Neck

Question 0

How does normal thyroid parenchyma appear on ultrasound?

Answer 0

Homogeneous medium level echoes

Question 1

What is the pyramidal lobe of the thyroid?

Answer 1

Normal variant extending superior to the isthmus

Question 2

How do the strap muscles of the neck appear on ultrasound?

Answer 2

Sternohyoid and sternothyroid

Sonolucent bands along the anterior surface of the thyroid gland

Question 3

Where is the common carotid artery and the internal jugular vein in relation to the thyroid lobes?

Answer 3

Directly lateral to the thyroid lobes with the internal jugular vein lateral to the carotid artery

Question 4

What muscle is posterior to the thyroid?

Answer 4

Longus colli muscle

Wedge shaped sonolucent structure adjacent to the cervical vertebrae

Question 5

What is the minor neurovascular bundle composed of?

Answer 5

Recurrent laryngeal nerve and inferior thyroid vessels

Question 6

Are the parathyroid glands typically visualized with ultrasound?

Answer 6

NO - due to their small size

Question 7

How does the trachea appear on ultrasound?

Answer 7

Midline, characteristic curvilinear reflecting surface with associated reverberation artifact

Question 8

How does the esophagus appear on ultrasound?

Answer 8

Transverse – target sign

Usually hidden by the trachea

Question 9

Where does the thyroid arterial supply come from?

Answer 9

Superior thyroid artery - from external carotid artery

Inferior thyroid artery - from thyrocervical trunk

Question 10

Where does the venous blood from the thyroid drain into?

Answer 10

Internal jugular vein via the superior and middle thyroid veins
Innominate veins via inferior thyroid veins

Question 11

Which glands regulate thyroid hormones?

Answer 11

Thyroid
Pituitary
Hypothalamus

Question 12

Where is TSH produced?

Answer 12

Pituitary

Stimulates the thyroid to produce thyroid hormones

Question 13

What is usually the first indication of hypothyroidism?

Answer 13

Increase in TSH

Question 14

Which gland regulates the pituitary gland?

Answer 14

Hypothalamus

Question 15

What is the percent of the US population with evidence of nodular thyroid disease?

Answer 15

50% of the United States population

Question 16

What is the overall incidence of cancer in patients with thyroid nodules?

Answer 16

10–13%

Question 17

What is the most commonly encountered benign thyroid nodule?

Answer 17

Follicular adenoma

Question 18

What can commonly occur within these benign nodules resulting in cystic thyroid nodules?

Answer 18

Hemorrhage or necrosis

Question 19

What are risk factors for thyroid cancer?

Answer 19

Age – 60yo
Head and neck irradiation
Family history of thyroid cancer

Question 20

What are physical findings of thyroid cancer?

Answer 20

Recent palpable neck mass
Mass is firm and nontender
Mass moves with swallowing
Enlarged cervical lymph nodes
Hoarseness
Trouble swallowing or breathing

Question 21

What is the most common primary thyroid cancer?

Answer 21

Papillary carcinoma

Question 22

How does papillary carcinoma appear on ultrasound?

Answer 22

Hypoechoic mass, with possible calcifications

Question 23

What is the major route for the spread of papillary carcinoma?

Answer 23

Through the lymphatics to nearby cervical lymph nodes

Question 24

What accounts for 10 to 20% of thyroid cancers?

Answer 24

Follicular carcinoma

Question 25

How do follicular cancers tend to spread?

Answer 25

Via the bloodstream

Question 26

What does medullary carcinoma typically secrete?

Answer 26

Calcitonin | Associated with multiple endocrine neoplasia syndrome

Question 27

How does anaplastic carcinoma behave?

Answer 27

Aggressive, rapidly invades surrounding tissue causing airway obstruction

Question 28

How are thyroid masses clinically evaluated?

Answer 28

Fine needle aspiration with cytologic evaluation

Question 29

When should FNA be considered?

Answer 29

``` > 1 cm with microcalcifications > 1.5 cm that is predominantly solid > 2 cm that has mixed components Nodule demonstrating growth Nodule with ipsilateral abnormal lymph nodes ```

Question 30

How is ultrasound used to differentiate thyroid nodules from other cervical masses?

Answer 30

Differentiate from cystic hygromas, glossal duct cysts, or enlarged lymph nodes

Question 31

Which factors improve the positive predictive value of ultrasound in determining the malignant nature of a nodule?

Answer 31

Composition Echogenicity Margination Calcification

Question 32

What aspect of composition is associated with higher risk of malignancy?

Answer 32

The solid component

Question 33

How do the margins appear in malignant lesions?

Answer 33

The regular or poorly defined margins

Question 34

Which calcifications are indicative of a malignancy?

Answer 34

Fine and punctate

Question 35

What are the features associated with thyroid cancer?

Answer 35

``` Microcalcifications Solid hypoechogenicity Irregular margins Absence of halo Intranodule central vascularity More tall than wide ```

Question 36

Which conditions cause diffuse thyroid disease?

Answer 36

Chronic autoimmune thyroiditis (Hashimoto's) Adenomatous goiter Graves' disease

Question 37

How does Hashimoto's thyroiditis appear on ultrasound?

Answer 37

Hypoechoic diffuse enlargement with a coarse parenchymal echotexture

Question 38

What is a goiter?

Answer 38

Enlarged thyroid gland that may be diffuse or nodular

Question 39

How is thyroid function in different types of goiters?

Answer 39

Normal – nontoxic goiter Overactive – toxic goiter Underactive – hypothyroid goiter

Question 40

What is the most common cause of a goiter worldwide?

Answer 40

Iodine deficiency

Question 41

How do goiters appears sonographically?

Answer 41

Multiple discrete nodules Diffuse parenchymal inhomogeneity Mixed echogenicity without normal tissue

Question 42

What is Graves disease?

Answer 42

Autoimmune disorder characterized by hyperthyroidism due to circulating antibodies

Question 43

How does Graves disease cause hyperthyroidism?

Answer 43

Thyroid antibodies bind to activate thyrotropin receptors causing the thyroid gland to grow causing an increased production of thyroid hormones

Question 44

How does the thyroid appear on ultrasound in Graves' disease?

Answer 44

Diffusely hypoechoic and inhomogeneous

Question 45

How does a parathyroid adenoma appear on ultrasound?

Answer 45

Oval hypoechoic mass posterior to the thyroid gland

Question 46

What is the most common type of hyperparathyroidism?

Answer 46

Development of an adenoma associated with one of the parathyroid glands

Question 47

How is primary hyperparathyroidism diagnosed?

Answer 47

Increased serum parathyroid hormone with increased serum calcium

Question 48

Which condition develops secondary hyperparathyroidism?

Answer 48

Chronic renal failure because of increased amounts of serum phosphates

Question 49

What stimulates parathyroid gland hyperplasia in secondary hyperparathyroidism?

Answer 49

Inability to synthesize vitamin D depresses the serum calcium level

Question 50

What is the most common manifestation of multiple endocrine neoplasia, type 1?

Answer 50

Hyperparathyroidism resulting in hyperplasia of all four parathyroid glands

Question 51

What are the salivary glands?

Answer 51

Exocrine glands that secrete saliva and amylase

Question 52

Where are the sublingual glands located?

Answer 52

Beneath the tongue, anterior to submandibular glands

Question 53

Where are the parotid glands located?

Answer 53

Anterior to the ear wrapped around the mandibular ramus

Question 54

Where are the submandibular glands located?

Answer 54

Beneath the jaw

Question 55

Name the salivary glands.

Answer 55

Parotid Sublingual Submandibular

Question 56

Which ducts are associated with each salivary gland?

Answer 56

Parotid - Stensen's duct | Submandibular - Wharton's duct

Question 57

What are the diseases of the salivary glands?

Answer 57

``` Mumps Sjögren's syndrome Mucoceles Neoplasms Salivary duct calculus ```

Question 58

What is the most common superficial midline neck mass in adolescents with an associated URI?

Answer 58

Thyroglossal duct cyst

Question 59

What is a thyroglossal duct cyst?

Answer 59

Cystic dilatation of the thyroglossal duct which is a remnant of the thyroid gland migration from the pharyngeal epithelium

Question 60

What is a branchial cleft cyst?

Answer 60

Solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the mandible under the SCM

Question 61

What is a cystic hygroma?

Answer 61

Congenital lymphatic malformation | 75% occur in neck

Question 62

How does a cystic hygroma appear on ultrasound?

Answer 62

Cystic multiloculated cervical mass that is evident at birth

Question 63

What syndromes are associated with a cystic hygroma?

Answer 63

Turner syndrome Down syndrome Klinefelter syndrome Trisomy 18 and 13

Question 64

What are the vessels of the aortic arch?

Answer 64

Innominate artery Left common carotid artery Left subclavian artery

Question 65

Is there a left innominate artery?

Answer 65

NO - only one innominate artery but bilateral innominate veins

Question 66

At what level does the common carotid artery bifurcate?

Answer 66

Superior border of the thyroid cartilage

Question 67

Where are the ICA and ECA located?

Answer 67

ICA – lateral and posterior | ECA – medial and anterior

Question 68

Describe the waveforms of the ICA and ECA.

Answer 68

ICA – low resistance | ECA – high resistance

Question 69

What is the first branch of the ICA and the ECA?

Answer 69

ICA – ophthalmic artery | ECA – superior thyroid artery

Question 70

Where is the internal jugular vein in relation to the common carotid artery?

Answer 70

Lateral

Question 71

What do the internal jugular vein and subclavian vein drain into?

Answer 71

The innominate or brachiocephalic veins bilaterally