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80 Cards in this Set
- Front
- Back
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T4 在周邊轉
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T3
有 tress 就轉 |
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T4 在周邊多為
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binding form with thyroglobulin
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T3 is ___ potent
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much more potent
DIT + MIT |
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rT3 = ?
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MIT + DIT
less functional |
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Thyroid cancer occurrence and prognosis order
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Pappillary > Follicular > Medullary > anaplastic
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Thyroid cancer
Pappillary meta through |
lymph node
in young people |
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I131 as chemo for thyroid cancer
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削除手術無法摘掉的 microscopic
residual tumor 因為會被 uptake |
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Follicular thyroid cancer
是否為梁性惡性 |
無法遊 Bx 決定
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Follicular thyroid cancer 不確定是否為梁性惡性
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惡性必須由 capsular invasion 決定
FNA / Frozen 都不能決定 只能等 patho 故稱 neoplasm 有可能切兩次 |
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Follicular thyroid cancer
有可能切兩次 |
completion thyroidectomy
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thyroglobuin as marker
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tumor marker for thyroid cancer
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I-131
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可想成 thyroid cancer 的 chemo
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thyroglobuin as marker
術後若昇高 |
有可能 recurrent
不以術後疼痛做判劇 |
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甲狀腺術後馬上聲音沙啞
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應該是術中傷害
若是術後恢復之後才聲音沙啞就要想 recurrence |
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Thyroid cancer
惡性度、裕後排明 |
P > F > M > A
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法洛氏四合症（tetralogy of Fallot）之心雜音是何種畸形造成？
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A.肺動脈下漏斗體狹窄（infundibular stenosis）
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風濕性心臟病（rheumatic heart disease）最常侵犯
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B.二尖瓣膜（mitral valve）
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一位7 歲男孩，因四肢冰冷、頭暈及腹痛至醫院求診。據家屬描述，該男孩於4 天前曾有感冒（commoncold）症狀。其血壓為70/48 mmHg，肝臟於右肋骨下4 公分摸得到，心電圖顯示 CAVB
下列何者適當的處理？ |
A.放置暫時性心律調節器（temporary pacemaker）
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16 個月男嬰，因排便後突然發生呼吸急促，發紺加劇而送至急診。此孩童以往即被發現有發紺及心雜音，其胸部X 光片顯示肺血管減少，心臟形狀似“馬靴”（boot-shaped）。
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Typical ToF acute attack
blue spell A. 馬上將孩童置膝抱胸（knee-chest）姿勢，並給予氧氣 B. 給予碳酸氫鈉（NaHCO3）以矯正酸血症 D. 給予靜脈注射propranolol，減緩肺動脈下漏斗體（infundibulum）之收縮 |
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Cyanotic CHD (R-L shunt or mixed or Pul Flow )
踢五遍做一次PE |
TOF (most common)
Triscuspid atresia TGA TAPVR Truncus Arteriosus Pulmonary atresia Ebstein anomaly (最常合併arrhythmia) |
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Acyanotic CHD (L-R shunt)
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(1) VSD (most common)
(2) ASD (3) PDA (4) ECD |
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Ebstein anomaly (最常合併arrhythmia)
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WPW syndrome
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Cyanotic Heart
Increased pulmonary flow go OP |
PA venting
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Cyanotic Heart
Decreased pulmonary flow go OP |
BT shunt
drain L to R |
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Acynotic Heart
Fluid overload => VSD |
L to R shunt
=> pulmonary HTN |
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Innocent (Functional) murmur:
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in 20-30% normal healthy children: rarely continuous murmur, not louder than grade 3
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Organic heart murmur
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Pansystolic murmur: VSD, MR
Systolic ejection murmur: PS Continuous murmur: PDA, coronary AV fistula Diastolic murmur: 少 Mid-diastoilic: relative MS due to large pulmonary flow (eg: large VSD) Early-diastolic: AR |
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ECD
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endocardial cushion defect
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ASD 的 murmur
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特例
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Pericarditis/ Pericardial effusion
CxR silhouette |
water bottle shape
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TGA
CxR silhouette |
egg on the table
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TOF
CxR silhouette |
boot shape
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TAPVR
CxR silhouette |
figure 8, snowman
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PAPVR
CxR silhouette |
Scimitar syndrome (congenital pulmonary venolobar syndrome)
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Trisomy 21 (Down syndrome):
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ECD (Endocardial cushion defect), VSD, ASD
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Congenital rubella:
defect |
PDA, peripheral pulmonic stenosis
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Fetal alcoholic syndrome:
defect |
ASD
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Fetal valproic effects:
defect |
CoA/ HLHS/ AS/ PS
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Coarctation of Aorta / Aortic arch abnormaly
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Tunner syndrome
DiGeorge syndrome |
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Pulmonary stenosis
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Wiliam syndrome (+ Aortic stenosis)
Alagille syndromelcoholic Noonan syndrome Tetralogy of Fallot Rubella (Congenital Rubella Syndrome) (PDA - PS) |
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MCC cyanotic CHD
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ToF
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ASD
Sinus venosus: |
SVC type: right upper PV into RA (PAPVR)
IVC type: Scimitar syndrome |
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ASD
Heart murmur: |
systolic ejection murmur (SEM)
RAE => RVH (volume overload) relative PS, 形同 PS 故為收縮期雜音 |
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Primum ASD
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Partial ECD (AVSD)
Down syndrome QRS axis: “superior” axis (-30~-120’) |
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VSD
Types: |
Type I: outlet (=subpulmonary; supracristal; infundibular)
Type II: perimembranous (=membranous; infracristal) Type III: inlet: 與ECD有關 Type IV: muscular types |
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VSD
Natural course: |
spontaneous closure; infundibular PS; AR (RCC prolapse)
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VSD
Eisenmenger’s syndrome |
R to L shunt
長期下來右心成受太多 flow 肺循環阻抗被養大，右心室推不上去了 進入 cyanosis phase |
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VSD
OP indications |
Failure to thrive, cannot control by medicaition
6~12 m/o with PAH > 24 mo with Qp: QS > 2:1 Supracristal VSD |
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VSD
Surgery approach |
Perimembrane & inlet: transatrial
Outlet: through main PA Muscular: apical right ventriculotomy |
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Supracristal VSD repair
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難 repair
不會 spontaneous closure |
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Ductus arteriosus closure
Functional close: |
10-15 hrs after birth
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Ductus arteriosus closure
Anatomic close: |
2-3 weeks after birth
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cyanotic newborn of unknown etiology
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不要給太多氧氣，說不定是
PDA dependent 的病人 給O2 PDA 關閉，小病人馬上 desaturation |
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PDA
PE |
Tachycardia
Bounding peripheral pulse Continuous murmur at LUSB |
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Endocardial Cushing Defect
aka |
(Atrioventricular Septal Defect)
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Marker of Down syndrome
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Endocardial Cushing Defect (Atrioventricular Septal Defect)
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Down syndrome
Goose neck: |
abnormal position of the aortic valve (anterosuperior to the right and left AV valves)
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ECD-EKG
The AV node is displaced inferiorly |
The bundle branches are also abnormal (RBBB / LBBB)
typically leftward and superior frontal QRS axis as the ventricles are depolarized from a right inferior position to a left superior position. |
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TOF ( TETRALOGY OF FALLOT)
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VSD (沒有 VSD 不能活)
Pulmonary stenosis (infundibular , valvular) Overriding of aorta RVH |
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TOF ( TETRALOGY OF FALLOT)
Symptoms/Signs |
Cyanosis, Systolic murmur
No pressure or flow overload (RV flow to PA or Ao), 所以很少以 heart failure 表現 |
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VSD 對 ToF 的重要性
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避免 pressure / volume overload
不會 heart failure |
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Hypoxic Spell (Blue Spell)
ToF |
First 2 yr of life, morning on first awaken, vigorous crying
Heart murmur disappear or decrease in intensity 惡化的時候反而雜音變小昇！ |
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Hypoxic Spell (Blue Spell)
Treatment |
knee- chest, O2, morphine SC 0.2 mg/kg, calm down patient; propranolol 0.1-0.2 mg/kg iv, correct acidosis
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Hypoxic Spell (Blue Spell)
ToF MOA |
PS 惡化
R shunt to L RVOT spasm |
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knee-chest position
MOA |
增加 systemic resistance
加大左心的 afterload 減少 ToF Blue spell 的 R to L shunt |
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最常見之ASD為哪一型：
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Ostium secundum type
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最常見之VSD為哪一型：
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membranous type
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CHD中最早發生cyanosis：
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TGA
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出生後一週內發生HF最常見之CHD為：
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hypoplastic left heart syndrome
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最易發生brain abscess之CHD為：
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TOF
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TOF最少發生之症狀為：
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heart failure
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最常見之心臟腫瘤為：
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Rhabdomyosarcoma
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最常合併WPW syndrome為：
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Ebstein’s Anormaly
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一位1 歲男孩，出生後即被發現有心雜音及哭鬧後嘴唇有發紺（cyanosis）現象。除嘴唇及四肢末端有發紺現象外，於左胸前可聽到第2-3 度收縮期心雜音。其胸部X 光檢查如 boot shape
最可能之診斷？ |
法洛氏四合症（tetralogy of Fallot）
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5 歲男孩因運動時會喘且有發紺現象而求診。身體檢查， 於左前胸可聽到第2 度收縮心雜音， 其胸部X 光檢查發現肺部血流增加，且心臟形狀似“8＂字（figure of eight）。下列何者為最可能診斷？
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總肺靜脈回流異常（TAPVR）， 注入處為無名靜脈（innominate vein）
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TAPVR
Three types: |
Supracardiac type:
CXR: snowman (8) The most common type 注入處：innominate vein Cardiac type Infracardiac type 最常見PV obstruction，造成pulmonary hypertension |
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PAPVR
Scimitar syndrome |
Hypogenic right lung syndrome
congenital pulmonary venolobar syndrome Dextrocardia |
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一位1 天大的足月產男嬰，出生後被發現有先天畸型及心雜音。出生體重為1.8 公斤，身長為43 公分，頭圍為31 公分；肌肉張力強（hypertonia）；其手腳之畸型如搖椅
最可能之診斷？ |
Trisomy 18 症候群
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PAPVR
Scimitar syndrome 左邊的 pulmonary vein 回到 |
IVC
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下列何者為嬰兒感染先天性德國麻疹（congenital rubella）後，最常合併之心臟病？
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開放性動脈導管（patent ductus arteriosus）
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