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General Surgery > Endocrine, H&N > Flashcards

Endocrine, H&N Flashcards

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1
Q

Ant triangle of neck boundaries

A

Superior: lower border of mandible
Anterior: midline
Posterior: anterior border of SCM

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2
Q

What does the ant triangle of the neck contain?

A

Carotid sheath

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3
Q

Post triangle of the neck boundaries + what does it contain

A

Anterior: posterior border of SCM
Posterior: anterior of trapezius
Inferior: clavicle

Contains spinal accessory nerve

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4
Q

Bony landmarks of C3-T3

A

C3: hyoid bone
C4: thyroid cartilage notch
C6: cricoid cartilage
C5-T1: thyroid gland
T2/3: suprasternal cartilage

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5
Q

Common carotid arteries split at the level of

A

C4

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6
Q

External carotid artery branches

A

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal

(Some Anatomists Like Freaking Out Poor Medical Students)

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7
Q

Internal carotid artery branch

A

enters carotid canal, gives off ophthalmic artery

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8
Q

Right IJV unites with the ___ vein behind ___ to give rise to ___. This vein joins the left ___ to form the ___.

A

subclavian
sternoclavicular joint
right brachiocephalic
brachiocephalic vein
superior vena cava

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9
Q

Most common cause of neck mass is

A

enlarged lymph node

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10
Q

Rule of 80s in neck masses (5 rules)

A

80% non-thyroid are neoplastic
80% neoplastic masses are malignant
80% malignant are SCC
80% of malignant are metastatic
80% of metastases are from primary sites above level of clavicle

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11
Q

DD of midline neck mass

A

submental lymph node
thyroglossal cyst
thyroid nodule in isthmus
sublingual dermoid cyst
plunging ranula

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12
Q

DD of ant triangle neck mass

A

lymph node along ant border of SCM
thyroid nodule
submandibular gland mass
branchial cyst
carotid body tumour
carotid aneurysm

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13
Q

DD of posterior triangle neck masses

A

lymph node
cystic hygroma
cervical rib
brachial plexus neuroma

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14
Q

Investigation of neck masses

A

triple assessment
- clinical exam
- histology: FNAC
- imaging: CT neck w contrast

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15
Q

biochemical tests for neck masses

A

fbc
thyroid function
+/- calcium panel
+/- calcitonin (medullary thyroid cancer)

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16
Q

Types of endoscopy for neck masses

A

Panendoscopy - triple endoscopy
- flexible nasopharyngoscopy
- bronchoscopy
- esophagogastroscopy

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17
Q

Nodules that move with swallowing

A

thyroglossal cyst, thyroid nodule

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18
Q

nodules that move w swallowing and tongue protrusion

A

thyroglossal cyst

*thyroid nodule moves with swallowing but NOT with protrusion

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19
Q

what is a thyroglossal cyst?

A

cystic expansion of remnant thyroglossal tract - failure of thyroglossal duct to obliterate after descent of thyroid gland from foramen cecum at base of tongue to anterior neck

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20
Q

where can thyroglossal cyst occur?

A

anywhere from base of tongue to behind sternum, most commonly adjacent to hyoid bone

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21
Q

Treatment for thyroglossal cyst

A

Sistrunk operation - removal of cyst + thyroglossal tract + central portion of hyoid bone

removing cyst alone can risk recurrence

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22
Q

What is a dermoid cyst & causes

A

small non-tender mobile subcutaneous lump - can be fluctuant, skin-coloured, bluish

congenital - inclusion of epidermis along lines of fusion of skin dermatomes (ends of eyebrows, midline of nose, midline of neck/trunk)

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23
Q

what is a plunging ranula & causes

A

pseudocyst of sublingual/submandibular ducts

congenital: due to imperforate salivary duct
acquire: trauma to sublingual glands causing mucus extravasation, formation of pseudocyst

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24
Q

Branchial cysts form ___ masses. Occurs due to ___

A

anterior triangle neck

failure of fusion of 2nd and /or 3rd branchial arches, causing failure of obliteration of 2nd branchial cleft (most common)

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25
Branchial cysts form ____ (location)
1st cleft: near parotid gland 2nd cleft: anterior to upper/middle third of SCM 3rd/4th cleft: left side of neck - can present as suppurative thyroiditis
26
Branchial cysts may form fistulas that run ___
between tonsillar fossa and anterior neck, passes between internal and external carotid arteries
27
What is a chemodectoma and where is it located
carotid body tumour tumour of the paraganglion cells - benign but locally invasive located at the bifurcation of common carotid artery
28
Features of chemodectoma
solid, non-painful mass at level of hyoid bone pulsatile but not expansile - transmitting pulses from carotid artery mostly do not secrete catecholamines, but 5% do - rule out associated syndromes like pheochromocytoma
29
how to differentiate chemodectoma and carotid body aneurysm
aneurysm can occur at any level, tumour occurs only at level of hyoid bone angiography to detect tumour - hypervascular mass that displaces bifurcation
30
Genetic associations of paragangliomas
MEN2, VHL, NF1, Carney-Stratakis dyad
31
What is a cystic hygroma, where is it found
congenital cystic lymphatic malformation found posterior triangle of neck, can be multiple interconnecting/separate cysts
32
features of cystic hygroma
soft, fluctuant, compressible can be found in other locations - axilla, groin "brilliantly transilluminable"
33
What is a cervical rib, where is it found
hard mass in posterior triangle, at the root of neck
34
cervical rib causes ___
thoracic outlet syndrome - compression of brachial plexus trunks, subclavian artery and/or subclavian vein
35
Neuroma is a __, found in __
slow growing tumour arising from peripheral neural structures of neck (eg. brachial plexus) posterior triangle of neck
36
Cervical lymph nodes are divided into ___ levels
seven
37
Drainage of H&N structures into what level of lymph nodes
Oral cavity: Level I, II, III Thyroid, larynx: Level II - VI (thyroid first spreads to level VI - central nodes) Nasopharynx: II - V
38
Differentials of enlarged lymph node (*categorise)
infectious inflammatory neoplastic
39
Infected lymph nodes causes
viral - EBV, CMV, HIV bacterial - TB, strep/staph fungal/parasitic - toxoplasma
40
neoplastic lymph node causes
primary - lymphoma metastases - H&N (90%), other sites (breast, lung, renal, GIT)
41
inflammatory lymph nodes causes
Kikuchi, Kimura, SLE, sarcoidosis
42
Nerves easily injured in submandibular gland excision
marginal mandibular nerve (CN VII) lingual nerve (CN V3) hypoglossal nerve
43
Structures running in the parotid gland (lateral to medial)
facial nerve & branches retromandibular vein external carotid artery
44
Parotid duct runs 5cm across ____, below the ____, pierces the ___ and empties into ___
masseter zygomatic arch buccinator opposite upper 2nd molar tooth
45
Histology of each salivary gland & their contribution to saliva
parotid - mostly serous (25% of saliva) submandibular - mixed serous and mucinous (70% of saliva) sublingual - mostly mucinous (5% of saliva)
46
What is sialolithiasis and which gland does it most commonly occur in
Stones in the salivary gland/duct Submandibular gland
47
Presentation of sialolithiasis
Pain and swelling of gland a/w meal times Can cause gland inflammation (sialadenitis) and infection/abscess, purulent discharge observed at duct opening
48
Most salivary gland tumours occur in the ___ gland, and are mostly __
parotid, benign 80% of the benign tumours are pleomorphic adenomas
49
Tumours that occur in smaller glands are more likely to be ___
malignant
50
Most common benign tumour of parotid gland
pleomorphic adenoma
51
clinical features of pleomorphic adenoma
slow-growing, painless irregular surface chance of malignant transformation if left unexcised
52
2nd most common tumour of salivary gland, only occurs in __. Related to ___, occurs in ___.
Warthin's tumour, parotid cigarette smoking, occurs in older patients
53
Unlike pleomorphic adenoma, Warthin's tumour is ___ to become malignant
unlikely can be left alone
54
embryonic origin of thyroid, parathyroid glands
thyroid: endoderm, from foramen caecum inferior para: from 3rd pharyngeal pouch, migrate tgt with thymus superior para: from 4th pharyngeal pouch
55
arterial supply of thyroid & parathyroid
superior TA - from external carotid inferior TA - from thyrocervical trunk, branch of subclavian Thyroid Ima Artery - 5% of pts *inferior TA supplies parathyroid
56
Venous supply of thyroid
Superior TV: drains into IJV middle TV: drains into IJV inferior TV: drains into brachiocephalic
57
impt nerves and artery relationships in thyroid
1) external branch of superior laryngeal nerve & superior thyroid artery 2) recurrent laryngeal nerve & inferior thyroid artery
58
nerve damage in thyroid surgery and what is affected
1) external branch of superior laryngeal nerve supplies cricothyroid - tenses vocal cord. damage affects ability to produce high pitch 2) RLN - supplies all intrinsic muscles of larynx except cricothyroid. unilateral damage causes hoarseness. bilateral causes acute dyspnea
59
thyroid stimulation pathway
TRH (from hypothalamus) -> TSH (from pituitary) -> T3 , T4 (from thyroid)
60
Common causes of primary hyperthyroidism
Graves' disease toxic multinodular goitre toxic adenoma
61
common causes of secondary hyperthyroidism
pituitary adenoma gestational thyrotoxicosis neoplasms - ovarian teratoma, choriocarcinoma, metastatic thyroid carcinoma
62
antithyroid drugs: ___ used for 1st trimester, switch to ___ for 2nd and 3rd trimester
Propylthiouracil (PTU) - less teratogenic Carbimazole - less hepatotoxicity
63
Impt side effect of antithyroid drugs
agranulocytosis
64
Common causes of hypothyroidism
iodine deficiency (most common) hashimoto's autoimmune cretinism - maternal hypothyroidism leading to thyroid agenesis/dysgnesis myxedema coma - severe hypothyroidism precipitated by infection/trauma/surgery
65
Risk factors for thyroid malignancy
Age, gender Exposure to ionising radiation Family history Associated with familial adenomatous polyposis, Gardner syndrome, Cowden disease, MEN2
66
what is gestational hyperthyroidism?
Hyperemesis gravidarum: High HCG levels in 1st trimester -> stimulates TSH receptors
67
Thyroid cytopathology is graded by the ____
Bethesda system used to grade chance of malignancy, guides management
68
follicular cell derived thyroid cancers
papillary, follicular, hurthle cell, anaplastic cancers
69
non-follicular cell derived thyroid cancers
medullary cancer, thyroid lymphoma
70
PTC spread by ___, FTC spread by ___
lymph, blood
71
Thyroid swellings move on ___, thyroglossal cyst moves on ___
swallowing only swallowing & tongue protrusion
72
Suspicious features on ultrasound (6) a/w thyroid cancer
1) taller than wide 2) micro-calcifications 3) intranodular vascularity 4) margins - infiltrative, spiculated 5) hypoechoic 6) presence of lymphadenopathy
73
Radioisotope used for thyroid scan
Sodium pertechnetate Iodine 123
74
Indications for thyroid surgery (6 Cs)
Cancer Cosmesis Cannot treat medically Compressive symptoms Compliance problems Child-bearing
75
___ syndrome is associated with medullary carcinoma. Screen for ___
MEN2A/2B Pheochromocytoma
76
Hashimoto's thyroiditis increases risk of ___
lymphoma
77
Ionising radiation increases risk of ____ and ___
papillary and follicular cell carcinoma
78
Medullary cancer causes ____ due to production of ___
flushing, diarrhea calcitonin
79
Most common sites of mets for thyroid cancers
lung, bone, brain + liver for medullary
80
T staging for thyroid based on
size of nodule T3: invaded strap muscle T4: invaded major neck structures
81
Molecular tests for each tumour
PTC: BRAF mutation FTC: RAS mutation Medullary: RET oncogene
82
Immediate post-surgical complications of thyroidectomy
Haematoma formation under/above strap muscles - tracheal compression Injury to RLN and SLN tracheomalacia - tracheal floppines due to chronic compression by large goiter thyrotoxic storm - resection release t4 into blood
83
Intermediate post-thyroidectomy complication
Hypoparathyroidism causing hypocalcemia, leading to (CATS go Numb) Convulsion Arrhythmias Tetany Spasm Numbness of extremities
84
MEN1 tumour suppressor gene mutation affects
3Ps Parathyroid - hyperplasia Pancreas - neuroendocrine tumours Pituitary - anterior pit adenoma, growth hormone secreting tumours
85
MEN2A: Activating proto-oncogene (RET) mutation causes/affects
Medullary thyroid CA Pheochromocytoma Parathyroid Hirschsprung disease
86
MEN2B: Activating proto-oncogene (RET) mutation causes/affects
Medullary thyroid CA Pheochromocytoma *no parathyroid in men2b
87
Most common cause of painful thyroid gland
DeQuervain's thyroiditis preceded by URTI viral infection causing damage to thyroid follicular cells
88
Drugs that cause thyroiditis
Amiodarone, lithium, IL-2, IFN-alpha
89
___ parathyroid migrates with the thymus, can sometimes be found within
Inferior
90
Superior parathyroid arises from ___ pharyngeal ___, inferior arises from ____
4th pharyngeal pouch 3rd pharyngeal pouch
91
PTH ___ calcium in blood, calcitonin ___ calcium in blood
increases, decreases
92
PTH effects on kidney
increases reabsorption of calcium & vitamin D increases excretion of phosphate
93
Calcitonin effects
Inhibit reabsorption of calcium in kidney and intestines Inhibit reabsorption of phosphate
94
Mnemonic for hyperparathyroidism
stones, bones, moans, groans kidney stones bone pain - osteoporosis abdominal groans - PUD, pancreatitis, cholelithiasis psychiatric moans - depression, psychosis
95
parathyroid 4 gland hyperplasia associated with
MEN 1 and 2a
96
most common cause of primary hyperparathyroidism
parathyroid adenoma
97
What is hungry bone syndrome?
- occurs after parathyroid gland removal - high calcium levels suppressed PTH production in normal glands - sudden drop in PTH stops osteoclastic activity in bone - osteoblastic activity continues. bone takes a lot of calcium, phosphate, magnesium
98
What causes secondary hyperparathyroidism?
Chronic hypocalcaemia Happens most commonly in chronic renal failure. Lack of calcium/vit D reabsorption
99
What causes tertiary hyperPTH?
Long term secondary hyperPTH, parathyroid glands develop autonomous secretion of PTH without need for stimulation by calcium
100
Substances produced by adrenal glands
Cortex: - zona glomerulosa: aldosterone - zona fasciculata: cortisol - zona reticularis: sex hormones medulla: - catecholamines (epinephrine, norepinephrine)
101
Adrenal incidentalomas can be classified into
Benign (non-secreting): adenoma, nodular hyperplasia Benign (secreting): conn's, cushing's, pheochromocytoma Malignant: adrenal cortical CA
102
Hyperaldosteronism commonly presents with
resistant HTN (>= 3 drugs) hypokalaemia HTN can be young onset
103
Most common cause of hypercortisolism
Iatrogenic (exogenous glucocorticoid use)
104
Cushing's disease is ___ Cushing's syndrome is ___
pituitary adenoma causing excessive ACTH secretion adrenal hyperplasia/adenoma/carcinoma causing cortisol hypersecretion
105
Ectopic ACTH can cause cushing's syndrome. Ectopic ACTH seen in
Small cell lung cancer Thymic tumours medullary thyroid cancer carcinoid (neuroendocrine) tumours of pancreas/gut
106
Hypercalcaemia can result from ___ malignancies
squamous cell lung cancer multiple myeloma
107
Clinical features of phaeochromocytoma (5 Ps)
pain - headache, chest pain palpitation - tachycardia, tremor pressure - HTN perspiration pallor
108
Rule of 20 for pheochromocytoma (6)
20% malignant 20% children 20% extra-adrenal 20% bilateral 20-25% familial (MEN2, VHL, NF1, tuberous sclerosis)
109
In managing pheochromocytoma, ___ given before ___ because
alpha blockers, beta blockers Beta blockers block vasodilation in the peripheries -> alpha receptors are unopposed -> keep stimulating vasoconstriction -> high bp Must use alpha blockers to block vasoconstrictive effects of alpha receptor first

General Surgery (13 decks)

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