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G.S > Final Exam > Flashcards

Final Exam Flashcards

1
Q

what’s the arterial supply of thyroid gLand ?

A
  • superior thyroid artery
  • inferior thyroid artery
  • thyroid ema artery.
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2
Q

what’s the venous drainage of thiroid gland

A

superior & middLe thyroid gland veins
inferior thyroid veins.

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3
Q

How many cervical Lymph node Levels ?

A

7 Group levels

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4
Q

what’s the nerve relation of thyroid gland?

A

Superior Laryngeal nerve.
recurrent Laryngeal nerve.

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5
Q

what’s the name of enzymes related of thyroid synthesis ?

A

Peroxidase enzyme
dehydrogenase protease enzyme

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6
Q

what’s the name of proteins which bonding with thyroid hormones in plasma?

A

albomin
thyroxine binding globulin
Pre albomen

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7
Q

whats the function of calcitonin hormone ?

A

ControL of calcium Plasma LeveL

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8
Q

what’s the function of thyroid hormone ?

A

Catabolic effect
metabolic effect.
Stimulate SkeletaL growth
increase sensitivity of A & B receptor
Decrease Seroum cholestrol
Decrease Seroum Ca Level

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9
Q

what’s simpatatic activity of thyroid hormone ?
OR
the effect of catecholamine for thyroid hormone ?

A

Increase HR
arrhythmia
tremor in hand
Increase sweating & temperature

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10
Q

what’s the symptoms of linguaL thyroid ?

A

Dyspnea.
Dysphagia.
Disarthria.
Haemorrhage.

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11
Q

what’s the definition of thyroglossal cyst ?

A

Remnent of thyroglossal duct

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12
Q

what’s the two clinical test regarding thyroglossaL Cyst ?

A

protrusion of the tonque.
Swallowing test.

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13
Q

what’s the complication of thyroglossaL cyst ?

A

Get infection & Perforation then changes to fistula:

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14
Q

what’s the treatment of thyroglossaL cyst Or thyroglossal fistule ? Name of surgical procedure ?

A

SurgicaL removing “excision” called / named ( Sistrunk operation )

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15
Q

whats the cause / aetiology / types of thyroid simple goiter ?

A

Simple diffuse hyperplasia.
Simple Colloid goiter.
Simple multinedular goiter.

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16
Q

what’s the cause / aetiology / types of toxic goiter “hyperthyroidism.”

A

Toxic diffuse goiter .
Toxic multinodular goiter .
Toxic Adenoma tumor .

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17
Q

what’s the cauce of inflammatory goiter ?

A

Autoimun disease. e.g Hashimoto’s thyroiditis
Granulomatoos thyroidit’s e.g Quervains thyroiditis
Infection “ acute (bacteriaL & viraL) “
“ Chronic (T.B , Syphilis ) “
others “ (amyloid ) “

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18
Q

what’s the treatment of simple, diffuse goiter ?

A

treated by given table thyroxin T4 treatment

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19
Q

what’s the causes of thyroid goiter “aetiology”

A

Stress
Iodine deficiency

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20
Q

what’s the definition of iodide goiter ?

A

its physiological goitre treated by large amount of iodine

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21
Q

whats are the difference between physiologic thyroid goiter & toxic thyroid goiter ?

A

In S. goiter = euthyroid normal
Toxic goiter = hyperthrodism + T3 + T4 - TSH

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22
Q

whats the meaning of endemic goiter ?

A

thyroid enlargment due to iodine deficiency

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23
Q

what’s the simple colloid goiter ?

A

its intermediate stage between simple
diffuse goiter & simple “multinodular goiter
it intermediate stage & irreversible stage

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24
Q

what’s the meaning of sporodic goiter?

A

thyroid enlargment due to defect / decrease in peroxidase enzyme

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25
Q

whats the complication of simple moltinodular goitre

A

cystic formation

calcification

malignant transformation 3%

complicated to 2ry thyrotoxicosis

retrosternaL extension

Compression on carotid artery

Compression on trachea

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26
Q

what’s the meaning of Berry’s sign

A

Pulse absent in carotid artery due to malignancy

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27
Q

what’s the meaning of tracheamalacia ?

A

Weakness of tracheal rings

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28
Q

whats the clinical calssification of thyroid goiter?

A

Grade 1 no Palpable or visible goiter
Grade 2 goiter palpable but not visible in normal head position.
Grade 3 goiter palpable and visible in normal head position

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29
Q

What are the benefits of tumor markers ?

A

Diagnosis , response to treatment & follow up .

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30
Q

what are the benefit of goiter. ultrasonography ?

A

Is commonly used to evaluate cystic or solid masses due to easy use , low expanses & non invasive .

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31
Q

retrosternal extension of large goiter & get downward with its capsule due to ?

A

Pushed by pre tracheal muscles ( strap muscles )

Pulled by negative intra thoracic pressure

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32
Q

what’s the different between primary and secondary thyrotoxicosis ?

A

primary thyrokoxicosis there is a swilling and the symptoms appear at same time + secondary thyrotoxicosis. swelling appear but the symptoms appear after years .

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33
Q

What are the treatment modalities of thyrotoxicosis ?

A

medical treatment
Surgical treatment
Radiotherapy

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34
Q

What are the complication of thyrotoxicosis

A

thyrotoxic Crisis
haemorrhage.
recurrent & external Laryngeal nerve injury
hypo parathyradism & thyroidism
recurrent of hyperthyroidism.

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35
Q

what’s the treatment of thyroid storm / Thyrotoxic crises ?

A

B blocker & antithyroid drugs.
IV fluid to treat dehydration.
Cooling the patient with ice packs
O2 & diuretic
I.V hydrocartisone

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36
Q

Treatment of haemorrhage ?

A

the opening of the wound immadiately , evacuatinging the clot , controlling the bleeding in the bed . > decrease the risk of suffocation

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37
Q

What are the predisposing factors of thyroid cancer ?

A

irradiation to the neck&raquo_space; papillary cancer
simple nodular goitre&raquo_space; follicular cancer
follicular adenoma&raquo_space; follicular cancer
Hashimoto’s thyroiditis&raquo_space; lymphoma or papillary cancer

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38
Q

The difference between T3 & T4 hormones

A

T3 = quick action in few hours
T4 = delayed action from 4 to 14 days

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39
Q

There is no middle thyroid artery ?

A

True

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40
Q

There is middle thyroid vein ?

A

True

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41
Q

Inferior thyroid artery is related to recurrent laryngeal nerve ?

A

True

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42
Q

Superior thyroid artery is related to external laryngeal nerve ?

A

True

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43
Q

Thyroidae ima artery is a branch from aortic arch ?

A

True

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44
Q

Is endocrine gland secrete T3 & T4 and effect every part of the body

A

Thyroid gland

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45
Q

Relation of thyroid gland

A

Medially : larynx + trachea oesophagus + recurrent laryngeal nerve
Posteriorly : carotid sheet and its content + superior and inferior parotid glands
Superficially : sup belly of omohyoid muscle , sternohyoid muscle , sternothyroid muscle , thyrohyoid muscle not in superficial relation , anterior border of stemomastoid muscle , plarysma muscle “ supplied by facial nerve , and skin & superficial fascia

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46
Q

Thyrohyoid muscle is not a superficial relation to thyroid gland

A

True

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47
Q

The content of carotid sheet ?

A

Common carotid artery

Internal jugular vein

Vagus nerve and lymph node

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48
Q

What is the median bud of pharynx ?

A

It is the place where thyroid gland develop called “ the thyroglossal duct as a other name .

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49
Q

Para thyroid gland / para follicular cells ( C cells ) are derived from ? Its secretion ?

A

Derived from neural crest and secrete calcitonin hormone !

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50
Q

Follicular cells release ?

A

T3 & T4 hormones

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51
Q

It is the junction between anterior 2/3 and posterior 1/3 of the tongue

A

Foramen caecum

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52
Q

The thyroglossal fistula it is a acquired or congenital disease ?

A

Acquired

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53
Q

Thyroglossal cyst is acquired or congenital ?

A

Congenital

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54
Q

Simple diffuse hyper-plastic goitre / simple diffuse goitre / physiologic goitre is common in ? Due to ? Treatment ? Prognosis without treatment ?

A

Common in young girls in property and pregnancy

Due to excessive metabolic demand

Exogenous thyroxin supply T4

Transformation to first simple colloid goitre then to meltable nodular goitre

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55
Q

Iodine in large quantity

A

Iodide goitre

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56
Q

If endemic goitre / iodine deficiency state continues ?

A

Transform to simple colloid goitre

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57
Q

Decrease in peroxidase enzyme / defective hormone synthesis causes

A

Sporadic goitre

58
Q

Goitregens caused by ?

A

Food “ cabbage “or drugs “ PASA or antithyroid drugs “

59
Q

Simple multinodular goitre caused by

A

Increase in TSH = hyperplasia & hyper atrophy

60
Q

Treatment of SDG simple diffuse goitre

A

Thyroxine

61
Q

What is the definition of simple colloid goitre ?

A

Its intermediate stage and irreversible

62
Q

Treatment of simple colloid goitre

A

Subtotal thyroidectomy ( excision of right and left parts and remain the central part )

Surgical removal

63
Q

Simple multi nodular goitre caused by

A

Iodine deficiency ( complication of simple diffuse hyper plastic goitre after years )

64
Q

Complication of simple moltinodular goitre

A

Cystic formation > haemorrhage > compression on trachea > suffocation

Calcification ( calcium deposition )

Malignant transformation 3%

2ry thyrotoxicosis 30%

Retrosternal extension leads to thoracic outlet or inlet syndrome

Compression on carotid artery ( pulse displacement > benign condition . or pulse disappears > malignant condition )

Pressure on trachea ( trachea displacement , or tracheomalacia chronic )

65
Q

It is absent of carotid pulse due to malignant tumour

A

Barry’s sign

66
Q

Weakness of tracheal cartilage

A

Tracheomalacia

67
Q

Tracheomalacia detected by

A

Kocker’s test

68
Q

Patient complain of neck swelling “ disfigurement “ seen in 20 - 40 in age in long duration of neck swelling causes dysphagia dyspnea & trecho malasia

A

Clinical picture of simple moltinodular goitre

69
Q

Sudden dyspnea caused by

A

Haemorrhage inside thyroid gland

70
Q

Clinical classification of thyroid goitre

A

Grade 1 : no palpable or visible goitre
Grade 2 : goitre palpable but not visible in normal head position
Grade 3 : goitre palpable and visible in normal head position

71
Q

Clinical classification detected by

A

Ultrasound

72
Q

Investigations of moltinodular goitre

A

Blood investigations
non invasive investigation
invasive investigation

73
Q

Blood investigation of moltinodular goitre

A

Thyroid function test

Thyroid auto-antibodies

Tumor markers

C.B.C

74
Q

Thyroid auto-antibodies test

A

Thyroid stimulating antibodies
automicrozomal antibodies titer
anti-thyroglobulin antibodies titer
anti-peroxidase antibodies titer

75
Q

What is the definition of Tumor markers

A

Proteneos substances in the blood (hormones) secreted by tumors indicate activity.

76
Q

thyroglobulin&raquo_space; papillary Carcinoma & follicular carcinoma
Calcitonine&raquo_space; medullary carcinoma.

A

Tumor markers in case of moltinodular goitre

77
Q

Tumor markers used for

A

Diagnosis , response to treatment and follow up check .

78
Q

Commonly used non invasive investigation of multi nodular goitre

A

Neck ultrasound

79
Q

Non invasive investigations of moltinodular goitre

A

Neck ultrasound

Chest xray , CT scan , MRI

Thyroid isotope scan

80
Q

Thyroid scan is detected by ?

A

Gamma camera

81
Q

Thyroid isotope scan of moltinodular goitre

A

Hot : over active <5% malignant
Cold : under active 20% malignant

82
Q

What are the x ray manifestation of thyroid goitre

A

Compression on trachea

Retrosternal extension

Calcification

83
Q

What are the benefits of ultra sound in goitre therapy

A

To detect where can we take the biopsy & Check surrounded lymph nodes

84
Q

Why the ultrasound is the better investigation in thyroid goitre

A

It is inexpensive , non invasive & easily done

85
Q

Invasive investigation of moltinodular goitre

A

Fine needle aspiration cytology ( small needle biopsy )

Large-bore needle (Trucut) biopsy

Indireet laryngoscope

86
Q

cannot distinguish between a benign follicular adenoma and follicular
carcinoma , because not demonstrating capsular & vascular invasion,

A

FNAC ( fine needle aspiration cytology )

87
Q

has a high diagnostic accuracy , it has a poor patient compliance and associated with complications such as pain ,bleeding, tracheal
and recurrent laryngeal nerve damage, so it’s not routinely done.

A

Large-bore needle (Trucut) biopsy

88
Q

to determine the mobility of the vocal cords pre - operatively & the state of recurrent laryngeal nerve & for medico-legal reason also.

A

Indirect laryngoscope

89
Q

Treatment of moltinodular goitre

A

for single thyroid nodule > “ Hemithyroidectomy. “

for multiple thyroid nodule > subtotal thyroidectomy.

Medical > Tab thyroxine (Eltroxin)

90
Q

What are the benefits of X ray ?

A

To look for compression of trachea , retrosternal extension & calcification

91
Q

Retrosternal goitre clinical picture & symptoms ?

A

CP : common in males

Symptoms : symptomless

92
Q

Engorgement of neck veins when the hands are raised up due to thoracic inlet

A

Pemberton’s signs

93
Q

Thyroid gland during deglutition is movable go up and down

A

False “ can’t go up and down “ “ immovable “

94
Q

Investigation of retrosternal goitre

A

Radiograph of thoracic inlet

Contrast CT & MRI

Thyroid isotope scan

Pulmonary function test

95
Q

Clinical types of retrosternal goitre

A

Substernal

Intra thoracic

96
Q

Treatment of retrosternal goitre

A

Subtotal thyroidectomy

Preoperative drug must be given = propanalol in toxic retrosternal goitre

Why ?

To reduce T3 and T4 during surgery

Antithyroid drugs are contraindicated

Why ?

Increase the size of thyroid which lead to more compression on trachea

97
Q

Increase in thyroid hormones increase in T3 and increase in T4

A

Thyrotoxicosis/ hyperthyroidism

98
Q

(Graves’ disease, exophthalmic goiter, diffuse T goitre). Are ?

A

Primary thyrotoxicosis

99
Q

Secondary to simple nodular goiter (multinodular).

A

Secondary thyrotoxicosis

100
Q

Autonomous nodule, which is not under the influence of TSH, but occurs due to hypertrophy and hyperplasia of nodules, ( tertiary thyrotoxicosis ).

A

Solitary toxic nodule

101
Q

Aetiopathogeneses of grave’s disease

A

genetics especially identical twins , emotion , stress & young age are features of grave’s disease

102
Q

Clinical features of grave’s disease

A

8 times more common in females between 15 to 25 years old .

103
Q

Unexpected loss of weight in spite of good appetite , diarrhoea , intolerance to heat , preference to cold , tremors , excitability & excessive sweating

A

Grave’s disease

104
Q

The difference between primary thyrotoxicosis & secondary thyrotoxicosis ?

A

Primary thyrotoxicosis > symptoms appear with swelling at the same time

Secondary thyrotoxicosis > swelling but the symptoms appear after months or years

105
Q

Differences between primary and secondary thyrotoxicosis Primary thyrotoxicosis (Graves), Secondary thyrotoxicosis_ (Toxic MNG )

A

Primary thyrotoxicosis :

Age 20-40 years

Symptoms & signs appear simultaneously with short duration

Skin warm

Consistency soft

Surface smooth

Auscultation bruit is common

Predominant symptoms CNS

Pre tibial myxoedema 1-2% of pt

Proximal myopathy 5% of pt

Malignant exophthalmus can be seen

Secondary thyrotoxicosis

Age 35-50 years

Symptoms & signs long duration of swelling and short duration of sign

Skin not warm

Consistency firm

Surface nodular

Auscultation bruit is uncommon

Predominant symptoms CVS

Pre tibial myxoedema never seen

Proximal myopathy never seen

Malignant exophthalmus never seen

106
Q

Eye signs of thyrotoxicosis

A

Protruding eyes , Exopthalmos.

Photophobia.

Blurring of vision, diplopia.

Lid Lag

Lid retraction

107
Q

Hand signs of thyrotoxicosis

A

Warm & moist, Tremor, increase pulse rate ,Tachycardia

108
Q

How do you know the exophthalmos of the eye ?

A

By ruler test between superior and inferior orbital ridge > if eye touch the ruler&raquo_space; exophthalmos

109
Q

Exophthalmos (stages)

A

false exophthalmos&raquo_space; lid retraction

true exophthalmos visible sclera of cornea

malignant exophthalmos cannot close his eyes

110
Q

Treatment of exophthalmos and the aim of treatment

A

Medical treatment

Surgical treatment

Orbital radiotherapy best results treatment of choice
_______________________________

To restore euthyroid state & to minimise complication

111
Q

(Medical treatment) of thyrotoxicosis

A

carbimazole /neomercazole

Propyl-thiouracil

Propranolol

112
Q

complications of thyroidectomy

A

thyroid storm ( Chvrotoxic crisis )

Haemorrhage

recurrent ، external larvngeal nerve injury

Hypo-parathyroidism

113
Q

its a sever hyper-metabolic stale

A

Thyroid storm / thyrotoxicosis crisis

114
Q

Treatment of papillary & follicular Carcinoma ?

A

total thyroidectomy & en-block neck dissection , and iodine ablation

115
Q

Which tumor with 4% incidence

A

Lymphoid cells, (lymphoma)

116
Q

Which tumor with 6% incidence, and may present at any age

A

medullary carcinoma

117
Q

Which tumor with 13% incidence
M > F, in old age group, more than 60 years .

A

anaplastic carcinoma

118
Q

Which tumor with 17 % incidence . F:M 2:1.

A

follicular carcinoma

119
Q

the main metastasis of Follicular Carcinoma is ?

A

Blood (haematological)

120
Q

the main metastasis of papillary carcinoma is ?

A

Lymph node ( lateral aberrant thyroid )

121
Q

Which tumor with 60% incidence , F:M 3:1.

A

papillary carcinoma

122
Q

peritonsillar abscess

A

Ouinsy

123
Q

Treatment of Quinsy ( peritonsillar abscess )

A

intravenous antibiotics

124
Q

Treatment of acute sinusitis

A

IV Antibiotics according to culture sensitivity test

125
Q

Most common bacteria which cause otitis media

A

Streptococcus pneumonia

126
Q

What is the treatment of lingual thyroid

A

thyroxine therapy > Surgical excision

127
Q

Patient complain of neck swelling “ disfigurement “ seen in 20 - 40 in age

A

Simple moltinodular goitre

128
Q

in long duration of neck swelling causes dysphagia dyspnea & trecho malasia

A

Simple moltinodular goitre

129
Q

Superficial relation ( antero lateral relation ) of thyroid gland

A

sup belly of omohyoid m

sternohyoid m

sternothyroid m

thyrohyoid m (not in superficial relation )

anterior of stenomastoid m

platysma m“

130
Q

Long standing infection of the sinus

A

Chronic sinusitis

131
Q

inflamation of the middle ear

A

otitis Media

132
Q

are Usually exlarged and coated with pus

A

Tonsils

133
Q

Peritonsiller abscess

A

Quinsy

134
Q

What’s the couses of Sinusitis

A

cold or influenza

swimming and diving

Dental extraction or infection

Fractures involving the sinuses

135
Q

inflammation of the paranasal sinuses

A

sinusitis

136
Q

Air Containing Gravities

A

Paranasal Sinuses

137
Q

What is the CSSD

A

Central Sterilisation surface Department.

138
Q

Levels of disinfection

A

High Level

Intermediate Level

Low Level

139
Q

What are the the methods of sterilisation ?

A

Chemical Way

Biological Way

140
Q

Reduction of Population of Pathological micro organisms or Killing the Vegetative Forms without Killing spores

A

Disinfection

141
Q

Destruction of micro organisms in all Forms including spores

A

Sterilisation

G.S (2 decks)

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