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Jaspie - Surgery > 07 - Head and Neck, Parathyroid and Thyroid > Flashcards

07 - Head and Neck, Parathyroid and Thyroid Flashcards

1
Q

Identify: PNS cells that produce myelin sheath:

A

Schwann cells

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2
Q

Head and Neck TNM staging:

Describe T staging

A
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3
Q

Head and Neck TNM staging:

Describe N staging

A
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4
Q

Identify the cervical lymph nodes:

level VI

A

Anterior compartment nodes

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5
Q

Identify the cervical lymph nodes:

level IV

A

lower jugular lymph nodes

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6
Q

Identify the cervical lymph nodes:

level VII

A

superior mediastinal lymph nodes

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7
Q

Identify the cervical lymph nodes:

level VA

A

occipital lymph nodes

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8
Q

Identify the cervical lymph nodes:

level VB

A

supraclavicular lymph nodes

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9
Q

Identify the cervical lymph nodes:

level IIA

A

jugulo-digastric lymph nodes

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10
Q

Identify the cervical lymph nodes:

level IIB

A

submuscular lymph nodes

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11
Q

Identify the cervical lymph nodes:

level IA

A

submental lymph nodes

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12
Q

Identify the cervical lymph nodes:

level IB

A

submandibular lymph nodes

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13
Q

Identify the cervical lymph nodes:

level III

A

middle jugular lymph nodes

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14
Q

Enumerate: (3) what structures are spared in MRND? (compared to RND)

A
  • internal jugular vein
  • spinal accessory nerve
  • sternocleidomastoid muscle
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15
Q
  • Enumerate (4): infrahyoid muscles
  • another name for this group of muscles:
A
  • sternohyoid
  • sternothyroid
  • thyrohyoid
  • omohyoid

-strap muscles

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16
Q

Weight of the thyroid gland:

A

20 g

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17
Q

blood supply of the thyroid gland:

A
  • superior thyroid artery <- external carotid
  • inferior thyroid artery <-thyrocervical trunk
  • thyroidea ima
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18
Q

venous drainage of the thyroid gland:

A
  • superior thyroid vein -> internal jugular vein
  • middle thyroid vein -> internal jugular vein
  • inferior thyroid vein -> brachiocephalic vein
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19
Q

Left vs Right: recurrent laryngeal nerve

A
  • L: crosses arch of aorta, loops around ligamentum arteriosum
  • R: crosses and loops around subclavian artery; more oblique than L
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20
Q

Enumerate: Branches of the superior laryngeal nerve, and their functions:

A
  • internal branch: sensory to the supraglottic larynx
  • external branch: motor supply to the cricothyroid
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21
Q
  • Selective neck dissection for laryngeal malignancy:
  • what levels of lymph nodes are removed?
A
  • lateral lymph node dissection
  • levels II, III, IV
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22
Q
  • Selective neck dissection for oral cavity malignancies:
  • what levels of lymph nodes are removed?
A
  • supraomohyoid dissection
  • levels I, II, III
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23
Q
  • Selective neck dissection for thyroid malignancies:
  • what levels of lymph nodes are removed?
A
  • posterolateral neck dissection
  • levels II, III, IV, V
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24
Q

Identify: single most important test in the evaluation of thyroid masses

A

FNAB

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25
Q

Identify: This thyroiditis cannot be diagnosed using FNAB:

A

Reidel thyroiditis (FNAB is impossibly because the thyroid becomes too hard)

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26
Q

Enumerate: these types of thyroid carcinomas cannot be diagnosed using FNAB:

A
  • Follicular carcinoma
  • Hurthle cell carcinoma
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27
Q

In what conditions (3) will unilateral lobectomy become indicated for simple thyroid cysts?

A
  • more than 3 unsuccessful attempts at aspiration
  • cysts > 4 cms
  • complex cysts
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28
Q
A
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29
Q

most common preventable risk factor in the head and neck CA

A

tobacco and alcohol

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30
Q

It is a second tumor detected within 6 months of the diagnosis of the initial primary lesion

A

synchronous neopllasm

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31
Q

It is a second tumor detected more than 6 months of the diagnosis of the initial primary lesion

A

metachronous neoplasm

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32
Q

What is the initial evaluation of patients with primary CA of head and neck

A

panendoscopy

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33
Q

Most common location of squamous cell CA of the lip

A

lower lip

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34
Q

What nerve is involved when there is paresthesia of the lips

A

mental nerve

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35
Q

treatment of squamous cell cancer of the lip

A

T1 - T2: resection = radiation T3 - T4: surgical excision with histologic confirmation of tumor free margin and post operative radiation

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36
Q

What are the indications for supraomohyoid neck dissection

A
  1. tumor greater than 4 cm 2. desmoplastic tumor 3. perineural invasion
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37
Q

Tongue cancer with lingual nerve involvement causes

A

ipsilateral paresthesia

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38
Q

Tongue cancer with hypoglossal nerve involvement causes

A

deviation of tongue on protrussion and fasciculations

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39
Q

Most common location of tongue cancer

A

lateral and ventral surfaces

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40
Q

Treatment of tongue cancer

A

T1 - T2 - wide local excision Base of Tongue - partial glossectomy with supraomohyoid dissection (N0) or MRND (N+)

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41
Q

Featurs of plummer vinson syndrome

A
  1. cervical dysphagia 2. IDA 3. atrophic oral mucosa 4. brittle spoon finger nails
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42
Q

Treatment of tumor of alveolus and gingiva

A
  1. minimal bone invasion - mandibular resection 2. medullary cavitiy invasion - segmental mandibulectomy
43
Q

Treatment of tumors of nasopharynx

A

chemotherapy

44
Q

Most common nasophryngeal malignancy in the pedatric age group

A

lymphoma

45
Q

Lymphatic spread of nasopharynx

A
  1. bilateral regional 2. posterior triangle (level 5)
46
Q

Lymphatic spread of oropharynx

A
  1. upper and lower cervical lymphatics (level 2, 3, 4) 2. retropharyngeal spread
47
Q

Lymphatic spread of hypopharynx

A
  1. bilateral regional 2. mid and lower cervical lymphatics (level 3, 4)
48
Q

Tumors of the oropharynx are radiosensitive

A

Tumors of the oropharynx are radiosensitive

49
Q

Where does larngeal granuloma usually occur?

A

posterior larynx on the arytenoid mucosa

50
Q

Most common cause of vocal cord paralysis

A

iatrogenic

51
Q

Treatment of early stage glottic and supraglottic cancer

A

Radiation therapy

52
Q

Treatment of small glottic cancer

A

partial laryngectomy

53
Q

Treatment of supraglottic cancer without arytenoid or vocal cord extension

A

supraglottic laryngectomy

54
Q

Treatment of advanced laryngeal tumor with extension

A

total laryngectomy with post op RT

55
Q

Treatment of subglottic cancer

A

total laryngectomy

56
Q

Pattern of spread from primary tumor of oral cavity and lip

A

I, II, III

57
Q

Pattern of spread from primary tumor of oropharynx, hypopharynx and larynx

A

II, III, IV

58
Q

Pattern of spread from primary tumor of nasopharynx and thyroid

A

V

59
Q

Pattern of spread from primary tumor of nasopharynx, soft palate, and lateral and posterior walls of the oropharynx and hypopharynx

A

Retropharyngeal lymph nodes

60
Q

Pattern of spread from primary tumor of hypopharynx, cervical esophagus and thyroid

A

VII

61
Q

Pattern of spread from advanced tumor of glottis with subglottic spread

A

delphian node

62
Q

What is a radical neck dissection or CRILE method

A
  1. removal of level I to V lymph nodes 2. SCM 3. IJV 4. Spinal accesory nerve
63
Q

What is a modified radical neck dissections

A
  1. removal of level I to V lymph node
64
Q

What is a supraomohyoid neck dissection

A
  1. removal of level I to III 2. oral cavity malignancy
65
Q

What is a lateral neck dissection

A
  1. removal of level II to IV 2. laryngeal malignancy
66
Q

What is a posterolateral neck dissection

A
  1. removal of II to V 2. thyroid cancer
67
Q

What is the procedure of choice for thyroglossal duct cyst

A

Sistrunk procedure 1. removal of cyst, tract, and central portion of hyoid bone 2. removal of portion of the tongue base up to the foramen cecum

68
Q

Most common gland involved in salivary gland tumor

A

parotid gland

69
Q

most common benign tumor of salivary gland

A

pleomorphic adenoma

70
Q

most common malignant tumor of salivary gland

A

mucoepidermoid carcinoma

71
Q

Most frequently injured nerve in parotid surgery

A

greater auricular nerve - will produce numbness of the lower portion of the auricle and periauricular skin

72
Q

The syndrome when the auriculotemporal nerve is injured

A

Frey’s syndrome - postoperative gustatory sweating

73
Q

What are the nerves at risk in submandibular gland removal

A

lingual and hypoglossal nerve

74
Q

What crosses the recurrent laryngeal nerve

A

inferior thyroid artery

75
Q

What innervates the cricothyroid muscle

A

external laryngeal nerve of the superior laryngeal nerve of the vagus nerve

76
Q

What is a sensitive marker for medullary thyroid cancer

A

Serum calcitonin N: 0 - 4 pg/ml

77
Q

Treatment of lingual thyroid

A
  1. exogenous oral thyroid hormone 2. RAI 3. hormone replacement
78
Q

Most common GI symptom of grave’s disease

A

diarrhea

79
Q

Absolute contraindication of RAI

A
  1. pregnant 2. breastfeeding
80
Q

Relative contraindication of RAI

A
  1. young people 2. thyroid nodule 3. ophthalmopathy
81
Q

Treatment of toxic multinodular goiter

A

subtotal thyroidectomy

82
Q

Treatment of plummer disease

A

lobectomy and isthmusectomy -also known as toxic adenoma

83
Q

This is a self limiting PAINFUL thyroiditis usually occurs in 30 - 40 y.o women

A

Subacute Thyroiditis De quervain’s thyroiditis

84
Q

Treatment of de quervain’s thyroiditis

A

NSAID since it is self limiting

85
Q

This thyroid disease has a strong association with HLA B35 haplotype

A

Subacute Thyroiditis De quervain’s thyroiditis

86
Q

The most common presentation of this thyroid disease is minimally or moderately enlarged firm granular gland or the awareness of painless anterior neck mass

A

Hashimoto’s thyroiditis Chronic Thyroiditis

87
Q

What is seen in microscopic examination of hashimoto’s thyroiditis?

A

Hurthle cell or Askanazy cell

88
Q

This thyroid disease is characterized by replacement of all or part of the thyroid tissue parenchyma by fibrous tissue

A

Reidel’s thyroiditis

89
Q

Physical examination reveals a hard woody thyroid gland with fixation to surrounding tissues

A

Reidel’s thyroiditis

90
Q

What is the first diagnostice test in a solitary thyroid nodule

A

FNAB

91
Q

Most common site of metastasis in papillary thyroid CA

A

Lungs

92
Q

What is the type of spread in papillary thyroid CA

A

lymphatics

93
Q

What is the most important prognostic factor in determining long term survival of papillary CA

A

age

94
Q

Treatment of papillary CA

A
  1. < 1.5 cm - lobectomy + isthmusectomy 2. multicentric - near total or total thyroidectomy 3. with cervical lymph node - MDRD
95
Q

Most common route of spread of follicular CA

A

Hematogenous

96
Q

More common cancer in iodine deficient countries

A

follicular cancer

97
Q

Most common site of metastasis in follicular thyroid CA

A

lung and bone

98
Q

Treatment of follicular CA

A
  1. Follicular lesion - lobectomy + isthmusectomy 2. Follicular lesion > 4 cm - total thyroidectomy 3. Thyroid cancer - total thyroidectomy 4. Positive lymph node - MDRD
99
Q

Usual site of medullary thyroid cancer

A

superolateral in the thyroid lobes

100
Q

Where does medullary thyroid cancer arise from

A

parafollicular cells C cells

101
Q

Disease associated with men 2A

A

1, pheochromocytoma 2. parathyroid hyperplasia

102
Q

Disease associated with men 2B

A
  1. pheochromocytoma 2. neuroma
103
Q

Treatment of MTC

A

Total thyroidectomy with bilateral central node dissection

104
Q

Most common site of minor salivary gland tumor

A

junction of hard and soft palate

Jaspie - Surgery (18 decks)

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