Head & Neck physiology - Tracheal conditions and Graves disease

Question 1

what is graves disease?

Answer 1

autoimmune disease where you produce autoantibodies against thyroid stimulating hormone (TSH)
results in hyperthyroidism

Question 2

what are the complications of graves disease?

Answer 2

thyroid eye disease
acropachy/clubbing
pre- tibial myxoedema

Question 3

what is the treatment for graves disease?

Answer 3

Anti-thyroids
Radio-iodine
Surgery - Thyroidectomy

Question 4

in what sex is graves disease most common?

Answer 4

females

Question 5

what is the term for clinical sign of airway obstruction?

Answer 5

stridor

Question 6

where is the obstruction likely to be if the stridor is…

1. inspiratory?
2. expiratory?
3. biphasic?

Answer 6

1 = laryngeal (above the glottis)
2 = tracheobronchial (below the glottis)
3 = Glottis/subglottis

Question 7

what is the treatment for stridor?

Answer 7

02
nebuliser adrenaline
IV dexamethasone
airway management

Question 8

what is a brachial cyst ?

Answer 8

remnant of fusion failure of the brachial arches or lymph node cyst degeneration

Question 9

where is a brachial cyst found?

Answer 9

extends anterior to the SCM at the junction between the upper and middle thirds

Question 10

how are brachial cysts treated?

Answer 10

excision to prevent further infection

Question 11

what is a pharyngeal pouch?

Answer 11

herniation of the pharyngeal mucosa between the thyropharygeus and cricopharyngeus muscles of the inferior constrictor of the oesophagus

Question 12

what does a patient with a pharyngeal much present?

Answer 12

voice hoarsness
dysphagia
aspiration pneumonia 
regurgitation 
weight loss
neoplasia

Question 13

how is a pharyngeal pouch investigated?

Answer 13

barium swallow

Question 14

what is the treatment for a pharyngeal pouch?

Answer 14

dilate

excision

Question 15

what are the different types of thyroid cancers?

Answer 15

papillary - lymphatic metastasis
follicular - haematogenous metastasis
anapaestic - aggressive, local spread, poor prognosis, old age
medullary - 10% familial i.e. MEN

Question 16

which type of thyroid cancer has haematogenous spread?

Answer 16

follicular thyroid cancer

Question 17

what type of thyroid cancer arises from parafollicular C cells?

Answer 17

medullary thyroid cancer

Question 18

which type of thyroid cancer is aggressive and occurs in old age?

Answer 18

anaplastic

Question 19

a patient presents with a thyroid tumour which has spread via lymph nodes. what is the most likely type of cancer?

Answer 19

papillary thyroid cancer

Question 20

a patient is found to have lost the high pitch tone in her voice. what nerve is most likely to have been affected?

Answer 20

superior laryngeal nerve

Question 21

damage of what nerve causes hoarseness and why?

Answer 21

recurrent laryngeal nerve as it innervates the intrinsic muscles of the larynx which are responsible for movement of the vocal cords required for production sound.

Question 22

where does a pharyngeal pouch develop?

Answer 22

between the cricopharyngeus and the thyropharyngeus muscles

Question 23

what are the indications of a tracheostomy?

Answer 23

air way protection
if there is airway obstruction
to reduce dead space for ventilation

Question 24

what clinical finding on examination may indicate graves disease?

Answer 24

thyroid bruit on auscultation

Question 25

a patient presents with a left swollen side of the face which is painful.
what is the likely diagnosis?

Answer 25

parotitis

Question 26

what could be a contributing factor to parotitis?

Answer 26

poor dental hygiene

Question 27

what duct is calculi more commonly found in?

Answer 27

sub mandibular due to the horizontal course of the duct

Question 28

what is a pleomorphic adenoma?

Answer 28

a benign tumour of the salivary glands, most commonly the parotid

Question 29

what are the causes of a colloid goitre?

Answer 29

pregnancy
lactation
puberty
iodine deficiency

Question 30

what is a complication of tonsillitis and how does it present?

Answer 30

quinsy
extreme pain
can’t open the mouth
can’t breath

Question 31

what is the presentation of tonsillitis?

Answer 31

pus
swollen neck lymph nodes
pyrexia
(no cough)