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39 Cards in this Set
- Front
- Back
What are the RF for multinodular goitre?
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Physiologic (puberty, menses or pregnancy)
Pathophysiologic (iodine deficiency, congenital defect in TH production, goitrogenic foods or drugs (lithium, amniogluethimide, sulfonamides, phenylbutazone) Female |
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What are the Sx of a goitre?
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Obstructive sx (dysphagia, stridor, hoarse voice, pemberton's sign due to obstruction of venous return at the thoracic inlet)
Functional Sx |
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Lab findings in multinodular goitre?
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It depends if it is toxic or non-toxic
TFTs are usually normally (because patients may increase TSH production) - patients are usually euthyroid If some nodules develop autonomy, patients may have suppressed TSH or become hyperthyroid |
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Management of goitre?
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If euthryoid and small - no Rx
TH to patients with large goitres to reduce TSH stimulation of gland growth Endemic goitres - iodine administration Surgery - if no response to TH or obstructive, substernal extension, malignancy |
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What are the indications for surgical management of a goitre?
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Obstructive Sx
Thyrotoxicosis Suspicious or malignant changes on FNAB strong fhx thyroid cancer, retrosternal extension, past hx - head and neck radiation |
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What is the differential of a thyroid nodule?
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thyroid adenoma
cyst benign multinodular goitre hyperfunctioning nodule thyroiditis Hashimoto's thryoiditis Abscess Carcinoma/lymphoma PTH carcinoma |
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What investigations should be done for a thryoid nodule?
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Thyroid function tests
If euthyroid or hypothryoid --> FNAB If toxic --> Iodine scan (cold - malignant) |
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How do you tell the difference between a thyroglossal duct cyst and a thyroid nodule?
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They both change on swallowing but thyroglossal duct cyst moves on tongue protrusion
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What % of follicular adenoma will progress to follicular carcinoma?
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10%
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What is the most common cause of thyroid pain?
Cystic nodules or thryoiditis? |
Cystic thryoid nodules NOT thyroiditis
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What do most thyroid cystic nodules consist of?
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Partly solid structures that have undergone cystic degeneration (mixed or complex nodules)
They are predominanly autonomously functioning thyroid adenomas |
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Rf for thryoid cancer?
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faminly history
radiation exposure f > M |
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What are orphan annie nuclie specific for?
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papillary thryoid cancer
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Where does papillary thyroid cancer met to?
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cervical nodes and lung
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Which thyroid cancer is not accurately diagnosed by FNAB?
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follicular
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Where does follicular cancer usually met to?
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lung and bone
Haematogenous spread |
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What is medullary carcinoma associated with?
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MEN IIa or IIb
Amyloidosis |
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Which cells is a thyroid medullary cancer derived from?
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paradollicluar C cells that prodcue calcitonin
Calcitonin (acts as a tumour marker, may produce hypocalcaemia and is converted into amyloid) |
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Which demographic is anaplastic thyroid cancer most common in?
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Elderly women
Hx of differentiated thyroid ca (mostly papillary) or nodular goitres |
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Which lymph nodes should be dissected if you have medullary thyroid cancer?
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median lymph nodes
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What is the most common form of benign parotid gland neoplasm?
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pleomorphic adenoma (most common)
Adenlymphoma (Warthin's tumour) |
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If you have a lump in the area of the parotid gland and the facial nerve seems to be affected what could it be?
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SCC
NOT benign parotid neoplasm - facial nerve plane is not affected by these |
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What is the most common parotid neoplasm?
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malignant melanoma invading from the skin
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What type of neoplasm do pleomorphic adenomas (parotid tumours) transform into?
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SCC
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Where is the carotid body located?
Fxn |
near the bifurcation of the common carotid artery
Detects changes in the the O2 concentration |
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Which cells do carotid body tumour arise in?
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Glomus cells
- chromaffin tissue called a paraganlioma - i.e. from paraganglia which are islands of cells derived from neural crest cells Tumours that arise from these specialised neural crest cells have the ability to secrete neuropeptides and catecholamines |
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How does a carotid body tumour present?
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Painless mass at the side of the neck below the angle of the jaw (palpable at the anterior border of the SCM)
Mobile laterally but not vertically Hoarseness and horner's syndrome may result from pressure on the vagus or sympathetic nerves Can also present with Can be source of TIA DDx: branchial cleft cyst, mixed tumour of salivary gland, carcinomas, aneurysms |
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Investgiations in a suspected carotid body tumour?
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Angiogram - carotid artery with a vascular blush
FNA often yields blood but if cells are obtained FNA can be definitive |
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Management of carotid body tumour?
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Surgical preop embolisation (minimises blood loss) and then surgical excision
Can use RT in elderly patients who are poor surgical candidates |
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What is a branchial cyst?
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Remnant of the embryonic clefts which undergoes cystic enlargement
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How does a branchial cyst usually present?
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smooth, painless, slowly enlarging lateral neck mass, (anterior to the SCM) often following an URTI
If infected it will be tender and firm Can also develop a fistula tract to the skin |
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How do you manage a branchial cyst?
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control of infection then surgical removal of cyst
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What are the 3 types of branchial cleft cysts?
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1: typically apper face near auricle
2: most common - located just inferior to the angle of the mandible and anterior to SCM 3: anterio to SCM, lower in the neck than 2 |
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Management of thyroglossal duct cysts?
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En bloc cystectomy and excision of the central hyoid bone to minimise recurrence
NB: 1% are found to cintain cancer usually papillary |
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What is a thyroglossal duct cyst?
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a vestigal remnant of the tract that the thyroid takes during gestation
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Difference in clinical features between thyroid lump and thyroglossal duct cyst?
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both move on swallowing
thyroglossal cyst will move on poking out tongue |
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Difference between malignant and benign parotid gland tumor
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malignant affects facial nerve
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What is Warthin's tumor?
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benign adenoma of salivary gland, most likely parotid, less common than pleimorphic adenoma, association with cigarette smoking
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Midline neck pathology
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thyroglossal cyst, thyroid
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