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Surgery > Thyroid > Flashcards

Thyroid Flashcards

1
Q

___ is the fascia that coveres the thyroid

A

loose investing fascia

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2
Q

___ ligament attaches the thyroid gland to the cricoid cartilage

A

ligament of berry

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3
Q

the ligament of berry arises from what fascia

A

pre-tracheal fascia

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4
Q

arteries that supply the thyroid gland

A

superior thyroid artery

inferior thyroid artery

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5
Q

Aside from supplying the upper 1/3 of the lobe, the superior thyroid artery also supplies ____

A

upper 1/2 of the isthmus

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6
Q

the inferior thyroid artery is a branch of ___

A

thyrocervical trunk

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7
Q

The tributaries of the superior and middle thyroid vein

A

internal jugular vain

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8
Q

the tributary of the inferior thyroid vein

A

brachiocephalic vein

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9
Q

This nerve loops around the ligamentum arteriosum

A

left RLN

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10
Q

this loops around the subclavian artery

A

right RLN

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11
Q

this nerve crosses the arch of the aorta

A

left RLN

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12
Q

this nerve ascends at the tracheoesophageal groove

A

left RLN

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13
Q

Damage to one RLN leads to paralysis of the ____ (ipsilateral/contralateral) cord

A

ipsilateral cord

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14
Q

___ is a sensory nerve to supraglottic larynx

A

Internal branch of the superior laryngeal nerve

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15
Q

what are the branches of the superior laryngeal nerve?

A

internal and external branch

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16
Q

___ is the only motor NS to cricothyroid

A

external branch of the superior laryngeal nerve

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17
Q

what nerve is affected if…

inability to tense the cord
difficulty hitting high notes
voice fatigue

A

external branch of the superior laryngeal nerve

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18
Q

what descends alongside the external branch of the superior laryngeal nerve?

A

superior thyroid vessels

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19
Q

serum TSH levels reflect the ability of the anterior pituitary to detect ___ (FT3/FT4)

A

FT4

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20
Q

this reflects the output from the thyroid gland

A

total T4

NOT FT4

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21
Q

this reflects the peripheral thyroid hormone metabolism

A

Total T3

NOT FT3

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22
Q

this detects early hyperthyroidism

A

FT3

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23
Q

___ syndrome

endorgan resistance to T4

FT4 increased
TSH normal

A

Refetoff Syndrome

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24
Q

most important in monitoring differentiated thyroid cancer recurrence, after total thyroidectomy and RAI ablation

A

serum thyroglobulin

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25
Q

this is secreted by C cells

A

calcitonin

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26
Q

serum calcitonin is a sensitive marker of _____ cancer

A

medullary thyroid

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27
Q

[thyroid imaging]

I 123 vs I 131, which considered a low dose radiation

A

I 123

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28
Q

This radionuclide is better in detecting papillary and follicular CA

A

Iodine 131

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29
Q

[WHO GRADE OF THYROID SIZE]

goiter palpable
but not visible in normal head positon

A

Grade II

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30
Q

[diagnose]

female, 40-60 years old

heat intolerance, weight loss, diarrhea, palpitation, amenorrhea, afib, ophthalmopathy, dermopathy

A

graves disease

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31
Q

genes associated with graves disease

A

HLA B8
HLA DR3
HLA DQA1

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32
Q

[diagnose]

low TSH
with or without elevated FT4/FT3

(+) ophtalmopathy, female

A

graves

33
Q

[pharma]

drugs that block synthesis of new T4 and T3

A 
Methimazole
Amiodarone
Lithium
Iodine
PTU

MA LIP

34
Q

[pharma]

drugs that block TRH stimulation

A

Somatostatin

Glucocorticoids

35
Q

[pharma]

drugs that block pituitary secretion

A

dopamin

36
Q

[pharma]

Drug that block peripheral conversion of T4 ot T3

A

Propanolol, PTU
Amiodarone
Glucocorticoids
Iopanic acid

PAGI

37
Q

[pharma]

causes congenital aplasia/aplasia cutis

A

methimazole

38
Q

[pharma]

drugs that cause agrarnulocytosis

A

PTU

Methimazole

39
Q

What is the dose of I 131 as treatment for graves?

A

Oral dose 8-12 mCi

40
Q

absolute contraindication for RAI therapy

A

pregnancy

breastfeeding

41
Q

this is given 7 to 10 days prior to thyroidectomy

A

KISS

42
Q

Potassium iodide saturated solution is given prior to thyroidectomy because

A

it decreases vascularity of the thyroid

43
Q

Also called plummers disease

A

toxic multinodular goiter

44
Q

[diagnose]

Graves SSx
(-) ophthalmopathy

A

TMNG

45
Q

[diagnose]

younger patient
low TSH
high FT4/FT3
hot nodule

A

Toxic adenoma

46
Q

A burch-wartofsky score of 40 means that the patient is ___

A

impending storm (25 to 45)

47
Q

in cases of recurrent acute thyroiditis, you suspect ____ fistula

A

pyriform sinus

48
Q

[diagnose]

painful thyroid, 30-40 years old, women, previous history of URTI

What is the etiology?

A

Subacute thyroiditis, viral

self limited

49
Q

most common inflammatory disorders of the thyroid gland

A

hashimoto thyroiditis

50
Q

leading cause of hypothyroidism

A

hashimoto thyroiditis

51
Q

[diagnose]

CD8 T cells and antibodies directed agains

Tg, TPO and TSH, HLA B8 HLA DR3, HLA DR5

A

hashimoto thyoiditis

52
Q

[diagnose]

woman (30–50)
moderately painless diffusely enlarged thyroid gland

high TSH

A

hashimoto thyroiditis

53
Q

[diagnose]

painless, hard anterior neck mass

hard, woody thyroid gland

A

reidel thyrodiits

Wedge resection
L thyroxine

54
Q

the single most important test in the evaluation of thyroid nodules

A

FNAB

55
Q

What is the cut off to say that the FNAB has optimum cytology?

A

Follicles: at least 6
contains: 10-15 cells in each follicle
Aspirates: 2 aspirates

56
Q

These types of CA cant be diagnosed by FNAB

A

Follicular

Hurthle cell CA

57
Q

FNAB is less reliable in?

A

patients with history of radiation

Family history of thyroid CA

58
Q

what is the risk of malignancy for cold nodules

A

20%

59
Q

[Management of thyroid cytopathology]

Non-diagnostic/Unsatisfactory

A

Repeat FNAB with UTZ guided

1-4% risk of CA

60
Q

[Management of thyroid cytopathology]

Benign

A

critical follow-up

61
Q

[Management of thyroid cytopathology]

Atypia of undetermined significance

OR

Follicular lesion of undetermined significance

A

Repeat FNA

62
Q

Diagnostic modality that is useful for detecting nonpalpable thyroid nodules

A

ultrasound

63
Q

Characteristic of a malignancy in a cervical lymph node

A

taller than wide

loss of fatty hilym

64
Q

Papillary thyroid CA accounts for what percent of all thyroid malignancies?

A

80%

65
Q

[diagnose: type of MEN]

  1. Pituitary adenoma
  2. Parathyroid hyperplasia
  3. Pancreatic tumor
A

MEN 1

66
Q

[diagnose: type of MEN]

  1. Parathyroid hyperplasia
  2. Medullary thyroid CA
  3. Pheochromocytoma
A

MEN 2A

67
Q

[diagnose: type of MEN]

  1. Medullary thyroid CA
  2. Pheochromocytoma
  3. Mucosal neuroma
  4. Marfanoid body habitus
A

MEN 2B

68
Q

What thyroid malignancy is common in iodine deficient areas?

A

follicular CA

69
Q

This thyroid malignancy relies on the presence of capsular and vascular invasion

A

hurthle cell CA

70
Q

[diagnose: thyroid malignancy]

not avid for RAI
more likely to metastasize to LN and distant sites

A

hurthle cell CA

71
Q

What is the thyroglobulin value during post-op surveillance if the patient is taking levothyroxine?

A

<0.2 ng/mL

72
Q

What is the thyroglobulin value during post-op surveillance when the patient is hypothyroid?

A

<1ng

73
Q

___ CA that arises from the parafollicular cells

A

medullary thyroid CA

74
Q

what is the premalignant lesion for medullary thyroid CA?

A

chief cell hyperplasia

75
Q

[diagnose]

woman (7th to 8th decade)
long standing neck mass
rapidly enlarging

A

anaplastic thyroid CA

76
Q

most common type of of thyroid lymphoma

A

Non-hodgkin B cell type

77
Q

Thyroid lymphoma usually arises from ___ thyroiditis

A

hashimoto

78
Q

Regimen for thyroid lymphoma

A

RCHOP

Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
79
Q

most common malignancy that metastasize to the thyroid

A

renal cell CA

Surgery (19 decks)

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