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7- Surgery > Thyroid And Neck Swellings > Flashcards

Thyroid And Neck Swellings Flashcards

1
Q

goitre définition

A

Swelling of the thyroid

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2
Q

Goitre classification

A

Simple
Toxic
Neoplastic
Inflammatory
Infective
Others

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3
Q

What is simple goitre

A

Diffuse hyperplasia due to increased physiological demand like puberty or pregnancy, iodine deficiency , medications ( amiodarone, lithium)

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4
Q

Population at risk of multinodular goitre

A

Middle aged women

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5
Q

Chances of malignancy of multinodular goitre

A

5%

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6
Q

Complications of multinodular goitre

A

hyper/hypothyroidism
Hemorrhage
Nodule rupture
Malignancy
Tracheal compression / deviation
Oesophageal compression
SVCO

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7
Q

Man causes of toxic goitre

A

Graves disease

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8
Q

Other causes toxic goitre

A

Thyroiditis
Carcinoma
TSH secreting pituitary tumor
Iatrogenic
Choriocarcinoma
Hydatidiform mole

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9
Q

Types of benign tumor

A

Adenoma
Follicular tumor

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10
Q

Primary malignant tumor

A

Papillary carcinoma
Follicular carcinoma
Medullary thyroid cancer
Anaplastic thyroid cancer
Lymphoma

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11
Q

Type of inflammatory goitre

A

Autoimmune (hashimoto disease)
Granulomatous thyroiditis

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12
Q

Types of infective goitre

A

Acute bacterial thyroiditis
Chronic tb
Viral thyroiditis sub acute

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13
Q

WHO goitre grading

A

0 = no palpable goitre
1 = palpable goitre
1A = goitre detectable by palpation
1B = goitre palpable and visible
2= goitre visible with neck in normal position
3= large goitre from distance

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14
Q

Investigations

A

Thyroid function tests
Autoantibody screen
Tumour markers : calcitonin
Ultrasound : consistency, nodule number, size, position
Chest x ray : tracheal compression
CT, MRI => size, anatomy, retrosternal extension
Radionuclide imaging
FNAC

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15
Q

Treatment

A

Thyroxine
Radioiodine (thyrotoxicosis, euthyroid with large goiters)
Tetracycline ( cystic recurrence )
Thyroidectomy
Lobectomy

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16
Q

Post operative complications

A

Hemorrhage
Tracheal compression
Nerve damage
Temporary Hypocalcemia
Parathyroid injury or excision
Wound infection
Recurrence
Thyroid storm

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17
Q

Neck swellings

A

Sebaceous cyst
Lipoma
Neurofibroma
Capillary malformation
Tumors (SCC, melanoma, secondary metastasis )

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18
Q

Muscular neck swellings

A

Sternomastoid tumor
Rhabdomyosarcoma
Fibroma

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19
Q

Lymphadenopathy neck swellings

A

Acute infective
Chronic infective
Primary malignant
Secondary malignant

20
Q

Commonest congenital neck swelling

A

Thyroglossal cyst

21
Q

Thyroglossal cyst cause

A

Persistence of any part of Thyroglossal duct

22
Q

Characteristics Thyroglossal cyst

A

Non tender
Between thyroid and hyoid
Transilluminate

23
Q

Treatment Thyroglossal cyst

A

Excision

24
Q

What is Cystic hygroma

A

Congenital benign lymphangioma

25
Q

Characteristics of cystic hygroma

A

Neck and floor of mouth
No spontaneous regression
Clear lymph fluid
Transilluminates

26
Q

Treatment cystic hygroma

A

Surgical removal

27
Q

Sublingual Dermoid cyst bulge all the time ?

A

No can be wholly intra oral

28
Q

Bronchial cyst occurs mostly before or after adolescence

A

After

29
Q

Causes of branchial cyst

A

Failure of fusion of 2nd and 3 branchial arches

30
Q

Treatment branchial cyst

A

Excision

31
Q

Examination inspection

A

Site location
Asymmetry
Color changes
Sinuses
Scars
Punctum
Movement on swallowing

32
Q

Examination palpation

A

Induration
Tenderness
Temp
Mobility
Limits definition
Pulsatility
Emptying
Consistency
Systematic back of the neck
Cranial nerve assessment
Direction of movement
Transillumination

33
Q

Investigations

A

Radio. - plain x ray , ct, mri , sialography, ultrasound, barium swallow

Angiography

Immune studies

Bone scan

Histopathology - FNAB, biopsy

Hemato - FBC, ESR, CRP

Microbiology - AFBs, STIs

34
Q

What are the three strap muscles , fixing the lobes of thyroid to cartilage

A

Sterno thyroid muscle
Sternohyoid muscle
Superior belly of omohyoid

35
Q

The postero lateral surface of each lateral lobe of the thyroid gland is related to which structure

A

Carotid sheath

36
Q

Tractors related to the medial border of the lobes of the thyroid gland

A

Inferior constrictor
cricothyroid muscles
Oesophagus
Upper six tracheal rings
recurrent laryngeal nerve

37
Q

Two hormones produced by thyroid gland

A

T3 tri iodothyronine
T4 thyroxine

38
Q

Function of thyroid hormones

A

Increase heart rate , contractility of heart, cardiac output
Glycogen to glucose
Glucose absorption
Lipogenesis , lipolyses
CNS function
Growth , maturation

39
Q

Amount of iodine in gland

A

5000mg
90% storage of body

40
Q

Amount of iodine secreted by gland

A

100-120 microgram

41
Q

Main tests of thyroid function

A

In vitro test :
Serum t3 concentration
Serum free thyroxine
Serum thyroid stimulating hormone TSH
Test of hypothalamic pituitary axis

42
Q

Most sensitive indicator of hypothyroidism

A

Serum t3

43
Q

Most sensitive test for hypothyroidism

A

Serum TSH

44
Q

In vivo test

A

Isotope uptake test : high in hyperthyroidism , low in hypothyroidism

TSH stimulation and uptake test

45
Q

Imaging techniques used

A

Plain x ray - soft tissue and calcification
Ultrasound scan
CT
MRI
Fine needle aspiration
Test for auto immune antibodies
Laryngoscopy

7- Surgery (13 decks)

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