Final Exam Flashcards
what’s the arterial supply of thyroid gLand ?
- superior thyroid artery
- inferior thyroid artery
- thyroid ema artery.
what’s the venous drainage of thiroid gland
superior & middLe thyroid gland veins
inferior thyroid veins.
How many cervical Lymph node Levels ?
7 Group levels
what’s the nerve relation of thyroid gland?
Superior Laryngeal nerve.
recurrent Laryngeal nerve.
what’s the name of enzymes related of thyroid synthesis ?
Peroxidase enzyme
dehydrogenase protease enzyme
what’s the name of proteins which bonding with thyroid hormones in plasma?
albomin
thyroxine binding globulin
Pre albomen
whats the function of calcitonin hormone ?
ControL of calcium Plasma LeveL
what’s the function of thyroid hormone ?
Catabolic effect
metabolic effect.
Stimulate SkeletaL growth
increase sensitivity of A & B receptor
Decrease Seroum cholestrol
Decrease Seroum Ca Level
what’s simpatatic activity of thyroid hormone ?
OR
the effect of catecholamine for thyroid hormone ?
Increase HR
arrhythmia
tremor in hand
Increase sweating & temperature
what’s the symptoms of linguaL thyroid ?
Dyspnea.
Dysphagia.
Disarthria.
Haemorrhage.
what’s the definition of thyroglossal cyst ?
Remnent of thyroglossal duct
what’s the two clinical test regarding thyroglossaL Cyst ?
protrusion of the tonque.
Swallowing test.
what’s the complication of thyroglossaL cyst ?
Get infection & Perforation then changes to fistula:
what’s the treatment of thyroglossaL cyst Or thyroglossal fistule ? Name of surgical procedure ?
SurgicaL removing “excision” called / named ( Sistrunk operation )
whats the cause / aetiology / types of thyroid simple goiter ?
Simple diffuse hyperplasia.
Simple Colloid goiter.
Simple multinedular goiter.
what’s the cause / aetiology / types of toxic goiter “hyperthyroidism.”
Toxic diffuse goiter .
Toxic multinodular goiter .
Toxic Adenoma tumor .
what’s the cauce of inflammatory goiter ?
Autoimun disease. e.g Hashimoto’s thyroiditis
Granulomatoos thyroidit’s e.g Quervains thyroiditis
Infection “ acute (bacteriaL & viraL) “
“ Chronic (T.B , Syphilis ) “
others “ (amyloid ) “
what’s the treatment of simple, diffuse goiter ?
treated by given table thyroxin T4 treatment
what’s the causes of thyroid goiter “aetiology”
Stress
Iodine deficiency
what’s the definition of iodide goiter ?
its physiological goitre treated by large amount of iodine
whats are the difference between physiologic thyroid goiter & toxic thyroid goiter ?
In S. goiter = euthyroid normal
Toxic goiter = hyperthrodism + T3 + T4 - TSH
whats the meaning of endemic goiter ?
thyroid enlargment due to iodine deficiency
what’s the simple colloid goiter ?
its intermediate stage between simple
diffuse goiter & simple “multinodular goiter
it intermediate stage & irreversible stage
what’s the meaning of sporodic goiter?
thyroid enlargment due to defect / decrease in peroxidase enzyme
whats the complication of simple moltinodular goitre
cystic formation
calcification
malignant transformation 3%
complicated to 2ry thyrotoxicosis
retrosternaL extension
Compression on carotid artery
Compression on trachea
what’s the meaning of Berry’s sign
Pulse absent in carotid artery due to malignancy
what’s the meaning of tracheamalacia ?
Weakness of tracheal rings
whats the clinical calssification of thyroid goiter?
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
What are the benefits of tumor markers ?
Diagnosis , response to treatment & follow up .
what are the benefit of goiter. ultrasonography ?
Is commonly used to evaluate cystic or solid masses due to easy use , low expanses & non invasive .
retrosternal extension of large goiter & get downward with its capsule due to ?
Pushed by pre tracheal muscles ( strap muscles )
Pulled by negative intra thoracic pressure
what’s the different between primary and secondary thyrotoxicosis ?
primary thyrokoxicosis there is a swilling and the symptoms appear at same time + secondary thyrotoxicosis. swelling appear but the symptoms appear after years .
What are the treatment modalities of thyrotoxicosis ?
medical treatment
Surgical treatment
Radiotherapy
What are the complication of thyrotoxicosis
thyrotoxic Crisis
haemorrhage.
recurrent & external Laryngeal nerve injury
hypo parathyradism & thyroidism
recurrent of hyperthyroidism.
what’s the treatment of thyroid storm / Thyrotoxic crises ?
B blocker & antithyroid drugs.
IV fluid to treat dehydration.
Cooling the patient with ice packs
O2 & diuretic
I.V hydrocartisone
Treatment of haemorrhage ?
the opening of the wound immadiately , evacuatinging the clot , controlling the bleeding in the bed . > decrease the risk of suffocation
What are the predisposing factors of thyroid cancer ?
irradiation to the neck»_space; papillary cancer
simple nodular goitre»_space; follicular cancer
follicular adenoma»_space; follicular cancer
Hashimoto’s thyroiditis»_space; lymphoma or papillary cancer
The difference between T3 & T4 hormones
T3 = quick action in few hours
T4 = delayed action from 4 to 14 days
There is no middle thyroid artery ?
True
There is middle thyroid vein ?
True
Inferior thyroid artery is related to recurrent laryngeal nerve ?
True
Superior thyroid artery is related to external laryngeal nerve ?
True
Thyroidae ima artery is a branch from aortic arch ?
True
Is endocrine gland secrete T3 & T4 and effect every part of the body
Thyroid gland
Relation of thyroid gland
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
Thyrohyoid muscle is not a superficial relation to thyroid gland
True
The content of carotid sheet ?
Common carotid artery
Internal jugular vein
Vagus nerve and lymph node
What is the median bud of pharynx ?
It is the place where thyroid gland develop called “ the thyroglossal duct as a other name .
Para thyroid gland / para follicular cells ( C cells ) are derived from ? Its secretion ?
Derived from neural crest and secrete calcitonin hormone !
Follicular cells release ?
T3 & T4 hormones
It is the junction between anterior 2/3 and posterior 1/3 of the tongue
Foramen caecum
The thyroglossal fistula it is a acquired or congenital disease ?
Acquired
Thyroglossal cyst is acquired or congenital ?
Congenital
Simple diffuse hyper-plastic goitre / simple diffuse goitre / physiologic goitre is common in ? Due to ? Treatment ? Prognosis without treatment ?
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
Iodine in large quantity
Iodide goitre
If endemic goitre / iodine deficiency state continues ?
Transform to simple colloid goitre
Decrease in peroxidase enzyme / defective hormone synthesis causes
Sporadic goitre
Goitregens caused by ?
Food “ cabbage “or drugs “ PASA or antithyroid drugs “
Simple multinodular goitre caused by
Increase in TSH = hyperplasia & hyper atrophy
Treatment of SDG simple diffuse goitre
Thyroxine
What is the definition of simple colloid goitre ?
Its intermediate stage and irreversible
Treatment of simple colloid goitre
Subtotal thyroidectomy ( excision of right and left parts and remain the central part )
Surgical removal
Simple multi nodular goitre caused by
Iodine deficiency ( complication of simple diffuse hyper plastic goitre after years )
Complication of simple moltinodular goitre
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 )
It is absent of carotid pulse due to malignant tumour
Barry’s sign
Weakness of tracheal cartilage
Tracheomalacia
Tracheomalacia detected by
Kocker’s test
Patient complain of neck swelling “ disfigurement “ seen in 20 - 40 in age in long duration of neck swelling causes dysphagia dyspnea & trecho malasia
Clinical picture of simple moltinodular goitre
Sudden dyspnea caused by
Haemorrhage inside thyroid gland
Clinical classification of thyroid goitre
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
Clinical classification detected by
Ultrasound
Investigations of moltinodular goitre
Blood investigations
non invasive investigation
invasive investigation
Blood investigation of moltinodular goitre
Thyroid function test
Thyroid auto-antibodies
Tumor markers
C.B.C
Thyroid auto-antibodies test
Thyroid stimulating antibodies
automicrozomal antibodies titer
anti-thyroglobulin antibodies titer
anti-peroxidase antibodies titer
What is the definition of Tumor markers
Proteneos substances in the blood (hormones) secreted by tumors indicate activity.
thyroglobulin»_space; papillary Carcinoma & follicular carcinoma
Calcitonine»_space; medullary carcinoma.
Tumor markers in case of moltinodular goitre
Tumor markers used for
Diagnosis , response to treatment and follow up check .
Commonly used non invasive investigation of multi nodular goitre
Neck ultrasound
Non invasive investigations of moltinodular goitre
Neck ultrasound
Chest xray , CT scan , MRI
Thyroid isotope scan
Thyroid scan is detected by ?
Gamma camera
Thyroid isotope scan of moltinodular goitre
Hot : over active <5% malignant
Cold : under active 20% malignant
What are the x ray manifestation of thyroid goitre
Compression on trachea
Retrosternal extension
Calcification
What are the benefits of ultra sound in goitre therapy
To detect where can we take the biopsy & Check surrounded lymph nodes
Why the ultrasound is the better investigation in thyroid goitre
It is inexpensive , non invasive & easily done
Invasive investigation of moltinodular goitre
Fine needle aspiration cytology ( small needle biopsy )
Large-bore needle (Trucut) biopsy
Indireet laryngoscope
cannot distinguish between a benign follicular adenoma and follicular
carcinoma , because not demonstrating capsular & vascular invasion,
FNAC ( fine needle aspiration cytology )
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.
Large-bore needle (Trucut) biopsy
to determine the mobility of the vocal cords pre - operatively & the state of recurrent laryngeal nerve & for medico-legal reason also.
Indirect laryngoscope
Treatment of moltinodular goitre
for single thyroid nodule > “ Hemithyroidectomy. “
for multiple thyroid nodule > subtotal thyroidectomy.
Medical > Tab thyroxine (Eltroxin)
What are the benefits of X ray ?
To look for compression of trachea , retrosternal extension & calcification
Retrosternal goitre clinical picture & symptoms ?
CP : common in males
Symptoms : symptomless
Engorgement of neck veins when the hands are raised up due to thoracic inlet
Pemberton’s signs
Thyroid gland during deglutition is movable go up and down
False “ can’t go up and down “ “ immovable “
Investigation of retrosternal goitre
Radiograph of thoracic inlet
Contrast CT & MRI
Thyroid isotope scan
Pulmonary function test
Clinical types of retrosternal goitre
Substernal
Intra thoracic
Treatment of retrosternal goitre
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
Increase in thyroid hormones increase in T3 and increase in T4
Thyrotoxicosis/ hyperthyroidism
(Graves’ disease, exophthalmic goiter, diffuse T goitre). Are ?
Primary thyrotoxicosis
Secondary to simple nodular goiter (multinodular).
Secondary thyrotoxicosis
Autonomous nodule, which is not under the influence of TSH, but occurs due to hypertrophy and hyperplasia of nodules, ( tertiary thyrotoxicosis ).
Solitary toxic nodule
Aetiopathogeneses of grave’s disease
genetics especially identical twins , emotion , stress & young age are features of grave’s disease
Clinical features of grave’s disease
8 times more common in females between 15 to 25 years old .
Unexpected loss of weight in spite of good appetite , diarrhoea , intolerance to heat , preference to cold , tremors , excitability & excessive sweating
Grave’s disease
The difference between primary thyrotoxicosis & secondary thyrotoxicosis ?
Primary thyrotoxicosis > symptoms appear with swelling at the same time
Secondary thyrotoxicosis > swelling but the symptoms appear after months or years
Differences between primary and secondary thyrotoxicosis Primary thyrotoxicosis (Graves), Secondary thyrotoxicosis_ (Toxic MNG )
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
Eye signs of thyrotoxicosis
Protruding eyes , Exopthalmos.
Photophobia.
Blurring of vision, diplopia.
Lid Lag
Lid retraction
Hand signs of thyrotoxicosis
Warm & moist, Tremor, increase pulse rate ,Tachycardia
How do you know the exophthalmos of the eye ?
By ruler test between superior and inferior orbital ridge > if eye touch the ruler»_space; exophthalmos
Exophthalmos (stages)
false exophthalmos»_space; lid retraction
true exophthalmos visible sclera of cornea
malignant exophthalmos cannot close his eyes
Treatment of exophthalmos and the aim of treatment
Medical treatment
Surgical treatment
Orbital radiotherapy best results treatment of choice
_______________________________
To restore euthyroid state & to minimise complication
(Medical treatment) of thyrotoxicosis
carbimazole /neomercazole
Propyl-thiouracil
Propranolol
complications of thyroidectomy
thyroid storm ( Chvrotoxic crisis )
Haemorrhage
recurrent ، external larvngeal nerve injury
Hypo-parathyroidism
its a sever hyper-metabolic stale
Thyroid storm / thyrotoxicosis crisis
Treatment of papillary & follicular Carcinoma ?
total thyroidectomy & en-block neck dissection , and iodine ablation
Which tumor with 4% incidence
Lymphoid cells, (lymphoma)
Which tumor with 6% incidence, and may present at any age
medullary carcinoma
Which tumor with 13% incidence
M > F, in old age group, more than 60 years .
anaplastic carcinoma
Which tumor with 17 % incidence . F:M 2:1.
follicular carcinoma
the main metastasis of Follicular Carcinoma is ?
Blood (haematological)
the main metastasis of papillary carcinoma is ?
Lymph node ( lateral aberrant thyroid )
Which tumor with 60% incidence , F:M 3:1.
papillary carcinoma
peritonsillar abscess
Ouinsy
Treatment of Quinsy ( peritonsillar abscess )
intravenous antibiotics
Treatment of acute sinusitis
IV Antibiotics according to culture sensitivity test
Most common bacteria which cause otitis media
Streptococcus pneumonia
What is the treatment of lingual thyroid
thyroxine therapy > Surgical excision
Patient complain of neck swelling “ disfigurement “ seen in 20 - 40 in age
Simple moltinodular goitre
in long duration of neck swelling causes dysphagia dyspnea & trecho malasia
Simple moltinodular goitre
Superficial relation ( antero lateral relation ) of thyroid gland
sup belly of omohyoid m
sternohyoid m
sternothyroid m
thyrohyoid m (not in superficial relation )
anterior of stenomastoid m
platysma m“
Long standing infection of the sinus
Chronic sinusitis
inflamation of the middle ear
otitis Media
are Usually exlarged and coated with pus
Tonsils
Peritonsiller abscess
Quinsy
What’s the couses of Sinusitis
cold or influenza
swimming and diving
Dental extraction or infection
Fractures involving the sinuses
inflammation of the paranasal sinuses
sinusitis
Air Containing Gravities
Paranasal Sinuses
What is the CSSD
Central Sterilisation surface Department.
Levels of disinfection
High Level
Intermediate Level
Low Level
What are the the methods of sterilisation ?
Chemical Way
Biological Way
Reduction of Population of Pathological micro organisms or Killing the Vegetative Forms without Killing spores
Disinfection
Destruction of micro organisms in all Forms including spores
Sterilisation
