Week 4 - G - Endocrine imaging - pituitary, thyroid, adrenal, bone

Question 1

What is the pea sized gland that is a midline structure in the skull?

Answer 1

The pituitary gland

Question 2

Where is the pituitary gland found? (depression in what bone) What connects it to the brain? What sinuses is it closely related to?

Answer 2

Found in the sella turcica - depression in the sphenoid bone

Connected to the hypothalamus via the infundibulum (pituitary stalk)

Closely related to the sphenoid sinus

Question 3

On CT scan of the pituitary What is it inferior to? (what is this structure inferior to) What lies laterally? (the arteries and the name of the sinus)

Answer 3

Pituitary gland lies inferior to the optic chiasm which is inferior to the hypothalamus

The carotid arteries contained in the cavernous sinus lie laterally

Question 4

What are the contents of the cavernous sinus? What is the curve of the internal carotid artery in the cavernous sinus known as?

Answer 4

Cavernous sinus contains the

• O culomotor nerve (CN III)
• T rochlear nerve (CN IV)
• O pthamic division of the trigeminl nerve (CN V1)
• M axillary division of the trigemnial nerve (CN V2)
• C arotid artery (internal carotid artery)
• A bducent nerve (CN VI)

Known as the carotid siphon

Question 5

Identify the indicated structure of the brain. What forms this structure?

Answer 5

optic chiasm

The right and left optic nerves

Question 6

What are the two sides of the visual field?

Answer 6

The nasal side and the temporal side

Question 7

What two structures is the thyroid gland anterior to?

Answer 7

Lies anterior to the oesophagus and the trachea

Question 8

What muscles is the thyroid gland deep to? What arteries and veins is the thyroid gland medial to?

Answer 8

Thyroid gland is deep to the strap muscles

Gland is medial to common carotid arteries and the internal jugular veins

Question 9

What two structures are at risk during thyroid surgery?

Answer 9

Parathyroid glands

Recurrent laryngeal nerves

Question 10

What bony structure lies inferior to the thyroid gland?

Answer 10

The sternum

Question 11

What structures are the numbers?

Answer 11

1. superior vena cava
2. Ascending Aorta
3. descending aorta
4. Trachea
5. Right lung
6. Left lung
7. sternum

Question 12

A 25 year old woman presents with palpitations and sweating. On further questioning, she states that she has involuntarily lost 10kg over the last 3 months. On examination, she looks flushed and seems anxious. Her pulse is 100 at rest and her BP is raised. There is a tender fullness in her lower neck. What do you think the cause is?

Answer 12

Grave’s causing hyperhtyoidism causing the diffuse goitre

Question 13

What are diffuse causes of neck swelling? What is a focal cause?

Answer 13

Goitre - diffuse enlargment of thyroid gland

Caused by grave’s and hashimotos

Focal causes of neck swelling - dominant adenoma

Question 14

In scintigraphy (can use Tc 99m scan), what type of thyroid disease has a symmetrical uptake? What type has homogenously reduced uptake?

Answer 14

Symmetrical - grave’s disease

Homogenously reduced - thyroditis

Question 15

A 32 year old man presents with several months of ‘shivering attacks’, associated with headache, sweating and palpitations. The attacks last several hours but he is completely well at other times. Examination is normal, except for BP which is raised at 165/100. Following a urine test, he is referred for CT. What do you expect to see on CT? What is the cause?

Answer 15

Bilateral adrenal masses

Caused by pheochromocytoma

Question 16

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Answer 16

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Question 17

What is the 10% rule of pheochromocytomas?

Answer 17

~ 10% are extra-adrenal

~ 10% are bilateral

~ 10% are found in children

~ 10% are familial

~ 10 % are not associated with hypertension

~ 10% are malignant

Question 18

What is the hard type of bone seen in the diaphysis of bone? What is the spongy bone seen in the epiphysis of bone?

Answer 18

Spongy bone is the trabecular (cancellous) bone

Hard bone is the cortical (compact) bone

Question 19

What is the difference between lyctic bone and sclerotic bone?

Answer 19

Lyctic bone is bone destruction

Sclerotic bone is bone formation

Question 20

What is seen on xray for osteoarthritis?

Answer 20

L oss of joint space

O steophyte formation

S ubchondral sclerosis

S ubchondral cysts

Question 21

What are the nodes on the proximal interphalangeal joints seen in rheumatoid arthritis? What are the nodes seen on the DIPs in osteoarthritis?

Answer 21

Bouchard’s nodes

OA- Heberden’s nodes

Question 22

Diffuse bone abnormality when your bone is too brittle is what? When your bone is to soft is what diseases?

Answer 22

Diffuse Bones too brittle

• Osteoporosis
• Osteogenesis imperfecta

Bones too soft

• Rickets and osteomalacia
• Pagets disease

Question 23

What bone disease is there where lyctic bone is found on xray initially before becoming sclerotic?

Answer 23

Paget’s disease