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ABD > Thyroid/Neck/Vessels > Flashcards

Thyroid/Neck/Vessels Flashcards

1
Q

The thyroid gland has ___ lobes that are situated on eitehr side of the _____.

A

2

trachea

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2
Q

What is a normal thyroid variant that extends from sueprior from the isthmus?

A

pyramidal lobe

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3
Q

NML thy parenchyma has a _____ level homogeneous echotexture and appears _____ compared to the anterior strap muscles.

A

medium

hyperechoic

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4
Q

Where are the sternoclastoid muscles located to the thyroid?

A

anterolaterally

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5
Q

Sonolucent bands along the anterior surface of the thyroid gland?

A

strap muscles (sternohyoid, sternothroid, omohyoid)

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6
Q

What vessel is directly lateral to the thyroid gland?

A

common carotid artery

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7
Q

What vessel is directly lateral to the CCA?

A

internal jugular vein

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8
Q

What msucles are posterior to the thyroid gland?

A

longus-colli muscles seen as a wedge-shaped sonolucent structure adjacent to the cervical vertebrare

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9
Q

What is the minor neurovascular bundle and where is it located?

A

composed of the recurrent laryngeal nerve and inferior thyroid vessels
seen as a vague hypoechoic area between the longus colli muscle and thyroid gland

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10
Q

Parathyroid glands are typically not seen unless abnormal, where are they located?

A

posetrior aspect of the thyroid

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11
Q

The trachea gives a charcateristic refecting surface that creates what artifact?

A

reververation artifact

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12
Q

The esophagus is usually hidden by the trachea but can seen as a ______ sign in TRV.

A

target

ask patient to swallow to identify

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13
Q

Where does the thyroid arterial supply come from?

A

superior thyroid arteries (branches from ECA)

inferior thyroid arteries (branches from thyrocervical trunk)

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14
Q

Describe the venous vasculature for the thyroid

A

drained into the IJV via the superior and middle thyroid veins. then into the innominate veins via the inferior thyroid veins

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15
Q

What do thyroid hormones control?

A 
meatbolism*
growth
body temp
muscle strength
appetite
health of heart, brain, kidney, reproductive system
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16
Q

Thyroid cells are the only cells in the body that absorb____.

A

iodine

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17
Q

What glands regulate thyroid hormones?

A

Thyroid (T3/T4)
Pituitary (TSH)
Hypothalamus (TRH, thyrotropin-releasing hormone)

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18
Q

TSH

A

produced by the pituitary

stimuates thyroid hormone production

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19
Q

First indication of the hypothyroidism?

A

increased TSH (NML 0.3-3.0)

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20
Q

-serum THY hormones:

A

T4 - tetraiodothyronine (thyroxine)

T3 - triiodothyronine

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21
Q

What regulates the pituitary gland?

A

hypothalamus

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22
Q

Graves and TSH

A

Hyper
low TSH
elev T4/T3

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23
Q

Hashis and TSH

A

Hypo
elev TSH
low T4/T3

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24
Q

Benign Dx assoc with nodular thy disease

A 
colloid nodules
degenerative cysts
hyperplasia
thyroiditis
benign neopasms
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25
Q

Thyroid adenomas are ______ neoplasms, which are usually classified as ______ or _____.

A

benign
follicular
papillary

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26
Q

What is the most common type of adenoma?

A

follicular adenomas

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27
Q

LEast common type of thyroid adenoma?

A

papillary adenomas

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28
Q

Characteristics of follicular adenomas

A

homogeneous
solitary
encapsulated
further classified according to their cellular architecture (fetal, colloid, embryonal, Hurthle cell types)

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29
Q

Cystic lesions are common in thyroids, they may be simple or they can contain a bright echogenic foci, which typically represent ______-_____ cysts.

A

Colloid-filled cysts

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30
Q

Most common primary thyroid carcinoma?

A

papillary carcinoma, accounts for 75-80% of all cases

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31
Q

Sono appearance of papillary thyroid carcinoma?

A

hypoechoic mass with possible calcifications

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32
Q

T/F The presence of nodual metastasis of papillary carcinoma does not adversely alter the prognosis.

A

T

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33
Q

Patient with nonpalpable papillary carcinoma may repsent with enlarged ______ _______ ______.

A

cervical lymph nodes

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34
Q

Follicular carcinomas account for ______ - ______% of thyroid cancers.

A

10-20%

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35
Q

What are similar in appearance to follicular carcinomas, which are encapsulated?

A

benign follicular adenomas, may be indistinguishable

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36
Q

Follicular thyroid cancers tend to spread through the _____ rather than the lymphatics. Metastasis to the ____ and ______- is more likely than cervical lymph nodes.

A

blood

lung and bone

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37
Q

Medullary carcinomas account for ____% of all thyroid carcinomas.

A

5%

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38
Q

Medullary thyroid carcinomas secrete ______, which can be a useful serum marker.

A

calcitonin

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39
Q

Medullary thyroid carcinoma is associated with ______ ____ ________ syndrome.

A

multiple endocrine neoplasia syndrome

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40
Q

Groups with a higher prevalence for thyroid cancer:

A 
hx of head and neck irradiation
family hx of:
multiple endocrine neoplasia II
familial adenomatous polyposis
Gardner's syndrome
Cowden's disease
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41
Q

FNA should be considered in a nodule

A 
>1.0cm w/ microcalcifications
>1.5cm predominantly solid
>2.0cm mixed components
if it demonstrates growth
if ipsilateral abnormal lymph nodes (>7mm in short axis)
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42
Q

In particular, a predominantly ______thyroid nodule with ________ has a ______% likelihood of being a cancer

A

solid
microcalcifications
31.6%

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43
Q

What is the recommended minimal size of a soild nodule for FNA?

A

1.0cm

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44
Q

Are thyroid cancers usually hypoechoic or hyperechoic?

A

hypoechoic

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45
Q

Benign thyroid nodules tend to have _____, ________ margins.

A

sharp, well-defined

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46
Q

Malignant thyroid nodules tend to have ____ or _____ defined margins.

A

irregular, poorly

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47
Q

When it comes to calcifications, the most reliable feature of a benign thyroid nodule is ______ or _______ callcifications.

A

peripheral or eggshell calcification

48
Q

Factors used to determine the malignant nature of a thyroid nodule

A

composition
echogenicity
margination
calcification

49
Q

Features associated with thyroid cancer

A 
microcalcifications
solid hypoechogenicity
irregular margins
absence of halo
intranodule central vascularity
nodule more tall than wide
50
Q

Calcifications that are ____ and _____ are more suggestive of a malignancy.

A

fine and punctate

51
Q

Diffuse thyroid disease results in

A

generalized enlargement of the gland (goiter)

52
Q

How is diffuse thyroid disease Dx?

A

usually made on the basis of clinical and laboratory findings, and FNA

53
Q

Worldwide, what is the most common casue of a goiter?

A

iodine deficiency

54
Q

Conditions that commonly produce diffuse enlargement of the thyroid (3)

A

chronic lymphocytic thyroiditis (Hashimoto’s)
Multinodular goiter
Grave’s Disease

55
Q

What are the 5 types of thyroiditis?

A 
Hashis
subacute granulomatous 
subacute lymphocytic
acute suppurative
riedel struma
56
Q

What is the most common type of thyroiditis and goiter in the US?

A

chronic lymphocytic thyroiditis (Hashimoto’s)

57
Q

Autoimmune condition in which there is destruction of the thyroid gland by the immune system

A

chronic lymphocytic thyroiditis (Hashimoto’s)

58
Q

What happens as the gland bceomes more damaged in the setting of Hashimoto’s?

A

gland is less able to make adequate supplies of thyroid hormone
the pituitary senses low thyroid hormone levels and secretes more TSH to stimulate the thyroid, which causes the gland to grow
-TSH elevated and T4/T3 decreased

59
Q

Common cause of chronic lymphocytic thyroiditis (Hashimoto’s)

A

hypothyroidism

60
Q

Sonographic appearance of chronic lymphocytic thyroiditis

A

hypoechoic
diffuse enlargement
coarse parenchyma

61
Q

multinodular goiter (MNG)

A

enlargement of the thyroid gland or have multiple nodules that leads to enlargement of the whole gland

62
Q

What are the 2 forms of MNG?

A 
Nontoxic MNG (goiter makes normal amounts of thyroid hormone)
Toxic MNG (goiter makes higher than normal amounts of thyroid hormone leading to a suppressed TSH
63
Q

What is a multinodylar goiter, MNG?

A

enlargement of the thyroid gland either it is generallly enlarged or there are multiple nodules that enlarge the whole thyroid

64
Q

Most common cause of hyperthyroidism?

A

Grave’s disease

65
Q

Autoimmune disorder where the immune system produces a protein, thyroid stimulating immunoglobulin (TSI), which stimulates the thyroid to enlarge into a goiter and stimulates gand to make too much thyroid hormone, causing hyperthyroidism. The pituitary senses to much thyroid hormone and stops secreting TSH

A

Grave’s Disease

low TSH
elevated T4/T3

66
Q

Symptoms of Grave’s disease?

A 
diffusely enlarged thyroid (goiter)
opthalmopathy-prominent eyes (hallmark sign)
tachycardia
tremors, muscle weakness
papitations, dyspnea on exertion
weight loss
67
Q

What snographic finding is strongly associated with Grave’s disease?

A

hypervascularity, thyroid inferno
could be an audible bruit, palpable thrill

Will also appear diffusely hypoechoic and inhomogeneous

68
Q

There are ______ parathyroid glands located ______ to the thyroid gland.

A

4
posterior

-can be located ectopic locations (retrotracheal, mediastinal, intrathyroid or near the carotid bifurcation)

69
Q

T/F the minor neurovascular bundle may be mistaken for an enlarged parathyroid gland?

A

T

70
Q

SOnographic appearance of a parathyroid adenoma

A

oval hypoechoic mass posterior to the thyroid gland

71
Q

Most common type of hyperparathyroidism

A

Primary Hyperparathyroidism

72
Q

Primary Hyperparathyroidism is due to the development of an _______ associated with one of the parathyroid glands

A

adenoma (Parathyroid adenoma)

73
Q

HOw is the diagnosis of Primary Hyperparathyroidism (parathyroid adenoma) established?

A

If serum calcium level is elevated, which increases serum parathyroid hormone (PTH)
-surgical excision is teh treatment

74
Q

What neck pathology is associated with chronic renal failure?

A

secondary hyperparathyroidism

75
Q

In patient with chronic renal failure, the inability of the kidneys to filter results in______ amounts of serum _________.

A

increased
phosphates
(GFR <25%)

76
Q

With secondary hyperparathyroidism, the inability to synthesize Vit ____ depresses the serum calcium level, which stimulates parathyroid gland ______.

A

vit D

hyperplasia

77
Q

With secondary hyperparathyroidism, ______ of the parathyroid glands enlarges.

A

4

78
Q

Secondar y hyperparathyroidism results in

A

bone demineralization

calcification of soft tissue and vascular structures

79
Q

Hyperparathyroidism is the most common manifesttaion of ______ ________ _______, type I, which results in hyeprplasia of all fouru parathyroid glands

A

multiple endocrine neoplasia (MEN Type 1)

80
Q

exocirne glands that secrete saliva and the enzyme amylase

A

salivary glands

81
Q

What are the three types of salivary glands

A

Parotid
Submandibular
sublingual

82
Q

Parotid is located _____ to the ear at the angle of the mandible adjacent to the masseter msucle.

A

anterior

83
Q

What duct drains the parotid gland into the oral cavity?

A

Stensen’s duct

84
Q

Most common benign tumor of the parotid gland

A

plemorphic adenoma

85
Q

bacterial infection of a salivary gland, usually from a stone obstruction or gland hyposecretion

A

Sialadenitis

most common in the parotid and typically occurs in patients with zerostomia, Sjoren syndrome or radiation therapy

86
Q

Gland located benath the jaw within level I of the neck

A

submandibular glands

87
Q

Secretions from this gland enter the oral cavity through Wharton’s ducts

A

submandibular glands

88
Q

________ condition most common within the submandibular gland where a calcified mass or sialolith forms within the salivary gland, usually in the duct of the submandibular gland

A

sialolithiasis

89
Q

Where are the sublingual glands located

A

beneathe the tongue, anterior to the submandibular glands

90
Q

Most common superficial ML neck mass

A

thyroglossal duct cyst

91
Q

What age group is associated with thyroglossal duct cyst

A

adolescents typically

92
Q

sonographic appearance of thyroglossal duct cysts

A

cytsic dilatation of the thyroglossal duct (remnant of the thyroid gland migration from the pharyngeal epithelium)

93
Q

Are upper respiratory infections assocated with thyroglossal cysts?

A

y

94
Q

How does a branchial cleft cysts present?

A

solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the andible under the sternoclastoid muscle

95
Q

The branchial cysts is a remnant of what?

A

embryoninc development

96
Q

What can happen if a branchial cleft cysts is connected to the mouth?

A

can become infected

97
Q

Cystic hygromas aka

A

cystic lymphangioma

98
Q

congenital lymphatic malformation

A

cystic hygroma

99
Q

Where are cystic hygromas found?

A

75% occur in th eneck but can cocur throughout the body and is evidenced at birth

100
Q

Sonographic appearance of a cystic hygroma

A

cystic multiloculated cervical mass evidenced at birth

101
Q

Cystic hygromas are associated with

A

Turner Syndrome - females born with only 1 X chromosome, short staure, infertility, heart defects
Trisomy 21 - Down’s
XXY - Klinefelter Syndrome - genetic error after conception so not inherited, where males have an extra copy of the X chromosome, devlop breasts, little fascial, possibly no sperm production
Trisomy 18 - low birth wt, clenched hands, abn head shape, Edward’s
Trisomy 13 - multiple physical and mental defects, may not live past 1st week

102
Q

What are the vessels of the aortic arch?

A

innominant (brachiocephalic trunk)
left common carotid artery
left subclavian

103
Q

What does the brachiocephalic trunk divide into?

A

right common carotid artery

right subclavian

104
Q

Which vessels in the neck do not originate from the aortic arch?

A

right common carotid artery

right subclavian

105
Q

What is the relationship in location of the common carotid arteries and internal jugular vein as they ascend in the neck

A

the CCA are medial to the IJV

106
Q

how many innominate arteries and veins are there Rt to LT.

A

Only one innominant artery on the right but the innominant veins are bilateral

107
Q

At what level does the common carotid artery bifurcate into the internal carotid artery and external carotid artery

A

at the level of the superior border of the thyroid cartilage

108
Q

Typically the ICA is ______ and _______ and the ECA is ______ and ______ in location.

A

lateral and posterior

medial and anterior

109
Q

What kind of waveform does the ICA typically have?

A

low-resistance

110
Q

What kind fo waveform does the ECA typically have?

A

high-resistance

111
Q

What can happen to the ECA if there is a stenosis in the ICA?

A

The ECA may collateralize resulting in a low resistance waveform

112
Q

What is the first branch of the ICA

A

opthalmic artery

113
Q

What is the first branch of the ECA

A

superior thyroid artery

114
Q

The internal jugular vein is located ______ to the common carotid artery

A

lateral

115
Q

Where does the internal jugular vein and subcalvian veins drain into

A

innominant (brachiocephalic) veins

116
Q

The external jugular vein is located _______ on the ______ aspect of the neck

A

suepriorly

lateral

ABD (20 decks)

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