Neck Anatomy and physiology

Question 1

what is a thyroglossal cyst?

Answer 1

Dilatation of thyroglossal duct remnant (birth defect)

Question 2

describe the signs of a thyroglossal cyst

Answer 2

midline neck lump
Moves on tongue protrusion
usually painless, smooth and cystic
if infected, pain can occur

Question 3

give three causes of a thyroid mass

Answer 3

Solitary nodule
Diffuse enlargement
Multi-nodular goitre

Question 4

what are the causes of Solitary thyroid nodule?

Answer 4

Cyst: due to localised haemorrhage
Adenoma: benign follicular tissue 
Carcinoma
Lymphoma
Prominent nodule in multi-nodular goitre

Question 5

how would you investigate a Solitary thyroid nodule

Answer 5

Investigate by fine-needle aspiration cytology (FNAC) ultrasound scanning

Question 6

what investigation can distinguish between a follicular adenoma and a follicular carcinoma?

Answer 6

FNAC CANNOT

tissue required for histological diagnosis=THYROID LOBECTOMY

Question 7

What is simple diffuse goiter?

Answer 7

the enlargement of the entire thyroid gland

often displayed by adolescents (at puberty)

Question 8

What is Graves’ disease?

Answer 8

Auto-antibodies against thyroid-stimulating hormone receptor stimulate receptor
Hyperthyroidism results

Question 9

who is more susceptible to thyroid disorders?

Answer 9

women

Question 10

what are Indications for Thyroidectomy?

Answer 10

Airway obstruction
Malignancy or suspected malignancy
Thyrotoxicosis
Cosmesis
Retrosternal extension

Question 11

what causes Multi-nodular goitre?

Answer 11

Grave’s disease OR toxic goitre

Question 12

what are indications of toxic goitre?

Answer 12

Older, no eye signs, atrial fibrillation

Question 13

give the Symptoms of Parathyroid Disease (Hyperparathyroidism)?

Answer 13

Renal calculi, polyuria, renal failure
Pathological fractures, osteoporosis, bone pain

Abdominal pain, constipation, peptic ulceration, pancreatitis, weight loss

Anxiety & depression, confusion, paranoia

Question 14

what causes Hyperparathyroidism?

Answer 14

too much parathyroid hormone (PTH) which can lead to:

high blood calcium and/or high blood phosphate

Question 15

what can lead to Hyperparathyroidism?

Answer 15

Adenoma 80%

Hyperplasia 12%

Malignancy (rare)

Question 16

what is the treatment for Parathyroid disease?

Answer 16

Surgery easiest if patient fit

Question 17

what is stridor?

Answer 17

a harsh or grating sound

Clinical sign of airway obstruction

Question 18

where is the obstruction if the stridor occurs on:

• Inspiratory
• Expiratory(wheeze)
• Biphasic

Answer 18

Inspiratory - laryngeal
Expiratory - tracheobronchial
Biphasic – glottic/subglottic

Question 19

how would you treat stridor?

Answer 19

O2, Nebulised Adrenaline, IV Dexamethasone, (Heliox), (Definitive) airway management

Question 20

what is a Branchial cyst?

Answer 20

Remnant of fusion failure of branchial arches OR lymph node cystic degeneration
arises on the lateral part of the neck

Question 21

what is a Pharyngeal pouch?

Answer 21

Herniation of pharyngeal mucosa between
thyropharyngeus and cricopharyngeus muscles of the
inferior constrictor of the pharynx

Question 22

what are symptoms of a Pharyngeal pouch?

Answer 22

Voice hoarseness			
Regurgitation
Dysphagia				
Weight loss
Aspiration pneumonia