Treatment of Thyroid Nodules

Question 1

what divides the anterior and posterior triangle?

Answer 1

sternocleidomastoid

Question 2

causes of midline neck lumps?

Answer 2

thyroid
thyroglossal cyst
dermoid cyst

Question 3

questions to determine whether midline lump is related to thyroid?

Answer 3

does it move on swallowing

Question 4

causes of anterior triangle swellings?

Answer 4

lymph nodes
branchial cyst
salivary glands
carotid body tumour

Question 5

causes of posterior triangle sweeling?

Answer 5

lymph nodes

cystic fibroma

Question 6

what do you look for in neck lumps?

Answer 6

position
size
shape
mobility
consistency
lymph nodes

Question 7

types of cervical lymphadenopathy?

Answer 7

infective
malignant
haematological (leukaemia/lymphoma)

Question 8

symptoms of cervical lymphadenopathy?

Answer 8

fever, weight loss, sweats (systemic)
hoarseness, cough, dyspnoea (specific)
recent immigrant, travel abroad (background)
cause of node

Question 9

what must you always look for in cervical lymphadenopathy?

Answer 9

look for other nodes
look for primary sites
look for hepatosplenomegaly

Question 10

investigations for cervical lymphadenopathy?

Answer 10

CXR
ENT opinion
fine needle aspiration

Question 11

when is CXR/biopsy/ENT used?

Answer 11

if only in neck and suspected primary

Question 12

when is haematology used?

Answer 12

if more generalised

Question 13

features of thyroglossal cyst?

Answer 13

arisesin part of thyroglossal tract
in young people
moves with swallowing and protrusion of tongue

Question 14

what is a dermoid cyst?

Answer 14

abnormal growth containing epidermis, hair follicles, sebaceous glands and in some cases, teeth
derived from residual embryonic tissue

Question 15

what is a branchial cyst?

Answer 15

persisting second branchial arch
arises in upper part of anterior triangle in teenage years
feels like a half filled hot water bottle

Question 16

what is a cystic hygroma?

Answer 16

fluid filled sac due to blockage of lymphatic system
usually in first year of life
can be large and cause
- pressure symptoms
- lymph filled
- transmilluminate

Question 17

what can cause swelling of submandibular gland?

Answer 17

stone

pleomorphic adenoma

Question 18

what can cause swelling of parotid gland?

Answer 18

infective
pleomorphic adenoma
stone

Question 19

investigation of a solitary thyroid nodule?

Answer 19

onset, duration, progression
pressure symptoms - dysphagia, dyspnoea, hoarseness, weight loss
risk factors/red flags
age, sex, family history pf thyroid cancer, radiation, thyroiditis

Question 20

female vs male with thyroid nodule?

Answer 20

male most likely to be a cancer

female more likely to be benign

Question 21

investigations in STN?

Answer 21

TSH
US
isotope scan sometimes

Question 22

classification of thyroid nodules?

Answer 22

bethseda system
thy 1 = inadequate
thy 2 = benign
Thy 3 = suspicious
Thy 4/5 = malignant