07 - Lumo in Neck

Question 1

Basic effects of T3/4

Answer 1

Increased metabolism
Growth and development
Increased catecholamine effect

Question 2

What 2 hormones influence calcium content of blood?

Answer 2

PTH

Calcitonin (thyroid)

Question 3

How does PTH raise blood calcium?

What else does PTH affect?

Answer 3

by stimulating osteoblasts and osteoclasts to break down bone

Increased gut absorption

Reduces renal filtration

Phosphorus levels

Question 4

Conditions producing a goitre

Answer 4

Graves’, Hashimoto’s, congenital, cancers, nodules, pituitary disease (raised TSH)

Question 5

What cells do thyroid cancers arise from?

Which type produce a hormone? Which?

Answer 5

follicular or parafollicular

C type produce calcitonin

Question 6

Mx of thyroid Ca?

Rfs?

Answer 6

radioactive ablation or thyroidectomy.
Good prognosis

Risks: MEN2, radiation exposure

Question 7

Eg Sx of hyperthyroid? Most common cause?

Answer 7

Tachycardia, hyperthermia, goitre, diarrhoea, weight loss, anxiety.

Graves

Question 8

2 obvious Ix in hyperthyroid? What can be used to control Sx?

Answer 8

t3/4, TSH

Bblockers

Question 9

Basic of how graves works? Key Sx? Mx?

Answer 9

Autoimmune Ig binds to TSH receptors ->hyperthyroid

Opthalmopathy/proptosis only seen in 30%
Non pitting pretibial myxoedema

carmibazole, radioiodine or surgery and replace

Question 10

Sx of hypothyroid? common causes?

Answer 10

Opposite of hyper + hirtuism

Hashimoto’s. Also pituitary disease, past cancer/removal, drug side effects, congenita

Question 11

Mx of hypothyroid

Answer 11

iodine

levothyroixine

Question 12

What is hashimotos?Sx/ What can it lead to?

Answer 12

Autoimmune destruction of thyroid.

Symptoms: painless goitre (chronically shrinks), hypothyroidism

Can develop into a lymphoma.

Question 13

Difference between Primary and secondary hyperparathyroidism?
Tertiary?

Answer 13

Primary: PTH release not determined by blood calcium levels. Usually silent. Causes hypercalcaemia

Secondary: Blood calcium has no response to PTH. Hypocalcaemia.

Tertiary: Long term secondary. PTH no longer responds to blood Ca

Question 14

Rfs of hyperparathyroidism

Answer 14

Renal disease, drugs, Vit D deficiency

Question 15

Calcium in hypoparathyroidism?

causes?

Answer 15

hypocalcaemia

thyroid surgery, congenital, autoimmune, haemochromatosis

Question 16

pseudo/pseudopseudo hypoparathyroidism?

Levels of PTH?

Answer 16

Pseudohypoparathyroidism: Genetic condition causing skeletal defects (short 4th and 5th metacarpals and round facies). PTH high.

Pseudopseudohypoparathyroidism: Genetic condition causing skeletal defects. PTH normal.

Question 17

What causes mononucleosis?

Complications?

Diagnosis?

Answer 17

EBV 90% (also CMV / herpesvirides)

Hepato / splenomegaly
Risk of developing lymphoma / chronic fatigue syndrome

specific tests unreliable (monospot, heterophile)

Question 18

Lymphoma Sx?
Ix?
Mx?
Rfs?

Answer 18

A - Enlarged painless lymph nodes
 B symptoms (weight loss, fever, night sweats weight loss).

Lymph node biopsy
Treat with chemo, radio and surgery.

Risk: EBV, AIDS, drugs

Question 19

Cells on histology of Hodgkin’s ? Usual age?

Answer 19

Reed-Sternberg cells
Aka Owl cells, with bilobed nuclei

Age 20-40 and 75+

Question 20

Rfs for non hodgkins?

Answer 20

immunodeficiency, thyroid disease, EBV, H Pylori, Hep C