Endocrine

Question 0

Causes of solitary thyroid nodule

Answer 0

Cyst (commonest)
Adenoma
Dominant nodule in MNG
Carcinoma

Question 1

Causes of diffuse thyroid enlargement

Answer 1

Graves’ disease
Thyroiditis
Physiological

Question 2

Prognostic factors in thyroid cancer

Answer 2

"AGES"
Age (worse at the extremes of age)
Gender (men have worse prognosis)
Extent (mets obviously bad)
Size (large is bad)

Question 3

Main investigations

Answer 3

Bloods: TFTs, thyroid autoAbs (anti-TSHR); anti-TPO.
Imaging: USS +/- FNAC and bx; CT/MRI; radio-isotope scan (in solitary nodules, only useful if the patient is thyrotoxic, and can help determine whether the nodule itself is toxic and symptomatic.

Question 4

Complications of thyroid surgery

Answer 4

Recurrent laryngeal nerve damage - hoarse voice
Superior laryngeal nerve damage - loss of high pitch
Hypocalcaemia
Haematoma (need to decompress it)
Respiratory obstruction
Thyroid storm intra-operatively
Hypothyroidism

Question 5

Complications of retro eternal goitre extensions

Answer 5

Tracheal shift
SVCO
Oesophageal obstruction
Tracheomalacia

Question 6

Submandibular triangle lump

Answer 6

Lymph node
Submandibular gland (obstructed, infected, neoplasm)
Parotid tail
(Lymphangioma - like a more invasive and difficult to treat cystic hygroma)

Question 7

Submental triangle lump causes

Answer 7

Sublingual gland enlargement (?ranula. As the gland enlarges and plunges through the myelohyoid muscle)
Lymph node
Dermoid cyst/teratoma

Question 8

Carotid triangle lump causes

Answer 8

Carotid body tumours
Lymph nodes - JUGULODIGASTRIC LYMPH NODE
neuromas/schwannomas/neurofibromas of vagus nerve
BRANCHIAL CYST

Question 9

Muscular triangle lump causes

Answer 9

Thyroid
Thyroglossal cyst
Lymph node
Dermoid cyst
Laryngeal masses
Laryngocele (air-filled saccule, which can develop in instrument players, particularly brass players who do a lot of blowing)

Question 10

Occipital triangle lump causes

Answer 10

Lymph node

Cystic hygroma

Question 11

Supraclavicular triangle lump causes

Answer 11

VIRCHOW’S LYMPH NODE

• need to examine for malignancies anywhere below the clavicle - mainly CHEST, ABDO, BREAST
• also could be thyroid malignancy

Question 12

Investigations in head and neck lumps

Answer 12

X-ray
Angio (vascular lesions, eg carotid body stuff)
Sialogram
Nuclear imaging
Others: viral serology etc.

Question 13

Causes of enlarged lymph node

Answer 13

Infectious - local or systemic
Mets - local or systemic
Primary (lymphoma)
Miscellaneous (eg. Rheumatoid, sarcoid etc)

Question 14

Rule of 80s in salivary tumours

Answer 14

80% in parotid
80% is adenomas
80% is pleomorphic