necks Flashcards
1
Q
thyroid isthmus located inferior to __ and superior to __
A
inferior to circoid cartilage
superior to sternal notch
2
Q
embryology of thyroid
A
develops at base of tongue and descends down ML thyroglossal duct
3
Q
common variants of thyroid
A
pyramidal lobe
ectopia
thyroglossal duct cysts
4
Q
normal vascularity of thyroid
A
veins anterior, arteries posterior
good supply
5
Q
what is the functional unit of the thyroid
A
follicle
6
Q
what element is used by the thyroid to make T3 and T4
A
iodine
7
Q
where is T3 and T4 stored
A
colloid
8
Q
what type of cells make calcitonin
A
parafollicular cells
9
Q
what does calcitonin do
A
lower blood calcium
10
Q
what type of feedback mechanism involves the thyroid
A
hypothalamus - pituitary - thyroid axis
11
Q
what does the thyroid regulate
A
metabolism
12
Q
what is euthyroidism
A
normal thyroid function
13
Q
what is hypothyroidism
A
decreased function
high TSH
slow metabolism
14
Q
what is hyperthyroidism
A
thyrotoxicosis
increased thyroid function
low TSH
fast metabolism
15
Q
NM radioactive iodine can be used for what
A
scan and assess function of thyroid
16
Q
thyroid is anterior to __
A
trachea
17
Q
what should happen to thyroglossal duct as fetus develops
A
should degenerate
is an embryonic structure
*an open connection between initial area of thyroid development in oropharynx and the final position inferior to cricoid cartilage
should atrophy and close off before birth
18
Q
thyroid tissue extending into a persistent portion of inferior thyroglossal duct
A
pyramidal lobe
~50%
less prominent with age
19
Q
a fibrous muscular band that attaches the thyroid isthmus to hyoid bone
A
levator muscle
*pulls thyroid superiorly during swallowing
20
Q
swallowing and extending tongue is key technique when investigating __
A
thyroglossal duct anomalies
*should move with swallowing because within pretracheal fascia
21
Q
projection of normal thyroid tissue from the posterior aspect of lateral lobes of thyroid gland
A
Zuckerkandl tubercle
aka posterior thyroid tubercle
22
Q
where is typical location of ectopic thyroid tissue
A
ML and superior to normal
inferior
rarely intratracheal or lateral
23
Q
superior thyroid artery comes off __
A
first branch off the ECA
24
Q
inferior thyroid artery arises from __
A
thyrocervical trunk
*second branch off SCA
25
what do the follicular cells make
thyroid hormones
26
colloid aka
thyroglobulin
27
what is stored in thyroglobulin
thyroid hormones
28
what type of gland is the thyroid
endocrine
secretes hormones into bloodstream
29
what are the thyroid hormones
T3, T4, calcitonin
30
what does T3 and T4 do
regulates metabolism
31
T3 aka
triiodothyronine
32
T4 aka
thyroxine
33
parafollicular cells aka
C cells
*nice to remember these make CCCCCalcitonin to lower blood CCCCalcium
34
TRH aka
thyrotropin release hormone
*hypothalamus
35
TSH aka
thyroid stimulating hormon
*anterior pituitary
36
low TSH indicates
suppressed thyroid function
too much T3 and T4
hyperthyroid
37
high TSH indicates
stimulated thyroid
not enough T3 and T4
hypothyroid
38
what would be the physiological expectations with a goiter
iodine deficiency = goiter
low T3, low T4
high TRH, high TSH
overall hypothyroid
39
pt with slow metabolism, weight gain, lethargy, dry skin and feeling cold
hypothyroid
decreased function
high TSH
40
pt with fast metabolism, slim, hyperactive, sweaty and always feeling hot, high heart rate
hyperthyroidism
increased function
low TSH
41
which muscle is posterior to thyroid gland
longus colli muscle
42
which muscle is anterior to thyroid
strap muscles
43
where would you expect to find the parathyroid and minor neurovascular bundle
posterior to thyroid
44
where would you expect to find the sternocleidomastoid
lateral, slightly anterior to thyroid
45
what is posterior to the trachea
esophagus
46
what is inside the minor neurovascular bundle
inferior thyroid artery and recurrent laryngeal nerve
47
what are the normal measurements expected in an adult thyroid
4-6 x 1.5 cm
48
what are the names of the strap muscles
omohyoid
sternohydoid
sternothyroid
thyrohyoid
49
where is the platysma muscle
direclty below epididymus anterior neck
*''platypus'' - like = flatplate along neck
50
where is the anterior scalenus muscle
along vertebral, posterior neck
51
anterior neck triangle incorporates which smaller triangles
submental triangle (chin)
submandibular triangle (diagastric - under mandible)
carotid triangle (contains BIF)
muscular triangle (contains thyroid)
52
which triangles are within the posterior triangle
occipital triangle (posterior LN chain)
supraclavicular triangle (LN and SCA)
53
how many LN levels are there
6
54
where do we usually see the esopahgus even though it is a ML structure
left when pt head to rt
rt when pt head to lt
55
size of normal LN
<8 mm
L/T ratio >2
56
wtf is the trachea
windpipe
extends from pharynx to primary bronchii
57
thyroid nodules more common in female or male
female
20-50 y
58
types of benign nodules
colloid nodule (hyperplasia)
adenoma
cyst
59
what are the 4 main types of thyroid cancers
papillary
follicular
medullary
anaplastic (rare)
60
features of benign nodules
cystic
well defined
internal comet tails
minimal or no flow
no calcs
if solid, hyperechoic
61
features of malignancy
solid, hypoechoic
ill defined
large
TALLER THAN WIDE
internal calc
no halow, or thick halo
marked internal flow
adenopathy
62
what are the classifications of thyroid disease
focal
diffuse
63
types of diffuse thyroid disease
multinodular goiter
graves
hashimotos thyroditis
64
what type of anethesia is used to dx thyroid noduels
local b/c FNA
65
hyperplastic adenomatous nodule aka
colloid
66
true, benign neoplasm of thyroid that typically does not cause thyroid disfunction
thyroid adenoma
67
what is a 'hot' nodule in NM
increased focal uptake
hyperfunctioning
68
what is a 'cold' nodule in NM
decreased focal uptake
non functioning
69
which type of NM nodule is more likely to be malignant
solitary 'cold' nodule
70
thyroid cancers from least to most aggressive
PFMA
71
thyroid cancers from easiest to treat to most difficulte
PFMA
72
what is a follicular variant that tends to occur in slightly older pt and has similar management to follicular cell cancer
Hurthle cell cancer
73
type of cancer that arises from parafollicular (C cells)
medullary
serum calcitonin can be used as tumour marker
74
which type of cancer associated with MEN II syndrome
medullary cancer
75
MEN II syndrome aka
Sipple syndrome
76
associations with MEN II syndrome
medullary thyroid cancer
hyperparathyroidism
***parathyroid adenoma or hyperplasia
adrenal pheochromocytoma
77
what is associated with MEN I syndrome
parathyroid
**hyperparathyroidism
pituitary
**tumours
pancreas
**Zollinger-Ellison syndrome
78
anaplastic cancer is v rare but usually found with
older pt
79
microscopic round collection of calcium
psammoma bodies
"sand"
80
why do we care about psammoma bodies
commonly seen in certain tumours
***papillary thyroid, papillary renal cell, ovarian papillary serous cystadenocarcinoma, endo adenocarcinoma
81
wider than tall = ?
more likely benign
82
which type of cancer most likely with tracheal deviation
anaplastic
83
a benign nodule that has shrunk over time and may now display calcs or other signs of malignancy but is NOT malignant
mummified nodules
**can only be confirmed with close correlation with prev studies
84
what is the most likely primary regarding mets TO the thyroid
renal cell carcinoma
v rare
85
complications of thyroidectomy
loss of thyroid function
loss of parathyroid function
vocal nerve damage
86
small inflammatory mass that forms around a suture - difficult to ddx from recurrent thyroid cancer
suture granuloma
87
thyroid bed recurrence
post op masses have extensive DDX
occurs in 20%
88
which elastography technique is qualitative
strain
89
which type of elastography is quantitative
shear wave
90
toxic goiter aka
goiter + hyperthyroid
91
non toxic goiter aka
goiter + euthyroid or hypothyroid
92
hashimotos thyroiditis aka
hypothyroidism
non toxic goiter
autoimmune
93
sono features of hypothyroiditis
striations
enlarged heterogeneous gland
pseudo nodules
normal or diminished blood flow (when it settles)
lymphadenitis
94
uncommon types of thyroiditis
bacterial infeciton
viral infection (deQuervain's)
95
graves disease aka
hyperthyroidism
toxic goiter
exophthalmos
autoimmune
96
sono features of hyperthyroidism
diffuse deterogeneous gland
prominant blood flow (inferno)
97
many causes of goiter
iodine deficiency
multinodular
autoimmune disorder
98
trick to remember which autoimmunie disorder relates to thyroid function
hashimOOOOOto = hypOOOO
gRRRRaves = hypeRRRR
99
diffuse enlargement due to hyperplastic, adenomatous nodules
MNG
100
hashimotos thyroiditis AKA chronic __
chronic lyphocytic thyroditis
101
sono feature of end stage hashimotos
diffusely small heteroeneous thyroid tissue
102
ML prelaryngeal nodes aka
Delphian nodes
may enlarge with spread from thyroid or laryngeal cancer
**superior to itshmus
103
what can sometimes mimic graves with hashimotos
increased vascularity if flared up inflammation
typically low to no vascularity
104
rapid enlargement of thyroid, lymphadenopathy, older pt, and hashimotos increases risk for __
non-Hodgkin's lymphoma of thyroid
105
acute bacterial infection of thyroid, rare but will find in kids or immunocompromised if ever`
acute suppurative thyroiditis
106
term for protrusion of eyes - and why tf
exophthalmos
infiltration of lymphocytes into tissue behind eye and inflammation/thickening or muscles and orbital tissues
107
thyrotoxicosis aka
graves disease
hyperthyroidism
108
what will you expect metabolism to be with graves
increased
hyperhtyroid
low TSH
109
vascularity of graves
inferno
high PSV
110
big diff in graves and hashimotos if both displaying inferno
striations to heterogeneous tissue of hashimotos
111
what type of gland is parathyroid
endocrine
112
what hormone is in parathyroid and what does it do
parathyroid hormone
raises blood calcium levels
** stimulates vit D activity to absorb more calcium from gut to kidneys
113
what is the most common pathology of parathyroid
solitary functioning adenoma
114
technique needed for dx parathyroid adenoma
graded compression
*** to find it like an appi and improves visual
115
most likely dx for lateral cystic neck mass
branchial cleft cyst
anterolat to carotid
adj to SCM
116
benign or malignant tumour of carotid body
carotid body tumour
++ vascular
at BIF
117
what is the carotid body
paraganglion chemoreceptor
118
what is indicator for parathyroid rather than LN
vascularity is polar (from one end continuing peripheral) rather than hilar feeding vessel
119
what is ddx when symptoms "painful bones, renal stones, abdominal groans and psychic moans"
hyperparathyroidism causing excessive PTH resultant hypercalcemia
120
excessive PTH results
hypercalcemia
- renal colic, bone joint pain
- muscle fatique
- nephrolithiasis
- nephrocalcinosis
- HTN
- peptic ulcer
- neuro dysfuntion (tough neurotransmission at synapses)
121
other test to find parathyroid adenoma
NM Sestamibi scan
122
associated MEN I > MEN II but still both
parathyroid hyperplasia
**similar appearance to adenoma; but usually multiple
123
which neck masses are typically pediatric
cystic hygroma
hemangioma
124
brachial cleft cysts are __ anomaly
congenital
branchial apparatus is embryological tissue
**failure of obliteration of second branchial cleft
**non tender
125
sono features of branchial cleft cysts
**non tender
anterolateral neck
may contain cholesterol crystals
thin walls, filled with fluid ( can be complex)
most have enhancement
can be site of infection or hemorrhage
126
what does the paraganglion chemoreceptor do
carotid body
contains sensory nerves that monitor o2 and co2
127
malignant lymphadenopathy is more likely to be __
non tender
128
solitary enlarged, palpable, supraclavicular node most commonly in LT side - called 'sentinel node'
Virchow's node
aka signal note
129
may be the first sign of a malignant chest neoplasm
signal node/ sentinel node/
virchow's node
130
most common benign soft tissue tumour; majority subcutaneous
lipoma
131
pulsatile neck mass, bruit, hx of atherosclerosis or trauma
arterial aneurysm
focal dilatation of vessel x2 normal size
usually in CA or Innominate
132
what are the 3 paired glands of the 'neck'
parotid
sublingual
submandibular
** = salivary glands
133
infection of salivary glands
sialadenitis
134
stone formation of salivary glands
sialolithiasis
135
obstruction of parotid duct
Stensen's
136
obstruction of submandibular duct
Wharton's
137
parotid glands are __ to the masseter muscle
superficial
138
most common intraparotid mass
benign lymph node
139
salivary simulation with __ enhances sono dx of obstructive sialadenitis
ascorbic acid
140
the most common benign condition to effect the salivary glands
calculus disease
submandibular most commonly affected
141
clinical presentation of calculi in paramandibular glands
painful glands
worsening pain when chewing
142
autoimmune syndrome that attacks salivary glands
Sjögren's syndrome
** decreased function, dry mouth, dry eyes
143
xerostomia
dry mouth
144
Sjögren's demographic
mostly adult females
145
most common salivary tumour in females
pleomorphic adenoma
146
most common salivary tumour in males
warthin's tumour
147
adenomas of the salivary glands
pleomorphic adenoma
warthin's tumour
148
which salivary tumour ++ incidence with smokers
warthin tumour
149
most common site for warthin's tumour
parotid tail
150
maldevelopment of the lymphatic sys to communicate with the venous sys of the neck
lyphangioma
= cystic hygroma
** endothelial lined cavernous lymphatic spaces
