arteriosum
- R: crosses and loops around subclavian artery; more oblique than L
20
Q
Enumerate: Branches of the superior laryngeal nerve, and their functions:
A
- internal branch: sensory to the supraglottic larynx
- external branch: motor supply to the cricothyroid
21
Q
- Selective neck dissection for laryngeal malignancy:
- what levels of lymph nodes are removed?
A
- lateral lymph node dissection
- levels II, III, IV
22
Q
- Selective neck dissection for oral cavity malignancies:
- what levels of lymph nodes are removed?
A
- supraomohyoid dissection
- levels I, II, III
23
Q
- Selective neck dissection for thyroid malignancies:
- what levels of lymph nodes are removed?
A
- posterolateral neck dissection
- levels II, III, IV, V
24
Q
Identify: single most important test in the evaluation of thyroid masses
A
FNAB
25
Identify: This thyroiditis cannot be diagnosed using FNAB:
Reidel thyroiditis (FNAB is impossibly because the thyroid becomes too hard)
26
Enumerate: these types of thyroid carcinomas cannot be diagnosed using FNAB:
* Follicular carcinoma
* Hurthle cell carcinoma
27
In what conditions (3) will unilateral lobectomy become indicated for simple thyroid cysts?
* more than 3 unsuccessful attempts at aspiration
* cysts \> 4 cms
* complex cysts
28
29
most common preventable risk factor in the head and neck CA
tobacco and alcohol
30
It is a second tumor detected within 6 months of the diagnosis of the initial primary lesion
synchronous neopllasm
31
It is a second tumor detected more than 6 months of the diagnosis of the initial primary lesion
metachronous neoplasm
32
What is the initial evaluation of patients with primary CA of head and neck
panendoscopy
33
Most common location of squamous cell CA of the lip
lower lip
34
What nerve is involved when there is paresthesia of the lips
mental nerve
35
treatment of squamous cell cancer of the lip
T1 - T2: resection = radiation T3 - T4: surgical excision with histologic confirmation of tumor free margin and post operative radiation
36
What are the indications for supraomohyoid neck dissection
1. tumor greater than 4 cm 2. desmoplastic tumor 3. perineural invasion
37
Tongue cancer with lingual nerve involvement causes
ipsilateral paresthesia
38
Tongue cancer with hypoglossal nerve involvement causes
deviation of tongue on protrussion and fasciculations
39
Most common location of tongue cancer
lateral and ventral surfaces
40
Treatment of tongue cancer
T1 - T2 - wide local excision Base of Tongue - partial glossectomy with supraomohyoid dissection (N0) or MRND (N+)
41
Featurs of plummer vinson syndrome
1. cervical dysphagia 2. IDA 3. atrophic oral mucosa 4. brittle spoon finger nails
42
Treatment of tumor of alveolus and gingiva
1. minimal bone invasion - mandibular resection 2. medullary cavitiy invasion - segmental mandibulectomy
43
Treatment of tumors of nasopharynx
chemotherapy
44
Most common nasophryngeal malignancy in the pedatric age group
lymphoma
45
Lymphatic spread of nasopharynx
1. bilateral regional 2. posterior triangle (level 5)
46
Lymphatic spread of oropharynx
1. upper and lower cervical lymphatics (level 2, 3, 4) 2. retropharyngeal spread
47
Lymphatic spread of hypopharynx
1. bilateral regional 2. mid and lower cervical lymphatics (level 3, 4)
48
Tumors of the oropharynx are radiosensitive
Tumors of the oropharynx are radiosensitive
49
Where does larngeal granuloma usually occur?
posterior larynx on the arytenoid mucosa
50
Most common cause of vocal cord paralysis
iatrogenic
51
Treatment of early stage glottic and supraglottic cancer
Radiation therapy
52
Treatment of small glottic cancer
partial laryngectomy
53
Treatment of supraglottic cancer without arytenoid or vocal cord extension
supraglottic laryngectomy
54
Treatment of advanced laryngeal tumor with extension
total laryngectomy with post op RT
55
Treatment of subglottic cancer
total laryngectomy
56
Pattern of spread from primary tumor of oral cavity and lip
I, II, III
57
Pattern of spread from primary tumor of oropharynx, hypopharynx and larynx
II, III, IV
58
Pattern of spread from primary tumor of nasopharynx and thyroid
V
59
Pattern of spread from primary tumor of nasopharynx, soft palate, and lateral and posterior walls of the oropharynx and hypopharynx
Retropharyngeal lymph nodes
60
Pattern of spread from primary tumor of hypopharynx, cervical esophagus and thyroid
VII
61
Pattern of spread from advanced tumor of glottis with subglottic spread
delphian node
62
What is a radical neck dissection or CRILE method
1. removal of level I to V lymph nodes 2. SCM 3. IJV 4. Spinal accesory nerve
63
What is a modified radical neck dissections
1. removal of level I to V lymph node
64
What is a supraomohyoid neck dissection
1. removal of level I to III 2. oral cavity malignancy
65
What is a lateral neck dissection
1. removal of level II to IV 2. laryngeal malignancy
66
What is a posterolateral neck dissection
1. removal of II to V 2. thyroid cancer
67
What is the procedure of choice for thyroglossal duct cyst
Sistrunk procedure 1. removal of cyst, tract, and central portion of hyoid bone 2. removal of portion of the tongue base up to the foramen cecum
68
Most common gland involved in salivary gland tumor
parotid gland
69
most common benign tumor of salivary gland
pleomorphic adenoma
70
most common malignant tumor of salivary gland
mucoepidermoid carcinoma
71
Most frequently injured nerve in parotid surgery
greater auricular nerve - will produce numbness of the lower portion of the auricle and periauricular skin
72
The syndrome when the auriculotemporal nerve is injured
Frey's syndrome - postoperative gustatory sweating
73
What are the nerves at risk in submandibular gland removal
lingual and hypoglossal nerve
74
What crosses the recurrent laryngeal nerve
inferior thyroid artery
75
What innervates the cricothyroid muscle
external laryngeal nerve of the superior laryngeal nerve of the vagus nerve
76
What is a sensitive marker for medullary thyroid cancer
Serum calcitonin N: 0 - 4 pg/ml
77
Treatment of lingual thyroid
1. exogenous oral thyroid hormone 2. RAI 3. hormone replacement
78
Most common GI symptom of grave's disease
diarrhea
79
Absolute contraindication of RAI
1. pregnant 2. breastfeeding
80
Relative contraindication of RAI
1. young people 2. thyroid nodule 3. ophthalmopathy
81
Treatment of toxic multinodular goiter
subtotal thyroidectomy
82
Treatment of plummer disease
lobectomy and isthmusectomy -also known as toxic adenoma
83
This is a self limiting PAINFUL thyroiditis usually occurs in 30 - 40 y.o women
Subacute Thyroiditis De quervain's thyroiditis
84
Treatment of de quervain's thyroiditis
NSAID since it is self limiting
85
This thyroid disease has a strong association with HLA B35 haplotype
Subacute Thyroiditis De quervain's thyroiditis
86
The most common presentation of this thyroid disease is minimally or moderately enlarged firm granular gland or the awareness of painless anterior neck mass
Hashimoto's thyroiditis Chronic Thyroiditis
87
What is seen in microscopic examination of hashimoto's thyroiditis?
Hurthle cell or Askanazy cell
88
This thyroid disease is characterized by replacement of all or part of the thyroid tissue parenchyma by fibrous tissue
Reidel's thyroiditis
89
Physical examination reveals a hard woody thyroid gland with fixation to surrounding tissues
Reidel's thyroiditis
90
What is the first diagnostice test in a solitary thyroid nodule
FNAB
91
Most common site of metastasis in papillary thyroid CA
Lungs
92
What is the type of spread in papillary thyroid CA
lymphatics
93
What is the most important prognostic factor in determining long term survival of papillary CA
age
94
Treatment of papillary CA
1. \< 1.5 cm - lobectomy + isthmusectomy 2. multicentric - near total or total thyroidectomy 3. with cervical lymph node - MDRD
95
Most common route of spread of follicular CA
Hematogenous
96
More common cancer in iodine deficient countries
follicular cancer
97
Most common site of metastasis in follicular thyroid CA
lung and bone
98
Treatment of follicular CA
1. Follicular lesion - lobectomy + isthmusectomy 2. Follicular lesion \> 4 cm - total thyroidectomy 3. Thyroid cancer - total thyroidectomy 4. Positive lymph node - MDRD
99
Usual site of medullary thyroid cancer
superolateral in the thyroid lobes
100
Where does medullary thyroid cancer arise from
parafollicular cells C cells
101
Disease associated with men 2A
1, pheochromocytoma 2. parathyroid hyperplasia
102
Disease associated with men 2B
1. pheochromocytoma 2. neuroma
103
Treatment of MTC
Total thyroidectomy with bilateral central node dissection
104
Most common site of minor salivary gland tumor
junction of hard and soft palate
