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Endocrine > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What forms the following borders of the anterior triangle in the neck?

  • Superiorly
  • Medially
  • Laterally
A

Bounded by mandible superiorly
Midline medially
Anterior border SCM laterally

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2
Q

What forms the following borders of the poserior triangle in the neck?

  • Anteriorly
  • Laterally
  • Inferiorly
A

Posterior border SCM anteriorly
Anterior border trapezius laterally
Clavicle inferiorly

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3
Q

Give three possible causes of a superificial neck lump

A

Sebaceous Cysts
Lipomas
Neurofibromas

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4
Q

Give three possible causes of midline swellings in the neck

A

Thyroid
Thyroglossal Cyst
Dermoid Cyst

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5
Q

What two questions should you ask in any patient with a neck swelling and why?

A
  1. Does it move on swallowing? -> If it does, then it’s in the thyroid, vice versa
  2. Does it move on sticking out the tongue? -> If the lump comes up when you sick out the tongue, it’s a thyroglossal cyst
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6
Q

Give four possible causes of an anterior triangle swelling in the neck

A

Lymph Nodes – this accounts for a lot of neck problems; doesn’t move when you swallow
Branchial Cyst
Salivary glands
Carotid Body Tumour

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7
Q

What are the two most common causes of neck lumps?

A

Lymph Nodes - 85%

Goitre - 8%

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8
Q

What three things should you look for in a patient with cervical lymphadenopathy?

A
  1. Look for other nodes
  2. Look for primary sites
  3. Look for hepatosplenomegaly
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9
Q

What steps should you take if cervical lymphadenopathy has each of the following?

  • Only in neck?
  • Solitary?
  • Generalized?
A

Only in neck - look for primary site, then refer to ENT/CXR/biopsy
Solitary - is it infective or maignant? -> Biopsy
Generalized - is it in the liver and spleen? Refer to haematology or biopsy

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10
Q

Give three things that you should a patient presenting with cervical lymphadenopathy?

A
  1. Systemic symptoms – fever, sweats, weight loss etc
  2. Specific symptoms- e.g. hoarseness -> think cancer affecting the recurrent laryngeal nerve, cough, dyspnoea
  3. Background travel abroad – recent immigrant, travel abroad
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11
Q

Thyroglossal cyst
Where in the thyroglossal tract does it occur?
What does it contain and what does this risk?
What is special about its movement?
Who gets it?
Possible complication?

A

Can arise in any part of the thyroglossal tract
Contains lymphatics which may become infected
Moves with the tongue
Usually presents in teenage years
Can fistulate

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12
Q

Dermoid cyst
What is this?
Who gets it?
What does it feel like on palpation?

A

Rare congenital cyst
Usually presents in teenage years
Soft, nonfluctuant

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13
Q 
Branchial cyst 
Where in the neck is this found?
What is this formed of?
Who gets it?
What does it feel like on palpation?
What do you see on FNA?
Potential complication?
A

Anterior triangle
Persisting second branchial arch
Arises in upper third of the anterior triangle
Usually presents in teenage years
“half filled hot water bottle”
FNA - cholesterol crystals
Can fistulate -> remember that the hole will always be anterior to the sternocleidomastoid

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14
Q

Cystic hygroma

  • Where in the neck is this found?
  • How big can it be?
  • What fills it?
  • What can you do to it on palpation?
  • Who gets it?
A

Posterior triangle of the neck
Can be large & cause pressure symptoms
Lymph filled
Transilluminate
Usually present in the first year of life

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15
Q

What should you remember to examine in any neck lump?

A

The mouth + salivary glands

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16
Q

Which gland comes down into the top part of the anterior triangle?
Give three things that can cause swelling of this structure.

A

Parotid salivary gland

  • Infective
  • Pleomorphic adenoma
  • Stone
17
Q

In a patient with a solitary thyroid nodule,
give two things related to each of the following which you would do:
- Questions
- Examination
- Investigation

A

History
- Do they have a family history of thyroid carcinoma?
- Have they had previous neck irradiation
Examination
- Is the patient hoarse? -> Probably thyroid cancer with RLN invasion
Presence of lymphadenopathy? -> Will have a lump which moves up and down when they swallow and a lump in the anterior triangle which doesn’t move when you swallow -> most likely papillary thyroid cancer
Investigation
- TSH – 99% of the time, TSH is normal
- USS- fine needle aspiration (FNA)

18
Q

In a patient with a solitary thyroid nodule and suppressed TSH, what should you be thinking?
What should you do to investigate this?

A

Think about solitary toxic adenoma

Do an isotope scan

19
Q

In FNA of a thyroid nodule, what four results might you get back?

A
  1. Inadequate Thy1
  2. Benign Thy2 (presence of colloid macrophages, benign follicular cells)
  3. Suspicious Thy 3 (25% malignant)
  4. Malignant Thy 4-5
20
Q

What should you do it you get each of the following results?

  • Inadequate
  • Benign
  • Suspicious
  • Malignant
A

Inadequate: Thy 1- repeat FNA (can’t see enough to get an answer)
Benign: Thy 2 – repeat FNA 6/12 -> most common
Suspicious: Thy 3 – thyroid lobectomy
Malignant: Thy 4-5 – total thyroidectomy

21
Q

What is special about steroid hormone receptors?

What kind of effect do they typically have?

A

There isn’t a ligand receptor at the cell membrane; these are intracellular receptors, either in the cytoplasm or in the nucleus. When a ligand binds to the steroid receptor, you end up with a complex of ligand at the receptor which is bound to DNA and induces transcriptional changes.
They typically modulate activity, i.e. not an on/off switch.

22
Q

Give five factors which can affect hormone measurement reliability

A
  1. Pattern of secretion – remember that there are peaks and troughs throughout the day of hormone concentration in the blood, so you need to be aware of these when interpreting results
  2. The presence of carrier proteins – like in thyroid tests
  3. Interfering agents e.g. some individuals have antibodies which interfere with measurement of thyroid hormone – you’re typically not measuring the hormone itself, but looking at something secondary to it; IV heparin can majorly affect thyroid hormones
  4. Stability of hormone (consider ½ life)
  5. Absolute concentrations
23
Q

What is the major determinant of hormone concentration?

A

The major determinant of hormone concentration is rate of secretion, which is typically determined by highly refined feedback loops.

24
Q

Which one test will be done for the thyroid in primary care?

Why might this be misleading?

A

Only one test will be done to measure thyroid hormone from primary care – TSH. If TSH is normal then you might be allowed to do T4 and T3. TSH is maintained in a very tight range – if the feedback loop is intact then TSH will be reliable. Things which may disrupt the loop:
- Pituitary gland dysfunction e.g. tumour or irradiation or pituitary surgery to remove it
- Very rare mutations in the thyroid hormone receptor
Basically, the negative feedback loop needs to be intact for you to be able to rely on TSH. It is abnormal in secondary hypothyroidism, i.e. pituitary dysfunction.

25
Q

What should you note about thyroid blood testing in a patient acutely unwell?

A

Thyroid function tests in an acutely unwell patient are of limited value.
Only indicated when considered central to clinical picture (e.g. profound hypothyroidism, Thyroid ‘storm’).
If someone is very ill then don’t pay too much attention to their thyroid values, wait a couple of months and then do again.

26
Q

When in the day should you measure cortisol and why?

A

The peak is at about 9 am, so do test then if you suspect low cortisol in the patient. There is a trough at around midnight, so measure it then if you have a patient where you suspect a lot of cortisol – absence of this dip can be useful.
Formal assessment of HPA axis requires dynamic testing.

27
Q

What should you note about GH testing?

Measurement of what may indicate GH hypersecretion?

A

Random GH measurement is of little value – there are lots of peaks and troughs at random points in the day.
Formal assessment of GH axis required dynamic testing.
IGF-1 measurement may indicate GH hypersecretion – produced in the liver.

28
Q

When in the day should you test sex hormones?

A

In men, testosterone is highest in the morning, dwindles through the day, then slowly rises in anticipation of the next day, so do the test first thing in the morning.
Female – depends on timing of the menstrual cycle.

29
Q

What should you note when measuring lactin?

A

You don’t have to do very much to put prolactin up – everyone worries that you might have a lactin producing tumour, which is quite common.
Pretty much anything can raise your prolactin, but mostly
- Stress
- Exercise
- Drugs
- Lots of medical conditions
- Pituitary stalk or hypothalamic disorders
- It’s very sensitive to changes in physiology
If someone has raised prolactin, then test it again first thing in the morning when they’re calm.

30
Q

What three groups of hormone does the adrenal gland produce?

A
  1. Aldosterone
  2. Cortisol (steroid)
  3. Testosterone
31
Q

How do you test pituitary hormone excess vs deficiency?

A

Dynamic testing to detect hormone excess /deficiency

  • Hormone excess – suppression test
  • Hormone deficiency – stimulation test
32
Q

What are the four possible causes of Cushing’s syndrome?

A

Cushing’s disease
ACTH-independent Cushing’s
Ectopic ACTH
Exogenous steroids

Endocrine (9 decks)

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