Tt Flashcards
When is surgical treatment indicated for bronchiectasis?
Only in a small number of cases, specifically if bronchiectasis is confined to a single lobe or segment on CT.
Why are many patients unsuitable for surgery despite unsuccessful medical treatment?
Due to either extensive bilateral bronchiectasis or coexisting severe airflow obstruction.
In what context should resection of destroyed lung areas be considered?
As a last resort in progressive forms of bronchiectasis.
What is the prognosis for bronchiectasis associated with ciliary dysfunction and cystic fibrosis?
The disease is progressive and eventually causes respiratory failure.
What can improve the prognosis of bronchiectasis in other cases?
Regular physiotherapy and aggressive use of antibiotics.
What are essential preventive measures for bronchiectasis?
Adequate prophylaxis for and treatment of childhood measles, whooping cough, and primary tuberculous infection.
What is a solitary thyroid nodule?
A discrete swelling in an otherwise impalpable gland
It indicates a localized abnormality within the thyroid.
What is the difference between a solitary nodule and a dominant nodule?
A solitary nodule is a discrete swelling in an otherwise normal gland, while a dominant nodule is similar but occurs in a gland with clinical evidence of generalized abnormality.
What percentage of individuals are affected by solitary thyroid nodules?
Approximately 4% of individuals.
In which gender are solitary thyroid nodules more frequent?
3-4 times more frequent in women.
What percentage of discrete thyroid swellings are clinically solitary?
About 70 percent.
What percentage of discrete thyroid swellings are classified as dominant?
About 30 percent.
What is the significance of discrete thyroid swellings?
They have a risk of neoplasia compared with other thyroid swellings.
What percentage of solitary thyroid swellings are malignant?
Some 15 percent.
What types of non-neoplastic conditions can solitary thyroid swellings consist of?
- Areas of colloid degeneration
- Thyroiditis
- Cyst
What details are important regarding the nodule?
Time of onset, change in size, associated symptoms (pain, dysphagia, dyspnea, choking)
These details help assess the potential malignancy of the nodule.
What unusual symptom should raise suspicion for intrathyroidal hemorrhage in a benign nodule?
Pain
Pain may also indicate thyroiditis or malignancy.
What may hoarseness indicate in relation to thyroid nodules?
Involvement of the recurrent laryngeal nerves (rlns)
Hoarseness can be a sign of nearby tissue involvement.
What exposure history is relevant to thyroid nodules?
Exposure to ionizing radiation
Ionizing radiation is a known risk factor for thyroid malignancies.
What family history is significant when evaluating thyroid nodules?
Family history of thyroid cancer
A genetic predisposition may increase the risk of malignancy.
What characteristics of nodules are more likely to indicate malignancy?
Hardness and fixation to surrounding structures
These physical examination findings raise suspicion for malignancy.
What physical examination finding may indicate thyroid malignancy?
Cervical lymph nodes enlargement
Enlarged lymph nodes can suggest metastatic disease.
What is the status of most patients with thyroid nodules?
Euthyroid
Most patients do not have abnormal thyroid hormone levels.
What laboratory test is commonly used in the evaluation of thyroid nodules?
TSH (Thyroid-Stimulating Hormone)
TSH levels help assess thyroid function.
What autoantibody titres are relevant in the context of thyroid nodules?
Autoantibody titres for chronic lymphocytic thyroiditis
These can indicate autoimmune processes affecting the thyroid.
What can serum Tg levels indicate regarding thyroid nodules?
Cannot differentiate benign from malignant nodules unless extremely high
Serum Tg (Thyroglobulin) is more useful in specific contexts.
What serum level is measured in the evaluation of medullary thyroid carcinoma (MTC)?
Serum calcitonin
Elevated calcitonin levels are associated with MTC.
What 24-hour urine collection measures are relevant in the assessment of thyroid nodules?
Levels of vanillylmandelic acid (VMA), metanephrine, and catecholamine
These substances are assessed for neuroendocrine tumors.
What genetic testing should be performed for all patients with medullary thyroid carcinoma (MTC)?
RET oncogene mutations
Testing for RET mutations is crucial for management and family screening.
What are the ultrasound features of thyroid neoplasia?
Microcalcification and increased vascularity
These features help in the evaluation of thyroid tumors.
When are CT and MRI necessary in the evaluation of thyroid tumors?
For large, fixed, or retrosternal lesions
Routine evaluation does not require these imaging techniques.
What is the usefulness of a PET scan in thyroid disease?
Particularly in localising disease that does not take up radioiodine
This can aid in identifying certain types of thyroid cancer.
What types of thyroid scans are rarely necessary?
Thyroid scan with I123 or 99mTc
These scans are not commonly used in routine evaluations.
Fill in the blank: Thyroid nodules can be classified as ______, ______, or ______ based on their activity.
‘hot’ (overactive), ‘warm’ (active), or ‘cold’ (underactive)
This classification helps in assessing the risk of malignancy.
What percentage of discrete thyroid swellings are cold, and what percentage subsequently prove to be malignant?
80 percent are cold; only 15 percent prove to be malignant
This statistic highlights the low likelihood of malignancy in cold nodules.
What imaging technique can confirm tracheal deviation or retrosternal extension?
Chest and thoracic inlet radiographs
These X-rays can help visualize structural changes in the thoracic region.
Why is laryngoscopy performed in relation to thyroid evaluation?
For medicolegal reasons to determine the mobility of the vocal cords
This procedure assesses potential impacts on vocal function.
What is the investigation of choice for discrete thyroid swellings?
Fine-Needle Aspiration (FNA)
Excellent patient compliance, simple and quick to perform in the outpatient setting.
What thyroid conditions can be diagnosed by FNAC?
- colloid nodules
- thyroiditis
- papillary carcinoma
- medullary carcinoma
- anaplastic carcinoma
- lymphoma
These conditions represent a range of benign and malignant thyroid disorders.
What is a limitation of FNAC in diagnosing thyroid conditions?
It cannot distinguish between a benign follicular adenoma and follicular carcinoma
This limitation can lead to challenges in treatment decisions.
How is FNAC classified in terms of results?
- Nondiagnostic or unsatisfactory: 10%-15%
- Benign: 70%
- Malignant: 5%
- Indeterminate: 10%-15%
These classifications help in assessing the reliability of FNAC results.
What is the percentage of false-negative results in FNAC?
3%
False-negative results can affect patient management and treatment plans.
What percentage of biopsies may yield atypia of unknown significance?
3% to 6%
This result indicates uncertainty in the diagnosis and may require further evaluation.
What is the risk of malignancy in lesions classified as malignant by FNAC?
97% to 99%
This high percentage underscores the reliability of FNAC in identifying malignant lesions.
What is the treatment for malignant tumors?
Thyroidectomy
Thyroidectomy is the surgical removal of the thyroid gland.
What percentage of simple thyroid cysts resolve with aspiration?
About 75%
Aspiration is a minimally invasive procedure used to remove fluid from the cyst.
What should be done if a colloid nodule enlarges?
Repeat FNAB if benign, levothyroxine in doses sufficient to maintain a serum TSH between 0.1 and 1.0 μU/mL
FNAB stands for Fine Needle Aspiration Biopsy.
What is recommended for patients with previous irradiation of the thyroid gland or a family history of thyroid cancer?
Total or near-total thyroidectomy
This recommendation is due to the high incidence of thyroid cancer in these patients.
List indications for thyroid operation.
- If nodule is malignant
- Follicular neoplasm
- Hyper functioning nodule
- Clinical suspicion
- Nodule enlarges on TSH suppression
- Causes pressure symptoms
- For cosmetic reasons
These indications guide the decision-making process for surgical intervention.
What percentage of clinically isolated swellings contain fluid and are cystic or partly cystic?
30%
This statistic highlights the prevalence of cystic formations in thyroid swellings.
What often presents with a history of sudden painful swelling in thyroid cysts?
Bleeding into a cyst
This can indicate complications associated with thyroid cysts.
What are the indications for surgery for thyroid cysts?
- Malignant cytology
- If the cyst persists after three attempts at aspiration
- Cysts >4 cm in diameter
- Complex cysts
- Bloody aspirate
These criteria help determine when surgical intervention is necessary for thyroid cysts.
