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ABD & SMALL PARTS > necks > Flashcards

necks Flashcards

1
Q

thyroid isthmus located inferior to __ and superior to __

A

inferior to circoid cartilage

superior to sternal notch

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2
Q

embryology of thyroid

A

develops at base of tongue and descends down ML thyroglossal duct

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3
Q

common variants of thyroid

A

pyramidal lobe

ectopia

thyroglossal duct cysts

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4
Q

normal vascularity of thyroid

A

veins anterior, arteries posterior

good supply

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5
Q

what is the functional unit of the thyroid

A

follicle

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6
Q

what element is used by the thyroid to make T3 and T4

A

iodine

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7
Q

where is T3 and T4 stored

A

colloid

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8
Q

what type of cells make calcitonin

A

parafollicular cells

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9
Q

what does calcitonin do

A

lower blood calcium

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10
Q

what type of feedback mechanism involves the thyroid

A

hypothalamus - pituitary - thyroid axis

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11
Q

what does the thyroid regulate

A

metabolism

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12
Q

what is euthyroidism

A

normal thyroid function

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13
Q

what is hypothyroidism

A

decreased function

high TSH

slow metabolism

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14
Q

what is hyperthyroidism

A

thyrotoxicosis

increased thyroid function

low TSH

fast metabolism

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15
Q

NM radioactive iodine can be used for what

A

scan and assess function of thyroid

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16
Q

thyroid is anterior to __

A

trachea

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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

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18
Q

thyroid tissue extending into a persistent portion of inferior thyroglossal duct

A

pyramidal lobe

~50%

less prominent with age

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19
Q

a fibrous muscular band that attaches the thyroid isthmus to hyoid bone

A

levator muscle

*pulls thyroid superiorly during swallowing

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20
Q

swallowing and extending tongue is key technique when investigating __

A

thyroglossal duct anomalies

*should move with swallowing because within pretracheal fascia

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21
Q

projection of normal thyroid tissue from the posterior aspect of lateral lobes of thyroid gland

A

Zuckerkandl tubercle

aka posterior thyroid tubercle

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22
Q

where is typical location of ectopic thyroid tissue

A

ML and superior to normal

inferior

rarely intratracheal or lateral

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23
Q

superior thyroid artery comes off __

A

first branch off the ECA

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24
Q

inferior thyroid artery arises from __

A

thyrocervical trunk
*second branch off SCA

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25
Q

what do the follicular cells make

A

thyroid hormones

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26
Q

colloid aka

A

thyroglobulin

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27
Q

what is stored in thyroglobulin

A

thyroid hormones

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28
Q

what type of gland is the thyroid

A

endocrine

secretes hormones into bloodstream

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29
Q

what are the thyroid hormones

A

T3, T4, calcitonin

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30
Q

what does T3 and T4 do

A

regulates metabolism

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31
Q

T3 aka

A

triiodothyronine

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32
Q

T4 aka

A

thyroxine

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33
Q

parafollicular cells aka

A

C cells

*nice to remember these make CCCCCalcitonin to lower blood CCCCalcium

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34
Q

TRH aka

A

thyrotropin release hormone

*hypothalamus

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35
Q

TSH aka

A

thyroid stimulating hormon

*anterior pituitary

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36
Q

low TSH indicates

A

suppressed thyroid function

too much T3 and T4

hyperthyroid

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37
Q

high TSH indicates

A

stimulated thyroid

not enough T3 and T4

hypothyroid

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38
Q

what would be the physiological expectations with a goiter

A

iodine deficiency = goiter

low T3, low T4

high TRH, high TSH

overall hypothyroid

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39
Q

pt with slow metabolism, weight gain, lethargy, dry skin and feeling cold

A

hypothyroid

decreased function

high TSH

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40
Q

pt with fast metabolism, slim, hyperactive, sweaty and always feeling hot, high heart rate

A

hyperthyroidism

increased function

low TSH

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41
Q

which muscle is posterior to thyroid gland

A

longus colli muscle

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42
Q

which muscle is anterior to thyroid

A

strap muscles

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43
Q

where would you expect to find the parathyroid and minor neurovascular bundle

A

posterior to thyroid

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44
Q

where would you expect to find the sternocleidomastoid

A

lateral, slightly anterior to thyroid

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45
Q

what is posterior to the trachea

A

esophagus

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46
Q

what is inside the minor neurovascular bundle

A

inferior thyroid artery and recurrent laryngeal nerve

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47
Q

what are the normal measurements expected in an adult thyroid

A

4-6 x 1.5 cm

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48
Q

what are the names of the strap muscles

A

omohyoid

sternohydoid

sternothyroid

thyrohyoid

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49
Q

where is the platysma muscle

A

direclty below epididymus anterior neck

*'’platypus’’ - like = flatplate along neck

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50
Q

where is the anterior scalenus muscle

A

along vertebral, posterior neck

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51
Q

anterior neck triangle incorporates which smaller triangles

A

submental triangle (chin)

submandibular triangle (diagastric - under mandible)

carotid triangle (contains BIF)

muscular triangle (contains thyroid)

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52
Q

which triangles are within the posterior triangle

A

occipital triangle (posterior LN chain)

supraclavicular triangle (LN and SCA)

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53
Q

how many LN levels are there

A

6

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54
Q

where do we usually see the esopahgus even though it is a ML structure

A

left when pt head to rt

rt when pt head to lt

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55
Q

size of normal LN

A

<8 mm

L/T ratio >2

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56
Q

wtf is the trachea

A

windpipe

extends from pharynx to primary bronchii

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57
Q

thyroid nodules more common in female or male

A

female
20-50 y

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58
Q

types of benign nodules

A

colloid nodule (hyperplasia)

adenoma

cyst

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59
Q

what are the 4 main types of thyroid cancers

A

papillary

follicular

medullary

anaplastic (rare)

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60
Q

features of benign nodules

A

cystic

well defined

internal comet tails

minimal or no flow

no calcs

if solid, hyperechoic

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61
Q

features of malignancy

A

solid, hypoechoic

ill defined

large

TALLER THAN WIDE

internal calc

no halow, or thick halo

marked internal flow

adenopathy

62
Q

what are the classifications of thyroid disease

A

focal

diffuse

63
Q

types of diffuse thyroid disease

A

multinodular goiter

graves

hashimotos thyroditis

64
Q

what type of anethesia is used to dx thyroid noduels

A

local b/c FNA

65
Q

hyperplastic adenomatous nodule aka

A

colloid

66
Q

true, benign neoplasm of thyroid that typically does not cause thyroid disfunction

A

thyroid adenoma

67
Q

what is a ‘hot’ nodule in NM

A

increased focal uptake

hyperfunctioning

68
Q

what is a ‘cold’ nodule in NM

A

decreased focal uptake

non functioning

69
Q

which type of NM nodule is more likely to be malignant

A

solitary ‘cold’ nodule

70
Q

thyroid cancers from least to most aggressive

A

PFMA

71
Q

thyroid cancers from easiest to treat to most difficulte

A

PFMA

72
Q

what is a follicular variant that tends to occur in slightly older pt and has similar management to follicular cell cancer

A

Hurthle cell cancer

73
Q

type of cancer that arises from parafollicular (C cells)

A

medullary

serum calcitonin can be used as tumour marker

74
Q

which type of cancer associated with MEN II syndrome

A

medullary cancer

75
Q

MEN II syndrome aka

A

Sipple syndrome

76
Q

associations with MEN II syndrome

A

medullary thyroid cancer

hyperparathyroidism
***parathyroid adenoma or hyperplasia

adrenal pheochromocytoma

77
Q

what is associated with MEN I syndrome

A

parathyroid
**hyperparathyroidism

pituitary
**tumours

pancreas
**Zollinger-Ellison syndrome

78
Q

anaplastic cancer is v rare but usually found with

A

older pt

79
Q

microscopic round collection of calcium

A

psammoma bodies

“sand”

80
Q

why do we care about psammoma bodies

A

commonly seen in certain tumours

***papillary thyroid, papillary renal cell, ovarian papillary serous cystadenocarcinoma, endo adenocarcinoma

81
Q

wider than tall = ?

A

more likely benign

82
Q

which type of cancer most likely with tracheal deviation

A

anaplastic

83
Q

a benign nodule that has shrunk over time and may now display calcs or other signs of malignancy but is NOT malignant

A

mummified nodules

**can only be confirmed with close correlation with prev studies

84
Q

what is the most likely primary regarding mets TO the thyroid

A

renal cell carcinoma

v rare

85
Q

complications of thyroidectomy

A

loss of thyroid function

loss of parathyroid function

vocal nerve damage

86
Q

small inflammatory mass that forms around a suture - difficult to ddx from recurrent thyroid cancer

A

suture granuloma

87
Q

thyroid bed recurrence

A

post op masses have extensive DDX

occurs in 20%

88
Q

which elastography technique is qualitative

A

strain

89
Q

which type of elastography is quantitative

A

shear wave

90
Q

toxic goiter aka

A

goiter + hyperthyroid

91
Q

non toxic goiter aka

A

goiter + euthyroid or hypothyroid

92
Q

hashimotos thyroiditis aka

A

hypothyroidism

non toxic goiter

autoimmune

93
Q

sono features of hypothyroiditis

A

striations

enlarged heterogeneous gland

pseudo nodules

normal or diminished blood flow (when it settles)

lymphadenitis

94
Q

uncommon types of thyroiditis

A

bacterial infeciton

viral infection (deQuervain’s)

95
Q

graves disease aka

A

hyperthyroidism

toxic goiter

exophthalmos

autoimmune

96
Q

sono features of hyperthyroidism

A

diffuse deterogeneous gland

prominant blood flow (inferno)

97
Q

many causes of goiter

A

iodine deficiency

multinodular

autoimmune disorder

98
Q

trick to remember which autoimmunie disorder relates to thyroid function

A

hashimOOOOOto = hypOOOO

gRRRRaves = hypeRRRR

99
Q

diffuse enlargement due to hyperplastic, adenomatous nodules

A

MNG

100
Q

hashimotos thyroiditis AKA chronic __

A

chronic lyphocytic thyroditis

101
Q

sono feature of end stage hashimotos

A

diffusely small heteroeneous thyroid tissue

102
Q

ML prelaryngeal nodes aka

A

Delphian nodes

may enlarge with spread from thyroid or laryngeal cancer

**superior to itshmus

103
Q

what can sometimes mimic graves with hashimotos

A

increased vascularity if flared up inflammation

typically low to no vascularity

104
Q

rapid enlargement of thyroid, lymphadenopathy, older pt, and hashimotos increases risk for __

A

non-Hodgkin’s lymphoma of thyroid

105
Q

acute bacterial infection of thyroid, rare but will find in kids or immunocompromised if ever`

A

acute suppurative thyroiditis

106
Q

term for protrusion of eyes - and why tf

A

exophthalmos

infiltration of lymphocytes into tissue behind eye and inflammation/thickening or muscles and orbital tissues

107
Q

thyrotoxicosis aka

A

graves disease

hyperthyroidism

108
Q

what will you expect metabolism to be with graves

A

increased

hyperhtyroid

low TSH

109
Q

vascularity of graves

A

inferno

high PSV

110
Q

big diff in graves and hashimotos if both displaying inferno

A

striations to heterogeneous tissue of hashimotos

111
Q

what type of gland is parathyroid

A

endocrine

112
Q

what hormone is in parathyroid and what does it do

A

parathyroid hormone

raises blood calcium levels
** stimulates vit D activity to absorb more calcium from gut to kidneys

113
Q

what is the most common pathology of parathyroid

A

solitary functioning adenoma

114
Q

technique needed for dx parathyroid adenoma

A

graded compression
*** to find it like an appi and improves visual

115
Q

most likely dx for lateral cystic neck mass

A

branchial cleft cyst

anterolat to carotid
adj to SCM

116
Q

benign or malignant tumour of carotid body

A

carotid body tumour

++ vascular

at BIF

117
Q

what is the carotid body

A

paraganglion chemoreceptor

118
Q

what is indicator for parathyroid rather than LN

A

vascularity is polar (from one end continuing peripheral) rather than hilar feeding vessel

119
Q

what is ddx when symptoms “painful bones, renal stones, abdominal groans and psychic moans”

A

hyperparathyroidism causing excessive PTH resultant hypercalcemia

120
Q

excessive PTH results

A

hypercalcemia

  • renal colic, bone joint pain
  • muscle fatique
  • nephrolithiasis
  • nephrocalcinosis
  • HTN
  • peptic ulcer
  • neuro dysfuntion (tough neurotransmission at synapses)
121
Q

other test to find parathyroid adenoma

A

NM Sestamibi scan

122
Q

associated MEN I > MEN II but still both

A

parathyroid hyperplasia

**similar appearance to adenoma; but usually multiple

123
Q

which neck masses are typically pediatric

A

cystic hygroma

hemangioma

124
Q

brachial cleft cysts are __ anomaly

A

congenital

branchial apparatus is embryological tissue

**failure of obliteration of second branchial cleft

**non tender

125
Q

sono features of branchial cleft cysts

A

**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
Q

what does the paraganglion chemoreceptor do

A

carotid body

contains sensory nerves that monitor o2 and co2

127
Q

malignant lymphadenopathy is more likely to be __

A

non tender

128
Q

solitary enlarged, palpable, supraclavicular node most commonly in LT side - called ‘sentinel node’

A

Virchow’s node

aka signal note

129
Q

may be the first sign of a malignant chest neoplasm

A

signal node/ sentinel node/

virchow’s node

130
Q

most common benign soft tissue tumour; majority subcutaneous

A

lipoma

131
Q

pulsatile neck mass, bruit, hx of atherosclerosis or trauma

A

arterial aneurysm

focal dilatation of vessel x2 normal size

usually in CA or Innominate

132
Q

what are the 3 paired glands of the ‘neck’

A

parotid

sublingual

submandibular

** = salivary glands

133
Q

infection of salivary glands

A

sialadenitis

134
Q

stone formation of salivary glands

A

sialolithiasis

135
Q

obstruction of parotid duct

A

Stensen’s

136
Q

obstruction of submandibular duct

A

Wharton’s

137
Q

parotid glands are __ to the masseter muscle

A

superficial

138
Q

most common intraparotid mass

A

benign lymph node

139
Q

salivary simulation with __ enhances sono dx of obstructive sialadenitis

A

ascorbic acid

140
Q

the most common benign condition to effect the salivary glands

A

calculus disease

submandibular most commonly affected

141
Q

clinical presentation of calculi in paramandibular glands

A

painful glands

worsening pain when chewing

142
Q

autoimmune syndrome that attacks salivary glands

A

Sjögren’s syndrome

** decreased function, dry mouth, dry eyes

143
Q

xerostomia

A

dry mouth

144
Q

Sjögren’s demographic

A

mostly adult females

145
Q

most common salivary tumour in females

A

pleomorphic adenoma

146
Q

most common salivary tumour in males

A

warthin’s tumour

147
Q

adenomas of the salivary glands

A

pleomorphic adenoma

warthin’s tumour

148
Q

which salivary tumour ++ incidence with smokers

A

warthin tumour

149
Q

most common site for warthin’s tumour

A

parotid tail

150
Q

maldevelopment of the lymphatic sys to communicate with the venous sys of the neck

A

lyphangioma

= cystic hygroma

** endothelial lined cavernous lymphatic spaces

ABD & SMALL PARTS (16 decks)

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