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50 Cards in this Set
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- Back
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What are some things that should be assessed in the history?
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1. Determine if the patient is euthyroid, hypothyroid, or hyperthyroid.
2. Assessment of risk factors. - Exposure to ionizing radiation. - Family history 3. Assessment of symptoms of mass effect. - Difficulty swallowing, hoarseness of voice, SOB when lying flat. - Determine the rate of growth of the nodule or goiter (e.g, has your collar size changed) |
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What are some things that you should look for on physical exam in a patient with thyroid issues?
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Vitals: HR, Weight
HEENT: Lid lag, proptosis, conjunctival irritation, loss of lateral 1/3 of eyebrows. Neck: Thyroid: size, texture, nodules, bruits, Pemberton's Sign. CV: Tachycardia, bradycardia, Lungs: Rales Neuro: Motor strength, reflexes, tremors Skin: Moist/dry, brittle hair, vitiligo. Psych: Affect, speech patterns. |
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What is Pemberton's Sign? What is it indicative of?
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The development of:
- facial flushing - elevation of jugular venous pressure - inspiratory stridor upon raising both arms above the head simultaneously Indicates SVC syndrome secondary to thyroid goiter or tumor. |
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It is rare for a hyperfunctioning thyroid to be _________.
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It is rare for a hyperfunctioning thyroid to be MALIGNANT.
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If TSH is ___, then the patient would proceed to what to determine what?
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If the TSH is LOW, then the patient would proceed to a RADIOACTIVE IODINE UPTAKE (because there is a low risk of malignancy)
If the RAIU scan shows increased uptake, then you proceed with hyperthyroid workup. If the RAIU scan is low or normal, then you do ultrasound --> fine needle aspiration. |
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If the TSH is ______ or ____, then the patient should proceed to ultrasound and possibly fine needle aspiration.
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If the TSH is NORMAL or HIGH, then the patient should proceed to ultrasound and possibly fine needle aspiration.
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Features of a benign thyroid nodule.
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Sharp borders, cystic appearance, no increased vascularity, hyperechoic, comet-tail sign (indicates the presence of colloid)
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Features of a malignant thyroid nodule.
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Ill-defined borders without a halo, hypo-echoic, chaotic intranodal vascularity, punctuate microcalcifications
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What are the four different results that are possible from fine needle aspiration of a thyroid nodule?
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1. Benign --> monitor with ultrasound
2. Non-diagnostic --> Repeat FNA 3. Indeterminate --> Repeat FNA/Monitor by US/Surgery 4. Malignant --> Surgery 4. Malignant |
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Benign follicular adenoma: clinical presentation?
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Euthyroid with solitary lump.
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Benign follicular adenoma: presentation on RAIU?
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Usually cold
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Benign follicular adenoma: microscopic features.
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Well encapsulated
Well preserved architecture |
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What are the two types of differentiated thyroid cancers? What percentage of thyroid cancers are these?
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Follicular and papillary. These together make up 90-95% of all thyroid malignancies.
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What percentage of primary thyroid cancers are papillary?
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85%
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What percentage of thyroid cancers are medullary?
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3-5%
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What percentage of thyroid cancers are primary thyroid lymphomas?
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3-5%
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What are some cancers that metastisize to the thyroid?
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Breast cancer
Colon cancer Renal carcinoma Melanoma |
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"Orphan Annie" nuclei
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Papillary thyroid carcinoma
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Papillary thyroid carcinoma: important microscopic findings
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Orphan Annie nuclei
Psammoma bodies (calcified structures) |
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Papillary thyroid carcinoma: spread of cancer
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Spreads via the lymphatics to regional cervical lymph nodes and upper mediastinal nodes
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Papillary thyroid carcinoma: Aggresive variants
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Tall cell
Columnar cell Sclerosing Oxyphilic |
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Papillary carcinoma: etiology
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- Ionizing radiation
- ret/PTC gene rearrangement of the ret proto-oncogene on the long arm of chromosome 10 - B-RAF mutation - Hashimoto's thyroiditis |
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Follicular carcinoma: clinical presentation
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Encapsulated variant: difficult to differentiate from adenomas. Minimally invasive
Invasive variant: widely invasive, ill-defined mass. |
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Follicular carcinoma: microscopic appearance
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Looks like follicular adenoma, but with capsular and vascular invasion
Invasive variant mo aru. |
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Follicular carcinoma: presentation on RAIU
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Cold nodule
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Follicular carcinoma: compare demographics to papillary cancer.
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Incidence of Follicular carcinoma is higher in older populations. Peak in 50-60s
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Papillary carcinoma: peak age of incidence.
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in 40s
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What type of thyroid cancer has an increased incidence in areas of dietary iodine deficiency?
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Follicular carcinoma
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Follicular carcinoma: c/c with the spread of papillary thyroid carcinoma.
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Follicular carcinoma: hematogenous spread to lungs and bones. Less lymph involvement
Papillary thyroid cancer: lymphatagenous spread to regional nodes |
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Follicular carcinoma: c/c prognosis with papillary thyroid cancer.
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Follicular carcinoma: 5 year survival is 30%. Generally poorer prognosis than papillary thyroid cancer.
Papillary thyroid cancer: 90% survival at 20 years. |
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What cells are anaplastic thyroid cancer derived from?
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From follicular cells.
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Anaplastic thyroid cancer: clinical presentation
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Rapidly growing, often painless neck mass.
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Anaplastic thyroid cancer: possible histologic patterns
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- Spindle cell carcinoma
- Giant cell carcinoma - Squamoid cell carcinoma May contain areas of necrosis |
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Anaplastic thyroid cancer: etiology
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High prevalence of p53 mutations.
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Anaplastic thyroid cancer: prognosis
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Very poor: 100% mortality at six months.
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Anaplastic thyroid cancer: treatment
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No survival advantage from surgery, radiotherapy, or chemotherapy.
May need tracheostomy for airway control. |
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Medullary thyroid cancer: microscopic appearance
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Amyloid in 50% of cases
Foci of C-cells may be seen Stain positive for calcitonin and negative for thyroglobulin |
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Medullary thyroid cancer: see what kind of granules on electron microscopy?
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See neurosecretory granules
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Medullary thyroid cancer: Incidence
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Familial: 3-4th decade
Sporadic: 5-6th decade |
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Medullary thyroid cancer: Spread
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Local nodes and metastisis to lung, bone, liver.
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Medullary thyroid cancer: treatment
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total thyroidectomy
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Medullary thyroid cancer, sporadic type: prognosis
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30-50% survival at 10 years.
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Medullary thyroid cancer, familial type: prognosis
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90% survival at 10 years
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Medullary thyroid cancer: what percentage have association with MEN IIa and MEN IIb?
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20-25%
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Medullary thyroid cancer: produce what?
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Calcitonin and:
somatostatin, prostaglandins, ACTH, serotonin, carcinoembryonic antigen, histaminase, neurone specific enolase. |
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Thyroid lymphoma: clinical presentation.
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Usually seen as a rapidly growing goiter usually in an elderly patient
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Thyroid lymphoma: Associated with what othe diseases
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Autoimmune thyroid disease. (especially seen in elderly women)
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Thyroid lymphoma: treatment
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External radiation and chemotherapy with CHOP
(cyclophosphamide, doxorubicin, vincristine, and prednisolone) |
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Thyroid cancer: risks of surgery
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Damage to the recurrent laryngeal nerve
Damage to the parathyroid glands |
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One is one scary histologic charateristic of a pheochromocytoma?
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You often see a lot of mitoses, but this doesn't indicate malignancy. Only 10% of pheos are malignant.
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