Neck

Question 1

What is a pyramidal lobe

Answer 1

NL variarnt extending superior to the isthmus

Question 2

What are the following spatial relationships of the thyroid
- Strap muscle
- Sternocleidomastoid
- CCA & IJV
- Minor nerovascular bundle
- Longus collis muscle
- Parathyroid

Answer 2

Anterior - Strap muscle
Anterolateral - Sternocleidomastoid
Lateral - CCA & IJV
Posterior - Minor nerovascular bundle
Posterior - Longus collis muscle
Posterior - Parathyroid

Question 3

Where does the thyroid arterial supply come and branch from?

Answer 3

Superior thyroid and inferior thyroid arteries
- Superior from ECA
- Inferior from thyrocervical trunk

Question 4

Where does the thyroid venous supply drain into ?

Answer 4

IJV from Superior and Middle thyroid vein
innomonate from the inferior thyroid vein

Question 5

What are glands that regulating thyroid hormones?

Answer 5

thyroid ( T3 and T4)
pituitary (TSH)
Hypothalamus (TRH)

Question 6

The pituitary produces what hormone?

Answer 6

Thyroid stimulating Hormones TSH

Question 7

What does an Increase of TSH indicate?

Answer 7

HYPOthyroidsm

Question 8

What is the pituitary regulated by?

Answer 8

Hypothalamus

Question 9

With a normal functioning pituitary and hypothalamus what are the lab values for hypothyroidism and hyperthyroidism ?

Answer 9

HYPO- Hasho
- Increase TSH Decrease T4/T3
Hyper- Graves
- Decrease TSH Increase T4/T3

Question 10

What are the two thyroid adenomas?

Answer 10

Follicular and papillary

Question 11

What thyroid adenoma is the most common?

Answer 11

Follicular

Question 12

Cystic lesion in they thyroid typically represent why cyst?

Answer 12

Colloid filled cyst

Question 13

What are the three types of thyroid carcinomas

Answer 13

Papillary, follicular, and medullary

Question 14

What thyroid carcinomas is the most common?

Answer 14

Papillary

Question 15

How does thyroid papillary carcinomas spread and how does it look sonographically?

Answer 15

Spreads through lymphatics
Hypoechoic with calcifications

Question 16

How does thyroid follicular carcinomas spread and how does it look sonographically?

Answer 16

Spreads through blood stream
Homogeneous, solitary, encapsulated

Question 17

What hormone does thyroid medullary carcinoma secrete and what is this cancer associated with?

Answer 17

Calcitonin
Multiple endocrine neoplasia syndrome

Question 18

When should a FNA be considered?

Answer 18

> 1cm micro calcifications
1.5cm mostly solid
2cm mixed components
is it growing
does it have ipsilateral lymohnodes (>7mm)

Question 19

What are the thyroid nodules features for benign or malignancy?
- composition
- echogenicity
- shape
- margination
- calcification

Answer 19

composition B- cystic M- solid
echogenicity B- Hyper M- Hypo
shape M- taller than wide
margination M lobulated or irregular
calcification- mostly suggest M

Question 20

When does the isthmus need to be FNA?

Answer 20

> 5mm

Question 21

What are the 5 types of thyroiditis?

Answer 21

Hashimotos
subacute granulomatous
subacute lymohocytic
acute suppurative
riedel struma

Question 22

What is chronic lymphocytic thyroiditis and what does it look like sonographically?

Answer 22

Hashimotos
autoimmune dz that damages the thyroid and it cant make thyroid hormones. the pituitary senses low thyroid hormones so it send an increase of TSH and causes the thyroid to grow.
- enlarged, coarse echo texture

Question 23

What is a goiter?

Answer 23

abnormal enlargement of the thyroid

Question 24

what is it called when a thyroid is producing the correct amount of thyroid hormone?

Answer 24

euthyrooidism

Question 25

What is the most common causes of a goiter ?

Answer 25

Old iodine deficiency New hashimotos

Question 26

What are the two forms of multi nodular goiter

Answer 26

Nontoxic MNG- goiter makes normal amounts of thyroid hormones Toxic MNG- autonomously functioning resulting in hyperthyroidism

Question 27

What is graves dz and what does it look like sonographically?

Answer 27

Autoimmune disorder and the immune system produces a protein called thyroid stimulating immunoglobulin and makes the thyroid glade produce too much thyroid hormone. the pituitary senses and that and stops secreting TSH - Hyporechoic and inhomogenous

Question 28

What is also seen with graves dz?

Answer 28

Hypervascularity thyroid inferno - audible bruit, palpable thrill or color evaluation

Question 29

How many parathyroid glands are there ?

Answer 29

four

Question 30

Where can a ectopic parathyroid be located?

Answer 30

retrotracheal, mediastinal, intrathyroid, and near carotid bifurcation.

Question 31

What is the difference between primary and secondary hyperparathyroidism?

Answer 31

Primary- development of adenoma and ONE parathyroid. PTH and serum calcium increase. Secondary- occurs with CKD and all FOUR parathyroid. Increase serum phosphates. Decrease serum calcium.

Question 32

What is the treatment of primary hyperparathyroidism?

Answer 32

Surgical excision of the parathyroid adenoma

Question 33

Where are the following salivary glands and what ducts drain them? - parotid - submandibular - sublingual

Answer 33

Parotid- ant to ear. stensens duct Submandibular- beneath the jaw. Whartons duct. sublingual- beneatht the tongue. ant to subman gland. no duct.

Question 34

What is the most common benign tumor of the parotid gland?

Answer 34

pleomorphic adenoma

Question 35

What is sialadenitis and what gland is it seen in?

Answer 35

bacterial infection of the salivary gland d/t stone or gland hyposecretion. parotid.

Question 36

what is sialolithiasis and what gland is it seen in?

Answer 36

calcified mass or sialoith forms in the submandibular gland.

Question 37

What is a thyroglossal duct cyst? - remnant of what?

Answer 37

midline neck mass. cystic dilatation of the duct. remnant of the thyroid gland migration from the pharyngeal epithelium.

Question 38

What is a branchial cleft cyst - remnant of what?

Answer 38

Cystic mass on the llateral aspect of the neck by mandible and sternocleidomastoid muscle. remnant of embryonic development

Question 39

What is a cystic hygroma

Answer 39

Congential lymphatic malformation. cystic mutililoculation near neck.

Question 40

What is the anatomy of the neck and aortic arch vessels?

Answer 40

Aortic arch vessels - innominate artery - left CCA - left Subclavian.

Question 41

What vessels come off of the innominate ( brachiocephalic trunk)

Answer 41

RT CCA and RT subclavian art.

Question 42

What side is the innominate arteries and veins on?

Answer 42

RT innominate arteries Bilateral innominate veins

Question 43

What is the first branch of the ECA and ICA?

Answer 43

ECA- Superior thyroid artery ICA- opthalmic