ABD Board-Neck Flashcards by miranda wilcox

lobes of thyroid are located

lower part of the neck along either side of the trachea

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normal variant extending superior to the isthmus

pyramidal lobe

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thyroid appearance

homogeneous medium level echoes

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seen as thin sonolucent bands along the anterior surface of the thyroid gland

strap muscles (infrahyoid muscles)

sternohyoid

sternothyroid,

thyrohyoid

omohyoid

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larger muscles located anterolaterally to thyroid glands

sternocleidomastoid

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the ____ ____ ____ is directly lateral to the thyroid lobes with the ____ ____ _____ lateral that

common carotid artery

internal jugular vein

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posterior to the thyroid

seen as a sonolucent structure adjacent to the cervical vertebrae posterior to the thyroid gland

longus colli muscle

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composed of the recurrent laryngeal nerve and inferior thryroid vessels

minor neurovascular bundle

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appearance of neurovascular bundle

vague hypoechoic area between the longus colli muscle and the thyroid gland (posterior to thyroid gland)

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parathyroid glands are located

posterior aspect of the thyroid

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can help identify the esophagus that is usually hidden by the trachea

have patient swallow

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thyroid arterial supply comes from

superior thyroid arteries (branches of the external carotid artery)

inferior thyroid artery )branches of the thyrocervical trunk)

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venous blood from the thyroid is drained into the

internal jugular vein via the superior and middle thyroid veins and into the innominate veins via the inferior thyroid veins

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glands that regulate thyroid hormones

thyroid

pituitary

hypothalamus

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gland that regulates T3(triiodothyronine) and T4 (thyroxine)

thyroid gland

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gland that regulates thyroid stimulating hormone TSH

pituitary

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gland that reulates thyrotropin releasing hormone TRH

hypothalamus

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produced to stimulate the thyroid to produce thyroid hormones

TSH thyroid stimulating hormone

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in increase in TSH is usually the first indication of

hypothyroidism

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normal levels of TSH

0.3 - 3.0

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the pituitary gland is regulated by the

hypothalamus

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lab values for hypothyroidism

increased TSH

decreased T4 and T3

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lab values for hyperthyroidism

decreased TSH

increased T4 and T3

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50% of the united states poulation has

evidence of nodular thyroid disease

only 10 to 13% cancer

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most commonly encountered benign thyroid nodule silitary, spherical, and encapsulated hemorrhage or necrosis within these is common

thyroid adenomas

risk factors for thyroid cancer

age 60 head and neck irradiation family history of thyroid cancer

physical findings of thyroid cancer

a recent palpable neck mass mass is firm and nontender mass moves with swallowing enlarged cervical lymph nodes hoarsness, voice changes or caugh trouble swallowing or breathing

most common primary thryroid cancer accounting for 75 to 80% of all cases

papillary carcinoma

appearance of papillary carcinoma

hypoechoic mass with possible calcifications

major route of spread of papillary carcinoma

through the lymphatics to nearby cervical lymph nodes

accounts for 10 to 20% of thyroid cancers often encapsulated spread via the blood stream and distanct metastasis to lung and bone is more likely than cervical lymph noes

follicular carcinoma

accounts for 5% of thyroid cancers secretes the hormone cacitonin which can be a serum marker

medullary carcinoma

medullary carcinoma is associated with

multiple endocrine neoplasia syndrome

1% of thyroid cancers most often ppl > 60 yrs old poor prognosis due to aggressive behavior and resistance to treatment rapidly invades surrounding tissue causing airway obstriction

anaplastic carcinoma

FNA should be considered if

nodule > 1 cm with microcalcifications nodule > 1.5 cm that is predominantly solid nodule > 2 cm that has mixed components nodule demonstating growth nodule with ipsilateral abnormal lymph nodes (nodes > 7mm in short axis)

most reliable geature of a benign nodule

peripheral or eggshell calcification calcifications that are fine and punctate (small dots or holes) are more suggestive of malignancy

features associated with thyroid cancer

microcalcifications solid hypoechogenicity irregular margins absence of halo intranodule central vascularity more tall than wide

results in generalized enlargement of the gland (goiter) diagnosis through lab findings and FNA

diffuse thyroid disease

causes of diffuse thyroid disease

chronic autoimmune thyroiditis (hashimotos) adenomatous goiter graves disease

autoimmune thyroid disease painless, diffuse enlargement of the thyroid in young or middle aged women common cause of hypothyroidism

chronic lymphacytic thyroiditis (hashimotos)

appearance of chronic lymphocytic thyroiditis (hashimotos)

hypoechoic diffuse enlargement with course parenchymal echo tecture difficult to distinguich from multinodular goiter histology will determine diagnosis

thyroid function with goiter

normal (non toxic goiter) overactive (toxic goiter) underactive (hypothyroid goiter)

most common cause of goiter worldwide

iodine deficiency

common cause of goiter in the US

an increase in TSH in response to decrease in thyroid hormone production of the thyroid

autoimmune disorders that are a common cause of goiters in the US

hashimotos thyroiditis and graves disease

goiter appearance

multiple discete nodules diffuse parenchymal inhomogeneity mixed ehogenicity without normal tissue

autoimmune isorder characterized by hyperthyroidism due to circulating antibodies (thyroid stimulating immunoglobulins) antibodies bind to the activate thyrotropin receptors, causing the thyroid gland to grow causing an increased productioin of thryroid hormones most common cause of hyperthyroidism

graves disease

symptoms of graves

diffusely enlarged thyroid (goiter) ophthalmopathy (prominent eyes) tachycardia tremors and muscle weakness palpitations, dyspnea(labored breathing) on exertion weight loss

appearance of graves

hypervascularity of thyroid gland audible bruit or palpable thrill(carotid exam may be ordered due to this) diffusley hypoechloic and inhomogeneous similar to that of a multinodular goiter presence of thyroid stimulating immuloglobins (TSI)

untreated graves may result in

severe thyrotoxixosis (thyroid storm) leading to severe weight loss, loss of bone and muscle resluting in cardiac complication and psychocongnitive complications

parathyroid glands control

blood calcium between 8.5 and 10.5

an oval hypoechoic mass posterior to the thyroid gland

parathyroid adenoma

what may be mistaken for an enlarged parathyroid gland

neurovascular bundle

ectopic locations for parathyroid gland

retrotracheal mediastinal intrathyroid near the carotid bifurcation

most common type of hyperparathyroidism which is due to the developement of an adenoma associated with one of the parathyroid glands

primary hyperparathyroidism suspected with increased levels of serum calcium treatment is excision of the parathyroid adenoma

confirms diagnosis of primary hyperparathyroidism

serum parathyroid hormone (PTH) level that is increased with a increased serum calcium level

occurs in patients with chronic renal failure due to increased amounts of serum phsphates (kidneys can't filter) all 4 parathyroid glands enlarged

secondary hyperparathyroidism (parathyroid gland hyperplasia)

the inability to syntehsize ___ _ depresses the serum calcium level which stimulates ____________ _____ _______

vitamin D parathyroid gland hyperplasia

results from parathyroid gland hyperplasia

bone demineralization and cacification of soft tissue and vascular structures

hyperparathyroidism is the most common maifectation of

multiple endocrine neoplasia (MEN type 1)

lab levels for parathyroid hyperplasia (secondary hyperparathyroidism)

increased serum phsphates decreased serum calcium

exocrine glands that screte saliva and the enzyme amylase

salivary glands parotid submandibular sublingual

largest salivary glands and are found anterior to the ear wrapped around the mandubular ramus

parotid glands

drains the parotid glands into the oral cavity

stensens duct

located beneath the jaw secretions from these glands enter the oral cavity through whartons ducts

submandibular glands

located beneath the tongue, anterior to the submandibular glands

sublingual glands

diseases of the salivary glands

mumps sjogrens syndrome salivary gland neoplasms salivary duct calulus (causes obstruction of the salivary glands)

most common superficial midline neck mass typically seen in adolescents associated with upper respiratory infection cystic dilatation which is a remnant of the thyroid gland mirgration from the pharyngeal epithelium

thyroglossal duct cyst

solitary, predominantly cystic mass appearing on the lateral aspect of the neck at the angle of the mandible under the sternocleidomastoid muscle may be connected to the mouth and become infected

branchial cleft cyst most common cause of congenital neck mass

branchial cleft cysts are a remnant of

embryonic development

congenital lymphatic malformation can occur throughout the body although 75% are in the neck

cystic hygroma (cystic lymphangioma) myltiloculated cervical mass that is evidnet at birth

cystic hygroma (cystic lymphangioma) are associated with

turner syndrome down syndrome klinefelter syndrome (XXY) trisomy 18 and 13

arteries on the left that originate from the aortic arch

left common carotid subclavian

arteries on the right that arise from the aortic arch

innominate (brachiocephalic trunk) and then divides into the right comon carotid artery and right subclavian

true or false the innominate veins are bilateral

true | artery is only on the right

at the level of the superior border of the thyroid cartilage, the common carotid artery bifurcates into the

internal and external carotid arteries

typical positions of ICA and ECA

ICA is lateral and posterior and the ECA is medial and anterior

ICA waveform

low resistance

ECA waveform

high resistance

with ICA stenosis or occlusion the ECA may collateralize resulting in a

low resistance waveform

1st branch of the ICA

ophthalmic artery

1st branch of the ECA

superior thyroid artery

internal jugular vein is located

lateral to the common carotid artery

the internal jugular and the subclavian vein drain into the

innominate (brachiocephalic ) veins bilaterally

the external jugular vein is located

superficially on the lateral aspect of the neck

ABD Board-Neck Flashcards

(85 cards)